Flashcards in Cardiovascular Deck (42):
How do ACE inhibitors work?
Inhibit ACE and prevent the formation of angiotensin II
What are ACE inhibitors used for?
Hypertension, heart failure, diabetic nephropathy
Give examples of ACE inhibitors.
Rampipril, perindopril, enalapril, trandolapril.
What are the main adverse effects of ACE inhibitors - due to reduced angiotensin II formation?
Hypotension, acute renal failure, hyperkalaemia, teratogenic effects in pregnancy (deformity)
Main adverse effects of ACE inhibitors due to increased kinin production?
Cough, rash, anaphylactoid reactions (allergic reactions)
Why do ACE inhibitors cause an increase in kinin?
Bradykinin gets broken down by ACE in to inactive proteins, when ACE is inhibited bradykinin/ kinin levels increase.
Give some contraindications of ACE inhibitors.
Pregnancy, renal failure, hyperkalaemia, hyponatraemia, hypotension
How do Angiotensin II receptor blockers work?
By binding to AT-1 receptors on angiotensin II
When would ARBs be used?
Hypertension, diabetic nephropathy, heart failure (if ACE inhibitor intollerant)
Give some examples of ARBs
Candesartan, valstratan, losartan, irbesartan, telmisartan
What are the main adverse effects of ARBs?
hypotension, hyperkalaemia, rash, angio-oedema, potential renal dysfunction
How do Ca2+ channel blockers work?
Decrease cell entry of Ca2+ by blocking L-type Ca2+ channels, increasing vasodilation and reducing myocardial O2 demand.
What are type 1 calcium channel blockers?
Dihydropyridines -nifedipine, amlodipine
What are the effects of type 1 calcium channel blockers?
Mainly peripheral vasodilators (also coronary arteries) - can cause reflex tachycardia so used with a beta blcoker.
What are type 2 calcium channel blockers?
Phenylalkylamines - verapamil
mainly effects the heart (decreased heart rate and force of contraction)
DO NOT GIVE WITH BETA BLOCKERS - bradycardia!
What are type 3 calcium channel blockers?
Benzothiazepines - diltiazem
What are the main adverse effects of Ca2+ channel blockers?
Due to peripheral vasodilation:
flushing, headache, oedema, palpitations
Due to decreased heart rate(-ve chronotropic):
Bradycardia, atrioventricular block
Due to decreased contraction force -
worsening cardiac failure
verapamil causes constipation.
How do beta blockers work?
block beta- adrenoreceptors, antagonise sympathetic NS.
beta 1 : -ve ionotrophic & chronotrophic effects
beta 2 : decrease vaso/bronchoconstriction.
Give an example of a Beta1/cardio selective drug.
Give an example of a non-slective beta-blocker.
Uses of betablockers.
Angina, hypertension, antidysrhythmias, IHD, heart failure
Contraindications of beta-blockers?
Asthma/COPD, heart block
Main adverse effects of beta-blockers?
Fatigue, headache, sleep disturbance/nightmares, bradycardia, hypotension, cold peripheries, erectile dysfunction.
How do loop diuretics work?
Inhibit Na/2Cl/K cotransporter in the loop of Henle. Cause dehydration, decreased K+ and Ca2+
When are loop diuretics used?
How does thiazide work?
Inhibit Na/Cl cotransporter. Decrease K+ and Mg2+, increase Ca2+
When are thiazides used?
What are the main adverse effects of loop diuretics?
Hypovolaemia, hypotension, hypokaaemia, hyponatraemia, raised uric acid - gout
What are the main adverse effects of thiazides?
erectile dysfunction, impared glucose tolerance.
How do nitrates work?
Cause vasodilation, reduce preload and afterload, lower BP.
What are the main uses of nitrates?
IHD and heart failure
Give examples of nitrates.
Isosorbide mononitrate, GTN spray, GTN infusion
How do class 1 antiarrhythmis drugs work?
they are Na+ channel blockers.
Give examples of 1a, 1b and 1c anitarrhythmic drugs.
What are class 2 antiarrhythmic drugs
How do class 3 antiarrhythmic drugs work?
prolong the action potential - amiodarone
How do class 4 antiarrhythmic drugs work?
They're calcium channel blockers - verapamil.
How does digoxin work?
Blocks the Na+/k+ pump.
What are the main effects of digoxin?
bradycardia, slowing atrioventricular conduction, increased force of contraction.
What are the main adverse effects of digoxin?
Nausea, vomiting, diarrhoea, confusion.
when is digoxin used?
AF - to reduce ventricular rate response
Sever heart failure - positive ionotropic effect