Cardiovascular Drugs Flashcards
What are the two categories of drugs used in CV disease?
Drugs used to prevent further disease
Drugs used to manage symptoms of current CV disease
What drugs are used as a preventative measure for CV disease?
Anti platelet drugs
Anti-coagulation drugs
Anti-arrhythmia drugs - beta blockers and Ca channel blockers
Lipid lowering drugs - statins
Name the antiplatelet drugs used to prevent CV disease.
Aspirin
Clopidogrel
Prasugrel
What is the action of aspirin and how is this achieved?
Prevents platelet aggregation by ALTERING BALANCE between THROMBOXANE A2 and PROSTACYCLIN
Name the anticoagulation drugs used to prevent CV disease.
Warfarin
Apixaban
Rivaboxaban
Dabigatran
What does warfarin inhibit?
Factor 2, 7, 9, 10
Protein C
Protein S
How do you counteract the effects of warfarin?
Give patient vitamin K
What must you assume about a patient on Warfarin?
That all drugs interact
If a patient is taking anti-coagulants what drugs must the especially avoid?
NSAIDs
Name an example of a statin/lipid lowering drug.
Simvastiatin
What is the action on simvastatin?
Inhibits cholesterol SYNTHESIS in the liver
What is a property of simvastatin that makes it effective?
Prodrug - activated once metabolised in the liver.
What are the side effects of simvastatin/statins?
How is this managed?
Interacts with antifungals
and causes myositis (inflammation, weakness and ache of muscles)
Since statins work over a prolonged period of time they can be stopped whilst the antifungals are being taken and then restarted once the course of medication is finished.
Name examples of beta blockers. Are they selective or non-selective?
Atenolol - B1 selective
Propanolol - B1 and B2 non-selective
What are the actions of beta blockesr?
Preventative measure for arrhythmias.
Uses; B1 - blocks effects of adrenaline
Reduce excitability of cardiac muscle
Reduce the force of contraction.
What are the side effects of beta blockers?
Heart rate cannot speed up when required - prone to FAINTING and can cause POSTURAL HYPOTENSION.
Can WORSEN HEART FAILURE by reducing efficiency of the heart.
Non-selective BB can WORSEN ASTHMA - block receptors and prevent bronchodilation.
What drugs are used to manage current CV disease?
Diuretics
Anti- arrhythmia - Beta blockers
Ca channel blockers
ACE inhibitors
Nitrates
Name examples of diuretics.
Thiazide diuretics - bendroflumethiazide
Loop diuretics - frusemide
What are the actions of diuretics?
Anti-Hypertensive; via increasing salt and water loss and reducing plasma volume.
Reduce effects of heart failure by reducing the cardiac workload.
When are the side effects of diuretics?
Dry mouth (xerostomia) Gout - from lack of potassium Atherosclerosis if there is prolonged use.
Name examples of nitrates used in managing CV disease.
What are each used for?
Short acting - Glyceryltrinitrate spray
Emergency treatment of angina
Long acting - Isosorbide mononitrate
Prevention of angina
What are the actions of nitrates?
Dilate veins = reduced preload
Dilate resistance arteries = reduced cardiac workload and reduced oxygen consumption by cardiac muscle
Dilate colateral coronary arteries = relieves anginal pain.
What are the side effects of nitrates?
HEADACHES from cerebral dilation
Why do nitrates come in the form of under the tongue sprays and transdermal patches (long acting)?
Undergo First pass metabolism
Name an example of a Ca channel blocker.
Amlodipine
What are the actions of Ca blockers?
Reduce blood pressure via blocking ca channels in smooth muscle and in peripheral blood vessels = relaxation and vasodilation.
What are the side effects of Ca channel blockers?
Gingival hyperplasia
Name an example of a ACE inhibitor.
enalapril
What are the actions of ACE inhibitors?
Reduce blood pressure by preventing the conversion of angiotensin 1 to 2 (angiotensin 2 is a vasoconstrictor)
Prevents aldosterone dependant salt and water retention.
What are the side effects of ACE inhibitors?
Cough
Angio-oedema
Oral lichenoid
If the patient is experiencing bad side effects with ACE inhibitors what medication can they switch to?
AT2 blockers
