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Cardiovascular System > Drugs > Flashcards

Drugs Flashcards

1
Q

What are indications for ACE inhibitors?

A

Hypertension (<55 first line)

Chronic heart fibrillation

MI secondary prevention

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2
Q

What is ramipril?

A

ACE inhibitor

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3
Q

What is lisionpril?

A

ACE inhibitor

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4
Q

What is captopril?

A

ACE inhibitor

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5
Q

How do ACE inhibitors work?

A

Competitively inhibits the action of angiotensin converting enzyme (which converts angiotension I to II)

So reduces total peripheral resistance

Reduces blood pressure and end diastolic pressure

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6
Q

What are indications for angiotensin-II-antagonists?

A

Hypertension (<55 first line)

Chronic heart fibrillation

MI secondary prevention

Used when ACEI causes persistant cough

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7
Q

How do angiotensin-II-antagonists work?

A

Competitively block the action of angiotensin II at the angiotensin AT1 receptor

Same effect as ACEI

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8
Q

What is losartan?

A

ARB

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9
Q

What is valsartan?

A

ARB

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10
Q

What is irbesartan?

A

ARB

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11
Q

What is candesartan?

A

ARB

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12
Q

What are indications for centrally acting hypertensive drugs?

A

Hypertension (specialist use only)

Hypertension in pregnancy

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13
Q

How do centrally acting hypertensive drugs work?

A

Methyldopa is an a2 receptor agonist - reducing systemic resistance and therefore blood pressure

Moxonidine is an imadazoline receptor antagonist - also reducing sympathetic discharge

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14
Q

What is methyldopa?

A

Centrally acting hypertensive drug

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15
Q

What is moxonidine?

A

Centrally acting hypertensive drug

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16
Q

What are indications for thiazide type diuretics?

A

Hypertension (first line in Afro-Caribbean people)

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17
Q

How do thiazide type diuretics work?

A

Inhibit sodium reabsorption, causing urinary excretion of sodium and resulting in reduced extra cellular volume and reduced blood pressure

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18
Q

What is indapamide?

A

Thiazide type diuretic

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19
Q

What is cloratalidone?

A

Thiazide type diuretic

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20
Q

What are indications for spironlactone?

A

Resistant hypertension

Heart failure

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21
Q

How does spironlactone work?

A

Competitively inhibits aldosterone receptors - blocking the reabsorption of sodium resulting in reduced extra cellular volume and reduced blood pressure

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22
Q

What is aldosterone antagonist potassium sparing diuretic?

A

Spironlactone

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23
Q

What are indications for loop diuretics?

A

Pulmonary oedema (usually due to chronic heart failure)

Peripheral oedema

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24
Q

How do loop diuretics work?

A

Prevent reabsoprtion of sodium and therefore water, reducing BP

Also causes systemic and pulmonary vasodilation, reducing preload

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25
Q

What is bumetanide?

A

Loop diuretic

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26
Q

What is furosemide?

A

Loop diuretic

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27
Q

What is torasemide?

A

Loop diuretic

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28
Q

What are indications for potassium sparing diuretics?

A

Chronic heart failure

Hypertension

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29
Q

How do potassium sparring diuretics work?

A

Blocks sodium channels in the distal tube, thereby reducing sodium reabsorption and causing a loss of sodium and water

Lowering extracellular volume and BP

Also reduce potassium excretion in order to balance pH

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30
Q

What is amiloride?

A

Potassium sparring diuretic

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31
Q

What are indications for aspirin?

A

Secondary prevention of thrombotic cardiovascular diseases:

Stable angina

Unstable angina

NSTEMI

STEMI

Abdominal aortic aneurysm

Aneurysm

Stroke/TIA

Peripheral arterial disease/critical limb ischaemia

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32
Q

How does aspirin work?

A

Inhibits platelet thomboxane production - which usually stimulates platelet aggregation and vasoconstriction

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33
Q

What are indications for clopidogrel?

A

Monotherapy:

peripheral arterial disease
Ischaemic stroke
MI (only if aspirin is contra-indicated)

In combination with aspirin:

TIA
Ishaemic stroke
ACS

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34
Q

What does clopidogrel do?

A

Inhibits ADP receptor activated platelet aggregation

Prodrug which must be activated in the liver

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35
Q

What are indications for low molecular weight heparin?

A

Unstable angina

NSTEMI

STEMI

DVT/PTE

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36
Q

How does low molecular weight heparin work?

A

Anticoagulant - prevents clotting of the blood by inhibiting activated factor X

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37
Q

What is enoxaparin?

A

Low molecular weight heparin

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38
Q

What is enoxaparin?

A

Low molecular weight heparin

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39
Q

What is trizeparin?

A

Low molecular weight heparin

40
Q

What is the administeration of low molecular weight heparin?

A

Subcutaneous administration

41
Q

What are indications for warfarin?

A

Prophylaxis:

rheumatic heart disease
atrial fibrillation
after prosthetic valve insertion

Prophylaxis and treatment:

TIAs
DVT/PTE

42
Q

How does warfarin work?

A

Inhibits production of active clotting factors

43
Q

How does digoxin work?

A

Cardiac glycoside which inhibits the Na/K ATPase pump, allows more calcium to be available for contraction

Increases the force of myocardial contraction and reduces conductivity within the AV node

44
Q

What are indications for digoxin?

A

Heart failure

Atrial fibrillation/flutter

45
Q

How does adenosine work?

A

Slows conduction through the AV node by inhibiting calcium channels

Only administered by IV, very short half life

46
Q

What are indications for adenosine?

A

Immediate termination of supraventricular tachycardia

Diagnosis of SVT/VT

47
Q

How does amioderone work?

A

Anti-arrhythmatic agent (class III) which increases the length of the repolarisation phase of the cardiac cycle

48
Q

What are indications for amioderone?

A

Tachyarrhythmias

Cardiac arrest

49
Q

How does disopyramide work?

A

Class 1A antiarrhythmatic, inhibits sodium channels

Prolongs action potential

50
Q

How does lidocaine work?

A

Class 1B antiarrhythmic, inhibits sodium channels

Shortens the action potential

51
Q

How does flecainide work?

A

Class 1C antiarrhythmic, inhibits sodium channels

Do not change the action potential

52
Q

What are the different effects between class 1A, 1B and 1C antiarrhythmics due to?

A

Binding at different times

53
Q

What are indications for disopyramide?

A

Tachyarrhythmias

54
Q

What are indications for lidocaine?

A

Tachyarrhytmias

55
Q

What are indications for flecainide?

A

Tachyarrhythmias

56
Q

What is bisoprolol?

A

Beta blocker

57
Q

What is atenolol?

A

Beta blocker

58
Q

What is propanolol?

A

Beta blocker

59
Q

How do beta blockers work?

A

Block beta-adrenoreceptors which blocks the sympathetic nervous system

Reduces HR, BP and CO

Reduces contractility (afterload) and systolic wall tension (force and velocity of contraction)

Increases diastolic perfusion time and exercise threshold

60
Q

What are indications for beta blockers?

A

Stable angina

Unstable angina

NSTEMI

STEMI

Chronic heart failure

Marfan’s syndrome (aortic dilation/dissection)

Hypertension

Tachyarrhythmias

61
Q

How does ivabridine work?

A

Lowers the heart rate by its action on the sinus node

62
Q

What are indications for ivabridine?

A

Angina (combination with beta blocker or when beta blocker is contraindicated)

Mild to severe chronic heart failure (patients in sinus rhythm)

63
Q

What is amlodipine?

A

Calcium channel blocker

64
Q

What is felodipine?

A

Calcium channel blocker - vasodilator

65
Q

What is verapamil?

A

Calcium channel blocker - rate limiting

66
Q

What is diliazem?

A

Calcium channel blocker - rate limiting

67
Q

How do calcium channel blockers work?

A

Prevent calcium influx into myocytes and smooth muscle lining vessels by blocking L-type calcium channels

Relaxes arteries (vasodilation, reduce afterload)

Reduces total peripheral resistance

Reduces CO (rate limiting agents reduce HR and contraction force)

68
Q

What are indications for calcium channel blockers?

A

Hypertension (>55 first line)

Stable angina

69
Q

What is nicorandil?

A

Potassium channel blocker

70
Q

How do potassium channel blockers work?

A

Actovate ATP-sensitive potassium channels leading to vasodilation of coronary vessels

Activates guanylyl cyclase causing vasodilation of systemic and coronary vessels - reducing preload and afterload (reducing cardiac oxygen consumption)

71
Q

What are indications for potassium channel blockers?

72
Q

What is glyceryl trinitrate (GTN)?

A

Short acting nitrate

73
Q

What is isosorbide mononitrate?

A

Long acting nitrate

74
Q

How do nitrates work?

A

Metabolised in the cell to nitric oxide which activates guanylyl cyclase leading to decrease in intracellular calcium levels, causing

Vasodilation, decreased venous return (reducing cardiac workload)

75
Q

What are indications for nitrates?

A

Angina

Acute left ventricular failure

76
Q

What is alteplase?

A

Thrombolytics

77
Q

What is streptokinase?

A

Thrombolytics

78
Q

How do thrombolytics work?

A

Acts in the coagulation pathway by hydrolysing the peptide bond in plasminogen, activating the enzyme plasmin which promotes clot lysis

79
Q

What are indications for thombolytics?

A

ANY CONDITION WHICH REQUIRES URGENT BREAKDOWN OF A CLOT:

MI

Stroke

80
Q

How is GTN administered?

A

Sublingual spray

Transdermal patches

81
Q

What is simvastatin?

82
Q

What is atorvastatin?

83
Q

How do statins work?

A

Competatively inhibits and enzyme required for cholesterol production in the liver

Reduces total and LDL plasma cholesterol

84
Q

What are indications for statins?

A

Hyperlipoproteinaemia

Primary prevention of coronary events

Secondary prevention of cardiovascular events

85
Q

What is a class 1A antiarrhythmatic drug, and what does it do?

A

Disopyramide

Moderate Na-channel blockage, prolong action potential

86
Q

What is a class 1B antiarrhythmic drug, and what does it do?

A

Lidocaine

Weak sodium channel blockade, shortens the action potential

87
Q

What is a class 1C antiarrhythmic drug, and what does it do?

A

Flecainide

Strong sodium channel blockage, does not change the action potential

88
Q

What do class 1A, 1B and 1C antiarrhythmic drugs do?

A

Reduce amplitude of action potential and conduction velocity

89
Q

What are class II antiarrhthmic drugs?

A

Beta blockers

90
Q

What are class III antiarrhythmic drugs?

A

Potassium channel blockers

91
Q

What are class IV antiarrhythmic drugs?

A

Calcium channel blockers

92
Q

What are class V antiarrhytmic drugs?

A

Others, such as digoxin

93
Q

What are class II antiarrhythmics used for?

A

Atrial fibrillation

94
Q

What are class III antiarrhythmics used for?

A

Sustained ventricular tachycardia

Disrhythmias that are hard to treat

95
Q

What are class IV antiarrhythmias used for?

A

Supraventricular tachycardia

Rate control for atrial fibrillation and flutter

Cardiovascular System (41 decks)

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