Drugs Flashcards
Name an ace inhibitor, how they act and Side-effects - hypertension and HF
Lisinopril and rimapril
Prevent ace from converting angiotensin I to angiotensin II. This will reduce blood volume and therefore help hypertension.
Side-effects include hypotension dry cough hyperkalaemia agioedema and renal failure
Name in ARB how it works and the side-effects - Hypertension and HF
Candesartan and losartan
Acts by blocking angiotensin II at the AT1 receptor
No dry cough or angio-oedema
Name The three types of CCB - Hypertension
Dihydropyridine = Amlodipine Non-dihydropyridine = phenylalkylamines (verapamil) and benzothiazapine (diltiazem)
Name the functions of the three CCB’s - hypertension
Amlodipine acts on peripheral vasculature
Verapamil is a negative chronotrope and Ionotrope; prolongs the action potential and therefore slows the heart rate
Diltiazem is a mixture between both
Name a thiazide like drug and its actions - hypertension
Bendroflumethiazide
Inhibits sodium chloride transporter in DCT and therefore reduces blood volume reducing hypertension
State how spirilactone acts - hypertension and HF
It’s an aldosterone receptor antagonist
Name some beta-blockers and how they work in reducing hypertension + side-effects (+HF)
Labetalol, bisoprolol and metoprolol
Decreases sympathetic tone, reduces myocardial contraction and reduces renin secretion
Side-effects include bronchospasm, heart block, Raynauds, Legarthy, Impotence and mask tachycardia
Name an alpha receptor blocker, how it functions and side-effects - hypertension
Doxazosin
Selectively antagonises alpha-1 receptors to reduce peripheral vascular resistance
Side-effects include postural hypotension which can lead to dizziness syncope and fatigue
What are the contra indications and cautions for an ace inhibitor - Hypertension and HF
Contra indications; renal artery stenosis, AKT, pregnancy, breastfeeding
Cautions; NSAIDS, Potassium increasing drugs and antihypertensives
Contra indications and cautions for ARB’s - Hypertension and HF
Contra indications; renal artery stenosis, AKD, (risk of renal failure especially where construction of a front arterial is needed) pregnancy and breastfeeding (due to pressure effects and damage to fetal bone and skull)
Cautions; potassium increase in drugs (already at risk of hyperkalaemia)NSAIDS and other antihypertensive agents
Which drug is meant to be used in pregnancy for hypertension
Labetalol
Contra indications and cautions for dihydropyridine - hypertension
Contra indications; unstable angina, severe aortic stenosis
Cautions; amlodipine and Simvastatin together Because it increases the effect of the Statin and other antihypertensive agents
Contra indications for phenylalkyamines And side-effects - Hypertension
Side-effects include constipation bradycardia heart block and cardiac Phalia
Contra indications; Poor left ventricular function and an AV nodal conduction delay
Cautions; beta-blockers, antihypertensive and a antiarrhythmics
Contra indications and cautions and side-effects of thiazide like drugs -hypertension
Side effects; hypokalaemia, hyponatraemia, hyperuricaemia, arrhytmia increased glucose and triglyceride
Contra indications; hypokalaemia, hyponatraemia and gout
Cautions; NSAIDS and potassium decreasing drugs
Contra indications and cautions for spirilactinlnone -Hypertension and HF
Contra indications; hyperkalaemia and addisons
Caution; potassium increaseimg drugs, ACE inhibitors and ARB
Contra indications and cautions for beta-blockers - Hypertension and HF
Contra indications; asthma, hepatic failure, haemodynamic instability
Cautions: verapimil and diltiazem - asystole!
What is a caution of an alpha receptor blocker
A dihydropyridine
Carbonic anhydrase inhibitor - how they work - diuretics
Inhibit the carbonic anhydrase enzyme which converts water and carbon dioxide to bicarbonate. Less resorption of HCO3 in PCT. This carries out sodium
Carbonic anhydrase inhibitor side-effects - diuretics
Do you lose sodium HCO3
Hypokalaemic metabolic acidosis
Tolerance develops after 2 to 3 days
Uses of Carbonic anhydrase inhibitors - diuretics
Glucoma
Mountain sickness
How osmotic agents work and example of one – diuretics
Mannitol causes osmosis into the lumen due to incomplete increased oncotic pressure of manitol
Side-effects of mannitol - Diuretics
Water loss
Reduce intracellular volume
Hypernatraemia risk
Uses of osmotic diuretics
Reducing high intracerebral pressure
Statin - name some and how they function
Atorvastatin and simvastatin
Both of these act to inhibit HMG-coA which decreases cell cholesterol increasing the LDL receptor expression and LDL clearance
Difference between simvastatin and atorvostatin
Simvastatin = half life of 2 hours - take at night Atorvastatin = half life of > 30 hours which means can be taken in the morning and work at night but for ease of patients still take all statins at night
Prescription of statin for primary and secondary prevention
20 mg for primary with >10% risk
80mg for secondary
Complications and cautions of statins
Contraindications- GI upset, myalgia and rhabdomyalsis
Cautions- amlodipine (will increase potency of drug), grapefruit juice (higher dose because inhibitsCYP from working) pregnancy and breast feeding (because feaotus needs cholesterol)
How do fenofibrates work - cholesterol
Work by upregulating LPL by activating the transcription factor PPARalpha = increased TG uptake and fatty acid uptake by the liver.
Usually co-prescribed
Cautions and contraindications of fenofibrates - cholesterol
Cautions - gall stones and myositis (muscle inflam)
Contraindications - warfarin (can potentiate wafarin causing more bleeding)
How does ezetimibe work and its dosing - cholesterol
Works by inhibiting NPC1L1 so cholesterol uptake in the gut is reduced = 15% cholesterol reduction and 20% LDL reduction.
Also acts as synergistic with simvastatin and is often used if high doses of statins aren’t tolerated.
Standard dose is 10mg
Ezetimibe contraindications and cautions
Contraindications - GI upset and abdo pain
Cautions - hepatic
How much cholesterol reduction do you aim for in secondary prevention
Aim for 4 total cholesterol and 2 LDL
How does alirocumab work
Works by inhibiting PCK9 which usually promates LDL receptor internalisation
