6. Drugs used for lipid disorders, heart failure and hypertension Flashcards
Which groups benefit from statins?
Those with atherosclerotic CV disease
Those with high LDL
Those with diabetes and slightly elevated LDL
No current atherosclerotic CV disease but estimated 10 year risk of 7.5% or more
What are the causes of secondary hyperlipidaemia?
Diabetes Obesity Hypothyroidism Alcohol, liver disease, renal disease Drugs
Which drugs can cause hyperlipidaemia?
OCP
Thiazide
Steroids
What drugs are used in the treatment of hyperlipidaemia?
Statins
Bile acid binding resins
Fibrates
Nicotinic acid
What are statins also known as?
HMG-CoA reductase inhibitors
How do statins work?
Reduce LDL cholesterol
How does nicotinic acid work?
Increases HDL cholesterol
How do fibrates work?
Reduce TAGs
Increase the activity of peripheral LPL
What are the adverse effects of statins?
Myopathy
Diabetes
Increased risk haemorrhagic stroke
‘Nocebo’ effect
Which drugs interact with statins?
Most commonly gemfibrozil
Any other drug that interacts with CYP3A4: macrolides, azoles and cyclosporine
Name a fibrate
Gemfibrozil
What are the side effects of fibrates?
GI disturbance
Increases liver enzymes
Name a bile acid sequestrant
Cholestyramine
Why are bile acid sequestrants useful in children with congenital dyslipidaemia?
It isn’t absorbed from the gut
What instruction is important to give when prescribing bile acid sequestrants?
Take other drugs one hour before or 4 hours after as it prevents other drugs from being absorbed
What are the side effects associated with bile acid sequestrants?
Abdominal bloating
Dispepsia
What positive inotropes are used in the short term treatment of heart failure?
Phosphodiesterase inhibitors
B1-blockers
Both increase contractability and cardiac output
Name a cardiac glycoside which is used in the long-term treatment of heart failure
Digoxin
What effects does digoxin have on the heart?
Increases contractability by increasing intracellular calcium
increase activity in the vagal nerve (slow firing in SA node and conduction in AV)
Why should an ECG be done when a patient gets nauseous on digoxin?
It has a narrow therapeutic range and can cause arrhythmias
Name an ACE inhibitor
Captopril
How do ACE inhibitors work in the treatment of heart failure
Reduce angiotensin 2: reduce peripheral resistance
Reduce aldosterone: reduce water retention
Reduce sympathetic activity
What side effects are associated with ACE inhibitors?
Hypotension
Renal dysfunction and hyperkalaemia
Cough
Which type of diuretic is most potent?
Loop diuretics
How do loop diuretics work?
Act on the thick ascending loop of henle to inhibit the reabsorption of NaCl
also increase capacity of veins to reduce BP
What side effects are associated with loop diuretics?
Hypo Na, K, Mg, Ca
ototoxicity, deafness, tinnitus, vertigo
Increase uric acid, LDL, glucose
Where do thiazide diuretics work?
Distal tubule, prevent NaCl transport
What side effects are associated with thiazide diuretics?
Hypo Na, K, Mg
Increase uric acid and cholesterol
Impotence and pancreatitis
Name an aldosterone antagonist
Spironolactone
What side effects are associated with spironolactone?
Hyper K
Gynaecomastia
