Cardiovascular Drugs 2 Flashcards
What are examples of Angiotensin receptor blockers?
Losartan
Candersartan
What are the examples of aldosterone antagonists?
Spironolactone and Eplenerone - Used in heart failure (frequently coprescribed with ACE/ARB).
Spiro sometimes used in hypertension.
What do aldosterone antagonists do?
Enhanced diuretic effect, vasodilation
Reduces mortality in IHD and heart failure
What are the side effects of aldosterone antagonists?
Renal impairment
Hyponatraemia
Hyperkalaemia
Gynaecomastia (spiro > eplenerone)
NSAIDS should be used with extreme caution - marked hyperkalaemia seen if AKI occurs.
What are entresto?
Combination of valsartan and sacubitril
What are sacubitril?
Neprilysin inhibitor
What do sacubitril do?
Inhibits breakdown natriuretic peptides e.g ANP and BNP (and bradykinins)
Increase diuresis, natriuresis and vasodilation
Indicated in symptomatic chronic HF with reduced ejection fraction
Why should sacubitril not be co prescribed with ACE inhibitor?
Increased risk of angiodema (allow 36 hour washout period between medication)
What are calcium channel blockers?
Antihypertensive agent
What conditions does calcium channel blockers reduce symptoms for?
Angina - both dihydropyridine and non-dihydropyridine
AF/SVT - Non-dihydropyridine only
What do dihydropyridine(calcium channel blockers) do?
Block calcium entry into smooth muscle
Cause vasodilation
Less effect on myocardial pacemaking tissue
What are examples of dihydropyridine?
Amlodipine
Felodipine
Nifedipine
What are the side effects of dihydropyridine?
Postural hypotension
Peripheral oedema
Tachycardia (particularly short acting ones)
Rarely brachycardia (unless in overdose)
What do Non-dihydropyridine(calcium channel blockers) do?
Block calcium entry to smooth muscle
Block calcium entry in the myocardial pacemaking tissue
-Slow SA node function
-Slow AV conduction
What are examples of non-dihydropyridine?
Verapamil
Diltiazem
What are the side effects of non-dihydropyridine?
Bradycardia
Heart block (particularly if prescribed with beta blockers)
Postural hypotension
Peripheral oedema
What is the primary prevention of statins?
Reduce cardiovascular risk if pateints 10 year risk > 20%
What is secondary prevention of statins?
After cardiovascular event
What are examples of statins?
Simvastatin
Rosuvastatin
Atorvastatin
What do hydroxy-methyl-glutaryl Coenzyme A (HMGCoA) reductase inhibitor do?
Rate limiting step in production of cholesterol
What are the side effects of statins?
Muscle aches and pain but risk of myositis is low
Diuretics
Antihypertensive effects - thiazides
Symptomatic treatment in heart failure - generally loop diuretics eg. furosemide and bumetanide
Promote sodium and water loss in the kidney (also can lead to hypokalaemia)
How do thiazide diuretics act?
By blocking NaCl reabsorption in distal convoluted tubule of the kidney
-Mild diuretic effect
-Vasodilatory effect
What are examples of thiazide diuretics?
Indapamide
Bendroflumethiazide
What are the common side effects of thiazide diuretics?
Electrolyte disturbance (Low Na and K in particular but also Hypercalcaemia)
Hyperuricaemia (causing gout and increased cardiovascular risk)
Hyperglycaemia
Dehydration
Renal impairment
Orthostatic hypotension
How do loop diuretics act?
Act by blocking NaCl reabsorption in the ascending limb of the loop of Henle.
-Intense diuretic effect
-Pronounced vaso and venodilatory effect
What are examples of Loop diuretics?
Furosemide
Bumetanide
What are the common side effects of loop diuretics?
Electrolyte disturbance (Low K, Na and Mg and Ca)
Dehydration
Renal impairment
Orthostatic hypotension
Antihypertensives
Alpha (adrenoreceptor blockers)
- Cause peripheral vasodilation
- E.g doxasocin
Types of antianginals
Nitrates and Nicorandil
Nitrates
Short acting e.g GTN
Long acting eg isosorbide mononitrate
Directly act to cause vasodilation via nitric oxide
Headache and postural hypotension
Nb. Need to have nitrate free period
Nicorandil
Nitrate effect
K+ channel blocker
Vasodilation
Headache, postural hypotension and ulceration in GI tract.
