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Pharmacology > CV Drugs > Flashcards

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
Q

B blocker indications

  • Carvedilol
  • Sotalol
  • Atenolol
  • Bisoprolol
  • Metoprolol
  • Propanolol
A
  • 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
Q

CCB mechanism + types

A

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
Q

DHP CCBs examples

A

PINEs

  • Amlodipine
  • Nifedipine
  • Felodipine
  • Lacidipine
28
Q

Non-DHP CCBs examples

A
  • Diltiazem
  • Verapamil
29
Q

CCB indications

  • non-DHP
    • Diltiazem
    • Verapamil
  • DHP
    • Amlodipine
    • Nifedipine
A
  • 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
Q

Nitrate mechanism

A

VASO+VENO dilation: Coronary + prevent spasm

VASO (low afterload) -VENO (low preload)

31
Q

Nitrate examples

A
  • Glyceryl trinitrate (GTN)
  • Isosobide mono/ dinitrate
32
Q

Nitrate indications

A

Angina to ACS (acutely or every 12hr)

Tolerance: Every 8hrs

33
Q

Potassium channel activator mechanism

A

Vasodilation (opens potassium channels)

  • Nicorandil: has nitrate-like venodilation (reducing preload)
34
Q

Potassium channel activator example

A

Nicorandil

35
Q

Potassium channel activator indications

A

Angina (if failed duotherapy with Ca2+ antag + B blocker)

36
Q

Loop diuretic mechanism

A

Inhibit Na-K-2Cl (NaKCC2) co-transporter in thick ascending loop of Henle

37
Q

Loop diuretic examples

A

Frusemide Bumetanide

38
Q

Loop diuretic indications

A
  • HF (acute IV, chronic PO)
  • CKD hypertension/ fluid retention (2ndACEi/ARB)
39
Q

Loop diuretic monitoring

A
  • 2wk
  • 6m
40
Q

Thiazide diuretic mechanism

A

Inhibit NaCL co-transporter in DCT

Onset: 1-2hrs+

Compensatory Inc Ca2+ absorption by NaCa

41
Q

Thiazide diuretic examples

A

-thiazide

  • Bendroflumethiazide
  • Hydrochlorothiazide
  • Chlorthalidone

+Indapamide (thiazide-like)

42
Q

Thiazide diuretic indications

A
  • Hypertension 3rd line (A+C+D)
  • Past: HF
43
Q

Thiazide diuretic monitoring

A

1m

6m

44
Q

Potassium sparing diuretic mechanism

A

Act in DT+CD, 2 types;

  1. Inhibit NaK exchanger only
    * Amiloride, triamterene
  2. 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
Q

Potassium sparing diuretic examples

A

Weak NaK inhibitors

  • Amiloride
  • Triamterene

Aldosterone antagonists

  • Spironolactone
  • Eplerenone
46
Q

Potassium sparing diuretic 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)
47
Q

Potassium sparing diuretic monitoring

A

4x4wk 3x3m 6m

48
Q

Osmotic diuretic mechanism, example + indication

A

Inc osmolality: Pulls everything out

  • Mannitol IV
  • Urea IV
  • Glycerin PO
  • Isosorbide PO

CEREBRAL OEDEMA

49
Q

Carbonic anhydrase inhibitors

  • Mechanism
  • Example
  • Indication
A

Diuretic: Inhibit NaHCO3-

Acetazolamide

  • Idiopathic Intracranial Hypertension
  • Prophylaxis against mountain sickness
  • Glaucoma
50
Q

Class 1a antiarrhythmic

  • Mechanism
  • Examples
  • Uses
A

Mechanism

  • Block Myocyte Phase 0 Na+ influx (depolarisation)
  • Sodium blocker
  • Intermediate half life

Examples

  • Quinidine
  • Procainamide
  • Disopyramide

Uses

  • SVT, VT
51
Q

Class 1b antiarrhythmic

  • Mechanism
  • Examples
  • Uses
A

Mechanism

  • Block Myocyte Phase 0 Na+ influx (depolarisation)
  • Sodium blocker
  • Fast half life/ weak

Examples

  • Lidocaine
  • Phenytoin

Uses

  • MI associated VT
52
Q

Class 1c antiarrhythmic

  • Mechanism
  • Examples
  • Uses
A

Mechanism

  • Block Myocyte Phase 0 Na+ influx (depolarisation)
  • Sodium blocker
  • Slow half life/ strong

Examples

  • Flecainide

Uses

  • Rhythm control
53
Q

Class 2 antiarrhythmic

  • Mechanism
  • Examples
  • Uses
A

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
Q

Class 3 antiarrhythmic

  • Mechanism
  • Examples
  • Uses
A

Mechanism

  • Block Myocyte Phase 3 K+ efflux
  • Potassium blocker

Examples + Uses

  • Sotalol (2+3) - 1st Rhythm control
  • Amiodarone - Rhythm control, 1st VT (stable)
55
Q

Class 4 antiarrhythmic

  • Mechanism
  • Examples
  • Uses
A

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
Q

Cardiac Glycosides

  • Mechanism
  • Examples
  • Uses
A

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
Q

Adenosine

  • Mechanism
  • Uses
A

Mechanism

  • Opens Nodal K+ INFLUX -> HyPERpolarisation
  • Short half life
  • C: Total stop

Uses

  • Narrow Complex Tachy/ SVTs (stable)
    • (asthmatic: Verapamil)
58
Q

Magnesium Sulphate Indications

A

MgSO4 uses

  • Torsades de Pointes
  • Hypomagnesium
  • Asthma: Severe Exacerbation
  • Pre-Eclampsia: Severe/ neuro signs
59
Q

Atropine

  • Mechanism
  • Uses
A

Mechanism

  • Anti-muscarinic Inhibits parasympathetic input to NODES

Uses

  • Bradycardia

IM/SC - initial M1 presynaptic block prevents reuptake⇒ bradycardia

60
Q

Aldosterone antagonist monitoring

A

4x4wk 3x3m 6m

61
Q

Magnesium Sulphate

  • Signs of Toxicity
  • Management of Toxicity
A

Toxicity Signs

  • Loss of reflexes ← Monitor every 4-6hrs
  • Flushing
  • Double vision
  • Slurred speech

Treatment

  • Stop MgSO4 infusion
  • Calcium gluconate → relieves vascular spasm
62
Q

B Blocker overdose management

A

Bradycardic: Atropine

2nd: Glucagon

Pharmacology (14 decks)

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