Drug revision general Flashcards
What is amiodarone
Amiodarone is used for VT, as an antiarhythmic, and in some cardiac arrests. It is a Class III anti arrhythmic, a K+ channel blocker, (think also Dronedarone)
What is dronedarone
Dronedarone it is a Class III anti arrhythmic, a K+ channel blocker, (think also amiodarone)
Name 5 anti hypertensive drug classes
ACE inhibitors
Angiotension-II-receptor blockers
α-blockers
β-blockers
CCB (calcium channel blockers)
Name 3 ACE inhibitors
Ramipril, Lisinopril, Enalapril
What are Ramipril, Lisinopril, Enalapril
ACE inhibitors
Name 2 Angiotension-II-receptor blockers
Candesartan*, Losartan
what are Candesartan*, Losartan
Angiotension-II-receptor blockers
What is the MOA of Ace inhibitors
Block angiotensin converting enzyme and lowers BP by reducing angiotensin to anng-II, therefore also decreasing aldosterone production by adrenal cortex, reducing sodium and water retention.
These drugs also inhibit bradykinin breakdown by ACE (dry cough in 20%)
Reno-protective! Always consider for T2DM and early kidney failure.
What is the MOA of Angiotension-II-receptor blockers?
Selectively inhibit angiotensin II at the AT1 receptor site
Therefore blocking causes VASODILATION and blockage of aldosterone release
Often used second to ACE inhibitors when dry cough side-effect (bradykinin) not tolerated (20% pts)
Name an α-blocker
Doxazosin
What is Doxazosin
α-blockers
What is the MOA of doxazosin?
ALPHA BLOCKER: Doxazosin is a quinazoline derivative that acts as a competitive alpha1-antagonist at the post-synaptic receptor.
Doxazosin competitively inhibits post-synaptic alpha1-adrenergic receptors causing vasodilation of arterioles and veins, which results in decreased total peripheral resistance and blood pressure
What is a CCB, name two
Calcium channel blocker - Amlodipine, Diltiazem, Verapamil. CCB reduces ca entry to cells which reduces their ability/strength of contraction- reduce heart contraction strength and dilate smooth muscle of arteries
What are Amlodipine, Diltiazem, Verapamil
CCBs - calcium channel blockers
CCB MOA?
Calcium channel blockers disrupt the flow of calcium through calcium channels.
-Cardioselective (aka ‘second generation’) amlodipine, verapamil and felodipine,
-Non-cardioselective, diltiazem and nifedipine.
CCB block slow calcium channels, and slow the rate of conduction through the SA and AV nodes -prolongs the PR interval, and reduces the sinus rate
Which CCBs are unsafe in HF?
Short acting calcium channel blockers (diltiazem and verapamil) are particularly selective for cardiac muscle, and are strongly negatively inotropic. They reduce cardiac output and slow the heart rate and should be avoided in heart failure.
How can CCBs activate the sympathetic nervous system
cause peripheral vasodilation, which can then in turn cause activation of the sympathetic nervous system
Which CCbs are considered safe in HF
Dihydropyridine calcium channel blockers (e.g. amlodipine, felodipine, nifedipine) tend to affect vascular smooth muscle more than cardiac muscle, and are generally considered safe in heart failure.
How can withdrawal of CCBs cause angina
Abrupt withdrawal of calcium-channel blockers has been known to result in angina due to rebound vasoconstriction
What class of anti-arrythmics can CCBs be considered
They are sometimes classified as class IV anti-arrythmics because of their mechanism of action
Why do CCBs only slow heart rate (negatively inotropic) but don’t prevent contraction?
Interfere with calcium uptake into cells through the ‘slow calcium channels’ found in the SA and AV nodes. These tissues depend on slow acting calcium currents to develop their action potentials.
Fast response myocardial tissues (in the atria, ventricles and accessory pathways) instead depend on sodium channels
What are the first generation/typical antipsychotics
Not usually first line
Act mainly as D2 antagonists
Less cardiometabolic side effects compared to second generation
More extra pyramidal side effects compared to second generation
Haloperidol – Clopixol – Chlorpromazine - Depixol
(prochlorperazine)
what are the second generation “atypical” antipsychotics?
Usually first line choice
Act on 5HT2, DA2/DA4 receptors
More cardiometabolic side effects compared to first generation
Less extra pyramidal side effects compared to first generation
Olanzapine – Quetiapine – Risperidone – Clozapine - Aripiprazole
(Lurasidone, Olanzapine, Paliperidone*)
Which anti-psychotics are used as first line treatment and why
second generation “atypical” antipsychotics
Usually first line choice
Act on 5HT2, DA2/DA4 receptors
More cardiometabolic side effects compared to first generation
Less extra pyramidal side effects compared to first generation
Olanzapine – Quetiapine – Risperidone – Clozapine - Aripiprazole
(Lurasidone, Olanzapine, Paliperidone*)
