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CV Drugs Flashcards

1
Q

Platelet plug formation

A
  1. PLT adherance
  • 1a - collagen 123
  • 1b - vWF + microfibrils
  • 2b/3a - vWF + fibrinogen
  1. Monolayer, spheres, a and b granules
  • ADP (Adenosine DiPhosphate), thromboxane A2 and 5HT
  • Aggregation + vasoconstriction
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2
Q

Platelet plug inhibition

A

PGI2 + NO -inhibtits ADP, thomboxane A2, 5HT

vasoconstriction

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3
Q

Aspirin mechanism

A

Blocks thromboxane A2 irreversibly

Lasts life of PLT 8-9d

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4
Q

Thiopyridine mechanism

A

Irreversibly inhibits Adenosine diphosphate (ADP)

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5
Q

Thiopyridine examples

A
  • Ticlipidine
  • Clopidogrel
  • Prasugrel
  • Ticagrelor
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6
Q

Clopidogrel class + mechanism

A

Irrevers. inhibits ADP

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7
Q

Prasugrel class + mechanism

A

Irrevers inhibits ADP

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8
Q

Glycoprotein 2b/3a inhibitor mechanism

A
  • Abcliximab - monoclonca AB
  • Aptifibatise/ tirofiban - inhibitors
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9
Q

Abcliximab class + mechanism

A

Glycoprotein 2b/3a inhibitor

Monoclonal AB

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10
Q

Aptifibatise class + mechanism

A

Glycoprotein 2b/3a inhibitor

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11
Q

Tirofiban class + mechanism

A

Glycoprotein 2b/3a inhibitor

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12
Q

ACEi mechanism

A

BLOCK AG1 to AG2

AG2 functions;

  1. mass Vasoconstriction (Gq protein)
  2. ADH (post. pit)
  3. Aldosterone (adrenal cortex)
  4. Sympathetic
  5. Renal NaCL reabsorption (hence water) + K+ excretion (tubules)
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13
Q

ACEi examples

A

PRIL

  • Ramipril
  • Perindopril
  • Captopril
  • Analapril
  • Lisinopril
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14
Q

ACEi indications

A
  • Hypertension (1st line)
  • HF
  • Renal Hypertension (1st)
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15
Q

ACEi monitoring

When to stop?

A

BP and U+Es

  • 2wks
  • Annually

STOP: -Serum Cr >20% -eGFR >15%

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16
Q

ARBs mechanism

A

BLOCK AG2 receptor

AG2 functions;

  1. mass Vasoconstriction (Gq protein)
  2. ADH (post. pit)
  3. Aldosterone (adrenal cortex)
  4. Sympathetic
  5. Renal NaCL reabsorption (hence water) + K+ excretion (tubules)

aka AG2 receptor antagonists

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17
Q

ARBs examples

A

SARTAN’s

  • Losartan
  • Candesartan
  • Irbesartan
  • Telmisartan
  • Valsartan
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18
Q

ARBs indications

A

-2nd line to ACEi

  • HF (gold has a b A dvd)
  • CKD Hypertension 1st (/ACEi)
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19
Q

ARBs monitoring

A

BP and U+Es

  • 2wks
  • Annually

STOP: -Serum Cr >20% -eGFR >15%

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20
Q

Aldosterone antagonist mechanism -also known as?

A

BLOCKS Aldosterone receptor

  1. Na/K pump (DT+CD)
  2. Epithelial Na channel (ENaCs)
  3. Secretes K+
  4. Secretes H+ for Na+ (regulating pH, bicarb)

Stimulated by AG2, Adrenal cortex

aka Potassium sparing diuretics

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21
Q

Aldosterone antag examples

A

Spironolactone

Eplerenone

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22
Q

Aldosterone antag indications

A
  • HF (gold has aba Dvd)
    • Post-MI HF
  • Hypertension (step 4. K+
  • Ascites (cirrhotic pts develop 2ndary hyperaldosteronism)
  • Nephrotic syndrome
  • Conn’s syndrome (excess aldosterone and low K+ from adrenal cortex)
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23
Q

B blocker mechanism

A

Block sympathetic B-adrenergic input

  1. Slowing Nodal Phase 0 -ve chronotrope and Myocardial: -ve inotrope
  2. Systemic - lower BP
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24
Q

B blocker examples

A
  • Atenolol
  • Bisoprolol
  • Metoprolol
  • Nebivolol
  • Carvedilol
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25
B blocker indications * Carvedilol * Sotalol * Atenolol * Bisoprolol * Metoprolol * Propanolol
* Carvedilol - HF * Sotalol (2+3) - 1st Rhythm control * Atenolol - 1st Rate control, MI, Stable Angina(4th), SVT(3rd) * Bisoprolol - Stable Angina (4th) * Metoprolol - Stable Angina (4th) * Propanolol - Migraine prophyl, Anxiety, Thyrotoxicosis * Last stage of hypertension
26
CCB mechanism + types
Inhibit Calcium 'SLOW' channels Dihydropyridine (DHP) = vascular smooth muscle * Peripheral vasodilation, Low BP, Low afterload non-DHP = Myocardium and conduction system * Nodal Phase O (-ve chronotrope) * Myocyte Phase 2 (-ve inotrope)
27
DHP CCBs examples
PINEs * Amlodipine * Nifedipine * Felodipine * Lacidipine
28
Non-DHP CCBs examples
* Diltiazem * Verapamil
29
CCB indications * non-DHP * Diltiazem * Verapamil * DHP * Amlodipine * Nifedipine
* Hypertension (DHP: 1st \>55/ black: Amlopidine) * Rate control (nonDHP: Diltiazem\>Verapamil) * Angina 4th (nonDHP: Diltiazem, Verapamil) * Angina 5th Duo (DHP: Nifedipine mod. release + B-blocker) * Reynauds (Nifedipine + Diltiazem) * Cluster prophyl (Verapamil)
30
Nitrate mechanism
VASO+VENO dilation: Coronary + prevent spasm VASO (low afterload) -VENO (low preload)
31
Nitrate examples
* Glyceryl trinitrate (GTN) * Isosobide mono/ dinitrate
32
Nitrate indications
Angina to ACS (acutely or every 12hr) Tolerance: Every 8hrs
33
Potassium channel activator mechanism
Vasodilation (opens potassium channels) * Nicorandil: has nitrate-like venodilation (reducing preload)
34
Potassium channel activator example
Nicorandil
35
Potassium channel activator indications
Angina (if failed duotherapy with Ca2+ antag + B blocker)
36
Loop diuretic mechanism
Inhibit Na-K-2Cl (NaKCC2) co-transporter in thick ascending loop of Henle
37
Loop diuretic examples
Frusemide Bumetanide
38
Loop diuretic indications
* HF (acute IV, chronic PO) * CKD hypertension/ fluid retention (2ndACEi/ARB)
39
Loop diuretic monitoring
* 2wk * 6m
40
Thiazide diuretic mechanism
Inhibit NaCL co-transporter in DCT Onset: 1-2hrs+ Compensatory Inc **Ca2+** absorption by NaCa
41
Thiazide diuretic examples
-thiazide * Bendroflumethiazide * Hydrochlorothiazide * Chlorthalidone +Indapamide (thiazide-like)
42
Thiazide diuretic indications
* Hypertension 3rd line (A+C+D) * Past: HF
43
Thiazide diuretic monitoring
1m 6m
44
Potassium sparing diuretic mechanism
Act in DT+CD, 2 types; 1. Inhibit NaK exchanger only * Amiloride, triamterene 1. aka Aldosterone antagonist * Spironolactone * Eplerenone Aldosterone; 1. Na/K pump (DT+CD) 2. Epithelial Na channel (ENaCs) 3. Secretes K+ 4. Secretes H+ for Na+ (regulating bicarb) Stimulated by AG2, Adrenal cortex
45
Potassium sparing diuretic examples
Weak NaK inhibitors * Amiloride * Triamterene Aldosterone antagonists * Spironolactone * Eplerenone
46
Potassium sparing diuretic indications
* HF (gold has aba Dvd) * Post-MI HF * Hypertension (step 4. K+ * Ascites (cirrhotic pts develop 2ndary hyperaldosteronism) * Nephrotic syndrome * Conn's syndrome (excess aldosterone and low K+ from adrenal cortex)
47
Potassium sparing diuretic monitoring
4x4wk 3x3m 6m
48
Osmotic diuretic mechanism, example + indication
Inc osmolality: Pulls everything out * Mannitol IV * Urea IV * Glycerin PO * Isosorbide PO CEREBRAL OEDEMA
49
Carbonic anhydrase inhibitors * Mechanism * Example * Indication
Diuretic: Inhibit NaHCO3- **Acetazolamide** * Idiopathic Intracranial Hypertension * Prophylaxis against mountain sickness * Glaucoma
50
Class 1a antiarrhythmic * Mechanism * Examples * Uses
Mechanism * Block Myocyte Phase 0 Na+ influx (depolarisation) * Sodium blocker * Intermediate half life Examples * Quinidine * Procainamide * Disopyramide Uses * SVT, VT
51
Class 1b antiarrhythmic * Mechanism * Examples * Uses
Mechanism * Block Myocyte Phase 0 Na+ influx (depolarisation) * Sodium blocker * Fast half life/ weak Examples * Lidocaine * Phenytoin Uses * MI associated VT
52
Class 1c antiarrhythmic * Mechanism * Examples * Uses
Mechanism * Block Myocyte Phase 0 Na+ influx (depolarisation) * Sodium blocker * Slow half life/ strong Examples * Flecainide Uses * Rhythm control
53
Class 2 antiarrhythmic * Mechanism * Examples * Uses
Mechanism * Block sympathetic adrenergic input * Slowing Nodal Phase 0 * B-blockers Examples + Uses * Carvedilol - HF Sotalol (2+3) - 1st Rhythm control * Atenolol - Rate control, MI, Stable Angina (4th), SVT (3rd) * Bisoprolol - Stable Angina (4th) * Metoprolol - Stable Angina (4th) * Propanolol - Migraine prophyl * Last stage of hypertension
54
Class 3 antiarrhythmic * Mechanism * Examples * Uses
Mechanism * Block Myocyte Phase 3 K+ efflux * Potassium blocker Examples + Uses * Sotalol (2+3) - 1st Rhythm control * Amiodarone - Rhythm control, 1st VT (stable)
55
Class 4 antiarrhythmic * Mechanism * Examples * Uses
Mechanism * Non-DHP Calcium 'SLOW' channels * Nodal Phase O (-ve chronotrope) * Myocyte Phase 2 (-ve inotrope) Examples + Uses * Rate control (Diltiazem\> Verapamil) * SVT(2nd)/ asthmatic (Verapamil) * Angina 4th (Diltiazem, Verapamil) * Angina 5th Duo (DHP: Nifedipine mod. release + B-blocker) * Reynauds (Diltiazem + DHP: Nifedipine) * Cluster prophyl (Verapamil) DHP CCB are not Class 4 antiarrhythmics.
56
Cardiac Glycosides * Mechanism * Examples * Uses
Mechanism 1. ++Parasympathetic to SA node (-chronotrope) 2. ++NaCa exchange, increasing intracellular Ca and force of contraction (+inotrope) Example + Use * Digoxin - Rate control(2)
57
Adenosine * Mechanism * Uses
Mechanism * Opens Nodal K+ INFLUX -\> HyPERpolarisation * Short half life * C: Total stop Uses * Narrow Complex Tachy/ SVTs (stable) * (asthmatic: Verapamil)
58
Magnesium Sulphate Indications
MgSO4 uses * **Torsades de Pointes** * **Hypomagnesium** * **Asthma:** Severe Exacerbation * **Pre-Eclampsia:** Severe/ neuro signs
59
Atropine * Mechanism * Uses
Mechanism * Anti-muscarinic Inhibits parasympathetic input to NODES Uses * Bradycardia IM/SC - initial M1 presynaptic block prevents reuptake⇒ bradycardia
60
Aldosterone antagonist monitoring
4x4wk 3x3m 6m
61
Magnesium Sulphate * Signs of Toxicity * Management of Toxicity
Toxicity Signs * Loss of reflexes ← Monitor every 4-6hrs * Flushing * Double vision * Slurred speech Treatment * Stop MgSO4 infusion * Calcium gluconate → relieves vascular spasm
62
B Blocker overdose management
Bradycardic: Atropine 2nd: Glucagon

Pharmacology (14 decks)

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