Cardiology Drugs Flashcards
List the 7 main types of cardiology drugs.
Beta blockers ACE inhibitors Nitrates Calcium channel blockers HMG CoA reductase inhibitors Cardiac glycosides Anti-arrhythmic drugs
List the 2 types of beta blockers.
Give 2 examples of each.
CARDIOSELECTIVE:
- Bisoprolol
- Atenolol
NON-SELECTIVE:
- Propranolol
- Carvedilol
Describe the mechanism of action of beta blockers. (5)
What is the difference between selective and non-selective beta blockers?
MECHANISM OF ACTION:
1. Blocks beta 1 adrenoreceptors in cardiac and renal tissue
- Inhibits sympathetic stimulation of heart and renal vasculature
- Negative chronotropic effect:
a. Caused by blockage of SAN - Negative inotropic effect:
a. Caused by blocked receptors in the myocardium - Effects on renal tissue:
a. Inhibits release of renin
b. Inhibits RAS, causing vasodilation
NON-SELECTIVE BETA BLOCKERS:
-Block beta 1 and 2 adrenoreceptors
List 4 indications of cardioselective beta blockers.
List 6 indications of non-selective beta blockers.
CARDIOSELECTIVE: Hypertension Angina AF Mild-moderate heart failure
NON-SELECTIVE: Hypertension Angina Anxiety Migraine prophylaxis Secondary MI prophylaxis Mild-moderate heart failure
List 7 side effects of beta blockers.
Bradycardia Hypotension Bronchospasm Fatigue Cold extremities Sleep disturbances Loss of hypoglycaemic awareness
List 5 contraindications for beta blockers.
Give 1 condition in which beta blocker use requires caution.
AVOID IN: Peripheral vascular disease Asthma COPD Liver impairment Rate-limiting CCB use
CAUTION IN:
Diabetes
What would you tell the patient when prescribing beta blockers? (3)
Nightmares and sleep disturbances may occur
Compliance is important
Fatigue and cold extremities are common
Give 4 examples of ACE inhibitors.
Ramipril
Enalapril
Lisinopril
Perindopril
Describe the mechanism of action of ACE inhibitors. (2)
List 4 indications for ACE inhibitors.
MECHANISM OF ACTION:
1. Inhibits conversion of angiotensin I into angiotensin II
- This inhibits aldosterone release from the adrenal cortex
a. This causes decreased sodium/fluid retention
b. This decreases blood volume
INDICATIONS: Hypertension Heart failure Nephropathy Prophylaxis of cardiovascular events
List 5 side effects of ACE inhibitors.
Dry cough Hypotension Hyperkalaemia Renal impairment Angioedema
Describe important pharmacokinetics/dynamics of ACE inhibitors. (6)
What would you tell the patient when prescribing ACE inhibitors?
IMPORTANT PHARMA INFO: Adverse drug reactions are higher in patients with: -High dose diuretics -Hypovolaemia -Hyponatraemia -Hypotension -Unstable heart failure -Renovascular disease
PATIENT INFO:
Dry cough is very common
Blood tests required at 1-2 weeks to check electrolyte balance
Give 3 examples of nitrates.
Isosorbide mononitrate
Glyceryl trinitrate (GTN)
Sodium nitroprusside
Describe the mechanism of action of nitrates. (3)
List 2 indications for nitrates.
MECHANISM OF ACTION:
1. Converted to nitric oxide (NO), a potent vasodilator
- Cardioselective, acting predominantly on coronary blood vessels
a. This enhances blood flow to ischaemic areas of myocardium - Reduces cardiac preload and afterload
a. This decreases myocardial oxygen demand
INDICATIONS:
Angina
Severe hypertension
List 4 side effects of nitrates.
What would you tell the patient when prescribing nitrates? (2)
SIDE EFFECTS: Headache Postural hypotension Dizziness Tachycardia
PATIENT INFO:
Headaches are common initially, but decrease the longer the patient takes nitrates
Take GTN before activity you know will bring on angina
Describe important pharmacokinetics/dynamics of nitrates. (4)
Tolerance develops with long term use
To avoid tolerance, patients should have a daily nitrate-free period
Isosorbide mononitrate: oral
GTN: sublingual spray/tablet or IV
What are the 2 types of calcium channel blockers?
Give examples of each.
RATE-LIMITING CCBS:
- Verapamil
- Diltiazem
NON-RATE-LIMITING CCBS:
- Amlodipine
- Nifedipine
- Felodipine
Describe the mechanism of action of rate-limiting calcium channel blockers. (3)
How do non-rate-limiting calcium channel blockers differ? (2)
RATE-LIMITING CCBS:
- Prevent cellular entry of Ca2+ by blocking L-type calcium channels
a. This reduces myocardial and smooth muscle contractility
b. Therefore has a negative inotropic effect - Causes dilation of coronary blood vessels and reduced cardiac afterload
- Anti-dysrhythmic actions caused by prolonged AVN conduction rate
a. This decreases HR
NON-RATE LIMITING CCBS:
- Act mainly on smooth muscle; therefore no negative inotropic effect
- Do not decrease HR
List 3 indications for rate-limiting CCBs.
List 2 indications for non-rate-limiting CCBs.
RATE LIMITING CCBS:
Supraventricular arrhythmias
Angina
Hypertension
NON-RATE-LIMITING CCBS:
Hypertension
Angina
List 5 side effects of verapamil.
List 7 side effects of diltiazem.
VERAPAMIL: Constipation Flushing Headache Dizziness Hypotension
DILTIAZEM: GI disturbance Ankle swelling Bradycardia Peripheral oedema Dizziness Headache Hypotension
List 4 contraindications for rate-limiting CCBs.
Which drug can you NOT combine them with?
Heart failure
Left ventricular dysfunction
Bradycardia
Hypotension
Beta blockers
What would you tell the patient when prescribing rate-limiting CCBs? (3)
Compliance is important
Constipation is common with verapamil
Ankle swelling is common with diltiazem
List 7 side effects for non-rate-limiting CCBs.
Ankle oedema Abdominal pain Nausea Palpitations Flushing Headache Dizziness
In which conditions would you avoid using non-rate-limiting CCBs? (3)
Cardiogenic shock
Unstable angina
Significant aortic stenosis
What would you tell the patient when prescribing non-rate-limiting CCBs? (2)
Compliance is important
Ankle swelling is common
Give 1 example of a cardiac glycoside.
Digoxin
Describe the mechanism of action of digoxin. (4)
- Inhibits Na+/K+ pump, therefore causes increased levels of intracellular Na+
- This increases Na+/Ca2+ exchanger activity
a. Therefore increased intracellular Ca2+ - This has a positive inotropic effect
- Also decreases rate of conduction through AVN
List 2 indications of digoxin.
What would you tell the patient when prescribing digoxin? (1)
INDICATIONS:
Heart failure
Atrial fibrillation
PATIENT INFO:
Risk of toxicity
List 4 side effects of digoxin.
Nausea
Vomiting
Diarrhoea
Confusion
Describe important pharmacokinetics/dynamics of digoxin. (5)
Narrow therapeutic index
Plasma concentration NOT reliable indicator of toxicity
Symptoms of toxicity similar to clinical deterioration
Treatment of toxicity:
-Digoxin specific antibody fragments
Long half-life
Give 1 example of an anti-arrhythmic drug.
Amiodarone
Describe the mechanism of action of amiodarone. (2)
List 2 indications of amiodarone.
MECHANISM OF ACTION:
- Blocks cardiac K+ channels, causing prolonged repolarisation of cardiac AP
a. This restores regular sinus rhythm - Decreases rate of AVN conduction, which decreases HR
INDICATIONS:
Supraventricular/ventricular tachycardia
Atrial fibrillation
List 8 side effects of amiodarone.
Photosensitivity skin reaction Hypersensitivity Hyper/hypothyroidism Pulmonary fibrosis Corneal deposits Neurological disturbances GI disturbances Hepatitis
Describe the important pharmacokinetics/dynamics of amiodarone. (4)
Very long half-life:
- Once daily dosing
- Weeks-months needed for steady state
Monitoring needed:
- Thyroid function tests
- LFTs
What would you tell the patient when prescribing amiodarone? (3)
Good compliance is necessary
Avoid sun exposure
Report any rash
List 4 examples of statins.
Simvastatin
Atorvastatin
Pravastatin
Rosuvastatin
Describe the mechanism of action of statins. (3)
- Competitively inhibits HMG CoA reductase, the rate-determining enzyme in the mevalonate pathway synthesis of cholesterol
- This causes an increase in LDL receptor expression on hepatocytes
a. This increases hepatic uptake of cholesterol, reducing plasma cholesterol levels
b. This reduces the development of atherosclerotic plaques - Some statins may have additional pleiotropic effects (i.e. additional benefits unrelated to lowering cholesterol levels)
List 2 indications for statins.
Familial hypercholesterolaemia
Prevention of CVD in high risk patients
List 3 common side effects of statins.
List 2 uncommon side effects of statins.
COMMON SIDE EFFECTS:
Myalgia
GI disturbance
Deranged LFTs
RARE SIDE EFFECTS:
Myopathy
Rhabdomyolysis
Describe important pharmacokinetics/dynamics of statins. (2)
Hypothyroidism should be corrected before assessing need for statins
Myalgia and rhabdomyolysis are dose related, so start low
What would you tell the patient when prescribing statins? (2)
Report any unexplained muscle pain to GP (to check serum creatinine kinase)
Diarrhoea and abdominal pain may occur initially
