Drugs by class

Question 1

Anti-arrythmics

Answer 1

AMIODARONE
SV/ventricular arrhythmias

• Blocks cardiac K+ channels prolonging repolarisation of cardiac action potential to restore regular sinus rhythm and slow AV node conduction

SE: photosensitivity, hypo/hyperthyroidism, pulmonary fibrosis, corneal deposits

Question 2

Cardiac glycosides

Answer 2

DIGOXIN
Heart failure, rate control in AF

Causes Ca2+ build up in cardiac myocytes with increased force of contraction and reduced rates of conduction through the AV node.

SE: nausea, vomiting, diarrhoea, confusion

N.B. digoxin toxicity - give Ig fragment

Question 3

HMG CoA reductase inhibitors

Answer 3

SIMVASTATIN
Reduce cholesterol

Inhibit HMG CoA reductase, the rate determining enzyme in the synthesis of cholesterol, causing hepatocytes to take up cholesterol and reducing plasma levels.

SE: myalgia, myopathy, LFT derangement

Question 4

Non-rate limiting calcium channel blockers

Answer 4

AMLODIPINE, NIFEDIPINE
Hypertension, angina

Block L type Ca2+ channels, depressing smooth muscle contractility, dilating coronary blood vessels and reducing afterload.

SE: ankle oedema, abdo pain, palpitations, flushing

AVOID: unstable angina, aortic stenosis

Question 5

Cardioselective beta blockers

Answer 5

BISOPROLOL, ATENOLOL
Hypertension, angina, rate control AF, mild heart failure

Blockage of B1 receptors in cardiac and renal tissue
Inhibits sympathetic stimulation of heart, blocks sinoatrial node, reduces release of renin.

SE: bradycardia, hypotension, bronchospasm, loss of hypoglycaemic awaresness

Question 6

Non cardioselective beta blockers

Answer 6

PROPRANOLOL, CARVEDILOL
Hypertension, angina, anxiety, migraine prophylaxis, post MI prophylaxis, mild HF

Inhibits sympathetic stimulation in heart and vascular smooth muscle

SE: bradycardia, hypotension, bronchospasm, loss of hypoglycaemic awareness

Question 7

ACE inhibitors

Answer 7

RAMIPRIL, ENALAPRIL, LISINOPRIL, PERINDOPRIL
Hypertension, heart failure, nephropathy

Inhibits conversion of angiotensin 1 -> 2, potent vasoconstrictor. Via aldosterone decreases blood volume.

SE: dry cough, hypotension, HYPERkalaemia, renal impairment, angioedema

Question 8

Nitrates

Answer 8

ISOSORBIDE MONONITRATE, GLYCERYL TRINITRATE
Angina, severe hypertension

Converted to NO -> vasodilator. Predominantly acts on coronary vessels. Reduces preload and afterload so reduced cardiac oxygen requirements.

SE: headache, postural hypotension, tachycardia