Drugs Flashcards
What are types of drugs used to treat the CVS? (8)
Anti-platelets
Beta-blockers
Renin-angiotensin-aldosterone axis
Aldosterone antagonists
Entresto
Calcium channel blockers
Statins
Diuretics
What do antiplatelets do?
Stop platelets sticking together to form a clot
What are the most common antiplatelet drugs?
Aspirin
Clopidogrel/ticagrelor
Dipyridamole
GP2B/3A
How does aspirin work? (2 pathways)
- 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.) - Inhibits COX cyclo-oxygenase pathway
(reduces production of thromboxane A2)
How does clopidogrel/ticagrelor work?
Blocks specific ADP receptors on platelet surface P2Y12
(Upregulates cyclo-oxygenase, blocking function of ways of activating platelets)
What are antiplatelets used in treatment of?
Acute coronary disease
Acute stroke
Long term secondary prevention in strokes
How does dipyridamole work?
Is a phosphodiesterase inhibitor
How do GP2B/3A drugs work?
Fibrinogen receptor antagonists
What are GP2B/3A drugs used to treat?
Unstable coronary artery disease
What is the dosage of antiplatelets dependent on?
Why the drug is being prescribed
What are primary and secondary dosed of antiplatelets?
Primary = giving dose before diagnosis
Secondary = giving dose after diagnosis
What is aspirin used for?
Firstline treatment of stable coronary disease
(for acute stroke or TIA - mini stroke)
What is clopidogrel used for?
Secondary prevention agent after acute phase of a stroke,
(Used in combo with aspirin after percutaneous intervention of person with stable angina)
What is ticagrelor used for?
In combo with aspirin for those with acute coronary syndrome
What is the main side affect of antiplatelets?
Bleeding
What can beta blocker reduce mortality in? (2)
Ischemic heart disease and heart failure
What can beta blockers reduce symptoms in? (3)
Angina, atrial fibrillation and supraventricular tachycardia
What are some examples of beta blockers? (5)
Bisoprolol
Carvedilol
Atenolol
Metoprolol
Propranolol
Where are B1 receptors found
Predominant receptor in heart, found in:
- SA node
- AV node
- Myocardial cells
What are the positive effects of beta 1 receptors?
Slows HR and conduction
Increases diastolic time
Reduces BP
Protects heart from effects of catecholamines
What are the negative effects of B1 receptor blockers?
Reduces contractility
High dose can lead to bradycardia and heart block
What are some B1 receptor blocker drugs? (4)
Bisoprolol
Atenolol
Carvedilol
Metoprolol
What do B2 blockers act on?
Smooth muscles in peripheral vasculature and airways (and to a lesser extent myocardial cells)
What is a positive effect of B2 blocker drugs?
Reduces tremor
- Adrenaline and stress hormone effect on skeletal muscles is mediated by B2 receptors so blocking will reduce tremor and sweatiness
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
What is an example of a B2 blocker drug and what is it commonly used for?
Propranolol - to treat peripheral symptoms of anxiety
What does the renin-angiotensin-aldosterone axis do?
Preserves circulating volume to maintain perfusion of the vital organs
What is central hormone axis the development of?
Heart, liver and kidney failure
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
Where is renin produced and why?
In kidneys, as a response to reduction in perfusion pressure
Where are ACE enzymes found?
On endothelial tissue in lungs
What are ARBS?
Angiotensin converting enzyme inhibitors and angiotensin receptor antagonists
What are ARBS used for?
1st line antihypertensive
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
What is angiotensin 2?
A potent vasoconstrictor
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
What are some examples of ACE inhibitors?
Ramipril
Lisinopril
Captopril
Perindopril
What are the positive effect of ACE inhibitors? (4)
Reduces BP
Reduces afterload on the heart
Prevents aberrant remodelling after MI
Reduces proteinuria
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
What are some examples of ARBS?
Losartan
Candesartan
What are the positive effect of ARBS?
Reduced BP
Reduced afterload on heart
Prevents aberrant remodelling
Reduces proteinuria
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)
What are 2 examples of aldosterone antagonists?
Spironolactone and eplerenone
When are aldosterone antagonists used?
In heart failure
Spironolactone sometimes used in hypertension
What effect do aldosterone antagonists have?
Enhanced diuretic effect
Vasodilation
Reduced mortality in IHD and heart failure
What are the side effects of aldosterone antagonists?
Dehydration = renal impairment
Hyponatraemia
Hyperkalaemia
Gynaecomastia
What is entresto?
A combination of valsartan and sacubitril
What does sacubitril do?
Inhibits breakdown natriuretic peptides
- Increases diuresis, natriuresis and vasodilation
What is the effect of sacubitril in symptomatic chronic heart failure?
Reduce ejection fraction
What cannot be prescribed with sacubitril and why?
ACE inhibitor
- risk of angioedema
What are calcium channel blockers?
Antihypertensive agents
What are calcium channel blockers used for?
Reduce symptoms in
- angina
- antiarrhythmic effect in AF/SVT
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
What is the effect of dihydropyridine calcium channel blockers?
Vasodilation
Less effect on myocardial pacemaker tissue
What are some dihydropyridine drugs?
amlodipine, felodipine, nifedipine
What are some side effects of dihydropyridine drugs?
Postural hypotension
Peripheral oedema
Tachycardia
Rarely bradycardia (unless overdose)
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
What are some examples of non-dihydropyridine drugs?
verapamil and diltiazem
What are some side effects of non-dihydropyridine drugs?
Bradycardia
Heart block
Postural hypotension
Peripheral oedema
