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CVS Drugs Flashcards

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1
Q

What are some common Beta Blockers?

A

Bisoprolol, Atenolol, and Propranolol

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2
Q

What is the mechanism of action of Beta Blockers?

A

Beta 1 receptors - slows HR and conduction. Also decreases secretion of renin and contractibility.
Beta 2 receptors - can cause vasoconstriction and PVD

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3
Q

What are the side effects of Beta Blockers?

A

Bronchospasm in asthmatics
Can also cause acute heart failure and bradycardia

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4
Q

What conditions are beta blockers used for?

A

First line in AF - bisoprolol
Supresses VEs and some VTs
Used in HFrEF
Reduces symptoms in stable coronary disease
Used in BP management as an add on

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5
Q

What are some common loop diuretics?

A

Furosemide and Bumetanide

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6
Q

What is the mechanism of action of loop diuretics?

A

Act by blocking NaCl reabsorption in the limb of loop of Henle
Causes intense diuretics effect and pronounced veno- and vasodilatory effects

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7
Q

What are some side effects of loop diuretics?

A

Electrolyte disturbance
Dehydration
Renal impairment
Orthostatic hypotension

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8
Q

What are some drug - drug interactions of loop diuretics?

A

Can cause renal toxicity with aminoglycosides, lithium, NSAIDs and vancomycin.
Can cause profound hypotension with antihypertensive

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9
Q

What condition are loop diuretics used for?

A

Used in HFrEF
Used in mitral stenosis
Careful and limited in constrictive pericarditis

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10
Q

What are some common thiazide diuretics?

A

Indapamide and Bendroflumethiazide

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11
Q

What is the mechanism of action thiazide like diuretics?

A

Act by blocking the NaCl reabsorption in distal convoluted tubule in kidney.
Mild diuretic and vasodilatory effect

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12
Q

What are some side effects of thiazide diuretics?

A

Electrolyte disturbance
Hyperuricaemia, hyperglycaemia, Dehydration, Renal impairment and orthostatic hypotension
Also, gout and ED

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13
Q

When is thiazide diuretic used as treatment?

A

Can be added for the treatment of HFrEF
Used as an add on in treatment of hypotension

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14
Q

What are some common calcium channel blockers?

A

DHP - amlodipine and nifedipine
NDHP - verapamil and diltiazem

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15
Q

What is the mechanism of action for DHP calcium channels blockers?

A

Block calcium entry into smooth muscle and cause vasodilation
Less effect on myocardial pace-making tissue

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16
Q

What is the mechanism of action of NDHP calcium channel blockers?

A

Block calcium entry into smooth muscle and in myocardial pace-making tissue
This slows SA and AV node conduction

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17
Q

What is the most common side effects of calcium channels blockers?

A

DHP - postural hypotension, peripheral oedema and tachycardia
NDHP - heart block, bradycardia, postural hypotension and most common is peripheral oedema

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18
Q

What is a drug - drug interaction between NDPH?

A

With BB can cause heart block

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19
Q

When is CCBs used in treatment?

A

Used for paroxysmal SVT and rate control in AF and flutter
Used in angina to reduce symptoms as rate limiting
First line in hypertension if over 55 and of African/ Caribbean origin
Also under 55 as add on

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20
Q

What is the mechanism of action of nitrates?

A

Release NO which potentiates smooth muscle relaxation
GTN spray is sublingual option
Reduces myocardial workload as preload an afterload is reduced

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21
Q

What are some side effects of nitrates?

A

Headaches is main side effect for GTN spray
Also hypotension and severe aortic stenosis

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22
Q

When are nitrates used in treatment?

A

Used in NSTEMI and unstable angina

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23
Q

Describe the mechanism of action of potassium channel activator?

A

Activates ATP sensitive K channels causing potassium influx causing resultant inhibition of Ca influx leading to smooth muscle relaxation

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24
Q

What are some side effects of potassium channel activators?

A

Hypotension and GI ulceration

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25
When are potassium channel activators used in treatment?
Second line treatment for angina to relieve symptoms as vasodilator
26
What is a common potassium
Nicorandil
27
What is a common funny channel inhibitor?
Ivabradine
28
What is the mechanism of action for funny channel inhibitor?
Inhibits the channels located in the SA node so HR is reduced Can only be used when patient is in sinus rhythm Reduced rates of infarction
29
What are some side effects of funny channel inhibitors?
Bradycardia and SA node diseases Do not use in AF
30
When is ivabradine used as treatment?
Second line drug for chronic coronary syndromes Only works when patient is in sinus rhythm Used in HFrEF if symptomatic and receiving standard dose. Used in angina to relieve symptoms
31
What are some commonly used antiplatelets?
Aspirin Clopidogrel/ Ticagrelor/ Prasugrel Fondaparinux
32
What is the mechanism of action of aspirin?
Is a thromboxane- A2 inhibitor so inhibits platelets formation and recruitment
33
What is the mechanism of action of Clopidogrel?
Inhibits ADP activation of P2Y12 receptor
34
What is the mechanism of action of Fondaparinux?
Decreases conversion of prothrombin to thrombin, so fibrinogen is not converted to fibrin so less clot
35
What conditions are antiplatelets used for?
Disease modifying so used in angina NSTEMI and unstable angina
36
What is a common thrombolysis to use?
Alteplase
37
What is the mechanism of action of thrombolysis?
Recombinant tissue plasminogen activator which converts plasminogen to plasmin which can lyse clots Breaks down the fibrinogen and fibrin
38
What are the side effects of thrombolysis?
Bleeding so avoid if recent stroke or previous intracranial bleed
39
When is thrombolysis used?
Used in STEMI Used for strokes along with antiplatelets, statins and BP management
40
What is a commonly used sodium channel blocker?
Flecainide
41
What is the mechanism of action of sodium channel blockers?
Membrane stabilising agents which decrease the amplitude and reduces velocity of conduction Class 1c is most common
42
What are common ACE inhibitors used?
Ramipril, Enalapril and Lisinopril
43
What is the mechanism of action for ACE inhibitors?
Competitively block angiotensin converting enzyme and prevents the conversion of angiotensin I to angiotensin II Reduces preload and afterload
44
What are some side effects of ACE inhibitors?
Dry cough is the most common - then give ARB Angioedema, renal impairment/ failure and orthostatic hypotension
45
What are some drug - drug interactions between ACE inhibitors?
Acute renal impairment with NSAIDs Hyperkalaemia with potassium supplements and potassium sparing diuretics
46
When are ACE inhibitors used as treatment?
Used for HFrEF as patients with CHF it can reduce mortality and morbidity. Used as first line in under 55s who have hypertension or over 55s as add on
47
What is a common potassium channel blocker?
Amiodarone
48
What is the mechanism of action of potassium channel blockers?
Increases action potential duration, prolongs repolarisation and prolongs EPR
49
What are some side effects of potassium channel blockers?
Thyroid problems, pulmonary fibrosis, slate grey pigmentation, corneal deposits, and LFT abnormalities
50
What is a common drug that amiodarone interacts with?
Digoxin
51
When are potassium channel blockers used in treatment?
Used for dysrhythmias that are difficult to treat like VT or fibrillation, AF or flutter Also used in sustained VT
52
What is the mechanism of action for digoxin?
Is a class V drug which is a cardiac glycoside Inhibits the sodium potassium ATPase pump This increases vagal tone so slows SA/AV conduction Positive ionotropic effect
53
What are the possible side effects of digoxin?
Nausea, vomiting, xanthopsia , bradycardia, tachycardia, and arrhythmias - VT and VF Stop digoxin if causes toxicity and start on digibind
54
When is digoxin used as treatment?
Used for atrial dysrhythmias - AF and atrial flutter, and sometimes SVT. Also used in heart failure as second line with BB and CCB Can be used in HFrEF
55
What is the mechanism of action of adeonosine?
Is a class V drug which binds to adenosine receptors in the AV node. Slows/ blocks conduction through the AV node
56
What are some side effects of adenosine?
May cause asystole for a few seconds but other side effects are minimal Should be avoided in patients with asthma as can cause bronchospasms
57
When is adenosine used in treatment?
Used to convert paroxysmal SVT to sinus rhythm
58
What is the mechanism of action of Warfarin?
Oral anti-coagulant Is a vitamin K antagonist It inhibits the production of active clotting factors
59
What are the possible side effects of Warfarin?
Can cause bleeding, can interact with other drugs, and should be avoided where possible in pregnancy
60
What are some drug-drug interactions of Warfarin?
Aspirin, sulphonamides, cimetidine, erythromycin, and oral antibiotics increase warfarin activity. Aspirin and Heparin promote bleeding. Barbiturates, Phenytoin, Vitamin K and cholestyramine decreases warfarin activity.
61
What condition is warfarin used for?
Reduction of stroke in AF
62
What is a common angiotensin receptor blocker?
Candesartan Valsartan
63
What is the mechanism of action of angiotensin receptor blockers?
Selectively blocks angiotensin II at AT1 receptors This reduces BP and reduce afterload on the heart
64
What are some side effects of Angiotensin receptor blockers?
Can lead to renal impairment, hyperkalaemia via the effect on aldosterone levels - no cough and orthostatic hypotension
65
When are angiotensin receptor blockers used for treatment?
Used for patients who are intolerant to ACEi
66
Describe a Valsartan-Sacubitril (ARNI)
Combined valsartan, ARB, and neprilysin inhibitor
67
What is the mechanism of action of ARNI?
ARB blocks the ATI receptor for angiotensin II Nephrilysin inhibitor stops the breakdown of ANP and BNP by neural endopeptidases This increases diuresis so loss of Na and vasodilation
68
What are common Mineralocorticoid Receptor Antagonist (MRA)?
Spironolactone and Eplerenone
69
What is the mechanism of action of the MRA?
Block receptors that bind aldosterone and other steroid hormone receptors Act on the distal tubule Proven to reduce mortality when in combo with ACEi - enhanced diuretic effect and vasodilation
70
What are the side effects of MRA?
Renal impairment, dehydration, hyponatraemia, hyperkalaemia, and gynaecomastia NSAIDs are used with extreme caution as marker hyperkalaemia
71
When is MRAs used for treatment?
Recommended for all symptomatic patients with HFrEF and LEVF <35% to reduce mortality and hospitalisation Sometimes used in hypertension
72
When is anticoagulants used?
Main treatment for DVT and PE. Also used for metallic heart valves Used in AF and strokes
73
What is the mechanism of action of statins?
HMG CoA reductase inhibitor which reduces level of LDL cholesterol in the blood Also stabilises the plaque
74
When are statins used for treatment?
Primary prevention to reduce CV risk and secondary after cardiovascular event Used for disease modification in angina

Cardiovascular (33 decks)

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