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Flashcards in Drugs Deck (95):
1

What are indications for ACE inhibitors?

Hypertension (<55 first line)

Chronic heart fibrillation

MI secondary prevention

2

What is ramipril?

ACE inhibitor

3

What is lisionpril?

ACE inhibitor

4

What is captopril?

ACE inhibitor

5

How do ACE inhibitors work?

Competitively inhibits the action of angiotensin converting enzyme (which converts angiotension I to II)

So reduces total peripheral resistance

Reduces blood pressure and end diastolic pressure

6

What are indications for angiotensin-II-antagonists?

Hypertension (<55 first line)

Chronic heart fibrillation

MI secondary prevention

Used when ACEI causes persistant cough

7

How do angiotensin-II-antagonists work?

Competitively block the action of angiotensin II at the angiotensin AT1 receptor

Same effect as ACEI

8

What is losartan?

ARB

9

What is valsartan?

ARB

10

What is irbesartan?

ARB

11

What is candesartan?

ARB

12

What are indications for centrally acting hypertensive drugs?

Hypertension (specialist use only)

Hypertension in pregnancy

13

How do centrally acting  hypertensive drugs work?

Methyldopa is an a2 receptor agonist - reducing systemic resistance and therefore blood pressure

Moxonidine is an imadazoline receptor antagonist - also reducing sympathetic discharge

14

What is methyldopa?

Centrally acting hypertensive drug

15

What is moxonidine?

Centrally acting hypertensive drug

16

What are indications for thiazide type diuretics?

Hypertension (first line in Afro-Caribbean people)

17

How do thiazide type diuretics work?

Inhibit sodium reabsorption, causing urinary excretion of sodium and resulting in reduced extra cellular volume and reduced blood pressure

18

What is indapamide?

Thiazide type diuretic

19

What is cloratalidone?

Thiazide type diuretic

20

What are indications for spironlactone?

Resistant hypertension

Heart failure

21

How does spironlactone work?

Competitively inhibits aldosterone receptors - blocking the reabsorption of sodium resulting in reduced extra cellular volume and reduced blood pressure

22

What is aldosterone antagonist potassium sparing diuretic?

Spironlactone

23

What are indications for loop diuretics?

Pulmonary oedema (usually due to chronic heart failure)

Peripheral oedema

24

How do loop diuretics work?

Prevent reabsoprtion of sodium and therefore water, reducing BP

Also causes systemic and pulmonary vasodilation, reducing preload

25

What is bumetanide?

Loop diuretic

26

What is furosemide?

Loop diuretic

27

What is torasemide?

Loop diuretic

28

What are indications for potassium sparing diuretics?

Chronic heart failure

Hypertension

29

How do potassium sparring diuretics work?

Blocks sodium channels in the distal tube, thereby reducing sodium reabsorption and causing a loss of sodium and water

Lowering extracellular volume and BP

Also reduce potassium excretion in order to balance pH

30

What is amiloride?

Potassium sparring diuretic

31

What are indications for aspirin?

Secondary prevention of thrombotic cardiovascular diseases:

 

Stable angina

Unstable angina

NSTEMI

STEMI

Abdominal aortic aneurysm

Aneurysm

Stroke/TIA

Peripheral arterial disease/critical limb ischaemia

32

How does aspirin work?

Inhibits platelet thomboxane production - which usually stimulates platelet aggregation and vasoconstriction

33

What are indications for clopidogrel?

Monotherapy:

peripheral arterial disease
Ischaemic stroke
MI (only if aspirin is contra-indicated)

In combination with aspirin:

TIA
Ishaemic stroke
ACS

34

What does clopidogrel do?

Inhibits ADP receptor activated platelet aggregation

Prodrug which must be activated in the liver

35

What are indications for low molecular weight heparin?

Unstable angina

NSTEMI

STEMI

DVT/PTE

 

36

How does low molecular weight heparin work?

Anticoagulant - prevents clotting of the blood by inhibiting activated factor X

37

What is enoxaparin?

Low molecular weight heparin

38

What is enoxaparin?

Low molecular weight heparin

39

What is trizeparin?

Low molecular weight heparin

40

What is the administeration of low molecular weight heparin?

Subcutaneous administration

41

What are indications for warfarin?

Prophylaxis:

rheumatic heart disease
atrial fibrillation
after prosthetic valve insertion

Prophylaxis and treatment:

TIAs
DVT/PTE

42

How does warfarin work?

Inhibits production of active clotting factors

43

How does digoxin work?

Cardiac glycoside which inhibits the Na/K ATPase pump, allows more calcium to be available for contraction

Increases the force of myocardial contraction and reduces conductivity within the AV node

44

What are indications for digoxin?

Heart failure

Atrial fibrillation/flutter

45

How does adenosine work?

Slows conduction through the AV node by inhibiting calcium channels

Only administered by IV, very short half life

46

What are indications for adenosine?

Immediate termination of supraventricular tachycardia

Diagnosis of SVT/VT

47

How does amioderone work?

Anti-arrhythmatic agent (class III) which increases the length of the repolarisation phase of the cardiac cycle

48

What are indications for amioderone?

Tachyarrhythmias

Cardiac arrest

49

How does disopyramide work?

Class 1A antiarrhythmatic, inhibits sodium channels

Prolongs action potential

50

How does lidocaine work?

Class 1B antiarrhythmic, inhibits sodium channels

Shortens the action potential

51

How does flecainide work?

Class 1C antiarrhythmic, inhibits sodium channels

Do not change the action potential

52

What are the different effects between class 1A, 1B and 1C antiarrhythmics due to?

Binding at different times

53

What are indications for disopyramide?

Tachyarrhythmias

54

What are indications for lidocaine?

Tachyarrhytmias

55

What are indications for flecainide?

Tachyarrhythmias

56

What is bisoprolol?

Beta blocker

57

What is atenolol?

Beta blocker

58

What is propanolol?

Beta blocker

59

How do beta blockers work?

Block beta-adrenoreceptors which blocks the sympathetic nervous system

Reduces HR, BP and CO

Reduces contractility (afterload) and systolic wall tension (force and velocity of contraction)

Increases diastolic perfusion time and exercise threshold

60

What are indications for beta blockers?

Stable angina

Unstable angina

NSTEMI

STEMI

Chronic heart failure

Marfan's syndrome (aortic dilation/dissection)

Hypertension

Tachyarrhythmias

61

How does ivabridine work?

Lowers the heart rate by its action on the sinus node

62

What are indications for ivabridine?

Angina (combination with beta blocker or when beta blocker is contraindicated)

Mild to severe chronic heart failure (patients in sinus rhythm)

63

What is amlodipine?

Calcium channel blocker

64

What is felodipine?

Calcium channel blocker - vasodilator

65

What is verapamil?

Calcium channel blocker - rate limiting

66

What is diliazem?

Calcium channel blocker - rate limiting

67

How do calcium channel blockers work?

Prevent calcium influx into myocytes and smooth muscle lining vessels by blocking L-type calcium channels

Relaxes arteries (vasodilation, reduce afterload)

Reduces total peripheral resistance

Reduces CO (rate limiting agents reduce HR and contraction force)

68

What are indications for calcium channel blockers?

Hypertension (>55 first line)

Stable angina

 

69

What is nicorandil?

Potassium channel blocker

70

How do potassium channel blockers work?

Actovate ATP-sensitive potassium channels leading to vasodilation of coronary vessels

Activates guanylyl cyclase causing vasodilation of systemic and coronary vessels - reducing preload and afterload (reducing cardiac oxygen consumption)

71

What are indications for potassium channel blockers?

Angina

72

What is glyceryl trinitrate (GTN)?

Short acting nitrate

73

What is isosorbide mononitrate?

Long acting nitrate

74

How do nitrates work?

Metabolised in the cell to nitric oxide which activates guanylyl cyclase leading to decrease in intracellular calcium levels, causing

Vasodilation, decreased venous return (reducing cardiac workload)

75

What are indications for nitrates?

Angina

Acute left ventricular failure

76

What is alteplase?

Thrombolytics

77

What is streptokinase?

Thrombolytics

78

How do thrombolytics work?

Acts in the coagulation pathway by hydrolysing the peptide bond in plasminogen, activating the enzyme plasmin which promotes clot lysis

79

What are indications for thombolytics?

ANY CONDITION WHICH REQUIRES URGENT BREAKDOWN OF A CLOT:

MI

Stroke

80

How is GTN administered?

Sublingual spray

Transdermal patches

81

What is simvastatin?

Statin

82

What is atorvastatin?

Statin

83

How do statins work?

Competatively inhibits and enzyme required for cholesterol production in the liver

Reduces total and LDL plasma cholesterol

84

What are indications for statins?

Hyperlipoproteinaemia

Primary prevention of coronary events

Secondary prevention of cardiovascular events

85

What is a class 1A antiarrhythmatic drug, and what does it do?

Disopyramide

Moderate Na-channel blockage, prolong action potential

86

What is a class 1B antiarrhythmic drug, and what does it do?

Lidocaine

Weak sodium channel blockade, shortens the action potential

87

What is a class 1C antiarrhythmic drug, and what does it do?

Flecainide

Strong sodium channel blockage, does not change the action potential

88

What do class 1A, 1B and 1C antiarrhythmic drugs do?

Reduce amplitude of action potential and conduction velocity

89

What are class II antiarrhthmic drugs?

Beta blockers

90

What are class III antiarrhythmic drugs?

Potassium channel blockers

91

What are class IV antiarrhythmic drugs?

Calcium channel blockers

92

What are class V antiarrhytmic drugs?

Others, such as digoxin

93

What are class II antiarrhythmics used for?

Atrial fibrillation

94

What are class III antiarrhythmics used for?

Sustained ventricular tachycardia

Disrhythmias that are hard to treat

95

What are class IV antiarrhythmias used for?

Supraventricular tachycardia

Rate control for atrial fibrillation and flutter

Decks in Cardiovascular System Class (41):