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m1 > cvs - drugs for HF, IHD, HTN > Flashcards

cvs - drugs for HF, IHD, HTN Flashcards

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1
Q

name 5 1st line anti-hypertensives

A
  • ACE-inhibitors
  • Ang II type 1 (AT1) blockers
  • Beta-blockers
  • Ca2+ channel blockers
  • Diuretics - loop, thiazide
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2
Q

name 3 2nd line anti-hypertensives

A
  • Hydralazine
  • Potassium-sparing diuretics
  • Alpha-adrenergic antagonists
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3
Q

name 9 classes of drugs used in HF

A
  • ACE-I
  • Angiotensin II type 1 (AT1) blockers
  • Beta-blockers
  • Sacubitril-Valsartan
  • Diuretics - thiazides, potassium-sparing
  • Hydralazine
  • Ivabradine
  • Nitrates
  • Cardiac glycosides
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4
Q

name 4 classes of drugs for IHD

A
  • Nitrates
  • Ca2+ channel blockers
  • Beta-blockers
  • Ivabradine
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5
Q

name 4 beta blockers used in HF

A
  1. carvedilol (non-selective)
  2. bisoprolol (β1)
  3. metoprolol XL (β1)
  4. nebivolol (mixed)
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6
Q

name 6 beta blockers used in HTN and IHD

A
  1. carvedilol (non-selective)
  2. propanolol (non-selective)
  3. bisoprolol (β1)
  4. metoprolol XL (β1)
  5. atenolol (β1)
  6. nebivolol (mixed)
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7
Q

moa of beta blockers

A
  • β1 blockade →↓ conversion of ATP to cAMP →↓PKA →↓Ca2+ channel activation →↓ heart contractility →↓ CO
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8
Q

moa of carvedilol

A
  • blocks α1 receptors → reduce peripheral resistance
  • antioxidative
  • anti-ischaemic
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9
Q

moa of nebivolol

A
  • β1 selective in low dose/fast metab
  • non-selective in high dose/slow metab
  • vasodilatory effects through increase NO release
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10
Q

how do beta blockers lower bp?

A

↓ CO + inhibit renin release → ↓ bp

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11
Q

how do beta blockers work in HF?

A

↓ HR and myocardial contractility → ↓ O2 demand

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12
Q

clinical uses of beta-blockers

A
  1. hypertension
  2. cardiac failure
  3. post-MI
  4. arrhythmia
  5. anxiety disorders
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13
Q

adverse effects of beta-blockers

A
  1. hypotension
  2. bradycardia
  3. reduced exercise capacity
  4. AV nodal block
  5. bronchoconstriction (esp in asthmatics)
  6. vivid dreams, depression
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14
Q

contraindications for beta-blockers

A
  1. asthma
  2. diabetes
  3. severe bradycardia
  4. advanced heart block
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15
Q

name 3 ACE-I

A
  1. lisinopril
  2. captopril
  3. enalapril
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16
Q

clinical uses of ACE-I

A
  1. hypertension
  2. cardiac failure
  3. post-MI
  4. renal insufficiency
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17
Q

adverse effects of ACE-I

A
  1. severe hypotension
  2. acute renal failure
  3. hyperkalemia
  4. angioedema
  5. dry cough (common)
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18
Q

contraindications for ACE-I

A

pregnancy (causes fetal harm)

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19
Q

name 2 ang II type 1 blocker

A
  1. valsartan
  2. losartan
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20
Q

contraindications for ang II type I blocker

A

pregnancy

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21
Q

benefit of AT1 over ACE-I

A

less/no dry cough (as bradykinin pathway not affected)

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22
Q

moa of sacubitril-valsartan

A
  • sacubitril is a neprilysin inhibitor → prolong BNP effects → promote vasodilation, natriuresis, diuresis, antagonise RAAS
  • valsartan is an Ang II receptor blocker (since neprilysin also breaks down Ang II, sacubitril prolongs Ang II effects → HF progression → need valsartan to counter effects)
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23
Q

indication for sacubitril-valsartan

A

HFrEF

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24
Q

adverse effects of sacubitril-valsartan

A
  • hypotension
  • hyperkalemia
  • renal failure
  • cough
  • angioedema
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25
general effect of diuretics
reduce blood vol → decrease CO
26
moa of loop diuretics
- selectively inhibit Na+/K+/2Cl- transporter in loop of Henle - increase Mg2+ and Ca2+ excretion - increase renal blood flow (furosemide)
27
name 3 eg. of loop diuretics
1. furosemide 2. bumetanide 3. ethacrynic acid
28
clinical uses of loop diuretics
- hypertension - acute pulmonary oedema and other oedema - acute hyperkalemia - acute renal failure - anion overdose
29
adverse effects of loop diuretics
- hypokalemic metabolic alkalosis - ototoxicity - hyperuricemia - hypomagnesemia
30
what drugs should be avoided w loop diuretics
- aminoglycosides (ototoxicity) - NSAIDs (inhibit prostaglandin synthesis)
31
name 4 eg. of potassium-sparing diuretics
1. spironolactone 2. eplerenone 3. triamterene 4. amiloride
32
moa of potassium-sparing diuretics
- spironolactone and eplerenone block aldosterone receptor - triamterene and amiloride block Na+ channels ⇒ prevent Na+ and water retention → ↓ bp
33
clinical uses of potassium-sparing diuretics
- hypertension (2nd line) - hyperaldosteronism
34
adverse effects of potassium-sparing diuretics
- hyperkalemia - metabolic acidosis - gynecomastia (spironolactone) - acute renal failure (triamterene, indomethacin) - kidney stones (triamterene)
35
moa of thiazide
- inhibit NaCl reabsorption by blocking Na+/Cl- transporter → diuresis and reduced blood vol - enhance Ca2+ reabsorption in distal convoluted tubule
36
name 2 thiazides
1. hydrochlorothiazide 2. indapamide
37
4 clinical uses of thiazides
- hypertension - congestive HF - nephrolithiasis due to hypercalciuria - nephrogenic diabetes insipidus
38
how thiazides can help in nephrolithiasis
- enhances Ca2+ reabsorption in DCT → reduce urinary Ca2+ conc → prevent stone formation
39
how thiazides can help in diabetes insipidus
- paradoxically reduce urine output by inducing mild diuresis → to compensate, PCT increases Na+ and water reabsorption → reduces amt of fluid reaching collecting duct → treat excessive urination
40
adverse effects of thiazides
- hypokalemic metabolic alkalosis - hyponatraemia - hyperuricemia - hyperglycemia - hyperlipidemia - hypercalcemia
41
contraindication for thiazide
NSAIDs (reduces renal prostaglandin synthesis → interfere w antihypertensive action)
42
name 2 non-DHP calcium channel blockers
1. verapamil 2. diltiazem
43
name 2 DHP calcium channel blockers
1. nifedipine 2. amlodipine
44
diff btwn DHP and non-DHP
- DHP: primarily causes vasodilation - non-DHP: also affect HR and force of contraction
45
moa of calcium channel blockers
inhibit L-type calcium channels → ↓ intracellular calcium → vasodilation
46
clinical uses of non-DHP calcium channel blockers
- arrhythmia - angina
47
clinical uses of DHP calcium channel blockers
- hypertension - angina - ↓ risk of MI/stroke - Raynaud's phenomenon
48
adverse effect of calcium channel blockers
cardiac depression - bradycardia, AV block, HF
49
adverse effects of DHP calcium channel blockers
- hypotension - HF - MI - peripheral oedema
50
adverse effects of non-DHP calcium channel blockers
- constipation
51
contraindications for calcium channel blockers
- congestive HF - HFrEF - severe hypotension - heart block
52
moa of hydralazine
- direct arteriole vasodilator → decreases afterload - inhibit IP3-induced release of Ca2+ from smooth muscle cells sarcoplasmic reticulum - reduces peripheral resistance → compensatory release of epinephrine/NE → increase VR and CO
53
clinical uses of hydralazine
- HFrEF - essential hypertension - acute-onset, severe peripartum/post-partum hypertension
54
adverse effects of hydralazine
- reflex tachycardia - hypotension - hydralazine-induced lupus syndrome
55
contraindications for hydralazine
coronary artery disease
56
moa of isosorbide mononitrate/dinitrate
- vasodilators that release NO → dilation of coronary vessels - at low dose, ↓ preload - at high dose, ↓ preload and afterload → reduce myocardial O2 demand
57
clinical use of isosorbide mononitrate/dinitrate
prophylaxis for angina pectoris
58
adverse effect of isosorbide mononitrate/dinitrate
- dizziness - postural hypotension
59
contraindication for isosorbide mononitrate/dinitrate
concurrent use w phosphodiesterase inhibitors
60
moa of ivabradine
reduces HR by inhibiting I(f) current in SA node
61
unique ft of ivabradine
targets HR wo affecting BP or myocardial contractility
62
2 clinical uses of ivabradine
- stable angina pectoris - chronic HF w systolic dysfunc
63
adverse effects of ivabradine
- luminous phenomena - bradycardia → dizziness, hypotension
64
moa of digoxin
- inhibit Na+/K+ exchanger → intracellular [Na+] increase → less Ca2+ efflux → stronger systolic contraction
65
2 clinical uses of digoxin
- systolic dysfunc - atrial fibrillation
66
adverse effects of digoxin
- severe dysrhythmia (AV block, afib, vfib) - nausea, vomiting - headache, confusion, blurred vision
67
risk of digoxin
narrow therapeutic window and toxicity
68
toxic effects of digoxin
- automaticity - tachycardia - extrasystoles - fibrilation
69
treatment of digoxin toxicity
- discontinue cardiac glycoside therapy - correct K+/Mg2+ deficiency - anti-arrhythmic drugs - digoxin Ab
70
name 2 alpha blockers
- phenoxybenzamine (non-selective) - prazosin (α1)
71
moa of alpha blockers
block α1 → vasodilation → ↓ peripheral vascular resistance → ↓ bp
72
2 clinical uses of alpha blockers
- hypertension (2nd line) - benign prostatic hyperplasia
73
adverse effects of alpha blockers
- reflex tachycardia - postural hypotension - urinary frequency - depression

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