Cardiovascular Drugs Flashcards by A F

Function of statins

Reduce high cholesterol

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Function of fibrates

Lower triglyceride levels and can increase HDL cholesterol levels

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Function of PCSK 9 inhibitors

Inhibit PCSK 9 binding to LDL receptors and highly reduce cholesterol levels

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Diuretics

Inhibit sodium reabsorption in the kidneys

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Beta blockers

Reduce blood pressure by blocking the effects of adrenaline

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Calcium-channel blockers

Vasodilator, prevents Ca++ from entering the heart and vessels

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Alpha blockers

Vasodilator, block alpha-adrenoceptors in the sympathetic nervous system

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Mineralocorticoid antagonists

Vasodilator (diuretic), block aldosterone receptors, which promote sodium reabsorption

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Nitrates

Vasodilator

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Nicorandil

Vasodilator, potassium ATP channel activator -> increases blood flow to heart

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Ivabradine

Slows down heart rate, funny (If) channel modulator in the sinus node

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Ranolazine

Decrease Ca++ load on heart, metabolic modulator, late Na+ channel modulator

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Anti-platelets

Anti-thrombotic effect

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Anti-coagulants

Prevent new thrombosis

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Fibrinolytic drugs

Dissolve blood clots

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Digoxin

Anti-arrhythmic drug

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Neprilysin inhibitors

Anti-arrhythmic drug

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What is the first line treatment for patients under 55 y/o in hypertension?

ACE inhibitor or angiotensin ll receptor blocker (ARB)

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What is the first line treatment for patients of African or Caribbean family origin of any age or white individuals over 55 y/o?

Calcium-channel blockers

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What is the second line treatment for hypertensive patients?

ACE/ARB inhibitor and calcium-channel blockers

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What is the third line treatment for hypertensive patients?

ACE/ARB inhibitors, calcium-channel blockers and thiazide-like diuretic

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If hypertensive patients don’t respond to third line treatment either (resistant hypertension) what is the treatment?

ACE/ARB inhibitors, calcium channel blockers, thiazide-like diuretic and consider further diuretic or alpha-blocker or beta-blocker and consider seeking expert advice

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What is the general therapy in acute myocardial infarction?

MONA+C
Morphine (plus anti-emetic i.e. metoclopramide or cyclizine)
Oxygen (pulse ox>90% class l)
Nitroglycerin (SL GTN x3 for ischaemic pain)
Aspirin 300mg + clopidogrel 600mg (alternatives will be ticagrelor or prasugrel)

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Examples of statins

Simvastatin, atorvastain, fluvastatin, pravastatin, rosuvastatin

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What are statins used to treat?

Coronary heart disease Hypercholesterolaemia Those at risk of heart disease and stroke and angina/MI Diabetics

What are side effects of statins?

Myalgia, rhabdomyolysis, renal failure liver failure, hyperglycaemia, nausea, digestive problems, sore throat, nosebleeds, rhinitis, headache

Examples of fibrates

Bezafibrate, fenofibrate, gemfibrozil

What are fibrates used to treat?

``` Coronary heart disease Diabetics Those who don't cope well with statins Those will low HDL levels Hypertriglyceridaemia ```

What are side effects of fibrates?

Nausea, stomach upset, sometimes diarrhoea, muscle damage if used in conjunction with statins, liver irritation

Examples of PCSK 9 inhibitors

Evolocumab, alirocumab

What are PCSK 9 inhibitors used to treat?

Familial hypercholesterolaemia Severe hypercholesterolaemia Coronary heart failure

What are side effects of PCSK 9 inhibitors?

Injection-site swelling, rash, limb pain, fatigue, muscle pain, eye-related events

What are the two types of diuretics?

Thiazide diuretics, loop diuretics

What's the difference between thiazide diuretics and loop diuretics?

Thiazide diuretics are milder and used in hypertension whereas loop diuretics are stronger and used in heart failure

Examples of thiazide diuretics

Bendrofluazide

Examples of loop diuretics

Furosemide

What are some side effects of diuretics?

``` Hypokalaemia Hyperglycaemia Tiredness Arrhythmias Increase uric acid levels -> gout Impotence ```

What are thiazide diuretics used for?

These are milder and used in hypertension

What are loop diuretics used for?

These are stronger and use din heart failure

What are the two types of beta blockers?

Cardio-selective B1-blockers and non-selective B-blockers

Examples of cardio-selective B1-blockers

Atenolol, bisoprolol

Examples of non-selective B-blockers

Propanolol, carvedilol

What are cardio-selective B1-blockers used for?

``` Angina Acute coronary syndrome Myocardial infarction Hypertension Heart failure ```

What are non-selective B-blockers used for?

Thyrotoxicosis | Migraine

What are side effects of beta blockers?

``` Heart attack (in severe/brittle asthma) Block signs like tachycardia (in diabetics) Tiredness Heart failure (in the short term) Cold peripheries Cardiogenic shock ```

What are the two types of calcium-channel blockers?

Dihydropyridines and rate-limiting calcium antagonists

Examples of dihydropyridines

Amlodipine

Examples of rate-limiting calcium antagonists

Verapamil, diltiazem

What are dihydropyridines (calcium-channel blockers) used for?

Hypertension | Angina

What are side effects of dihydropyridines (calcium-channel blockers)?

Ankle angina

What are rate-limiting calcium antagonists (calcium channel blockers) used to treat?

Hypertension Angina Supraventricular arrhythmias (AF, SVT) Arrhythmias

What are the side effects of rate-limiting calcium antagonists (calcium-channel blockers)?

Avoid in use with beta blockers

Examples of ACE inhibitors

Lisinopril, ramipril, captopril, benazepril, enalapril, fosinpril

What are ACE inhibitors used to treat?

Hypertension Heart failure Good for kidneys in diabetic nephropathy but bad for the kidneys in renal artery stenosis

What are side effects of ACE inhibitors?

Cough, renal dysfunction, angioneurotic oedema, never used in pregnancy-induced hypertension

Examples of ARBs

Losartan

What are ARBs used to treat?

Hypertension Heart failure Good for kidneys in diabetic nephropathy but bad for the kidneys in renal artery stenosis

What are side effects of ARBs?

Renal dysfunction, angioneurotic oedema, never used in pregnancy-induced hypertension

Examples of alpha blockers

Doxazosin

What are alpha blockers used to treat?

Hypertension | Prosthetic hypertrophy

What are side effects of alpha blockers?

Postural hypotension

Examples of mineralocorticoid antagonists

Spironolactone, eplerenone

What are mineralocorticoid antagonists used to treat?

Resistant hypertension | Heart failure

What are side effects of mineralocorticoid antagonists?

Gynaecomastia, hyperkalaemia, renal impairment

Examples of nitrates

GTN spray, isosorbide

What are nitrates used to treat?

Angina Acute heart failure Coronary artery disease

What are side effects of nitrates?

Headache, hypotension/collapse

What is nicorandil used to treat?

Coronary artery disease

What are side effects of nicorandil?

Headache, ulcers in the mouth and GI tract

What is ivabradine used to treat?

Tachycardia | Slows down heart rate but not in AF

What are side effects of ivabradine?

Visual disturbance

What is ranolazine used to treat?

Refractory angina (slows down heart rate)

What are side effects of ranolazine?

Dizziness, nausea, headache, constipation, vomiting

Examples of anti-platelets

Asprin, clopidogrel, prasugrel, ticagrelor

What are anti-platelets used to treat?

``` Angina Acute MI Plaque rupture Stroke TIA ```

What are side effects of anti-platelets?

Haemorrhage, aspirin-sensitive asthma (rarely), peptic ulcer

Examples of anti-coagulants

Heparin (IV use only), warfarin (oral use only), rivaroxaban, dabigatran

What are anti-coagulants used to treat?

DVT PE NSTEMI AF

What are side effects of anti-coagulants?

Haemorrhage

Examples of fibrinolytic drugs

Streptokinase, tissue plasminogen activator (t-PA)

What are fibrinolytic drugs used to treat?

STEMI PE (sometimes) Stroke (sometimes)

What are side effects of fibrinolytic drugs?

Haemorrhage (serious risk, particularly after surgery, trauma, bleeding tendencies, severe diabetic retinopathy and peptic ulcer)

What is digoxin used to treat?

Heart failure | AF

What are side effects of digoxin?

Nausea, vomiting, yellow vision, bradycardia, heart block, ventricular arrhythmias

Examples of neprilysin inhibitors

Salcubitril valsartan, ARB, endopeptidase inhibitor

What are neprilysin inhibitors used to treat?

What are side effects of neprilysin inhibitors?

Hypotension, renal impairment, hyperkalaemia, angioneurotic oedema