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.
