Pharmacology Flashcards
(34 cards)
1
Q
ACE inhibitors
Used for, MOA, SE
A
- Dilation of vessels and reduced aldosterone secretion for hypertension, HF and post MI
- Inhibits ACE and stops conversion of angiotensin I to II
- SE include a dry cough and urticaria, hyperkalaemia (red skin rash), alcohol compounds hypotensive effects
- ACE found in endothelial cells of lungs
*Good prognostic affect for chronic heart failure - Reversed by NSAIDS
E.g. Ramapril, lisinopril
2
Q
Satins
Used for, MOA, SE
A
- Used to lower LDL cholesterol levels (angina and high BP)
- Inhibits HMG coA reductase enzyme in liver cells, cells can’t make cholesterol, making more LDL receptors and so more LDL pulled from blood circulation
- SE include: pain in muscles (rhabdomyolysis/myalgia), GI disturbance,
E.g. simvastatin, atorvastatin
- Give ezetimibe if can’t tolerate statin
3
Q
Anti platelet drugs
Used for, examples
A
- Secondary prevention, angina, peripheral vascular disease
- Aspirin, clopidogrel, prasugrel, ticagrelor, cangrelor, dipyridamole
4
Q
Aspirin
Used for, MOA, CI SE
A
- Anti platelet drug
- Inhibits cox 1 enzyme, preventing thromboxane A2 availability to activate platelets
- Secondary prevention for those at risk
- SE include: GI irritation, hypersensitivity reactions (rashes and asthma), Reyes syndrome in children (vomiting, brain damage), increased bleeding time
5
Q
Clopidogrel, prasugrel, ticagrelor, cangrelor + ticlopidine(order of potency)
Used for, MOA, CI, SE
A
- Inhibitor of ADP reducing platelet activation
- Mediating GPII/IIIa, reducing aggregation by blocking GPII/IIIa receptor on platelets plasma membrane, inhibiting fibrinogen binding
- Secondary prevention, when the patient is intolerant of aspirin, stop before operation
- SE include: GI irritation and bleeding, dyspepsia (indigestion), hypersensitivity reactions (skin and liver), dyspnoea (adenosine kept in lungs)
6
Q
Dipyridamole
Used for, MOA, CI, SE
A
- Anti platelet drug directly inhibiting thromboxane
- Phosphodiesterase inhibitor, preventing adenosine uptake, leading to dilation and reduced platelet activation
- Prevents thromboembolism in patients with prosthetic valve, given with
aspirin for secondary prevention such as stroke - SE include: GI irritation and bleeding, dizziness, flushing, headache, myalgia, chest pain and hypersensitivity reactions
7
Q
Anticoagulant drugs
Used for, examples
A
Prevents blood liquid turning to gel (clotting)
Warfarin, heparin,
8
Q
Warfarin
Used for, MOA, CI, SE
A
- Anti coagulant drug (allows blood to flow easier) - Preventing DVT, pulmonary embolism, atrial fibrillation
- Inhibits enzyme vitamin K epoxide reductase (reducing vitamin K for clotting factors 1972)
- Avoided during pregnancy as its a teratogen (can cross placenta)
- SE include: Haemorrhage, unexplained fall in Hb, GI upset, skin and tissue necrosis, alopecia, liver toxicity
9
Q
Heparin
Used for, MOA, CI, SE
A
- Anti coagulant drug - Prevention of DVT and pul ovary embolism,
- Activates antithrombin 3, inhibiting thrombin and factor 10 so less fibrin created for net
- SE include: Haemorrhage, rarely osteoporosis, hypersensitivity reactions, thrombocytopenia, reduced aldosterone secretion,/ hypokalaemia
- Large so can’t be absorbed across the placenta or into GI tract - Cant be given orally
10
Q
Nitrates
Used for, examples
A
Anti anginal medication
GTN spray, patches, isosorbide mono and dinitrate
11
Q
Nitrates
Used for, MOA, SE
A
- Angina medication
- Bind to receptor on smooth muscle, stimulating guanalate cyclase, increasing cGMP, decreasing calcium levels, casing vasodilation
- Headache, flushing, hypotension with syncope, tachycardia (all vasodilators), methaemoglobinaemia (rare)
12
Q
Isosorbide dinitrate, mononitrate and nitrate patches
A
- Isosorbide nitrates (long acting) - Good gut absorption but mono nitrate has better bioavailability
- Patches (less favourable) - Absorption depends on skin contact (sweating)
- Care when defibrillator is used as nitrates are highly explosive
- GTN spray (acute angina) - Under the tongue, bypassing the systemic system (buccal absorption giving a rapid effect)
13
Q
CCB’s
Used for, examples
A
- Calcium channel blockers prevent vasoconstriction and cause vasodilation by blocking L type calcium channels - Slow down heart (verapamil and diltiazem)
- Dihydropyridines - amlodipine, felodipine, lercanidipine, nifedipine… diltiazem, verapamil
14
Q
CCB’s Dihydropyridines
Used for, MOA, CoI, SE
A
- Non rate limiting CCB (used for hypertension and angina)
- Binds to and blocks depolarised L type ca channel, less ca for calmodulin, reaction - relaxing smooth muscle
- Aortic stenosis, LVOT (hypertrophic cardio myopathy), severe MI depression
- SE include: Headache, flushing, low BP, peripheral oedema
- Often causes tachycardia so give a beta blocker as well
E.g. Amlodipine, felodipine, lercanidipine, nifedipine
15
Q
Diltiazem and verapamil
Used for, MOA, CoI, SE
A
- Rate limiting CCB (used for angina, hypertension and dysrhythmias)
- Bind to and block hyper polarised L type ca channels, less ca, less ca-troponin, relaxing smooth muscle and cardiac muscle
- Diarrhoea, exacerbation of HF and heart block/stopping conduction between the atria and the ventricles (sick sinus syndrome), steal effect/worsening angina (verapamil)
16
Q
Nicorandil
Used for, MOA, SE
A
- Causes vasodilation used to treat angina
- K channel activator, opening and promoting K channels, smooth muscle hyper polarisation, closing Ca channels and so vasodilation
- May cause skin or mucosa ulceration, flushing
***Don’t give to those with acute pulmonary oedema
17
Q
Ivabradine
Used for, MOA, CI,
A
- Used for angina, heart failure and tachycardia syndromes
- Blocks pace maker of the heart by acting on the ion current in SA node , slowing pulse rate without significantly dropping BP
- Acute MI, bradycardia, long QT syndrome, shock
- Drug interactions with with calcium antagonists
18
Q
Diuretics
Used for, examples
A
Promotes urine excretion and reduces blood pressure
Osmotic, loop, thiazide, potassium sparring
19
Q
Osmotic diuretics
Used for, MOA, ADM, SE
A
- Increases urine secretion and reduces BP
- Draws water into the lumen of the nephron for excretion via urine (acts on the proximal convoluted tubule
- IV for raised intracranial pressure, tumour, bleeding, cerebral oedema
SE include: Hypotension, fluid and electrolyte disturbance
- Mannitol
20
Q
Loop diuretics
Used for, MOA, CI, SE
A
- Ankle oedema and congestive HF - reducing reabsorption of K, Na and Cl
- Inhibits Na/K 2Cl co-transporter in ascending loop of Henle preventing reabsorption, Increased prostaglandin, vasodilation, increasing BF, helping diuresis
- liver ascities, co negative HF, nephrotic syndrome, hypocalcaemia, hypomagnesia
SE include: Reduced Na, K, Ca, Mg and dehydration (best for offloading fluid), increased risk of gout
- Furosemide, bumetanide, torsemide
21
Q
Thiazide and thiazide like diuretics
Used for, MOA, CI, SE
A
- Hypertension and heart failure
- Inhibits Na and chloride transport in proximal DCT, causing reabsorption of Ca
- 2nd or 3rd line hypertension, first line if significant oedema or HF
- Fluid and electrolyte disturbance ( Reduced K, Na and increased calcium),
gout caused by uric acid, - T - Bendroflumethiazide, hydrochlorothiazide
*TL - Chlortalidone, indapamide, metolazone (can cause sexual dysfunction
- Acts in DCT
22
Q
Potassium sparring diuretics - Na channel blockers
Used for, MOA, CI, SE
A
- Hypertension
- Inhibits Na channels in epithelial cells in DCT, leading to increased Na excretion, increasing K and H levels
- Preventing SE of thiazide or loop diuretics that cause reduced K
- Increased K/reduced excretion, metabolic acidosis, gynaecomastia (tender breast tissue), impotence, hyperkalaemia
- Amilordie and triamterne
- Least effective
23
Q
Potassium sparring diuretics - Aldosterone antagonist
Used for, MOA, CI, SE
A
- Hypertension
- Aldosterone antagonist, inhibits mineralocorticoid receptor in cortical collecting ducts, increasing sodium excretion, increasing K and H levels
- Prevent SE of thiazide or loop diuretic causing hypokalaemia
- metabolic acidosis, gynaecomastia, acute renal failure, ED, hyperkalaemia
- Spironolactone (prescribed for conns where too much aldosterone is secreted due to hyperplasia of the adrenal cortex) and eplernone
- Acts in DCT
24
Q
Hydralazine
A
- Vasodilator
- Binds to smooth muscle receptors, activating cGMP, leading to smooth muscle dilation
SE: Dry mouth, flushing, headache, drug induced lupus
25
Amidarone
MOA - Blocks potassium channels on the heart directly slowing nerve impulse as well
used for - ventricular arrhythmia and A fib (if nothing else works)
SE: Hypothyroidism and hyperthyroidism, increased QT interval/long QT interval (ventricular depolarisation)
CI - Long QT syndrome (hypokalaemia)
26
Beta blockers
Slows down heart by blocking beta 1 receptors in the heart, preventing the action of adrenaline
- Can causes bronchospasm, asthma, drowsiness, insomnia
** Suppress release of renin from kidneys
27
Adenosine
*Used against supra ventricular tachycardias to bring your heart into normal rhythm
* Agonist of A1 receptor at the AV node
* Flushing sx
28
Digoxin
Inhibits sodium potassium pump an stimulates vagus nerve
- reduces heart rate
29
Calcium gluconate
* Used for hyperkalaemia and ECG changes to stabilise the membrane
30
Enoxparin sodium
Treating DVT and PE during pregnancy and after surgery
31
DC cardio version
Used in tachycardias when there is ischaemic change present E.g. chest pain - synched to the R wave
* Adenosine given if no ischaemia present
32
Acetazolamide
Carbonic anhydrase inhibitor
* Used to treat acute angle glaucoma
33
Dabigatran
Oral anticoagulant
* Direct thrombin inhibitor - prophylaxis for VTE post hip or knee replacement
CI - Kidney problems
34
Fludrocortisone
* Used in orthostatic hypotension to replenish mineralacortoid reduction
