Cardio Drugs Flashcards
ACEI Mech of Action
Block ACE, Angio1 NOT converted to Angio2.
Reduced Release of Aldosterone therefore inc. loss of Na+ and H20.
Hyponatremia
Hyperkalaemia
Causes venous dilatation reducing preload.
Arteriolar dilatation reducing afterload. By inhibiting the breakdown of bradykinin.
No effect on contractility.
ACEi uses and examples
HyperT
HF
Post MI
Ex. Lisinopril
ACEi Side Effects
Cough due to bradykinin build up in airways.
Renal Dysfunction.
Angioneurotic oedema.(Angioodema)
Hypotension(First dose).
ACEi Contraindications
Pregnancy
Past angiooedema
Renal artery stenosis
ARB’s
All features same as ACEi
No cough since bradykinin metabolism uninhibited
LOSARTAN
Nitrates Mech of A.
Relax all sm via their metabolism to NO.
Venodilators at clinical doses therefore reduce preload subsequently O2 req. and SV reduced.
At higher doses , arteriolar dilatation reduced afterload.
Increase coronary blood flow by redirecting bloodflow to ischaemic zone by dilating collateral vessels.
Nitrates uses and examples
Angina
ACUTE HF
MI
Ex.
ISMN- Resists first pass metabolism, 2-4hrs. Oral. Prophylactic
GTN- Extensive first pass metabolism, 30mins.
Spray/Patch.
Nitrates side effects
Headache
First dose hypotension
Collapse
Tolerance common crucial to leave 8-24hour nitrate free period.
Antiplatelets
Inhibit thromboxane(recruiter of platelets)
Uses: Angina Acute MI Post MI CVA/TIA
Ex. Aspirin, Clopidogrel
Antiplatelets side effects
HAEMORRHAGE
Peptic Ulcer.
Asthma (aspirin sensitivity)
Anticoagulants Mech of A.
Heparin
Binds antithrombin 3 leading to inactivation of clotting factors Xa and IIa and others.
Prevents existing clots from growing.
Warfarin
Inhibits vitK reductase, inhibiting synthesis of coagulation factors II, VII, IX, X and coag proteins C &a S.
Anticoagulant uses and examples
DVT
PE
NSTEMI
AF
Heparin - reversed by protamine
Warfarin - reversed by vitamin K
Anticoagulants side effects
HAEMORRHAGE
Osteoporosis
Hypoaldosteronism
Fibrinolytics
Dissolve formed clots.
Uses
STEMI
PE
CVA
Ex. Streptokinase, reversed by lymphalic acid
TPA
Fibrinolytic side effects and contraindications
HAEMORRHAGE
Inc stroke risk, MI risk from emboli of thrombus.
Avoid in recent haemorrhage, trauma, peptic ulcer.
Statins MoA
Competitive inhibitors of HMG CoA reductase. Rate limiting step in cholesterol synthesis.
Increase LDL receptor expression to increase clearance. Reduce inflammation. Decrease thrombosis. Reverse endothelium dysfunction. Stabilise atheromatous plaques.
Statins uses and examples
Hypercholesteraemia. Diabetes. Angina. MI. CVA/TIA.
Simvastatin
Fibrates
PPAR agonists. Reducing triglyceride levels and regulating energy homeostasis.
Uses: Hypertriglyceridaemia
Benzafibrate.
Side effects
Myositis
Rhabdomyolosis renal failure
Inc. side effects alongside STATINS
K+ channel blocker
Prolongs time taken for repolarisation to occur.
Prolong refractory period preventing re entrant arrhythmias
Ex. Amiodarone
Digoxin MoA and uses
Blocks AVN conduction producing AV delay.
Increase ventricular irritability - BAD
Use: AF
Digoxin side effects
Inc. AVN delay can cause bradycardia and heart block.
Vent irritability may produce vent arrhythmias
Nausea and vomiting
BLURRED YELLOW VISION
Has a narrow therapeutic index
Endothelin-1-Antagonist
Blocks endothelin-1 which when released from endothelial cells interacts with Endothelin A receptor on vascular SM causing vasoconstriction
Uses: PULMONARY hyperT
Ex. Bosentan
Ambritensan
Ivabradine
HCN channel blocker
Uses: HF
If, heart still fast after BetaB OR if asthmatic so can’t take BetaB or if BetaB side effects cannot be coped with
Aldosterone receptor antagonist (SPIRONOLACTONE)
Blocks aldosterone receptor to act as potassium sparing diuretic.
Uses: moderate/ severe heart failure
Side effects: GYNAECOMASTIA(caused by inhibition of male sex hormones)
