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Drugs Flashcards

(48 cards)

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1
Q

How do organic nitrates work? Give two examples

A

Relax all types of smooth muscle

  • Glyceryltrinitrate (short acting)
  • Isosorbide mononitrate (long acting)
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2
Q

How is GTN given?

A

Sublingual - tablet or spray in stable angina

IV in unstable angina/MI

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3
Q

How is ISMN given?

A

Orally for prophylaxis of angina

- take in morning and at lunch in order to have ‘nitrate low period’ for rest of day to avoid tolerance

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4
Q

What are some side effects of nitrates?

A 
Headaches
Hypotension and fainting
Reflex tachycardia (co-administer beta-blocker)
Tolerance
Formation of methaemoglobin (rare)
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5
Q

How do CCBs work?

A

Block Ca entry into cells, therefore reducing muscle contraction
Act on L-type Ca channels found in heart, smooth muscle and other locations

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6
Q

Which conditions are CCBs used in?

A

Hypertension
Stable angina
HR control in supra ventricular arrhythmias

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7
Q

Give 3 examples of CCBs and what is their selectivity for different channels?

A

Verapamil –> relatively selective for cardiac channels
Diltiazem –> intermediate selectivity
Amlodipine –> relatively selective for smooth muscle

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8
Q

Which CCBs are preferred for use in hypertension and angina, and why?

A

Drugs selective for smooth muscle
e.g. Amlodipine and nifedipine
To minimise unwanted cardiac effects

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9
Q

In which cardiac conditions should CCBs be avoided/stopped?

A

Heart failure

Heart block

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10
Q

Having which two conditions concurrently makes CCBs particularly useful?

A

Hypertension and angina

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11
Q

What are the side effects of CCBs?

A

hypotension
dizziness
flushing
ankle oedema

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12
Q

How do CCBs help in supraventricular arrhythmias? Which CCB is usually used?

A

Suppress conduction through the AV node

Verapamil

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13
Q

What is angiotensin converting enzyme (ACE) and what effects does it have?

A

Enzyme on surface on endothelial cells

  • converts angiotensin I to angiotensin II –> vasoconstriction
  • inactivates bradykinin (vasodilator)
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14
Q

What is the mode of action of ACE inhibitors?

A

Block conversion of angiotensin I to angiotensin II

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15
Q

What is the mode of action of angiotensin receptor blockers (ARBs)?

A

Block action of angiotensin II

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16
Q

What are some side effects of ACE inhibitors?

A 
Initial hypotension (especially if taking diuretics)
Dry cough (bradykinin in the lungs)
Hyperkalaemia
Angioedema
Renal dysfunction
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17
Q

What are some side effects of ARBs?

A

Same as ACE inhibitors but
NO DRY COUGH
–> as no effect on bradykinin

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18
Q

Can ACE inhibitors or ARBs be given in pregnancy?

A

NO –> foetal toxicity

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19
Q

Can ACE inhibitors/ARBs be used in renal disease?

A

Should not be used in bilateral renal artery stenosis
BUT
ACE inhibitors good in diabetic nephropathy

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20
Q

What are the clinical uses of ACE inhibitors and ARBs?

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A

Hypertension
Heart failure
Post MI

21
Q

Give some examples of beta-blockers used in CVD and why?

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A

Atenolol, bisoprolol

–> cardioselective (Beta-1 adrenoceptors)

22
Q

Give some examples of non-selective beta-blockers and their use?

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A

Propranolol, carvedilol

–> thyrotoxicosis, migraine

23
Q

What are some side effects of beta-blockers?

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A

Bronchospasm –> CI in severe asthma/COPD
Can worsen HR in the short term
Fatigue
Cold peripheries

24
Q

Give two examples of potassium channel openers and their uses:

Study These Flashcards
A

Nicorandil:
- used in angina refractory to other treatments

Minoxidil:
- last resort in severe hypertension but causes
reflex tachycardia (prevented by beta blocker)
salt and water retention (alleviated by diuretic)

25
Give two examples of alpha blockers:
Prazosin | Doxazosin
26
What are the clinical uses of alpha blockers?
Resistant hypertension | Symptomatic relief in BPH
27
Which group of patients are alpha blockers particularly useful in?
Patients with hypertension AND benign prostatic hyperplasia (BPH)
28
Give some examples of beta-adrenoceptor agonists
Dobutamine Adrenaline Noradrenaline (catecholamines)
29
What are the clinical uses of adrenaline?
``` Cardiac arrest (IV) Anaphylactic shock (IM) ```
30
What are the clinical uses of dobutamine?
Acute but potentially reversible HF | e.g. following cardiac surgery, cardiogenic or septic shock
31
Name some selective and non-selective beta-blockers
Non-selective --> propranolol | Selective --> atenolol, bisoprolol, metoprolol
32
What are the clinical uses of beta-blockers?
Arrhythmias (reduce sympathetic drive, delay AVN conduction) Angina (alternative to CCBs) HF (compensated) - low dose to improve morbidity and mortality Hypertension (no longer first line)
33
What are the adverse effects of beta-blockers?
Bronchospasm Aggravation of HF (can be used low dose in compensated HF) Bradycardia Hypoglycaemia in patients with poorly controlled DM Fatigue Cold extremities
34
What is atropine and how does it work?
Non selective muscarinic ACh receptor antagonist | --> blocks parasympathetics so increases HR
35
What are the clinical uses of atropine?
Severe or symptomatic bradycardia (first line) - glycopyrronium is an alternative Anticholinesterase poisoning
36
What are the clinical uses of digoxin?
Heart failure --> increases cardiac contractility AF --> rate control Particularly useful in HF + AF
37
Which electrolyte imbalance can dangerously enhance the effects of digoxin?
Hypokalaemia
38
What are some of the adverse effects of digoxin?
``` Heart block Propensity to cause arrhythmias Nausea and vomiting Diarrhoea Disturbance of colour vision ```
39
Which AADs are used for rate control?
Class II e.g. propranolol, atenolol (beta-blockers) | Class IV e.g. verapamil, diltiazem (CCBs)
40
Which AADs are used for rhythm control?
Class I e.g. flecainide, propafenone, lignocaine, quinidine | Class III e.g. amiodarone, sotalol, dronedarone
41
Which anti-arrhythmic drugs are only used in supra ventricular arrhythmias?
Adenosine Digoxin Verapamil
42
What is the clinical use of adenosine?
To terminate paroxysmal SVT
43
What is the anti arrhythmic use of digoxin?
Rate control in AF
44
What are the anti arrhythmic uses of verapamil?
AF and atrial flutter
45
What is the clinical use of lignocaine?
Treatment of ventricular arrhythmias post MI
46
What is the clinical use of flecainide?
Prophylaxis of paroxysmal AF
47
What is the clinical use of amiodarone?
Pharmacological cardioversion in SVT and VT
48
What are the adverse effects of amiodarone?
Pulmonary fibrosis Thyroid disorders Photosensitivity reactions Peripheral neuropathy

Cardiology (14 decks)

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