Common Cardiovascular Drugs Flashcards
What drug classes can be used to lower cholesterol?
- Statins
- Fibrates
- PCSK 9 Inhibitors (evolocumab, alirocumab)
What is the mechanism of action of a statin?
- inhibit HMG CoA reductase
- this is the rate controlling enzyme for the formation of cholesterol
When are statins likely to be used?
- hypercholesterolaemia
- diabetes
- Angina/MI
- Stroke/TIA
- High risk of MI/ Stroke
What are the main side effects of statins?
Myopathy
Rhabdomyolysis => renal failure
Give an example of a Fibrate drug and when this would specifically be used?
e.g. Bezafibrate
Used in:
- hypertriglyceridaemia
- low HDL cholesterol
What signs may indicate a patient has Familial Hypercholesterolaemia?
- Xanthomas => fatty deposits in tendons/ on elbows, buttocks, and knees
- Xanthelasma => cholesterol deposits around the eyelids
- Corneal Arcus => grey-white cholesterol deposits around cornea
What drugs are used for familial hypercholesterolaemia and how do these work?
PCSK 9 Inhibitors
- inhibit binding of PCSK9 to LDL Receptor
=> Drug increases the number of LDL Receptors available to clear LDL from blood
What drug classes can be used as anti-hypertensives?
- Thiazide Diuretics
- Beta Blockers
- Vasodilators – => Calcium Antagonists => Alpha Blockers => ACE Inhibitors (ACEI) => Angiotensin Receptor Blockers(ARB)
- Mineralocorticoid antagonist (spironolactone)
What is the main function of diuretics in the treatment of hypertension?
Block Na reabsorption in kidneys
- salt increases BP
What type of mild diuretic is often used in treatment of hypertension?
Thiazide diuretics
e.g. Bendroflumethiazide
What are stronger “Loop” diuretics used for?
Used in heart failure
e.g. Furosemide
What are the main side effects of diuretics?
- Hypokalaemia => Tired, Arrhythmias
- Hyperglycaemia => Diabetes
- Increased Uric Acid => Gout
- Impotence
What is the difference between cardioselective and non-selective beta blockers?
Cardioselective β Blockers
=> Only block β1 receptors
Non selective β Blockers
=> Block β1 and β2 receptors
Give examples of cardioselective beta blockers and conditions they would be used for?
- e.g. Atenolol, bisoprolol Used in: - angina - acute coronary syndrome - MI - hypertension - heart failure
Give examples of non-selective beat blockers and what these would be used for?
e.g. Propranolol
Used in:
- thyrotoxicosis
- migraine
Carvedilol blocks what 2 types of receptor?
carvedilol (alpha and beta-blocker)
What are the potential side effects of beta blockers?
- Contraindicated in ‘brittle/severe’ asthma
- Tired
- Heart Failure* (worsen it in short term)
- Cold peripheries
What are the two different types of calcium antagonists? Give examples of each.
Dihydropyridines
e.g. Amlodipine
Rate limiting calcium antagonists
e.g. Verapamil, Diltiazem
When would you prescribe a dihydropyridine, and when would a rate limiting calcium antagonist be prescribed?
Dihydropyridine => Used in hypertension and angina
Rate Limiting => HT, angina and SVTs
What side effect do dihydropyridines (e.g. amlodipine) cause?
Ankle oedema
What drug should NOT be prescribed with rate limiting calcium antagonists?
Beta Blockers
Describe the mechanism of action of ACE inhibitors
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)
What are ACE inhibitors useful in treating? Give an example of this drug class.
- Used in hypertension and heart failure
- Good for kidneys in diabetic nephropathy
e. g. Lisinopril or Rampiril
When should ACE inhibitors not be used?
- Bad for kidneys in renal artery stenosis
- Should NOT be used to control BP in pregnancy
What are the main side effects of ACE inhibitors?
- Cough
- Renal dysfunction
- Angioneurotic oedema
Describe the mechanism of Angiotensin Receptor Blockers and give an example of this drug class?
Block Angiotensin II Receptors
e.g. Losartan
When are ARB’s used?
- Used in hypertension and heart failure
- Good for kidneys in diabetic nephropathy
When should ARB’s NOT be used?
- Bad for kidneys in renal a stenosis
- Never use in pregnancy induced hypertension
What are the common side effects of ARBs?
- Renal dysfunction
- NO cough
=> patient’s on ACEi who are experiencing a cough may be swapped onto ARBs
Describe the mechanism of alpha-blockers
Block alpha adrenoceptors to cause vasodilatation
When are alpha blockers used? Give an example of a drug in this class.
Use in hypertension and prostatic hypertrophy
e.g. Doxazosin
What is the main side effects of alpha blockers?
Postural hypotension
How do mineralocorticoids (e.g. spironolactone) attempt to lower BP?
- Block aldosterone receptors
=> Na and water lost
When are mineralocorticoids (e.g. spironolactone) used? Give examples of agents in this drug class.
- Heart failure
- Resistant hypertension
e. g. spironolactone, eplerenone
What are the main side effects of mineralocorticoids (e.g. spironolactone)
- Gynaecomastia
- hyperkalaemia
- renal impairment
What drug classes can be used to combat angina?
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)
How does the mechanism of nitrates help in anging?
- Venodilators => lower pressure
Give an example of a short-acting and long-acting nitrate?
Short - GTN
Long - Isosorbide monoritrate
What else can nitrates be used for, other than angina?
- acute heart failure
What side effects can nitrates cause?
- Headache
- Hypotension/Collapse
Tolerance to nitrates is common. How can we attempt to combat this?
Leave 8 hr/day nitrate-free
=> patients often take tablet in morning and at lunch
How does Nicorandil act as a vasodilator?
K ATP channel activator
- activates intracellular pathways which eventually relaxes the vascular smooth muscle cell
What are the main side effects of nicorandil?
- Headache
- Mouth/ GI Ulcers
How does Ivabradine aim to help with angina?
- Modulates “If” channel in SA node
- Slows HR only in sinus rhythm (Doesn’t work in AF)
What side effect can Ivabradine cause?
Altered visual disturbance
Describe the mechanism of action of Ranolazine and when it is used.
- Late sodium channel modulator
=> Decrease calcium load on heart - Effective in refractory angina
Give examples of anti-platelets and what they are used for?
Aspirin, Clopidogrel, Ticagrelor, Prasugrel
- All prevent new thrombosis
Used in:
- angina
- acute MI
- Stroke/TIA
- Patients at high risk of MI & Stroke
What are the main side effects of anti-platelets?
- Haemorrhage anywhere
- Peptic ulcer haemorrhage
- Asthmatic patients have aspirin sensitivity
What anticoagulants can be used to prevent new thrombosis?
LMWH
Warfarin
Factor Xa inhibitors
Direct Thrombin Inhibitor (Dabigatran)
When are anticoagulants commonly used?
Deep Vein Thrombosis
Pulmonary embolism
NSTEMI
Atrial Fibrillation
What side effect can be caused by anticoagulants?
- Bleeding/ haemorrhage
- with LMWH/ Warfarin, this can be reversed using Vitamin K
What do fibrinolytic drugs aim to do?
Dissolve formed clot
Give examples of fibrinolytic drugs and when they would be used?
- Streptokinase
- tissue Plasminogen activator (tPA)
Used in:
- STEMI
- PE
- Stroke
What side effect can be caused by fibrinolytic drugs and when should they be avoided?
Side effects
- Haemorrhage serious risk
Avoid in
- recent haemorrhage (some strokes)
- trauma
- bleeding tendencies
- severe diabetic retinopathy
- peptic ulcer
What is the main aim of digoxin therapy (e.g. in AF)?
Blocks atrial-ventricular (AV) conduction
=> produces a degree of AV delay
Digoxin has a narrow therapeutic index, therefore what effects can it have at too high a dose?
- Bradycardia and Heart Block
- Increases ventricular irritability which produces ventricular arrhythmias
- If Digoxin toxic, patients can have N+V and yellow vision
Give an example of a Neprilysin Inhibitor and when it is used?
Sacubitril valsartan (Entresto)
- prevents breakdown of BNP
- BNP helps with diuresis
=> used in Heart failure
What are the main side effects of neprilysin inhibitors?
- Hypotension
- Renal impairment
- Hyperkalaemia
- Angioneurotic oedema
