Top 100 Drugs - Cardio

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19 Cards. Created by Affi ().
 
Term  
Definition

Adrenaline

I: - cardiac arrest (ALS) treatment - anaphylaxis - local vasoconstriction (control mucosal bleeding) - mixed with local anaethetic to prolong local anaesthesia

MoA - potent agonist of alpha1, alpha 2, beta1 and beta2 adrenoreceptors - vasocontriction of vessles (alpha 1) - increasing HR, force of contraction and myocardial excitability (beta 1) - vasodilation of vessels supplying heart and muscles (beta 2)

--> redistribution of blood flow --> improve chances of restoring organised rhythm

  • bronchodilation and suppression of inflammatory mediatory release from mast cells

SE: - adrenaline induced hypertension - anxiety, tremor, headache, palpitations, angina, MI, arrhythmias

C: - caution in heart disease - not used in areas suppled by end-artery (poor collateral supply) eg finger, toes

Interaction: - beta blocker --> widespread vasocontriciton

Adenosine

I: 1st line supraventricular tachycardia (SVT)

MoA agonist of adenosine Rs on cell surfaces Heart- activation of G protein couple receptors induces no. of effects - frequency of spontaneous depolarisations (automaticity) + increasing resistance to depolarisation (refractoriness) - slows sinus rate, conduction velocity and increases AV node refractoriness - increasing refractoriness of AV node --> breaks re-entry circuit - allows normal depolarisations from SA node to resume control of heart rate (cardioversion)

  • rapid uptake in red cells (half-life of 10 seconds)

SE - interfering with SA and AV node - bradycardia, asytole - sinking feeling in chest - accompanied by breathlessness and sense of impending doom

Contraindications - patients who do not tolerate transcient bradycardic effects (including hypotension, coronary ischaemia, decompensated heart failure) - bronchospasm (asthma, COPD, heart transplant)

Interactions - Dipyridamole - blocks cellular uptake of adenosine- prolongs and potentiates its effect - therefore dose should be halved

Aldosterone Anatogonists

Indications - Ascites and oedema due to liver cirrhosis - spironolactone - 1st line diurectic - Chronic HF - moderate severity or arising within 1 month of MI (in addition to beta blocker an ACEi/ARB) - primary hyperaldosteronism - patients awaiting surgery or who cannot have surgery

MoA - aldosterone - mineralocorticoid - produced in adrenal cortex (acts on distal tubules of kidney --> increase activity of luminal epithelial sodium channels (ENaC) --> increases reabsorption of Na and H2o (elevates BP) --> anatagonists - competitively binding to aldosterone receptor --> increases sodium and water excretion and potassium retention

SE - hyperkalaemia - muscle weakness, arrythmias, cardiac arrest - spironolactone - gynaecomastia - liver impairment/jaundice - Steven-Johnson syndome - T cell mediated hypersensitivity reaction --> bullous skin eruption

Contraindications - severe renal impairment - hyperkalemia - Addison's disease (aldosterone deficient) - pregnancy - caution

Interactions - Potassium elevating drugs (ACEi/ARBs)

ARB (losartan, candesartan, ibesartan)

Indications - HTN (1st or 2nd line) - chronic HF (1st line) - Ischemic heart disease - Diabetic neuropathy and CKD with proteinuria

MoA - block action of AngII on AT1 receptor - reduces afterload (peripheral vascular resistance) --> lowers BP - dilates efferent glomerular arteriole - reduces intraglomerular pressure --> slows progression of CKD - reducing aldosterone - promotes sodium and water excretion- reduce venous return (preload) - beneficial effect in HF

SE - hypotension - first dose - hyperkalemia - renal failure

Contraindications - renal artery stenosis or AKI

caution - pregnant - breast feeding - some CKD

Interactions - potassium elevating drugs

ACE i (ramipirl, lisinopril, perindopril)

Indications - HTN (1st or 2nd line) - chronic HF (1st line) - Ischemic heart disease - Diabetic neuropathy and CKD with proteinuria

MoA - block conversion of Ang I --> Ang II - reduces afterload --> lowers BP - dilates efferent glomerular arteriole -> reduces intraglomerular pressure --> slows progression of CKD - reducing aldosterone --> promotes sodium and water excretion --> helps reduce venous return (preload)

SE - hypotension - persistent dry cough - increased levels of bradykinin - usually inactivated by ACE - hyperkalaemia (lower aldosterone promotes potassium retention) - angioedema and anaphylactoid reactions

Contraindications - renal artery stenosis - AKI

pregnant, breast feeding, chronic kidney disease

Interactions - potassium elevating drugs (avoid prescribing with)

Alpha blockers

Indications - benign prostatic hyperplasia (5alpha reductase inhibitors) - add on treatment in resistant hypertension - when other medicines (CAB, ACEi, thiazide diurectics insufficient)

MoA - most highly selective for alpha1-adrenoceptor (SM- blood vessels and urinary tract- bladder neck and prostate) - blockade --> relaxation - vasodilation + reduced resistance to bladder outflow

SE postural HTN dizziness syncope Contraindications caution in postural HTN Interactions

Digoxin

Indications - AF and Atrial flutter (beta blocker or non-dihydropyridine - CCB more effective) - severe HF - 3rd line treatment in patients who are already taking ACEi, beta blocker and aldosterone antagonist or ARB

MoA - negatively chronotropic (reduces HR) and positively inotropic (increases force of contraction) - atrial fibrillation and flutter- therapeutic effect arises mainly via indirect pathway involving increased vagal (parasympathetic tone) - reduces conduction at AV node - reducing ventricular rate - heart failure - myocytes - inhibition of Na/K ATPase --> accumulation of Na in cell (extrusion of Ca requires low intracell Na) - elevation of Na causes Ca to accumulate in cell --> increasing contractile force

SE bradycardia, GI disturbance, rash, dizziness, visual disturbance

CI - 2nd degree heart block - intermittent complete heart block - ventricular arrhythmias - renal failure/hypokalaemia/hypomagenaemia/hypercalcaemia Interactions - loop and thiazide diuretics

Hartmanns soll (Sodium Lactate)

Indications - provide sodium and water intravenously in patients unable to take enough orally
- expand circulating volume in states of circulatory compromise (shock)

MoA - balanced salt solution

SE - HF - edema

CI - caution in HF and renal impairment - severe liver disease

Dipyridamole

Indications - cerebrovascular disease - secondary prevention of stroke (1st line in TIA, 2nd line in ischemic stroke where clopidogrel CI) - usually combination with aspirin - tachycardia during myocardial perfusion scan in Dx of IHD

MoA - antiPLT and vasodilatory effects

SE - headahce, flushing, dizziness, GI symptoms

CI caution in IHD, aortic stenosis, heart failure

Loop Diurectics

Loop - furosemide, bumetanide Indications - acute pulmonary edema in conjunction with oxygen and nitrates - chronic heart failure - other edematous states- renal disease or liver failure

MoA -inhibit Na/K/Cl co transporter - responsible for transporting Na, K and Cl ions from tubular lumen into epithelial cell - inhibiting -potent diuretic effect

  • direct effect on blood vessels - dilatation of capacitance veins

SE - dehydration and hypotension - increases urinary losses of sodium, K and Cl --> increases excretion of Mg, Ca and H ions - low electrolyte state - metabolic alkalosis

  • hearing loss and tinnitus

CI - hypovolemia and dehydration - caution encephalopathy/hypokalaemia/hyponatraemia

Interactiosn

Thiazide Diuretics

Thiazide (bendroflumethiazide)/Thiazide-like (indapamide/chlortalidone) Indications - alternative 1st line Tx for HTN (CCB unsuitable - edema) - add on HTN Tx (CCB + ACEi or ARB)

MoA - thiazide - inhibit Na/Cl transporter in distal convoluted tubule of nephron - prevents reabsorption of Na and its osmotically associated water --> diuresis causes an initial fall in extracellular fluid volume - compensatory changes (RAAS)- reverse this - long term- vasodilation

SE - hyponatraemia - increase Na into distal tubule - exchanged for K - increases urinary K losses - hypokalaemia --> cardiac arrhythmias - increase plasma concentrations of glucose (unmask type 2 diabetes) - impotence in men

CI - hypokalaemia and caution in hyponatraemia - gout attack (reduce uric acid excretion) Interactions

K sparing Diuretics

Potassium Sparing- amiloride Indications - combination treatment of hypokalaemia arising from loop or thiazide diuretic therapy - aldosterone antagonist (spironolactone) also have potassium-sparing effect

MoA - weak diurectics - counteract K loss and enhance diuresis - distal convoluted tubules in kidney - inhibits reabsorption of Na by epithelial Na channels --> leading to Na and water excretion

SE - GI - diuretics, dizziness, hypotension, urinary symptoms - electrolytes disturbances - hypokalaemia, hyper and hyponatraemia

CI - severe renal impairment - hyperkalaemia - hypokalaemia - volume depletion

Interactions - caution in K elevating drugs

Amiodarone

Indications - tachyarrhythmias - AF, atrial flutter, SVT, VT and refractory ventricular fibrillation

MoA - blockade of Na, Ca and K channels - antagonism of alpha and beta adrenergic receptors - reduce automaticity, conduction velocity and increase resistance to depolarisation (refractoriness) - including in AV node - interferring AV node conduction - amiodarone reduces the ventricular rate in AF and atrial flutter

SE - hypotension during IV infusion - pneumonitis, bradycardia, AV block - heptatis - photosensitivity and grey discolouration - thyroid abnomalities (due to iodine)

Contraindications - avoid in severe hypotension, heart block - active thyroid disease

Interactions - increases concentrations of digoxin, dilitiazem, verapamil

Antimuscarinic

Indications - Atropine - Mx of severe bradycardia - Antimuscarinic (hyoscine butylbromide) IBS - antispasmodic - Antimuscarinic - hyoscine butylbromide - copious resp secretions

MoA - bind to muscarinic receptor - competitive inhibitor of Ach - stimulation of muscarininc receptor --> rest and digest effects - blocking receptor - reduce these effects (increase HR and conduction, reduce SM tone and peristaltic contraction) reduce secretions from glands in resp tract and gut - eye - relaxation of pupillary constrictor and ciliary muscles --> pupiliary dilatation and preventing accommodation

SE - tachycardia - dry mouth - constipation - reducing detrusor muscle activity - urinary retention in patients with benign prostatic hypertrophy - blurred vision (near objects) - drowsiness and confusion

Contraindications - caution in angle closure glaucoma (intraocular pressure) - avoid in arrhythmias

Interactions TCA

Aspirin

Indications - acute coronary syndrome and acute ischemic stroke - long term - thrombotic arterial events in CV, cerebrovascular and peripheral arterial disease - reduce intracardiac thrombus and embolic stroke AF - control mild-moderate pain and fever (NSAIDs)

MoA - ireversibly inhibits cyclooxygenase (COX) to reduce production of pro-aggregatory factor thromboxane from arachidonic acid - reducing PLT aggregation and risk of arterial occlusion

SE - GI irritaition - ulceration and haemorrhage - bronchospasm (hypersensitivity) - tinnitus - overdose (hyperventilation, hearing change, metabolic acidosis, confusio, convulsion, cardiovascular collapse and resp arrest)

Contraindications - no under 16 - Reye's syndrome (liver and brian) - hypersensitivity - 3rd trimester preg (inhibition of PG - premature closure of DA) - caution in peptic ulcer + gout

Interactions - antiPLT drugs (clopidogrel) - anticoagulants (heparin, warfarin)

Beta blockers

Indications 1st line - IHD - angina and acute coronary syndrome - Chronic HF - AF - SVT

  • HTN - not 1st line - used after CCB, ACEi, diurectics

MoA - b1 adrenoreceptors - heart - b2 - SM of blood vessels and airways

  • block - reduce force of contraction and speed of conduction of heart --> relieves Myocardial ischemia by reducing cardiac work and o2 demand - increasing perfusion
  • slow ventricular rate in AF - prolonging refractory period and AV node

SE fatigue, cold extremities, headache, GI disturbance

Contraindications asthma - CI COPD - choose b1 selective (atenolol, bisoprolol, metoprolol) vs non selective (propanolol) - avoid in haemodynamic instability - contraindicated in heart block

Interactions - not to be used with non-dihydropyridine CCB (verapmil, diltiazem)

CCB (amlodipine, difedipine, diltiazem, verapamil)

Indications - Amlodipine - 1st or 2nd line HTN - stable angina - diltiazem/verapamil - control cardiac rate in SV arrhytmias - tachy, atrial fluter and AF

MoA - decrease Ca entry into vascular and cardiac cells - reducing intracellular Ca concentration --> relaxation and vasodilation in arterial SM - lowering arterial pressure - suppress cardiac conduction - particularly across AV node - slowing ventricualr rate - reduced cardiac rate, contractility and afterload reduce myocardial o2 demand - preventing angina - dihydropyridines - amlodipine, nifedipine - rel selective for vasculature whereas non-dihydropyridines - more selective for heart

SE - ankle swelling, flushing, headache, palpitations - vasodilation and compensatory tachycardia - constipation, bradycardia, heart block, cardiac

Contraindications - avoid in poor LV function and AV nodal conduction delay heart block) - CI in unstable angina and severe aortic stenosis

Interactions beta blockers

Clopidogrel

Indications - with aspirin - ACS - stents - long term- CV, cerebrovascular, PAD - reduce risk of intracardiac thrombus and embolic stroke with AF (when warfarin contraindicated)

MoA prevents PLT aggregation binding irreversibly to adenosine diphosphate (ADP) receptors - (P2Y12 subtype) - on surface of PLTs - process is independent of cyclooxygenase pathway

SE bleeding - GI, intracranial - dyspepsia, ab pain - thrombocytopenia

Contraindications - active bleeding - caution in elective surgery - renal and hepatic impairment

Interactions - pro-drug requires metabolism by hepatic p450 enzymes to have antiPLT effect - efficacy reduced by p450 inhibitors (omeprazole, ciprofloxacin, erythromycin)

Colloid

Indications expand circulating volume in circulatory compromise (but prefer compound sodium lactate, NaCL) - cirrhotic liver disease - albumin - prevent effective - hypovolemia in large volume paracentesis

MoA - large osmotically active molecule (albumin, gelatin) --> expand circulating volume - large volume paracentesis - cirrhotic liver disease - produce adverse haemodynamic effects - customary to admnister human albumin solution

SE - cardiac output and precipitate cardiac failure - increasing left ventricular filling beyond point of maximal contractility on Starling curve - edema

Contraindications HF, renal impairment