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CVS Drugs Flashcards

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1
Q

Thiazide like diuretics examples

A

Bendromethiazide

Indapamide

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2
Q

Thiazide like diuretics mechanism of action

A

Inhibition of sodium chloride co-transporter in the DCT. This is decreases sodium and water reabsorption.

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3
Q

Thiazide like diuretics indications

A

Hypertension

Heart failure

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4
Q

Thiazide like diuretics ADRs

A

Hypokalaemia

Arrhythmias

Hyperglycaemia

Hypercholesterolaemia

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5
Q

Thiazide like diuretics drug interactions

A

NSAIDs

Loop diuretics

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6
Q

Loop diuretics examples

A

Furosemide

Bumetanide

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7
Q

Loop diuretics mechanism of action

A

Inhibition of sodium potassium 2chloride co-transporter in the loop of henle

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8
Q

Loop diuretics indications

A

Oedema

Hypertension

Heart failure

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9
Q

Loop diuretics ADRs

A

Dizziness

Headache

Electrolyte imbalance

Nausea

Dehydration

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10
Q

Loop diuretics drug interactions

A

Thiazide like diuretics

Diabetic medication

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11
Q

Potassium sparing drugs examples

A

Amiloride

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12
Q

Potassium sparing drugs mechansim of action

A

Blocks ENaC channels at the luminal surface of the renal tubule. This decreases sodium reabsorption without affecting the reabsorption of potassium.

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13
Q

Potassium sparing drugs ADRs

A

Hyperkalaemia

Potential arrhythmias

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14
Q

Potassium sparing drugs indications

A

Heart failure

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15
Q

Potassium sparing drugs drug interactions

A

ACEi

ARBs

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16
Q

Aldosterone receptor antagonist example

A

Spironolactone

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17
Q

Aldosterone receptor antagonist indications

A

Oedema

Heart failure

Hypertension

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18
Q

Aldosterone receptor antagonist mechanism of action

A

competitively inhibits aldosterone dependant Na+ K+ exchange channels in the DCT. This action leads to increased sodium and water excretion, but more potassium retention

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19
Q

Aldosterone receptor antagonist ADRs

A

Hyperkalaemia

Gynaecomastia

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20
Q

Aldosterone receptor antagonist drug interactions

A

Drugs that increase potassium levels

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21
Q

Class 1b drugs indications

A

Ventricular tachycardia

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22
Q

Class 1b ADR

A

CNS effects : dizziness and drowsiness

GI upset

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23
Q

Class 1b drugs examples

A

Lidocaine

Mexiletine

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24
Q

Class 1b agents mechanism of action

A

Decreased depolarisation in ischaemic tissue

Increased sodium threshold

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25
Class 1c drugs examples
Flecainide
26
Class 1c drugs indications
Supraventricular arrhythmia | Wolff-Parkinson-White syndrome
27
Class 1c drugs ADR
Pro-arrhythmia Flecainide flutter CNS and GI effects
28
Class 1c agents mechanism of action
Increases refractory period and the action potential | Decreases automaticity
29
Class 2 drugs examples
Propranolol, bisoprolol and metoprolol
30
Class 2 drugs indications
Re-entrant arrhythmias AFIB Sinus tachycardia
31
Class 2 drugs ADR
Bronchospasm | Hypotension
32
Class 3 drugs examples
Amiodarone
33
Class 3 drugs indications
Wide spectrum - most arrhythmias
34
Class 3 ADR
``` Pulmonary fibrosis Hepatic injury Increase LDL cholesterol Thyroid disease Photosensitivity Optic neuritis ```
35
Class 3 drugs interactions
Digoxin | Warfarin
36
Common thromboembolic diseases
``` DVT PE Consequence of AF TIA MI Ischaemic stroke ```
37
How does Prostacyclin - PGI2 - prevent platelet aggregation ?
Prostacyclin is released from endothelial cells which then binds to platelet receptors. This increases the concentration of cAMP in platelets. This causes decreased calcium. This decreases platelet aggregatory events and stabilises inactive GPIIb/IIIa receptors.
38
What are 3 anti-platelet and fibrinolytic targets ?
The COX-1 enzyme Fibrinogen acting at the GPIIb/IIIa receptors ADP and thromboxane 2 upregulating receptors
39
What class is aspirin ?
Cyclo-oxygenase inhibitor
40
Indications of aspirin ?
AF post stroke Secondary prevention of stroke or TIA MI
41
Aspirin mechanism of action
Aspirin irreversibly inhibits COX-1 mediated production of thromboxane 2 and reduces platelet aggregation
42
Aspirin ADR
GI irritation GI bleeding Haemorrhage
43
Aspirin contra-indications
Reye’s syndrome - children having flu or chicken pox while taking aspirin Hypersensitivity Pregnancy in 3rd trimester
44
Aspirin DDI
Other anti-platelets and anti-coagulants
45
ADP receptor antagonist examples
Clopidogrel Prasugrel Ticagrelor
46
ADP receptor antagonists mechanism of action
Inhibit binding of ADP to P2Y12 receptor which inhibits activation of GPIIb/IIIa receptors.
47
Differences between Clopidogrel and prasugrel to Ticagrelor
Clopidogrel and Prasugrel are irreversible inhibitors of P2Y12 receptors Ticagrelor acts reversibly at a different site and has active metabolites
48
ADP receptor antagonists indications
Ischaemic stroke TIA MI + aspirin Usually used as a second agent in a dual anti platelet therapy
49
ADP receptor antagonist ADR
Bleeding | GI upset - dyspepsia and diarrhoea
50
ADP receptor antagonist cautions
High bleed risk patients | Renal and hepatic impairment
51
ADP receptor antagonist DDI
Clopidogrel requires CYPs for activation so CYP inhibitors such as omeprazole can affect drug efficacy
52
Dipyridamole drug class
Phosphodiesterase inhibitor
53
Dipyridamole mechanism of action
Dipyridamole inhibits cellular re-uptake of adenosine. This increases concentration of adenosine which inhibits platelet aggregation via adenosine receptors. It also prevents cAMP degradation which inhibits expression of GPIIb/IIIa
54
Dipyridamole indications
Secondary prevention of ischaemic stroke and TIA | Stroke
55
Dipyridamole ADR
Vomiting Diarrhoea Dizziness
56
Dipyridamole DDI
Anti-platelets Anti-coagulants Adenosine
57
Abciximab drug class
Glycoprotein IIb/IIIa inhibitor
58
Abciximab mechanism of action
Abciximab prevents the binding of fibrinogen and von Willebrand factor at the GPIIb/IIIa receptors
59
Abciximab ADR
Bleeding
60
Abciximab DDI
Anti-platelets | Anti-coagulants
61
Fibrinolytic agents - clot busters examples
Streptokinase | Alteplase
62
Fibrinolytic agents - clot busters mechanism of action
Promotes conversion of plasminogen into plasmin. This dissolves the fibrin mesh work of the thrombus.
63
Fibrinolytic agents - clot busters indications
Acute ischaemic stroke | STEMI
64
Fibrinolytic agents - clot busters ADR
Bleeding
65
Fibrinolytic agents - clot busters DDI
Anti-platelets | Anti-coagulants
66
What is given for secondary prevention of ACS ( STEMI, NSTEMI and unstable angina ) ?
ACEi Beta blocker Dual anti platelet therapy - aspirin + ADP receptor antagonist Statin
67
Clotting cascade - intrinsic pathway
Factor XII is converted to factor XIIa. Factor XI is converted to factor XIa by factor XIIa. Factor IX is converted to factor IXa by factor XIa. Factor X is then converted into factor Xa by factor IXa. Prothrombin is then converted into Thrombin by factor Xa. Thrombin converts fibrinogen into fibrin.
68
Clotting cascade - extrinsic pathway
Factor VII is converted into factor VIIa by tissue factor. Factor X is then converted into factor Xa by factor VIIa. Prothrombin is then converted into thrombin by factor Xa Thrombin then converts fibrinogen into fibrin.
69
Unfractionated heparin mechanism of action
Binds to antithrombin III causing a conformational change and increasing activity of ATIII. This inhibits factor Xa.
70
Low molecular weight heparin examples
Dalteparin Enoxaprain Fondaparinux
71
Dalteparin and enoxaparin mechanism of action
Enhance activity of ATIII activity and inhibit factor Xa specifically
72
Fondaparinux mechanism of action
It is a synthetic pentasaccharide which selectively inhibits Xa by enhancing ATIII.
73
Heparin indications
``` Prevention of thromboembolism DVT PE Acute coronary syndromes Can be used in pregnancy as it doesn’t cross the placenta ```
74
Heparin ADR
``` Bruising Bleeding Heparin induced thrombocytopenia Hyperkalaemia due to inhibition of aldosterone secretions Can cause osteoporosis in long term use ```
75
Heparin cautions
Clotting disorders | Renal impairment
76
Heparin DDI
Other anti - thrombotic drugs ACEi / ARB Amiloride Spironolactone
77
What is given for heparin reversal ?
Protamine sulphate as it forms an inactive complex with heparin. Heparin dissociates from ATIII and irreversibly binds to protamine sulphate.
78
Warfarin drug class
Vitamin k antagonist
79
Warfarin mechanism of action
Inhibits activation of vitamin k dependent clotting factors - factor II, VII, XI and X. This prevents the clotting cascade and the production of fibrin.
80
Warfarin indications
PE Venous thromboembolism DVT AF
81
Warfarin ADR
Bleeding - epistaxis
82
What is given for warfarin reversal ?
Vitamin K
83
Warfarin DDI
NSAIDs displace warfarin from albumin causing higher INR CYP Inducers - Barbiturates, phenytoin and rifampicin accelerate warfarin metabolism causing lower INR CYP2C9 inhibitors - amiodarone, Clopidogrel and alcohol inhibit hepatic metabolism causing higher INR Cephalosporin reduces vitamin K production by decreasing gut bacteria
84
DOAC examples
Apixaban Edoxaban Rivaroxaban Dabigatran
85
Apixaban mechanism of action
It inhibits both free Xa and that bound to ATIII.
86
Dabigatran mechanism of action
It is a selective direct competitive thrombin inhibitor of both circulating and thrombus bound IIa
87
DOAC ADR
Bleeding
88
DOAC cautions
Dabigatran is contra-indicated in low creatinine clearance | Avoid in pregnancy due to little information known
89
DOAC DDI
Reduced effectiveness by CYP inducers | Increased concentration by macrolides
90
DOAC antidotes
Andexanet | Idarucizumab
91
Tranexamic acid mechanism of action
Inhibits fibrinolysis
92
Tranexamic acid drug class
Anti-fibrinolytic
93
What are the primary hypertensive agents ?
ACEi ARB CCB Diuretics
94
ACEi mechanism of action
ACEi inhibit angiotensin converting enzyme and limit conversion of angiotensin 1 to angiotensin 2. This causes vasodilation, reduction in aldosterone release and reduced ADH release.
95
ACEi examples
Ramipril | Lisinopril
96
ACEi ADR
Hypotension Dry cough Hyperkalaemia Angio-oedema - more common in Afro-Caribbean patients
97
ACEi cautions
Renal artery stenosis AKD Pregnancy Idiopathic angioedema
98
ACEi DDI
Drugs that increase potassium NSAIDs Other anti-hypertensives
99
ARB examples
Losartan | Candesartan
100
ARB mechanism of action
Directly target and block AT1 receptors - more effective at inhibiting angiotensin 2 mediated vasoconstriction than ACEi.
101
ARB cautions
Renal artery stenosis AKD Pregnancy
102
ARB DDI
Drugs that increase potassium | NSAIDs
103
ARB ADR
Hypotension | Hyperkalaemia
104
ARB indications
Heart failure | Hypertension
105
ACEi indications
Hypertension | Heart failure
106
Dihydropyridine examples
Amlodipine | Nifedipine
107
Dihydropyridine mechanism of action
They are selective for peripheral vasculature and block L type calcium channels preventing calcium entrance into smooth muscle cells. This prevents vasoconstriction.
108
Chronotropic effect meaning
Changes in HR
109
Ionotropic effects meaning
Changes in the contractility of the heart
110
Dihydropyridine ADR
Ankle swelling Flushing Headaches Palpitations
111
Dihydropyridine cautions
Unstable angina | Severe aortic stenosis
112
Amlodipine DDI
Amlodipine increases the effect of simvastatin
113
Dihydropyridine indications
Angina | Hypertension
114
Verapamil drug class
Phenylalkylamine
115
Verapamil mechanism of action
They depress the SA node and slows AV conduction Prolongs action potential and effective refractory period Has negative chronotropic and ionotropic effects
116
Verapamil indications
Arrhythmia Angina Hypertension
117
Verapamil ADR
Constipation Bradycardia Heart block Cardiac failure
118
Verapamil cautions
Poor LV function | AV nodal delay
119
Verapamil DDI
Beta blockers | Other anti-hypertensive and anti-arrhythmia agents
120
Benzothiazapine example
Diltiazem
121
Spironolactone drug class
Aldosterone receptor antagonist
122
Spironolactone indication
Resistant hypertension
123
Spironolactone ADR
Hyperkalaemia | Gynaecomastia
124
Spironolactone cautions
Hyperkalaemia | Addison’s
125
Spironolactone DDI
Drugs that increase potassium | Pregnancy
126
What drugs should be given if potassium is high instead of Spironolactone ?
Alpha or beta blockers
127
What anti-hypertensive should be given in pregnancy ?
Labetolol
128
Beta blockers mechanism of action in hypertension
They decrease the sympathetic tone by blocking noradrenaline and reducing myocardial contraction resulting in decreased CO
129
Beta blocker cautions
Asthma | Hepatic failure
130
Beta blocker DDI
Non-Dihydropyridines can cause asystole with beta blockers | Beta agonists cancel out beta blockers
131
Doxazosin drug class
Alpha blocker
132
Doxazocin mechanism of action
Selectivel antagonism of alpha 1 receptors and reduce peripheral vascular resistance
133
What alpha blocker can be given for BPH ?
Tamsulosin
134
Doxazosin ADR
``` Postural hypertension Dizziness Syncope Headache Fatigue ```
135
Doxazosin cautions
Postural hypertension
136
Doxazosin DDI
Dihydropyridines - increase oedema
137
Glyceryl trinitrate drug class
Nitrate
138
Glyceryl trinitrate indications
Angina Hypertension Heart failure
139
Glyceryl trinitrate cautions
Aortic stenosis Hypovolaemia Hypotension
140
Glyceryl trinitrate ADR
``` Arrhythmia Dizziness Drowsiness Headaches Hypotension ```
141
Glyceryl trinitrate mechanism of action
It is denitrated to produce the active metabolite nitric oxide. This then causes venodilation.
142
Class 4 drug examples
Verapamil | Diltiazem
143
Class 4 drug mechanism of action
Slow conduction through AV | Increase refractory period in AV node
144
Class 4 drug indications
Supraventricular tachycardia
145
Class 4 drug ADR
Constipation | Hypotension
146
Class 4 drug DDI
Beta blockers can cause asystole if used together
147
Adenosine mechanism of action
Adenosine binds to A1 receptors and blocks adenylyl cyclase and reduces cAMP. This causes a potassium influx which results in hyperpolarisation. This decreases HR.
148
Adenosine indications
Re-entrant supraventricular arrhythmias
149
Ivabradine mechanism of action
It blocks the funny current in the SAN
150
Ivabradine ADR
Flashing lights
151
Ivabradine cautions
Avoid in pregnancy due to possible teratogenity
152
Ivabradine indications
Sinus tachycardia | Decreases HR in HF and angina
153
Digoxin indications
AF | Atrial flutter
154
Digoxin mechanism of action
Enhances vagal activity which slows AV conduction and HR
155
Atropine mechanism of action
It selectively blocks Muscarinic receptors and blocks vagal activity to increase AV conduction and increase HR
156
Atropine indications
Vagal bradycardia
157
Statin examples
Atorvastatin | Simvastatin
158
Statins mechanism of action
Competitively inhibit HMG-CoA reductase decreasing production of cholesterol It also contributes to the upregulation of hepatic LDL receptors and increases clearance of circulating LDL
159
Statin ADR
GI disruption Nausea Headaches Myalgia
160
Statin cautions
Renal and hepatic impairment | Pregnancy
161
Statins DDI
Amiodarone, diltiazem and macrolides increase statin concentration as well as Amlodipine
162
Fenofibrate drug class
Fibric acid derivatives ( fibrates )
163
Fenofibrate mechanism of action
Activation of nuclear transcription factor - PPAR alpha. This regulates expression of genes that control lipoprotein metabolism. There is also increased production of lipoprotein lipase. This results in increased triglyceride removal and increased fatty acid uptake by the liver.
164
Fenofibrate ADR
Cholelithiasis GI upset Myositis
165
Fenofibrate cautions
Photosensitivity | Gall bladder disease
166
Fenofibrate DDI
Warfarin - increased anti coagulation
167
Fenofibrate indication
Hyperlipidaemia
168
Ezetimibe drug class
Cholesterol absorption inhibitor
169
Ezetimibe indications
Used as an adjunct to a statin
170
Ezetimibe mechanism of action
It inhibits NPC1L1 transporter at brush border which reduces cholesterol absorption in the gut.
171
Ezetimibe ADR
Abdominal pain GI upset Angioedema
172
Ezetimibe caution
Hepatic failure
173
Ezetimibe DDI
Increased risk of rhabdomyolysis alongside statins
174
Alirocumab drug class
PCSK9 inhibitor
175
Alirocumab indications
Primary hypercholesterolaemia
176
Inclisiran mechanism of action
It is a siRNA which inhibits hepatic translation of PCSK9 blocking its action.

CPT Drugs (9 decks)

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