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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
Q

What are the 2 main types of ß-Blockers?

A

Cardioselective
Non-Selective

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26
Q

What are some examples of Cardio-selective ß-Blockers?

A

Atenolol
Bisoprolol

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27
Q

What are some examples of Non-selective ß-Blockers?

A

Propranolol
Carvedilol
Sotalol

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28
Q

What are the main uses of Cardio-selective ß-Blockers?

A

Angina
Myocardial infarction
Hypertension
Heart Failure

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29
Q

What are the main uses of Non-Selective ß-Blockers?

A

Thyrotoxicosis
Migraines

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30
Q

What are some common side effects of ß-Blockers?

A

Asthma
Tiredness
Heart failure
Cold peripheries

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31
Q

What are the 2 types of Ca2+ antagonists?

A

Dihydropyridines
Rate limiting

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32
Q

What are the common uses of Dihydropyridine Ca2+ antagonists?

A

Hypertension
Angina

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33
Q

What are the common uses of Rate limiting Ca2+ antagonists?

A

Hypertension
Angina
Supraventricular arrhythmias

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34
Q

What other drugs should be avoided with rate limiting Ca2+ antagonists?

A

ß-Blockers as together they increase the risk of hypotension and bradycardia

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35
Q

What are some examples of Dihydropyridine Ca2+

A

Amplodipine
Felodipine
Nicardipine

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36
Q

What are some examples of Rate-limiting Ca2+ antagonists?

A

Verapamil
Diltiazem

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37
Q

What is a common side effect of Dihydropyridine Ca2+ antagonists?

A

Ankle oedema

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38
Q

How do ACE inhibitors work?

A

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

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39
Q

What are the main uses of ACE inhibitors?

A

They are used in hypertension and heart failure

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40
Q

In which disease affecting the kidneys, are ACE inhibitors useful?

A

Diabetic nephropathy

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41
Q

IN which disease affecting the kidneys, are ACE inhibitors bad?

A

Renal Artery Stenosis

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42
Q

What are some examples of ACE inhibitors?

A

Lisinopril
Ramipril
Enalapril
Perindopril
Verapamil

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43
Q

What are some common side effects of ACE inhibitors?

A

Dry cough - Due to the breakdown of bradykinin
Renal dysfunction
Angioneurotic oedema - Swelling of mouth and face

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44
Q

What type of hypertension should ACE inhibitors never be used in?

A

Pregnancy induced hypertension

45
Q

How do Angiotensin Receptor Blockers work?

A

They inhibit Angiotensin II receptors, which prevent it from performing its function of vasoconstriction and water retention

46
Q

What are the main uses of Angiotensin Receptor Blockers?

A

Hypertension
Heart failure

47
Q

In which disease affecting the kidneys is an angiotensin receptor blockers helpful?

A

Diabetic nephropathy

48
Q

In which disease affecting the kidneys is an angiotensin receptor blocker bad?

A

Renal stenosis

49
Q

What are some examples of Angiotensin receptor blockers?

A

Losartan
Irbesartan
Candesartan
Valsartan

50
Q

What is a common side effect of Angiotensin Receptor Blockers?

A

Renal dysfunction

51
Q

What type of hypertension should Angiotensin Receptor Blockers never be used in?

A

Pregnancy Induced Hypertension

52
Q

How do Alpha blockers work?

A

They inhibit both Alpha 1 receptors, which causes vasodilation

53
Q

What are the main uses of alpha blockers?

A

Hypertension
Orthostatic hypertrophy

54
Q

What is an example of an alpha blocker?

A

Doxazosin

55
Q

What is a side effect of alpha blockers?

A

Postural hypotension

56
Q

How do mineralocorticoid antagonists work?

A

They inhibit aldosterone receptors, which prevents its effects which include water and Na+ retention

57
Q

What are the main uses of Mineralocorticoid antagonists?

A

Heart failure
Resistant hypertension

58
Q

What are some examples of mineralocorticoid antagonists?

A

Spironolactone
Epelerone

59
Q

What are some side effects of mineralocorticoid antagonists?

A

Gynaecomastia - breast swelling in males
Hyperkalaemia - tiredness
Renal impairment

60
Q

What is Gynaecomastia?

A

Swelling of the breast tissue in males

61
Q

How do Alpha2/Imidazoline receptor antagonists work?

A

They block the alpha 2 and imidazoline receptors, preventing the release of norepinephrine from sympathetic nerve terminals
This causes blood vessel relaxation

62
Q

What is an example of an Alpha2/imidazoline receptor antagonist?

A

Idazoxan

63
Q

What are some examples of drug classes used in the treatment of angina?

A

Vasodilators
Negative chronotropes
Metabolic modulators

64
Q

What are some examples of Vasodilator types used in the treatment of angina?

A

Organic nitrates
K+ channel openers
Dihydropyridine Ca2+ antagonists

65
Q

What are some examples of Negative chronotrope types used in the treatment of angina?

A

ß-Blockers
rate limiting Ca2+ antagonists
Ivabridine

66
Q

What is an example of a Metabolic modulator type used in the treatment of angina?

A

Late sodium channel modulators

67
Q

What are the main uses of organic nitrates?

A

They are used in angina and acute heart failure

68
Q

What are some side effects of organic nitrates?

A

Headache
Hypotension
Collapse

69
Q

What is recommended to prevent tolerance to organic nitrates?

A

Leave 8 hours per day, nitrate-free

70
Q

What are some examples of Organic nitrate drugs?

A

Glyceride Trinitride (GTN) spray
Isosorbide Mononitrate

71
Q

What is an example of a K+ channel opener?

A

Nicorandil

72
Q

What are some side effects of nicorandil?

A

Headache
Mouth/GI ulceration - Could cause fistulas

73
Q

How does Ivabridine work?

A

It is a HCN channel blocker, which affects the Sino-atrial node’s pacemaker current by elongating the funny current

74
Q

When does ivabridine work/not work?

A

Ivabridine only works during sinus rhythm, so cannot be used in atrial fibrillation

75
Q

What is a side effect of ivabridine?

A

Can cause altered visual disturbances

76
Q

What is an example of a Late sodium channel modulator?

A

Ranolazine

77
Q

How does Ranolazine work?

A

It modulates the late sodium channel, therefore decreasing Calcium load on the heart

78
Q

What is meant by ‘refractory angina’?

A

Angina that persists despite treatment with medication

79
Q

Which drug can be used in the treatment of refractory angina?

A

Ranolazine

80
Q

What are the 3 main categories of anti-thrombotic drugs?

A

Anti-platelets
Anti-coagulants
Fibrinolytics

81
Q

How does aspirin work?

A

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
Q

What are some examples of Anti-platelet drug types?

A

Aspirin
P2Y12 (ADP) Receptor inhibitors
GPIIbIIIa receptor inhibitors

83
Q

What are some examples of P2Y12 (ADP) receptor inhibitors?

A

Clopidogrel
Prasugrel
Ticlopidine

84
Q

How do P2Y12 (ADP) receptor inhibitors work?

A

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
Q

What are some examples of GPIIbIIIa receptor inhibitors?

A

Abciximab
Eptfibatide
Tirofiban

86
Q

What are the main uses of anti-platelet drugs?

A

Angina
Acute Myocardial infarction
Cerebrovascular Accidents
Transient Ischaemic Attack
Patients at risk of MI or CVA

87
Q

What are some side effects of anti-platelet drugs?

A

Haemorrhage
Peptic ulcers
Aspirin-Induced Asthma

88
Q

What are some examples of Anti-coagulant drugs?

A

Warfarin
Heparin
Rivaroxiban
Dabigatran

89
Q

How does warfarin work?

A

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
Q

How is warfarin treatment reversed?

A

Vitamin K

91
Q

How does Heparin work?

A

Heparin locks anti-thrombin II with thrombin or Factor Xa, which prolongs the reaction and prevents coagulation

92
Q

How does rivaroxiban work?

A

It is a Factor Xa inhibitor so prevents the conversion of prothrombin to thrombin

93
Q

How does dabigatran work?

A

It is a thrombin (factor IIa (thrombin)) inhibitor, which prevents the conversion of fibrinogen to fibrin and the amplification loop

94
Q

What are the main uses of Heparin and warfarin?

A

Deep Vein Thrombosis
Pulmonary Embolism
NSTEMI - Non-ST Elevation Myocardial Infarction
Atrial fibrillation

95
Q

What is a side effect of heparin and warfarin?

A

Haemorrhage

96
Q

How do fibrinolytics work?

A

They dissolve formed blood clots by converting plasminogen to plasmin
Plasmin breaks down fibrin into D-dimers

97
Q

What are some examples of fibrinolytics?

A

Streptokinase
tissue Plasminogen Activator (tPA)

98
Q

What are the main uses of fibrinolytics?

A

STEMI - ST elevation Myocardial Infarction
Pulmonary Embolism - some cases
CVA - some cases

99
Q

When should fibrinolytics be avoided?

A

Recent haemorrhage
Trauma
Bleeding tendencies
Severe diabetic retinopathy
Peptic ulcers

100
Q

What are some drug classes that should be used in heart failure?

A

ACE inhibitors
Angiotensin Receptor Blockers
ß-Blockers
Mineralocorticoid antagonists
Neprilysin inhibitors
Sglt2 inhibitors
Diuretics
Digoxin

101
Q

How do Neprilysin inhibitors work?

A

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
Q

What are some side effects of Neprilysin inhibitors?

A

Hypotension
Renal impairment
Hyperkalaemia
Angioneurotic oedema

103
Q

What is an example of a neprilysin inhibitor?

A

Sacubitril valsartan

104
Q

How do Sglt2 inhibitors work?

A
105
Q

What are some examples of Sglt2 inhibitors?

A

Dapagliflozin
Empagliflozin

106
Q

How does digoxin work?

A

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
Q

What are the risks of digoxin use?

A

It can induce bradycardia and heart block
It increases ventricular irritability which can produce ventricular arrhythmias

108
Q

What are the common symptoms of digoxin toxicity?

A

Nausea
Vomiting
Yellow vision
Bradycardia
Heart block
Ventricular arrhythmia

109
Q

What is meant by CCF?

A

Congestive Cardiac Failure

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