Pharmacology Flashcards
what is the first-line treatment in younger patients with hypertension?
Angiotensin-converting enzyme (ACE) inhibitors.
What are ACE inhibitors used to treat apart from hypertension?
heart failure
diabetic nephropathy
secondary prevention of ischaemic heart disease
what types of patients are ACE inhibitors less effective on?
hypertensive afro-caribbean patients
how do ACE inhibiters work?
inhibit the conversion of angiotensin I to angiotensin II
what are the side effects of ACE inhibitors?
cough - occurs in around 15% of patients and may occur up to a year after starting treatment.
angioedema - may occur up to a year after starting treatment.
hyperkalaemia
first-dose hypotension - more common in patients taking diuretics
what are the cautions and contraindictions of ACE inhibitors?
- avoid during pregnancy and breastfeeding
- renovascular disease - significant renal impairment may occur in patients who have undiagnosed bilateral renal artery stenosis
- aortic stenosis - may result in hypotension
- patients receiving high-dose diuretic therapy - significantly increases the risk of hypotension
- hereditary of idiopathic angioedema.
what should be checked before ACE Inhibitor treatment is initiated and after increasing the dose?
Urea and electrolytes
what would be expected to rise after starting ACE inhibitors? what are acceptable changes in those?
creatinine and potassium
increase in serum creatine - up to 30% from baseline
increase in potassium up to 5.5 mmol/l
what are the effects of adenosine enhanced by?
dipyridamole (anti-platelet agent)
what are the effects of adenosine blocked by?
theophyllines
what type of patients should adenosine be avoided in? and why?
asthmatics due to possible bronchospasm.
what does adenosine cause?
transient heart block in the AV node.
what does adenosine do?
agonist of the A1 receptor which inhibits adenylyl clyclase thus reducing cAMP and causing hyperpolarization by increasing outward potassium flux.
what is the half life of adenosine?
8-10 seconds
what are the side effects of adenosine?
chest pain
bronchospasm
can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)
what are the three types of anti-cholesterol drugs?
- statins
- fibrates
- PCSK 9 inhibitors
what is an example of a statin drug?
simvastatin, atrovastatin
what do statin drugs do?
block HMG coA reductase, anti-cholesterol drug
what conditions are statins used in?
- hypercholesterolaemia
- diabetes
- angina/MI
- CVA/TIA
- high risk of MI and CVA
what are side effects of satins?
myopathy
rhabdomyolysis… renal failure
what is an example of fibrates?
bezafibrate
what are fibrates used in?
hypertriglyceridaemia
low HDL cholesterol
hyperlipidaemia
what are examples of PCSK 9 inhibitors?
evolocumab, alirocumab
what are PCSK 9 inhibitors used for?
familial hypercholesterolaemia
how do PCSK 9 inhibitors work?
by inhibiting the binding of PCSK9 to LDLR, PCSR9 inhibitor increases the number of LDLRs available to clear LDL, thereby lowering LDL-C levels.
what do diuretics do?
block Na reabsorption in kidneys
what type of diuretic is used in hypertension? what is an example of it?
thiazide diuretics
bendrofluazide
what are loop diuretics used to treat? what is an example of one?
used in heart failure or resistant hypertension
furosemide
what are diuretic side effects?
hypokalaemia - tired arrhythmias hyperglycaemia - diabetes increase in uric acid - gout impotence
what do beta blockers do?
block beta1 and/or beta2 adrenoceptors
what do cardioselective beta blockers do?
only block beta1 receptors
what are examples of cardioselective blockers?
atenolol, bisoprolol
what are cardioselective blockers used in?
angina acute coronary syndrome myocardial infarction hypertension heart failure
what do non-selective beta blockers do?
block beta1 and beta2 receptors
what are examples of non-selective beta blockers?
propranolol, carvedilol (alpha and beta blocker)
what are non-selective beta blockers used in?
thyrotoxicosis
migraine
what are side effects of beta blockers?
- asthma - contraindicated in brittle/severe asthma
- tired
- heart failure (can worsen in short term especially cardiogenic shock)
- cold peripheries
what are the two types of calcium antagonists?
dihydropyridines
rate limiting calcium antagonists
what is an example of dihydropyridines?
amlodipine
what are dihydropyridines used in?
hypertension and angina
what are side effects of dihydropyridines?
ankle oedema
what are examples of rate limiting calcium antagonists?
verapamil, diltiazem
what are rate limiting calcium antagonists used in?
hypertension
angina
supraventricular arrhythmias (AF, SVT)
what should you avoid using rate limiting calcium antagonists with?
beta blockers.
what do angiotensin converting enzyme inhibitors do?
block angiotensin I becoming angiotensin II
what is an example of angiotensin converting enzyme inhibitor?
lisinopril
what are angiotensin converting enzyme inhibitor used in? what is it good for? what is it bad for?
- hypertension and heart failure
- good for kidneys in diabetic nephropathy
- bad for kidneys in renal artery stenosis
what are angiotensin converting enzyme inhibitors side effects?
cough
renal dysfunction
angioneurotic oedema
when should you never use angiotensin enzyme inhibitors?
in pregnancy induced hypertension
what do angiotensin receptor blockers do?
block angiotensin II receptors
what is an example of a angiotensin receptor blocker?
Losartan
what are angiotensin receptor blockers used in? what are they good for? what are they bad for?
- hypertension and heart failure
- good for kidneys in diabetic nephropathy
- bad for kidneys in renal stenosis
what are side effects of angiotensin receptor blockers?
renal dysfunction
when should angiotensin receptor blockers never be used?
pregnancy induced hypertension.
what do alpha blockers do?
block alpha adrenoceptors to cause vasodilatation
what are alpha blockers used in?
hypertension and prostatic hypertrophy
what is an example of an alpha blocker?
doxazosin
what are side effects of alpha blockers?
postural hypotension
what do mineralocorticoid antagonists do?
block aldosterone receptors
what are mineralocorticoid antagonists used in?
heart failure and resistant hypertension
what are examples of mineralocorticoid antagonists?
spironolactone, eplerenone
what are side effects of mineralocorticoid antagonists?
gynaecomastia
hyperkalaemia
renal impairment
what do nitrates do?
venodilators
what is an example of a nitrate?
isosorbide monoritrate
what are nitrates used in?
angina
acute heart failure
what are side effects of nitrates?
headache
hypotension/collapse
what is recommended with nitrates to avoid tolerance?
leave 8 hr/day nitrate-free
what does nicorandil do?
K ATP channel activator
vasodilator
what kind of drug is nicroandil?
anti-anginal
what are side effects of nicroandil?
headache
mouth/GI ulcers
what does ivabradine do?
Lf channel modulator in sinus node
slows HR in sinus rhythm
when does ivabradine not work?
atrial fibrillation
what does ranolazine do?
late sodium channel modulator
decrease calcium load on heart
is is a metabolic modulator
when is ranolazine effective?
in refractory angina