Cardiovascular System Flashcards
Class Ia
Sodium Channel Blockers
(Anti-arrhythmic Drugs)
Disopyramide, Quinidine
MoA:
Voltage-sensitive sodium channel blockade
Prolong QT interval, increase QRS duration.
Indication:
Ventricular and supraventricular arrhythmias
Adverse Effects/Interaction:
Oedema
Class Ib
Sodium Channel Blockers
(Anti-arrhythmic Drugs)
Lidocaine
MoA:
Voltage-sensitive sodium channel blockade
Prolong QT interval, increase QRS duration.
Indication:
CPR (used IV)
Adverse Effects/Interaction:
Oedema
Class Ic
Sodium Channel Blockers
(Anti-arrhythmic Drugs)
Flecainide, Propafenone
MoA:
Voltage-sensitive sodium channel blockade
Prolong QT interval, increase QRS duration.
Indication:
Paroxysmal atrial fibrillation and ventricular ectopic beats “pill in pocket”
Adverse Effects/Interaction:
Oedema
Class II
Beta blockers
(Beta-adrenergic antagonists)
(Anti-arrhythmic Drugs)
Bisoprolol, Atenolol (Beta-1 selective); Propranolol (Beta-1 & Beta-2 selective)
MoA:
Beta-adrenergic receptor blockade – reduction in adrenergic effects on rate and inotropy
Indication:
Prophylaxis of paroxysmal atrial tachycardia or fibrillation
Adverse Effects/Interaction:
Hypotension
Class III
Potassium Channel Blockers
(Anti-arrhythmic Drugs)
Amiodarone, Dronedarone, Sotalol (Sotalol also has some beta blocker activity)
MoA:
Potassium channel blockade, also evidence of beta blocker and calcium channel blocker properties – prolong QT interval
Indication:
Supraventricular, nodal and ventricular tachyarrhythmias, atrial fibrillation
(CPR - used IV)
Adverse Effects/Interaction:
Nausea, vomiting
Class IV
Calcium Channel Blockers (phenylalkylamine & benzothiazepine subclasses
(Anti-arrhythmic Drugs)
Verapamil, Diltiazem (for arrhythmia)
MoA:
Cardiac calcium channel blockade – reduction of action potential & cardiac output
Indication: Supraventricular tachycardia (especially paroxysmal SVT)
Adverse Effects/Interaction:
Hypotension (verapamil)
Constipation (diltiazem)
Cardiac Glycosides
Anti-arrhythmic Drugs
Digoxin
MoA:
Reduces conductivity of atrioventricular node
Indication:
Arrhythmias – atrial fibrillation, congestive heart failure
Adverse Effects/Interaction:
Fatigue, nausea
Adenosine
Anti-arrhythmic Drugs
Adenosine
MoA:
Activates adenosine receptors – causes hyperpolarization
Slows conduction through AV Node
Indication:
Supraventricular tachycardia
Adverse Effects/Interaction:
Nausea
*contraindicated in obstructive airway disease
Antimuscarinic
Anti-arrhythmic Drugs
Atropine
MoA:
Blockade of vagal muscarinic acetylcholine receptors
Indication:
Emergency bradycardia
Adverse Effects/Interaction:
Urinary retention
Magnesium
Anti-arrhythmic Drugs
Magnesium sulfate (intravenous)
MoA:
Unclear – possible alteration of Na+, K+ and Ca2+ ion balance via ion channels and transporters
Indication:
Emergency arrhythmia
(Also used IV for emergency asthma)
Adverse Effects/Interaction:
Electrolyte irregularities
Loop Diuretics
Diuretics
Furosemide
MoA:
Inhibits Na+/K+/2Cl- transporter in loop of Henle
Indication:
Left ventricular heart failure, oedema
Adverse Effects/Interaction:
Nausea, dizziness
NSAIDs, ACE inhibitors
Thiazides
Diuretics
Indapamide
Bendroflumethiazide
Chlorthalidone
Hydrochlorothiazide
MoA:
Decreases sodium and chloride reabsorption
Indication:
Hypertension
Adverse Effects/Interaction:
Electrolyte imbalance, exacerbation or precipitation of gout
NSAIDs, digoxin
Potassium Sparing Diuretics
Diuretics
Spironolactone, Epleronone
Amiloride
MoA:
Mineralocorticoid receptor blockade (spironolactone, epleronone)
Blockade of sodium reabsorption via ENaC channel (amiloride)
Indication:
Oedema, congestive heart failure
Adverse Effects/Interaction:
Gastrointestinal
NSAIDs, ACE inhibitors
Osmotic Diuretics
Diuretics
Mannitol
MoA:
Elevates plasma osmolarity
Indication:
Cerebral oedema, intra-ocular pressure
Adverse Effects/Interaction:
Hypotension
Carbonic Anhydrase Inhibitors
Diuretics
Acetazolamide
MoA:
Reduces aqueous humour volume
Indication:
Intra-ocular pressure – open & acute closed angle glaucoma
Adverse Effects/Interaction:
Paraesthesia
Carbonic Anhydrase Inhibitors
Diuretics
Acetazolamide
MoA:
Reduces aqueous humour volume
Indication:
Intra-ocular pressure – open & acute closed angle glaucoma
Adverse Effects/Interaction:
Paraesthesia
Angiotensin-converting enzyme (ACE) inhibitors
Drugs acting on heart and circulation
Ramipril
Captopril
Lisinopril
MoA:
Inhibits conversion of angiotensin I to II. Blocks vasoconstriction
Indication:
Hypertension, diabetic nephropathy, heart failure
Adverse Effects/Interaction:
Cough, hyperkalemia
Lithium, NSAIDs
Angiotensin II receptor blockers (ARBs)
Drugs acting on heart and circulation
Losartan, Valsartan
MoA:
Blocks angiotensin-renin system
Indication:
Hypertension, diabetic nephropathy, heart failure
Adverse Effects/Interaction:
Hypotension, fatigue
Diuretics
Neprilysin inhibitors (used in combination with an ARB)
Drugs acting on heart and circulation
Sacubitril (in combination with the ARB Valsartan)
MoA:
Inhibition of natriuretic peptide breakdown
Indication: Heart failure (with reduced ejection fraction)
Adverse Effects/Interaction:
Hypokalaemia, hypoglycaemia (from BNF)
Beta adrenergic receptor antagonists (beta blockers)
Drugs acting on heart and circulation
Bisoprolol, Atenolol (Beta-1 selective); Propranolol (Beta-1 & Beta-2 selective)
MoA:
Negative inotropic/
chronotropic agent
Indication:
Hypertension, stable angina
Adverse Effects/Interaction:
Bradycardia, bronchospasm
NSAIDs, digoxin
Alpha adrenergic receptor antagonists (Alpha blockers)
Drugs acting on heart and circulation
Doxazosin
MoA:
Vasodilator, decreases total peripheral resistance
Indication:
Hypertension, (see also BPH)
Adverse Effects/Interaction:
Dizziness, headache
Hypotensive drugs
Calcium channel antagonists
(Calcium channel blockers)
(Drugs acting on heart and circulation)
Amlodipine
Nifedipine
Diltiazem
MoA:
Blockade of vascular smooth muscle contraction
Indication:
Hypertension, stable angina
Adverse Effects/Interaction:
Ankle swelling, oedema
Beta blockers, digoxin
Nitrates
Drugs acting on heart and circulation
Glyceryl trinitrate (GTN), Isosorbide mononitrate (ISMN)
MoA:
Nitric oxide release, leading to smooth muscle relaxation & vasodilation
Indication:
Acute angina pectoris (GTN), heart failure
Adverse Effects/Interaction:
Hypotension, headache
Antihypertensives
Sympathomimetics
Drugs acting on heart and circulation
Adrenaline
Dobutamine
Noradrenaline
MoA:
Adrenergic stimulation, increased inotropy
Indication:
Cardiac arrest, cardiogenic shock
Adverse Effects/Interaction:
Arrhythmia
Antiplatelet drugs
Drugs acting on heart and circulation
Aspirin,
Clopidogrel
MoA:
Inhibition of thromboxane synthesis (aspirin).
Inhibition of platelet activation by ADP (clopidogrel).
Indication:
Primary and secondary relief for CVD, anticoagulant prophylaxis
Adverse Effects/Interaction:
Gastrointestinal irritation & bleeding
Anticoagulants
Anticoagulants - coumarin
Drugs acting on heart and circulation
Warfarin
MoA:
Inhibition of Vitamin K epoxide reductase complex 1 (VKORC1) enzyme
Indication:
Deep vein thrombosis, prophylaxis of stroke from atrial fibrillation
Adverse Effects/Interaction:
Abnormal bleeding,
Multiple drug interactions, notably NSAIDs, diuretics
Anticoagulants - coumarin
Drugs acting on heart and circulation
Warfarin
MoA:
Inhibition of Vitamin K epoxide reductase complex 1 (VKORC1) enzyme
Indication:
Deep vein thrombosis, prophylaxis of stroke from atrial fibrillation
Adverse Effects/Interaction:
Abnormal bleeding,
Multiple drug interactions, notably NSAIDs, diuretics
Anticoagulants – direct thrombin inhibitor
Drugs acting on heart and circulation
Dabigatran
MoA:
Inhibition of thrombin (also called Factor IIa)
Indication:
Prophylaxis of venous thromboembolism post-surgery
Adverse Effects/Interaction:
Abnormal bleeding
Anticoagulants – direct Factor Xa inhibitors
Drugs acting on heart and circulation
Apixaban, Edoxaban, Rivaroxaban
MoA:
Inhibition of Factor Xa in coagulation cascade
Indication:
Prophylaxis of stroke from atrial fibrillation; DVT
Adverse Effects/Interaction:
Abnormal bleeding
Anticoagulants - heparins
Drugs acting on heart and circulation
Dalteparin, Tinzaparin, Enoxaparin (low molecular weight); unfractionated heparins
MoA:
Inactivation of thrombin and Factor Xa via complexing antithrombin III
Indication:
Prophylaxis of venous thrombosis and pulmonary embolism
Adverse Effects/Interaction:
Abnormal bleeding
Thrombolytics/Fibrinolytics
Drugs acting on heart and circulation
Alteplase, Streptokinase, Urokinase
MoA:
Activation of plasminogen for proteolytic breakdown of thrombus fibrin
Indication:
Myocardial infarction, ischaemic stroke
HMG-CoA Reductase inhibitors
Drugs acting on heart and circulation
Simvastatin, Atorvastatin (statins)
MoA:
Inhibition of mavelonate pathway required for cholesterol synthesis
Indication:
Hypercholesterolaemia, risk of CVD and stroke
Adverse Effects/Interaction:
Myalgia
Verapamil, macrolides
