cvs - drugs for HF, IHD, HTN Flashcards
name 5 1st line anti-hypertensives
- ACE-inhibitors
- Ang II type 1 (AT1) blockers
- Beta-blockers
- Ca2+ channel blockers
- Diuretics - loop, thiazide
name 3 2nd line anti-hypertensives
- Hydralazine
- Potassium-sparing diuretics
- Alpha-adrenergic antagonists
name 9 classes of drugs used in HF
- ACE-I
- Angiotensin II type 1 (AT1) blockers
- Beta-blockers
- Sacubitril-Valsartan
- Diuretics - thiazides, potassium-sparing
- Hydralazine
- Ivabradine
- Nitrates
- Cardiac glycosides
name 4 classes of drugs for IHD
- Nitrates
- Ca2+ channel blockers
- Beta-blockers
- Ivabradine
name 4 beta blockers used in HF
- carvedilol (non-selective)
- bisoprolol (β1)
- metoprolol XL (β1)
- nebivolol (mixed)
name 6 beta blockers used in HTN and IHD
- carvedilol (non-selective)
- propanolol (non-selective)
- bisoprolol (β1)
- metoprolol XL (β1)
- atenolol (β1)
- nebivolol (mixed)
moa of beta blockers
- β1 blockade →↓ conversion of ATP to cAMP →↓PKA →↓Ca2+ channel activation →↓ heart contractility
moa of carvedilol
- blocks α1 receptors → reduce peripheral resistance
- antioxidative
- anti-ischaemic
moa of nebivolol
- β1 selective in low dose/fast metab
- non-selective in high dose/slow metab
- vasodilatory effects through increase NO release
how do beta blockers lower bp?
↓ CO + inhibit renin release → ↓ bp
how do beta blockers work in HF?
↓ HR and myocardial contractility → ↓ O2 demand
clinical uses of beta-blockers
- hypertension
- cardiac failure
- post-MI
- arrhythmia
- anxiety disorders
adverse effects of beta-blockers
- hypotension
- bradycardia
- reduced exercise capacity
- AV nodal block
- bronchoconstriction (esp in asthmatics)
- vivid dreams, depression
contraindications for beta-blockers
- asthma
- diabetes
- severe bradycardia
- advanced heart block
name 3 ACE-I
- lisinopril
- captopril
- enalapril
clinical uses of ACE-I
- hypertension
- cardiac failure
- post-MI
- renal insufficiency
adverse effects of ACE-I
- severe hypotension
- acute renal failure
- hyperkalemia
- angioedema
- dry cough (common)
contraindications for ACE-I
pregnancy (causes fetal harm)
name 2 ang II type 1 blocker
- valsartan
- losartan
contraindications for ang II type I blocker
pregnancy
benefit of AT1 over ACE-I
less/no dry cough (as bradykinin pathway not affected)
moa of sacubitril-valsartan
- sacubitril is a neprilysin inhibitor → prolong BNP effects → promote vasodilation, natriuresis, diuresis, antagonise RAAS
- valsartan is an Ang II receptor blocker (since neprilysin also breaks down Ang II, sacubitril prolongs Ang II effects → HF progression → need valsartan to counter effects)
indication for sacubitril-valsartan
HFrEF
adverse effects of sacubitril-valsartan
- hypotension
- hyperkalemia
- renal failure
- cough
- angioedema
general effect of diuretics
reduce blood vol → decrease CO
moa of loop diuretics
- selectively inhibit Na+/K+/2Cl- transporter in loop of Henle
- increase Mg2+ and Ca2+ excretion
- increase renal blood flow (furosemide)
name 3 eg. of loop diuretics
- furosemide
- bumetanide
- ethacrynic acid
clinical uses of loop diuretics
- hypertension
- acute pulmonary oedema and other oedema
- acute hyperkalemia
- acute renal failure
- anion overdose
adverse effects of loop diuretics
- hypokalemic metabolic alkalosis
- ototoxicity
- hyperuricemia
- hypomagnesemia
what drugs should be avoided w loop diuretics
- aminoglycosides (ototoxicity)
- NSAIDs (inhibit prostaglandin synthesis)
name 4 eg. of potassium-sparing diuretics
- spironolactone
- triamterene
- amiloride
- eplerenone
moa of potassium-sparing diuretics
- spironolactone and eplerenone block aldosterone receptor
- triamterene and amiloride block Na+ channels
⇒ prevent Na+ and water retention → ↓ bp
clinical uses of potassium-sparing diuretics
- hypertension (2nd line)
- hyperaldosteronism
adverse effects of potassium-sparing diuretics
- hyperkalemia
- metabolic acidosis
- gynecomastia (spironolactone)
- acute renal failure (triamterene, indomethacin)
- kidney stones (triamterene)
moa of thiazide
- inhibit NaCl reabsorption by blocking Na+/Cl- transporter → diuresis and reduced blood vol
- enhance Ca2+ reabsorption in distal convoluted tubule
name 2 thiazides
- hydrochlorothiazide
- indapamide
4 clinical uses of thiazides
- hypertension
- congestive HF
- nephrolithiasis due to hypercalciuria
- nephrogenic diabetes insipidus
adverse effects of thiazides
- hypokalemic metabolic alkalosis
- hyponatraemia
- hyperuricemia
- hyperglycemia
- hyperlipidemia
- hypercalcemia
contraindication for thiazide
NSAIDs (reduces renal prostaglandin synthesis → interfere w antihypertensive action)
name 2 non-DHP calcium channel blockers
- verapamil
- diltiazem
name 2 DHP calcium channel blockers
- nifedipine
- amlodipine
diff btwn DHP and non-DHP
- DHP: primarily causes vasodilation
- non-DHP: also affect HR and force of contraction
moa of calcium channel blockers
inhibit L-type calcium channels → ↓ intracellular calcium → vasodilation
clinical uses of non-DHP calcium channel blockers
- arrhythmia
- angina
clinical uses of DHP calcium channel blockers
- hypertension
- angina
- ↓ risk of MI/stroke
- Raynaud’s phenomenon
adverse effect of calcium channel blockers
cardiac depression - bradycardia, AV block, HF
adverse effects of DHP calcium channel blockers
- hypotension
- HF
- MI
- peripheral oedema
adverse effects of non-DHP calcium channel blockers
- constipation
contraindications for calcium channel blockers
- congestive HF
- severe hypotension
- heart block
- HFrEF
moa of hydralazine
- direct arteriole vasodilator → decreases afterload
- inhibit IP3-induced release of Ca2+ from smooth muscle cells sarcoplasmic reticulum
- reduces peripheral resistance → compensatory release of epinephrine/NE → increase VR and CO
clinical uses of hydralazine
- HFrEF
- essential hypertension
- acute-onset, severe peripartum/post-partum hypertension
adverse effects of hydralazine
- reflex tachycardia
- hypotension
- hydralazine-induced lupus syndrome
contraindications for hydralazine
coronary artery disease
moa of isosorbide mononitrate/dinitrate
- vasodilators that release NO → dilation of coronary vessels
- at low dose, ↓ preload
- at high dose, ↓ preload and afterload → reduce myocardial O2 demand
clinical use of isosorbide mononitrate/dinitrate
prophylaxis for angina pectoris
adverse effect of isosorbide mononitrate/dinitrate
- dizziness
- postural hypotension
contraindication for isosorbide mononitrate/dinitrate
concurrent use w phosphodiesterase inhibitors
moa of ivabradine
reduces HR by inhibiting I(f) current in SA node
unique ft of ivabradine
targets HR wo affecting BP or myocardial contractility
2 clinical uses of ivabradine
- stable angina pectoris
- chronic HF w systolic dysfunc
adverse effects of ivabradine
- luminous phenomena
- bradycardia → dizziness, hypotension
moa of digoxin
- inhibit Na+/K+ exchanger → intracellular [Na+] increase → less Ca2+ efflux → stronger systolic contraction
2 clinical uses of digoxin
- systolic dysfunc
- atrial fibrillation
adverse effects of digoxin
- severe dysrhythmia (AV block, afib, vfib)
- nausea, vomiting
- headache, confusion, blurred vision
risk of digoxin
narrow therapeutic window and toxicity
toxic effects of digoxin
- automaticity
- tachycardia
- extrasystoles
- fibrilation
treatment of digoxin toxicity
- discontinue cardiac glycoside therapy
- correct K+/Mg2+ deficiency
- anti-arrhythmic drugs
- digoxin Ab
name 2 alpha blockers
- phenoxybenzamine (non-selective)
- prazosin (α1)
moa of alpha blockers
block α1 → vasodilation → ↓ peripheral vascular resistance → ↓ bp
2 clinical uses of alpha blockers
- hypertension (2nd line)
- benign prostatic hyperplasia
adverse effects of alpha blockers
- reflex tachycardia
- postural hypotension
- urinary frequency
- depression
