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Clinical > Common Drugs Used in the Treatment of CVD > Flashcards

Common Drugs Used in the Treatment of CVD Flashcards

1
Q

What do diuretic do?

A

Block Na+ reabsorption in kidneys, so more water is excreted

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2
Q

Types of diuretics?

A

Thiazide diuretics (e.g: bendrofluazide) - mild and are used in HYPERTENSION

Loop diuretics (e.g: furosemide) - stronger and are used in HEART FAILURE

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3
Q

Side effects of diuretics?

A

Hypokalaemia - K+ follows Na+ into urine; this can result in fatigue and arrhythmias

Hyperglycaemia - produce diabetes

Increased uric acid - can cause gout

Impotence

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4
Q

What do β-blockers do?

A

Block β1 or β2 adrenoceptors, or block both

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5
Q

Types of β-blockers?

A

Cardio-selective β-blockers, e.g: atenolol - only block β1 adrenoceptors; used in ANGINA, HYPERTENSION and HEART FAILURE

Non-selective β-blockers, e.g: propranolol - block β1 and β2 adrenoceptors; used in THYROTOXICOSIS (disease where metabolic rate speeds up, causing a tremor)

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6
Q

Side effects of β-blockers?

A

Asthma - NEVER USE β-BLOCKERS IN ESTABLISHED ASTHMA (can cause bronchospasm)

Tired

Cold peripheries - e.g: Raynaud’s phenomenon

Heart failure - only use with initial low dose and then gradually increase; also, use only medium/long term in heart failure (not short-term)

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7
Q

What do Ca2+ antagonists do?

A

Decrease HR and cause vasodilatation

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8
Q

Types of Ca2+ antagonists?

A

Dihydropyridines, e.g: amlodipines - used in HYPERTENSION and ANGINA

Rate-limiting Ca2+ antagonists, e.g: verapamil, diltiazem - used in HYPERTENSION and ANGINA, plus supraventricular arrhythmias, like AF and SVT

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9
Q

Side effect of dihydropyridines?

A

Ankle oedema

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10
Q

Contraindications with rate-limiting Ca2+ antagonists?

A

Avoid use with β-blockers (also decrease HR so using both together may cause bradycardia)

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11
Q

What do α-blockers do and when are they used?

A

Block α-adrenoceptors to cause vasodilatation, e.g: Doxazosin

Used in HYPERTENSION and prostatic hypertrophy

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12
Q

Side effects of α-blockers?

A

Postural hypotension

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13
Q

What do Angiotensin Converting Enzyme (ACE) inhibitors do and when are they used?

A

Block angiotensin I from being converted to angiotensin II (a vasoconstrictor), e.g Lisinopril

Used in HYPERTENSION and HEART FAILURE

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14
Q

Cautions with ACE inhibitor use?

A

Good for kidneys in diabetic neuropathy but bad for kidneys in renal artery stenosis - kidneys may respond well/badly so recheck kidney function

NEVER USE IN PREGNANCY-INDUCED HYPERTENSION (can cause foetal abnormalities) - is there any possibility of being pregnant?

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15
Q

Side effects of ACE inhibitors?

A

Dry cough - no harm but, if too irritating, switch patient to Angiotensin Receptor Blockers

Renal dysfunction

Angioneurotic oedema (allergic swelling that can also occur in the larynx; more common in black people - ensure person has not had this side effect before)

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16
Q

What do Angiotensin Receptor Blockers do?

A

Block angiotensin II receptors, e.g: Losartan - used in HYPERTENSION and HEART FAILURE

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17
Q

Cautions with angiotensin receptor blockers?

A

Same as for ACE inhibitors:

Good for kidneys in diabetic neuropathy but bad for kidneys in renal artery stenosis

Never used in pregnancy-induced hypotension

18
Q

Side effects of angiotensin receptor blockers?

A

Renal dysfunction

No cough

No angioneurotic oedema

19
Q

What do nitrates do?

A

Are VENOdilators (so, not used for hypertension), e.g: isosorbide mononitrate

Used in ANGINA and HEART FAILURE

20
Q

Side effects of nitrates?

A

Headache

Hypotension/collapse

21
Q

Cautions with nitrates?

A

Tolerance is common so leave 8 hours/day nitrate-free (e.g: no tablet in the evening, so that the drug is gone by next morning)

22
Q

What do anti-platelet agents do?

A

All prevent new thrombosis

Used in ANGINA, ACUTE MI, CVA/TIA and also in patients ar high risk of MI and CVA (cerebro-vascular accident)

23
Q

Examples of anti-platelet agents?

A

Aspirin, Clopidogrel, Ticagrelor, Prasugrel

24
Q

Side effects of anti-platelet agents?

A

Haemorrhage anywhere

Peptic ulcer haemorrhage

Aspirin sensitivity leading to asthma

25
Q

What do anti-coagulants do?

A

Prevent new thrombosis

Used in DVT, PE, NSTEMI (Non ST elevation MI) and AF

26
Q

Examples of anti-coagulants?

A

Heparin - IV use only

Warfarin - oral use only (blocks clotting factor 2, 7, 9, 10)

Rivaroxaban - inhibitor of Facto Xa

Dabigatran - inhibitor of Thrombin Factor IIa

(Xa converts prothrombin - II - to thrombin - IIa)

27
Q

Side effects of anti-coagulants?

A

Haemorrhage anywhere

28
Q

Cautions with anti-coagulants?

A

Control dose carefully by International Normalised Ratio (INR) - can monitor warfarin using blood tests frequently

29
Q

Advantage of warfarin?

A

Reversed by Vitamin K

30
Q

What do fibrinolytic drugs do?

A

Dissolve formed clot, e.g: streptokinase, tissue plasminogen activator (tPA)

Used in STEMI (ST elevation MI), PE (selected cases only) and CVA (selected cases only)

31
Q

Side effects of fibrinolytic drugs?

A

Serious risk of haemorrhage

32
Q

When should fibrinolytic drugs be avoided?

A

Recent haemorrhage (some CVAs)

Trauma

Bleeding tendencies - e.g: haemophiliacs

Severe diabetic retinopathy - blood vessels here are fragile

Peptic ulcer

33
Q

Types of anti-cholesterol drugs?

A

Statins block HMG CoA reductase, e.g: simvastatin:

Used in hypercolesterolaemia, diabetes, angina/MI, CVA/TIA and in those at high risk of MI and CVA

Fibrates, e.g: Bezafibrate: Used in hypertriglyceridaemia, low HDL cholesterol

34
Q

Side effects of anti-cholesterol drugs?

A

Myopathy

Rhabdomyolysis renal failure - muscle breakdown that can lead to renal failure

35
Q

What drug is commonly used for supra-ventricular arrhythmias, like SVT?

A

Use adenosine (IV) in acute phase

36
Q

What drugs are commonly used for ventricular/supra-ventricular arrhythmias?

A

Amiodarone

β-blockers

Flecainide

37
Q

What is amiodarone?

A

Only used in life-threathening arrhythmias, as they produce bad side effects: Phototoxicity

Pulmonary fibrosis

Thyroid abnormalities (hypo or hyper)

38
Q

Effects of digoxin?

A

Blocks atrial-ventricular (AV) conduction - produces a degree of AV conduction delay this is desired in AF but, if excessive, it is bad as the HR can fall too low (bradycardia) and heart block can occur

Increases ventricular irritability, producing ventricular arrhythmias - always a bad effect and made worse as digoxin has a narrow therapeutic index

39
Q

Signs of digoxin toxicity?

A

Nausea and vomiting

Yellow vision

Bradycardia, heart block

Ventricular arrhythmias

40
Q

In summary, what types of drugs are used for what CVD problems?

A

Clinical (54 decks)

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