Cardiovascular Drugs Flashcards
How many people are living with heart and circulatory diseases in scotland?
Around 700,000
What % of scottish deaths is caused by heart and circulatory diseases?
29% - 50 people each day
What does the healing process of atherosclerosis entail?
- Activation of platelets
- Inflammatory cells - incorporation of cholesterol
- Fibrous cap
What are antiplatelets used as?
Secondary prevention (i.e after cardiovascular disease is diagnosed)
How is aspirin (antiplatelets) administered ?
75mg - To all patients with stable angina
75 - 150mg - To previous Coronary artery bypass graft
300mg - First two weeks after a stroke or Transient
ischaemic attack
How is clopidogrel (antiplatelet) administered?
75mg - TIA/stroke patients after the initial acute phase of treatment
In combination with aspirin - following percutaneous coronary intervention in stable patient.
How is ticagrelor(antiplatelets) administered?
90mg 2x/day used in combination with aspirin in all patients with Acute coronary syndrome for upto 1 year in NHSG
What are the side effects of antiplatelets?
Bleeding
Roughly 0.25 to 1% annual risk of a significant bleed with a single agent
Synergistic effect when multiple agents used
Effect will last for up to 1 week
What do beta blockers do?
Reduce mortality in Ischemic heart disease and heart failure
Reduce frequency of symptomatic attacks of angina, Atrial fibrilation and Supraventricular tachycardia
Antihypertensive (2nd line now) - (multiple mechanisms of action both central and peripheral).
What are beta 1 receptors?
Predominant receptor in the heart - Sinoatrial, Atrioventricular nodes and myocardial cells.
What organ reduces secretion of renin?
Kidneys
What are the positive effects of beta 1 receptors?
Slows heart rate and conduction (negatively chronotropic (and dromotropic)), increases diastolic time
Reduces BP
Anti-arrhythmic protects heart from effects of catecholamines
What are the negative effects of beta 1 receptors?
Reduces contractility (negatively inotropic), high doses can lead to bradycardia and heart block
What are beta 2 receptors?
Present in Smooth muscle e.g airways, vascular
Present in Skeletal muscle
Present on myocardial cells
What are the positive effects of beta 2 receptors?
Reduces tremor
What are the negative effects of beta 2 receptors?
Bronchospasm in asthmatic
Vasoconstriction in Peripheral vascular disease.
Example of beta 1 blockers
Bisoprolol
Atenolol
Carvediol
Metoprolol
Example of beta 1 and beta 2
Propanolol
Renin-angiotensin-aldosterone axis is a central hormonal axis that aids to the development of ___________
Heart failure
Liver failure
Kidney failure
What does Renin-angiotensin-aldosterone axis do?
Preserves circulating volume to maintain perfusion of the vital organs.
Why is renin enzyme released by the kidney?
In response to reduction in perfusion pressure.
Where is ACE Endothelial enzyme found predominantly in?
The lungs
What is angiotensinogen produced by?
Liver
What does renin convert angiotensinogen to?
Angiotensin 1
What does ACE convert angiotensin 1 to?
Angiotensin II
What does angiotensin II act on?
It acts on the adrenals releasing aldosterone
What do ACE inhibitors and angiotensin receptor antagonists do?
They are antihypertensive - First line in under 55 white/asian patient NICE 127
They reduce symptoms in heart failure
They prevent aberrant remodelling following Myocardial infarction
They reduce mortality and progression of disease in IHD, CVD and renal disease with proteinuria (particularly diabetic nephropathy)
What does Angiotensin II do?
It acts as a potent vasoconstrictor in the peripheral vasculature
It regulates the function of the efferent arteriole of the glomerulus in the kidney
What does Aldosterone do?
Plays a role in Retention of Na ( and therefore H2O) at the expense of K in the DCT of the Kidneys (sweat glands, Gut)
What are the positive effects of ACE inhibitors and ARBS?
Reduce blood pressure
Reduce afterload on heart
Prevents aberrant remodelling after MI
Reduces proteinuria
What are the negative effects of ACE inhibitors and ARBS?
Reduces perfusion pressure in glomerulus leading to renal impairment
Hyperkalaemia via effect on aldosterone levels: cough, orthostatic hypotension
What are examples of ACE inhibitors?
Ramipril
Lisinopril
Captopril
Perindopril
