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CVS Drugs Flashcards

1
Q

Thiazide like diuretics examples

A

Bendromethiazide

Indapamide

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2
Q

Thiazide like diuretics mechanism of action

A

Inhibition of sodium chloride co-transporter in the DCT. This is decreases sodium and water reabsorption.

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3
Q

Thiazide like diuretics indications

A

Hypertension

Heart failure

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4
Q

Thiazide like diuretics ADRs

A

Hypokalaemia

Arrhythmias

Hyperglycaemia

Hypercholesterolaemia

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5
Q

Thiazide like diuretics drug interactions

A

NSAIDs

Loop diuretics

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6
Q

Loop diuretics examples

A

Furosemide

Bumetanide

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7
Q

Loop diuretics mechanism of action

A

Inhibition of sodium potassium 2chloride co-transporter in the loop of henle

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8
Q

Loop diuretics indications

A

Oedema

Hypertension

Heart failure

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9
Q

Loop diuretics ADRs

A

Dizziness

Headache

Electrolyte imbalance

Nausea

Dehydration

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10
Q

Loop diuretics drug interactions

A

Thiazide like diuretics

Diabetic medication

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11
Q

Potassium sparing drugs examples

A

Amiloride

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12
Q

Potassium sparing drugs mechansim of action

A

Blocks ENaC channels at the luminal surface of the renal tubule. This decreases sodium reabsorption without affecting the reabsorption of potassium.

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13
Q

Potassium sparing drugs ADRs

A

Hyperkalaemia

Potential arrhythmias

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14
Q

Potassium sparing drugs indications

A

Heart failure

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15
Q

Potassium sparing drugs drug interactions

A

ACEi

ARBs

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16
Q

Aldosterone receptor antagonist example

A

Spironolactone

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17
Q

Aldosterone receptor antagonist indications

A

Oedema

Heart failure

Hypertension

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18
Q

Aldosterone receptor antagonist mechanism of action

A

competitively inhibits aldosterone dependant Na+ K+ exchange channels in the DCT. This action leads to increased sodium and water excretion, but more potassium retention

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19
Q

Aldosterone receptor antagonist ADRs

A

Hyperkalaemia

Gynaecomastia

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20
Q

Aldosterone receptor antagonist drug interactions

A

Drugs that increase potassium levels

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21
Q

Class 1b drugs indications

A

Ventricular tachycardia

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22
Q

Class 1b ADR

A

CNS effects : dizziness and drowsiness

GI upset

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23
Q

Class 1b drugs examples

A

Lidocaine

Mexiletine

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24
Q

Class 1b agents mechanism of action

A

Decreased depolarisation in ischaemic tissue

Increased sodium threshold

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25
Q

Class 1c drugs examples

A

Flecainide

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26
Q

Class 1c drugs indications

A

Supraventricular arrhythmia

Wolff-Parkinson-White syndrome

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27
Q

Class 1c drugs ADR

A

Pro-arrhythmia
Flecainide flutter
CNS and GI effects

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28
Q

Class 1c agents mechanism of action

A

Increases refractory period and the action potential

Decreases automaticity

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29
Q

Class 2 drugs examples

A

Propranolol, bisoprolol and metoprolol

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30
Q

Class 2 drugs indications

A

Re-entrant arrhythmias
AFIB
Sinus tachycardia

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31
Q

Class 2 drugs ADR

A

Bronchospasm

Hypotension

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32
Q

Class 3 drugs examples

A

Amiodarone

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33
Q

Class 3 drugs indications

A

Wide spectrum - most arrhythmias

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34
Q

Class 3 ADR

A 
Pulmonary fibrosis 
Hepatic injury 
Increase LDL cholesterol 
Thyroid disease
Photosensitivity
Optic neuritis
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35
Q

Class 3 drugs interactions

A

Digoxin

Warfarin

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36
Q

Common thromboembolic diseases

A 
DVT
PE
Consequence of AF
TIA
MI
Ischaemic stroke
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37
Q

How does Prostacyclin - PGI2 - prevent platelet aggregation ?

A

Prostacyclin is released from endothelial cells which then binds to platelet receptors. This increases the concentration of cAMP in platelets. This causes decreased calcium. This decreases platelet aggregatory events and stabilises inactive GPIIb/IIIa receptors.

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38
Q

What are 3 anti-platelet and fibrinolytic targets ?

A

The COX-1 enzyme
Fibrinogen acting at the GPIIb/IIIa receptors
ADP and thromboxane 2 upregulating receptors

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39
Q

What class is aspirin ?

A

Cyclo-oxygenase inhibitor

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40
Q

Indications of aspirin ?

A

AF post stroke
Secondary prevention of stroke or TIA
MI

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41
Q

Aspirin mechanism of action

A

Aspirin irreversibly inhibits COX-1 mediated production of thromboxane 2 and reduces platelet aggregation

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42
Q

Aspirin ADR

A

GI irritation
GI bleeding
Haemorrhage

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43
Q

Aspirin contra-indications

A

Reye’s syndrome - children having flu or chicken pox while taking aspirin
Hypersensitivity
Pregnancy in 3rd trimester

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44
Q

Aspirin DDI

A

Other anti-platelets and anti-coagulants

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45
Q

ADP receptor antagonist examples

A

Clopidogrel
Prasugrel
Ticagrelor

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46
Q

ADP receptor antagonists mechanism of action

A

Inhibit binding of ADP to P2Y12 receptor which inhibits activation of GPIIb/IIIa receptors.

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47
Q

Differences between Clopidogrel and prasugrel to Ticagrelor

A

Clopidogrel and Prasugrel are irreversible inhibitors of P2Y12 receptors
Ticagrelor acts reversibly at a different site and has active metabolites

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48
Q

ADP receptor antagonists indications

A

Ischaemic stroke
TIA
MI + aspirin
Usually used as a second agent in a dual anti platelet therapy

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49
Q

ADP receptor antagonist ADR

A

Bleeding

GI upset - dyspepsia and diarrhoea

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50
Q

ADP receptor antagonist cautions

A

High bleed risk patients

Renal and hepatic impairment

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51
Q

ADP receptor antagonist DDI

A

Clopidogrel requires CYPs for activation so CYP inhibitors such as omeprazole can affect drug efficacy

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52
Q

Dipyridamole drug class

A

Phosphodiesterase inhibitor

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53
Q

Dipyridamole mechanism of action

A

Dipyridamole inhibits cellular re-uptake of adenosine. This increases concentration of adenosine which inhibits platelet aggregation via adenosine receptors.
It also prevents cAMP degradation which inhibits expression of GPIIb/IIIa

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54
Q

Dipyridamole indications

A

Secondary prevention of ischaemic stroke and TIA

Stroke

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55
Q

Dipyridamole ADR

A

Vomiting
Diarrhoea
Dizziness

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56
Q

Dipyridamole DDI

A

Anti-platelets
Anti-coagulants
Adenosine

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57
Q

Abciximab drug class

A

Glycoprotein IIb/IIIa inhibitor

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58
Q

Abciximab mechanism of action

A

Abciximab prevents the binding of fibrinogen and von Willebrand factor at the GPIIb/IIIa receptors

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59
Q

Abciximab ADR

A

Bleeding

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60
Q

Abciximab DDI

A

Anti-platelets

Anti-coagulants

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61
Q

Fibrinolytic agents - clot busters examples

A

Streptokinase

Alteplase

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62
Q

Fibrinolytic agents - clot busters mechanism of action

A

Promotes conversion of plasminogen into plasmin. This dissolves the fibrin mesh work of the thrombus.

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63
Q

Fibrinolytic agents - clot busters indications

A

Acute ischaemic stroke

STEMI

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64
Q

Fibrinolytic agents - clot busters ADR

A

Bleeding

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65
Q

Fibrinolytic agents - clot busters DDI

A

Anti-platelets

Anti-coagulants

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66
Q

What is given for secondary prevention of ACS ( STEMI, NSTEMI and unstable angina ) ?

A

ACEi
Beta blocker
Dual anti platelet therapy - aspirin + ADP receptor antagonist
Statin

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67
Q

Clotting cascade - intrinsic pathway

A

Factor XII is converted to factor XIIa.
Factor XI is converted to factor XIa by factor XIIa.
Factor IX is converted to factor IXa by factor XIa.
Factor X is then converted into factor Xa by factor IXa.
Prothrombin is then converted into Thrombin by factor Xa.
Thrombin converts fibrinogen into fibrin.

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68
Q

Clotting cascade - extrinsic pathway

A

Factor VII is converted into factor VIIa by tissue factor.
Factor X is then converted into factor Xa by factor VIIa.
Prothrombin is then converted into thrombin by factor Xa
Thrombin then converts fibrinogen into fibrin.

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69
Q

Unfractionated heparin mechanism of action

A

Binds to antithrombin III causing a conformational change and increasing activity of ATIII.
This inhibits factor Xa.

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70
Q

Low molecular weight heparin examples

A

Dalteparin
Enoxaprain
Fondaparinux

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71
Q

Dalteparin and enoxaparin mechanism of action

A

Enhance activity of ATIII activity and inhibit factor Xa specifically

72
Q

Fondaparinux mechanism of action

A

It is a synthetic pentasaccharide which selectively inhibits Xa by enhancing ATIII.

73
Q

Heparin indications

A 
Prevention of thromboembolism 
DVT 
PE
Acute coronary syndromes 
Can be used in pregnancy as it doesn’t cross the placenta
74
Q

Heparin ADR

A 
Bruising 
Bleeding 
Heparin induced thrombocytopenia 
Hyperkalaemia due to inhibition of aldosterone secretions 
Can cause osteoporosis in long term use
75
Q

Heparin cautions

A

Clotting disorders

Renal impairment

76
Q

Heparin DDI

A

Other anti - thrombotic drugs
ACEi / ARB
Amiloride
Spironolactone

77
Q

What is given for heparin reversal ?

A

Protamine sulphate as it forms an inactive complex with heparin. Heparin dissociates from ATIII and irreversibly binds to protamine sulphate.

78
Q

Warfarin drug class

A

Vitamin k antagonist

79
Q

Warfarin mechanism of action

A

Inhibits activation of vitamin k dependent clotting factors - factor II, VII, XI and X. This prevents the clotting cascade and the production of fibrin.

80
Q

Warfarin indications

A

PE
Venous thromboembolism
DVT
AF

81
Q

Warfarin ADR

A

Bleeding - epistaxis

82
Q

What is given for warfarin reversal ?

83
Q

Warfarin DDI

A

NSAIDs displace warfarin from albumin causing higher INR
CYP Inducers - Barbiturates, phenytoin and rifampicin accelerate warfarin metabolism causing lower INR
CYP2C9 inhibitors - amiodarone, Clopidogrel and alcohol inhibit hepatic metabolism causing higher INR
Cephalosporin reduces vitamin K production by decreasing gut bacteria

84
Q

DOAC examples

A

Apixaban
Edoxaban
Rivaroxaban
Dabigatran

85
Q

Apixaban mechanism of action

A

It inhibits both free Xa and that bound to ATIII.

86
Q

Dabigatran mechanism of action

A

It is a selective direct competitive thrombin inhibitor of both circulating and thrombus bound IIa

87
Q

DOAC ADR

88
Q

DOAC cautions

A

Dabigatran is contra-indicated in low creatinine clearance

Avoid in pregnancy due to little information known

89
Q

DOAC DDI

A

Reduced effectiveness by CYP inducers

Increased concentration by macrolides

90
Q

DOAC antidotes

A

Andexanet

Idarucizumab

91
Q

Tranexamic acid mechanism of action

A

Inhibits fibrinolysis

92
Q

Tranexamic acid drug class

A

Anti-fibrinolytic

93
Q

What are the primary hypertensive agents ?

A

ACEi
ARB
CCB
Diuretics

94
Q

ACEi mechanism of action

A

ACEi inhibit angiotensin converting enzyme and limit conversion of angiotensin 1 to angiotensin 2. This causes vasodilation, reduction in aldosterone release and reduced ADH release.

95
Q

ACEi examples

A

Ramipril

Lisinopril

96
Q

ACEi ADR

A

Hypotension
Dry cough
Hyperkalaemia
Angio-oedema - more common in Afro-Caribbean patients

97
Q

ACEi cautions

A

Renal artery stenosis
AKD
Pregnancy
Idiopathic angioedema

98
Q

ACEi DDI

A

Drugs that increase potassium
NSAIDs
Other anti-hypertensives

99
Q

ARB examples

A

Losartan

Candesartan

100
Q

ARB mechanism of action

A

Directly target and block AT1 receptors - more effective at inhibiting angiotensin 2 mediated vasoconstriction than ACEi.

101
Q

ARB cautions

A

Renal artery stenosis
AKD
Pregnancy

102
Q

ARB DDI

A

Drugs that increase potassium

NSAIDs

103
Q

ARB ADR

A

Hypotension

Hyperkalaemia

104
Q

ARB indications

A

Heart failure

Hypertension

105
Q

ACEi indications

A

Hypertension

Heart failure

106
Q

Dihydropyridine examples

A

Amlodipine

Nifedipine

107
Q

Dihydropyridine mechanism of action

A

They are selective for peripheral vasculature and block L type calcium channels preventing calcium entrance into smooth muscle cells. This prevents vasoconstriction.

108
Q

Chronotropic effect meaning

A

Changes in HR

109
Q

Ionotropic effects meaning

A

Changes in the contractility of the heart

110
Q

Dihydropyridine ADR

A

Ankle swelling
Flushing
Headaches
Palpitations

111
Q

Dihydropyridine cautions

A

Unstable angina

Severe aortic stenosis

112
Q

Amlodipine DDI

A

Amlodipine increases the effect of simvastatin

113
Q

Dihydropyridine indications

A

Angina

Hypertension

114
Q

Verapamil drug class

A

Phenylalkylamine

115
Q

Verapamil mechanism of action

A

They depress the SA node and slows AV conduction
Prolongs action potential and effective refractory period
Has negative chronotropic and ionotropic effects

116
Q

Verapamil indications

A

Arrhythmia
Angina
Hypertension

117
Q

Verapamil ADR

A

Constipation
Bradycardia
Heart block
Cardiac failure

118
Q

Verapamil cautions

A

Poor LV function

AV nodal delay

119
Q

Verapamil DDI

A

Beta blockers

Other anti-hypertensive and anti-arrhythmia agents

120
Q

Benzothiazapine example

121
Q

Spironolactone drug class

A

Aldosterone receptor antagonist

122
Q

Spironolactone indication

A

Resistant hypertension

123
Q

Spironolactone ADR

A

Hyperkalaemia

Gynaecomastia

124
Q

Spironolactone cautions

A

Hyperkalaemia

Addison’s

125
Q

Spironolactone DDI

A

Drugs that increase potassium

Pregnancy

126
Q

What drugs should be given if potassium is high instead of Spironolactone ?

A

Alpha or beta blockers

127
Q

What anti-hypertensive should be given in pregnancy ?

128
Q

Beta blockers mechanism of action in hypertension

A

They decrease the sympathetic tone by blocking noradrenaline and reducing myocardial contraction resulting in decreased CO

129
Q

Beta blocker cautions

A

Asthma

Hepatic failure

130
Q

Beta blocker DDI

A

Non-Dihydropyridines can cause asystole with beta blockers

Beta agonists cancel out beta blockers

131
Q

Doxazosin drug class

A

Alpha blocker

132
Q

Doxazocin mechanism of action

A

Selectivel antagonism of alpha 1 receptors and reduce peripheral vascular resistance

133
Q

What alpha blocker can be given for BPH ?

A

Tamsulosin

134
Q

Doxazosin ADR

A 
Postural hypertension 
Dizziness 
Syncope
Headache
Fatigue
135
Q

Doxazosin cautions

A

Postural hypertension

136
Q

Doxazosin DDI

A

Dihydropyridines - increase oedema

137
Q

Glyceryl trinitrate drug class

138
Q

Glyceryl trinitrate indications

A

Angina
Hypertension
Heart failure

139
Q

Glyceryl trinitrate cautions

A

Aortic stenosis
Hypovolaemia
Hypotension

140
Q

Glyceryl trinitrate ADR

A 
Arrhythmia
Dizziness
Drowsiness
Headaches
Hypotension
141
Q

Glyceryl trinitrate mechanism of action

A

It is denitrated to produce the active metabolite nitric oxide. This then causes venodilation.

142
Q

Class 4 drug examples

A

Verapamil

Diltiazem

143
Q

Class 4 drug mechanism of action

A

Slow conduction through AV

Increase refractory period in AV node

144
Q

Class 4 drug indications

A

Supraventricular tachycardia

145
Q

Class 4 drug ADR

A

Constipation

Hypotension

146
Q

Class 4 drug DDI

A

Beta blockers can cause asystole if used together

147
Q

Adenosine mechanism of action

A

Adenosine binds to A1 receptors and blocks adenylyl cyclase and reduces cAMP. This causes a potassium influx which results in hyperpolarisation. This decreases HR.

148
Q

Adenosine indications

A

Re-entrant supraventricular arrhythmias

149
Q

Ivabradine mechanism of action

A

It blocks the funny current in the SAN

150
Q

Ivabradine ADR

A

Flashing lights

151
Q

Ivabradine cautions

A

Avoid in pregnancy due to possible teratogenity

152
Q

Ivabradine indications

A

Sinus tachycardia

Decreases HR in HF and angina

153
Q

Digoxin indications

A

AF

Atrial flutter

154
Q

Digoxin mechanism of action

A

Enhances vagal activity which slows AV conduction and HR

155
Q

Atropine mechanism of action

A

It selectively blocks Muscarinic receptors and blocks vagal activity to increase AV conduction and increase HR

156
Q

Atropine indications

A

Vagal bradycardia

157
Q

Statin examples

A

Atorvastatin

Simvastatin

158
Q

Statins mechanism of action

A

Competitively inhibit HMG-CoA reductase decreasing production of cholesterol
It also contributes to the upregulation of hepatic LDL receptors and increases clearance of circulating LDL

159
Q

Statin ADR

A

GI disruption
Nausea
Headaches
Myalgia

160
Q

Statin cautions

A

Renal and hepatic impairment

Pregnancy

161
Q

Statins DDI

A

Amiodarone, diltiazem and macrolides increase statin concentration as well as Amlodipine

162
Q

Fenofibrate drug class

A

Fibric acid derivatives ( fibrates )

163
Q

Fenofibrate mechanism of action

A

Activation of nuclear transcription factor - PPAR alpha. This regulates expression of genes that control lipoprotein metabolism. There is also increased production of lipoprotein lipase. This results in increased triglyceride removal and increased fatty acid uptake by the liver.

164
Q

Fenofibrate ADR

A

Cholelithiasis
GI upset
Myositis

165
Q

Fenofibrate cautions

A

Photosensitivity

Gall bladder disease

166
Q

Fenofibrate DDI

A

Warfarin - increased anti coagulation

167
Q

Fenofibrate indication

A

Hyperlipidaemia

168
Q

Ezetimibe drug class

A

Cholesterol absorption inhibitor

169
Q

Ezetimibe indications

A

Used as an adjunct to a statin

170
Q

Ezetimibe mechanism of action

A

It inhibits NPC1L1 transporter at brush border which reduces cholesterol absorption in the gut.

171
Q

Ezetimibe ADR

A

Abdominal pain
GI upset
Angioedema

172
Q

Ezetimibe caution

A

Hepatic failure

173
Q

Ezetimibe DDI

A

Increased risk of rhabdomyolysis alongside statins

174
Q

Alirocumab drug class

A

PCSK9 inhibitor

175
Q

Alirocumab indications

A

Primary hypercholesterolaemia

176
Q

Inclisiran mechanism of action

A

It is a siRNA which inhibits hepatic translation of PCSK9 blocking its action.

CPT Drugs (9 decks)

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