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Cardiovascular Medicine > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

What drugs are used to prevent further CV disease

A 
Anti platelet drugs
Statins
Anti-arrhythmics
Anticoagulants
Diuretics
Ace-inhibitors
Beta-Adrenergic Blockers
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2
Q

What drugs are used to reduce symptoms of current CV disease

A

Diuretics
Anti-arrhythmics
Nitrates
Calcium channel blockers

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3
Q

Give examples of anti platelet drugs

A

Aspirin
Clopidogrel
Dipyridamole

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4
Q

What is the function of Aspirin

A

Inhibits platelet aggregation, alters balance between Throboxane A2 and Prostacyclin

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5
Q

What is the function of Clopidogrel

A

Inhibits ADP induced platelet aggregation

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6
Q

What is the function of Dipyridamole

A

Inhibits platelet phosphodiesterase

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7
Q

What are other functions of anti platelets

A

Significantly reduce the chance of heart attack and stroke in the at risk population
Prolong the bleeding time following dental extraction

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8
Q

Give examples of new antiplatelet drugs and when are they used

A

Prasugrel, Ticagrelor
Only used in conjunction with aspirin
Only licensed for ACS

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9
Q

Give examples of oral anticoagulants

A 
Warfarin
Rivaroxiban
Apixaban
Dabigatran 
Edoxaban
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10
Q

Describe how oral anticoagulants work

A

By reducing the activation of the clotting cascade, they reduce the amount of fibrin formed and therefore clot stability
Once platelet has formed it will not stabilise properly as fibrin will not be deposited on the surface

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11
Q

Describe the bleeding pattern with oral anticoagulants

A

Typical bleeding pattern is to stop bleeding as normal but bleeding will continue after a few hours
Does not affect bleeding time

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12
Q

Describe how warfarin works

A

Inhibits synthesis of vitamin K dependent clotting factors
Factor 2,7,9,10 slow over 2 days as the supplies stored from liver are still in circulation
Immediate effect on protein C and S as it inhibits their function - they will not inhibit the inhibition of clotting

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13
Q

What is the outcome of using warfarin

A

Produces hypercoagulation then over a few days, as clotting factors are consumed and no replacements are made, patient will becomes anticoagulated

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14
Q

How can warfarin be used for an immediate coagulation effect

A

In combination with heparin

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15
Q

What type of drug is warfarin

A

Coumarin based anticoagulant

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16
Q

How long until warfarin loses its effect

A

Once stabilised will take 2-3 days to lose effect if drug is stopped

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17
Q

Why must warfarin be monitored regularly

A

Heavily bound to plasma proteins and metabolised in the liver so other medications can interfere with the warfarin action and change the degree of coagulation

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18
Q

What is INR

A

International Normalised Ratio

A ratio of healthy volunteers prothrombin time (time to convert prothrombin to thrombin) measured against the patient

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19
Q

What is a therapeutic INR range and how does it affect dental care

A

2-4
If within the range - no attention needed for dental care
If out of range - refer for medical advice

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20
Q

What should be given to patients on warfarin during dental treatment

A

Apply measures to area of surgery to help with bleeding - fibrinogen activator, suture or LA with a vasoconstrictor which will slow blood flow through the area

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21
Q

What drugs should be avoided in dental care if a patient is on warfarin

A

Avoid analgesics

22
Q

Give examples of NOACs as well as how often they should be taken and what they inhibit

A

Rivaroxaban - once daily (aXi)
Apixaban - twice daily (aXi)
Dabigatran - twice daily (dTi)
Edoxaban - once daily (aXi)

23
Q

Describe the properties of NOACs

A

Do not require monitoring and have predictable bioavailability so amount of drug absorbed and metabolised each day is the same and other drugs rarely interfere with their action
Short half live so their effect is rapidly lost

24
Q

Give examples of beta-adrenergic blockers and what receptors do they act on

A

Atenolol - selective - B1 only
Propranolol - non selective - B1 and B2
Many others ending in -olol

25
Q

What are the functions of beta blockers

A

Stops arrhythmias leading to cardiac arrest
Reduces heart muscle excitability
Prevent increase in HR which
Improve survival after MI

26
Q

What are the disadvantages of beta blockers

A

B2 blockers will prevent the action of salbutamol in the lungs making asthma worse or difficult to treat

27
Q

When beta blockers prevent an increase in HR, what can this cause

A

Postural hypotension
Poor brain perfusion, causing unconsciousness and collapse
Prevent unusual heart rhythms which can lead to heart attacks

28
Q

What are lipid lowering drugs and give examples

A

HMG coA Reductase Inhibitors (-statins)
Simvastatin - a prodrug
Atorvastatin
Rosuvastatin

29
Q

What is a prodrug

A

A biologically inactive compound which can be metabolised in the body to produce a drug

30
Q

What is the function of statins

A

Inhibits cholesterol synthesis in the liver reducing total cholesterol and LDLs

31
Q

What are the side effects of statins

A

Myosotis with some drug interactions - some dental antifungals - fluconazole
Must stop statins for antifungals

32
Q

When are nitrates used

A

In emergency management of angina, chats pain or long term prevention of angina

33
Q

What are the different types of nitrates and when are they used

A

Short acting - glyceryl trinitrate (GTN)
- emergency management of angina pectoris
Long acting - isosorbide mononitrate
- prevention of angina pectoris

34
Q

How should GTN be administered and why is this

A

Sublingually in a spray as it is metabolised in first pass metabolism

35
Q

How should isosorbide be administered

A

Via a dermal transcutaneous patch

36
Q

What are common side effects of nitrates

A

Headache

Hypertension

37
Q

What are the outcomes of using nitrates

A

Dilate veins - reducing preload to heart and cardiac workload
Dilate resistance arteries - reducing cardiac workload and oxygen consumption
Dilate collateral coronary artery supply - reducing anginal pain

38
Q

What are the different types of diuretics

A 
Thiazide diuretics (bendroflumethiazide)
Loop diuretics (frusemide)
39
Q

What is the function of diuretics

A

Increases salt and water loss, reducing plasma volume and reducing cardiac workload

40
Q

What are the side effects of diuretics

A

Can lead to N+/K+ imbalance if not monitored carefully

Fluid loss can be excessive leading to dehydration - presents as dry mouth

41
Q

What are diuretics used to treat

A

Hypertension

Heart failure

42
Q

What are calcium channel blockers used to treat

A

Hypertension

Migraines

43
Q

What is the side effect of calcium channel blockers

A

Can lead to gingival hyperplasia if oral hygiene is poor

44
Q

How to calcium channel blockers work

A

Blocks calcium channels in smooth muscles causing vasodilation and a reduction in blood pressure

45
Q

Give examples of calcium channel blockers

A

Nifedipine
Amlodipine
Verapamil

46
Q

Give examples of ACE inhibitors

A

Enalapril
Ramapril
Lisinopril

47
Q

How do ACE inhibitors work

A

Inhibit conversion of angiotensin I to angiotensin II, preventing aldosterone dependent reabsorption of salt and water
This reduces blood pressure and excess salt and water retention

48
Q

Give an example of an angiotensin II blocker and how it works, and why it is used

A

Losartan
Acts directly to block receptors used by angiotensin II
Gives the benefits of ACE inhibitors without the side effects

49
Q

What oral reactions can be found with ACE inhibitor use

A

Angio-oedema - tissue fluid infiltration in lips and tongue

Lichenoid reaction - area of ulceration and fibrinous deposit

50
Q

What are the other side effects of ACE inhibitors

A

Cough

Hypotension

Cardiovascular Medicine (11 decks)

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