CVD Flashcards
Risk factors of CVD
Smoking Genetics - FH Age Gender obesity diet excersise
Primary prevention for CVD
modify diet, excersise, stop smoking,
Secondary prevention for CVD
Medications for Angina Heart Attack Stroke Claudication
Prevention regime
Lifestyle changes
2.Control Total Cholesterol
Statin Treatment
Reduce cholesterol <5.0mmol/L or 25%
3.Control Hypertension
Moderate hypertension
mild hypertension with evidence of CV disease
Reduce blood pressure to target of <140/85
4.Anti Platelet drugs - Aspirin
When identified Cardiovascular disease
When HIGH RISK with no identified disease
Cardiovascular drug categories
Prevent disease
Reduce current symptoms
Prevent further disease Anti platelet drugs Lipid lowering drugs Anti-arrhythmics Anticoagulants Reduce symptoms of current disease Diuretics Anti-arrhythmics Nitrates Calcium channel blockers Ace inhibitors
Antiplatelet drugs and actions
Why are they prescribed
Aspirin - inhibits PLT aggregation
Clopidegrel - inhibit ADP and PLT aggregation
Dipyrimadole - inhibit PLT phosphodiesterase
Given to reduce chance of heart attack or stroke
Issues with antiplatelets
On own not a significant bleeding risk but if used in combination
Anticoagulants and their action
Warfarin
NOACS - rivaroxiban/apixiban/dabigatran
Wat is the action of warfarin
Coumarin based anitcoagulant
Inhibits synthesis of Vitamin K dependent clotting factors
2, 7, 9,10 (slow – 2 days)
Protein C, Protein S (quick)
Initial Hypercoagulation
Anticoagulation takes 2-3 days, then after 2-3d to clear
Often HEPARIN used concurrently initially
Therapeutic range of INR
2.0-4.0
NOAC drugs and their usually routine
Rivaroxiban -x1 daily – (aXi)
Apixaban -x2 daily – (aXi)
Dabigatran -x2 daily – (dTi)
NOAC interactions
Safe with ‘Dental’ Antibiotics except Macrolides
Erythromycin and Clarithromycin
Safe with Antifungals – topical and fluconazole
Safe with Local Anaesthetics
Safe with Antivirals
NSAID will prolong action and inhibit platelets – avoid
What are statins and their action
HMG coA Reductase inhibitors (“Statins”)
Simvastatin – (a ‘prodrug’)
Atorvastatin
Inhibit cholesterol synthesis in the liver
Reduce total cholesterol and LDL-cholesterol
Side effects – possible myositis with some drug interactions – includes antifungals
HMG coA Reductase inhibitors (-statin)
Simvastatin – (a ‘prodrug’)
Atorvastatin
Rosuvastatin
Inhibit cholesterol synthesis in the liver
Reduce total cholesterol and LDL-cholesterol
Side effects – possible myositis with some drug interactions – includes some dental antifungals
FLUCONAZOLE interaction
Omit statin during antifungal treatment
What are beta blockers - names and action
Beta-adrenergic blockers (β-blockers) Atenolol – selective - β1 only Propranolol – non-selective – β1 and β2 Many others (-olol) Stop arrhythmias leading to cardiac arrest (Ventricular fibrillation – VF) Reduces heart muscle excitability
How do beta blockers work
Beta-adrenergic blockers (β-blockers Prevent increase in heart rate Cause postural hypotension Prevent unusual heart rhythms which can lead to heart attacks Reduce heart efficiency Make heart failure worse Block beta receptors in the lungs Make asthma worse or difficult to treat
What are diuretics
Antihypertensive and for Heart Failure Thiazide diuretics (bendroflumethiazide) Loop diuretics (frusemide) Increase salt and water LOSS Reduce plasma volume Reduce cardiac workload Side effects – can lead to Na+/K+ imbalance if not monitored carefully Can lead to dry mouth in the elderly
What are nitrates
Short acting – Glyceryl Trinitrate (GTN)
Emergency management of angina pectoris
Long acting – Isosorbide Mononitrate
Prevention of angina pectoris
Dilate VEINS Reduce preload to the heart Dilate resistance arteries Reduce cardiac workload (afterload) Reduce cardiac oxygen consumption Dilate colateral coronary artery supply Reduce anginal pain
What are Ca channel blockers
Hypertension Block Calcium channels in smooth muscle Some more active on peripheral blood vessels Relaxation and vasodilation Nifedipine, amlodipine (-pine) Some more active on the heart muscle Slow conduction of pacing impulses Verapamil
What are ACE inhibitors
Angiotensin Converting Enzyme (ACE) inhibitors
Many on the market (-pril)
Enalapril
Ramapril
Lisinopril
Inhibit conversion of angiotensin I to angiotensin II
Prevents aldosterone dependent reabsorbtion of salt and water.
How do ACE inhibitors work
Reduce blood pressure Reduce excess salt and water retention - side effects – cough, hypotension Angiotensin II blockers Losartan and others (-artan) Inhibit same system but by a different mechanism
