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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
Q

What are the negative effects of B2 blocker drugs?

A

Potentially lethal bronchospasm in asthmatics
- blocks main receptor used to treat asthma attacks
Significant vasoconstriction
- affects those with peripheral vasoconstriction disease

26
Q

What is an example of a B2 blocker drug and what is it commonly used for?

A

Propranolol - to treat peripheral symptoms of anxiety

27
Q

What does the renin-angiotensin-aldosterone axis do?

A

Preserves circulating volume to maintain perfusion of the vital organs

28
Q

What is central hormone axis the development of?

A

Heart, liver and kidney failure

29
Q

What is the RAA axis pathway?

A

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
Q

Where is renin produced and why?

A

In kidneys, as a response to reduction in perfusion pressure

31
Q

Where are ACE enzymes found?

A

On endothelial tissue in lungs

32
Q

What are ARBS?

A

Angiotensin converting enzyme inhibitors and angiotensin receptor antagonists

33
Q

What are ARBS used for?

A

1st line antihypertensive

34
Q

What effect do ARBS have?

A
  • Reduce mortality and progression of:
    IHD, CVD and renal disease with proteinuria
  • Prevent aberrant remodelling after MI
  • Reduce symptoms of heart failure
35
Q

What is angiotensin 2?

A

A potent vasoconstrictor

36
Q

What does aldosterone do?

A

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
Q

What are some examples of ACE inhibitors?

A

Ramipril
Lisinopril
Captopril
Perindopril

38
Q

What are the positive effect of ACE inhibitors? (4)

A

Reduces BP
Reduces afterload on the heart
Prevents aberrant remodelling after MI
Reduces proteinuria

39
Q

What are some negative effects of ACE inhibitors?

A

Reduces perfusion pressure in glomerulus leading to renal impairment
Hyperkalaemia via affect on aldosterone levels
Cough
Orthostatic hypotension

40
Q

What are some examples of ARBS?

A

Losartan
Candesartan

41
Q

What are the positive effect of ARBS?

A

Reduced BP
Reduced afterload on heart
Prevents aberrant remodelling
Reduces proteinuria

42
Q

What are the negative effects of ARBS?

A

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
Q

What are 2 examples of aldosterone antagonists?

A

Spironolactone and eplerenone

44
Q

When are aldosterone antagonists used?

A

In heart failure
Spironolactone sometimes used in hypertension

45
Q

What effect do aldosterone antagonists have?

A

Enhanced diuretic effect
Vasodilation
Reduced mortality in IHD and heart failure

46
Q

What are the side effects of aldosterone antagonists?

A

Dehydration = renal impairment
Hyponatraemia
Hyperkalaemia
Gynaecomastia

47
Q

What is entresto?

A

A combination of valsartan and sacubitril

48
Q

What does sacubitril do?

A

Inhibits breakdown natriuretic peptides
- Increases diuresis, natriuresis and vasodilation

49
Q

What is the effect of sacubitril in symptomatic chronic heart failure?

A

Reduce ejection fraction

50
Q

What cannot be prescribed with sacubitril and why?

A

ACE inhibitor
- risk of angioedema

51
Q

What are calcium channel blockers?

A

Antihypertensive agents

52
Q

What are calcium channel blockers used for?

A

Reduce symptoms in
- angina
- antiarrhythmic effect in AF/SVT

53
Q

What is dihydropyridine and non-dihydropyridine?

A

Dihydropyridine = Block calcium entry to smooth muscles
Non-dihydropyridine = blocks calcium entry to smooth muscle and MYOCARDIAL PACEMAKING TISSUE

54
Q

What is the effect of dihydropyridine calcium channel blockers?

A

Vasodilation
Less effect on myocardial pacemaker tissue

55
Q

What are some dihydropyridine drugs?

A

amlodipine, felodipine, nifedipine

56
Q

What are some side effects of dihydropyridine drugs?

A

Postural hypotension
Peripheral oedema
Tachycardia
Rarely bradycardia (unless overdose)

57
Q

What do non-dihydropyridine drugs do?

A

Block calcium entry to smooth muscle
Blocks calcium entry in the myocardial pacemaking tissue:
- Slow SA node function
- Slow AV conduction

58
Q

What are some examples of non-dihydropyridine drugs?

A

verapamil and diltiazem

59
Q

What are some side effects of non-dihydropyridine drugs?

A

Bradycardia
Heart block
Postural hypotension
Peripheral oedema

CVS Physiology (10 decks)

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