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CARDIOLOGY > Common Cardiovascular Drugs > Flashcards

Common Cardiovascular Drugs Flashcards

1
Q

What drug classes can be used to lower cholesterol?

A
  • Statins
  • Fibrates
  • PCSK 9 Inhibitors (evolocumab, alirocumab)
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2
Q

What is the mechanism of action of a statin?

A
  • inhibit HMG CoA reductase

- this is the rate controlling enzyme for the formation of cholesterol

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3
Q

When are statins likely to be used?

A
  • hypercholesterolaemia
  • diabetes
  • Angina/MI
  • Stroke/TIA
  • High risk of MI/ Stroke
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4
Q

What are the main side effects of statins?

A

Myopathy

Rhabdomyolysis => renal failure

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5
Q

Give an example of a Fibrate drug and when this would specifically be used?

A

e.g. Bezafibrate

Used in:

  • hypertriglyceridaemia
  • low HDL cholesterol
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6
Q

What signs may indicate a patient has Familial Hypercholesterolaemia?

A
  • Xanthomas => fatty deposits in tendons/ on elbows, buttocks, and knees
  • Xanthelasma => cholesterol deposits around the eyelids
  • Corneal Arcus => grey-white cholesterol deposits around cornea
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7
Q

What drugs are used for familial hypercholesterolaemia and how do these work?

A

PCSK 9 Inhibitors
- inhibit binding of PCSK9 to LDL Receptor
=> Drug increases the number of LDL Receptors available to clear LDL from blood

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8
Q

What drug classes can be used as anti-hypertensives?

A
  • Thiazide Diuretics
  • Beta Blockers
- Vasodilators – 
=> Calcium Antagonists
=> Alpha Blockers
=> ACE Inhibitors (ACEI)
=> Angiotensin Receptor Blockers(ARB)
  • Mineralocorticoid antagonist (spironolactone)
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9
Q

What is the main function of diuretics in the treatment of hypertension?

A

Block Na reabsorption in kidneys

- salt increases BP

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10
Q

What type of mild diuretic is often used in treatment of hypertension?

A

Thiazide diuretics

e.g. Bendroflumethiazide

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11
Q

What are stronger “Loop” diuretics used for?

A

Used in heart failure

e.g. Furosemide

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12
Q

What are the main side effects of diuretics?

A
  • Hypokalaemia => Tired, Arrhythmias
  • Hyperglycaemia => Diabetes
  • Increased Uric Acid => Gout
  • Impotence
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13
Q

What is the difference between cardioselective and non-selective beta blockers?

A

Cardioselective β Blockers
=> Only block β1 receptors

Non selective β Blockers
=> Block β1 and β2 receptors

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14
Q

Give examples of cardioselective beta blockers and conditions they would be used for?

A 
- e.g. Atenolol, bisoprolol
Used in:
- angina
- acute coronary syndrome
- MI
- hypertension 
- heart failure
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15
Q

Give examples of non-selective beat blockers and what these would be used for?

A

e.g. Propranolol
Used in:
- thyrotoxicosis
- migraine

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16
Q

Carvedilol blocks what 2 types of receptor?

A

carvedilol (alpha and beta-blocker)

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17
Q

What are the potential side effects of beta blockers?

A
  • Contraindicated in ‘brittle/severe’ asthma
  • Tired
  • Heart Failure* (worsen it in short term)
  • Cold peripheries
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18
Q

What are the two different types of calcium antagonists? Give examples of each.

A

Dihydropyridines
e.g. Amlodipine

Rate limiting calcium antagonists
e.g. Verapamil, Diltiazem

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19
Q

When would you prescribe a dihydropyridine, and when would a rate limiting calcium antagonist be prescribed?

A

Dihydropyridine => Used in hypertension and angina

Rate Limiting => HT, angina and SVTs

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20
Q

What side effect do dihydropyridines (e.g. amlodipine) cause?

A

Ankle oedema

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21
Q

What drug should NOT be prescribed with rate limiting calcium antagonists?

A

Beta Blockers

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22
Q

Describe the mechanism of action of ACE inhibitors

A

Block Angiotensin converting enzyme (ACE)
=> stops angiotensin I becoming angiotensin II

(angiotensin II = vasoconstrictor => not having this allows vessels to stay dilated and lower BP)

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23
Q

What are ACE inhibitors useful in treating? Give an example of this drug class.

A
  • Used in hypertension and heart failure
  • Good for kidneys in diabetic nephropathy
    e. g. Lisinopril or Rampiril
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24
Q

When should ACE inhibitors not be used?

A
  • Bad for kidneys in renal artery stenosis

- Should NOT be used to control BP in pregnancy

25
Q

What are the main side effects of ACE inhibitors?

A
  • Cough
  • Renal dysfunction
  • Angioneurotic oedema
26
Q

Describe the mechanism of Angiotensin Receptor Blockers and give an example of this drug class?

A

Block Angiotensin II Receptors

e.g. Losartan

27
Q

When are ARB’s used?

A
  • Used in hypertension and heart failure

- Good for kidneys in diabetic nephropathy

28
Q

When should ARB’s NOT be used?

A
  • Bad for kidneys in renal a stenosis

- Never use in pregnancy induced hypertension

29
Q

What are the common side effects of ARBs?

A
  • Renal dysfunction
  • NO cough
    => patient’s on ACEi who are experiencing a cough may be swapped onto ARBs
30
Q

Describe the mechanism of alpha-blockers

A

Block alpha adrenoceptors to cause vasodilatation

31
Q

When are alpha blockers used? Give an example of a drug in this class.

A

Use in hypertension and prostatic hypertrophy

e.g. Doxazosin

32
Q

What is the main side effects of alpha blockers?

A

Postural hypotension

33
Q

How do mineralocorticoids (e.g. spironolactone) attempt to lower BP?

A
  • Block aldosterone receptors

=> Na and water lost

34
Q

When are mineralocorticoids (e.g. spironolactone) used? Give examples of agents in this drug class.

A
  • Heart failure
  • Resistant hypertension
    e. g. spironolactone, eplerenone
35
Q

What are the main side effects of mineralocorticoids (e.g. spironolactone)

A
  • Gynaecomastia
  • hyperkalaemia
  • renal impairment
36
Q

What drug classes can be used to combat angina?

A

Vasodilators

  • Nitrates
  • Nicorandil (K ATP channel opener)
  • Calcium Antagonists (Dihydropyridine)

Slow Heart rate

  • Beta Blockers
  • Calcium Antagonists (Diltiazem, Verapamil)
  • Ivabradine

Metabolic modulator
- Ranolazine (late sodium channel modulator)

37
Q

How does the mechanism of nitrates help in anging?

A
  • Venodilators => lower pressure
38
Q

Give an example of a short-acting and long-acting nitrate?

A

Short - GTN

Long - Isosorbide monoritrate

39
Q

What else can nitrates be used for, other than angina?

A
  • acute heart failure
40
Q

What side effects can nitrates cause?

A
  • Headache

- Hypotension/Collapse

41
Q

Tolerance to nitrates is common. How can we attempt to combat this?

A

Leave 8 hr/day nitrate-free

=> patients often take tablet in morning and at lunch

42
Q

How does Nicorandil act as a vasodilator?

A

K ATP channel activator

- activates intracellular pathways which eventually relaxes the vascular smooth muscle cell

43
Q

What are the main side effects of nicorandil?

A
  • Headache

- Mouth/ GI Ulcers

44
Q

How does Ivabradine aim to help with angina?

A
  • Modulates “If” channel in SA node

- Slows HR only in sinus rhythm (Doesn’t work in AF)

45
Q

What side effect can Ivabradine cause?

A

Altered visual disturbance

46
Q

Describe the mechanism of action of Ranolazine and when it is used.

A
  • Late sodium channel modulator
    => Decrease calcium load on heart
  • Effective in refractory angina
47
Q

Give examples of anti-platelets and what they are used for?

A

Aspirin, Clopidogrel, Ticagrelor, Prasugrel
- All prevent new thrombosis

Used in:

  • angina
  • acute MI
  • Stroke/TIA
  • Patients at high risk of MI & Stroke
48
Q

What are the main side effects of anti-platelets?

A
  • Haemorrhage anywhere
  • Peptic ulcer haemorrhage
  • Asthmatic patients have aspirin sensitivity
49
Q

What anticoagulants can be used to prevent new thrombosis?

A

LMWH
Warfarin
Factor Xa inhibitors
Direct Thrombin Inhibitor (Dabigatran)

50
Q

When are anticoagulants commonly used?

A

Deep Vein Thrombosis
Pulmonary embolism
NSTEMI
Atrial Fibrillation

51
Q

What side effect can be caused by anticoagulants?

A
  • Bleeding/ haemorrhage

- with LMWH/ Warfarin, this can be reversed using Vitamin K

52
Q

What do fibrinolytic drugs aim to do?

A

Dissolve formed clot

53
Q

Give examples of fibrinolytic drugs and when they would be used?

A
  • Streptokinase
  • tissue Plasminogen activator (tPA)

Used in:

  • STEMI
  • PE
  • Stroke
54
Q

What side effect can be caused by fibrinolytic drugs and when should they be avoided?

A

Side effects
- Haemorrhage serious risk

Avoid in

  • recent haemorrhage (some strokes)
  • trauma
  • bleeding tendencies
  • severe diabetic retinopathy
  • peptic ulcer
55
Q

What is the main aim of digoxin therapy (e.g. in AF)?

A

Blocks atrial-ventricular (AV) conduction

=> produces a degree of AV delay

56
Q

Digoxin has a narrow therapeutic index, therefore what effects can it have at too high a dose?

A
  • Bradycardia and Heart Block
  • Increases ventricular irritability which produces ventricular arrhythmias
  • If Digoxin toxic, patients can have N+V and yellow vision
57
Q

Give an example of a Neprilysin Inhibitor and when it is used?

A

Sacubitril valsartan (Entresto)
- prevents breakdown of BNP
- BNP helps with diuresis
=> used in Heart failure

58
Q

What are the main side effects of neprilysin inhibitors?

A
  • Hypotension
  • Renal impairment
  • Hyperkalaemia
  • Angioneurotic oedema

CARDIOLOGY (14 decks)

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