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MP323 > MP323 - CVD DRUGS > Flashcards

MP323 - CVD DRUGS Flashcards

1
Q

antihypertensives indicated in heart failure

A

diuretic
beta blocker
ACE-I
ARB
aldosterone antagonist

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2
Q

antihypertensives indicated post MI

A

beta blocker
ACE-I
aldosterone antagonist

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3
Q

antihypertensives indicated in coronary artery disease risk

A

diuretic
beta blocker
ACE-I
CCB

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4
Q

antihypertensives indicated in diabetes

A

diuretic
beta blocker
ACE-I
ARB
CCB

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5
Q

antihypertensives indicated in chronic kidney disease

A

ARB
ACE-I

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6
Q

antihypertensives indicated in recurrent stroke prevention

A

diuretic
ACE-I

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7
Q

loop diuretics

A

furosemide supplemented with spironolactone or amiloride
- works in PCT and loop of henley
- inhibit Na+/K+/2Cl co transporter

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8
Q

thiazides (diuretics)

A

bendroflumethiazide
- work in distal convoluted tubule
- inhibit the Na+/Cl- cotransporter

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9
Q

potassium-sparing diuretics

A

amiloride, eplerenone, spironolactone
- act in collecting duct
- not acting directly on Na+ channels

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10
Q

renin inhibitors

A

aliskiren
beta-1 antagonists
catalyses the cleavage of angiotensinogen to angiotensin I

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11
Q

ACE inhibitors

A

ramipril, captopril, lisinopril, enalapril
- ACE is a membrane-bound enzyme
- catalyses the conversion of angiotensin I to angiotensin II

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12
Q

ACE inhibitors effect on the heart

A
  • reduces peripheral vascular resistance which lowers BP
  • reducing aldosterone levels promotes sodium and water excretion which can help to reduce venous return
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13
Q

ARBs (angiotensin receptor blockers)

A

losartan, valsartan, candesartan
- block the action of angiotensin II on the AT1 receptor

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14
Q

aldosterone antagonists

A

spironolactone, eplerenone
- competitively bind to aldosterone receptor
- promote sodium and water excretion in the collecting tubule and duct

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15
Q

beta blockers

A

block of cardiac beta-1 receptors decreasing HR, contractility and CO

blockage of beta-1 receptors in JG cells in kidney, decreasing renin release

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16
Q

non-selective beta blockers

A

propanolol, carvedilol, timolol
- used to prevent recurrent variceal haemorrhage in patients with cirrhosis and portal hypertension (bad liver function)

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17
Q

selective beta-1blockers

A

atenolol, bisoprolol, metoprolol
- used in heart therapy

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18
Q

CCBs (dihydropyridines)

A

nifedipine, amlodipine
- block Ca channels in arterioles
- do not block cardiac channels at therapeutic doses

19
Q

CCBs (dihydropyridines) effects on the heart

A

indirect reflex effect which increases HR and contractility of heart - may not be desirable in someone with heart disease

20
Q

CCBs (non-dihydropyridines)

A

verapamil, diltiazem
both cardiac specific

  • will reduce Ca2+ in cells and cause a reduction in vascular tone (NOT VASODILATORS)
  • indirect vasodilatory effect
  • act on heart to slow conduction and decrease contractility (arrhythmia)
21
Q

alpha-1antagonists (alpha-blockers)

A

Prazosin, doxazosin, tamsulosin
- inhibit smooth muscle contraction
- used in hypertension and benign prostate hypertrophy

22
Q

alpha-2 agonists (sympathomimetics)

A

clonidine
- stimulates alpha-adrenoceptors in the brain stem
- results in reduced sympathetic outflow from CNS
- decreases in peripheral resistance, renal vascular resistance, HR and BP

23
Q

aspirin MOA

A

blocks production of thromboxane A2 by inhibiting COX1 which is responsible for its synthesis

action is permanent lasting the lifespan of the platelet (7-10 days)

24
Q

clopidogrel MOA

A

ADP is a platelet agonist produced and released by platelets

irreversible inhibitor of ADP receptor on platelets and so prevents ADP from activating platelets

25
Q

statins MOA

A

lipid-lowering drugs
reduce plasma LDL

HMG-CoA reductase inhibitors, and so inhibit the synthesis of cholesterol

26
Q

alleviation of angina symptoms

A

BBs FIRST LINE
- if intolerant treat with rate-limiting CCB, long-acting nitrates or nicorandil

inadequate control of symptoms - add a CCB

sublingual GTN tabs or spray for immediate relief

27
Q

nitrates MOA

A
  • relax coronary arteries and veins decreasing preload, myocardial oxygen consumption and increasing myocardial perfusion
  • nitrates donate nitric oxide, stimulates cGMP cyclase increasing cGMP to decrease calcium entry and increase calcium removal
28
Q

nitrates

A

glyceryl trinitrate (GTN), isosorbide mononitrate, isosorbide dinitrate

29
Q

K+ channel activators

A

nicorandil
activation of K+ ATP channels on smooth muscle cells hyperpolarises the membrane and decreases calcium entry

30
Q

ticagrelor

A

antiplatelet
inhibits P2Y12 ADP-receptor preventing platelet activation
benefit with dual antiplatelet therapy

31
Q

secondary prevention (A,B,C,D,E)

A

A - antiplatelet, ACE-I/ARB
B - BB, breathing
C - cholesterol, cigarettes
D - diuretic, diet, diabetes
E - eplerenone, education

32
Q

penetration enhancers

A

dimethysulfozide, lecithin, water, oleic acid, azone

33
Q

use of diuretics in HF

A
  • loop diuretics usually required
  • aim for lowest possible dose
  • require monitoring of renal function and electrolytes
  • symptom control
34
Q

use of ACE inhibitors in HF

A
  • most evidence for enalapril
  • aim to reach target dose 20mg
  • not to lower BP but symptom control
  • require renal monitoring after initiation and dose change
35
Q

use of ARBs in HF

A
  • similar effect to ACE-I
  • candesartan/valsartan
  • can combine with ACE-I for more benefit
  • can be used if intolerant to ACE-I
36
Q

use of beta blockers in HF

A
  • reduce hospitalisation, morbidity and mortality
  • patient’s HF must be stable before initiation
  • avoid abrupt withdrawl
37
Q

use of ivabradine in HF

A
  • reduce mortality and hospitalisation
  • use in beta-blocker intolerant patients or in combo with BB if HR>75bpm
  • avoid grapefruit
38
Q

use of aldosterone antagonists in HF

A
  • reduces morbidity and mortality when added to treatment in advanced patients
  • eplerenone reduced mortality when added to treatment in MI complicated by HF or spironolactone intolerant patients
39
Q

use of digoxin in HF

A
  • indicated in AF with HF
  • consider patients who can’t tolerate ACE-I/ARB
  • narrow therapeutic index
  • careful in patients with hyperkalaemia
40
Q

use of vasodilators in HF

A

hydralazine combined with isosorbide dinitrate
- inferior to ACE-I
- only indicated if patient remains asymptomatic and all other options explored
- use in renal impairment

41
Q

drugs that exacerbate HF

A
  • NSAIDs/COX-2 inhibitors
  • rate-limiting CCBs
  • chemotherapy
  • anti-psychotics
  • glitazones
  • corticosteroids and fluid retaining drugs
  • meds with high Na content
42
Q

warfarin

A
  • inhibits synthesis of vitamin K dependent clotting factors
  • delayed onset of action as clotting factors decline
  • daily monitoring of INR
43
Q

oral anticoagulants

A

warfarin, rivaroxaban, apixaban, edoxaban

MP323 (9 decks)

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