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OSCE Pharmacology > CVS drugs - Anti-hypertensives and anti-clotting > Flashcards

CVS drugs - Anti-hypertensives and anti-clotting Flashcards

1
Q

What are three indications for ACE inhibitors?

A

Hypertension
Heart failure
Renal dysfunction

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2
Q

Give three contraindications for ACE inhibitors

A

Pregnancy
Renovascular Disease
Aortic Stenosis

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3
Q

Give four ADRs of ACE inhibitors

A

Dry cough due to bradykinin
Angio-oedema
Renal Failure
Hyperkalaemia

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4
Q

What is the mechanism of action of an ACE inhibitor?

A

Inhibition of angiotensin converting enzyme

Reduced bradykinin breakdown

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5
Q

How do ACE inhibitors lower BP? (3)

A
  • Decreased sympathetic drive
  • Peripheral vasodilation
  • Decreased aldosterone
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6
Q

Give a DDI of ACE inhibitors

A

Beta blockers - both lower blood blood pressure

Aspirin, at a push?

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7
Q

What is the indication for angiotensin receptor blockers?

A

Hypertension

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8
Q

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

A
  • Pregnancy
  • Renovascular disease
  • Aortic stenosis
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9
Q

Give two ADR of angiotensin receptor blockers

A

Renal Failure

Hyperkalaemia

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10
Q

What is the mechanism of action of angiotensin receptor blockers

A

Antagonism of angiotensin 2 receptor => AT1R

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11
Q

What are four indications for B blockers?

A

Angina
Post MI
Hypertension, especially in younger patient
Arrhythmias

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12
Q

Give five contra-indications for B blockers

A 
Asthma (non-selective only)
Bradycardia
Hypotension
AV-block
Congestive heart failure
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13
Q

Give 7 ADRs of beta blocekrs

A 
Bronchospasms
Fatigue
Insomnia
Dizziness
Cold extremities
Hypotension and bradycardia
Death in diabetic hypoglycaemia
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14
Q

Give two DDIs of B blockers

A

Prevents salbutamol actions

Verapamil -> both –ve inotropes

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15
Q

What is the mech of action of B blockers

A

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

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16
Q

What is the indication for direct renin inhibitor

A

Hypertension

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17
Q

Give four ADRs for direct renin inhibitors

A

Angio-oedema,
hyperkalaemia,
hypotension,
GI disturbances

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18
Q

What is the mechanism of action of direct renin inhibitors

A

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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19
Q

Give the general 3 indications for calcium channel blockers

A

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

Supraventricular arrhythmias

angina

20
Q

Give three contraindications for calcium channel blocker

A

Heart failure
Bradycardia
AV node block

21
Q

What is the mechanism of action of calcium channel blockers?

A

Block specific alpha subunit of L-type calcium

reduce calcium entry
Vasodilation of arteries

22
Q

Give four ADRs to calcium channel blockers

A

 Hypotension, bradycardia, heart failure, heart block

23
Q

What is an indication for a thiazide diuretic?

A

 Hypertension

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

24
Q

What is the mechanism of action of thiazide diuretics?

A

 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

25
Q

Give some adverse drug reactions of thiazide diuretics

A

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

26
Q

What do calcium channel blockers dilate?

A

Peripheral, coronary and pulmonary arteries

27
Q

What are some ADRs of nifedipine?

A

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

28
Q

Aside from vasodilating effects, what do verapamil do?

A

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

29
Q

What are three ADRs for verapamil?

A

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

30
Q

What are four indications for streptokinase?

A

ife-threating venous thrombus
MI
PE
Arterial thromboembolia

31
Q

What are 6 contraindications for streptokinase

A

ife-threating venous thrombus
MI
PE
Arterial thromboembolia

32
Q

What is mech of action of streptokinase?

A

Converts plasminogen to plasmin, which breaks down fibrinogen

33
Q

What are three ADRs of streptokinase

A

Hypotension
Haemorrhage
GI

34
Q

Give two indication for tPa

35
Q

What are three ADRs for tPAs?

A

Hypotension
Haemorrhage
GI

36
Q

What are three ADRs for warfarin?

A

Teratogenic
Bleeding
Bruising
Purpura

37
Q

What DDIs does warfarin have?

A

CYP450 inducers and inhibitors

38
Q

What is the mech of action of warfarin?

A

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

39
Q

Give four ADRs of heparin

A

Bleeding, bruising, thrombocytopenia, osteoporosis

40
Q

What is the mechanism of heparin?

A

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

41
Q

What are 3 ADRs for aspirin

A

Reye’s syndrome, GI haemorrhage

42
Q

Why should aspirin not be used with warfarin?

A

Displaces it, increasing warf conc

43
Q

How does aspirin work as an anti-platelet

A

COX inhibitor and ↓ thromboxane A2 production

150g post MI decreases mortality

44
Q

What is clopidogrel used for?

A

Secondary prevention of CVS and CVA

45
Q

Give to ADRs for clopidogrel

A

Haemorrhage

GI

46
Q

What is the advantage of clopidogrel over aspirin

A

Works with warfarin

47
Q

How does clopidogrel work?

A

ADP antagonist => ADP receptors’ interference

Instead of aspirin i.e. allergy

OSCE Pharmacology (10 decks)

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