Cardiovascular Drugs

Question 1

what are the 6 main classes of drugs used in hypertension?

Answer 1

• calcium antagonist
• ACE inhibitors
• Angiotensin Receptor Blockers
• Alpha Blockers
• Mineralocorticoid antagonists
• Diuretics

Question 2

examples of cardioselective beta blockers 2

Answer 2

Atenolol and bisoprolol

Question 3

examples of nonselective beta blockers 2

Answer 3

propanolol and carvedilol (block b1 and b2 receptors)

Question 4

side effects of beta blockers? 4

Answer 4

• B2 blockers can worsen asthma
• tiredness
• cold peripheries
• can worsen heart failure

Question 5

what are the two types of calcium antagonists and give examples for each. What are calcium antagonists used in?

Answer 5

dihydropyridnes (amlodipine) and rate limiting calcium antagonists (verapamil and piltiazem). Used in hyertension and angina

Question 6

what should you avoid using rate limiting calcium antagonists with?

Answer 6

beta blockers

Question 7

what is the mechanism of ACE inhibitors?

Answer 7

Block angiotensin 1 becoming angiotensin 2 therefor there is no vasoconstriction

Question 8

what are ACE inhibitors and angiotensin receptor blockers good and bad for?

Answer 8

good for kidneys in diabetic nephropathy

bad for kidneys in renal artery stenosis

Question 9

when should ACE inhibitors and angiotensin receptor blockers not be used?

Answer 9

pregnancy induced hypotension

Question 10

name an example of angiotensin receptor blockers

Answer 10

losartan

Question 11

what is the mechanism of alpha blockers in hypertension?

Answer 11

block a adrenoreceptors to cause vasolation

Question 12

example of an alpha blockers? and a side effect?

Answer 12

Doxazosin. Postural hypotension

Question 13

mechanism of mineralocoricosteroid antagonist

Answer 13

block aldosterone receptors

Question 14

examples of mineralocorticoid antagonists?

Answer 14

spironolactone and eplerenone

Question 15

side effects of mineralocorticoid antagonists?

Answer 15

gynaecomastia, hyperkalaemia and renal impairment

Question 16

what are the two types of diuretics?

Answer 16

loop diuretics (strong) and thiazide diuretics (mild)

Question 17

example and use of loop diuretics?

Answer 17

furosemide (heart failure)

Question 18

example and use of thiazide diuretics?

Answer 18

bendrofluazide

Question 19

side effects of diuretics?5

Answer 19

• hypokalemia (low k resulting in tiredness)
• arrhythmias
• hyperglycaemia (diabetes)
• increase in uric acid (gout)
• impotence

Question 20

3 types of anticholestrol drugs? which one is the strongest?

Answer 20

Statins, fibres and PCSK9 Inhibitors (strong)

Question 21

Action and example of a statin?

Answer 21

Simvastatin. Blocks HMG CoA Reductase so cholesterol is not produced (reduction of LDL)

Question 22

action and example of a Fibrate?

Answer 22

Bezafibrate. They reduce the livers production of VLDL (triglyceride carrying particle) and speed up the removal of triglycerides in the blood.

Question 23

antithrombotic drugs are split into what two categories?

Answer 23

anticoagulants and antiplatalet drugs

Question 24

example of anticoagulant drugs? 7

Answer 24

• heparin
• fondaparinux
• warfarin (weekly bloods)
• rivaroxoban
• edoxaban
• dabigatran
• fibrinolytics (another class)

Question 25

what do fibrinolytics do? example 2

Answer 25

dissolve clots and prevent them from growing. Streptokinase and tPA

Question 26

when are fibrinolytics used?

Answer 26

STEMI , serious risk of haemorrhage

Question 27

examples antiplatalets drugs? 4

Answer 27

- aspirin - clopidogrel - prasugrel - ticagrelor

Question 28

which anticoagulant are given orally?

Answer 28

warfarin, rivaroxoban, dabigatran, edoxaban

Question 29

what is the holy trinity of heart failure?

Answer 29

ACE inhibitors, ARBs and betablockers

Question 30

example of HF drugs? 6 Hypertension plus two others

Answer 30

-ACE inhibitors -ARBs -betablockers -Mineralocorticoid Antagonists - Calcium antagonists -Alpha blockers PLUS -digoxin -Neprilysin Inhibitors

Question 31

what are the two effects of digoxin?

Answer 31

1. Blocks AV conduction (delay) good for AF | 2. Increases ventricular irritability which produces ventricular arrhythmias (always BAD)

Question 32

what can digoxin cause if used excessively?

Answer 32

bradycardia

Question 33

what do neprilysin inhibitors do?

Answer 33

they are endopeptidases. Inhibition of neprilysin increases the bioavailability of natriuretic peptides resulting in vasodilatory effects. They are superior to ACE Inhibitors and ARBs

Question 34

name of a neprilysin inhibitor? 1

Answer 34

Salcubitril valsartan

Question 35

two examples of PCSK9 Inhibitors

Answer 35

alirocumab and evolocumab

Question 36

action of PCSK9 Inhibitors?

Answer 36

they inhibit the binding of PCSK9 to LDL receptors which increases the number of LDL receptors available to clear LDL. Increases rate of LDL recycling

Question 37

what are the three types of anti-anginal drugs?

Answer 37

vasodilators, slow heart rate and metabolic modulator

Question 38

what are the three types of vasodilators used in anti-anginal drugs?

Answer 38

nitrates, nicorandil and calcium antagonists (dihydropyridnes)

Question 39

action and example 1 of nitrates?

Answer 39

ventilators. Open up mostly veins but also arteries. Example - isosorbide monoritrate

Question 40

what is different about the dosage of nitrates?

Answer 40

patient must have 8 hours nitrate free because a tolerance can be built up

Question 41

what is nicorandil and why is not preferred?

Answer 41

K ATP channel activator that can cause really bad mouth/GI ulcers

Question 42

what is a drug other than beta blockers that can slow down heart rate? what is its action?

Answer 42

Ivabradine. If channel modulator in the sinus node. It slows down the heart rate in sinus rhythm and won't work in A fib

Question 43

what is the metabolic modulator used in ant-anginal treatment?

Answer 43

ranolazine

Question 44

what is the action of ranolazine?

Answer 44

it a late sodium channel modulator which decreases the calcium load on heart. It stops the heart from working so hard

Question 45

what drugs can control atrial fibrillation? 4

Answer 45

- betablockers - digoxin - rate limiting calcium antagonists - amiodarone

Question 46

ACTION OF ANTICOAGULENTS what is the action of warfarin?

Answer 46

it blocks a modification of factors II, VII, IX and X which are essential for their function

Question 47

ACTION OF ANTICOAGULENTS what is the action of rivaroxiban?

Answer 47

it directly inhibits factor Xa

Question 48

ACTION OF ANTICOAGULENTS what is the action of heparin, LMWH and fendaparinux?

Answer 48

it inactivates factor Xa via antithrombin III

Question 49

ACTION OF ANTICOAGULENTS what is the action of dabigatran?

Answer 49

it directly inhibits factor IIa

Question 50

ACTION OF ANTICOAGULENTS what is the action of heparin?

Answer 50

it inactivates factor IIa via antithrombin III