Cardio AP drugs Flashcards
Aspirin
(Main indications/ 3 main side effects/ mechanism of action)
Mild/ moderate pain + secondary prevention of major cardiovascular events + treatment of acute coronary syndromes (STEMI, NSTEMI + unstable angina) + acute ischaemic stroke
MOA -inhibits cyclooxygenase - anti-platelet effects/ reduces platelet aggregation + reduces risk of arterial occlusion / limits arterial thrombosis
Common side effect - dyspepsia, haemorrhage or peptic ulcer formation
Aspirin
(Contraindications/ key interactions/ monitoring)
Contraindications -
Children (increased risk of reye’s syndrome)
Pregnancy - third trimester
Aspirin hypersensitivity
Key interactions-
Caution when combined to other anti-platelet drugs - in certain situations ACS
Patient education -
reduce risk of heart attack/ stroke or blocked arteries - prolong life
Monitoring-
Enquiry regarding side effects
Dual anti-platelet therapy - limited 12 months - review necessary
Clopidogrel
(Main indications/ 3 main side effects/ mechanism of action)
Indications - treatment of ACS usually combined with aspirin (STEMI, NSTEMI + unstable angina)
Prevention of coronary artery stent occlusion
Secondary prevention of major cardiovascular events in pt’s with ischaemic/ heart disease/ peripheral vascular disease etc
MOA - Anti-platelet drug, inhibit platelet aggregation/ reduces the risk of thrombus + arterial occlusion - ADP receptor antagonists bind to the ADP receptors on platelet surface
Haemorrhage/ diarrhoea/ dyspepsia
Clopidogrel
(Contraindications/ key interactions/ monitoring)
Contraindications -
active bleeding/ stopped 7 days before elective surgery or procedure Caution - hepatic or renal impairments
Key interactions - grapefruit juice/ omeprazole/ SSRI’s (selective serotonin reuptake inhibitors) / erythromycin etc
Patient education -
Reduce risk of heart attacks/ stroke + blocked arteries etc.
Stent - clopidogrel 12 months - prevent stent occlusion - prevent block clot or heart attack
Bleeding - may take longer to stop - inform doctor unusual bleeding
Monitoring -
Clinical monitoring of adverse effects
Dual anti-platelet therapy is limited to 12 months - review
Statin
(Main indications/ 3 main side effects/ mechanism of action)
Reduce cholesterol levels -
Primary prevention of major cardiovascular events (e.g MI + stroke/ over age of 40 QRISK score greater than 10%)
Secondary prevention of major cardiovascular events (stroke, MI, ischaemic heart disease/ acute coronary syndrome etc.
Hyperlipaemia
MOA -
Slow the atherosclerotic process
Inhibits co-enzyme A reductase -r reduces LDL + slightly increases HDL levels
Side effects - generally well tolerated
headaches, muscle aches + GI discomfort - nausea
Statins
(Contraindications/ key interactions/ monitoring)
Contradictions-
Pregnancy/ breast feeding + hepatic impairment
Key interactions-
Amlodipine
Cytochrome P450 (CYP) inhibitor e.g protease inhibitor
Patient info-
Lowers cholesterol reduces risk of developing heart attack or stroke
Monitoring
Life-long - monitor adverse effects/ cholesterol levels
Check liver enzymes at baseline/ 3 + 12months
Warfarin
(Main indications/ 3 main side effects/ mechanism of action)
To treat + reduce risk of venous thromboembolism - (VTE - DVT + PE) - DOAC’s usually preferred
To prevent arterial embolism from AF + mechanical heart valves
MOA -
Reduces the production of vitamin k dependent clotting factors - produce an anticoagulant effect
Haemorrhage, bleeding risk, nausea + vomiting
Warfarin
(Contraindications/ key interactions/ monitoring)
Contraindication-
Active bleeding/ liver disease/ pregnancy
Interactions-
CYP inhibitors, CYP reducers (Cytochrome P450 reducers)
Patient info-
Yellow book - record warfarin dose
Monitoring-
INR ratio - dependent on indication (e.g 2 -3 in AF) warfarin treatment 3-6 months single-episode of VTE
Long-term anticoagulation - AF
Beta blockers
(Main indications/ 3 main side effects/ mechanism of action)
MOA - lowers cardiac output - reduces cardiac contraction vis the b1 adrenoreceptors - located in the heart
blood pressure reduction - reduced B1 renin secretion from the kidneys
Main indications improve symptoms + prognosis - IHD, ACS (STEMI, NSTEMI + unstable angina), prophylaxis migraines/chronic heart failure/ AF/ hypertension (4th line),
Side effects - headache/ sleep disturbances / fatigue
Beta blockers
(Contraindications/ key interactions/ monitoring)
Contraindications -
asthma (bronchospasms)/ Heart failure - started at a lower dose/ hypotension/ heart block
Key interaction -
non=dihydropyridine CCB (e.g varapamil)
Patient education -
Can initially make symptoms worse in HF - seek medical advice
Obstructive airway disease - symptoms worsen stop treatment + medical advice - difficulty breathing
Monitoring-
Heart rate
Reduction in chest pain symptoms
Body weight - access fluid accumulation
B-blocker stopped - gradually over 2 weeks
Calcium channel blockers
(Main indications/ 3 main side effects/ mechanism of action)
Main indications-
Amlodipine - 1st or 2nd line treatment for hypertension - used to prevent stroke/ MI
Used in treatment/ control angina - in patients with IHD (BB’a are alternatives)
Used to control heart rate in patients with supraventricular arrythmias
Main side effects-
Headaches, dizziness + palpitations
MOA -
CCB block the Ca+ ions from entering the vascular + cardiac cells - reduction in intracellular calcium concentration - relaxation +dilation of arteriole smooth muscle - lowers arterial block pressure
Reduction in the contractility of the heart - reduces O2 demands / reduction in cardiac conduction - AV node - slows ventricular rate
CCB
(Contraindications/ key interactions/ monitoring)
Contraindications
Unstable angina - vasodilation results in a reflux increase in tachycardia
Severe aortic stenosis - can cause collapse
AV node conduction delay/ impaired left ventricular function - caution
Key interactions-
Non-dihydropyridine CCB should not be prescribed with BB only under specialist supervision
Monitoring-
Monitor BP/ chest pain symptoms + ECG - access cardiac function
ACE inhibitors
(Main indications/ 3 main side effects/ mechanism of action)
Main indications
1st + 2nd line treatment of hypertension (e.g ramipril)
Chronic heart failure
Secondary prevention of major cardiovascular events
Diabetic nephropathy/ CKD
3 main side effects-
Dry cough/ hypotension/ nausea
MOA-
Inhibits the action of the angiotensin converting enzyme (ACE) / which converts angiotensin I to angiotensin II - leads to vasoconstriction + stimulates aldosterone secretion/ blocking this action - reduces peripheral vascular resistance + lowers BP
CKD - reduces intraglomerular pressure + slows progression of CKD
ACE inhibitors
(Contraindications/ key interactions/ monitoring)
Contraindications-
Renal artery stenosis/ AKI/ pregnancy + breastfeeding
Key interactions-
Potassium supplements - due to risk of hyperkalaemia
NSAIDs - kidney damage
Monitoring -
Check renal function before - repeat 1-2 weeks into treatment - serum creatinine levels
Blood test monitoring - potassium levels - increasing stop other potassium elevating drugs/ nephrotoxic drugs - may need to reduce ACE dosage
Diarrhoea/ vomiting - stop ACE to prevent dehydration + hypotension
