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Heart drugs Flashcards

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1
Q

How does digoxin work?

A

reduces heart rate and increases contractile force

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2
Q

What are the common indications for digoxin?

A

AF
atrial flutter
heart failure

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3
Q

What are some adverse reactions of digoxin?

A

bradycardia, rash, GI disturbance, dizziness, visual disturbances
digoxin toxicity = life threatening arrythmias
potassium disturbances

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4
Q

What are some warnings for digoxin?

A

heart block
ventricular arrythmias
renal failure

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5
Q

What are the important interactions of digoxin?

A

loop and thiazide diuretics - hypokalaemia increases risk of digoxin toxicity
CCB, amiodarone, spironolactone, quinine - increase chance of digoxin toxicity by increasing plasma conc.

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6
Q

What are the common indications of dalteparin/heparin?

A 
primary prevention (sometimes treatment) of VTE
in ACS with antiplatelet agents to reduce clot progressino or maintain revascularisation
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7
Q

What is the mechanism of action of heparin/dalteparin?

A

enhances anticoagulation of antithrombin (AT inactivates clotting factors).

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8
Q

What are the adverse effects of heparin/dalteparin?

A

haemorrhage, bruising at injection site

high K+

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9
Q

What are warning for heparin/dalteparin?

A

clotting disorders, uncontrolled hypertension, recent surgery/trauma, invasive procedures, renal impairment

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10
Q

What are important interactions of dalteparin/heparin?

A

combining with other antithrombotic drugs

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11
Q

What are common uses of aspirin?

A

treatment of acute coronary syndrome
long term secondary prevention of thrombotic arterial event
(used to be used to treat pain and fever but now NSAIDs)

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12
Q

How does aspirin work?

A

irreversibly inhibits COX which reduces platelet aggregation

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13
Q

What are important adverse effects of aspirin?

A

GI irritation, peptic ulceration, haemorrhage
bronchospasm (allergic)
tinnitus
overdose - hyperventilation, metabolic acidosis, hearing changes, confusion, cardiac and resp arrest

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14
Q

What are the warnings for aspirin?

A 
not for <16yrs 
aspirin hypersensitivity
third trimester of prenancy 
gout 
peptic ulcers
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15
Q

What are important interactions for aspirin?

A

antiplatelet or anticoagulant drugs

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16
Q

What are common indications of of statins?

A

primary or secondary prevention of cardiovascular events

primary hyperlipidaemia

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17
Q

What is the mechanism of action of statins?

A

inhibit HMG CoA - decrease cholestrol production in liver, decrease LDL and indirectly trigger increase in HDL

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18
Q

What are adverse effects of statins?

A

headache, GI disturbance, muscle (aches, myopathy, rhabdomyolysis), rise in liver enzyme ALT

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19
Q

What are warnings of statins?

A

hepatic impairment, renal impairment, pregnant/breastfeeding

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20
Q

What are important interactions with statins?

A

reduced by cytochrome P450 inhibitors (amiodarone, amlodpine etc)

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21
Q

What are the common uses of clopidogrel?

A

(+aspirin) - treatment of ACS, occlusion of artery stents, secondary prevention of thrombotic arterial events

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22
Q

How does clopidogrel work?

A

prevent platelet aggregation by binding irreversibly with ADP receptors

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23
Q

What are important adverse effects of clopidogrel?

A

bleeding
GI upset
thrombocytopenia

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24
Q

What are warnings of clopidogrel?

A

active bleeding
stop 7 days before surgery (takes longer to stop than NOAC)
renal and hepatic impairment

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25
What are interactions with clopidogrel?
clopidogrel needs cytochrome P450 enzyme so effect is reduced by CYP inhibitors avoid with other antiplatelet and anticoagulant drugs
26
What are the common indicators of warfarin?
secondary prevention of VTE | prevent arterial thrombolism in AF
27
What is the mechanism of action of warfarin?
Inhibits hepatic production of vit K dependant clotting factors - II, VII, IX, X
28
What are the important adverse affects of warfarin?
bleeding
29
What are the warnings for warfarin?
haemorrhage e.g. post-surgery liver disease pregnancy
30
What are interactions with warfarin?
Any drug/substance that affects cytochrome P450 | antibiotics
31
What are the indications of a NOAC and what are some examples?
apixiban, rivoroxaban, edoxaban, dabigatran treatment or prevention of VTE anti-thrombotic in AF
32
What is the mechanism of action of NOAC?
inhibit factor X, fibrin, thrombin formation
33
What are adverse reactions of NOAC?
bleeding, GI bleeding, GI upset, anaemia, dizziness, elevated liver enzymes
34
What are the warnings for NOAC?
hepatic or renal failure pregancy, breastfeeding bleeding
35
What are the interactions with NOAC?
other anticoagulants | CYP interactions
36
What are the common indicators of calcium channel blockers and what are some examples?
hypertension, stable angina, supraventricular arrhythmias | amlodopine, verapamil, nifidipine, diltiazem
37
What is the mechanism of calcium channel blockers?
decrease calcium entry into vascular and cardiac cells - relaxation and vasodilation of arterial smooth muscle = reduce myocardial contractility
38
What are some adverse reactions of CCB?
ankle swelling, flushing, headache, palpitations, constipation, bradycardia, heart block, cardiac failure
39
What are some warnings of CCB?
poor left ventricular function, AV nodal problems, unstable angina, severe aortic stenosis
40
What are some interactions with CCB?
beta blockers
41
What are indications for loop diuretics and what are some examples?
to treat acute pulmonary oedema, chronic heart failure and other oedemas
42
What is the mechanism of action of looop diuretics?
acts on loop of Henle to inhibit Na/K/Cl co-transporter to cause diuretic also causes dilation of capacitance veins which reduces preload
43
What are some adverse reactions of loop diuretics?
electrolyte disturbance, dehydration, hypotension | hearing loss, tinnitus
44
What are some warnings for loop diuretics?
hypovolaemia, dehydration hepatic encephalopathy hyponatraemia, hypokalaemia can worsen gout
45
What are some interactions for loop diuretics?
drugs metabolised by the kindeys - e.g. lithium, digoxin
46
What are the indications of nitrates?
to treat acute angina and chest pain associated with ACS prophylaxis of angina pulmonary oedema
47
What is the mechanism of action of nitrates?
relaxation of veins = reduction of cardiac preload
48
What are some adverse reactions of nitrates?
headache, flushing, hypotension, arrythmias, light-headedness, tolerance
49
What are some warnings of nitrates?
not with severe aortic stenosis or hymodynamic instability (especially hypotension)
50
What are some interactions with nitrates?
PDE inhibitors e.g. sildenafil
51
What is the inidication of adenosine?
supraventricular tachycardia
52
What is the mechanism of action of adenosine?
increases atrioventricular node refractories = breaks re-entry circuit to resume control of heart rate
53
What are some adverse reactions of adenosine?
bradycardia, asystole breathlessness sense of impending doom, sinking feeling
54
What are some warnings of adenosine?
coronary ischaemia, decompensating heart failure, hypotension. heart transplant asthma, COPD
55
What are some important interactions of adenosine?
dipyridamole (antiplatelet) - prolongs affect of amlodipine | theophylline, aminophylline - reduces effect
56
What are common indications of amiodarone?
tachyarrhythmias
57
What is mechanism of action of amiodarone?
reduce spontaneous depolarisation, slow conduction velocity
58
What are adverse effects of amiodarone?
``` hypotension, bradycardia, AV block hepatitis pneumonitis photosensitivity grey discolouration thyroid abnormalities ```
59
What are warnings for amiodarone?
severe hypotension, heart block, active thyroid disease
60
What are important interactions of amiodarone?
MANY | digoxin, ditiazem, verapamil
61
What are some examples of ACE-i and how do they work?
ramipril, lisinopril, perindopril | prevent conversion of angiotension I to II - reduces peripheral vascular resistance - lowers BP
62
What are indications of ACE-i?
hypertension, chronic heart failure, ischaemic heart disease | diabetic neuropathy, CKD with proteinuria
63
What are important adverse effects of ACE-i?
``` hypotension DRY COUGH hyperkalaemia renal failure angioedema, anaphylactoid reactions ```
64
What are warnings of ACE-i?
renal artery stenosis, AKI, CKD | pregnancy, breastfeeding
65
What are important interactions of ACE-i?
other potassium-elevating drugs | NSAIDs or other nephrotoxic drugs
66
What are types of angiotensin receptor blockers and how do they work?
losartan, candesartan, irbesartan | block action of angiotensin II
67
What are common indications of angiotensin receptor blockers?
hypertension chronic heart failure, IHD diabetic neuropathy CKD with proteinuria
68
What are adverse reactions of angiotensin receptor blockers?
hypotension hyperkalaemia renal failure
69
What are warnings of angiotensin receptor blockers?
AKI, renal artery stenosis, CKD | pregnancy, breastfeeding
70
What are important interactions with angiotensin receptor blockers?
other potassium elevating drugs | NSAIDs and other drugs which increase risk of nephrotoxicity
71
What conditions mean a higher warfarin dose is needed?
alcoholics | hyperthyroidism
72
What common drug should be avoided in people taking warfarin?
ibuprofen
73
What electrolyte disturbance increases risk of digoxin activity?
low potassium
74
What do you need to monitor with digoxin?
renal function
75
What are examples of antimuscarinics used for cardiovascular and GI, what are they used for and how do they work?
atropine, hyoscine butylbromide, glycopyrronium to treat bradycardia, IBS, copious respiratory secretions they increase HR, reduce smooth muscle tone and reduce secretions
76
What are some warnings and interactions of cardiovascular and GI antimuscarinics ?
angle-closure glaucoma, arrhythmias | don't prescribe with other antimuscarinics effect drugs
77
What are some beta blockers, what are they used for and how do they work?
bisoprolol, atenolol, propranolol, metoprolol, carvedilol used for IHD, CHF, AF, SVT, hypertension reduce force of contraction, and speed of conduction
78
What are some adverse effects of beta blockers?
fatigue, cold extremities, headache, GI disturbance, sleep disturbace, nightmares, impotence
79
What are some warnings and interactions of beta blockers?
don't give in asthma, haemodynamic instability caution in heart failure, hepatic failure caution with calcium channel blockers
80
What are some thiazide diuretics and what are they used for?
bendroflumethiazide, indapamide, chlortalidone | used for hypertension
81
What are some adverse reactions of thiazide diuretics?
hyponatraemia, hypokalaemia cardiac arrhythmias impotence in men low glucose
82
What are some cautions and interactions of thiazide diuretics?
warnings - hypokalaemia and hyponatraemia reduce uric acid excretion so can trigger attacks of gout interactions - NSAIDs can reduce effectiveness, other drugs that lower Na or K
83
What are some fibrinolytic drugs, what are they used for and how do they work?
alteplase, streptokinase acute ischaemia stroke, acute STEMI, massive PE they dissolve fibrinous clots
84
What are some adverse effects of fibrinoytic drugs?
nausea, vomiting, bruising, hypotension serious bleeding, allergic reaction, cardiogenic shock, cardaic arrest cerebral oedema, arrhythmia
85
What are some warnings and interactions with fibrinolytic drugs?
don't give if predisoposed to bleeding, haven't excluded intracranial haemorrhge, have had streptokinase treatment Interactions - anticoagulants, antiplatelets, ACE-i increase risk of antiphylaxis

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