Common CV Drugs Flashcards
describe the cardiovascular continuum
risk factors endothelial dysfunction atherosclerosis coronary artery disease plaque rupture (can lead to stroke) myocardial infarction dilatation/remodelling heart failure end stage heart disease
name anti cholesterol drugs
statins
fibrates
PCSK 9 inhibitors
name anti hypertensive drugs
thiazide diuretics
beta blockers
vasodilators
name statins
simvastatin
atorvastatin
name PCSK 9 inhibitors
evolocumab
alirocumab
name vasodilators
calcium antagonists
alpha blockers
ACE inhibitors (ACEI)
angiotensin receptor blockers (ARB)
describe statins mechanism of action
blocks HMG CoA reductase
use of statins
hypercholeterolaemia diabetes angina/MI CVA/TIA high risk of MI and CVA
side effects of statins
myopathy rhabdomyolysis (renal failure)
use of fibrates
hypertriglyceridaemia
low HDL cholesterol
mechanism of PCSK 9 inhibitors
by inhibiting the binding of PCSK9 to LDLR, they increase the number of LDLRs available to clear LDL, thereby lowering LDL-C levels
use of PCSK 9 inhibitors
for familial hypercholesterolaemia
results of hypertension
stroke blindness heart attack and heart failure kidney failure arteriosclerosis
name anti hypertensive drugs
thiazide diuretics
beta blockers
vasodilators
mechanism of action of diuretics
block Na reabsorption in kidneys
describe thiazide diuretics
mild
eg bendrofluazide
used in hypertension
describe loop diuretics
stronger
eg furosemide
used in heart failure
diuretic side effects
hypokalaemia- tired arrhythmias hyperglycaemia- diabetes increase in uric acid- gout impotence
mechanism of action of beta blockers
block B1 and sometimes B2 adrenoreceptors
describe cardioselective B blockers
only block B1 receptors
name cardioselective B blockers
atenolol
bisoprolol
use of cardioselective B blockers
angina acute coronary syndrome myocardial infarction hypertension heart failure
mechanism of action of non selective B blockers
block B1 and B2 receptors
name non selective beta blockers
propranolol
carvedilol
use of non selective beta blockers
thyrotoxicosis
migraine
beta blocker side effects
asthma- contraindicated in brittle/severe asthma
tired
heart failure (can worsen it in short term)
cold peripheries
name the two types of calcium antagonists
dihydropyridines
rate limiting calcium antagonists
name dihydopyridines
amlodipine
use of dihydropyridines
hypertension
angina
side effect of dihydropyridines
ankle oedema
name rate limiting calcium antagonists
verapamil
diltiazem
(avoid use with beta blockers)
use of rate limiting calcium antagonists
hypertension
angina
supracalvicular arrhythmias
describe mechanism of action of ACE inhibitors
block angiotensin I becoming angiotensin II
name an ACE inhibitor
lisinopril
never use in pregnancy induced hypertension
describe the effect of ACE inhibitors and angiotensin receptor blockers on kidneys
good for kidneys in diabetic nephropathy
bad for kidneys in renal artery stenosis
side effects of ACE inhibitors
cough
renal dysfunction
angioneurmtic oedema
describe the mechanism of action of angiotensin receptor blockers
block angiotensin II receptors
name an angiotensin receptor blocker
losartan
never use in pregnancy induced hypertension
use of angiotensin receptor blockers
hypertension
heart failure
side effects of angiotensin receptor blockers
renal dysfunction (no cough)
mechanism of action of alpha blockers
block alpha adrenoreceptors to cause vasodilation
use of alpha blockers
hypertension
prostatic hypertrophy
name an alpha blocker
doxazosin
side effect of alpha blockers
postural hypotension
mechanism of action of mineralocorticoid antagonists
block aldosterone receptors
use of mineralocorticoid antagonists
heart failure
resistant hypertension
name mineralocorticoid antagonists
spironolactone
eplerenone
side effects of mineralocorticoid antagonists
gynaecomastia
hyperkalaemia
renal impairment
name anti anginal drugs
vasodilators
slow heart rate
metabolic modulators
name vasodilators used in angina
nitrates
nicorandil
calcium antagonisti
name drugs used to slow heart rate
beta blockers
calcium antagonists
ivabradine
name the metabolic modulator used in angina
ranolazine
describe the mechanism of action of nitrates
ventilators
name a nitrate
isosorbide mononitrate
use of nitrates
angina
acute heart failure
side effects of nitrates
headaches
hypotension/collapse
treatment of tolerance of nitrates
leave 8hr/day nitrate free
mechanism of action of nicorandil
K ATP channel activator
side effects of nicorandil
headache
mouth/ GI ulcers
describe ivabradine
If channel modulator in the sinus node
slows HR only in sinus rhythm
does not work in atrial fibrillation
altered visual disturbance
describe ranolazine
late sodium channel modulator
decrease calcium load on heart
effective in refractory angina
what is acute coronary syndrome
unstable angina
NSTEMI
STEMI
name anti thrombotic drugs
anti platelet drugs anticoagulants warfarin rivaroxaban dabigatran edoxaban fibrinolytic
name antiplatelets
aspirin
clopidogrel
prasugrel
ticagrelor
name anticoagulants
heparin
fondaparinux
name fibrinolytics
streptokinase
tPA
role of antiplatelet agents
all prevent new thrombosis
use of antiplatelet agents
angina
acute MI
CVA/TIA
patients at high risk of MI and CVA
side effects of antiplatelet agents
haemorrhage anywhere
peptic ulcer which can lead to a haemorrhage
aspirin sensitivity which results in asthma
role of anticoagulants
prevent new thrombosis
mechanism of action of warfarin
block clotting factors 2,7,9,10
use of warfarin
deep vein thrombosis
pulmonary embolism
NSTEMI
atrial fibrillation
side effects of warfarin
haemorrhage anywhere
heparin use
IV only
warfarin use
oral only
control dose carefully by INR
reversed by vitamin K
rivaroxaban
anticoagulant
factor X a inhibitor
dabigatran
anticoagulant
thrombin factor Ica inhibitor
Xa converts prothrombin (II) to thrombin (IIa)
role of fibrinolytic drugs
dissolve formed clot
use of fibrinolytic drugs
STEMI PE (selected cases only) CVA (selected cases only)
side effects of fibrinolytics
haemorrhage serious risk
when to avoid fibrinolytics
recent haemorrhage (some CVAs) trauma bleeding tendencies severe diabetic retinopathy peptic ulcer
name atrial fibrillation drugs
rate control with BB, digoxin or rate limiting calcium channel blockers
or chemically cardiovert with amiodarone
name heart failure drugs
ACE inhibitors ARBs BBs mineralocorticoid antagonists neprilusin inhibitor diuretics digoxin
name a neprilysin inhibitor
salcubitril valsartan
describe the 2 effects of digoxin
blocks atrial-ventiruclar conduction
increases ventricular irritability which produces ventricular arrhythmias
effect of blocking AV conduction by digoxin
produces a degree of AV conduction delay
good in AF
if excessive, bad because HR falls too much giving bradycardia and heart block
effect of increasing ventricular irritability by digoxin
always bad
-ve therapeutic index
digoxin toxicity
nausea, vomiting
yellow vision
bradycardia, heart block
ventricular arrhythmias
mechanism of action of a neprilysin inhibitor
ARB and endopeptidase inhibitor
superior to ACEI or ARB
side effects of neprilysin inhibitor
hypotension
renal impairment
hyperkalaemia
angioneutoritc oedema