Cardiovascular Drugs Flashcards
what are the ABCD hypertension drugs
acelnhib, beta blocker, C channel blocker, Diuretics
what are some example of ACE inhibitors (ACEi)
ramipril, lisinopril, perindopril
what are the main indications of ACE inhibitors
- ypertension - first line
- Heart failure
- Secondary prevention after MI
what is the mechanism of action of ACE inhibitors
- 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
what are the contradictions and cautions of ACE inhibitors
- 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
what are the adverse side effects if ACE inhibitors
- Persistent dry cough
- Renal dysfunction
- Angioedema
= swelling of the deeper layers of the skin, caused by a build-up of fluid
administration of ACE inhibitors
PO (bedtime)
main indications of amiodarone
- Arrhythmias, particularly when other drugs are ineffective or contra-indicated
- Atrial fibrillation, atrial flutter
- Ventricular fibrillation or pulseless ventricular tachycardia refractory to defibrillation
Mechanism of action of amiodarone
- 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
Contraindications and cautions of amiodarone
- Contraindicated in heart block, bradycardia, thyroid dysfunction and hypokalaemia
- Avoid injection in cardiomyopathy; congestive heart failure; severe respiratory or heart failure
adverse side effects of amiodarone
- Corneal microdeposits
- Hypokalaemia
- Hepatic disorders
- Hyperthyroidism
- Respiratory disorders
- Phototoxic → skin reactions
administration of amiodarine
PO or IV
main indication of atropine
bradycardia
mechanism of action of atropine
Binds to and inhibit muscarinic acetylcholine receptors, producing a wide range of anticholinergic effects, inc HR
Contraindications and cautions of atropine
- Acute MI
- Arrhythmias
- Tachycardia
- Heart failure
- Coronary artery disease
- Hypertension
- Hyperthyroidism
adverse effects of atropine
- Dry mouth
- Dizziness
- Blurred vision
- Nausea
administration of atropine
PO or IV
main indication of aspirin
- Main antiplatelet agent (arterial thrombosis)
- ACS
- Ischaemic stroke
- Thromboprophylaxis in patients at high cardiovascular risk (MI)
mechanism of action of aspirin
Irreversibly blocks cyclooxygenase (COX) in platelets - inhibits TXA2 synthesis and also inhibits production of antithrombotic prostaglandin I2 (PGI2)
Contraindications and cautions of aspirin
Avoid in active peptic ulceration and bleeding disorders
adverse effects of aspirin
GI bleeding and ulceration
administration of aspirin
PO
examples of Angiotensin receptor blockers (ARBs)
losartan, valsartan
Main indications of angiotensin
- Hypertension
- Post-MI
- Heart failure - when ACEi not tolerated (dry cough)
mechanism of action of angiotensin
- 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
Contraindications and cautions of angiotensin
Contraindicated in pregnancy/planning to become pregnant
adverse effects of angiotensin
- Dizziness (postural hypertension)
- Hyperkalaemia (high potassium level in blood)
- Localised angioedema
administration of angiotensin
PO or IV
examples of ⍺ blockers
doxazosin
main indication of ⍺ blockers
Confirmed resistant hypertension
mechanism of action of ⍺ blockers
Block ⍺ adrenoceptors to cause vasodilation
contradiction and caution of ⍺ blockers
Contraindicated if patient has a history of postural hypotension
adverse effects of ⍺ blockers
- Dizziness (postural hypotension)
- Hyperkalaemia
- Localised angioedema
administration of ⍺ blockers
PO
what is the main indication of cardioselectuve β-blockers eg atenolol, bisoprolol
- Only block β1 receptors
- Used in angina, acute coronary syndrome, MI, hypertension and heart failure
what is the main indication of non-selective β-blockers eg propranolol, carvedilol
- Block β1 and β2 receptors
- Used in thyrotoxicosis, migraine
mechanism of action of β-blockers
Competitive inhibition of B1 only/ B1 and 2 adrenergic receptors - lowers the heart rate and blood pressure
Contraindications and cautions of β-blockers
- Contraindicated in ‘brittle’ asthma
- Can worsen heart failure in short term (especially cardiogenic shock)
Adverse effects of β-blockers
- Tiredness
- Cold peripheries
Administration of β-blockers
- PO
main indication of bile binding resins
- Hyperlipidaemia
- (also for jaundice itch - GI)
Mechanism of action of bile binding resins
- 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
Contraindications and cautions of bile binding resins
- Can interfere with the absorption of fat-soluble vitamins - vitamin supplements may be required if treatment is prolonged
administration of bile binding resins
PO
adverse effects of bile binding resins
GI tract irritation
Ca2+ antagonists (CCB)
indications of Dihydropydines Ca2+ antagonists (CCB) (eg amlodipine)
Used in hypertension and angina
Rate limiting calcium antagonists Ca2+ antagonists (CCB) (e.g. verapamil, diltiazem)
Used in hypertension, angina and supraventricular arrhythmias (AF, SVT – to slow HR)
Mechanism of action of Ca2+ antagonists (CCB)
Interfere with inward displacement of Ca2+ ions through slow channels of active cell membranes
Contraindications and cautions of Ca2+ antagonists (CCB)
- 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
side effects of Ca2+ antagonists (CCB)
- Dizziness
- Flushing
- Headache
- Nausea
- Dihydropydines - ankle oedema
administration of Ca2+ antagonists (CCB)
PO
Clopidogrel Main indications
- Thromoprophylaxis in patients intolerant to asprin
- ACS (When combined with aspirin has a synergistic action)
Mechanism of action ofClopidogrel
- Inhibits P2Y12 receptors (stops ADP binding)
Contraindications and cautions of Clopidogrel
- Patients at increased risk of bleeding, peptic ulcer etc.
Adverse effects Clopidogrel
- GI bleeding and ulceration
administration of Clopidogrel
PO
main indication of Digoxin
- Heart failure
- Arrhythmias
- Hypertension (fourth line)
mechanism of action of Digoxin
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
Contraindications and cautions of Digoxin
- 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)
side effects of Digoxin
- Heart block
- Arrhythmias
- N+V
- Diarrhoea
- Disturbances of colour vision
administration of Digoxin
IV
