CVS Drugs

Question 1

What are examples of antiplatelets?

Answer 1

Aspirin - NSAIDs.
Clopidogrel / Ticagrelor - ADP receptor antagonists.
Dipyridamole - phosphodiesterase inhibitors.
Abciximab - GPIIB/IIIA fibrinogen receptor antagonists.
Vorapaxar - thrombin receptor inhibitors.

Question 2

What are the side effects of antiplatelets?

Answer 2

Bleeding (1wk) - do not underestimate, particularly with multidrug therapy.
Usually a synergistic effect when multiple agents are used.

Question 3

What do beta blockers reduce?

Answer 3

Mortality in IHD and heart failure.
Symptoms in angina, AF and SVT.

Question 4

What are beta 1 blockers?

Answer 4

Slows HR, BP and conduction.
Increases diastolic time.

Reduces contractility.
High doses can cause bradycardia and heart block.

Bisoprolol, Carvediol, Atenolol, Metoprolol.

Question 5

What are beta 2 blockers?

Answer 5

Reduces tremors.

Can cause potentially lethal bronchospasms in asthmatics, vasoconstriction and PVD.

Propranolol.

Question 6

What can the RAAA cause?

Answer 6

The development of heart, liver or kidney failure.

Question 7

What are ACEIs and ARBs?

Answer 7

First line antihypertensives in <55yr old Caucasian/Asian patients.
Prevents aberrant remodelling following an MI.

Can cause hyperkalemia and orthostatic hypotension.

Question 8

What do ACEIs and ARBs reduce?

Answer 8

Mortality and progression of disease in IHD, CVD, and proteinuria.
Heart failure symptoms, BP, and afterload.
Perfusion pressure in the glomerulus - renal impairment.

Question 9

What are examples of ACEIs and ARBs?

Answer 9

ACEIs - Ramipril, Lisinopril, Captopril, Perindopril. Can cause a cough.
ARBs - Iosartan, Candersartan. Cannot cause a cough.

Question 10

What are aldosterone antagonists?

Answer 10

Spironolactone and Eplenerone - used in heart failure (frequently co-prescribed with ACE/ARB).

Question 11

What is Spironolactone?

Answer 11

Sometimes used in hypertension.
Enhanced diuretic effect; vasodilation.
Reduces mortality in IHD and heart failure.
Renal impairment, hyponatraemia, hyperkalaemia (marked if AKI).
Gynecomastia (Spironolactone > Eplenerone).

Question 12

What is Entresto?

Answer 12

A combination of Valsartan and Sacubitil (inhibits the breakdown of ANP and BNP).
Increases diuresis, natriuresis, and vasodilation.
Increased risk of angioedema.

Question 13

When should Sacubitil be used?

Answer 13

Indicated in symptomatic chronic HF with reduced ejection fraction.
Do not co-prescribe with ACE inhibitors (allow a 36hr washout period).

Question 14

What are Dihydropyridines?

Answer 14

An antihypertensive CCB.
Amlodipine, Felodipine, Nifedipine.
Causes vasodilation.
Reduces symptoms of angina.
Causes postural hypotension, peripheral oedema, and bradycardia (rare, unless OD).

Question 15

What are Non-dihydropyridines?

Answer 15

An antihypertensive CCB.
Verapamil, Diltiazem.
Slows SAN function and AV conduction.
Reduces symptoms of angina, AF, and SVT.
Postural hypotension, peripheral oedema, bradycardia, heart block (particularly if prescribed with beta blockers).

Question 16

What are statins?

Answer 16

Simvastatin, Rosuvastatin, Atorvastatin.
Primary prevention - reduces cardiovascular risk if patients 10yr risk > 20%.
Secondary prevention - after cardiovascular event.
Muscle aches and pain.

Question 17

What are thiazide diuretics?

Answer 17

Indapamide and Bendoflumethiazide.
Blocks NaCl reabsorption in the DCT of the kidney.
Mild diuretic and vasodilatory effects.
Low Na+ and K+, high Ca2+, hyperuricaemia, hyperglycaemia, dehydration, renal impairment, orthostatic hypotension.

Question 18

What are loop diuretics?

Answer 18

Furosemide and Bumetanide.
Blocks NaCl reabsorption in the ascending limb of the loop of Henle.
Intense diuretic effect; pronounced vasodilatory and venodilatory effects.
Low Na+, K+, Mg2+, and Ca2+, dehydration, renal impairment, orthostatic hypotension.

Question 19

What are antianginals?

Answer 19

Nitrates -
Directly acts to cause vasodilation via NO.
Headache and postural hypotension.

Nicorandil -
Vasodilation.
Headache, postural hypotension, and ulceration in the GI tract.

Question 20

What are antihypertensives?

Answer 20

Doxasocin.
Alpha-adrenoreceptor blockers.
Causes peripheral vasodilation.