Cardiovascular Drug Names and Examples Flashcards
What is the first-line treatment of hypertension?
Give examples.
ACE inhibitor (cilazapril) to start or ARB (losartan), plus a calcium channel blocker (amylodipine) and then a thiazide (bendroflumethiazide) diuretic.
Alpha 1 blocker example and indications.
Doxazocin
Vasodilator so used in mild hypertension but not useful as a monotherapy.
alpha 2 agonist example and indications?
Clonidine
Initial hypertensive response due to vascular effects, but over time acts on presynaptic sympathetic terminals causing a decrease in NA effect on vasculature and heart.
1st, 2nd and 3rd generation betablockers and the receptors which they work on?
1st: Propanolol works on beta 1 and beta 2, therefore, contraindicated in asthma.
2nd: Metoprolol and atenolol which are beta 2 selective.
3rd: Carvedilol which is beta 1, beta 2 and alpha 1 selective (added vasodilatory effect).
How do beta blockers work and the indications?
Works on the heart (negative chronotrope, ionotrope and dromotrope) and on the kidney to reduce renin output. Carvedilol also works on the vasculature to reduce vasoconstriction.
Indications: Anti-arrhythmic used in atrial fibrillation, angina and MI (reduces heart O2 consumption), heart failure (use carvedilol), not used in hypertension unless sympathetic stimulation is the reason for HTN.
ACE inhibitor name, MOA and indications?
Cilazapril
Reduces the amount of Ang 2 released reducing arteriolar vasoconstriction (reduced afterload), reduces venous constriction (reduced preload), increased bradykinin (vasodilation), reduced sympathetic impact (vasodilation and cardiac hypertrophy/fibrosis), promote natriuresis (reduced aldosterone production).
Indications: Essential hypertension, renovascular hypertension, chronic heart failure (preload/afterload effect improve heart efficiency and reduced cardiac remodelling)
Angiotensin receptor blocker name, MOA and indications?
Lorsartan
Selective inhibition of AT1 receptor therefore reduces vascular smooth muscle contraction, reduction in aldosterone secretion, reduced sympathetic activation and reduced fibrotic pathways plus it has the effects of AT2 receptor (which ACE inhibitors don’t have but ARBs don’t have positive bradykinin effects)
Indications: Hypertension and heart failure (same as ACE inhibitors and used if cannot tolerate ACE inhibitors).
Statin name, MOA and indications?
Atorvastatin
HMG-CoA reductase inhibitors: reduce de novo cholesterol synthesis and increase in LDL-R synthesis which causes an increase in LDL clearance and an increase in HDL. Pleiotropic effects: reduction in inflammatory processes (prevention of NFkB transcription), inhibit macrophage LDL uptake to reduce CRP release, increase NO release, etc.
Indications: prevention of CV events in high-risk patients, primary hypercholesterolemia or combined hyperlipidemia, familial hypercholesterolemia.
Cholesterol uptake inhibitor name, MOA and indications?
Ezetimibe
Impairs billary and cholesterol absorption in the intestines therefore results in LDL-R upregulation.
Indications: hypercholesterolemia etc.
Fibrates name, MOA and indications?
Bezafibrate
Increase fatty acid oxidation in muscle and liver and lipogenesis in the liver via peroxisome proliferator-activator receptor alpha (PPARalpha) activation. Increase HDL and decrease triglycerides, LDL and VLDL.
Indications: Hyperlipidemia.
What is low dose aspirins MOA and indications?
What class of drugs is it in?
Antiplatelet: inhibits platelet aggregation and reduces the risk of thrombus formation.
Irreversibly acetylates COX in platelets therefore reduces the production of TXA2.
Minimal effects on endothelial COX2 as it is metabolised by the liver (therefore prostaglandins are still produced).
Indications: People who have occlusive vascular disease (such as MI) or post coronary bypass surgery.
What is the other antiplatelet which isnt aspirin?
What is its MOA and indications?
Clopidogrel
Block ADP receptors on platelet which prevents activation of GPIIb-IIIa.
Indications: Coronary vascular disease such as MI (used if the patient cannot tolerate aspirin).
Class of drug unfractionated heparin, MOA and indication?
Anit-coagulant
Increases the action of antithrombin III which binds and inactivates thrombin and factor 10.
Indications: prolonged immobility, acute MI, thrombotic stroke.
What is the low molecular weight heparin which we need to know? MOA and Indications?
Enoxaparin (trade name clexane).
MOA: potentiates action of antithrombin III on factor 5a but not so much on thrombin.
Indications: Prevention of DVT, to treat DVT and coronary syndromes (MI sometimes). Used as a bridging therapy to warfarin.
What vitamin K antagonist do we need to know?
MOA and indications?
Warfarin
MOA: Blocks hepatic vitamin K reductase (epoxide reductase) which prevents vit K from being recycles and further activating factors 2, 7, 9 and 10 plus protein C and S. Overall warfarin reduces fibrin formation.
What are the fibrinolytic which we need to know?
MOA and indications?
Alteplase and tenecteplase.
Tissue plasminogen activator works by converting plasminogen into plasmin which degrades a clot. Indications: Increased survival if given acutely post MI or ischemic stroke.
What class of drug is amlodipine its MOA and its indications?
Calcium channel blocker used for hypertension.
MOA: Binds and inactivates L and T type channels (doesnt affect heart because it binds in inactive state which is more likely for the arterioles to be). Dilates peripheral arterioles, therefore, reducing afterload (total peripheral resistance) and cardiac consumption.
Indications: Hypertension (dont use with angina because of reflex tachycardia).
What class of drug is verapamil? MOA and indications?
Calcium channel blocker.
Binds to open cardiac L type calcium channels promoting inactivation (channel inhibition works more at higher heart rates). Also acts as a vasodilator for arterioles.
Indications: Angina (reduced O2 demand without reflex tachycardia), hypertension.
Diltiazem class of drugs, MOA and indications?
Calcium channel blocker.
MOA: Inhibits Ca2+ influx during cardiac and smooth muscle. Also interferes with Ca2+ depolarisation in excitable tissue (therefore antiarrhythmic).
Indications: Atrial fibrillation (antiarrhythmic), angina (reduced O2 demand),
What is the nitrodilator which is used under the tongue?
Oral nitrodilator?
MOA and indications?
Glyceryl trinitrate (GTN)
Isosorbide mononitrate/dinitrate
Releases NO inside the vascular smooth muscle cell and promotes relaxation. Reduces preload as it works on the venous system and afterload because it works on the arterial system.
Indications: symptomatic relief of angina and MI (reduced wall stress, reduced cardiac work and therefore O2 demand). Also used in heart failure (venous pressure reduced=less oedema, reduced afterload=higher stroke volume). Long term management of coronary artery disease=isosorbide and angina attack=GTN.
Antiplatelet effect from NO. Acute hypertensive emergency useful.
Osmotic diuretic name, MOA and indications?
Mannitol
MOA: Osmotically pulls water into the nephron as it is freely filtered in the glomerulus but not reabsorbed in the tubules.
Indications: Emergency reduction in intracranial pressure.
Loop diuretic which we need to know? MOA and indications?
Frusemide
MOA: Inhibits luminal NKCC2 cotransporter by competing with Cl- for binding. This increases the Na+ and Cl- excretion (prevents Na+ reabsorption).
Indications: Hypertension, oedema
Thiazide which we need to know, MOA and indication?
Bendroflumethiazide
MOA: Inhibits the Na+/Cl- cotransporter (eNCC-1) at the distal tubule. Leads to Na+ loss.
Indications: Hypertension (used in combo with ACE inhibitors and CCBs).
K+ sparing diuretic which we need to know?
Spironolactone and amiloride
MOA: Aldosterone antagonist which competitively binds and prevents translocation of mineralocorticoid receptor which increases Na+/K+ channels in the collecting duct.
Indications: Amiloride used with thiazide to spare some K+, spironolactone can be used with ACE Is and CCBs to treat hypertension. Treatment of CHF and associated oedema.
Class 3 antiarrhythmic name, MOA and indications?
Amioderone
Block K+ channels, action potential prolonged decreasing the chance of re-entry wave.
Indications: Used as a rate controller in atrial fibrillation.
What is the non VW class of antiarrhythmics that we need to know, MOA and indications?
Digoxin-Cardiac Glycoside
Inhibitor of Na+/K+ ATPase which means that myocytes relies on the Na+/Ca2+ ATPase. This causes high intracellular Ca2+ concentrations and increases force of contraction, decreases sympathetic tone (therefore less renin, more urine production). It also causes increase in vagal stimulation, more Ach release, which decreases the SA firing and AV velocity.
Indications: Heart failure and atrial fibrillation.
