Cardiovascular Flashcards
(alpha blocker)
Selective blockers of alpha-1-adrenoreceptor found in smooth muscle, blood vessel and urinary tract. Causes vasodilation and increased bladder outflow
✖ Postural hypotension
Doxazosin
Alpha blocker
Benign prostatic elargement
Tamulosin
Benign prostatic enlargement
Adenosine
Diagnostic and therapeutic agent in supraventricular tachycardia
Agonist of adenosine receptors on heart cell surface. Reduces frequency of spontaneous depolarisation and increases refractory. Used in cardioversion
✖Hypotension
✖Coronary ischemia
✖heart failure
✖asthma
Adrenaline
Cardiac arrest
Anaphylaxis
Local vasoconstriction (i.e. control of bleeding)
Potent agonist of alpha-1, alpha-2, beta-1 and beta-2 adrenoceptors. Induces systemic vasoconstriction but vasodilation of heart (increasing blood flow in heart). Additional affects: bronchodilation and suppression of inflammatory mediator release
(Aldosterone antagonists)
Aldosterone: mineralocorticoid produced in adrenal cortex. Acts on mineralcorticoid receptors in disal tubules (ENaC), increasing reabsorption of sodium + water. Elevating blood pressure with corresponding potassium excretion. Aldosterone antagonist competitively inhibit this effect
✖severe renal impairement
✖hyperkalaemia
✖Addison’s disease
Spironolactone
(Aldosterone antagonist)
Ascites
Chronic heart failure
Primary hyperaldosteronism
Eplerenone
Aldosterone antagonist
Chronic heart failure
(Amiodarone)
Tachyarrhythmias (i.e. atrial fib, flutter, supraventricular tachy, ventricular tachy, refractory ventriculat fib
Several effects: blocks sodium, calcium, potassium channels. Antagonist to alpha and beta adrenergic receptors. Overall reduces ventricular rate, reduce spontaneous depolarisation, slow conduction velocity
(Angiotensin receptor blockers)
Generally used when ACE inhibitors are not tolerated due to cough
Similar effects to ACE inhibitors, instead block action of angiotensin II on angiotensin type 1 receptor. Reduces peripheral vascular resistance, lowers blood pressure, dilated efferent glomerular arteriole (reduces intraglomerular pressure and slows CKD)
✖Renal artery stenosis
✖Acute kidney injury
Losartan
(Angiotensin receptor blockers) Hypertension Chronic heart failure Ischaemic heart disease Diabetic nephropathy + Chronic kidney disease
Candesartan
(Angiotensin receptor blockers) Hypertension Chronic heart failure Ischaemic heart disease Diabetic nephropathy + Chronic kidney disease
Irbesartan
(Angiotensin receptor blockers) Hypertension Chronic heart failure Ischaemic heart disease Diabetic nephropathy + Chronic kidney disease
(Angiotensin coverting enzyme inhibitors)
Commonly used in heart conditions and kidney disease
Prevents conversion of angiotensin to angiotensin II. Blockage reduces afterload, dilates efferent glomerular arteriole, reduces aldosterone level (promotes sodium and water secretion)
Ramipril
(Angiotensin coverting enzyme inhibitors)
Hypertension
Chronic heart failure
Ischaemic heart disease
Diabetic nephropathy + Chronic kidney disease
Lisinopril
(Angiotensin coverting enzyme inhibitors)
Hypertension
Chronic heart failure
Ischaemic heart disease
Diabetic nephropathy + Chronic kidney disease
Perindopril
(Angiotensin coverting enzyme inhibitors)
Hypertension
Chronic heart failure
Ischaemic heart disease
Diabetic nephropathy + Chronic kidney disease
(Antimuscarinics)
Binds to muscarinic receptor as competitive inhibitor of acetylcholine. Muscarinic receptor responsible for parasympathetic effects. Antimuscarinics have oppositve effects: increasing heart rate and conduction, reduce smooth muscle tone and peristaltic condition, reduce secretion from respiratory glands
Atropine
(Antimuscarinics)
Bradycardia
(Anti-platelet drugs / ADP-receptor antagonists)
Prevent platelet aggregation by binding to adenosine diphosphate (ADP) receptors on platelet surface. Independant of COX pathway so synergistic with aspirin
✖ Active bleeding
Clopidogrel
(ADP-receptor antagonists)
Acute coronary syndrome
Prevent occlusion in coronary artery stents
Prevention of thrombolitic events
Ticagrelor
(ADP-receptor antagonists)
Acute coronary syndrome
Prevent occlusion in coronary artery stents
Prevention of thrombolitic events
Prasugrel
(ADP-receptor antagonists)
Acute coronary syndrome
Prevent occlusion in coronary artery stents
Prevention of thrombolitic events
(Aspirin)
Irreversibly inhibits cyclooxygenase (COX), reducing production of thromboxane from arachidonic acid. Reduces platelet aggregation
Acute coronary syndrome + Ischemic stroke Prevention of thrombotic events ✖ < 16 years ✖ Aspirin hypersensitivity ✖ Third trimester
(Beta blockers)
Beta-1 adrenoreceptors found in hear, beta-2 adrennoreceptors found in blood vessel smooth muscle. Beta-blockers reduce force and speed of heart condition. Reduce blood pressure by reducing renin secretion in kidney via beta-1 receptors
✖ Asthma
✖Heart block
Bisoprolol
(Beta blockers) Ischemic heart disease Chronic heart failure Atrial fibrillation Supraventricular tachycardia Hypertension
Atenolol
(Beta blockers) Ischemic heart disease Atrial fibrillation Supraventricular tachycardia Hypertension
Propanolol
(Beta blockers) Ischemic heart disease Atrial fibrillation Supraventricular tachycardia Hypertension
Metoprolol
(Beta blockers) Ischemic heart disease Atrial fibrillation Supraventricular tachycardia Hypertension
Carvedilol
(Beta blockers) Ischemic heart disease Chronic heart failure Atrial fibrillation Supraventricular tachycardia Hypertension
(Calcium channel blockers)
Decrease calcium ion entry into vascular and cardiac cells. Causes vasodilation and relaxation of smooth muscle, reduce cardiac contractility, suppress cardiac condition/heart rate.
Two classes:
(Dihydropyridines) Amlodipine, nifedipine - more selective for vasculature
(Non-dihydropyridine) Verapimil - more selective for heart
✖Unstable angina
✖Severe aortic stenosis
Amlodipine
(Calcium channel blockers)
Hypertension
Stable angina
Nifedipine
(Calcium channel blockers)
Hypertension
Stable angina
Diltiazem
(Calcium channel blockers)
Stable angina
Supraventricular arrythmia
Verapimil
(Calcium channel blockers)
Stable angina
Supraventricular arrythmia
(Colloids, plasma substitutes)
Expand circulating volume from containing large, osmotic active molecules, cannot easily cross membranes.
Albumin
(Colloids, plasma substitutes)
Tissue hypoperfusion
Cirrhotic liver disease involving large volume paracentesis (i.e. ascitic fluid drainage)
Gelatins
(Colloids, plasma substitutes)
Tissue hypoperfusion
(Compound sodium lactate, Hartmann’s solution)
Balanced crystalloid solution containing lactate. Lactate readily broken down into bicarbonate. Therefore provides sodium and water. Lower chloride content than sodium chloride solution, reducing risk of hyperchloraemic acidosis
Provide sodium and water
Expand circulating volume in states of impaired tissue perfusion
(Digoxin)
Negatively chronotropic (reduce heart rate), positively inotropic (increases force of contraction)
In AF it acts on indirect pathway increasing vagal/parasympathetic tone. In heart failure, it inhibits Na+/K+ ATPase pumps, causing NA+ accumulation in cells. Low Na+ needed to remove calcium ions from cells. Leads to high calcium ion concentration and increased contractility in cells
✖Heart blocks
✖Ventricular arrhythmia
(Loop diuretics)
Mainly acts on ascending loop of Henle. inhibits Na+/K+/2Cl- co-transporter moving sodium, potassium and chloride ions into cells. Also causes dilation of capacitance veins, reducing pre-load so useful in heart failure
Heart blocks
✖Hypovolemia
✖Dehydration
Furosemide
(Loop diuretics)
Acute pulmonary oedema
Chronic heart failure fluid overload
Other oedematous states
Bumetanide
(Loop diuretics)
Acute pulmonary oedema
Chronic heart failure fluid overload
Other oedematous states
(Thiazide and Thiazide-like diuretics)
Inhibits Na+/Cl- co-transporter in distal convoluted tubule of nephron. Prevents reabsorption of sodium and therefore water
✖Hypokalaemia
Bendroflumethiazide
(Thiazide and Thiazide-like diuretics)
First line or add-on treatment for hypertension
Indapamide
(Thiazide and Thiazide-like diuretics)
First line or add-on treatment for hypertension
Chlortalidone
(Thiazide and Thiazide-like diuretics)
First line or add-on treatment for hypertension
(Fibrinolytic drugs)
a.k.a. thrombolytic drugs catalyse conversion of plasminogen to plasmin. Plasmin dissolves fibrinous clots and re-open occluded vessels ✖Bleeding ✖Intracranial haemorrhage ✖Previous Streptokinase treatment
Alteplase
(Fibrinolytic drugs)
Acute ischemic stroke
STEMI
Massive pulmonary embolism
Streptokinase
(Fibrinolytic drugs)
STEMI
Massive pulmonary embolism
(Heparin and Fondaparinux)
Antithrombin inactivates clotting factors especially IIa (thrombin) and Xa. Heparins and fondaparinux enhace effect of antithrombin. Size of herparin determine molecular specificity. Unfractionated heparin inactivates factor IIa and Xa. LMWH more specific for factor Xa. Fondaparinux specific for Xa
Enoxaparin
(Heparin)
Prevention of DVT and pulmonary embolism
Acute coronary syndrome
Dalteparin
(Heparin)
Prevention of DVT and pulmonary embolism
Acute coronary syndrome
Fondaparinux
(Fondaparinux)
Prevention of DVT and pulmonary embolism
Acute coronary syndrome
Unfractionated heparin
(Heparin)
Prevention of DVT and pulmonary embolism
Acute coronary syndrome
(Lidocaine)
Lidocaine enter cells uncharged then accepts a proton to become positively charged. It blocks intracellular voltage-gated sodium channels, preventing initiation of action potential. Useful in anaesthetics. Slows conduction and refractory period in heart tissue.
Local anaesthetic
Anti-arrhythmic drug in ventricular tachycardia and ventricular fibrillation
(Nitrates)
Nitrates converted into nitric oxide (NO). NO causes relaxation of arteries and veins. Reducing artery pre-load and filling. Increases coronary perfusion and reduces systemic vascular resistance
✖severe aortic stenosis
✖haemodynamic instability
✖hypotension
Isosorbide mononitrate
(Nitrates)
Prophylaxis of angina
Pulmonary oedema
Glyceryl trinitrate
(Nitrates)
Acute coronary syndrome
Pulmonary oedema
(Strong opioids)
Activation of opioid receptors in central nervous system. There G-protein coupled receptors reduce neuronal excitability and pain transmission. Reduces respiratory drive. Reduces sympathetic nervous system activity.
Morphine
(Strong opioids) Acute severe pain Chronic pain End-of-life care Acute pulmonary oedema
Oxycodone
(Strong opioids) Acute severe pain Chronic pain End-of-life care Acute pulmonary oedema
(Sodium chloride)
Sodium ions draw water from intracellular to extracellular fluid compartment
(Sodium chloride 0.9%)
Provide sodium and water
Expand circulating volume during tissue hypo-perfusion (i.e. shock)
Reconstitution and dilution of drugs
(Sodium chloride 0.45%)
Provide sodium and water
(Warfarin)
Inhibits hepatic production of vitamin K dependant coagulation factors (2,7,9,10) by inhibiting vitamin K epoxide reductase (enzyme responsible for restoring vitamin K to its reduced form)
✖Immediate risk of haemorrhage
✖Pregnancy
(Statin)
Reduces serum cholesterol levels by inhibiting 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG CoA) involved in making cholesterol. Indirectly reduce triglycerides, clearance of LDLs.
Simvastatin
(Statin)
Primary prevention of cardiovascular disease
Secondary prevention of cardiovascular events
Primary hyperlipidaemia
Atorvastatin
(Statin)
Primary prevention of cardiovascular disease
Secondary prevention of cardiovascular events
Primary hyperlipidaemia
Pravastatin
(Statin)
Primary prevention of cardiovascular disease
Secondary prevention of cardiovascular events
Primary hyperlipidaemia
Rosuvastatin
(Statin)
Primary prevention of cardiovascular disease
Secondary prevention of cardiovascular events
Primary hyperlipidaemia
