CVS Drugs Flashcards
How is aspirin used as secondary prevention?
75mg - stable angina
75-150mg - previous cabg
300mg - first two weeks after stroke or TIA
How is clopidogrel used as secondary prevention?
75mg- TIA/Stroke patients after the initial acute phase of treatment
In combination with Aspirin- following Percutaneous Intervention in Stable patient
How is ticagrelor used as secondary prevention?
90mg 2 x/day used In combination with Aspirin in all patient with ACS for upto 1 year in NHSG
Antiplatelet side effects?
Bleeding
Shouldn’t be underestimated particularly when combinations of antiplatelets are used
Roughly 1% annual risk of a significant bleed with a single agent, usually synergistic effect when multiple agents used rather than just simply additive
Effect will last for up to 1 week.
What are ACEi and ARBs for?
-Antihypertensive- first line in under 55 White/ Asian patient
-Reduction in mortality and progression of disease in IHD, CVD and renal disease with proteinuria (particularly diabetic nephropathy)
-Prevent aberrant remodelling following MI
-Reduction in symptoms in heart failure
What is angiotensin II?
vasoconstrictor
What does aldosterone do?
Causes sodium retention at the expense of potassium.
ACEi positive and negative effects?
Eg Ramipril, Lisinopril, captopril, perindopril
-Positive effects- Reduce blood pressure, reduce afterload on heart, prevents aberrant remodelling after MI and reduces proteinuria
-Negative effects- reduces perfusion pressure in glomerulus leading to renal impairment; hyperkalaemia via effect on aldosterone levels,; cough; orthostatic hypotension
Positive and negative effects of ARBs?
Eg, losartan, candersartan
-Positive effects- Reduce blood pressure, reduce afterload on heart, prevents aberrant remodelling and reduces proteinuria
-Negative effects- reduces perfusion pressure in glomerulus leading to renal impairment; hyperkalaemia via effect on aldosterone levels, No cough; orthostatic hypotension
What do spironolactone and eplerenone do?
Aldosterone antagonists
Diuretic, vasodilation
Reduces mortality in IHD and heart failure
Side effects
Renal impairment, hyponatraemia, HYPER KALAEMIA
Gynaecomastia (Spiro > Eplenerone)
Entresto characteristics?
Combination of Valsartan and Sacubitil
Sacubitil - inhibits breakdown natriuretic peptides eg. ANP and BNP (and Bradykinins)
- increase diuresis, natriuresis and vasodilation
- indicated in symptomatic chronic HF with reduced ejection fraction
- Do not co prescribe with ACE inhibitor (allow 36 hour washout period) as increased risk of angioedema
What are thiazide diuretics?
Act by blocking NaCl reabsorption in distal convoluted tubule of the kidney
Mild diuretic effect
Vasodilatory effect
Eg. Indapamide, Bendroflumethiazide
