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Common Cardiovascular drugs Flashcards

1
Q

What are the stages of the Cardiovascular Continuum?

A

Risk factors
Endothelial dysfunction
Atherosclerosis
Coronary artery disease
Plaque rupture
Stroke or Myocardial infarction
Dilatation or remodelling
Heart failure
End-stage heart disease
Death

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2
Q

What are the main categories of Anti-cholesterol drugs?

A

Statins
Fibrates
PCSK-9 inhibitors
Inclisiran

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3
Q

What are statins?

A

Statins are HMG CoA reductase inhibitors

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4
Q

What are statins used in the treatment of?

A

Hypercholesterolaemia
Diabetes
Angina
Myocardial Infarction
CerebroVascular Accidents (CVA)
Patients at risk of MI or CVA

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5
Q

What are some side effects of statins?

A

Myopathy - Muscle weakness
Rhabdomyolysis - Muscle breakdown resulting in high protein levels in the blood, which can lead to renal failure

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6
Q

What are some examples of statins?

A

Simvastatin
Atorvastatin

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7
Q

What are the main uses of fibrates?

A

Low HDL cholesterol levels
Hypertriglyceridaemia

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8
Q

What is an example of a fibrate?

A

Bezofibrate

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9
Q

What is familial hypercholesterolaemia?

A

A genetic pre-disposition to high LDL levels due to missing or degradation of LDL receptors on the liver, therefore increasing the risk of hypercholesterolaemia

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10
Q

What is Arcus Senilis?

A

A white/grey ring around the outside of the iris

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11
Q

What is Xanthelasma?

A

fatty deposits around the eyes

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12
Q

What are some common symptoms of familial hypercholesterolaemia?

A

Arcus senilis
Xanthelasma

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13
Q

What are some examples of PCSK-9 inhibitors?

A

Alirocumab
Evolocumab

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14
Q

How do PCSK-9 inhibitors work?

A

They work by inhibiting the binding of PCSK-9 to LDL receptors
This increases the number of available LDL receptors, to increase clearance of LDL, thus lowering LDL-C levels

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15
Q

How does inclisiran work?

A

It is a small interfering RNA that limits PCSK-9 gene expression, so boosts the livers ability to remove LDL-C as there are more available LDL receptors

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16
Q

What are some common types of anti-hypertensives?

A

Thiazide diuretics
ß-Blockers
Vasodilators
Mineralocorticoid antagonists

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17
Q

What are some common types of vasodilators used in hypertension?

A

Ca2+ antagonists
Alpha-1 Blockers
ACE inhibitors
Angiotensin Receptor Blockers

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18
Q

How do diuretics work?

A

They block Na+ reabsorption in the kidneys, therefore increasing water levels excreted as water follows Na+
This therefore decreases blood volume and thus blood pressure

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19
Q

What are the 2 types of Diuretics?

A

Thiazide diuretics - Mild
Loop diuretics - Strong

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20
Q

What is the main use of thiazide diuretics?

A

Hypertension

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21
Q

What is the main use of loop diuretics?

A

Heart failure

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22
Q

What are some examples of thiazide diuretics?

A

Indapamide
Bendroflumethiazide

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23
Q

What are some examples of loop diuretics?

A

Furosemide
Bumetanide

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24
Q

What are some side effects associated with diuretics?

A

Hypokalaemia - Tiredness
Hyperglycaemia - Diabetes
High Uric acid - Gout
Impotence
Arrhythmias

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25
What are the 2 main types of ß-Blockers?
Cardioselective Non-Selective
26
What are some examples of Cardio-selective ß-Blockers?
Atenolol Bisoprolol
27
What are some examples of Non-selective ß-Blockers?
Propranolol Carvedilol Sotalol
28
What are the main uses of Cardio-selective ß-Blockers?
Angina Myocardial infarction Hypertension Heart Failure
29
What are the main uses of Non-Selective ß-Blockers?
Thyrotoxicosis Migraines
30
What are some common side effects of ß-Blockers?
Asthma Tiredness Heart failure Cold peripheries
31
What are the 2 types of Ca2+ antagonists?
Dihydropyridines Rate limiting
32
What are the common uses of Dihydropyridine Ca2+ antagonists?
Hypertension Angina
33
What are the common uses of Rate limiting Ca2+ antagonists?
Hypertension Angina Supraventricular arrhythmias
34
What other drugs should be avoided with rate limiting Ca2+ antagonists?
ß-Blockers as together they increase the risk of hypotension and bradycardia
35
What are some examples of Dihydropyridine Ca2+
Amplodipine Felodipine Nicardipine
36
What are some examples of Rate-limiting Ca2+ antagonists?
Verapamil Diltiazem
37
What is a common side effect of Dihydropyridine Ca2+ antagonists?
Ankle oedema
38
How do ACE inhibitors work?
They inhibit the Angiotensin Converting Enzyme which converts Angiotensin I to Angiotensin II Angiotensin II is a vasoconstrictor, which increases blood pressure and causes water retention in the blood
39
What are the main uses of ACE inhibitors?
They are used in hypertension and heart failure
40
In which disease affecting the kidneys, are ACE inhibitors useful?
Diabetic nephropathy
41
IN which disease affecting the kidneys, are ACE inhibitors bad?
Renal Artery Stenosis
42
What are some examples of ACE inhibitors?
Lisinopril Ramipril Enalapril Perindopril Verapamil
43
What are some common side effects of ACE inhibitors?
Dry cough - Due to the breakdown of bradykinin Renal dysfunction Angioneurotic oedema - Swelling of mouth and face
44
What type of hypertension should ACE inhibitors never be used in?
Pregnancy induced hypertension
45
How do Angiotensin Receptor Blockers work?
They inhibit Angiotensin II receptors, which prevent it from performing its function of vasoconstriction and water retention
46
What are the main uses of Angiotensin Receptor Blockers?
Hypertension Heart failure
47
In which disease affecting the kidneys is an angiotensin receptor blockers helpful?
Diabetic nephropathy
48
In which disease affecting the kidneys is an angiotensin receptor blocker bad?
Renal stenosis
49
What are some examples of Angiotensin receptor blockers?
Losartan Irbesartan Candesartan Valsartan
50
What is a common side effect of Angiotensin Receptor Blockers?
Renal dysfunction
51
What type of hypertension should Angiotensin Receptor Blockers never be used in?
Pregnancy Induced Hypertension
52
How do Alpha blockers work?
They inhibit both Alpha 1 and 2 receptors, which causes vasodilation
53
What are the main uses of alpha blockers?
Hypertension Orthostatic hypertrophy
54
What is an example of an alpha blocker?
Doxazosin
55
What is a side effect of alpha blockers?
Postural hypotension
56
How do mineralocorticoid antagonists work?
They inhibit aldosterone receptors, which prevents its effects which include water and Na+ retention
57
What are the main uses of Mineralocorticoid antagonists?
Heart failure Resistant hypertension
58
What are some examples of mineralocorticoid antagonists?
Spironolactone Epelerone
59
What are some side effects of mineralocorticoid antagonists?
Gynaecomastia - breast swelling in males Hyperkalaemia - tiredness Renal impairment
60
What is Gynaecomastia?
Swelling of the breast tissue in males
61
How do Alpha2/Imidazoline receptor antagonists work?
They block the alpha 2 and imidazoline receptors, preventing the release of norepinephrine from sympathetic nerve terminals This causes blood vessel relaxation
62
What is an example of an Alpha2/imidazoline receptor antagonist?
Idazoxan
63
What are some examples of drug classes used in the treatment of angina?
Vasodilators Negative chronotropes Metabolic modulators
64
What are some examples of Vasodilator types used in the treatment of angina?
Organic nitrates K+ channel openers Dihydropyridine Ca2+ antagonists
65
What are some examples of Negative chronotrope types used in the treatment of angina?
ß-Blockers rate limiting Ca2+ antagonists Ivabridine
66
What is an example of a Metabolic modulator type used in the treatment of angina?
Late sodium channel modulators
67
What are the main uses of organic nitrates?
They are used in angina and acute heart failure
68
What are some side effects of organic nitrates?
Headache Hypotension Collapse
69
What is recommended to prevent tolerance to organic nitrates?
Leave 8 hours per day, nitrate-free
70
What are some examples of Organic nitrate drugs?
Glyceride Trinitride (GTN) spray Isosorbide Mononitrate
71
What is an example of a K+ channel opener?
Nicorandil
72
What are some side effects of nicorandil?
Headache Mouth/GI ulceration - Could cause fissures
73
How does Ivabridine work?
It is a HCN channel blocker, which affects the Sino-atrial node's pacemaker current by elongating the funny current
74
When does ivabridine work/not work?
Ivabridine only works during sinus rhythm, so cannot be used in atrial fibrillation
75
What is a side effect of ivabridine?
Can cause altered visual disturbances
76
What is an example of a Late sodium channel modulator?
Ranolazine
77
How does Ranolazine work?
It modulates the late sodium channel, therefore decreasing Calcium load on the heart
78
What is meant by 'refractory angina'?
Angina that persists despite treatment with medication
79
Which drug can be used in the treatment of refractory angina?
Ranolazine
80
What are the 3 main categories of anti-thrombotic drugs?
Anti-platelets Anti-coagulants Fibrinolytics
81
How does aspirin work?
Aspirin Blocks the COX enzyme This is a precursor to thromboxane A2 Thromboxane A2 usually binds to cell surface receptors and allows for platelet aggregation Aspirin stops this
82
What are some examples of Anti-platelet drug types?
Aspirin P2Y12 (ADP) Receptor inhibitors GPIIbIIIa receptor inhibitors
83
What are some examples of P2Y12 (ADP) receptor inhibitors?
Clopidogrel Prasugrel Ticlopidine
84
How do P2Y12 (ADP) receptor inhibitors work?
ADP is released by platelets It binds to P2Y12 receptors on the cell surface P2Y12 receptor inhibitors block these receptors and so prevent platelet aggregation
85
What are some examples of GPIIbIIIa receptor inhibitors?
Abciximab Eptfibatide Tirofiban
86
What are the main uses of anti-platelet drugs?
Angina Acute Myocardial infarction Cerebrovascular Accidents Transient Ischaemic Attack Patients at risk of MI or CVA
87
What are some side effects of anti-platelet drugs?
Haemorrhage Peptic ulcers Aspirin-Induced Asthma
88
What are some examples of Anti-coagulant drugs?
Warfarin Heparin Rivaroxiban Dabigatran
89
How does warfarin work?
Warfarin inhibits the Vitamin K epoxate reductase enzyme This prevents vitamin K formation, which usually carboxylates Clotting factors 2, 7, 9 and 10, giving them the negative charge required to bind to the Ca2+ on the platelet surface
90
How is warfarin treatment reversed?
Vitamin K
91
How does Heparin work?
Heparin locks anti-thrombin II with thrombin or Factor Xa, which prolongs the reaction and prevents coagulation
92
How does rivaroxiban work?
It is a Factor Xa inhibitor so prevents the conversion of prothrombin to thrombin
93
How does dabigatran work?
It is a thrombin (factor IIa (thrombin)) inhibitor, which prevents the conversion of fibrinogen to fibrin and the amplification loop
94
What are the main uses of Heparin and warfarin?
Deep Vein Thrombosis Pulmonary Embolism NSTEMI - Non-ST Elevation Myocardial Infarction Atrial fibrillation
95
What is a side effect of heparin and warfarin?
Haemorrhage
96
How do fibrinolytics work?
They dissolve formed blood clots by converting plasminogen to plasmin Plasmin breaks down fibrin into D-dimers
97
What are some examples of fibrinolytics?
Streptokinase tissue Plasminogen Activator (tPA)
98
What are the main uses of fibrinolytics?
STEMI - ST elevation Myocardial Infarction Pulmonary Embolism - some cases CVA - some cases
99
When should fibrinolytics be avoided?
Recent haemorrhage Trauma Bleeding tendencies Severe diabetic retinopathy Peptic ulcers
100
What are some drug classes that should be used in heart failure?
ACE inhibitors Angiotensin Receptor Blockers ß-Blockers Mineralocorticoid antagonists Neprilysin inhibitors Sglt2 inhibitors Diuretics Digoxin
101
How do Neprilysin inhibitors work?
Neprilysin usually decreases B natriuretic peptides, which allow for vasodilation and decreased sympathetic tone Neprilysin inhibitors prevent this degradation and thus increase vasodilation and decrease sympathetic tone, thus decreasing Oxygen requirements of the heart
102
What are some side effects of Neprilysin inhibitors?
Hypotension Renal impairment Hyperkalaemia Angioneurotic oedema
103
What is an example of a neprilysin inhibitor?
Sacubitril valsartan
104
How do Sglt2 inhibitors work?
105
What are some examples of Sglt2 inhibitors?
Dapagliflozin Empagliflozin
106
How does digoxin work?
It blocks atria-ventricular conduction by increasing vagal activity It also blocks the Na+/K+ ATPase This prevents concentration gradient of sodium forming for the Ca2+/Na+ ATPase This increases intracellular Ca2+ levels This increases Ca2+ induced Ca2+ release This increases force of contraction
107
What are the risks of digoxin use?
It can induce bradycardia and heart block It increases ventricular irritability which can produce ventricular arrhythmias
108
What are the common symptoms of digoxin toxicity?
Nausea Vomiting Yellow vision Bradycardia Heart block Ventricular arrhythmia
109
What is meant by CCF?
Congestive Cardiac Failure

Cardiovascular system (45 decks)

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