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
