Systemic Drugs- cardiovascular Flashcards
What is the major cause of death?
Heart and cardiovascular disorders
What does prophylactic mean?
Intended to prevent disease
What are modifiable risk factors of cardiovascular disease?
- Better diet (reduce salt intake, limit alcohol consumption, 5 fruit and veg a day, reduce intake of saturated fat)
- Stop smoking
- More exercise (maintain healthy bmi, aerobic exercise)
- Lipid modification
- Hypertension treatment
Which diseases are hypertension a major risk factor for?
Stroke, myocardial infarction, heart failure, chronic kidney disease, premature death
How is hypertension diagnosed?
If clinic BP is 140/90 mmHg or higher , then it needs to be repeated at home and an average is taken using a HBPM or ABPM
Describe the three stages of hypertension classification
stage 1: clinic bp is 140/90 mmHg or higher AND ABPM or HBPM average is 135/85 or higher
stage 2: clinic bp is 160/100 mmHg or higher AND ABPM or HBPM average is 150/95 or higher
severe hypertension: clinic bp is 180 mmHg or higher or clinic diastolic BP is 110 mmHg or higher
How is hypertension treated?
Using a stepped approach, using low doses of several drugs to minimise adverse events and maximise compliance
- Aim is to reduce systolic to 140 and diastolic to 90
Why is hypertension treated?
Reduces cerebrovascular disease and reduces MI (myocardial infarction)
If you are under 55 years old what first line treatment is given to the px?
ACE inhibitor
If you are over 55 years old or black px which two treatments could you be give to treat hypertension?
Calicum-channel blocker or thiazide-type diruetic
At what point would you start combining drugs and why would you not just increase the dose of that drug instead of combining?
If a single drug is not effective.
Increases the likelihood of adverse side effects, combining lower doses is better
Give four examples of ACE inhibitors
- Captopril
- Enalapril
- Lisinopril
- Ramipril
What are some side effects of ACE inhibitors?
- Cough
- Taste disturbance
- Angiodema
- First-dose hypotension
- Hyperkalaemia
What is the downside of a ACE inhbitor?
Expensive
What is the role of ACE?
Its role is to break down angiotensin I into angiotensin II (this causes increased BP)
What is an alternative way instead of using an ACE inhibitor to prevent angiotensin being formed?
Competitively inhibit the receptor which angiotensin II is binding to
Why would an angiotensin II receptor antagonist be used instead of an ACE inhibitor?
It has fewer side effects
Give three examples of an angiotensin II receptor antagonist
Losartan, Candesartan, Valsartan
- Tan
What does CCBs stand for?
Calcium channel blockers
How do CCBs work?
Inhibit inward movement of calcium ions through slow L-type calcium channels in active membranes e.g cells of myocardium, cells with His-purkinje system and cells of vascular smooth muscle
- this effects cardiac contractility and causes vasodilation
Give four examples of CCBs
1) Nifedipine
2) Amlodipine
3) Verapamil
4) Diltiazem
What do diuretics do?
Enhance excretion of salt and get rid of water by increasing urine production + salt composition
; act in different areas of the nephron
Name the main three classes of diuretics
- Thiazide
- Loop diuretic
- Potassium sparing
What is a risk of taking thiazide and why is this the case ?
Can lead to a potassium deficiency because it inhibits the absorption of sodium in the DCT (distal convoluted tubule)
*side note; its secondary role is reduces BP by vasodilation and reduction in blood volume
Name three thiazides examples
Bendrofluazide
Hydrochlorthiazide
Indapamide
What do loop diuretics do?
Inhibit absorption of sodium and potassium in the TAL of loop of henle
When are loop diuretics used?
Renal and heart failure
Give two examples of loop diuretics
Furosemide and Bumetanide
When is potassium sparing used?
Used in conjunction with thiazide and loop diuretics
Give two examples of potassium sparing?
Amiloride and Spironolactone
How does increasing salt excretion lower blood pressure?
Generates increased amounts of urine which reduces blood volume which lowers BP
Before CCBs, ACE inhibitors and diuretics, what was used to lower BP?
Beta-blockers
Give two example of beta-blockers used to lower BP?
Atenolol and metoprolol
How do beta blockers reduce BP?
Mechanism is unknown but we predict it involves:
1. Reduction in heart rate
2. Reduction in peripheral resistance
3. Inhibition of renin release
What five less commonly used anti-hypertensive drugs which lower BP and how do they do this?
Doxazosin- alpha-adrenoceptor antagonist
Methyldopa and Moxonidine- centrally acting agents
Hydralazone and minoxidil- vasodilators
What is angina?
Insufficient oxygen being supplied to the cardiac muscle due to the narrowing of coronary arteries
What are two ways angina is treated?
By a stent or by using a vasodilator
If a px has a clot in their heart, what condition will they get?
Myocardial infarction (heart attack)
After having an heart attack which drugs may these patients be on?
Immediately- analgesia, thromboylsis, asprin
Prophylaxis- ACE inhibitors, aspirin, lipid lowering therapy
What is the treatment of heart failure?
Diuretics, ACE inhibitors, nitrates, bet-blockers, Ionotropic drugs
What do lipoproteins do ?
and name the two types?
Transport cholesterol around the body
LDL; Low density lipoprotein (bad)–> associated with athroema formation
HDL; high density lipoprotein (good)
What is lipid modification ?
A cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease
What drug is most commonly used to reduce cholesterol?
Statins; Simavastatin, atrovastatin, pravastatin
What drug is most commonly used to reduce cholesterol + give examples?
Statins; Simavastatin, atrovastatin, pravastatin
How do statins work?
Inhibit enzyme (HMG- CoA) increasing uptake of LDL from the blooD
