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Cardiovascular System Flashcards

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1
Q

Loop Diuretics
Furosemide, Bumetanide
Mechanism of Action

A

Act on ascending loop of Henle as Na/K/2Cl co-transporter inhibitors to reduce reabsorption of Na/K and therefore water

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2
Q

Loop Diuretics

Indications

A

Acutely - pulmonary oedema, hyperkalaemia

Long term - oedematous states such as CHF, renal failure, liver failure

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3
Q

Loop Diuretics

Contraindications

A

Hypovolaemia/dehydration

Hepatic encephalopathy, hypokalaemia, hyponatraemia, gout (may inhibit uric acid secretion), may exacerbate DM

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4
Q

Loop Diuretics

Side Effects

A

Hypotension

Low electrolytes, Hearing loss/tinnitus at high doses

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5
Q

Loop Diuretics

Interactions

A

Affects renal secretion, increased risk of digoxin toxicity due to hypokalaemia and ototoxicity/nephrotoxicity of other drugs increased

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6
Q

Thiazide-type diuretics

Names

A

Hydrochlorothiazide, Bendroflumethiazide, Indapamide, Chlortalidone

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7
Q

Thiazide-type diuretics

Mechanism of Action

A

Inhibit Na/Cl cotransporter in distal convoluted tubule to prevent absorption of water

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8
Q

Thiazide-type diuretics

Indications

A

Second line for hypertension treatment

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9
Q

Thiazide-type diuretics

Contraindications

A

Low K+/Na+, gout

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10
Q

Thiazide-type diuretics

Side effects

A

Hyponatraemia, risk of low potassium/increased glucose

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11
Q

Thiazide-type diuretics

Interactions

A

Other potassium lowering drugs

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12
Q

Thiazide-type diuretics

Prescription Advice

A

Give am to avoid nocturia, work wel with ACEi/AIIRB as work on opposing limbs of RAAS and K homeostasis

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13
Q

K+ Sparing Diuretics (Combo)

Names

A

Spironolactone, Amiloride (Co-amulifrose/co-amilozide)

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14
Q

K+ Sparing Diuretics

Mechanism of Action

A

Antagonist of aldosterone or act at ENaCs at DCT to reduce loss of K+

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15
Q

K+ Sparing Diuretics

Indications

A

Combination therapy if patient is hypokalaemic due to loop/thiazide therapy, ascitic, or hypertensive

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16
Q

K+ Sparing Diuretics

Contraindications

A

Renal imparment, hyperkalaemia, increasing hypokalaemia, rising volume depletion

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17
Q

K+ Sparing Diuretics

Side effects

A

hepatotoxicity, malaise, dizziness, gynaecomastia, breast pain, menstrual changes (spiro alters metabolism of testosterone in peripheral circulation)

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18
Q

K+ Sparing Diuretics

Interaction

A

Potassium supplements, renal clearance drugs (digoxin, lithium)

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19
Q

Beta-Blockers

Mechanism of Action

A

Anagonist of Beta-1 adrenoreceptors which gives negatively inotropic/chronotropic effect to reduce O2 demand and improve perfusion, reduces renin secretion, prolongs refractory period at AV node

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20
Q

Beta-Blockers

Indications

A

IHD, CHF, AF, SVT, HTN

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21
Q

Beta-Blockers

Contraindications

A

Asthma (bronchospasm), COPD (although not propranolol), haemodynamic instability, heart block, hepatic failure/heart failure require low dose

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22
Q

Beta-Blockers

Side effects

A

Fatigue, cold extremities, headache, GI change, sleep disturbance, impotence

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23
Q

Beta-Blockers

Interactions

A

Non-dihydro CCBs (verapamil/dilitiazem) - together can cause heart block, bradycardia, asystole

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24
Q

Calcium Channel Blockers

Mechanism of Action

A

Reduce Ca entry into vascular/cardio-myocytes to reduce contractility, reduce AV conduction to slow ventricular rate and decrease afterload - overall reduces O2 demand of heart

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25
CCBs - Indications
Antihypertensives (dihydros) | Rhythm control drugs (SVT, AF, AFl, non-dihydros)
26
CCBs - contraindications
Poor LV function, AV nodal conduction delay, unstable angina and severe aortic stenosis (dihydros)
27
CCBs - Side effects
Dihydros - ankle oedema, flush, headache, palpitations Verapamil - constipation, bradycardia, heart block, cardiac failure Diltiazem - both
28
CCBs - interactions
Beta-blockers - negatively chronotopic and inotropic
29
CCBs - Dihydro vs non-dihydropytidine
``` Dihydro = -dipine (amlodipine, nifedipine) Non-D = Verapamil and Diltiazem (verapamil most cardioselective) ```
30
ACE-inhibitors | Names
Rampiril, Lisinopril, Perindopril
31
ACE-inhibitors | Mechanism of Action
Prevent conversion of AT1-->AT2. AT2 is a vasoconstrictor and stimulates aldosterone/ADH therefore afterload is reduced with ACEi and efferent glomerular arteriole dilates which promotes excretion of Na/H20 to reduce preload alongside systemic vasodilatation
32
ACE-inhibitors | Indications
HTN, CHF, IHD, diabetic nephropathy/CKD with proteinuria
33
ACE-inhibitors | Contraindications
RAS, AKI, pregnancy/breastfeeding
34
ACE-inhibitors | Side effects
Hypotension, dry cough, hyperkalaemia, angioedema
35
ACE-inhibitors | Interactions
K supplements/K sparing diuretics, NSAIDs
36
Angiontensin II Receptor Blockers | Names
Losartan, Candesartan, Irbesartan
37
Angiotensin II Receptor Blockers | Mechanism of Action
Block action of angiotensin II on AT1 receptor with similar effect to ACEi
38
Angiotensin II Receptor Blockers | Inidcations
Replace ACEi if cough not tolerated
39
Angiotensin II Receptor Blockers | Contraindications
RAS, AKI, pregnancy/breast feeding
40
Angiotensin II Receptor Blockers | Side Effects
Hypotension, hyperkalaemia, renal failure (short term) | Long term - cardiometabolic protective, renal protective
41
Angiotensin II Receptor Blockers | Interactions
Potassium supplements/K+ sparing diuretics, NSAIDs
42
Angiotensin II Receptor Blockers | Prescription Advice
No effect on bradykinin, less likely to cause angioedema, useful in Afro-Caribbean origin
43
Nitrates | Names
Isosorbide mononitrate (ISMN) glyceryl trinitrate (GTN)
44
Nitrates | Mechanism of Action
Nitrates are converted to NO which incerases cGMP and reduces Ca in smooth muscle cells (mostly venous) causing dilatation, reducing preload and LV filling, reduce workload and relieve angina
45
Nitrates | Indications
GTN - acute angina, ACS | ISMN - long acting prophylaxis of angina where CCB/BB are insufficient or given IV in pulmonary oedema treatment
46
Nitrates | Contraindications
Severe aortic stenosis, haemodynamic instability (esp hypotensive)
47
Nitrates | Side effects
Flushing, headaches, light-headedness, hypotension
48
Nitrates | Interactions
Phosphodiesterase inhibitor (sildenafil) - prolongs the effect can lead to severe hypotension
49
Digoxin Cardiac Glycoside Mechanism of Action
Inhibits Na/K-ATPase pumps to increase intracellular Ca (positively inotropic), also stimulates vagus nerve tone to reduce AV conduction rate (negatively chronotropic)
50
Digoxin | Indications
AF/AFl (if CCB/BB ineffective), severe heart failure
51
Digoxin | Contraindications
2nd degree heart block, intermittent complete heart block, ventricular arrhythmia, renal failure
52
Digoxin | Side Effects
Bradycardia, anorexia, rash, dizziness, visual disturbance (yellow-green vision), gynaecomastia
53
Digoxin | interactions
Diuretics, amiodarone, CCB, sprionolactone, quinine (all increase plasma concentration) Can be precipitated by hypokalaemia
54
``` Amiodarone Class III (I) antiarrhythmic Mechanism of Action ```
Inhibits K+ channels to slow repolarisation, blocks Na channels to prevent depolarisation, slows conduction velocity, reduces ventricular rate can break arrhythmic circuit
55
Amiodarone | Indications
Tachyarrhythmias (AF, AFL, SVT, VT, refractoy VF) when other drugs are ineffective
56
Amiodarone | Contraindications
Severe hypotension, heart block, active thyroid disease
57
Amiodarone | Side effects
``` Hypotension Pneumonitis/Hepatitis Bradycardia Photosensitivity Skin becomes grey Thyroid change Corneal deposits Peripheral Neuropathy ```
58
Amiodarone | Interactions
Digoxin, dilitazem/verapamil
59
Aspirin Anti-platelet Mechanism of Action
Irreversible COX-inhibitor reduces thromboxane in arachidonic pathway to reduce platelet aggregation, wears off as new platelets are synthesised
60
Aspirin | Indications
ACS/Ischaemic stroke, long term preventative therapy, reduce risk of intracardiac thrombus in AF (if others contraindicated), control of moderate pain/fever
61
Aspirin | Contraindications
Children, post viral <16 (Reye's syndrome of liver/brain), aspirin hypersensitivity, 3rd trimester (may close DA early), PUD, gout
62
Aspirin | Side Effects
GI irritation, ulceration/haemorrhage, bronchospasm, tinnitus, OD (leads to hyperventilation, metabolic acidosis, arrest)
63
Aspirin | Interactions
Synergistic with other anti-platelets/anti-coagulants
64
Clopidogrel Antiplatelet Mechanism of Action
Irreversibly binds ADP receptors on platelets to prevent coagulation
65
Clopidogrel | Indications
As aspirin:ACS/Ischaemic stroke, long term preventative therapy, reduce risk of intracardiac thrombus in AF (if others contraindicated)
66
Clopidogrel | Contraindications
Active bleeding, elective surgery (7-10 days as this is average lifespan of platelet)
67
Clopidogrel | Side effects
bleeding, thrombocytopenia, GI upset
68
Clopidogrel | Interactions
Pro-drug of CYP450 therefore inhibitors reduce efficacy (omeprazole, cipro, erythromycin, antifungals, some SSRIs), caution with other antiplatelets/coags
69
Tissue Plasminogen Activator (Fibrinolytics) | Names
Alteplase, Streptokinase
70
TPa | Mechanism of Action
Catalyse conversion of plasminogen to plasmin to dissolve fibrinous clots and recanalise occlude vessels to reperfuse affected tissue, very short half-life
71
TPa | Indications
Acute ischaemic stroke, acute STEMI, massive PE
72
TPa | Contraindications
Predisposition to bleeding, intracranial haemorrhage, previous streptokinase (risk of Abs if repeat dosing)
73
TPa | Side effects
N&V, bruising, hypotension, bleeding, allergic reaction, cardiogenic shock/arrest, reperfusion injury
74
TPa | Interactions
ACE-i increase risk of anaphylaxis | Risk of haemorrhage if also taking antiplatelet/coag
75
TPa | prescription advice
Injection only, dose based on weight
76
Heparin | Names
Enoxaparin, Dalteparin, Fondaparinux, Unfractioned heparin
77
Heparin | Mechanism of Action
UFH - activates antithrombin LMWH - preferentially inhibit Xa to give predictable effect Fondaparinux - only inhibits Xa, no monitoring needed, used in ACS
78
Heparin | Indications
VTE prophylaxis/treatment | ACS
79
Heparin | Contraindications
Bleeding, clotting disorders, severe uncontrolled hypertension, invasive procedures, renal impairment, falls risk
80
Heparin | Side effects
Bleeding, injection site reaction, heparin-induced-thrombocytopenia
81
Heparin | Interactions
Anthrombotics, can be reversed by protamine (excl fondaparinux)
82
Warfarin Anticoagulant Mechanism of Action
Inhibits vitamin K epoxide reductase to prevent coagulation factor synthesis of FX, IX, VII, II
83
Warfarin | Indications
Prevent VTE or embolism in AF/valve replacement, arterial events prevented by antiplatelets (not anticoagulant)
84
Warfarin | Contraindications
haemorrhage, liver disease, pregnancy
85
Warfarin | Side effects
Bleeding (epistaxis, retroperitoneal haemorrhage)
86
Warfarin | Interactions
Low TPI, metabolised by CYP450, also abx can reduce gut flora that synth vK so potentiate the effect
87
NOACs | Name
Rivaroxaban, Dabigatran, Apixaban
88
NOAC | Mechanism of action
Selectively inhibit FXa, and prothrombinase to to reduce thrombin
89
NOAC Indications
Thromboprophylaxis, warfarin substitute
90
NOAC | Contraindications
bleeding, artificial heart valve, clotting disorders, renal/hepatic impairment
91
NOAC | Side effects
Allergy, anaemia, tachycardia, hypotension
92
NOAC | Interactions
Other antiplatelets/anticoagulants
93
Statin | Name
Simvastatin Atorvastatin Pravastatin Rosuvastatin
94
Statin | Mechanism of action
Inhibits HMG-CoA reductase, reducing LDL and increasing clearance and increases HDL to slow/reverse atherosclerotic process
95
Statin | Indications
Hyperlipidaemia, control of risk factors in CAD
96
Statin | Contraindications
Hepatic impairment, pregnant/breast feeding
97
Statin | Side effects
headache, muscle aches, rhabdomyolysis, increases liver enzymes
98
Statin | Interactions
Grapefruit juice, alcohol, CYP450 inhibitors (amiodarone, itraconazole, protease inhibitors)
99
Nicorandil | Indication/side effects
Second line anti-anginal Causes serious mucosal ulceration, headache, flushing
100
Flecainide Class 1c anti-arrhythmic Pre-dose test Contraindications
Potent sodium channel blocker Echo to rule out structural ischaemic damage Previous MI - electrical conduction already hindered

Pharmacology (14 decks)

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