Cardiovascular & Renal Pharmacology Flashcards
Acetazolamide
Carbonic anhydrase inhibitor - inhibits NaHCO3 reabsorption
Weak diuretics only used in glaucoma & to acclimatise to high altitudes
Saralasin
Angiotensin II partial agonist but doesn’t match up to other antihypertensives because it’s a peptide
Clopidogrel
Inhibits ADP-binding to its receptor on platelets inhibiting aggregation
Combined with low dose oral aspirin reduces mortality/morbidity in a range of heart diseases
Amiloride, Triamterene
Potassium-sparing diuretics
Block apical Na channels
Diuresis weak but K-loss reduced
Problems with loop/thiazide diuretics
Hypokalaemia and resulting metabolic alkalosis
Increased Mg loss (Ca loss increased with loop, decreased in thiazide)
Decreased uric acid excretion potentially leading to gout
Tirofiban
Non-peptide inhibitor of alpha-IIb-beta-3-integrin (responsible for fibrinogen bridging between platelets)
Used to prevent MI in unstable angina or after certain types of MI
Theophylline
Non-selective PDE inhibitor and adenosine receptor antagonist have positive ino/chronotropic effects
Diltiazem
Benzothiazepine - blocks L-type calcium channels from the outside
Spironolactone
Aldosterone receptor antagonist
Metabolised in liver to canrenone, salt: potassium canrenoate acts as a potassium-sparing diuretic
Eptifibatide
Cyclic heptapeptide inhibitor of alpha-IIb-beta-3-integrin (responsible for fibrinogen bridging between platelets)
Losartan
Non-peptide AT-1 receptor antagonist blocking angiotensin II function
Nifedipine
Dihydropyridine - blocks L-type calcium channels
Binding modified by benzothiazepines
Alteplase, duteplase
Single chain/double chain recombinant tissue plasminogen activators
Greater activity on plasminogen bound to fibrin localising its activity
Class II antidysrhythmics
Beta-blockers: Propranolol, Atenolol
Dobutamine
Beta-1-receptor agonist (inotropic>chronotropic) given IV in shock, to increase CO after open heart surgery and in heart failure without hypertension
Class IV antidysrhythmics
Calcium channel blockers - verapamil
Bisoprolol, carvedilol
Third-generation B-1-receptor antagonists limit effects of chronic SNS stimulation in congestive heart failure
Abciximab
mAb against the receptor binding the vitronectin receptor
Used with coronary angioplasty for coronary artery thrombosis
Furosemide, Bumetanide
Loop diuretics - very powerful
Effects reduced on repeated administration
Block NKCC in TAL, furosemide also a venodilator
Anistreplase
Combined plasminogen and anisoylated streptokinase
Streptokinase inactive until anisoyl group is removed giving prolonged activity
Class I antidysrhythmics
Block voltage-gated sodium channels:
1A: Quinidine, Procainamide
1B: Lidocaine
1C: Flecainide
Aminocaproic acid, Tranexamic acid
Inhibit plasminogen activation to prevent excessive clot lysis
Chemically similar to lysine
Verapamil
Phenylalkylamine - blocks L-type calcium channels from the outside
Rivaroxaban
Inhibits factor Xa (first of its kind)
Prophylaxis after knee/hip surgery
Digoxin, Digitoxin, Ouabain
Cardiac glycosides: block Na/K-ATPase
Mannitol
Osmotic diuretic filtered but not reabsorbed at all
Useful in cerebral oedema (reduce ICP) and where urine flow reduced due to excessive reabsorption
Streptokinase
Activates plasminogen
Levosimendan (& pimobendan - vets)
New class of inodilators - calcium sensitisers
Increase calcium sensitivity binding efficiency without increasing energy demand
Inhibits PDE III giving its peripheral vasodilatory effects
Class III antidysrhythmics
Prolong AP and therefore refractory period: Amiodarone
Dabigatran
Inhibits thrombin
Used in atrial fibrillation with one other stroke risk factor & after knee/hip surgery
Milrinone
Inodilator most often used in heart failure especially short-term in severe failure unresponsive to conventional therapy - inhibits PDE-III
Hydrochlorothiazide, Bendroflumethiazide
Thiazide diuretics
Block Na/Cl co-transport in TAL/DT, in long term also have vasodilator effects
Captopril, Enalapril
ACE inhibitors reducing pre/afterload (TPR)
Used in heart failure and hypertension
Warfarin
Inhibits synthesis of clotting factors (II, VII, IX, X) & regulatory factor proteins (C, S & Z)
Used prophylactically from recurrence or with prosthetic valves
Heparin
Naturally occurring anticoagulant in mast cells/basophils
Activates antithrombin III which inhibits thrombin & factor Xa
Used prophylactically (during/after surgery) & in DVT
Must be injected