CVS drugs

Question 1

Amlodipine

Answer 1

• drug class: ca2+ channel blockers
• common indications: hypertension, prophylaxis of angina
• mechanism of action: prevent influx of ca2+ into cardiomyocytes and vascular SM cells -> reduced myocardial contractility
• side effects: abdo pain, dizziness, drowsiness, headache, nausea
• drug-drug interactions: inc risk for hypotension when combined with a multitude of drugs
• contra-indications: cardiogenic shock, aortic stenosis (significant), unstable angina

Question 2

Losartan

Answer 2

• drug class: angiotensin receptor blockers (ARB)
• common indications: hypertension, chronic heart failure when you can’t use ACEi, diabetic nephropathy
• mechanism of action: blocks AT1 receptors so AngII can’t exhibit effects eg vasoconstriction, ADH, aldosterone
• side effects: abdo pain, cough, dizziness, back pain, asthenia
• drug-drug interactions: inc risk of hypotension with some drugs eg acebutolol. inc risk of hyperkalaemia with some drugs eg amiloride
• contra-indictions: afro caribbean patients w/ LVH, aortic/mitral valve stenosis, elderly, 1 aldosteronism

Question 3

Indapamide

Answer 3

• drug class: thiazide like diuretic
• common indications: hypertension
• mechanism of action: inhibits Na+Cl- channel in DCT
• common side effects: hypokalaemia, constipation, dry mouth, ED, fatigue, headache
• uncommon side effects: aplastic anaemia, pancreatitis, photosensitivity, paraesthesia (rare)
• drug-drug interactions: causes hypotension, hyponatraemia with many drugs
• contra-indications: addison’s disease, hypercalcaemia, hyponatraemiap

Question 4

Atorvastatin

Answer 4

• drug class: statins
• common indications: primary hypercholesterolaemia patients (with no response to diet/exercise), familial hypercholesterolaemia patients, prevention (1&2) of cardiovascular event
• mechanism of action: inhibit HMG CoA reductase
• common side effects: asthenia, constipation/diarrhoea, dizziness, GI discomfort
• uncommon side effects: alopecia, hepatic disorders, paraesthesia, myopathy (rare)
• drug-drug interactions: hepatotoxicity with many drugs, rhabdomyolysis with many drugs
• contra-indications: hepatic disease, pregnancy, breastfeeding

Question 5

Spironolactone

Answer 5

• drug class: diuretic (aldosterone antagonist)
• common indications: ascites, oedema in CHF, nephrotic syndrome, hypertension, 1 hyperaldosteronism
• mechanism of action: blocks aldosterone antagonist, stops it from binding, so less na+ uptake so less h2o uptake
• common side effects: hyperkalaemia, AKI
• drug-drug interactions: hypotension, hyponatraemia, hyperkalaemia with many drugs
• contra-indications: addison’s disease, anuria, hyperkalaemia

Question 6

clopidogrel

Answer 6

• drug class: anti platelets, NSAIDs
• common indications: stasis, cvd risk
• mechanism of action: stop adp entering platelet by blocking P2Y12 receptor which stops GP IIA/IIIB formation so stops aggregation
• common side effects: diarrhoea, GI discomfort
• uncommon side effects: constipation, dizziness, thrombocytopenia
• drug-drug interactions: other anti platelets,
• contra-indications: platelet disorders eg von willebrands disease

Question 7

amiodarone

Answer 7

• drug class: class 3 anti arrhythmic
• common indications: moat arrhythmias
• mechanism of action: a mix of all but specifically block k+ channels so prevent k+ efflux therefore increased refractory period therefore increased APD
• common side effects: bradycardia
• uncommon side effects:
• drug-drug interactions: other antiarrythmics,
• contra-indications: bradycardia, hypotension, heart block

Question 8

verapamil

Answer 8

• drug class: class 4 anti arrhythmic
• common indications: SVTs, angina, hypertension
• mechanism of action: ca2+ channel blocker on SA and Av node so prevents calcium influx so decreases conduction therefore decreases phase 4s spontaneous depolarisation
• common side effects: abdo pain, drowsiness, constipation
• uncommon side effects:
• drug-drug interactions: other anti arrhythmics
• contra-indications: bradycardia, hypotension, heart block, a fib, a flutter

Question 9

aspirin - after cardiovascular event - 300 mg loading dose and 75 mg baby from then on

Answer 9

• drug class: anti platelet - salicylates
• common indications: after a cardiovascular event to prevent another one, someone who is high risk for cardiovascular event
• mechanism of action: COX1 inhibitor which prevents the formation of TXA2 (platelet aggregating agent) from arachiodonic acid
• common side effects: gi upset and ulcers
• uncommon side effects:
• drug-drug interactions: other anti platelets
• contra-indications: active PUD, children under 16 (can cause reye’s syndrome), haemophilia

Question 10

flecainide

Answer 10

• drug class: class 1c anti arrhythmic
• common indications: a fib, a flutter, PVTs, wolffe parkinson white
• mechanism of action: na+ channel blocker that decreases phase 0. blocked channels prevent na+ influx therefore no depolarisation
• common side effects: arrhythmias, dizziness, cns and gi effects
• uncommon side effects: GI effects
• drug-drug interactions: other anti arrhythmics
• contra-indications: bradycardia, heart block, hypotension, coronary artery disease, structural heart diseases