Cardiovascular System Flashcards by Gursh Hayer

Class Ia
Sodium Channel Blockers

(Anti-arrhythmic Drugs)

Disopyramide, Quinidine

MoA:
Voltage-sensitive sodium channel blockade
Prolong QT interval, increase QRS duration.

Indication:
Ventricular and supraventricular arrhythmias

Adverse Effects/Interaction:
Oedema

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Class Ib
Sodium Channel Blockers

(Anti-arrhythmic Drugs)

Lidocaine

MoA:
Voltage-sensitive sodium channel blockade
Prolong QT interval, increase QRS duration.

Indication:
CPR (used IV)

Adverse Effects/Interaction:
Oedema

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Class Ic
Sodium Channel Blockers

(Anti-arrhythmic Drugs)

Flecainide, Propafenone

MoA:
Voltage-sensitive sodium channel blockade
Prolong QT interval, increase QRS duration.

Indication:
Paroxysmal atrial fibrillation and ventricular ectopic beats “pill in pocket”

Adverse Effects/Interaction:
Oedema

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Class II
Beta blockers
(Beta-adrenergic antagonists)

(Anti-arrhythmic Drugs)

Bisoprolol, Atenolol (Beta-1 selective); Propranolol (Beta-1 & Beta-2 selective)

MoA:
Beta-adrenergic receptor blockade – reduction in adrenergic effects on rate and inotropy

Indication:
Prophylaxis of paroxysmal atrial tachycardia or fibrillation

Adverse Effects/Interaction:
Hypotension

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Class III
Potassium Channel Blockers

(Anti-arrhythmic Drugs)

Amiodarone, Dronedarone, Sotalol (Sotalol also has some beta blocker activity)

MoA:
Potassium channel blockade, also evidence of beta blocker and calcium channel blocker properties – prolong QT interval

Indication:
Supraventricular, nodal and ventricular tachyarrhythmias, atrial fibrillation
(CPR - used IV)

Adverse Effects/Interaction:
Nausea, vomiting

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Class IV
Calcium Channel Blockers (phenylalkylamine & benzothiazepine subclasses

(Anti-arrhythmic Drugs)

Verapamil, Diltiazem (for arrhythmia)

MoA:
Cardiac calcium channel blockade – reduction of action potential & cardiac output

Indication:
Supraventricular tachycardia (especially paroxysmal SVT)

Adverse Effects/Interaction:
Hypotension (verapamil)
Constipation (diltiazem)

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Cardiac Glycosides

Anti-arrhythmic Drugs

Digoxin

MoA:
Reduces conductivity of atrioventricular node

Indication:
Arrhythmias – atrial fibrillation, congestive heart failure

Adverse Effects/Interaction:
Fatigue, nausea

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Adenosine

Anti-arrhythmic Drugs

Adenosine

MoA:
Activates adenosine receptors – causes hyperpolarization
Slows conduction through AV Node

Indication:
Supraventricular tachycardia

Adverse Effects/Interaction:
Nausea
*contraindicated in obstructive airway disease

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Antimuscarinic

Anti-arrhythmic Drugs

Atropine

MoA:
Blockade of vagal muscarinic acetylcholine receptors

Indication:
Emergency bradycardia

Adverse Effects/Interaction:
Urinary retention

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Magnesium

Anti-arrhythmic Drugs

Magnesium sulfate (intravenous)

MoA:
Unclear – possible alteration of Na+, K+ and Ca2+ ion balance via ion channels and transporters

Indication:
Emergency arrhythmia
(Also used IV for emergency asthma)

Adverse Effects/Interaction:
Electrolyte irregularities

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Loop Diuretics

Diuretics

Furosemide

MoA:
Inhibits Na+/K+/2Cl- transporter in loop of Henle

Indication:
Left ventricular heart failure, oedema

Adverse Effects/Interaction:
Nausea, dizziness
NSAIDs, ACE inhibitors

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Thiazides

Diuretics

Indapamide
Bendroflumethiazide
Chlorthalidone
Hydrochlorothiazide

MoA:
Decreases sodium and chloride reabsorption

Indication:
Hypertension

Adverse Effects/Interaction:
Electrolyte imbalance, exacerbation or precipitation of gout
NSAIDs, digoxin

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Potassium Sparing Diuretics

Diuretics

Spironolactone, Epleronone
Amiloride

MoA:

Mineralocorticoid receptor blockade (spironolactone, epleronone)
Blockade of sodium reabsorption via ENaC channel (amiloride)

Indication:
Oedema, congestive heart failure

Adverse Effects/Interaction:
Gastrointestinal
NSAIDs, ACE inhibitors

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Osmotic Diuretics

Diuretics

Mannitol

MoA:
Elevates plasma osmolarity

Indication:
Cerebral oedema, intra-ocular pressure

Adverse Effects/Interaction:
Hypotension

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Carbonic Anhydrase Inhibitors

Diuretics

Acetazolamide

MoA:
Reduces aqueous humour volume

Indication:
Intra-ocular pressure – open & acute closed angle glaucoma

Adverse Effects/Interaction:
Paraesthesia

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Carbonic Anhydrase Inhibitors

Diuretics

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Acetazolamide

MoA:
Reduces aqueous humour volume

Indication:
Intra-ocular pressure – open & acute closed angle glaucoma

Adverse Effects/Interaction:
Paraesthesia

Angiotensin-converting enzyme (ACE) inhibitors

Drugs acting on heart and circulation

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Ramipril
Captopril
Lisinopril

MoA:
Inhibits conversion of angiotensin I to II. Blocks vasoconstriction

Indication:
Hypertension, diabetic nephropathy, heart failure

Adverse Effects/Interaction:
Cough, hyperkalemia
Lithium, NSAIDs

Angiotensin II receptor blockers (ARBs)

Drugs acting on heart and circulation

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Losartan, Valsartan

MoA:
Blocks angiotensin-renin system

Indication:
Hypertension, diabetic nephropathy, heart failure

Adverse Effects/Interaction:
Hypotension, fatigue
Diuretics

Neprilysin inhibitors (used in combination with an ARB)

Drugs acting on heart and circulation

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Sacubitril (in combination with the ARB Valsartan)

MoA:
Inhibition of natriuretic peptide breakdown

Indication:
Heart failure (with reduced ejection fraction)

Adverse Effects/Interaction:
Hypokalaemia, hypoglycaemia (from BNF)

Beta adrenergic receptor antagonists (beta blockers)

Drugs acting on heart and circulation

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Bisoprolol, Atenolol (Beta-1 selective); Propranolol (Beta-1 & Beta-2 selective)

MoA:
Negative inotropic/
chronotropic agent

Indication:
Hypertension, stable angina

Adverse Effects/Interaction:
Bradycardia, bronchospasm
NSAIDs, digoxin

Alpha adrenergic receptor antagonists (Alpha blockers)

Drugs acting on heart and circulation

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Doxazosin

MoA:
Vasodilator, decreases total peripheral resistance

Indication:
Hypertension, (see also BPH)

Adverse Effects/Interaction:
Dizziness, headache
Hypotensive drugs

Calcium channel antagonists
(Calcium channel blockers)

(Drugs acting on heart and circulation)

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Amlodipine
Nifedipine
Diltiazem

MoA:
Blockade of vascular smooth muscle contraction

Indication:
Hypertension, stable angina

Adverse Effects/Interaction:
Ankle swelling, oedema
Beta blockers, digoxin

Nitrates

Drugs acting on heart and circulation

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Glyceryl trinitrate (GTN),
Isosorbide mononitrate (ISMN)

MoA:
Nitric oxide release, leading to smooth muscle relaxation & vasodilation

Indication:
Acute angina pectoris (GTN), heart failure

Adverse Effects/Interaction:
Hypotension, headache
Antihypertensives

Sympathomimetics

Drugs acting on heart and circulation

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Adrenaline
Dobutamine
Noradrenaline

MoA:
Adrenergic stimulation, increased inotropy

Indication:
Cardiac arrest, cardiogenic shock

Adverse Effects/Interaction:
Arrhythmia

Antiplatelet drugs | Drugs acting on heart and circulation

Aspirin, Clopidogrel MoA: Inhibition of thromboxane synthesis (aspirin). Inhibition of platelet activation by ADP (clopidogrel). Indication: Primary and secondary relief for CVD, anticoagulant prophylaxis Adverse Effects/Interaction: Gastrointestinal irritation & bleeding Anticoagulants

Anticoagulants - coumarin | Drugs acting on heart and circulation

Warfarin MoA: Inhibition of Vitamin K epoxide reductase complex 1 (VKORC1) enzyme Indication: Deep vein thrombosis, prophylaxis of stroke from atrial fibrillation Adverse Effects/Interaction: Abnormal bleeding, Multiple drug interactions, notably NSAIDs, diuretics

Anticoagulants - coumarin | Drugs acting on heart and circulation

Anticoagulants – direct thrombin inhibitor | Drugs acting on heart and circulation

Dabigatran MoA: Inhibition of thrombin (also called Factor IIa) Indication: Prophylaxis of venous thromboembolism post-surgery Adverse Effects/Interaction: Abnormal bleeding

Anticoagulants – direct Factor Xa inhibitors | Drugs acting on heart and circulation

Apixaban, Edoxaban, Rivaroxaban MoA: Inhibition of Factor Xa in coagulation cascade Indication: Prophylaxis of stroke from atrial fibrillation; DVT Adverse Effects/Interaction: Abnormal bleeding

Anticoagulants - heparins | Drugs acting on heart and circulation

Dalteparin, Tinzaparin, Enoxaparin (low molecular weight); unfractionated heparins MoA: Inactivation of thrombin and Factor Xa via complexing antithrombin III Indication: Prophylaxis of venous thrombosis and pulmonary embolism Adverse Effects/Interaction: Abnormal bleeding

Thrombolytics/Fibrinolytics | Drugs acting on heart and circulation

Alteplase, Streptokinase, Urokinase MoA: Activation of plasminogen for proteolytic breakdown of thrombus fibrin Indication: Myocardial infarction, ischaemic stroke Adverse Effects/Interaction: ---

HMG-CoA Reductase inhibitors | Drugs acting on heart and circulation

Simvastatin, Atorvastatin (statins) MoA: Inhibition of mavelonate pathway required for cholesterol synthesis Indication: Hypercholesterolaemia, risk of CVD and stroke Adverse Effects/Interaction: Myalgia Verapamil, macrolides

Cardiovascular System Flashcards

(32 cards)