cardio drugs Flashcards
What is the mechanism of action of Beta blockers?
Beta blockers lower blood pressure by reducing renin release and reduces cardiac output of heart.
What are examples of olol drugs
Bisoprolol
Atenolol
What is the mechanism of calcium channel blockers?
Causes relaxation and vasodilation in arterial smooth muscle.
What is Verapimil example of?
CCB
What are examples of CCB?
Amlodipine, nifedipine, verapamil, diltiazem.
What drug to treat for hypertension in people who are under 55 and not black?
ACEi
What drug to treat for hypertension in people who are diabetic and black?
ARB
What drug to treat for hypertension in people who are diabetic and white?
ACEi
What is the mechanism of ACE inhibitors?
Inhibit conversion of Angiotensin I to Angiotensin II.
What are the drug interactions of ACEi?
ACEi/ARB + thiazide diuretic + NSAIDs together can cause renal failure.
What is the mechanism of Angiotensin II receptor antagonists?
Block type 1 angiotensin II receptors, causing vasodilation.
What class of drugs end in pril?
ACEi
What class of drugs end in pril?
ACEi- ramipril, lisinopril, captopril
What class of drugs end in sartan?
ARB - losartan, candesartan, valsartan
What are the drug interactions of ARB?
Avoid with potassium-elevating drugs e.g. potassium supplements or potassium sparing diuretics as can cause hyperkalaemia. ACEi reduce aldosterone secretion (a mineralocorticoid that causes potassium excretion and stimulates sodium reabsorption).
What are CI of ARB?
Avoid in pregnancy, breast feeding, start with low dose in renal problems.
What are the uses of diuretics?
Oedema in heart failure, hypertension, nephrotic syndrome, hepatic cirrhosis
What is the mechanism of action of thiazide diuretics?
Inhibit Na/Cl co transporter in the distal convoluted tubule of nephron.
What is Bendroflumethiazide an example of?
Thiazide diuretic
What is a side effect of thiazide diuretic?
Hypokalaemia and hyponatraemia due to reduced reabsorption.
What is the mechanism of a loop diuretic?
Inhibit Na/Cl/K co transporter in the ascending loop of henle, causes increased excretion of sodium and water from kidney.
What furosemide and bumetanide an example of?
Loop diuretic
What are the CI of loop diuretics?
In patients with severe hyponatraemia and dehydration.
What is amiloride, spironolactone an example of?
Potassium sparing diuretic
What is the mechanism of action of potassium sparing diuretics?
Inhibit Na co transporter in the distal convoluted tubule of nephron and helps potassium retention (counteracts potassium losses associated with loop/thiazide diuretics).
What are the side effects of potassium sparing diuretics?
Hyperkalaemia
What are the drug interactions to avoid when using potassium sparing diuretics?
Other potassium elevating drugs e.g. potassium supplements can cause hyperkalaemia.
What are the CI of potassium sparing diuretics?
Pregnancy, severe AKI.
What are three examples of anticoagulants?
Oral anticoagulants e.g. Warfarin, IV/SC anticoagulants e.g. LMWH and DOACs direct oral anticoagulants e.g. apixaban
What is warfarin and its mechanism?
Warfarin is an oral coagulant, prevents activation of Vitamin K so reduces production of coagulation factors.
What is enoxaparin and its mechanism of action?
SC/IV anticoagulant LMWH, activates antithrombin.
What is apixaban and its mechanism of action?
DOAC, factor Xa inhibitors.
What anticoagulant is monitored and how?
Warfarin use must be monitored via regular blood test called INR (international normalised ratio), measured how long it takes blood to clot, average 2-3 if on warfarin.
Advantages of DOACs over Warfarin?
- does not require monitoring
- onset of action in 3 hours
- less drug interactions
Disadvantages of DOACS over Warfarin?
- reversible not possible with some drugs, whereas warfarin reversed can be with vitamin K
- CI in valvular heart diseases.
What are the indications of DOACS?
Newly diagnosed DVT, PE, AF, prevention of VTE post surgery.
What are the side effects of warfarin?
-Haemorrhage in bowel, or brain. Reversal of this can be done with vitamin K.
What is mechanism of action of aspirin?
Inhibits COX enzyme and reduces platelet aggregation.
What are the indications of aspirin?
- Antiplatelet effect for acute coronary syndrome (STEMI.NSTEMI.UNSTABLE)
- Analgesiac
- Prophylaxis in CVD
- AF
When can you not give aspirin (CI)?
In patients with:
- Children under 16
- GI ulcers
- Haemophilia
What complication can arise from use of loop/thiazide diuretics?
Gout. Loop or thiazide diuretics increase the absorption of uric acid and decrease the secretion, therefore increasing the risk of developing gout.
What are the side effects of Beta blockers?
Bronchospasm (CI in asthmatics)
Erectile dysfunction
Sleep disturbances
What are the CI of BB?
Asthma (causes bronchospasm)
Uncontrolled heart failure.
Continuous use may lead to severe bradycardia so CI in bradycardia.
What is a complication of subarachnoid haemorrhage that can be seen in an ECG?
Torsades de pointes is a life-threatening form of ventricular tachycardia and QT prolongation where the QRS vary in size and duration (hence the name polymorphic)
What are the CI of ACEi?
Avoid in pregnancy and breastfeeding
AKI/CKD as can cause and worsen renal impairment.
What are the side effects of Acei? (5)
Cough
Hyperkalaemia
Renal impairment
GI disturbances - dyspepsia
Angioedema
What medication is given to torsardes de pointes?
IV Magnesium sulphate.
What antihypertensive can cause oedema?
CCB e.g. verapamil
What is needed to monitor before prescribing simvastatin?
Serum liver transaminases (ALT), can cause drug induced hepatitis.
What is the normal INR range?
<1.1, if on warfarin it will be 2-3
What macrolide can increase INR?
Clarithromycin
What diuretic can precipitate gout?
Loop e.g. furosemide and Thiazide diuretics e.g. bendroflumethiazide can cause hyperuricemia due to decreased uric acid secretion.
What are the adverse effects of BB? (4)
Bradycardia, hypotension, fatigue, dizziness.
What are the adverse effects of digoxin?
Blurred vision, dizziness, GI disturbances
What are the CI of warfarin use?
- peptic ulcer disease as at risk of GI bleed
- pregnancy as it is teratogenic,
- bleeding disorders
What should INR be for patients on warfarin with recurrent DVT?
INR 3-4 (usually 2-3 if no recurrent DVT)
