Common Drugs Used in the Treatment of CVD Flashcards
What do diuretic do?
Block Na+ reabsorption in kidneys, so more water is excreted
Types of diuretics?
Thiazide diuretics (e.g: bendrofluazide) - mild and are used in HYPERTENSION
Loop diuretics (e.g: furosemide) - stronger and are used in HEART FAILURE
Side effects of diuretics?
Hypokalaemia - K+ follows Na+ into urine; this can result in fatigue and arrhythmias
Hyperglycaemia - produce diabetes
Increased uric acid - can cause gout
Impotence
What do β-blockers do?
Block β1 or β2 adrenoceptors, or block both
Types of β-blockers?
Cardio-selective β-blockers, e.g: atenolol - only block β1 adrenoceptors; used in ANGINA, HYPERTENSION and HEART FAILURE
Non-selective β-blockers, e.g: propranolol - block β1 and β2 adrenoceptors; used in THYROTOXICOSIS (disease where metabolic rate speeds up, causing a tremor)
Side effects of β-blockers?
Asthma - NEVER USE β-BLOCKERS IN ESTABLISHED ASTHMA (can cause bronchospasm)
Tired
Cold peripheries - e.g: Raynaud’s phenomenon
Heart failure - only use with initial low dose and then gradually increase; also, use only medium/long term in heart failure (not short-term)
What do Ca2+ antagonists do?
Decrease HR and cause vasodilatation
Types of Ca2+ antagonists?
Dihydropyridines, e.g: amlodipines - used in HYPERTENSION and ANGINA
Rate-limiting Ca2+ antagonists, e.g: verapamil, diltiazem - used in HYPERTENSION and ANGINA, plus supraventricular arrhythmias, like AF and SVT
Side effect of dihydropyridines?
Ankle oedema
Contraindications with rate-limiting Ca2+ antagonists?
Avoid use with β-blockers (also decrease HR so using both together may cause bradycardia)
What do α-blockers do and when are they used?
Block α-adrenoceptors to cause vasodilatation, e.g: Doxazosin
Used in HYPERTENSION and prostatic hypertrophy
Side effects of α-blockers?
Postural hypotension
What do Angiotensin Converting Enzyme (ACE) inhibitors do and when are they used?
Block angiotensin I from being converted to angiotensin II (a vasoconstrictor), e.g Lisinopril
Used in HYPERTENSION and HEART FAILURE
Cautions with ACE inhibitor use?
Good for kidneys in diabetic neuropathy but bad for kidneys in renal artery stenosis - kidneys may respond well/badly so recheck kidney function
NEVER USE IN PREGNANCY-INDUCED HYPERTENSION (can cause foetal abnormalities) - is there any possibility of being pregnant?
Side effects of ACE inhibitors?
Dry cough - no harm but, if too irritating, switch patient to Angiotensin Receptor Blockers
Renal dysfunction
Angioneurotic oedema (allergic swelling that can also occur in the larynx; more common in black people - ensure person has not had this side effect before)
What do Angiotensin Receptor Blockers do?
Block angiotensin II receptors, e.g: Losartan - used in HYPERTENSION and HEART FAILURE
Cautions with angiotensin receptor blockers?
Same as for ACE inhibitors:
Good for kidneys in diabetic neuropathy but bad for kidneys in renal artery stenosis
Never used in pregnancy-induced hypotension
Side effects of angiotensin receptor blockers?
Renal dysfunction
No cough
No angioneurotic oedema
What do nitrates do?
Are VENOdilators (so, not used for hypertension), e.g: isosorbide mononitrate
Used in ANGINA and HEART FAILURE
Side effects of nitrates?
Headache
Hypotension/collapse
Cautions with nitrates?
Tolerance is common so leave 8 hours/day nitrate-free (e.g: no tablet in the evening, so that the drug is gone by next morning)
What do anti-platelet agents do?
All prevent new thrombosis
Used in ANGINA, ACUTE MI, CVA/TIA and also in patients ar high risk of MI and CVA (cerebro-vascular accident)
Examples of anti-platelet agents?
Aspirin, Clopidogrel, Ticagrelor, Prasugrel
Side effects of anti-platelet agents?
Haemorrhage anywhere
Peptic ulcer haemorrhage
Aspirin sensitivity leading to asthma
What do anti-coagulants do?
Prevent new thrombosis
Used in DVT, PE, NSTEMI (Non ST elevation MI) and AF
Examples of anti-coagulants?
Heparin - IV use only
Warfarin - oral use only (blocks clotting factor 2, 7, 9, 10)
Rivaroxaban - inhibitor of Facto Xa
Dabigatran - inhibitor of Thrombin Factor IIa
(Xa converts prothrombin - II - to thrombin - IIa)
Side effects of anti-coagulants?
Haemorrhage anywhere
Cautions with anti-coagulants?
Control dose carefully by International Normalised Ratio (INR) - can monitor warfarin using blood tests frequently
Advantage of warfarin?
Reversed by Vitamin K
What do fibrinolytic drugs do?
Dissolve formed clot, e.g: streptokinase, tissue plasminogen activator (tPA)
Used in STEMI (ST elevation MI), PE (selected cases only) and CVA (selected cases only)
Side effects of fibrinolytic drugs?
Serious risk of haemorrhage
When should fibrinolytic drugs be avoided?
Recent haemorrhage (some CVAs)
Trauma
Bleeding tendencies - e.g: haemophiliacs
Severe diabetic retinopathy - blood vessels here are fragile
Peptic ulcer
Types of anti-cholesterol drugs?
Statins block HMG CoA reductase, e.g: simvastatin:
Used in hypercolesterolaemia, diabetes, angina/MI, CVA/TIA and in those at high risk of MI and CVA
Fibrates, e.g: Bezafibrate: Used in hypertriglyceridaemia, low HDL cholesterol
Side effects of anti-cholesterol drugs?
Myopathy
Rhabdomyolysis renal failure - muscle breakdown that can lead to renal failure
What drug is commonly used for supra-ventricular arrhythmias, like SVT?
Use adenosine (IV) in acute phase
What drugs are commonly used for ventricular/supra-ventricular arrhythmias?
Amiodarone
β-blockers
Flecainide
What is amiodarone?
Only used in life-threathening arrhythmias, as they produce bad side effects: Phototoxicity
Pulmonary fibrosis
Thyroid abnormalities (hypo or hyper)
Effects of digoxin?
Blocks atrial-ventricular (AV) conduction - produces a degree of AV conduction delay this is desired in AF but, if excessive, it is bad as the HR can fall too low (bradycardia) and heart block can occur
Increases ventricular irritability, producing ventricular arrhythmias - always a bad effect and made worse as digoxin has a narrow therapeutic index
Signs of digoxin toxicity?
Nausea and vomiting
Yellow vision
Bradycardia, heart block
Ventricular arrhythmias
In summary, what types of drugs are used for what CVD problems?
