CVS drugs - Anti-hypertensives and anti-clotting Flashcards by Matt Quinn

What are three indications for ACE inhibitors?

Hypertension
Heart failure
Renal dysfunction

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Give three contraindications for ACE inhibitors

Pregnancy
Renovascular Disease
Aortic Stenosis

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Give four ADRs of ACE inhibitors

Dry cough due to bradykinin
Angio-oedema
Renal Failure
Hyperkalaemia

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What is the mechanism of action of an ACE inhibitor?

Inhibition of angiotensin converting enzyme

Reduced bradykinin breakdown

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How do ACE inhibitors lower BP? (3)

Decreased sympathetic drive
Peripheral vasodilation
Decreased aldosterone

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Give a DDI of ACE inhibitors

Beta blockers - both lower blood blood pressure

Aspirin, at a push?

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What is the indication for angiotensin receptor blockers?

Hypertension

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Give three situations in which it would be unwise to give an angiotensin blocker

Pregnancy
Renovascular disease
Aortic stenosis

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Give two ADR of angiotensin receptor blockers

Renal Failure

Hyperkalaemia

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What is the mechanism of action of angiotensin receptor blockers

Antagonism of angiotensin 2 receptor => AT1R

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What are four indications for B blockers?

Angina
Post MI
Hypertension, especially in younger patient
Arrhythmias

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Give five contra-indications for B blockers

Asthma (non-selective only)
Bradycardia
Hypotension
AV-block
Congestive heart failure

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Give 7 ADRs of beta blocekrs

Bronchospasms
Fatigue
Insomnia
Dizziness
Cold extremities
Hypotension and bradycardia
Death in diabetic hypoglycaemia

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Give two DDIs of B blockers

Prevents salbutamol actions

Verapamil -> both –ve inotropes

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What is the mech of action of B blockers

Antagonise β1 receptors => negative ionotropic and chronotropic effect
Inhibits renin

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What is the indication for direct renin inhibitor

Hypertension

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Give four ADRs for direct renin inhibitors

Angio-oedema,
hyperkalaemia,
hypotension,
GI disturbances

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What is the mechanism of action of direct renin inhibitors

Antagonises Renin, preventing the conversion of Angiotensinogen  Angiotensin I.
Reduces plasma renin activity by 50-80%
40h t ½
Elimination in faeces

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Give the general 3 indications for calcium channel blockers

Hypertension (2nd line and in over 55/black)

Supraventricular arrhythmias

angina

Give three contraindications for calcium channel blocker

Heart failure
Bradycardia
AV node block

What is the mechanism of action of calcium channel blockers?

Block specific alpha subunit of L-type calcium

reduce calcium entry
Vasodilation of arteries

Give four ADRs to calcium channel blockers

 Hypotension, bradycardia, heart failure, heart block

What is an indication for a thiazide diuretic?

 Hypertension

 Oedema secondary to congestive cardiac failure, liver disease or nephrotic syndrome

What is the mechanism of action of thiazide diuretics?

 Thiazide diuretics inhibit the Na+/Cl- co-transporter in the luminal membrane in the distal tubule of the kidney. This blocks the reabsorption of Na+ and therefore water. Result is lower blood volume and pressure

Give some adverse drug reactions of thiazide diuretics

 Hypokalaemia, hyperuricaemia, impaired glucose tolerance, Hyponatraemia, hypermagnesemia, Hypercalcaemia, metabolic alkalosis

What do calcium channel blockers dilate?

Peripheral, coronary and pulmonary arteries

What are some ADRs of nifedipine?

 Sympathetic nervous system activation – tachycardia and palpitations  Flushing, sweating, throbbing headache  Oedema

Aside from vasodilating effects, what do verapamil do?

depresses SA node and slows A-V conduction by impeding calcium transport across myocardial and vascular smooht muscle cell membrane

What are three ADRs for verapamil?

 Constipation  Risk of bradycardia  Reduced myocardial contractility (-‘ve inotrope) so can worsen heart failure

What are four indications for streptokinase?

ife-threating venous thrombus MI PE Arterial thromboembolia

What are 6 contraindications for streptokinase

ife-threating venous thrombus MI PE Arterial thromboembolia

What is mech of action of streptokinase?

Converts plasminogen to plasmin, which breaks down fibrinogen

What are three ADRs of streptokinase

Hypotension Haemorrhage GI

Give two indication for tPa

MI | PE

What are three ADRs for tPAs?

Hypotension Haemorrhage GI

What are three ADRs for warfarin?

Teratogenic Bleeding Bruising Purpura

What DDIs does warfarin have?

CYP450 inducers and inhibitors

What is the mech of action of warfarin?

Inhibits vit k epoxide reductase, reducing vit K and thus vit K dependent clotting factors 2,7,9 and 10 from being formed

Give four ADRs of heparin

Bleeding, bruising, thrombocytopenia, osteoporosis

What is the mechanism of heparin?

Binds to ant-thrombin 3 and inactivates factor 10 and (thrombin: unfractionated only) Monitor APTT

What are 3 ADRs for aspirin

Reye's syndrome, GI haemorrhage

Why should aspirin not be used with warfarin?

Displaces it, increasing warf conc

How does aspirin work as an anti-platelet

COX inhibitor and ↓ thromboxane A2 production | 150g post MI decreases mortality

What is clopidogrel used for?

Secondary prevention of CVS and CVA

Give to ADRs for clopidogrel

Haemorrhage | GI

What is the advantage of clopidogrel over aspirin

Works with warfarin

How does clopidogrel work?

ADP antagonist => ADP receptors’ interference | Instead of aspirin i.e. allergy