CARDIO common drugs Flashcards
1
Q
what are the anticholesterol drugs?
A
statins eg simvastatin
fibrates eg bezafibrate
PCSK 9 inhibitors
2
Q
how do statins work?
A
- they block HMG CoA reductase which is the rate limiting enzyme in hepatic cholesterol synthesis
3
Q
what are the side effects of statins?
A
- myopathy
- rhabdomyolysis
4
Q
who should recieve a statin?
A
- anyone with a CVD
- diabetes
- hypercholesterolaemia
5
Q
when should statins be taken?
A
orally at night as this is when cholesterol synthesis takes place
6
Q
how do fibrates work?
A
they are an agonist of PPAR-alpha, therefore increases lipoprotein lipase expression
7
Q
what are the side effects of fibrates?
A
- myositis = inflammation of muscles
- pruritus = itchy skin
- cholestasis
8
Q
what are the antihypertensive drugs?
A
- thiazide diuretics
- beta blockers
- mineralcorticosteroids
- vasodilators eg calcium antagonists, alpha blockers, ACEi, ARBs
9
Q
give an example of a thiazide diuretic?
A
eg bendrofluazide
10
Q
how do thiazide diuretics work?
A
- they inhibit sodium reabsorption by blocking the thiazide-sensitive N+-Cl_ symporter at the beginning of the distal convoluted tubule
11
Q
what are the side effects of thiazide diruetics?
A
- hyperglycaemia
- increased uric acid
- impotence
- gout
- dehydration
- hypokalaemia
12
Q
what are thiazide diruetics used for?
A
- hypertension
13
Q
what is an example of a loop diuretic?
A
eg furosemide
14
Q
how do loop diuretics work?
A
- by inhibiting NaCl reabsorption in the thick ascending loop of henle
- they inhibit the costransport of NaKCl
15
Q
what are loop diuretics used for?
A
- heart failure
- resistant hypertension
16
Q
what are the side effects of loop diruetics?
A
- hyperglycaemia
- increased uric acid
- impotence
- hypotension
- renal impairment
- hypokalaemia
- deafness (over use of drug)
17
Q
what are cardioselective beta blockers? give an example.
A
they only block b1
eg atenolol, bisoprolol
18
Q
what are cardioselective beta blockers used for?
A
- angina
- acute coronary syndrome
- MI
19
Q
what are non-selective beta blockers? give an example
A
- block b1 and b2
- eg propranolol
20
Q
what are non-selective beta blockers used for?
A
- migraine
21
Q
what are the side effects of beta blockers?
A
- asthma
- tired
- worsened heart failure symptoms
- cold peripheries
22
Q
what are dihydropyridines used for? give an example
A
eg amoldipine
- used in hypertension
- angina
- raynauds
23
Q
what are the side effects of dihydropyridines?
A
ankle oedema
24
Q
what are rate limiting calcium antagonists used for?
A
- hypertension
- angina
25
give an example of a rate limiting calcium antagnosits?
- verapamil
26
when should you avoid using a rate limiting calcium antagnosist and why?
- when given with a betablocker
| - it may cause heart block
27
how do angiotensin converting enzymes work?
by blocking angiotensin 1 from becoming angiotensin 2
28
give an example of ACEi?
- lisinopril
29
when are ACEis used?
- hypertension
| - heart failure
30
what are the side effects of ACEis?
- dry cough
- renal dysfunction
- very steep drop in blood pressure for first dose, eg in patients who are on diuretics because they are Na+ depleted
31
when should you avoid the use of ACEis?
- pregnancy
32
give an example of an angiotensin receptor blocker?
- losartan
33
how do angiotensin receptor blockers work?
they block angiotensin 2 at the AT1 receptor
34
when should angiotensin receptor blockers be used?
- hypertension
| - heart failure
35
what are the side effects of angiotensin receptor blockers?
- renal dysfunction
- no cough
- hypotension
- hyperkalaemia
36
why would you use an angiotensin receptor blocker instead of an ACEi?
- if patient develops a cough
37
how do alpha blockers work and what do they do?
- block a adrenoceptors to cause vasodilation
38
when are a blockers used?
- hypertension
| - prostatic hypertrophy
39
give an example of an a blocker?
doxazosin
40
what are the side effects of a blockers?
postural hypotension
41
how do mineral corticosteroids work?
- they block aldosterone receptors and therefore increases excretion of Na+
42
when are mineral corticosteroids used?
- heart failure
| - resistant hypertension
43
what are examples of mineral corticosteroids?
- spironolactone
44
what are the side effects of mineral corticosteroids?
- gynaecomastia
- renal impairment
- hyperkalaemia
45
what are the commmon antianginal drugs?
- vasodilators = nitrates, calcium antagonists (dihydropyridine), nucorandil
- slow heart rate = beta blockers, calcium antagnoists, ivabradine
- metabolic modulator = ranolazine
46
what are nitrates and give an example?
- venodilators
| - eg short acting = glyceral trinirtate, long acting = isosorbide monoritrate
47
how do nitrates work?
- they cause release of nitric oxide in smooth muscle which activate guanylate cyclase which converts GTP to cGMP which leads to fall in intracellular calcium levels
- in angina, they both dilate the coronoary artery and also reduce venous return which in turn reduces left ventricular work, reducing myocardial oxygen demand
48
when are nitrates used?
- angina
| - acute heart attack
49
what are the side effects of nitrates?
- headache due to arterial dilation
- hypotension
- tachycardia
- fainting
50
how do nicroandil work?
- K ATP channel activator
| - anti-anginal
51
what are the side effects of nicroandil?
- headache
| - mouth/GI ulcers
52
how does ivabradine work?
- If channel modulator in the sinus node
- slows HR only in sinus rhhythm
- does not work in AF
53
what are the side effects of ivabradine?
altered visual disturbance
54
how does renolazine work?
- anti anginal
- late sodium modulator
- decrease calcium load on heart
- effective in refractor angina
55
what are the common antithrombotic drugs?
- antiplatelets
- anticoagulants
- fibinolytics
56
what are some examples of antiplatelet agents?
- aspirin
- clopidogrel
- ticagrelor
- presugrel
57
when are antiplatelets used?
- in all new thrombosis
- angina
- acute MI
- CVA/TIA
58
what are the side effects of antiplatelets?
- haemorrhage
| - asthma
59
what is the role of anticoagulants?
- to prevent new thrombosis
60
what are the 2 types of anticoagulants?
1. herparin IV use only
| 2. warfarin oral use only
61
when are anticoagulants used?
- DVT
- PR
- atrial fibrilation
- NSTEMI
62
what are the side effects of anticoagulants?
- haemorrhage
63
what is the role of fibrinolytic drugs?
- dissolve formed clots
64
what is an exmaple of an antifibrinolytic drug?
streptokinase
65
when are anti fibrinolytic drugs used?
- STEMI
- PE
- CVA
66
what are the side effects of fibrinolytic drugs?
- haemorrhage
67
when should you avoid fibrinolytic drugs?
- in trauma
- recent haemorrhage
- bleeding tendencies
- severe diabetic retinopahty
- peptic ulcer
68
what are the common heart failure drugs?
- ACE inhibitors
- ARBs
- beta blockers
- diuretics
- digoxin
- mineralcorticoid antagonsits eg spironolactone
- seprilysin inhibitors
69
what are the mechanisms of action for digoxin?
- decreases conduction throgh AV node which slows the ventricular rate in AF and flutter
- increases force of cardiac muscle contraction due to inhibitor pf the NA/K ATPase pump, also stimulates vagus nerve
- narrow therapeutic window
70
what are the side effects of digoxin?
- digoxin toxicity
- nausea
- vomiting
- yellow vision
- bradycardia
- heart block
71
what are the effects of neprilysin inhibitors?
- hypotension
- renal impairment
- hyperkalaemia
- angioneurotic oedema
72
when are loop diuretics effective when thiazide diuretics arent?
- in patients with diminished renal function
73
what are the side effects for calcium-channel blockers used in hypertension?
- dizziness
- hypotension
- flushing
- ankle oedema
all caused by excessive vasodilation
74
what are the first line antianginal drugs?
- nitrates
75
when does stable angina occur?
- when an atheromatous plaque produces a coronary artery stenosis
76
when does unstable angina occur?
- when there is a fissure or erosion of the atheromatous plaque
- this causes platelet aggregation and the formation of an intracoronary thrombus which results in a sudden decrease of blood flow through the artery
77
when should you not use a beta blocker?
- in asthmatics as it can cause bronchospasm
78
what are PCSK 9 inhibitors used for?
familial hypercholesterolaemia
79
how do PCSK 9 inhibitors work?
- by inhibiting binding of PCSK 9 to LDLR, CSK9 inhibitor increases the number of LDLRs available to clear LDL, therby reducing LDL-C levels
80
what is an example of a neprilysin inhibitor?
- sulcubitril valsartan
81
what are the 2 types of calcium antagonist?
- dihydropyridines
| - rate limiting calcium antagonists
82
what enhances the effects of adenosine?
dipyridamole (antiplatelet agent)
83
what can reduce the anti-hypertensive effects of ACEis?
NSAIDS eg ibuprofen
84
what is sexual dysfunction a main side effect of?
thiazide-like diuretics such as indapamide
85
which drugs are used for secondary prevention post MI?
ACEi, Aspirin, statins.
