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Year 1 Cardiology > Pharmacology > Flashcards

Pharmacology Flashcards

(93 cards)

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1
Q

Beta adrenoreceptor agonists

A

Increase force, rate and cardiac output as well as O2 consumption
Reduce cardiac efficiency
Can cause disturbances in cardiac rhythm

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2
Q

Three Beta adrenoreceptor agonist

A

Dobutamine, Adrenaline, Noradrenaline

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3
Q

Adrenaline uses

A

Acute cardiac arrest, Anaphylactic shock

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4
Q

How can adrenaline be administered?

A

IM SC IV and IV infusion, in anaphylactic shock IM only IV if induced Cardiac arrest. Usually 500 micrograms

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5
Q

Adrenalines action

A

Beta 1 receptors positive inotropic chronotropic effect
Alpha 1 receptors vasoconstriction in gut skin
Beta 2 receptors dilation of coronary arteries

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6
Q

Adrenalines Half life

A

Roughly 2 minutes

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7
Q

Dobutamine uses

A

Acute potentially reversible heart failure, following cardiac surgery or during septic shock

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8
Q

How is dobutamine administered

A

IV infusion in high dependancy or critical units

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9
Q

Dobutamines action

A

Selective beta 1 agonist leads to increased contractile strength but not increased heart rate- unknown why
Rarely used only in short term

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10
Q

Three types of Beta antagonists

A

Non selective Propanol
Selective Atenolol Bisoprolol Metoprolol
Non selective partial agonists Alprenolol

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11
Q

Alprenolol and Non selective partial agonists

A

Weakly activate receptor yet prevent more potent agonist from binding, so slight rise in heart rate but block full effect

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12
Q

Effect of beta blockers at rest

A

Little effect as sinus rhythm, parasympathetic system, is dominant , Alprenolol will show slight rise

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13
Q

Beta blockers during exercise

A

reduced tolerance as rate force and CO are significantly lowered.

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14
Q

Overall effect of Beta blockers

A

Coronary Vessels constriction as B2 receptors blocked , however better oxygenation of myocardium as O2 requirement falls

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15
Q

Clincal usage of beta blockers

A

Arrythmias, Atrial fibrillation Supraventricular tachycardia , angina, and compensated heart failure.
With comorbidities e.g. angina can be first line for hypertension

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16
Q

Beta blockers in arrhythmia

A

Decrease excessive sympathetic drive to restore normal sinus rythm

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17
Q

Beta blockers in atrial fibrillation

A

Delays conduction through AV node preventing spread and helping restore normal sinus rhythm

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18
Q

Beta blockers in Angina

A

First line over Ca2+ blockers, helps reduce O2 consumption reducing waste product build up and in turn the symptoms

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19
Q

Beta blocker used in compensated heart failure treatment

A

Carvedilol, start low dose and increase slow

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20
Q

Carvedilol how does it work

A

Low dose reduces excessive sympathetic drive swell as alpha antagonist so vasodilation occurs less force required for same effect

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21
Q

Adverse effects of Beta blockers

A

Bronchospasms B2 receptor blockage, avoid asthmatics etc
Aggravation of non compensated heart failure as reliant or sympathetic drive for adequate CO
Hypoglycaemia B2 receptors activated release glucose from liver, no tachychardic warning signs either, avoid in poorly controlled diabetics
Fatigue CO reduced skeletal muscle perfusion B2 reduced
Cold extremities B2 mediated vasodilation

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22
Q

In what cases are the adverse effect negated if using selective agents e.g. atenolol

A

Bronchospasms and hypoglycaemia as use B2 receptors

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23
Q

Atropine

A

Non selective muscarinic ACh competative antagonist

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24
Q

Atropine clinical uses

A

Used to reverse symptomatic bradychardia as a result of a cardiac arrest
In anticholinesterase poisoning to reduce excessive parasympathetic activity

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25
Atropine action
Increases heart rate at all but low doses No effect on arterial BP as no parasympathetic innervation No effect upon exercise resistance
26
Atropine for symptomatic bradycardia as a result of an cardiac arrest
300-600 microgram minimum dosage, titrate upwards. Too little has adverse slowing effect Increased vagal tone as a result of cardiac arrest is reduced increasing heart rate IV with constant monitoring for the adverse effects
27
Function of cardiac glycosides?
Increase contractility of the heart
28
Digoxin
Increases contractility of myocardium by increasing amount of Ca2+ in sarcoplasmic reticulum
29
Danger around digoxin
very low therapeutic ratio especially when coupled with low plasma K+ increases likely hood of ventricular fibrillation and tachycardia
30
Clinical use of digoxin
IV- acute heart failure Oral in chronic heart failure if not responding to other drugs Atrial fibrillation, as blocks of AV node preventing spread
31
Digoxin side effects
Can cause arrhythmias if lower AV conductance too low | Nausea, vomiting, colour vision disturbances
32
Levosimendan
Acute decompensated heart failure Sensitises troponin C increasing contractility of myocardium Dilates vascular smooth muscle by hyperpolarising membranes by opening k+ channels
33
Phosphodiesterase inhibitors
Amrinone and Milrinone
34
Action of Amrinone and milrinone
Inhibit PDE so increase conc of cAMP increasing contractility of the cardiac muscle Reduced peripheral resistance
35
Clinical Usage of Amrinone and milrinone
Limited use as in long term increases mortality and morbidity, quality not quantity of life IV for acute heart failure
36
Clinical use of organic nitrates
Acute angina, chest pain from acute MI, alongside other drugs treatment of pulmonary oedema
37
Action of organic nitrates
Broken-down in NO which activates guanylate cyclase, converts GTP into cGMP- relaxation pathway
38
Clinical use of Ca2+ channel blockers
Treat hypertension, stable angina ( beta blockers are first line)
39
Ca2+ channel blocker side effects
Due to action on nodal tissue AV and SA node suppression can cause atrial fibrillation and flutter
40
Verapamil
Selective for cardiac L type Ca2+ blocker
41
Amlodipine
Smooth muscle L type Ca 2+ blockers
42
Verapamil side effects
Avoid with beta blockers slow heart down to much
43
Amlodipine side effects
Ankle oedema
44
Statins
Simvastatin and atorvastatin
45
Statins uses
Hypercholesterolemia, diabetes, angina, MI strokes , high risk of MI
46
Statins side effects
Myopathy, Rhabdomyolysis- muscular tissue breakdown which can lead to renal failure
47
Fibrates
Bezafibrate
48
Fibrates uses
Hypertriglyceridemia, low HDL cholesterol
49
Bezafibrate side effects
decreased appetite, GI disturbances
50
For those unable to tolerate statins
Ezetimibe
51
Ezetemibe function
blocks cholesterol absorption
52
Ezetemibe side effects
GI discomfort diarrhoea
53
PCSK-9 inhibitors
Alirocumab and evolucumab
54
PCSK-9 inhibitor uses
Hypercholesterolemia- more effective than statins reduce cholesterol by up to 60%
55
PCSK-9 side effects
Nasopharyngeal complaints pain congestion etc
56
Thiazide Diuretics
Bendroflumethiazide
57
Bendroflumethiazide
Reduce oedema, reduce hypertension
58
Bendroflumethiazide side effects
Hyperkalaemia , arrhythmias , hyperglycaemia, gout , impotence , diabetes
59
Cardioselective B1 bockers
Atenolol, bisoprolol
60
Atenolol abd bisoprolol uses
Angina, acute coronary syndrome, MI hypertension
61
Non selective B1 and B2 blockers
Propranolol
62
Propranolol uses
Hypertension, thyrotoxicosis, migraines
63
Beta blocker side effects
Bronchospasms, tired, cold peripheries, can acutely worsen heart failure.
64
ACE inhibitors
Lisinopril
65
Lisinopril uses
Hypertension, haemodynamically stable short term post MI patients, Supraventricular arrhythmias
66
Lisinopril side effects
Dry cough, renal dysfunction, angioneurotic oedema,
67
When should lisinopril NEVER be used
Pregnancy
68
Angiotensin receptor blockers
Losartan
69
Losartan uses
Hypertension, MI patients if ACE inhibitors aren suitable
70
Losartan side effects
Cough diarrhoea dizziness hypotension
71
Alpha 1 blockers
Doxazosin
72
Doxazosin uses
Hypertension, prostatic hyperplasia
73
Doxazosin side effects
Postural hypertension
74
Mineral corticoid antagonists
Spironolactone
75
Spironolactone uses
Oedema due to congested heart failure, hypertension, moderate to severe heart failure
76
Spironolactone side effects
Gynaecomastia- male breast tissue develops, hyperkalaemia,
77
Isosorbride Mononitrate uses
Angina acute heart failure
78
Isosorbide mononitrate side effect
Headache hypertension/collapse
79
issues surrounding nitrate use
Tolerance can build up so introducing nitrate free period during the day helps prevent this
80
GTN or glyceryl trinitrate uses
Angina, hypertension and myocardial ischaemia during and after cardiac surgery
81
GTN side effects
Headache flushing vomiting nausea arrythmias
82
Nicorandil
used in angina, head aches mouth and GI ulcers so avoid
83
Ivabradine
If channel modulator, used in angina, slow HR in sinus rhythm, not in atrial fibrillation
84
Ranolazine
effective for refractory angina
85
Antiplatelet Aspirin
Clopidogrel, Prasugrel, ticagrelor
86
Asprinin uses
Angina, MI, strokes
87
Aspirin side effects
Haemorrhage, peptic ulcer, asthma
88
Anticoagulants
Heparine IV warfarin Oral, rivaroxaban
89
Anticoagulant uses
DVT PE atrial fibrillation
90
Anticoagulant side effects
haemorrhage hypotension
91
Fibrinolytic drugs
Streptokinase breaks up fibrin
92
Streptokinase uses
PE stroke
93
Streptokinase side effects
Haemorrhage, avoid in trauma, peptic ulcers

Year 1 Cardiology (17 decks)

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