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CARDIOVASCULAR > Drugs and their mechanisms > Flashcards

Drugs and their mechanisms Flashcards

1
Q

What drug class does clopidogrel belong to and what is its mechanism of action

A

ANTI-PLATELET

antagonist of the P2Y12 adenosine diphosphate (ADP) receptor, inhibiting the activation of platelets

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2
Q

Which drug class does aspirin belong to and what is its mechanism of action?

A

ANTI-PLATELET

blocks the action of both cyclooxygenase-1 and 2. Cyclooxygenase is responsible for prostaglandin, prostacyclin and thromboxane synthesis.

(Antiplatelet - inhibits the production of thromboxane)

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3
Q

Which channel do the 4 anti-arrhythmic classes of drugs block?

A

1 (a,b+c) - all block NA+ channels
2- block b-adrenoceptors
3- block potassium channels
4- block calcium channels

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4
Q

What drug is recommended for the first-line treatment of heart failure and may help to remodel the left ventricle?

A

ACE inhibitors

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5
Q

Name 3 anticoagulant drugs. Which diseases are they used for?

A

Warfarin
Heparin
Rivaxoban

Used for DVT / PE / STEMI / AF

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6
Q

Which clotting factors does warfarin block?

A

2,7,9 and 10

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7
Q

What does rivaroxaban inhibit to cause an anticoagulant effect?

A

It inhibits factor Xa to prevent the formation of clots

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8
Q

What is the general mechanism of action of diuretics?

A

Promote sodium and water excretion by inhibiting reabsorption

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9
Q

Loop diuretics are the stronger type of diuretics used in heart failure. An example is furosemide. What is its mechanism of action and where exactly does it have an effect?

A

Inhibit the Na-K-Cl cotransporter (NKCC) in the thick ascending limb of the loop of Henle, reducing the absorption of NaCl.

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10
Q

Give an example of a thiazide diuretic. These are more mild than loop diuretics and are used to treat hypertension.

A

Bendrofluazide

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11
Q

B-blockers can be cardio-selective, or non-cardioselective. Name an example from each category.

A

Cardioslective - Bisoprolol and atenolol

Non cardioselective - Propranolol

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12
Q

What is the mechanism of action of Beta blockers?

A

Block B1 receptors reducing contractiity and therefore oxygen demand
They have a negative inotropic and chronotropic effect

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13
Q

Name 3 calcium channel blockers

A

Amlodopine
Verapamil
Diltiazem

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14
Q

Describe the mechanism of action of calcium channel antagonists

A

Block a1 receptors, block calcium influx and cause vasodilation - increases perfusion of the myocardium

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15
Q

What can calcium channel antagonists be used to treat?

A

Hypertension
Arrhythmias
Angina

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16
Q

What are the 3 main classes of vasodilators? Give an example of each

A

Alpha blockers - prazosin
Ace inhibitors - lisinopril
ARBs -losartan

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17
Q

What is the mechanism of action of ACE inhibitors?

A

Blocks conversion of angiotensin I to angiotensin II

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18
Q

What is the mechanism of action of ARBs?

A

Blocks the action of angiotensin II

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19
Q

Name a potassium channel opener and describe its mechanism of action and what its used for

A
  • Nicorandil
  • Decreases the calcium sensitivity of smooth muscle causing relaxation of smooth muscle and coronary vasodilation
  • Used to treat stale angina
20
Q

What is the mechanism of action of ivabridine and when is it used?

A
  • Prolongs diastole by inhibiting the If current.
  • It decreases HR and increases SV
  • ONLY WORKS IF THE PATIENT IS IN SINUS RHYTM
21
Q

GTN (short acting) and isorbide mononitrate (longer acting) are nitrates used to manage angina and acute heart failure. Describe their mechanism of action.

A

VASODILATORS

MECHANISM;

  • Cause release of nitric oxide in smooth muscle, increasing cGMP which leads to a fall in intracellular calcium levels - causes relaxation of the cardiac muscle
  • Dilate the coronary arteries (increases perfusion to ischaemic zones)
  • Decrease preload and afterload by dilating arteries and veins
22
Q

Name a fibrinolytic drug and state what it is used for?

A

Streptokinase

  • Used to dissolve clots
  • Used to treat STEMI and PE
23
Q

List 4 anti-cholesterol drug classes and give examples

A

Statins - Atorvastatin
Fibrates - Bezafibrate
Bile acid binding resins - Colestipol
Ezetimibe

24
Q

What is the mechanism of action of statins?

A

Blocks the HMG CoA reductase enzyme

Reduces production of LDL and increases its clearance

25
Q

What is the mechanism of action of fibrates?

A

Agonist of PPAR-alpha - increases lipoprotein lipase expression
Decreases triglycerides, Decrease LDL and decrease HDL

26
Q

What is the mechanism of action of bile acid binding resins?

A

Bind bile acids, preventing them from being reabsorbed in the SI, this thus up regulates the amount of cholesterol converted to bile salts which are then excreted (lowers cholesterol)
There is increased LDL receptor expression causing increased clearance

REDUCES LDL CHOLESTEROL

27
Q

Which other anti-cholesterol drug class is ezetimibe used in combination with?

A

Statins

28
Q

Calcium sensitisers are an inotropic drug class. What is their mechanism of action and when should they be used?

A

Bind to troponin, making it more sensitive to calcium. Cause opening of kATP channels- causing vasodilation.
Used in acute decompensated heart failure.

29
Q

Name two inotropic drug classes

A

Calcium Sensitisers

B-Adrenoceptor Agonists

30
Q

Give two examples of B-adrenoceptor agonists and state when they wold be used

A

Adrenaline - used for anaphylactic shock ad cardiac arrest

Dobutamine - Used for acute heart failure

31
Q

What is the mechanism of action of ezetimibe?

A

Decreases cholesterol absorption in the small intestine

32
Q

Which anti-arrhythmic drug class do; Disopyramide, lignocaine an flecainide belong to?

A

Class 1

33
Q

Name a class II anti - arrhythmic drug

A

Metaprolol

34
Q

Name a class III anti-arrhythmic drug

A

Amiodarone

35
Q

Name a class IV anti-arrhythmic drug

A

Verapamil

36
Q

What is the mechanism of action of digoxin? When should this drug be used?

A

Causes AV node conduction delay
Increases contractility of the heart
Used for AF and heart failure

37
Q

Atropine is a non-selective muscarinic receptor antagonist. What is it used for?

A

Severe bradycardia

38
Q

What is adenosine used to treat?

A

Used to convert supra-ventricular tachycardias back to sinus rhythm

39
Q

Describe the step-up treatment of hypertension

A

<55 - Ace inhibitors or ARB
>55 or afro-carribean - CCB

ACE I/ARB +CCB

ACEI/ARB +CCB +thiazide-like diuretic

ACEI/ARB +CCB +thiazide-like diuretic + alpha or beta- blocker

40
Q

Name 4 drug classes which can be used in the treatment of angina

A

Nitrates
Potassium channel openers
CCB
B-Blockers

41
Q

List 3 drug classes which come under ‘Anti-Thrombotic Drugs’

A

Fibrinolytics - streptokinase
Antiplatelets - e.g aspiring and clopidogrel
Anti-coagulants - e.g warfarin/ heparin/ rivaroxaban

42
Q

What is the most appropriate first-line anti-anginal for stable angina in a patient with known heart failure. (If there are no contraindications)?

A

Atenolol

43
Q

Which two drugs does AF cardio version involve?

A

Amiodarone and Flecainide

44
Q

Describe the step up management of heart failure

A

Ace. I (or ARB) and Beta blocker

Aldosterone antagonist
ARB
Hydralazine and nitrate

Cardiac resynchronisation therapy
Digoxin

45
Q

What drug directly inhibits thrombin?

A

Rivaroxiban

46
Q

Where does angiotensin II act and what effect does it have at these sites?

A

Acts on sympathetic neutrons to influence vascular smooth muscle
Acts on the adrenal cortex to stimulate aldosterone release

CARDIOVASCULAR (11 decks)

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