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Cardiovascular Drugs Flashcards

1
Q

Examples of acetylcholinesterase (ACE) inhibitors

A

Ramipril, Lisinopril, Quinapril

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2
Q

Examples of ARBs (angiotensin II receptor blockers)

A

Losartan
Valsartan
Eprosartan

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3
Q

Examples of CCBs (Calcium Channel Blockers) - rate limiting

A

Verapamil, Diltizem

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4
Q

Action of ACE inhibitors

A

Inhibits ACE conversion of angiotensin I to angiotensin II, therefore reducing BP due to Vasodilation (as angiotensin II is a vasoconstrictor and is inhibited)

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5
Q

Action of ARBS (angiotensin II receptor blockers)

A

Antagonise angiotensin II. Prevents vasoconstriction, aldosterone release and sympathetic activation. Results in BP reduction secondary to vasodilation

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6
Q

Action of CCBs (calcium channel blockers)

A

Vasodilators with balance of actions -> reducad heart rate. (These drugs have noticiable cardiac effects)

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7
Q

ACE inhibitors use

A

Combined with thiazide-like diuretics and CCBs as anti-hypertensive agents
Used in patients under 55
For heart failure
Left ventricular dysfunction
Post MI or congenital heart defects
Stroke prevention

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8
Q

ARBs use

A

Combined with thiazide-like diuretics and CCBs as anti-hypertensive agents
Patients under 55
Angiotensin-converting enzyme inhibitors (ACEIs) intolerance
Type 2 diabetic nephropathy (deterioration of kidney function)

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9
Q

CCBs use

A

Anti-hypertensives in combination with ACEIs/ARBs
Anti-arrhythmic: tachyarrhythmias such as AF
Post myocardial infarction

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10
Q

ACE inhibitors side effects

A

Dry irritant cough (due to accumulation of bradykinin)
Angioedema (swelling underneath he skin)
Hyperkalaemia (due to potassium retention, mediated by reduction of aldosterone)
Renal dysfunction

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11
Q

ARBs side effects

A

Hyperkalaemia due to potassium retention mediated by reduction of aldosterone
Impairment of renal function
Dizziness and syncope

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12
Q

CCBs side effects

A

Bradychardia and AV conduction delay
Constipation with verapamil

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13
Q

ACE inhibitors cautions

A

Renal dysfunction in patients with renal artery stenosis
Avoid in women with child bearing potential due to danger of foetal renal maldevelopment

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14
Q

ARBs cautions

A

Renal dysfunction in patients with artery stenosis
Avoid in women with child bearing potential due to danger of foetal renal maldevelopment

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15
Q

CCBs cautions

A

Negatively chronotropic and inotropic, so should be used with caution in combination with beta-blockers (Chronotropic factors are factors that affect the rate at which the cardiac muscle fibers contract. Inotropic factors are factors that affect the amount of force that the cardiac fibers contract)
Heart block and heart failure

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16
Q

Anti cholesterol drugs

A

Statins - anti lipid drugs
Fibrates
PCSK 9 inhibitors (for very high risk patients e.g inherited hyperlipopedia)
siRNA of PCSK9 (Inclisiran) - small interfering RNA that limits production of PCSK 9

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17
Q

Anti hypertensive drugs

A

Thiazide diuretics
Beta blockers
Vasodilators:
-calcium antagonists
-alpha 1 blockers
-ACE inhibits (ACEI)
-angiotensin receptor blockers (ARB)
Mineralocorticoid antagonist (spironolactone)
Alpha 2 or imidazoline receptor agonist (clonidine, moxonidine)

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18
Q

Statins

A

Anticholesterol
Example: simvastatin
Blocks HMG CoA redactase
Used in:
- hypercholesterolaemia
- diabetes
-angina/MI
-CVA/TIA
- high risk of MI and CVA
Side effects:
- myopathy
- rhabdomyolysis… renal failure

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19
Q

Fibrates

A

Anticholesterol
Example: bezafibrate
Used in:
- hypertriglyceridaemia
- low HDLcholesterol

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20
Q

PCSK 9 inhibitors

A

Anticholesterol
Examples: alirocumab, evolocumab
Used for: familial hypercholesterolaemia
Mechanism: inhibits the binding of PCSK9 to LDLR, PCSK9 inhibitor increases the number of LDLRs available to clear LDL, therefore lowering LDL-C levels

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21
Q

siRNA of PCSK9 (Inclisiran) - small interfering RNA that limits production of PCSK 9

A

Completely new class of drugs called gene silencing drugs
Mechanism: turns off/“silences” the gene PCSK9, boosting the livers ability to remove harmful cholesterol from the blood

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22
Q

Low blood pressure “numbers”

A

Systolic:<90mmHg
Diastolic:<60mmHh

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23
Q

Normal blood pressure “numbers”

A

Systolic: <140mmHg
Diastolic:<90mmHg

Current guidelines suggest:
Systolic:135mmHg or lower
Diastolic: 85mmHg or lower

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24
Q

Possible hypertension blood pressure “numbers”

A

Systolic: 140-180mmHg
Diastolic: 90-110mmHg

*further checks such as home monitoring, repeated checks or ABMP

25
Sever hypertension blood pressure “numbers”
Systolic:>180mmHg Diastolic:>110mmHg
26
Diuretics (and whats the two types)
Mechanism: block Na reabsorption to kidneys 1.) thiazide diuretics e.g. bendrofluazide - mild Used in: hypertension 2.) loop diuretics e.g. furosemide - stronger Used in: heart failure
27
Diuretic Side effects
Hypokalaemia (plasma potassium level less than 3.5 mmol/L) - tired - arrhythmias Hyperglycaemia - diabetes Increase uric acid - >gout (type of arthritis) Impotence (Erectile dysfunction)
28
Beta blockers
Mechanism: block B1and/or B2 adrenoceptors 1.) cardioselective beta blockers - only block B1 E.g. atenolol, bisoprolol Used in: angina, acute coronary syndrome, MI, hypertension and heart failure 2.) non selective Beta blockers - block B1+B2 E.g. propranolol, carvedilol (alpha and beta blocker) Used in: thyrotoxicosis hyperthyroidism), migraine
29
Beta blocker side effects
Asthma - contraindicated in ‘brittle/severe’ asthma Tired Cold peripheries Heart failure* *NOTE: beta blockers can worsen heart failure in SHORT term (especially cardiogenic shock)
30
What are the two types calcium antagonists
1.) dihydropyridines e.g. amlodipine Used in: hypertension and angina Side effect: ankle oedema 2.) rate limiting calcium antagonists e.g. verapamil, diltiazem Used in: hypertension and angina plus supraventricular arrhythmias (AF,SVT) AVOID use with beta blockers
31
Angiotensin converting enzyme inhibitors
Mechanism: block angiotensin I becoming angiotensin II Example: lisinopril Used in: hypertension and heart failure Good for kidneys in diabetic nephropathy Bad for kidneys in renal artery stenosis
32
Angiotensin converting enzyme inhibitors side effects
Cough Renal dysfunction Angie neurotic oedema Never use in pregnancy induced hypertension
33
Angiotensin receptor blockers
Mechanism: block angiotensin II receptors Example: losartan Used in: hypertension and heart failure Good for kidneys in diabetic nephropathy Bad for kidneys in renal stenosis
34
Angiotensin receptor blockers side effects
Renal dysfunction No cough Never use in pregnancy induced hypertension
35
Alpha blockers
Mechanism: block alpha adrenoceptors to cause vasodilation Example: doxazosin Use in: hypertension and prostatic hypertrophy
36
Alpha blockers side effects
Postural hypotension
37
Mineralcorticoid antagonists
Mechanism: block aldosterone receptors Example: spironolactone, eplerenone Use in: heart failure and resistant hypertension
38
Mineralcorticosteroid antagonists side effects
> Gynaecomastia -boys' and men's breasts to swell and become larger than normal > Hyperkalaemia - higher than normal potassium levels > Renal impairment - kidneys are no longer able to filter and clean blood
39
Anti anginal drugs
Vasodilators - nitrates -nicroandil (K ATP channel opener) - calcium antagonists (dihydropyridine) Slow heart - beta blockers - calcium antagonists (diltiazem, verapamil) - ivabradine Metabolic modulator - ranolazine (late sodium channel modulator)
40
Nitrates
Venodilators e.g. isosobide monoritrate Used in: angina and acute heart failure Tolerance common - leave 8hr/day nitrate-free
41
Nitrates side effects
Headache Hypotension/collapse
42
Nicorandil side effects
Anti-anginal- K ATP channel activator Side effects: Headache Mouth/GI ulcers
43
Ivabradine
Anti anginal- If channel modulator in the sinus node Slows heart rate only in sinus rhythm Does not work in atrial fibrillation Altered visual disturbance
44
Ranolazine
Anti-anginal Late sodium channel modulator Decrease calcium load on heart Effective in refactory angina
45
What is acute coronary syndrome?
Unstable angina NSTEMI - Non-ST-elevation myocardial infarction STEMI - ST segment elevation myocardial infarction
46
Anti thrombotic drugs
Antiplatelet drugs - aspirin, clopidogrel, prasugrel, ticagrelor Anticoagualnts - heparin and fondaparinux (subcutaneously), warfarin, rivaroxaban, dabigatran, edoxaban (oral) Fibrinolytics - streptokinase, tPA
47
Antiplatlet agents
All prevent new thrombosis Aspirin, clopidogrel, ticagrelor, prasugrel Used in: angina, acute MI, CVA/TIA, patients at risk of MI & CVA
48
Side effects of antiplatelet agents
Haemorrhage anywhere Peptic ulcer -> haemorrhage Aspirin sensitivity -> asthma
49
Anticoagulants
Prevent new thrombosis 1.) heparin IV use only 2.) warfarin oral use only Block clotting factors (2,7,9,10) Use in: deep vein thrombosis, pulmonary embolism, NSTEMI, atrial fibrillation Control dose carefully by International normalised ratio (INR) Reversed by vitamin K - rivaroxaban (factor Xa inhibitor) - dabigatran (thrombin factor IIa inhibitor) Xa converts prothrombin (II) to thrombin (IIa)
50
Fibrinolytic drugs
Anti thrombosis Dissolve formed clot e.g. streptokinase, tissue plasminogen activator (tPA) Use in STEMI: pulmonary embolism (selected cases only) CVA (selected cases only)
51
When to avoid fibrinolytic drugs
Recent haemorrhage (some CVAs) Trauma Bleeding tendencies Severe diabetic retinopathy Peptic ulcer
52
Fibrinolytic drugs side effects
Serious risk of haemorrhage
53
Anti arrhythmic drugs
For atrial fibrillation Beta blockers - rate control Digoxin - rate control Calcium channel blockers - rate limiting Aminodarone - chemically cardiovert (convert the rhythm back into a normal sinus rhythm)
54
Heart failure drugs
ACE inhibitors ARBs Beta-blockers Mineralocorticoid antagonists (spironolactone, eplerenone) Neprilysin inhibitors (salcubitril valsartan) Sglt2 inhibitors (dapagliflozin/empagliflozin) Diuretics Digoxin
55
Digoxin (two effects)
1.) blocks atrial-ventricular (AV) conduction -produces a degree of AV conduction delay - good in atrial fibrillation (AF) If excessive, bad because heart rate falls too much giving bradychardia and heart block 2.)increases ventricular irritability which produce ventricular arrhythmias Always bad Narrow therapeutic index (range of doses at which a medication is effective without unacceptable adverse events)
56
Digoxin toxicity side effects
Nausea, vomiting Yellow vision Bradycardia, heart block Ventricular arrhythmias
57
Neprilysin inhibitors
ARB and endopeptidase inhibitor Example: salcubitril valsartan Superior/better than ACEI or ARB
58
Neprilysin inhibitor side effects
Hypotension Renal impairment Hyperkalaemia Angioneurotic oedema
59
Sblt2 inhibitors
CV risk factor reduction (is actually a diabetic medication) Examples: dapagliflozin, empagliflozin What it does: - lowers blood glucose levels -lowers BP via osmotic diuresis -increases urinary caloric loss with reductions in body weight Reduces albuminuria possibly due to alterations in tubuloglomerular feedback

Cardiology (20 decks)

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