1. Epidemiology and Drugs Flashcards
CVD risk factors may be (2)
Irreversible
Reversible
Irreversible CVD risk factors (3)
Age
Sex
Family history/genetics
Reversible CVD risk factors (4)
Smoking
Obesity
Diet
Exercise
Modifiable CVD risk factors (4)
Hypertension
Hyperlipidaemia
Diabetes
Stress
Types of CVD prevention (2)
Primary
Secondary
Examples of primary CVD prevention (3)
Exercise
Diet
Smoking cessation
Assess total risk - medical treatment if high risk
Difference between primary and secondary CVD prevention (2)
Secondary - primary with medical treatment to reduce risk
Secondary - undertaken after presenting with CVD
Primary prevention approach addresses (6)
Family history Diet Smoking Test cholesterol Test blood pressure Test for diabetes
Examples of CVD (4)
Angina
Myocardial infarction/heart attack (MI)
Stroke (CVA)
Claudication (leg/calf pains)
Approach to prevention involves (4)
Lifestyle changes
Control total cholesterol
Control hypertension
Anti-platelet drugs
Total cholesterol control involves (2)
Statin treatment
Reduce <5mmol/l or by 25%
Hypertension control is for (2) and aims to
Moderate hypertension
Mild hypertension with evidence of CVD
Reduce BP to < 140/85
Anti-platelets are used when (2)
CVD identified
When patient is at high risk of CVD (with no identified disease)
Drugs used in the CVS (2)
Prevent further disease
Reduce symptoms of current disease
Drugs which prevent further CVS disease include (4)
Anti-platelet drugs
Lipid lowering drugs
Anti-arrhythmic drugs
Anticoagulants
Drugs which reduce symptoms of current disease (5)
Diuretics Anti-arrhythmic drugs Nitrates Calcium channel blockers ACE inhibitors
Anti-platelet drug aim
Significantly reduce chance of MI/CVA in at risk individuals
Anti-platelet drug side effects
Prolong bleeding (during extraction)
Types of anti-platelet drugs (3)
Platelet aggregation inhibitors (aspirin)
ADP-induced platelet aggregation inhibitors (clopidogrel)
Platelet phosphodiesterase inhibitors (dipyridamole)
Use of more than one anti-platelet drug in combination (3)
Decrease platelet aggregation
Decrease thrombosis risk
Increased effect
Anticoagulants used for
Those at risk of thrombosis/primary embolism in slow-moving blood areas (legs/ankles)
Types of anticoagulants (5)
Warfarin Heparin Apixiban Dabigatran Rivaroxiban
Warfarin action
Inhibits synthesis of vitamin-K clotting factors (2, 7, 9, 10, protein C and protein S)
Treatment for patient taking warfarin who begins to bleed excessively
Flood area with vitamin K
Issues with warfarin and treatment (2)
Initial hypercoagulation (anticoagulation takes 2-3 days) Initially prescribe warfarin with heparin concurrently
Warfarin monitoring test and value ranges
INR - standardised prothrombin time
1 - normal
2-4 - therapeutic range of patient taking warfarin
Anticoagulant/warfarin drug interactions (3)
Amoxicillin
Metronidazole
NSAIDs
New oral anticoagulants (NOACs) include (3)
Rivaroxiban - FX activation inhibitor
Apixiban - direct thrombin inhibitor
Dabigatran - direct thrombin inhibitor
NOAC drug interactions (2)
Macrolides - erythromycin and clarithromycin
NSAIDs - prolong action and inhibit platelets
Statins definition and types (3)
Lipid-lowering drugs
Simvastatin, atorvastatin, rosuvastatin
Statin side effects
Possible myositis with some drug interactions - antifungals
Beta-adrenergic blockers function (2)
Stop arrhythmias leading to cardiac arrest (VF)
Reduce heart muscle excitation
Beta-blocker types (2)
Selective B1 only (atenolol) - reduce HR and heart electrical activity leading to prevention of arrhythmias
Beta-blocker side effects and contraindications (3)
Prevent increase in HR, may lead to postural hypotension
Reduce heart efficiency, worsening HF
Block beta-receptors in lungs, exacerbating asthma
Diuretics definition and function
Antihypertensive drugs
Used to treat HF
Diuretic types (2)
Thiazide diuretics (bendroflumethiazide) Loop diuretics (frusemide)
Diuretics action
Increase salt and water loss (reduce plasma volume and cardiac workload)
Diuretics side effects (2)
Na/K imbalance if not monitored correctly
Xerostomia (in elderly)
Nitrates can be (2)
Short-acting
Long-acting
Use of short-acting diuretics and example
Emergency management of angina pectoris
Use of long-acting diuretics and example
Prevention of angina pectoris - isosorbide mononitrate
Action of nitrates (3)
Venodilation (dilate veins) - reduce preload to heart
Reduce peripheral resistance (dilate resistance arteries) - reduces cardiac workload and cardiac oxygen consumption
Dilate collateral coronary artery supply - reduces angina pain
Method of nitrate administration and why
Sublingual, transdermal, IV
Inactivated by first-pass metabolism
Nitrates side effects
Headaches
Function and action of calcium channel blockers
Reduce hypertension
By blocking calcium channels in smooth muscle
Different calcium channel blockers are more active in different places (2)
Peripheral blood vessels - relaxation and vasodilation of arterioles (nifedipine, amlodipine)
Heart muscles - slow conduction of pacing impulses (verapamil)
Calcium-channel blockers side effects
Gingiva hyperplasia
Function ACE inhibitors (2)
Reduce BP
Reduce excess salt and water retention (prevent aldosterone-dependent reabsorption of salt and water)
Action of ACE inhibitors
Inhibit conversion of Angiotensin I into Angiotensin II
Side effects of ACE inhibitors (2)
Cough
Hypotension
Oral reactions to ACE inhibitors (2)
Angio-oedema
Lichenoid reactions
Difference between Ang II blockers and ACE inhibitors
Ang II blockers inhibit the same system but by a different mechanism
