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Cardiovascular > Drugs > Flashcards

Drugs Flashcards

1
Q

What is an example of an alpha blocker?

A

Doxazosin, prazosin

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2
Q

How do alpha blockers work?

A

Blocking the alpha channel results in decreased TPR and MABP

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3
Q

What are alpha blockers used for?

A

Hypertension

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4
Q

What is the side effect of alpha blockers?

A

Postural hypotension

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5
Q

What is an example of an ACE inhibitor?

A

Lisinopril

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6
Q

How do ACE inhibitors work?

A

Block conversion of angiotensin 1 to angiotensin 2

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7
Q

What are ACE inhibitors used for?

A

Hypertension and heart failure

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8
Q

What are the side effects of ACE inhibitors?

A

Dry cough, renal failure and hypotension (especially with diuretics)

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9
Q

What is an example of an ARB?

A

Losartan

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10
Q

How do ARBs work?

A

Block the AT1 receptor for AT2

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11
Q

When are ARBs used?

A

When the dry cough of ACE inhibitors cannot be tolerated

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12
Q

What is the side effect of ARBs?

A

Renal failure

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13
Q

Why should ACE inhibitors and ARBs not be used in pregnancy?

A

Risk of renal artery stenosis

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14
Q

What is the general class of drug of alpha blockers, ACE inhibitors and ARBs?

A

Vasodilators

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15
Q

What is an example of a thiazide diuretic?

A

Bendroflumethiazide

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16
Q

How do thiazide diuretics work?

A

Block NaCl reabsorption in the distal tubule by blocking the NaCl co-transporter

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17
Q

What are thiazide diuretics used for?

A

Hypertension

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18
Q

What are side effects of diuretics?

A

Hypokalaemia (tiredness), hypoglycaemia (diabetes), increased uric acid (gout), arrhythmias

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19
Q

What is an example of a loop diuretic?

A

Furosemide

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20
Q

How do loop diuretics work?

A

Block NaCl reabsorption in the thick ascending loop of Henle by blocking the NaClK co-transporter

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21
Q

What are loop diuretics used for?

A

Hypertension, heart failure, oedema

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22
Q

What is an example of a dihydropyridine Ca++ antagonist?

A

Amlodipine

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23
Q

How do Ca++ antagonists work?

A

The L type Ca++ channels in vascular smooth muscle normally increase FoC, so blocking these means decreased TPR and MABP.
There is also coronary vasodilation

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24
Q

What are Ca++ antagonists used for?

A

Hypertension, angina and supraventricular arrhythmias

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25
Q

What are side effects of Ca++ antagonists?

A

Oedema, dizziness and hypotension

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26
Q

What are examples of rate limiting Ca++ antagonists?

A

Verapamil, diltiazem

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27
Q

When should you avoid use of rate limiting Ca++ antagonists?

A

With beta blockers

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28
Q

What is an example of a cardio selective beta blocker?

A

Atenolol

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29
Q

How do cardio selective beta blockers work?

A

Block beta 1 so stimulate Gs, increase cAMP and contractibility

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30
Q

When should beta blockers be used?

A

Heart failure, hypertension, angina

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31
Q

What is an example of a non-selective beta blocker?

A

Propranolol

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32
Q

When should a non-selective beta blocker be used?

A

Thyrotoxicosis

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33
Q

What do cardio non-selective beta blockers so the selective ones don’t?

A

Block beta 2 which causes coronary vasodilation and increases HR

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34
Q

What are side effects of beta blockers?

A

Cold peripheries, heart failure worsened if long term, bradycardia and tiredness

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35
Q

When should beta blockers not be used?

A

Asthma (can do selective) and intermittent claudication

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36
Q

What do Ca++ antagonists do to myocardial O2 requirement?

A

Decrease it

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37
Q

Which beta blocker is used in angina?

A

Atenolol

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38
Q

What does atenolol do to the oxygenation of the myocardium?

A

Increases it

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39
Q

What is a short acting nitrate?

A

GTN

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40
Q

What do small doses of nitrates cause?

A

Decreased preload and SV

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41
Q

What do large doses of nitrates cause?

A

Decreased MABP and afterload

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42
Q

What extra effect do nitrates have on the myocardium?

A

Increase perfusion to the ischaemic zone

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43
Q

What are side effects of nitrates?

A

Tolerance, headache, postural hypotension

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44
Q

What is an example of a long acting nitrate?

A

Isosorbide mononitrate

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45
Q

What is important about the metabolism of isosorbide mononitrate?

A

Resistant to first pass metabolism

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46
Q

What is an example of a sodium channel blocker?

A

Ranolozine

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47
Q

What do sodium blockers do?

A

Inhibit sodium current which decreases intracellular Ca++. This leads to reduced tension and oxygen requirements for the myocardium

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48
Q

When are sodium blockers used?

A

Chronic angina

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49
Q

What are side effects of sodium blockers (ranolozine)?

A

Constipation and dizziness

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50
Q

What is an example of a potassium channel opener?

A

Nicorandril

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51
Q

How do potassium channel openers work?

A

Promotes K+ efflux causing hyperpolarisation and smooth muscle relaxation/coronary vasodilation

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52
Q

When are potassium channel openers (nicorandril) used?

A

Stable angina not controlled by nitrates

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53
Q

What are side effects of potassium channel openers (nicorandril)?

A

Low BP and hypovolaemia, palpitations, weakness

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54
Q

What is another anti-anginal drug which doesn’t have a specific class?

A

Ivabradine

55
Q

How does ivabradine work?

A

Prolongs diastolic time, decreases HR, increases SV, preserving BP

56
Q

When is ivabradine used?

A

Chronic heart failure or angina

57
Q

What are side effects of ivabradine?

A

Oedema, prolonged AV block

58
Q

What are the three groups of anti-thrombotic drugs?

A

Anti-platelets, anti-coagulants, fibrinolytics

59
Q

What are examples of anti-platelet drugs?

A

Aspirin, clopidogrel, ticagrelor, prasugrel

60
Q

What do anti-platelet drugs do?

A

Prevent new thrombosis

61
Q

When are anti-platelet drugs used?

A

Angina, acute MI, stroke, transient ischaemic attack

62
Q

What are side effects of anti-platelet drugs?

A

Haemorrhage

63
Q

When should you try to avoid use of anti-platelets?

A

Asthma and peptic ulcers

64
Q

What are examples of anti-coagulants?

A

Warfarin, heparin, dabigatran, rivaroxiban

65
Q

What is the only way warfarin can be taken?

A

Orally

66
Q

What does warfarin do?

A

Prevents new thrombosis by blocking clotting factors 2, 7, 9, 10

67
Q

When should anti-coagulants be used?

A

DVT, PE, NSTEMI, AF

68
Q

What is the side effect of anti-coagulants?

A

Haemorrhage

69
Q

How does rivaroxaban work?

A

Factor Xa inhibitor

70
Q

How does dabigatran work?

A

Factor IIa inhibitor

71
Q

What is a fibrinolytic drug?

A

Streptokinase

72
Q

What do fibrinolytics do?

A

Dissolve formed clots

73
Q

When are fibrinolytics used?

A

Primarily STEMI, rarely PE and stroke

74
Q

When should you avoid using fibrinolytics?

A

Recent trauma or haemorrhage, bleeding tendancies

75
Q

What are examples of anti-cholesterol drugs?

A

Statins, fibrates, bile acid binding resins and ezetimibe

76
Q

What are examples of statins?

A

Simvastatin and atorvastatin

77
Q

How do statins work?

A

Block enzyme HMG CoA reductase which reduces LDL production in the liver, also decreases inflammation and stabilises atherosclerotic plaques

78
Q

When should statins be used?

A

Hypercholesterolaemia, diabetes, angina/MI/stroke/TIA

79
Q

What are side effects of statins?

A

Myopathy, renal failure, aches

80
Q

Why should statins not be given in pregnancy?

A

Cholesterol needed for foetus development

81
Q

When are statins ineffective?

A

Familial hypercholesterolaemia

82
Q

What is an example of a fibrate?

A

Bezafibrate

83
Q

How do fibrates work?

A

mainly by decreasing triglyceride levels and a slight decrease in LDL and HDL

84
Q

When are fibrates used?

A

First line for hypertriglyceridaemia but also in low HDL

85
Q

What is the side effect of fibrates and what is done to decrease this?

A

Myositis- use with statins

86
Q

What are examples of bile acid binding resins?

A

Colestipol and colestyramine

87
Q

How do bile acid binding resins work?

A

Excretion of bile salts so more cholesterol is converted to bile salts

88
Q

What is a side effect of bile acid binding resins?

A

GI tract irritability

89
Q

How does ezetimbe work?

A

Inhibits a protein transporter in duodenum enterocytes that reduces absorption of cholesterol

90
Q

When is ezetimbe used?

A

In combination with statins when they are not effective enough alone

91
Q

What are side effects of ezetimbe?

A

Diarrhoea, abdominal pain and headaches

92
Q

What do all class I anti-arrhythmic drugs do?

A

Block sodium channels

93
Q

What is a class IA anti-arrhythmic drug?

A

Disopyramide

94
Q

What is the rate of dissociation of class IA anti-arrhythmics i.e. Disopyramide?

A

Moderate

95
Q

What is a class IB anti-arrhythmic?

A

Lignocaine

96
Q

What does lignocaine prevent?

A

Premature beats

97
Q

What is lignocaine used for?

A

Ventricular tachycardias

98
Q

What is the rate of dissociation of class IB anti-arrhythmic drugs i.e. lignocaine?

A

Fast (bypasses first pass metabolism)

99
Q

What should lignocaine not be used with?

A

Beta blockers

100
Q

When is Disopyramide used?

A

Life threatening arrhythmias

101
Q

What is a class IC anti-arrhythmic drug?

A

Flecainide

102
Q

What is the rate of dissociation of flecainide?

A

Slow

103
Q

What effect does flecainide have on conduction?

A

Depresses it

104
Q

What effect does flecainide have on the AP?

A

Slows conduction

105
Q

When is flecainide contra-indicated?

A

Ventricular arrhythmias post MI

106
Q

When should flecainide be used?

A

Atrial fibrillation or SVTs associated with an accessory pathway e.g. WPW

107
Q

What are some side effects of all anti-arrhythmic drugs?

A

Phototoxicity, pulmonary fibrosis and thyroid abnormalities

108
Q

What type of drugs are class II anti-arrhythmics?

A

Beta blockers

109
Q

What is an example of a class II anti-arrhythmic?

A

Metaprolol

110
Q

What do class to drugs i.e. metaprolol do?

A

Decrease rate of depolarisation in SA and AV nodes

111
Q

What is an example of a class III anti-arrhythmic?

A

Amiodarone/Sotalol

112
Q

What do class III anti-arrhythmics do?

A

Block potassium channels, prolong AP duration and increase refractory period

113
Q

What are class III anti arrhythmics used for?

A

Atrial, nodal and ventricular tachycardias

114
Q

What drug gives a slate grey appearance?

A

Amiodarone

115
Q

What is an example of a class IV anti-arrhythmic drug?

A

Verapamil/Diltiazem

116
Q

What do class IV anti-arrhythmic drugs e.g. verapamil do?

A

Block Ca++ channels and decrease force of contraction

117
Q

What are examples of inotropic drugs?

A

Digoxin, Ca++ sensitisers and certain beta blockers

118
Q

What does digoxin I do?

A

Blocks AV conduction to produce AV nodal delay

Blocks sarcolemma ATPase to increase contractility

119
Q

When should digoxin be used?

A

AF and heart failure

120
Q

What are side effects of digoxin?

A

Bradycardia and heart block, nausea, vomiting, ventricular arrhythmias

121
Q

What is the bad side of digoxin?

A

Very narrow therapeutic index and so can produce ventricular arrhythmias

122
Q

What is an example of a calcium sensitizer?

A

Levosimendan

123
Q

How does levosimendan work?

A

Binds to troponin C in cardiac muscle sensitising it to the action of Ca++ and making it positively inotropic

124
Q

What type of beta adrenoceptor agonists are inotropic?

A

Adrenaline and dobutamine

125
Q

How must dobutamine be given?

A

IV

126
Q

What do inotropic beta blockers increase?

A

Force, rate, CO and O2 ocnsumption

127
Q

What do inotropic beta blockers decrease?

A

Cardiac efficiency

128
Q

When should adrenaline be given and how?

A

IM in anaphylactic shock and IV in cardiac arrest

129
Q

What side effect does adrenaline have?

A

Can cause arrhythmias

130
Q

What does adrenaline block?

A

Beta 1 and 2 and alpha 1 receptors

131
Q

What is dobutamine selective for?

A

Beta adrenoceptors

132
Q

When is dobutamine used?

A

Acute heart failure

133
Q

What is an unclassified non-selective muscarinic ACh receptor antagonist?

A

Atropine

134
Q

What is atropine used for and how much should you give?

A

Severe bradycardia or ACh poisoning- always >600mg

Cardiovascular (23 decks)

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