Cardiovascular Drugs Flashcards
ASPIRIN COX
(Anti-platelet)
In: Treatment of ACS, AIS and AF, 2nd line prevention of (CVS,CV,PAD events)
MOA: Irreversibly inhibits cyclooxygenase (COX), reduces platelet aggression
SE: GI irritation,ulceration, haemorrhage. Bronchospasm due to hypersensitivity. Tinnitus and overdose
KI: Antiplatelet drugs (clopidogrel/dipyridamole) + Anticoagulants (warfarin, heparin)
CI: Children <16 (Reye’s syndrome), Pregnancy (3rd trimester), hypersensitivity
C: Peptic ulceration, GOUT
M: Side effects
CLOPIDOGREL
Anti-platelet
I:Treatment of ACS, 2nd line prevention of thrombus in (CVS,CV,PAD events), Prevent occlusion of coronary artery stents
MOA: Binds irreversibly to adenosine diphosphate (ADP) receptors and prevents platelet aggression
SE: Bleeding, Abdo pain, Diarrohea, Thrombocytopenia
KI: CYP inhibitors ( macrolides, diltiazem) can ↓ efficacy
Antiplatelet (Aspirin) + Anticoagulants (Warfarin, Heparin) + NSAIDS can ↑ bleeding
Cannot give omeprazole - give lansoprazole
CI: ↑ risk bleeding, stop 7 days before surgery
C: Hepatic impairment -> risk of bleeding
M: Side effects
PC: Compliance for 12 months
STATINS
Simvastatin, Atorvastatin, Pravastatin, Rosuvastatin
I: Primary and Secondary prevention of CVS disease, Hyperlipidaemia
MOA: Inhibits 3-hydroxy-3-methyl-glutaryl coenzyme (HMG- COA) reductase
SE: Headaches, Muscle aches, GI distrubance, Rhabdomyolosis, ↑ in liver enzymes
KI: CYP inhibitors (Amiodarone, macrolides) reduce metabolism of statins
CI: Pregnancy + breastfeeding
C: Hepatic impairment, low doses in renal impairment
M: Primary prevention : check lipid profile before treatment and 3 months after
Secondary prevention: baseline and check efficacy of target
(Aim 40% reduction in non-HDL cholesterol) - BOTH primary and secondary
ALT baseline 3 and 12 months >3x normal upper limit
PC: Come back for blood tests in 3 and 12 months
Avoid grapefruit in simvastatin and atorvastatin
Seek medical help for muscle symptoms
WARFARIN (invKer)
I: Venous thromboembolism, Prevent embolism in AF + prosthetic heart valves
MOA: inhibits Vitamin K Epoxide Reductase
SE: Bleeding, severe-overwarfarinisation
KI: CYP InduCers ↑ clotting and metabolism
CYP InhiBitors ↑ bleeding
ABX can increase the effect of Warfarin
CI: Pts @ risk of immediate haemorrhage, pregnancy
C: Liver disease
M: Target INR range (2.0-3.0).
Inpatients - daily
Outpatients- every few days
Stable- Less frequently
PC: Alcohol, Food and other drugs (green vegetables) can affect warfarin treatment
Yellow book - record results and doses
HEPARIN
Enoxaparin, Dalteparin, Unfractioned Heparin
I: VTE, ACS
MOA: Antithrombin (AT) - Enhances effect of AT (LMWH : activates 10A, unfractioned: 10A+2A)
SE: Haemorrhage, Hyperkalaemia, Bruising at injection site, Heparin Induced Thrombocytopenia (HIT)
I: Combining other AT drugs can ↑ bleeding
C: Clotting disorders, severe uncontrolled HTN, recent surgery or trauma, withold before and after invasive surgery, Low doses in renal impairment
M: Platelet count (Thrombocytopenia) + serum Potassium concentration (Hyperkalaemia) , Antifactor Xa Activity should be measured
DOAC’s
Apixaban, Endoxaban, Rivaroxaban, Dabigatran
I: VTE, AF
MOA: Directly inhibit A factor X (10) preventing conversion of prothrombin to thrombin. Dabigatran inhibits thrombin preventing conversion of fibrinogen to Fibrin
SE: Bleeding (GI), Anaemia + Dizziness, upset GI and ↑liver enzymes
KI: ↑ bleeding with other AT agents
CYP inducers + CYP inhibitors affect metabolism + excretion
CI: Active bleedings + risk of bleeding, pregnancy and breastfeeding
C: Dose reduction in renal and hepatic disease
PC: Alert card - show all healthcare contacts, accident, need surgery
LOOP DIURETICS
Furoseminde, Bumetanide
I: Acute pulmonary oedema, CHF, other oedematous states
MOA: Acts on the ascending loop of henle. Inhibits NA+/K+/2Cl- co-transporter causes a dilatation of capacitence veins
SE: Dehydration, Hypotension, Metabolic Alkalosis (Hyponatreamia, Hypokalaemia), tinnitus and hearing loss
KI: Affects drugs excreted by the kidneys, ↑ lithium levels –> nephrotoxicity and ototoxcity of aminoglycosides)
CI: Severe hypovolaemia + dehydration
C: Hypokalaemia, Hyponatraemia, Worsen GOUT
M: Symptoms, BP and weight (<1kg a day)
PC: Take during day not night
BETA BLOCKERS
(Bisoprolol, Atenolol, Metoprolol) Selective ❤︎
(Propanolol, Carvedilol) Non Selective - PC
I: IHD (BAM)
CHF (BAM)
AF (BAM)
SVT (BAM)
HTN (PC)
NEGATIVE Iaonotropic (T- contraction) + Conotropic (C- conduction)
MOA: Reduce force of contraction and speed connduction of the heart
[AF] prolongs refractory period of AV node beta 1 adrenoreceptors
[HTN] reduces renin secretion from kidneys
SE: CHEF (cold extremities, headache, erectile dysfunction, fatigue)
KI: Non-Dihydropyridine CCB (Verapamil, Diltiazem) - cause HF, bradycardia
CI: Asthma, Haemodynamic instability - heart block
C: ↓ dose in signficant hepatic failure
↓ dose + titration in HF
M: dose adjustment in symptoms, HR in IHD (resting hr 55-60bpm)
PC: impotence in men
ALPHA BLOCKERS
Tamsulosin, Doxazocin, Alfuzosin
I: 1st line of BPH, resistant HTN (5th line)
MOA: blocks alpha 1 adrenal receptor and causes vasodilation + reduced resistance to bladder outflow.
SE: Postural hypotension, Dizziness + Syncope [prominent in 1st dose]
KI: omit doses/ stop antihypertensive drugs (particulary BB) the day pt starts alpha blockers to avoid first dose hypotension
CI: Avoid in pts. with existing hypotension
M: Symptoms, BP standing and sitting down
THIAZIDE DIURETICS
(Bendroflumethiazide, Indapamide, Chlortalidone)
I: 1st line alternative for HTN, add on for HTN
MOA: Inhibit the NA+/Cl- co transporter in the distal convoluated tubule of the nephron - causes vasodilation
SE: Hyponatraemia, Hypokalaemia, postural hypotension, gout
KI: NSAIDS ↓ efficacy of thiazide diuretics. Loop + thiazide can ↓ potassium concentration
CI: Avoid in hypokalaemia
C: Hyponatraemia, gout (trigger attacks due to uric acid)
M: BP monitoring, U+Es before and 2-4 weeks into therapy
CALCIUM CHANNEL BLOCKERS
(Amlodopine, Nidedipine) Dihydropyridine
(Diltiazem, Verapamil) Non- Dihydropyridine
I: SAASH (stable angina, AF, A flutter, supraventricular arrythmias, 2nd line HTN)
MOA: Diphyropyridine - Relaxation + vasodilation in arterial smooth muscle
Non-Diphydropyridine- Reduce myocardial contractility, suppress cardiac conduction from AV node - reducing oxygen demand
SE: Ankle swelling, flushing, palpatations, headache ( Amlodopine)
Constipation (Verapamil), bradycardia, heart block, CF
KI: BB - can lead to HF, bradycardia and asystole
CI: AV Nodal conduction delay (Non-Diphydropyridine)
Unstable angina, Severe aortic stenosis (Dihydropyridine - ↓BP. ↑ HR + 02)
C: poor LV function
M: BP, Chest pain ECG
ACE INHIBITORS (Ramipril, Lisinopril, Perindopril)
I: HTN, CHF, IHD, CKD with proteinuria, Diabetic Neuropathy
MOA: Prevents conversion of Angiotensin I to II
SE: Angioedema, persistent dry cough, electrolyte imbalance
Hypotension (1st dose), hyperkalaemia, renal failure [ARBS]
KI: Avoid ACEi with potassium ↑ drugs, NSAIDS can ↑ nephrotoxicity
CI: Renal artery stenosis, pregnancy, breastfeeding, child bearing age
C: ↓ dose in CKD
M: check renal function before treatment and repeat 1-2 weeks into treatment and after titration. STOP ACEi if:
- Serum creatinine ↑30%
- eGFR ↓ more than 25%
- Serum Potassium >6.0mmol
PC: Avoid NSAIDS, allergic reactions is rare
ALDOSTERONE ANTAGONISTS
Spironolactone
I: Ascites + Oedema due to liver cirrhosis, HF, Hyperaldosteronism
MOA: Inhibit the effect of aldosterone by competitively binding to the aldosterone blocker
SE: Hyperkalaemia, Gynaecosmastia
KI: Potassium elevating drugs (ACEi/ARBS) can ↑ risk of hyperkalaemia, avoid potassium supplements
CI: Severe renal impairment, hyperkalaemia, adddisons disease, pregnancy + breastfeeding
M: symptoms, renal function and serum potassium (hyperkalaemia and renal impairment)
PC: Men - impotence and possibility of gynaecosmastia
NITRATES
(glyceryl trinitrate) Short Acting
(isosorbide mononitrate) Long Acting
I: Acute angina + ACS (SA). Prophylaxis of angina (LA), Pulmonary oedema (IV)
MOA: Relaxation of the venous capacitance vessels, reduces cardiac work and 02 demand
SE: Flushing, Headaches, Light-headedness and hypotension.
KI: Avoid use with PDE inhibitors (Sildenafil) as it can enhance and prolong hypotensive effects
CI: Severe aortic stenosis, haemodynamic instability, hypotension
M: Symptoms, BP
PC: Sit down and rest 5 mins after taking GTN.
