Cardio Pharmacology Flashcards
How does aspirin inhibit platelet aggregation?
Irreversibly acetylenes cyclo-oxygenase, preventing production of thromboxane A2, inhibiting platelet aggregation
When are anti-platelets used?
Used in low dose for secondary prevention following MI, TIA/ stroke, and for patients with angina or peripheral vascular disease
Have a role in primary prevention
Name some anticoagulants
Low molecular weight heparin, warfarin, fondaparinux (Xa inhibitor), and bivalirudin (thrombin inhibitor)
What is warfarin the anticoagulant of choice for?
Mechanical valves
Which drugs are used to treat AF and clots?
Direct oral coagulants (DOACs) e.g. Xa inhibitors and direct thrombin inhibitors
When are beta blockers used?
Angina, hypertension, arrhythmia, post MI, heart failure
What are some side effects of beta blockers?
Lethargy, ED, headache, sleep disturbance, hypotension
Give 2 examples of beta blockers
Bisoprolol, propranolol
When are ACE inhibitors used?
Hypertension, heart failure, post MI, diabetic nephropathy
What are some side effects of ACE inhibitors?
Dry cough, urticaria, hypotension, acute renal failure (reduced angiotensin II formation), rash
Give 2 examples of ACE inhibitors
Ramipril, captopril
When are loop diuretics used?
Heart failure - inhibit the Na/2Cl/K co-transporter
What are the side effects of loop diuretics?
Dehydration, low Na+, K+, Ca2+, hypovolaemia
When are thiazides and thiazide-like diuretics used?
Hypertension and heart failure
What are the side effects of thiazides and thiazide-like diuretics?
Low K+, raised Ca2+, low Mg2+, increased urate, impotence, impaired glucose tolerance
When are vasodilators used?
Heart failure, IHD, hypertension
Which vasodilators lower pre-load and how?
Nitrates dilate veins and the larger arteries, lowering filling pressure
Which vasodilators lower after-load and how?
Hydralazine dilates the resistance vessels, lowering blood pressure
How do calcium antagonists work?
Decrease cell entry of Ca2+ via voltage-sensitive channels in smooth muscle, thereby promoting coronary and peripheral vasodilation and reducing myocardial oxygen consumption
What are the side effects of calcium antagonists?
Flushes, headaches, ankle oedema, lowered LV function, palpitations
Give an example of a dihydropyridine and when it would be used
Amlodipine - used in hypertension and angina
Mainly peripheral vasodilators and cause a reflex tachycardia, so are often used with a beta blocker
Give an example of a non-dihydropyridine and when it would be used
Verapamil - hypertension and angina and dysrhythmias
Slow conduction at the AV and SA nodes
Give 2 examples of calcium channel blockers
Amlodipine, nifedipine, verapamil (unusual ending)
How does Digoxin work?
Blocks the Na+/K+ pump
When is digoxin used?
Anti-arrhythmic drug - To slow the pulse in fast AF
What are the side effects of digoxin?
Nausea, decreased appetite, yellow vision, confusion
How does amiodarone work?
Prolongs the cardiac action potential, reducing the potential for tachyarrhythmicas
When is amiodarone used?
Anti-Arrhythmic - tachycardias (including cardiac arrest)
What are the side effects of amiodarone?
Thyroid disease, liver disease, pulmonary fibrosis, QT prolongation (polymorphic ventricular tachycardia)
What medications may be given for acute coronary syndromes?
Pain relief - GTN spray, diamorphine
Dual anti platelet therapy - aspirin + clopidogrel
Antithrombin therapy - fondaparinux
Lipid lowering therapy - statins
What medications may be given for chronic stable angina?
1st line - beta/calcium channel blocker
Antiplatelet therapy - aspirin or clopidogrel
Lipid lowering therapy - statins
Short acting nitrates - GTN spray
Name 2 angiotensin receptor blockers
Valsartan, losartan
When are angiotensin receptor blockers used?
Hypertension, diabetic nephropathy, heart failure (used when cannot have ACEi)
What are the side effects of angiotensin receptor blockers?
Symptomatic hypotension, hyperkalaemia, rash, angio-oedema, renal dysfunction
