Cardiovascular Flashcards
Irbesartan
Class: ARB
MOA: Angiotensin II receptor antagonist, inhibiting angiotensin induced vasoconstriction and aldosterone output.
Adverse effects: Similar to ACE except with no dry cough
Perindopril
Class: ACE Inhibitor
MoA: Inhibits conversion of angiotensin I to angiotensin II –> Decreases BP in addition to inhibiting bradykinin breakdown. Reduces RAAS -mediated renal water reabsorption.
Clinical Use: HT, CHF.
Adverse effects: Dry cough due to bradykinin buildup. Pregnancy problems, hypotension, Potassium, hyperkalaemia (aldosterone upregulate Na+/K+ pump, if aldosterone is inhibited, less K+ excreted)
Other: ARB have same AEs and contraindications, without dry cough. ACE use preferably as cheaper.
Verapamil
Class: Calcium Channel Blocker
MoA: Reduces cardiac contractility (negative inotrope) by decreasing Ca influx through blocking L-type channels. Decreased contractility.
Verapamil is a CENTRAL blocker most effect on cardiac muscle.
Clinical Use: Used in dysrrhythmias (central), angina and hypertension (peripheral)
Adverse Effects: Peripheral oedema, palpitations, headache, constipation, cardiac depression. Contraindications: CHF and Bblockers.
Other: CENTRAL Ca2+ antagonists cause a decrease in BP, HR and TPR, however peripheral Ca2+ antagonists causes a reflexive increase in HR.
Amlodopine
Class: Calcium Channel Blocker
MoA: Reduces cardiac contractility (negative inotrope) by decreasing Ca influx through blocking L-type channels. Decreased contractility.
Amlodopine is a PERIPHERAL blocker, most effect on smooth muscle.
Clinical Use: Used in dysrrhythmias (central), angina and hypertension (peripheral)
Adverse Effects: Peripheral oedema, palpitations, headache, hypotension. Contraindications: CHF and Bblockers.
Other: CENTRAL Ca2+ antagonists cause a decrease in BP, HR and TPR, however peripheral Ca2+ antagonists causes a reflexive increase in HR.
Name a central, peripheral and mixed Ca2+ antagonist
Central: Verapamil
Peripheral: Amlodopine
Mixed: Diltiazem
What happens to the HR and BP when you administer verapamil and amlodopine respectively?
Verapamil: Decrease in HR, Decrease in BP
Amlodopine: INCREASE in HR, Decrease in BP (reflex tacchycardia)
Why must you never give Ca Channel Blockers with Beta blockers?
Heart block
Frusemide
Class: Loop Diuretic
MoA: Inhibits ion transporters at thick ascending Loop of Henle, reducing renal water reabsorption.
Clinical Use: CHF, pulmonary oedema
Adverse Effects: Ototoxicity, Hypokalaemia (use with K sparing diuretic), dehydration, allergy rash, nephritis, gout (Remember OHDANG), glucose intolerance, hypotension.
Contraindications: ACE and NSAID.
Other: drug interaction with digoxin (hypokalaemia). Remember Fru(it) Loops.
Hydrochlorothiazide
Class: Thiazide Diuretic
MoA: Inhibits ion transporters at early distal convoluted tubule, reducing renal water reabsorption.
Clinical Use: CHF, hypertension, hypoglycaemia, diabetes insipidus
Adverse Effects: Hypokalaemia (use with K sparing diuretic), hyperuricaemia, hypercholesterolaemia, hyperglycaemia (avoid in diabetics), rash.
Contraindications: ACE and NSAID, prediabetes, gout
Other: drug interaction with digoxin (hypokalaemia).
Spironolactone
Class: K+ sparing Diuretic
MoA: Inhibits Na+/K+ antiporters targeted by aldosterone. As aldosterone upregulates Na+/K+ pumps (pumps out K+), an aldosterone antagonist, reduces K+ excretion.
Clinical Use: With loops/ thiazides.
Adverse Effects: Hyperkalaemia, decreased libido, menstrual disturbances
Contraindications: ACE/ARB
Other: as a weak diuretic, it is used with other diuretics to minimise K+ loss.
Atenolol
Class: Beta Blocker
MoA: Decrease HR and force of contraction by blocking B1adrenoceptors (decreases sympathetic drive to the heart) (Remember: one heart two lungs)
Clinical use: CHF, HT, arrhythmias and angina
Adverse effects: BRONCHOCONSTRICTION (B2) decreased heart contractility, bradycardia, AV block, fatigue, exercise intolerance, nightmares, claudication, exacerbation and masking of hypoglycaemia, impotence, depression, sudden withdrawal can produce rebound HT or angina,
Contraindications: ASTHMA, COPD with central Ca antagonists
Other: olol = two backwards bs. Atenolol acts as a B1 selective antagonist, most commonly used BB, preferrerd to metropolol because of its relatively long half life (6-9 hours vs 3 hours)
Name a cardio selective and non cardio selective beta blocker
Cardio selective (antagonist of B1) - Atenolol / metoprolol Non-selective (antagonist of B1 and B2) - Propranolol (NEVER give to an asthmatic)
Essentially all beta blockers are not fully selective,
What does BSCARED stand for?
Common adverse effects of of Beta blockers: Bradycardia Sleep disturbances/nightmares Cold hands Asthmatics (broncho constriction) Rebound angina/HT upon sudden withdrawal Exercise intolerance Depression/sedation
COntraindicated in DIABETICS - mask/exacerbate hypoglycaemia
Glyceryl Trinitrate (GTN)
Class: Vasodilators
MoA: Prodrug which reduces BP through conversion to NO intracellularly to cGMP resulting in vasodilation in vascular smooth muscles
Clinical Use: Angina, DURING acute angina attack
Adverse Effects: headaches, hypotension, reflex tachycardia, long-term tolerance, flushing, fainting. Contraindications: sildenafil
Other: GTN may be taken sublingually (30 min) or as a transdermal patch (24 hours), isosorbid mononitrate is longer acting with a greater tolerance risk.
Digoxin
Class: Anti-Arrhythmic Drug
MoA: Inhibits Na+/K+ ATPase in cardiac muscle and increases intracellular Ca2+ thus slightly polarising the cell. Increases myocardial contractility (positive inotrope) and decreases oxygen use. Increases CO
Clinical use: CHF, atrial fibrillation/flutter
Adverse effects: arrhythmias, GI and visual disturbances. Contraindicated by St John’s wort (depression)
Other: Very long half life (30-40 hours)
