Cardiovascular Drugs Flashcards
1
Q
what are the ABCD hypertension drugs
A
acelnhib, beta blocker, C channel blocker, Diuretics
2
Q
what are some example of ACE inhibitors (ACEi)
A
ramipril, lisinopril, perindopril
3
Q
what are the main indications of ACE inhibitors
A
- ypertension - first line
- Heart failure
- Secondary prevention after MI
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
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
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
7
Q
administration of ACE inhibitors
A
PO (bedtime)
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
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
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
11
Q
adverse side effects of amiodarone
A
- Corneal microdeposits
- Hypokalaemia
- Hepatic disorders
- Hyperthyroidism
- Respiratory disorders
- Phototoxic → skin reactions
12
Q
administration of amiodarine
A
PO or IV
13
Q
main indication of atropine
A
bradycardia
14
Q
mechanism of action of atropine
A
Binds to and inhibit muscarinic acetylcholine receptors, producing a wide range of anticholinergic effects, inc HR
15
Q
Contraindications and cautions of atropine
A
- Acute MI
- Arrhythmias
- Tachycardia
- Heart failure
- Coronary artery disease
- Hypertension
- Hyperthyroidism
16
Q
adverse effects of atropine
A
- Dry mouth
- Dizziness
- Blurred vision
- Nausea
17
Q
administration of atropine
A
PO or IV
18
Q
main indication of aspirin
A
- Main antiplatelet agent (arterial thrombosis)
- ACS
- Ischaemic stroke
- Thromboprophylaxis in patients at high cardiovascular risk (MI)
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)
20
Q
Contraindications and cautions of aspirin
A
Avoid in active peptic ulceration and bleeding disorders
21
Q
adverse effects of aspirin
A
GI bleeding and ulceration
22
Q
administration of aspirin
A
PO
23
Q
examples of Angiotensin receptor blockers (ARBs)
A
losartan, valsartan
24
Q
Main indications of angiotensin
A
- Hypertension
- Post-MI
- Heart failure - when ACEi not tolerated (dry cough)
25
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
26
Contraindications and cautions of angiotensin
Contraindicated in pregnancy/planning to become pregnant
27
adverse effects of angiotensin
- Dizziness (postural hypertension)
- Hyperkalaemia (high potassium level in blood)
- Localised angioedema
28
administration of angiotensin
PO or IV
29
examples of ⍺ blockers
doxazosin
30
main indication of ⍺ blockers
Confirmed resistant hypertension
31
mechanism of action of ⍺ blockers
Block ⍺ adrenoceptors to cause vasodilation
32
contradiction and caution of ⍺ blockers
Contraindicated if patient has a history of postural hypotension
33
adverse effects of ⍺ blockers
- Dizziness (postural hypotension)
- Hyperkalaemia
- Localised angioedema
34
administration of ⍺ blockers
PO
35
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
36
what is the main indication of non-selective β-blockers eg propranolol, carvedilol
- Block β1 and β2 receptors
- Used in thyrotoxicosis, migraine
37
mechanism of action of β-blockers
Competitive inhibition of B1 only/ B1 and 2 adrenergic receptors - lowers the heart rate and blood pressure
38
Contraindications and cautions of β-blockers
- Contraindicated in ‘brittle’ asthma
- Can worsen heart failure in short term (especially cardiogenic shock)
39
Adverse effects of β-blockers
- Tiredness
- Cold peripheries
40
Administration of β-blockers
- PO
41
main indication of bile binding resins
- Hyperlipidaemia
- (also for jaundice itch - GI)
42
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
43
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
44
administration of bile binding resins
PO
45
adverse effects of bile binding resins
GI tract irritation
46
Ca2+ antagonists (CCB)
47
indications of Dihydropydines Ca2+ antagonists (CCB) (eg amlodipine)
Used in hypertension and angina
48
Rate limiting calcium antagonists Ca2+ antagonists (CCB) (e.g. verapamil, diltiazem)
Used in hypertension, angina and supraventricular arrhythmias (AF, SVT – to slow HR)
49
Mechanism of action of Ca2+ antagonists (CCB)
Interfere with inward displacement of Ca2+ ions through slow channels of active cell membranes
50
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
51
side effects of Ca2+ antagonists (CCB)
- Dizziness
- Flushing
- Headache
- Nausea
- Dihydropydines - ankle oedema
52
administration of Ca2+ antagonists (CCB)
PO
53
Clopidogrel Main indications
- Thromoprophylaxis in patients intolerant to asprin
- ACS (When combined with aspirin has a synergistic action)
54
Mechanism of action ofClopidogrel
- Inhibits P2Y12 receptors (stops ADP binding)
55
Contraindications and cautions of Clopidogrel
- Patients at increased risk of bleeding, peptic ulcer etc.
56
Adverse effects Clopidogrel
- GI bleeding and ulceration
57
administration of Clopidogrel
PO
58
main indication of Digoxin
- Heart failure
- Arrhythmias
- Hypertension (fourth line)
58
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
59
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)
60
side effects of Digoxin
- Heart block
- Arrhythmias
- N+V
- Diarrhoea
- Disturbances of colour vision
61
administration of Digoxin
IV
62
