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CPT - Other Drugs > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

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1
Q

Name two thiazide/thiazide-like diuretics

A

Bendroflumethiazide

Indapamide

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2
Q

What is the mechanism of action of thiazide diuretics?

A

Inhibit Na+/Cl- cotransporter in DCT

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3
Q

What are some ADRs of thiazides?

A
  • Loss of Na+ and water
  • Hypokalaemic metabolic alkalosis (loss of H+ via Na+- H+ transporter (Na+ reabsorbed later on due to high conc ) and more K+ loss later in tubule due to more Na+)
  • Increased Ca2+ reabsorption (hypercalcaemia)
  • Gout
  • Erectile dysfunction

HyperGLUC

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4
Q

Name two loop diuretics.

A

Bumetanide and Furosemide

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5
Q

What is the mechanism of action of loop diuretics?

A

Inhibit Na+/K+/2Cl- cotransporter in loop of Henle

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6
Q

What are some ADRs of loop diuretics?

A
  • Loss of Na+ and water - hyponatraemia
  • Hypokalaemic metabolic alkalosis (increased loss of H+ and increased loss of K+ later on, due to more Na+ in tubule)
  • Increased Ca2+ loss (loss of positive luminal membrane as less K+ transported back into tubule via ROMK, so no driving force for divalent cation reabsorption)
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7
Q

What is an example of a potassium sparing diuretic?

A

Amiloride

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8
Q

What is the mechanism of action of amiloride?

A

Block ENaC at luminal surface of renal tubule

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9
Q

What are some ADRs specific to furosemide?

A
  • Ototoxicity
  • Gout
  • Alkalosis
  • Raised LDL and TG
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10
Q

What is an ADR specific to bumetanide?

A

Myalgia

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11
Q

What is an example of an aldosterone antagonist?

A

Spironolactone

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12
Q

What is the mechanism of spironolactone?

A

Competes with aldosterone at mineralocorticoid receptor in DCT/CD

(normally aldosterone upregulates ENaC channels)

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13
Q

What are common indications for diuretics and which classes are used?

A
  • Hypertension - thiazides, spironolactone
  • HF - loop, spironolactone
  • Decompensated liver disease - spironolactone, loop
  • Nephrotic syndrome - Loop, thiazides, amiloride
  • CKD - loop
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14
Q

What are the concerns of using ACEi and K+ sparing diuretics together?

A

Increased hyperkalaemia risk - cardiac problems

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15
Q

What are the concerns of using aminoglycosides and loop diuretics together?

A
  • ototoxicity

* nephrotoxicity

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16
Q

What are the concerns of using digoxin and thiazide/loop diuretics together?

A
  • Hypokalaemia
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17
Q

What are the concerns of using beta blockers and thiazides together?

A
  • Hyperglycaemia
  • Hyperlipidaemia
  • Hyperuricaemia
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18
Q

What are the concerns of using steroids and thiazide/loop diuretics together?

A

Hypokalaemia risk increased

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19
Q

What are the concerns of using lithium and thiazide/loop diuretics together?

A
  • Lithium toxicity (thiazides)

* Reduced lithium levels (loop)

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20
Q

What are the concerns of using carbamezepine and thiazides together?

A

Increased risk of hyponatraemia

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21
Q

What is an example of a class IB anti-arrhythmic?

A

Lidocaine

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22
Q

What is an example of a class IC anti-arrhythmic?

A

Flecainide

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23
Q

When is flecainide indicated?

A
  • Supraventricular tachycardia
  • Ventricular arrhythmia
  • WPW syndrome
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24
Q

What are the ADRs of flecainide?

A
  • Pro-arryhthmic
  • Flecainide flutter - increased ventricular response
  • GI and CNS effects
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25
What is the effect of flecainide?
Decreased phase 0
26
Give two examples of beta-blockers used as anti-arrhythmics.
Bisoprolol and metoprolol
27
What are the effects of bisoprolol and metoprolol on the heart? and on the ECG?
Increased APD and refractory period in the AVN Decreased phase 4 depolarisation Increased PR and decreased HR
28
What are the uses for bisoprolol and metoprolol?
Treat sinus and catecholamine dependent tachycardias Cardioconvert reentrant arrhythmias at AVN Protect ventricles in atrial flutter/fibrillation or flecainide flutter
29
What are some ADRs of bisoprolol and metoprolol?
* Bronchospasm | * Hypotension
30
What are two examples of class III anti-arrhythmics?
Amiodarone and sotalol
31
What are some ADRs of amiodarone?
* pulmonary fibrosis * hepatic injury * increased LDL cholesterol * thyroid disease * photosensitivity * optic neuritis
32
What are the cardiac effects of amiodarone?
``` Increased ADP and refractory period Decreased phase 0 and conduction Increased threshold Decreased phase 4 Decreased AVN conduction ``` varying class effects
33
What are the effects of amiodarone on an ECG?
Increased PR, QT and QRS | Decreased HR
34
What are the uses for sotalol?
Wide spectrum: supraventricular tachycardias and ventricular tachycardias
35
What are the cardiac effects of sotalol?
Increased ADP and refractory period in atrial and ventricular tissue Slowed phase 4 (beta blocker part of it) Slowed AVN conduction
36
Which drugs are good for AF?
Rate and rhythm control Rate: Bisoprolol/verapamil/diltiazem +/- digoxin Rhythm: Sotalol/Flecainide + bisoprolol/amiodarone
37
Which drug do you give via IV for VT?
Metoprolol/lidocaine/amiodarone
38
Should flecainide be used alone in atrial flutter?
No - give with a AVN blocking drug to reduce ventricular rates in atrial flutter e.g. bisoprolol
39
Whats the best treatment for WPW? Which type of drugs should you avoid?
Flecainide | avoid AVN blocking drugs due to risk of exacerbating the symptoms
40
Which drugs can you use for ectopic beats?
First line: bisoprolol | then calcium channel blockers
41
Which drugs can you use to treat sinus tachycardia?
Ivabradine - no drop in BP Bisoprolol/verapamil - more tolerated? can use in pregnancy
42
Which drugs can you use in re-entrant NCT acutely and chronically?
Acutely (IV) - adenosine, verapamil if asthmatic or fleciainide if above fails Chronically (oral) - Bisoprolol/verapamil, if not then... sotalol, flecainide, amiodarone
43
What are some ADRs of sotalol?
* pro-arrhythmic * fatigue * insomnia
44
What are two examples of non-dihydropyridine CCBs/class IV anti-arrhythmics?
Verapamil and diltiazem
45
What are the ADRs of class IV anti-arrhythmics?
* Asystole if use with beta-blocker * Hypotension * Decreased CO/sick sinus * Constipation
46
What are the cardiac effects of class IV anti-arrhythmics?
Slow conduction through AVN (preventing Ca2+ influx) Increased refractory period at AVN Increase slope of phase 4 in SA - slows HR
47
What effect does adenosine have on the heart?
Binds to A1 receptors and blocks adenylyl cyclase - reduced cAMP - activated K+ currents in the AVN and SAN - hyperpolarisation - reduced HR
48
What is the mechanism of action of ivabradine?
Blocks If ion current at SAN - slows the SAN but doesn't effect BP
49
What are some ADRs of ivabradine?
* flashing lights | * unknown if teratogenic
50
When is ivabradine used?
Reduce HR in heart failure (no effect on BP)
51
What is the mechanism of action of digoxin as an anti-arrhythmic?
Increases vagal activity (Increased K+ currents, decreased Ca2+ currents, increased refractory period) Slows AV conduction and hence HR
52
What is atropine?
a selective muscarinic antagonist
53
What is the mechanism of action of atropine?
blocks vagal activity so speeds AV conduction increased HR
54
When is atropine used?
In vagal bradycardia
55
When is digoxin used?
In Afib and flutter and to reduce ventricular rates
56
What are two examples of alpha adrenoreceptor blockers?
Doxazosin and tamsulosin
57
What are 3 examples of beta-blockers used for hypertension?
Atenolol Labetalol Propanolol
58
What are two ACEi's?
Ramipril | Lisinopril
59
What are two ARBs?
Losartan | Candesartan
60
How do nitrates like glyceryl trinitrate and isorbide mononitrate work?
Activate guanylyl cyclase - increase in cGMP - leads to vasodilation
61
Name the two dihydropyridine CCBs
Amlodipine | Nimodipine
62
Name the two non-dihydropyridine CCBs
Verapamil | Diltiazem
63
Which calcium channels do the CCBs block?
L-type calcium channels
64
What is the mechanism of action of warfarin?
Vitamin K antagonist - inhibits vitamin K epoxide reductase
65
What are the vitamin K dependent clotting factors?
10, 9, 7 and 2
66
Why is warfarin's onset of action delayed?
Due to the circulation of already produced clotting factors
67
Which drugs potentiate warfarin?
Antibiotics that reduce vitamin synthesis by bacteria in the gut e.g. cephalosporins CYP2C9 inhibitors - amiodarone, clopidogrel NSAIDs displace warfarin from plasma albumin
68
How do you monitor warfarin?
Measuring the INR - lower means thicker blood (less anti coagulated), higher means thinner blood (more anti-coagulated) - aiming for around 2.5-3
69
What does unfractionated heparin do?
Inhibit Xa and IIa (thrombin) For Xa needs to bind to only ATIII For IIa needs to bind to ATIII and IIa
70
Give two examples of LMWHs
Dalteparin | Enoxaparin
71
What is LMWH's mechanism of action?
Inhibit factor Xa by enhancing ATIII activity
72
What is fondaparinux?
Synthetic heparin pentasaccharide - inhibits Xa by binding to ATIII
73
What drug can be used for heparin reversal?
Protamine sulphate - binds to heparin forming an inactive compound
74
What can be used for warfarin reversal?
Vitamin K1 or prothrombin complex concentrate - they promote the production of clothing factors
75
Which DOACs work on inhibiting Xa?
Apixaban Edoxaban Rivaroxaban
76
Which DOAC work on inhibiting IIa?
Dabagitran
77
How does aspirin work as an antiplatelet drug?
Reduced TXA2 synthesis by COX-1 inhibition
78
What is an example of a phosphodiesterase inhibitor?
Dipyridamole
79
What is the mechanism of action of a phosphodiesterase inhibitor?
Inhibits phosphodiesterase so prevents cAMP degradation so inhibits the expression of GPIIb/IIa Also Inhibits cellular reuptake of adenosine, so increased adenosine plasma conc - so inhibits platelet aggregation via A2 receptors
80
What are three ADRs of dipyridamole?
Vomiting Diarrhoea Dizziness
81
When is dipyridamole used?
* Secondary prevention of ischaemic stroke and TIA | * Adjunct for thromboembolism prophylaxis
82
What are three examples of ADP receptors antagonists?
Clopidogrel Prasugrel Ticagrelor
83
Which of the ADP receptor antagonists bind irreversibly and are prodrugs? Which have a faster onset of action?
Clopidogrel and Prasugrel Prasugrel and Ticagrelor
84
When are Prasugrel/Ticagrelor used?
With aspirin in ACS patients undergoing PCI for up to 12 months
85
What class of drug is Abciximab?
Glycoprotein IIb/IIIa inhibitor (GPIIb/IIIa)
86
What are the two fibrinolytic drugs?
Alteplase | Streptokinase
87
What is the antifibrinolytic drug and when is it used?
Tranexamic acid Nose bleeds Heavy painful periods
88
Name two statins
Atorvastatin | Simvastatin
89
Name a fibrate
Fenofibrate
90
What is the mechanism of action of fenofibrate?
Activates nuclear transcription factor PPAR-alpha - factor that regulates expression of genes that control lipoprotein metabolism - increased LPL production
91
What are some ADRs of fenofibrate?
* Cholelithiasis * GI upset * Myositis
92
What is a DDI of fenofibrate?
Warfarin - increased anticoagualtion when taking with fenofibrate
93
What is an example of a cholesterol absorption inhibitor?
Ezetimibe
94
What is the mechanism of action of ezetimibe?
Inhibits the NPC1L1 transporter in the brush border of the gut - so reduced cholesterol absorption It's a prodrug and has enterohepatic circulation
95
What are the ADRs of ezetimibe?
* Abdo pain | * GI upset
96
DDIs of ezetimibe?
Caution with statins - increased risk of rhabdomyolysis Ciclosporin increased levels of ezetimibe
97
What drug class is Alirocumab? And hence mechanism of action?
PCSK9 inhibitor | Monoclonal antibody that inhibits the PCSK9 enzyme, so prevents degradation and internalisation of LDL-R

CPT - Other Drugs (11 decks)

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