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CVS Physiology > Drugs > Flashcards

Drugs Flashcards

1
Q

What are types of drugs used to treat the CVS? (8)

A

Anti-platelets
Beta-blockers
Renin-angiotensin-aldosterone axis
Aldosterone antagonists
Entresto
Calcium channel blockers
Statins
Diuretics

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2
Q

What do antiplatelets do?

A

Stop platelets sticking together to form a clot

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3
Q

What are the most common antiplatelet drugs?

A

Aspirin
Clopidogrel/ticagrelor
Dipyridamole
GP2B/3A

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4
Q

How does aspirin work? (2 pathways)

A
  1. Inhibits the production of thromboxane A2
    (which is involved in expression of surface proteins and activation of platelets and release/de-granulation of inflammatory substances for platelets.)
  2. Inhibits COX cyclo-oxygenase pathway
    (reduces production of thromboxane A2)
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5
Q

How does clopidogrel/ticagrelor work?

A

Blocks specific ADP receptors on platelet surface P2Y12
(Upregulates cyclo-oxygenase, blocking function of ways of activating platelets)

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6
Q

What are antiplatelets used in treatment of?

A

Acute coronary disease
Acute stroke
Long term secondary prevention in strokes

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7
Q

How does dipyridamole work?

A

Is a phosphodiesterase inhibitor

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8
Q

How do GP2B/3A drugs work?

A

Fibrinogen receptor antagonists

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9
Q

What are GP2B/3A drugs used to treat?

A

Unstable coronary artery disease

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10
Q

What is the dosage of antiplatelets dependent on?

A

Why the drug is being prescribed

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11
Q

What are primary and secondary dosed of antiplatelets?

A

Primary = giving dose before diagnosis
Secondary = giving dose after diagnosis

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12
Q

What is aspirin used for?

A

Firstline treatment of stable coronary disease
(for acute stroke or TIA - mini stroke)

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13
Q

What is clopidogrel used for?

A

Secondary prevention agent after acute phase of a stroke,
(Used in combo with aspirin after percutaneous intervention of person with stable angina)

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14
Q

What is ticagrelor used for?

A

In combo with aspirin for those with acute coronary syndrome

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15
Q

What is the main side affect of antiplatelets?

A

Bleeding

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16
Q

What can beta blocker reduce mortality in? (2)

A

Ischemic heart disease and heart failure

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17
Q

What can beta blockers reduce symptoms in? (3)

A

Angina, atrial fibrillation and supraventricular tachycardia

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18
Q

What are some examples of beta blockers? (5)

A

Bisoprolol
Carvedilol
Atenolol
Metoprolol
Propranolol

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19
Q

Where are B1 receptors found

A

Predominant receptor in heart, found in:
- SA node
- AV node
- Myocardial cells

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20
Q

What are the positive effects of beta 1 receptors?

A

Slows HR and conduction
Increases diastolic time
Reduces BP
Protects heart from effects of catecholamines

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21
Q

What are the negative effects of B1 receptor blockers?

A

Reduces contractility
High dose can lead to bradycardia and heart block

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22
Q

What are some B1 receptor blocker drugs? (4)

A

Bisoprolol
Atenolol
Carvedilol
Metoprolol

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23
Q

What do B2 blockers act on?

A

Smooth muscles in peripheral vasculature and airways (and to a lesser extent myocardial cells)

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24
Q

What is a positive effect of B2 blocker drugs?

A

Reduces tremor
- Adrenaline and stress hormone effect on skeletal muscles is mediated by B2 receptors so blocking will reduce tremor and sweatiness

25
What are the negative effects of B2 blocker drugs?
Potentially lethal bronchospasm in asthmatics - blocks main receptor used to treat asthma attacks Significant vasoconstriction - affects those with peripheral vasoconstriction disease
26
What is an example of a B2 blocker drug and what is it commonly used for?
Propranolol - to treat peripheral symptoms of anxiety
27
What does the renin-angiotensin-aldosterone axis do?
Preserves circulating volume to maintain perfusion of the vital organs
28
What is central hormone axis the development of?
Heart, liver and kidney failure
29
What is the RAA axis pathway?
Angiotensin produced in liver Converted to angiotensin 1 by renin Converted to angiotensin 2 by ACE enzyme Angiotensin 2 acts on adrenals to release aldosterone
30
Where is renin produced and why?
In kidneys, as a response to reduction in perfusion pressure
31
Where are ACE enzymes found?
On endothelial tissue in lungs
32
What are ARBS?
Angiotensin converting enzyme inhibitors and angiotensin receptor antagonists
33
What are ARBS used for?
1st line antihypertensive
34
What effect do ARBS have?
- Reduce mortality and progression of: IHD, CVD and renal disease with proteinuria - Prevent aberrant remodelling after MI - Reduce symptoms of heart failure
35
What is angiotensin 2?
A potent vasoconstrictor
36
What does aldosterone do?
helps to retain circulating volume by retaining Na at the expense of K in the distal convoluted tubule of the kidneys. Acts of sweat glands and gut
37
What are some examples of ACE inhibitors?
Ramipril Lisinopril Captopril Perindopril
38
What are the positive effect of ACE inhibitors? (4)
Reduces BP Reduces afterload on the heart Prevents aberrant remodelling after MI Reduces proteinuria
39
What are some negative effects of ACE inhibitors?
Reduces perfusion pressure in glomerulus leading to renal impairment Hyperkalaemia via affect on aldosterone levels Cough Orthostatic hypotension
40
What are some examples of ARBS?
Losartan Candesartan
41
What are the positive effect of ARBS?
Reduced BP Reduced afterload on heart Prevents aberrant remodelling Reduces proteinuria
42
What are the negative effects of ARBS?
Reduces perfusion pressure in glomerulus leading to renal impairment Hyperkalaemia via affect on aldosterone levels Orthostatic hypotension (same as ACE inhibitors but NO COUGH)
43
What are 2 examples of aldosterone antagonists?
Spironolactone and eplerenone
44
When are aldosterone antagonists used?
In heart failure Spironolactone sometimes used in hypertension
45
What effect do aldosterone antagonists have?
Enhanced diuretic effect Vasodilation Reduced mortality in IHD and heart failure
46
What are the side effects of aldosterone antagonists?
Dehydration = renal impairment Hyponatraemia Hyperkalaemia Gynaecomastia
47
What is entresto?
A combination of valsartan and sacubitril
48
What does sacubitril do?
Inhibits breakdown natriuretic peptides - Increases diuresis, natriuresis and vasodilation
49
What is the effect of sacubitril in symptomatic chronic heart failure?
Reduce ejection fraction
50
What cannot be prescribed with sacubitril and why?
ACE inhibitor - risk of angioedema
51
What are calcium channel blockers?
Antihypertensive agents
52
What are calcium channel blockers used for?
Reduce symptoms in - angina - antiarrhythmic effect in AF/SVT
53
What is dihydropyridine and non-dihydropyridine?
Dihydropyridine = Block calcium entry to smooth muscles Non-dihydropyridine = blocks calcium entry to smooth muscle and MYOCARDIAL PACEMAKING TISSUE
54
What is the effect of dihydropyridine calcium channel blockers?
Vasodilation Less effect on myocardial pacemaker tissue
55
What are some dihydropyridine drugs?
amlodipine, felodipine, nifedipine
56
What are some side effects of dihydropyridine drugs?
Postural hypotension Peripheral oedema Tachycardia Rarely bradycardia (unless overdose)
57
What do non-dihydropyridine drugs do?
Block calcium entry to smooth muscle Blocks calcium entry in the myocardial pacemaking tissue: - Slow SA node function - Slow AV conduction
58
What are some examples of non-dihydropyridine drugs?
verapamil and diltiazem
59
What are some side effects of non-dihydropyridine drugs?
Bradycardia Heart block Postural hypotension Peripheral oedema

CVS Physiology (10 decks)

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