CPT Drugs Flashcards
Give the names of 2 ACE inhibitors.
naproxen= NSAID
Explain why a patient may get a dry cough as a result of taking lisinopril or ramipril.
- Bradykinin is a substrate for ACE aswell as ACEi.
- Use of ACEi potentiates bradykinin
- Bradykinin causes vasodilation via NOS/NO and prostacyclin (vasodilator)
- Dry cough due to build up of bradykinin
What are some of the contraindications of ACE inhibitors? (5) Who should they not be given to? (3)
Contraindications
- Hypotension
- Dry cough
- Hyperkalaemia (low aldosterone)
- Renal failure (renal artery stenosis)
- AKD
Who should we not give ACE inhibitors to?
- Patients w./ CKD
- Pregnancy
- Breastfeeding
Give 2 examples of angiotensin II receptor blockers (ARBs).
- Candesartan
- Losartan
How do ARBs act to reduce BP?
(ARBs= Angiotensin-II blockers= AT1 Receptor blockers)
Angiotensin II acts on AT1 and AT2 receptors
Directly target AT1 receptors (more effective at inhibiting Angiotensin II mediated vasoconstriction - chymase production)
Why do ARBs not cause a dry cough or angioedema but ACE inhibitors do?
Angioedema is an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes
ARBs have no effect on bradykinin
Less effective in low- renin hypertensives
What are some of the important drug interactions with ACEi to note?
- Drugs that increase K+
- NSAIDs
- Other antihypertensive agents
How do CCBs (calcium channel blockers) work to reduce hypertension?
CCBs- target calcium initiated smooth muscle contraction
Different classes (3) interact with different sites on α1 subunit of VOCC
Outline the mechanism/site of action of the 3 classes of CCBs which are used to treat hypertension:
- State the names of drugs in each class
- State how they work
- Which class is the first line CCB in hypertension
- Which drug has selectvity for cerebral vasculature
- Which drug is use to treat arrythmia and angina
What are the 2 important drug interactions to know for the dihydropyridine class of CCBs?
- Amlodipine + simvastatin - increase effect of statin
- Other antihypertensive agents
What are some of the contraindications of ACE inhibitors? (3) Who should they not be given to? (3)
Contraindications
- Hyperkalaemia (low aldosterone)
- Renal failure (renal artery stenosis)
- AKD
Who should we not give ACE inhibitors to?
- Patients w./ CKD
- Pregnancy
- Breastfeeding
Give the name of a thiazide diuretic and a thiazide like diuretic.
Thiazide diuretic: bendroflumethiazide
Thiazide like diuretic: indapamide
What are some of the important drug interactions with ARBs to note?
- Drugs that increase K+
- NSAIDs
- Other antihypertensive agents
Why are CCBs used in the first instances to treat hypertension in over 55s and those of black African and Caribbean groups?
These populations have low levels of renin in first place- not ideal target system in first instance (RAAS)
What drugs can be used to treat resistant hypertension (stage 4)? (3) Which of these should be used if blood potassium is >4.5 mmol/l and if blood potassium is <4.5 mmol/l?
What are some of the side effects of dihydropyridines and who should it not be given to (contraindications)?
Side effects:
Ankle swelling
Flushing
Headaches
Palpitations
Contraindications:
Unstable angina
Severe aortic stenosis
What are some of the side effects of phenylalkylamines and who should it not be given to (contraindications)?
Side effects:
- Constipation
- Bradycardia (iv)
- Heart block
- Cardiac failure
Contraindications:
- Poor left ventricular function
- AV nodal conduction delay
What are 3 important drug interactions with phenylalkylamines that we should be aware of?
- β-blockers
- Other hypertensives
- Other antiarrythmics
Identify some drugs used to treat and manage heart failure:
What are some of the side effect of thiazides and what are their 2 important drug interactions?
Side effects:
- Hypokalaemia
- Hyponatraemia
- Impaired glucose tolerance
- Increased cholesterol and triglyceride levels
- Gout
- Increased urea and uric acid levels
Interations:
- NSAIDs
- Potassium lowering drugs
Thiazides are more likely to be chosen to treat hypertension over CCBs if the patient has what sign/symptom?
Oedema
Why are ACE inhibitors or ARBs the first line treatment for hypertension secondary to type 2 diabetes irrespective of age or ethnicity?
ACEis and ARBs have added benefits at kidneys
- Decrease incidence of diabetic nephropathy and CKD w./proteinuria
- Dilation of efferent glomerular arteriole
- Reduced intraglomerular pressure
- Dilation of efferent glomerular arteriole
How does spironolactone work? What are its contraindications (2) and what are its important drug interactions to consider?
Sprionolactone= aldosterone antoagonist–> stops action of aldosterone at ENaC and also blocks ROMK
Contraindications:
- Hyperkalaemia
- Addison’s
Interactions:
- Other K+ increasing drugs
- ACE inhibitors
- ARBs
Name 3 β-adrenoreceptor blockers (used to treat hypertension) and explain how beta blockers work to reduce blood pressure.
-
Labetalol (β1, β2 and α1)
- Used: preganncy and hypertensive emergencies)
- Bisoprolol (β1)
- Metoprolol (β1)
How do they work?
- Block noradrenaline
- Decrease sympathetic tone
- Reduce CO
- Reduce release of renin in kidneys (release= partly regulated by β1- adrenoreceptors)
- ie REDUCE SYMPATHETIC OUTFLOW
With relation to β-blockers give the:
Side effects (5)
Contraindications (4)
Interactions (1)
Side effects:
- Bronchospasm
- Heart block
- Raynaud’s
- Lethargy
- Impotence
Contraindications:
- Asthma
- COPD
- Haemodynamic instability
- Hepatic failure
Interactions:
- Non-dihydropyridine CCBs
- Verapamil
- Diltiazem
Name 2 α-blocker and describe how they work to treat hypertension. Apart from hypertension what else are they used to treat?
- Doxazosin
- Tamsulosin
How does it work?
- Selective antagonism- α-1 adrenoreceptors
- Reduce peripheral vascular resistance
Tamsulosin also used to treat symptoms of BPH
State the main contraindications and interactions from α-adrenoreceptor blockers.
Contraindications:
- Postural hypotension
Interactions:
- Dihydropyridien CCBs- oedema
What are the seven different types of diuretic drugs acting on the kidney?
- Carbonic anhydrase inhibitors
- Osmotic diuretics
- Loop diuretics
- Thiazides
- K+ sparing diuretics
- Aldosterone antagonists
- ADH Antagonists
Describe the actions (2) and side effects (2) of carbonic anhydrase inhibitors
Actions:
- Sodium bicarbonate diuresis
- Excretion of Na+, K+ and PO3
Side effects:
- Metabolic acidosis
- Hypokalemia
Describe the actions and side effects of osmotic agents
Name an example of an osmotic agent.
Actions:
- Filtered at glomerulus
- Increase osmotic gradient throughout nephron
- Excessive water loss
Side effects:
- Hypernatraemia
Example:
- Mannitol
Describe the actions and side effects of thiazides.
Name 2 examples.
Actions:
- Inhibits NaCl reabsorption
- Promotes Ca reabsorption
Side effects:
- Hypokalaemia
- Hyperuricaemia
Examples:
- Bendroflmethiazide
- Indapamide
Describe the actions and effects of aldosterone antagonists.
Name an example:
- Competes with aldosterone at mineralcorticosteroid receptor
- Aldosterone increases expression of ENaC and Na/K/ATPasein principal cells of the collecting duct
Example:
Spironolactone (potassium sparing)
Outline the action of ADH antagonists. (aquaretics)
Give 2 examples
ADH antagonists reduce concentrating ability of urine in collecting ducts
Describe the actions and side effects of loop diuretic.
Name 2 examples.
Actions:
- Thick ascending limb loop of Henle
- Inhibit NaCl reabsorption (block Na/K/2Cl co-transporter)
- Concurrent Ca/Mg excretion
Side effects:
- Hypokalaemia (CD)
Examples:
- Bumetanide
- Furosemide
Identify 5 common specific ADRs from thiazides
- Gout
- Hyperglycaemia
- Erectile dysfunction
- ↑LDL & TG
- Hypercalcaemia
Identify 3 common specific ADRs from spironolactone
- Hyperkalaemia
- Impotence
- Painful gynaecomastia (male breasts)
Identify 4 common specific ADRs from furosemide (loop diuretic)
- Ototoxicity
- Alkalosis
- ↑LDL & TG
- Gout
Identify a common specific ADRs from bumetanide (loop diuretic)
Myalgia
Explain the effect of ACE Inhibitors interacting with K+ sparing diuretics
Increased hyperkalaemia → cardiac problems
What is the effect of aminoglycosides interacting with loop diuretics?
- Ototoxicity
- Nephrotoxicity
Explain the effect of digoxin interacting with thiazide and loop diuretics
Hypokalaemia → increased digoxin binding & toxicity
What is the effect of β- Blockers interacting with thiazide diuretics?
- Hyperglycemia
- Hyperlipidemia
- Hyperuricaemia
What is the effect of steroids interacting with thiazide & loop diuretics?
Increased risk of hypokalaemia
What is the effect of lithium interacting with thiazide & loop diuretics?
- Lithium toxicity (thiazides)
- Reduced lithium levels (loop)
What is the effect of carbamazepine interacting with thiazide diuretics?
Increased risk of hyponatraemia
Which diuretics are commonly used to treat hypertension? Why are loop diuretics not usually used?
- Thiazide diuretics (vasodilatation as well as diuresis)
- Spironolactone
(Loop diuretics) - don’t work well as body compensates quickly
Which diuretics are commonly used to treat heart failure?
- Loop diuretics
- Spironolactone (non-diuretic benefits)
(ACE inhibitors/ ARBs)
(Beta- blockers)
Which diuretics are commonly used to treat decompensated liver disease?
- Spironolactone
- Loop diuretics
Useful table for drug-drug interactions with diuretics:
Which diuretics are commonly used to treat nephrotic syndrome?
- Loop diuretic (often big doses needed)
- ± Thiazides
- ± K+ sparing diuretic / K+ supplements
Which diuretics are commonly used to treat Chronic Kidney Disease?
- Loop diuretics
- ± Thiazide-like
- Generally avoid K+ sparing diuretics
(Alkalosis and kalliuretic effects potentially beneficial)
Kalliuretic= getting rid of potassium in urine)
Identify four potentially nephrotoxic drugs
- Aminoglycosides e.g gentamicin
- Vancomycin (IV only)
- Aciclovir (antiviral)
- NSAIDs
What are SGLT2 inhibitors used for?
Treating type 2 diabetes
Get rid of uric acid
Identify four drugs which can exacerbate renal dysfunction
- ACE-Inhibitors
- Diuretics
- NSAIDs
- Metformin
Apart from spironolactone, give another example of a potassium sparing diuretic and state how is works:
Amiloride
Block ENaC at luminal surface of renal tubule
What are carbonic anhydrase inhibitors used to treat?
- Glaucoma
- Mountain sickness
(BUT tolerance builds up in 2-3 days)
Mannitol is an osmotic agent (diuretic), what is it used for?
(need to be careful as patients can become hypernaetraemic)
Used as diuretic in ITU to 1) relieve ICP and to 2) force urine production in people with acute (sudden) kidney failure
