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Cardiology > Cardiovascular Drugs > Flashcards

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
Q

Sever hypertension blood pressure “numbers”

A

Systolic:>180mmHg
Diastolic:>110mmHg

26
Q

Diuretics (and whats the two types)

A

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
Q

Diuretic Side effects

A

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
Q

Beta blockers

A

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
Q

Beta blocker side effects

A

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
Q

What are the two types calcium antagonists

A

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
Q

Angiotensin converting enzyme inhibitors

A

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
Q

Angiotensin converting enzyme inhibitors side effects

A

Cough
Renal dysfunction
Angie neurotic oedema

Never use in pregnancy induced hypertension

33
Q

Angiotensin receptor blockers

A

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
Q

Angiotensin receptor blockers side effects

A

Renal dysfunction
No cough

Never use in pregnancy induced hypertension

35
Q

Alpha blockers

A

Mechanism: block alpha adrenoceptors to cause vasodilation
Example: doxazosin
Use in: hypertension and prostatic hypertrophy

36
Q

Alpha blockers side effects

A

Postural hypotension

37
Q

Mineralcorticoid antagonists

A

Mechanism: block aldosterone receptors
Example: spironolactone, eplerenone
Use in: heart failure and resistant hypertension

38
Q

Mineralcorticosteroid antagonists side effects

A

> 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
Q

Anti anginal drugs

A

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
Q

Nitrates

A

Venodilators e.g. isosobide monoritrate
Used in: angina and acute heart failure

Tolerance common - leave 8hr/day nitrate-free

41
Q

Nitrates side effects

A

Headache
Hypotension/collapse

42
Q

Nicorandil side effects

A

Anti-anginal-
K ATP channel activator

Side effects:
Headache
Mouth/GI ulcers

43
Q

Ivabradine

A

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
Q

Ranolazine

A

Anti-anginal
Late sodium channel modulator
Decrease calcium load on heart
Effective in refactory angina

45
Q

What is acute coronary syndrome?

A

Unstable angina
NSTEMI - Non-ST-elevation myocardial infarction
STEMI - ST segment elevation myocardial infarction

46
Q

Anti thrombotic drugs

A

Antiplatelet drugs - aspirin, clopidogrel, prasugrel, ticagrelor
Anticoagualnts - heparin and fondaparinux (subcutaneously), warfarin, rivaroxaban, dabigatran, edoxaban (oral)
Fibrinolytics - streptokinase, tPA

47
Q

Antiplatlet agents

A

All prevent new thrombosis
Aspirin, clopidogrel, ticagrelor, prasugrel
Used in: angina, acute MI, CVA/TIA, patients at risk of MI & CVA

48
Q

Side effects of antiplatelet agents

A

Haemorrhage anywhere
Peptic ulcer -> haemorrhage
Aspirin sensitivity -> asthma

49
Q

Anticoagulants

A

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
Q

Fibrinolytic drugs

A

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
Q

When to avoid fibrinolytic drugs

A

Recent haemorrhage (some CVAs)
Trauma
Bleeding tendencies
Severe diabetic retinopathy
Peptic ulcer

52
Q

Fibrinolytic drugs side effects

A

Serious risk of haemorrhage

53
Q

Anti arrhythmic drugs

A

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
Q

Heart failure drugs

A

ACE inhibitors
ARBs
Beta-blockers
Mineralocorticoid antagonists (spironolactone, eplerenone)
Neprilysin inhibitors (salcubitril valsartan)
Sglt2 inhibitors (dapagliflozin/empagliflozin)
Diuretics
Digoxin

55
Q

Digoxin (two effects)

A

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
Q

Digoxin toxicity side effects

A

Nausea, vomiting
Yellow vision
Bradycardia, heart block
Ventricular arrhythmias

57
Q

Neprilysin inhibitors

A

ARB and endopeptidase inhibitor
Example: salcubitril valsartan

Superior/better than ACEI or ARB

58
Q

Neprilysin inhibitor side effects

A

Hypotension
Renal impairment
Hyperkalaemia
Angioneurotic oedema

59
Q

Sblt2 inhibitors

A

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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