Common Cardiovascular Drugs Flashcards by Zoe Doak

What drug classes can be used to lower cholesterol?

Statins
Fibrates
PCSK 9 Inhibitors (evolocumab, alirocumab)

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What is the mechanism of action of a statin?

inhibit HMG CoA reductase

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

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When are statins likely to be used?

hypercholesterolaemia
diabetes
Angina/MI
Stroke/TIA
High risk of MI/ Stroke

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What are the main side effects of statins?

Myopathy

Rhabdomyolysis => renal failure

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

e.g. Bezafibrate

Used in:

hypertriglyceridaemia
low HDL cholesterol

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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

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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

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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)

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

Block Na reabsorption in kidneys

- salt increases BP

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

Thiazide diuretics

e.g. Bendroflumethiazide

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What are stronger “Loop” diuretics used for?

Used in heart failure

e.g. Furosemide

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What are the main side effects of diuretics?

Hypokalaemia => Tired, Arrhythmias
Hyperglycaemia => Diabetes
Increased Uric Acid => Gout
Impotence

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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

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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

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

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

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Carvedilol blocks what 2 types of receptor?

carvedilol (alpha and beta-blocker)

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What are the potential side effects of beta blockers?

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

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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

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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

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

Ankle oedema

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

Beta Blockers

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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)

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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

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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