Cardiovascular Drugs Flashcards
ACE inhibitors
ATHLETICS
Examples: Ramipril, Lisinopril
A: ACE inhibitors inhibit ACE enzymes which converts angiotensin I to angiotensin II and therefore prevent the effects of angiotensin II and aldosterone. Overall prevent fluid retention and cause blood volume and pressure to be reduced. Dilate vasculature by decreasing arterial pressure, and decrease cardiac/vascular hypertrophy.
A (for patients): Ramipril is a type of drug called an ACE inhibitor. This drug works in the kidneys to lower the volume of the blood and therefore lowers the blood pressure. They also work to reduced the rate the heart beats at, which again will lower the blood pressure. ACE inhibitors can be used for high blood pressure, heart failure, or after a heart attack.
T: Taken in the morning
H: Take one tablet (1.25-2.5mg), first dose is usually taken at night due to postural hypotension
L: Lifelong medication unless changed by GP
E: …
T: U& E’s should be tested prior to starting Ramipril and will be monitored regularly in hepatic impairment.
I: Persistent Dry cough Hyponatraemia Hyperkalaemia Hypotension Renal artery stenosis
C: Dehydration, angioedema, impaired renal function
S: if unsuitable can switch to an ARB
ARB’s
- Example
- ATHLETICS
Examples: Candesartan, Losartan, Valsartan
A: ARB’s block angiotensin II receptor and therefore prevent the effects and angiotensin II and aldosterone. Overall prevent fluid retention and cause blood volume and pressure to be reduced.
T: Takes in the morning H: one tablet once daily (25-50mg) L: Lifelong E: .. T: Monitor plasma potassium I: Hypotension, Hyponatraemia, Hyperkalaemia, Headaches, Angioedema C: Pregnancy/Breastfeeding, Renal artery stenosis,
Beta blockers
- Examples
- ATHLETICS
Examples: Atenolol (B-1), Bisoprolol (B-1), Carvedilol (B-2), Sotalol (B-2), Propranolol (B-2)
A: Beta blockers bind to Beta-adrenoreceptors to block the binding of norepinephrine and epinephrine. They block either Beta-1 or Beta-2. They reduce the contractility of the heart and therefore reduce the blood pressure. Beta blockers are used in hypertension, angina, MI, arrhythmia’s, heart failure and migraines.
T: Taken in the morning
H: HTN = Once daily (25-50mg)
Angina = 1-2 divided doses (100mg)
Arrhythmia = Once daily (50-100mg)
L: Lifelong
E: ..
T: Monitor lung function in patients with obstructive airway disease
I: Hypotension
Bradycardia
Bronchospasm
Cold peripheries
Hyperglycaemia/ Hypoglycaemia
Tiredness
Impotence
C: A = Asthma (don't use B-2)
B = Bradycardia /Heart block
C = COPD (don't use B-2)
D = Diabetes
E = Electrolyte disturbances
Calcium channel blockers
- Examples
- ATHLETICS
Examples: Amlodipine, Nifedipine (Dihyrdopyridine)
Verapamil, Diltiazem (non-dihydropyridine)
A: Block Calcium channel on the vascular smooth muscle, cardiac myocytes and cardiac nodal tissue. This reduces contractility, heart rate and conduction velocity to relax the smooth muscle and decrease the heart rate. Used for hypertension, angina, AD, raynaud’s syndrome, and cluster headaches.
T: Taken in the morning
H; Amlodopine = Once daily (5-10mg) - HTN
Nifedipine = twice daily (10mg) - HTN
Verapamil = 3-4 divided doses (240-960mg) - HTN
Diltiazem = Twice Daily (120mg) - HTN
L = Lifelong
E = ..
T = …
I = Headaches, Dizziness, Flushing, Hypotension, Bradycardia, Oedema, Constipation
C: Non-dihydropyridines should be avoided if using Beta blockers, if bradycardic, if heart failure /conduction defect is present
Thiazide Diuretics
- Example
- ATHLETICS
Example: Bendroflumethiazide
A: Thiazide diuretics work on Na+/Cl- co-transporters in the DCT to increase Na+ and H2O excretion. This decreases preload and stroke volume, cardiac output and oedema, Used in hypertension, liver disease and mild heart failure
T: Take in the morning (avoid at night due to frequent urination)
H: Once daily (2.5mg)
L: Lifelong
E: ..
T: Electrolytes Monitored
I: Hypokalaemia, Hyperglycaemia, Hypotension, Hyponatraemia, Dehydration, polyuria, Metabolic acidosis
C: Liver conditions, Diabetes
Drug interactions: NSAID’s = decreased efficacy of diuretic, B-Blockers = hyperglycaemia, Corticosteroids - Hypokalaamia
Loop Diuretic
- Example
- ATHLETICS
Example: Furosemide
A: Loop diuretics work on the Na+/K+/Cl- transporter in the thick ascending limb. Results in increased Na+ and H2O excretion, to decrease preload, stroke volume, cardiac output and oedema.
T: Take in the morning
H: Once daily (40-80mg)
L: Lifelong
E: ..
T: Monitor electrolytes
I: Hyponatraemia, Hypokalaemia, Hypotension, Dehydration, Polyuria, ototoxicity, gout
C: Drug interactiosn = NSAID’s = decrease diuretic efficacy, B-Blockers = Hyperglycaemia, corticosteroids = Hypokalaemia
K+ sparing diuretics /Aldosterone antagonists
- Examples
- ATHLETICS
Examples: Spironolactone
A: Inhibits the actions of aldosterone. Therefore increases Na+ and H2O excretion, to reduce preload, stroke volume and oedema. Used in HTN (if other diuretics not suitable), in mod -severe heart failure
T: Taken in the morning
H: Once daily (25mg for HTN)
L: …
E: …
T: Monitor plasma-potassium concentration
I: Hyperkalaemia, arrhythmia, metabolic acidosis, gynaecomastia
C: Drug interactions: NSAID’s = decrease diuretic efficacy, ACE inhibitors = Hyperkalaemia
Aspirin
- ATHLETICS
A: aspirin is an anti-platelet and NSAID drug. It is a COX inhibitors that prevents platelet aggregation. It is used as secondary prevention for cardiovascular disease, and in the management of ACS, TIA, stroke, AF,
T:Taken in the morning
H: Once daily (300mg)
L: Lifelong
E: ..
T: …
I: risk of GI bleed, Reye’s syndrome, haemorrhage and bruising
C: active bleeding, bleedining disorder, caution in renal failure, avoid in hepatic impairments. Drug interactions = NSAID’s = Increase GI bleed risk further
Warfarin
- ATHLETICS
A; Warfarin is an anti-coagulant which inhibits the synthesis of blood coagulation factors, decreases the synthesis of Vitamin k and therefore inhibits vitamin K dependent factors (II, VII, IX, X)
T: Tablet taken once daily (usually in the evening)
H: ..
L: 3Months for DVT, 6 months for PE and lifelong for AF
E: 2-3 days
T: Start 5mg for 4 days and test INR on day 5 +8 and adjust dose accordingly.
Start concomitantly with LMWH if immediate effect is required
Regular INR check in clinic (regularity depends on stability of the INR)
I: Bleeding (1-2%), Diarrhoea, rash, hair loss, nausea
Drug interactions e.g. Steroids
C: Contraindicated in pregnancy, haemorrhagic stroke, significant bleeding or patients at high falls risk
S: avoid liver, spinach, cranberry juice, alcohol binges/ No NSAID’s/ASpiring
Given anticoagulant book
Heparin/ Dalteparin. Enoxoparin/Fondaparinux
ATHLETICS
A: These anticoagulatns activate anti-clotting factor (anti-thrombin III) and inhibit clotting factor II, IX, X XI
T: Taken once daily
H: Injection (subcutaneous or intravenous)
L: Length depends on reason for administration
E: Immediate
T: Test platelets before treatment and regularly if given for more than 4 days. Measure plasma- K+ concentration before taking regularly
I: Bleeding, thrombocytopenia, hyperkalaemia
C: Active bleeding, Bleeding disorder, risk of falss
S: Can be taken concomitantly with warfarin for immediate effects.
Statins
ATHLETICS
A: Statins work to reduce the level of cholesterol in the blood stream by stopping the production by the liver. Cholesterol is a predisposing factor for artery problems causing heart disease, stokes or kidney disease.
T: Taken in the evening (work more effectively)
H: Tablet (10-40mg)
L: Lifelong
E: Decreases risk over many years
T: Review in 4 weeks and then every 6mths. LFTs before starting, at 3 mths and 12 months.
I: Muscle pains, hair loss, itching, N+ V+ D + abdo pain
C: Rhamdomyolysis (damaged muscles breakdown rapidly), pregnancy
S: avoid grapefruit
Digoxin
ATHLETICS
A: T: H: L: E: T: I: C: S:
Nitrites
ATHLETICS
A: T: H: L: E: T: I: C: S
