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Cardio protective drugs Flashcards

1
Q

what is Cardio-vascular disease?

A

a group of conditions and diseased that affect the cardio vascular system.

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2
Q

What are the symptoms of cardiovascular disease?

A

chest pain
breathlessness
rapid or slow heartbeat
dizziness
nausea and vomiting
cold sweats
pale pallor
pain/numbness/tingling
weakness/swelling of limbs

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3
Q

what are the Risk factors for Cardio-Vascular disease?

A

hypertension
Diabetes
hyperlipidemia
smoking (80,000 smoke-related, 15,000 heart/circulatory deaths)
Air pollution (11,000)
obesity (1/6 heart/circulatory deaths- elevated BMI)

Additional factors:

age, gender, gender, family history, ethnicity, renal failure

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4
Q

what conditions affect the heart?

A

DVT
Stroke: CVA/TIA
Acute MI
Angina
HTN
Diabetes
Congestive heart failure
Peripheral arterial disease
Hypercholesterolemia
Rheumatic heart disease
AAA
Cor pulmonale
Vascular dementia
Cardiomyopathy
Congenitalheart disease

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5
Q

What is a Stroke?

A

A stroke is a condition where parts of the brain’s blood supply is restricted, either by a blood clot or bleeding.

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6
Q

What is a Deep Vein Thrombosis (DVT)?

A

A blood clot that forms in a deep. vein

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7
Q

What are the risk factors for a DVT?

A

Immobility
Pregnancy
Cancer
Family history
Heart
Lung Disease

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8
Q

What are the symptoms of a DVT?

A

Shortness of breath (SOB)
Discolouration
pain
swelling
haemoptysis
chest pain

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9
Q

What is the Treatment for a DVT?

A

Anticoagulants (warfarin. DOAC)

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10
Q

What is an Arterial thrombosis?

A

A blood clot that forms in the artery.

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11
Q

What are the risk factors of atherosclerosis?

A

hardened narrow arteries
Plaque
smoking
sedentary lifestyle
diet high in saturated fat and salt

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12
Q

What are the symptoms of arterial clot?

A

Symptoms where clot is formed

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13
Q

What is the treatment for Arterial Thrombosis?

A

Surgery
medication
antiplatelet
anticoagulants

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14
Q

What is Angina?

A

Angina pain is caused by a reduction in blood supply to the heart muscle usually caused by narrowing of affected vessels by buildup of plaque.

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15
Q

What are risk factors for Angina?

A

CHD
Smoking
Obesity
Hypertension
Hyperlipidemia
older age (45 + men, 55+ women)

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16
Q

What are the symptoms of Angina?

A

Chest Pain
Shortness of breath
Sweating
Dizzyness
Nausea

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17
Q

How do you diagnose Angina?

A

ECG
Stress Echo
Coronary angiography

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18
Q

What is the Treatment for Angina?

A

Glyceryl Trinitrate spray
stent
heart bypass surgery

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19
Q

What is Hypertension?

A

Hypertension is when the Pressure/force of blood in arteries is too high.

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20
Q

What are the risk factors for hypertension?

A

stress
obesity
alcohol
sedentary lifestyle
High sodium intake

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21
Q

What are the symptoms of hypertension?

A

Dizzyness
Headache
visual disturbances
chest pain
elevated blood pressure

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22
Q

How do you diagnose Hypertension?

A

home blood pressure monitoring?
Ambulatory BP
elevated to 120/180 can be diagnosed in acute settings.

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23
Q

What is the treatment for Hypertension?

A

ACE inhibitors
ARBS
Beta Blockers
Diurectics

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24
Q

How can Diabetes cause Heart Disease?

A

Elevated blood sugar levels can damage blood vessels which control the heart increasing the risk of heart disease.

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25
What are the risk factors for Diabetes?
hyperlipidemia Smoking Obesity excessive alcohol Ethnicity
26
What are the Symptoms of Diabetes?
Thirst Frequency of micturition Tiredness Peripheral neuropathy
27
What is the treatment for Diabetes
SGLT2 Inhibitors, metformin DPP4 Inhibiters (sitagliptin) Insulin
28
What is Congestive Heart Failure?
long-term conditions hindering the heart from pumping the blood the body needs.
29
What are the risk factors of Congestive Heart failure?
Age. Renal impairment history of coronary artery disease thyroid disease Diabetes Hypertension smoking valve disease
30
What are the Symptoms of Congestive Heart Failure
Shortness of breath tiredness cough swelling nocturne dizziness chest pain
31
How would you diagnose Congestive Heart Failure?
Bloods (type natriuretic peptide) chest x-ray Echo/Stress Echo ECG
32
What's the treatment for Congestive Heart Failure?
ACE inhibitors ARBS Diuretics Potassium SCLT2 Digoxin Beta Blocker Surgery
33
what is b type natriuretic peptide? (BNP)?
A hormone-peptide chain of amino acids. measures aå by heart in response to stretching due to increased blood volume.
34
What is Peripheral Artery Disease?
Blockage or narrowing of the blood vessels in the legs which carries blood from the heart.
35
What are the risk factors for Peripheral Artery Disease
Smoking Hypertension Diabetes High Cholesterol Age
36
What are the symptoms of Peripheral Artery Disease?
Leg Pain Atrophy skin cool to the touch decreased or absent pulses coldness and numbness in toes non-healing wounds
37
How do you diagnose Peripheral Artery disease?
Ankle-brachial index (ABI) Ultrasound CT angiogram
38
How do you treat Peripheral Artery Disease?
Angioplasty Catheter-directed thromboysis
39
What is Hypercholesterolemia?
Hypercholesterolemia is a lipid disorder resulting from high levels of low density lipoprotein (LDL) so increasing the risk of CVD, CAD. PAD.
40
What are the risk factors for Hypercholesterolemia?
A diet high in saturated fat Diabetes Obesity central abdominal fat liver disease hypothyroidism
41
What are the symptoms of Hypercholesterolemia?
May not show symptoms until too late significant plaque in arteries.
42
How do you diagnose Hypercholesterolemia?
Blood test
43
What is the treatment for Hypercholesterolemia?
Dietary and lifestyle modification Statins
44
What are the classes of Cardio protective drugs?
Antiplatelets Angiotensin-converting enzyme (ACE) inhibitors Angiotensin Receptor Blockers Beta-blockers Statins Sodium-Glucose Transporter-2 (SGLTT-2) inhibitors
45
What do Antiplatelets do?
Antiplatelets are used to treat acute coronary syndrome (ACS) Prevent occlusion of coronary artery stents Secondary prevention of thrombotic arterial events
46
Antiplatelet-Acetysalicyllic acid ASPRIN - mode of action?
works by inhibiting the COX pathway to prevent or reduce pro-aggregatory factor thromboxane from arachidonic acid. Thromboxane speeds up platelet aggregation which leads to arterial occlusion.
47
What are the Pros of Aspririn?
The pros of Aspirin are: multi-purpose use 1. pre-eclampsia DVT, PE 2. can be used with other antiplatelets but increases the risk of bleeding 3. One of the 1st line for use in acute settings ACS OR ischaemic stroke
48
What are the Cons of Aspirin use?
1.GI Irritation, bleed, peptic ulceration 2.hypersensitivity/bronchospasm 3.Overdose (cardiovascular collapse/resp arrest)
49
Aspirin- what are Contraindications?
Not to use under age 16- Reyes Syndrome Active peptic ulcer Patients with Haemophilia
50
When should you be casutious with Aspirin?
3rd trimester previous peptic ulcer patient with history of hypersensitivity skin reactions/breathlessness after taking NSAID
51
what are Antiplatelets 
(P2Y12-inhibitors-Clopidogrel)?
Clopidogrel is to prevent platelets formation to reduce risk of arterial occlusion and atherothrombotic events by binding to adenosine diphosphate receptors (ADP) located on the surface of platelets.
52
What are the Pros of Clopiderogrel?
Multipurpose use can be used when warfarin is unsuitable can be used with other platelets but increases risk of bleeding one of the 1st line for use in acute settings after ACSor ischaemic stroke
53
What are the Cons of Clopodogrel?
increased risk of bleeding GI irritation Pro drug metabolise by hepatic cytochrome P450 (cup enzyme)
54
What are the contraindications of Clopidogrel?
Pregnancy/ breastfeeding Active bleeding BMJ 2018 (CVD drugs during pregnancy) https://www.bmj.com/content/bmj/suppl/2018/03/08/bmj.k478.DC3/pregnancy_heart_disease_v28_web.pdf
55
What are the Cautions with Clopidogrel?
1.Stop 7 days prior to surgery  2. History of hypersensitivity reactions 3. Modeate renal impairment  4. Elderly 
56
How do Angiotensin converting enzyme (ACE) Inhibitors (Ramipril)  work?
ACE Inhibitors work by preventing the conversion of enzyme angiotensin 1 to angiotensin 2. Angiotensin 2 allows blood vessels to narrow and constrict. Without angiotensin 2, blood vessels dilate
57
What are the Pros of Ramipril?
1. Cardio and renal protective  2. mproves kidney function  3. Protect the heart following a cardiac event   4. Prevent cardiovascular events in patients with atherosclerotic CVD or with diabetes mellitus and additional risk factors for CVD
58
What are the Cons of Ramipril?
1. Intractable cough (due to increased levels of bradykinin) 2. Hyperkaliemia  3. Initial risk of hypotension with the first dose 
59
What are the contraindications of Ramipril?
1. When used with aliskiren (renin inhibitor used to treat HTN) in patients with eGFR <60ml/litre or patients with DM Idiopathic or hereditary angioedema Pregnancy 
60
What are the Cautions of using Ramipril?
1. Using alongside diuretics 2. Patients with aortic/mitral valve stenosis (hypotension risk) 3. Risk of hyperkalaemia  4. Avoid with NSAIDs due to the risk of kidney damage 5. Renal artery stenosis 6. Maybe less effective in lowering BP in the black population, low renin (renin-angiotensin-aldosterone system level)
61
How do Angiotensin 2 receptor blockers (ARBs) Losartan work?
Block the action of angiotensin 2 on the angiotensin type 1 (AT1) receptor, thus angiotensin 2 cannot cause vasoconstriction to increase BP.
62
What is Losartan used to treat?
Used to treat: Hypertension Heart failure Ischaemic heart disease Diabetes nephropathy and CKD with proteinuria
63
What are the Pros of prescribing Losartan?
It does not cause a cough Reduce peripheral vascular resistance (afterload) and lower BP  Slows CKD progression Improve symptoms and outcomes in heart failure
64
What are the Cons of prescribing Losartan?
Initial risk of hypotension Hyperkalemia risk Risk of renal failure
65
What are the contraindications of prescribing Losartan?
When used with aliskiren (renin inhibitor used to treat HTN) in patients with eGFR <60ml/litre or patients with DM Acute kidney failure Severe hepatic impairment Pregnant women (consider those planning pregnancy, breastfeeding)
66
What are the cautions of prescribing Lowsartan
Avoid prescribing other potassium-sparing drugs like diuretics due to the risk of hyperkalemia Renal artery stenosis Monitor renal function when used in CKD
67
How do Beta Blockers work?
Block the action of adrenaline and noradrenalin on the beta andreno receptors (part of the sympathetic nervous system which mediates the fight or flight response)
68
Name the 3 types of Beta receptors
Beta 1 Beta 2 Beta 3
69
Where are Beta receptors Located
Beta 1: located mainly in the heart muscles and kidneys (cardio-selective drugs acts mainly on this receptor)  Beta 2: located mainly in the lungs, GI tract, liver, smooth and skeletal muscles (non-cardio-selective) acts on both receptors Beta 3: located in the fat cells and bladder
70
what is beta blockers (Cardio Selective β1-antagonists- Bisoprolol) used to treat?
Ischaemic heart disease  Chronic heart failure Supraventricular tachycardia (SVT) Hypertension
71
What are the pros of Bisoperol?
Improves prognosis and symptoms associated with angina-type pain  Lower BP as heart rate and force of contraction is reduced Reduce ventricular rate in people with atrial fibrillation by prolonging atrioventricular node
72
What are contraindications for Bisoperol
Respiratory conditions Asthma Heart block Non-dihydropyridine calcium channel blockers e.g. verapamil, (weakens heart contractibility causing slow heart rate)   
73
what are the cautions for Bisoperol?
Caution in heart failure  Caution in hepatic failure (possible cause of hepatotoxicity)  Haemodynamic instability (insufficient blood flow to the body causing hypotension, arrhythmia,  confusion, LOC)
74
How does Beta blocker Non-Cardio Selective Antagonists Labetalol Hydrochloride work?
combined alpha blocker (reduce/ block adrenalin and noradrenalin from interacting/binding to alpha receptors so blood vessels can relax
75
What is labetalol Hydrochloride used to treat?
hypertension Prevention of heart disease, (strokes, angina, cardiac events)
76
What are the pros of taking Labetalol?
Works to treat, high BP, heart failure and chest pain It can be used in hypertensive crises using IV route. Also available in oral form Licensed to use in pregnancy but possible harm in the first trimester  Breastfeeding thought small amounts present in breast milk
77
What are the cons of taking Labetalol?
Hypotensive when taken with antihypertensive drugs like diuretics AKI and hepatic impairment  Avoided in uncontrolled HF Sudden withdrawal may cause angina attacks, even heart attacks in patients with ischaemic heart disease
78
Contraindications for Labetalol?
Asthma Cardiogenic shock Hypotension Bradycardia Severe PAD 2nd and 3rd degree AV block
79
Cautions for Labetalol?
Asthma Cardiogenic shock Hypotension Bradycardia Severe PAD 2nd and 3rd degree AV block

Independent non-medical prescribing course (17 decks)

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