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42 Cards in this Set
- Front
- Back
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What is the treatment course for Hypertension? |
A C D (B, A)
Ace inhibitor
Calcium antagonist
Diuretic - Loop diuretic such as Furosemide
Then beta-blocker and alpha antagonist if not responding well to initial treatment and spironolactone another diuretic can be given
NB - Change order to C A D if patient is over 55 years old |
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What is the treatment course for Chronic Heart Failure? |
D A B
-Diuretic to all -ACE inhibitor -Beta Blocker
Also give spironolactone another diuretic which can improve effectiveness of other diuretics |
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What is the course of treatment for Angina Pectoris (chronic angina) |
To prolong life think SAAB
Statin Asprin ACE inhibitor Beta blocker
To relieve symptoms use:
Beta blocker Calcium antagonists Coronary angioplasty New anti-anginals such as Ivabradine or Ranalozine
Coronary artery surgery also possible? |
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How do you differentiate between types of chest pain and whether or not they are related to Myocardial infarction? |
If it is cardiac related chest pain then you test for Troponin levels
If troponin +ve then = Myocardial infarction
If Troponin -ve then = troponin negative acute coronary syndrome (ACS)
MI can be ST elevated or Non ST elevated on and ECG |
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Treatment for myocardial infarction includes? |
STEMI tends to be worse - emergency angioplasty often required
NSTEMI - affects a smaller part of the heart, not the whole thinkness of the myocardium and so generally less serious so angioplasty can still be used but not as an emergency treatment.
Treatment for both are similar:
Asprin, Clopidogrel, ticagrelor, fondaparinux antiplatelets Statin ACE inhibitor Beta Blocker
SAAB - Same as angina treatment
Also thrombolytic treatment should be used |
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Troponin negative ACS treatment involves? |
SAAB
Statin ACE inhibitor Asprin and clopidogrel (antiplatelets) Beta-blocker |
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How would you treat atrial fibrillation? |
1 - Prevent emboli - Warfarin, Rivaroxban
2 - Control rate - Beta blocker, Digoxin
3 - Control rhythm (not really done anymore) |
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Treatment for stroke involves what? |
Determine wether it is haemorrhagic first,
If not then give emergency thrombolysis |
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What are the side effects of ACE inhibitors? |
Cough
Renal Dysfunction
Angioneurotic oedema
Never give in pregnancy |
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What are the side effects of Beta Blockers? |
Bradycardia
Tiredness
Asthma |
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What are the side effects of Ca++ antagonists? |
Ankle oedema for amlodipine
Heart block for Diltiazem and Verapamil |
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What are the side effects of diuretics? |
Hypokalaemia
Diabetes
Gout |
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What are the side effects of Angiotensin receptor blockers? |
Renal dysfunction
Never in pregnancy |
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Which drug type should not be given to those with heart failure? |
Calcium antagonists due to the potential risk of heart block |
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Which drug type should not be given to those with angina? |
Diuretics |
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What is the mechanism of action of renin-angiotensin system inhibitors? |
ACE inhibitors - Inhibit the conversion of angiotensin I to angiotensin II and this results in preventing vasoconstriction of blood vessels directly but also by reducing noradrenaline release from sympathetic nerves, It also retains salt via aldosterone secretion as angiotensin II causes it to be secreted from the adrenal glands
Angiotensin II receptor antagonists - block the angiotensin 2 receptors and thus have a similar effect to ACE inhibitors in their action |
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What is the mechanism of action of Diuretics |
Diuretics act mostly on the kidneys to increase the amount of water removed from the blood and therefore reduce the blood volume and can reduce BP
Loop Diuretics - act on the ascending part of the loop of henle in the kidneys and reduce the levels of Na+ andCl- ions reabsorbed into the blood and thus increase its osmotic pressure so water moves out
Thiazides - Such as Indapamide prevent resabsorbtion of Na+ and Cl- also and therefore have a similar effect |
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What type of drug is Spirinolactone and what is its action? |
Spirinolactone is an aldosterone antagonist, it reduces the effect aldosterone has on the kidney and therefore prevents reabsorption of ions and thus results in water being removed from the blood
used in conjunction with other diuretics to improve how effective they are |
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What is the mechanism of action of Calcium channel antagonists and name 2 of these drugs? |
Verapamil, Diltiazem, Nifedipine, Amlodipine
They work by blocking L-type voltage gated calcium channels found in cardiac, smooth and skeletal muscle and for regulating aldosterone and cortisol secretion, this has a number of effects - It relaxes and dilates the blood vessels to reduce BP - It reduces contractility of the heart and the rate of contractions of the heart -It also reduces aldosterone production which in turn reduces blood pressure, by blocking calcium signal on the adrenal cortex cells |
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What are the ACE inhibitor drugs? |
Ramipril
Catopril
Lisinopril
Enalipril |
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Give some examples of alpha antagonists and their action |
Doxazosin, Prazosin, Terazosin
These are sometimes used if needed to treat resistant hypertension |
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RAS system inhibitors include ACE inhibitors and Angiotensin II receptor antagonists, name two angiotensin II receptor antagonists |
Losartan
Valsartan |
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When would Digoxin be used and how does it work? |
It can be used in congestive heart failure as is a cardiotonic agent which will increase cardiac contractility |
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What action does Nitric oxide have? |
Its a powerful vasodilator that can be used in congestive heart failure |
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Give two examples of organic nitrates and their mechanism of action |
GTN - glyceryl trinitrate and isosorbide mononitrate
These are powerful vasodilators which dilate coronary arteries to increase blood flow to the pericardium and can relieve the symptoms of angina
Can be given IV for heart failure |
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Name two potassium channel blocking drugs, what they are used to treat and their action |
Nicorandil
Amiodarone
These drugs can also be used in angina as are vasodilators used when organic nitrates aren't sufficient |
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List the classes of Anti-Dysrhythmic Drugs and give an example for each |
Class 1 are all sodium channel blockers Class 1a = Disopyramide Class 1b = Lidocaine Class 1c = Flecainide Class 2 = Beta-adrenoreceptor blockers such as propanolol Class 3 = Potassium channel blockers, amiodarone Class 4 = Calcium channel blockers, Verapamil
adenosine and digoxin are unclassified drugs used in treating dysrhythmias |
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What is the mechanism of action of Sodium Channel blockers? |
These work by binding to the alpha subunit of sodium channels acting like local anaesthetics
They inhibit cardiac action potentials by reducing the rate of cardiac depolarisation during phase 1 of the cycle
They are classed a,b and c depending on how they alter the channels whether it be open, refractory (inactive) or resting |
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What is the mechanism of action of B-blockers in treating dysrhythmias |
They block Beta-1 receptors to result in a reduced heart rate and decreased cardiac output
Blocking these receptors reduces the entry of Calcium ions into cardiac muscle cells in phase 2 of cardiac muscle contraction and reduces the rate of depolarisation
They also increase the refractory period at the AVN so useful in treating supraventricular tachycardias |
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What is the mechanism of action of Potassium channel blockers in treating dysrhythmias? |
Their main action is to prolong the action potential by prolonging the refractory period and preventing another AP from firing |
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What clinical use can the class 3 anti-dysrhythmia drug amiodarone have? |
Can be used to treat tachycardia associated with the Wolff-Parkinson-White syndrome |
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What are the features of Wolff-Parkinson-White syndrome? |
Is a heart condition which results in episodes of abnormally fast heart rate, it can last seconds to days and when combined with atrial fibrillation can actually be life-threatening |
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What is the mechanism of action of action of calcium channel blockers in treating dysrhythmias? |
Verapamil and Diltiazem
They block voltage dependent L-type calcium channels which results in slowing the conduction through the SAN and AVN.
They also shorten the plateau phase of a cardiac AP and reduce the force of contraction of the heart |
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What is Verapamil used to treat? |
Its a class 4 antidysrhythmic which is a calcium channel blocker
It is used to prevent recurrence of supraventricular tachycardias
its can also reduced the ventricular rate in patients with atrial fibrillation if the don't have WPW syndrome |
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When is the drug amiodarone used? |
Tachycardia associated with Wolff-Parkinson-White syndrome
Also effective in other supraventricular and ventricular tachyarrhythmias
It is a class 3 potassium channel blocking antidysrhythmic drug |
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When would you used propranolol as a treatment method? |
This beta blocking drug is a class 2 antidysrhythmic used to reduce mortality following MI and to prevent recurrence of tachycardias
It is also used in treatment of heart failure and angina |
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What type of drug is disopyramide and when is it used? |
A class 1a sodium channel blocker used to treat dysrhythmias
Used in ventricular dysrhythmias and preventing recurrent atrial fibrilation |
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What type of drug is lidocaine and when is it used? |
A class 1b sodium channel blocker used to treat dysrhythmias
it is used to prevent ventricular tachycardia and fibrillation directly after an MI |
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What type of drug is flecainide and when is it used? |
Its a class 1c sodium channel blocker used in treating dysrhythmias
It suppresses ventricular atopic beats. It also prevents atrial fibrillation and recurrent tachycardia's associated with abnormal conducting pathways through the heart |
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When giving drugs by IV what characteristics of a drug would cause you to administer it by continuous infusion? |
-Stable drug -Short half life -Time dependent effects -Needs a dedicated IV site |
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When giving drugs by IV what characteristics of a drug would cause you to administer it by Intermittent infusion? |
-Unstable drug -Long half life -Concentration dependent effects -Less compatibility concerns -If a rapid delivery could cause problems |
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When giving drugs by IV what characteristics of a drug would cause you to administer it by Bolus injection |
-Rapid response required -Incompatibilities -Drug may be unstable |
