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cardio pharmacology > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

what are the ABCD hypertension drugs

A

acelnhib, beta blocker, C channel blocker, Diuretics

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2
Q

what are some example of ACE inhibitors (ACEi)

A

ramipril, lisinopril, perindopril

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3
Q

what are the main indications of ACE inhibitors

A
  • ypertension - first line
  • Heart failure
  • Secondary prevention after MI
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4
Q

what is the mechanism of action of ACE inhibitors

A
  • ACE inhibitors competitively inhibit the angiotensin converting enzyme (ACE), and blocks generation of angiotensin-II, and also aldosterone
  • Thisreduces sodium and water retention
  • Reduced tissue concentration of angiotensin-II also → arterial and venous dilation
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5
Q

what are the contradictions and cautions of ACE inhibitors

A
  • Afro-Caribbean’s do not respond well - CCBs first line instead
  • May lower blood glucose in diabetics
  • Contraindicated in pregnancy
  • Be careful when used in combination with other drugs that can increase potassium e.g. thiazide-like diuretics, potassium-sparing diuretics
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6
Q

what are the adverse side effects if ACE inhibitors

A
  • Persistent dry cough
  • Renal dysfunction
  • Angioedema
    = swelling of the deeper layers of the skin, caused by a build-up of fluid
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7
Q

administration of ACE inhibitors

A

PO (bedtime)

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8
Q

main indications of amiodarone

A
  • Arrhythmias, particularly when other drugs are ineffective or contra-indicated
  • Atrial fibrillation, atrial flutter
  • Ventricular fibrillation or pulseless ventricular tachycardia refractory to defibrillation
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9
Q

Mechanism of action of amiodarone

A
  • Class III anti-arrhythmic - blocks K+channels therefore prolonging the refractory period
  • Also effective at blocking Na+, having a high affinity for inactivated channels
  • Anti-adrenergic effects by non-competitively blocking α and β receptors
  • Also has weak Ca2+blocking effect
  • Slows down the sinus rate and AV conduction, and slightly prolongs the QT interval
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10
Q

Contraindications and cautions of amiodarone

A
  • Contraindicated in heart block, bradycardia, thyroid dysfunction and hypokalaemia
  • Avoid injection in cardiomyopathy; congestive heart failure; severe respiratory or heart failure
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11
Q

adverse side effects of amiodarone

A
  • Corneal microdeposits
  • Hypokalaemia
  • Hepatic disorders
  • Hyperthyroidism
  • Respiratory disorders
  • Phototoxic → skin reactions
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12
Q

administration of amiodarine

A

PO or IV

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13
Q

main indication of atropine

A

bradycardia

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14
Q

mechanism of action of atropine

A

Binds to and inhibit muscarinic acetylcholine receptors, producing a wide range of anticholinergic effects, inc HR

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15
Q

Contraindications and cautions of atropine

A
  • Acute MI
  • Arrhythmias
  • Tachycardia
  • Heart failure
  • Coronary artery disease
  • Hypertension
  • Hyperthyroidism
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16
Q

adverse effects of atropine

A
  • Dry mouth
  • Dizziness
  • Blurred vision
  • Nausea
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17
Q

administration of atropine

A

PO or IV

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18
Q

main indication of aspirin

A
  • Main antiplatelet agent (arterial thrombosis)
  • ACS
  • Ischaemic stroke
  • Thromboprophylaxis in patients at high cardiovascular risk (MI)
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19
Q

mechanism of action of aspirin

A

Irreversibly blocks cyclooxygenase (COX) in platelets - inhibits TXA2 synthesis and also inhibits production of antithrombotic prostaglandin I2 (PGI2)

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20
Q

Contraindications and cautions of aspirin

A

Avoid in active peptic ulceration and bleeding disorders

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21
Q

adverse effects of aspirin

A

GI bleeding and ulceration

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22
Q

administration of aspirin

A

PO

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23
Q

examples of Angiotensin receptor blockers (ARBs)

A

losartan, valsartan

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24
Q

Main indications of angiotensin

A
  • Hypertension
  • Post-MI
  • Heart failure - when ACEi not tolerated (dry cough)
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25
Q

mechanism of action of angiotensin

A
  • Competitively inhibits the binding of angiotensin II to AT1 in many tissues including vascular smooth muscle and the adrenal glands
  • Causes vasodilation and blockage of aldosterone release
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26
Q

Contraindications and cautions of angiotensin

A

Contraindicated in pregnancy/planning to become pregnant

27
Q

adverse effects of angiotensin

A
  • Dizziness (postural hypertension)
  • Hyperkalaemia (high potassium level in blood)
  • Localised angioedema
28
Q

administration of angiotensin

A

PO or IV

29
Q

examples of ⍺ blockers

A

doxazosin

30
Q

main indication of ⍺ blockers

A

Confirmed resistant hypertension

31
Q

mechanism of action of ⍺ blockers

A

Block ⍺ adrenoceptors to cause vasodilation

32
Q

contradiction and caution of ⍺ blockers

A

Contraindicated if patient has a history of postural hypotension

33
Q

adverse effects of ⍺ blockers

A
  • Dizziness (postural hypotension)
  • Hyperkalaemia
  • Localised angioedema
34
Q

administration of ⍺ blockers

A

PO

35
Q

what is the main indication of cardioselectuve β-blockers eg atenolol, bisoprolol

A
  • Only block β1 receptors
  • Used in angina, acute coronary syndrome, MI, hypertension and heart failure
36
Q

what is the main indication of non-selective β-blockers eg propranolol, carvedilol

A
  • Block β1 and β2 receptors
  • Used in thyrotoxicosis, migraine
37
Q

mechanism of action of β-blockers

A

Competitive inhibition of B1 only/ B1 and 2 adrenergic receptors - lowers the heart rate and blood pressure

38
Q

Contraindications and cautions of β-blockers

A
  • Contraindicated in ‘brittle’ asthma
  • Can worsen heart failure in short term (especially cardiogenic shock)
39
Q

Adverse effects of β-blockers

A
  • Tiredness
  • Cold peripheries
40
Q

Administration of β-blockers

A
  • PO
41
Q

main indication of bile binding resins

A
  • Hyperlipidaemia
  • (also for jaundice itch - GI)
42
Q

Mechanism of action of bile binding resins

A
  • Cause the excretion of bile salts, resulting in more cholesterol to be converted to bile salts by interrupting enterohepatic recycling
  • Prevent the reabsorption of bile salts (normally nearly all are reabsorbed)
  • Causes decreased absorption of TAGs and increased LDL receptor expression
43
Q

Contraindications and cautions of bile binding resins

A
  • Can interfere with the absorption of fat-soluble vitamins - vitamin supplements may be required if treatment is prolonged
44
Q

administration of bile binding resins

A

PO

45
Q

adverse effects of bile binding resins

A

GI tract irritation

46
Q

Ca2+ antagonists (CCB)

A
47
Q

indications of Dihydropydines Ca2+ antagonists (CCB) (eg amlodipine)

A

Used in hypertension and angina

48
Q

Rate limiting calcium antagonists Ca2+ antagonists (CCB) (e.g. verapamil, diltiazem)

A

Used in hypertension, angina and supraventricular arrhythmias (AF, SVT – to slow HR)

49
Q

Mechanism of action of Ca2+ antagonists (CCB)

A

Interfere with inward displacement of Ca2+ ions through slow channels of active cell membranes

50
Q

Contraindications and cautions of Ca2+ antagonists (CCB)

A
  • CCBs, especially rate limiting CCBs, should not be administererd to patients being treated with a β-blocker
    • β-blockers also depress cardiac electrical and mechanical activity and therefore the addition of a CCB augments the effects of β-blockade
51
Q

side effects of Ca2+ antagonists (CCB)

A
  • Dizziness
  • Flushing
  • Headache
  • Nausea
  • Dihydropydines - ankle oedema
52
Q

administration of Ca2+ antagonists (CCB)

A

PO

53
Q

Clopidogrel Main indications

A
  • Thromoprophylaxis in patients intolerant to asprin
  • ACS (When combined with aspirin has a synergistic action)
54
Q

Mechanism of action ofClopidogrel

A
  • Inhibits P2Y12 receptors (stops ADP binding)
55
Q

Contraindications and cautions of Clopidogrel

A
  • Patients at increased risk of bleeding, peptic ulcer etc.
56
Q

Adverse effects Clopidogrel

A
  • GI bleeding and ulceration
57
Q

administration of Clopidogrel

A

PO

58
Q

main indication of Digoxin

A
  • Heart failure
  • Arrhythmias
  • Hypertension (fourth line)
58
Q

mechanism of action of Digoxin

A

Inhibits the Na-K-ATPase membrane pump, resulting in an increase in intracellular sodium and calcium -

increasing contraction of muscles and reducing conduction of the AV node

59
Q

Contraindications and cautions of Digoxin

A
  • Narrow therapeutic index
    • Too much - AV delay will be too long causing brachycardia and heart block
    • Increases ventricular irritability which produces ventricular arrhythmias (always bad)
    • Overdose - digoxin toxicity (N+V, yellow vision, headache)
60
Q

side effects of Digoxin

A
  • Heart block
  • Arrhythmias
  • N+V
  • Diarrhoea
  • Disturbances of colour vision
61
Q

administration of Digoxin

A

IV

62
Q
A

cardio pharmacology (2 decks)

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