Pharmacology Flashcards
(169 cards)
Digoxin
Used for fast AF and in heart failure if diuretics and ACEi not working
Cardiac glycoside, -ve chronotrope and +inotrope (slows HR and increases contractility).
Narrow therapeutic index-usew ith caution!
Dobutamine
Heart block
B1 selective agonist (direct).
Positive inotrope- Stimulates cardiac contraction without major effect on HR
half-life 2mins (rapid metabolism by COMT)
Lacks isoprenaline’s reflex tachycardia.
Atenolol
Angina, post MI, dysrhythmias, CHF, hypertension.
B1 blocker (selective)
Not safe for asthmatic patients.
Diltiazem + verapamil
Correcting/controlling dysrhythmias
CCB - negative inotrope (rate limiting on cardiac and smooth muscle)
Verapamil > Diltiazem
Verapamil- phenylalkaylamine
Diltiazem - benzothiazepine
Caution with carbemazepine - can double its levels (an anticonvulsant/mood stabiliser)
Enalapril + captopril
Hypertension- first line in <55, caucasians,
Also used in HF, post-MI, diabetic nephropathy, progressive renal insufficiency, high CVD risk
ACEi - reduces preload and afterload
Losartan
Angiotensin II receptor blocker (ARB/AIIA)- acts on AT1 R
Hypertension as alternative to ACEIs with less side effects first line if >55 or afrocaribbean. Second line when started on ACEi
CHF in patients who cannot tolerate ACEIs.
Nicorandil
Angina, acute and chronic HF, BP control with anaesthesia
K channel opener and organic nitrate (+ guanylate cyclase = VASODILATION)
SE: hypotension and headache
Bendrofluazide
aka bendroflumethiazide.
HF, HTN, severe resistant oedema, idiopathic hypercalciuria, nephrogenic diabetes insipidus.
SE: inhibits insulin secretion (DM)
Thiazide diuretic. Inhibit Na and Cl reabsorption in early distal tubule. Increases Na/Cl, K and Mg loss, Ca reabsorption.
Moderate increase in urine volume.
Spironolactone
Primary and secondary hyperaldosteronism, fluid retention in CHF, cirrhosis and renal failure
Potassium sparing diuretic/aldosterone receptor antagonist. Acts in the distal convoluted tubule. Small increase in urine volume and Na loss.
Side effects - gynaecomastia, menstrual disorders, hyperkalaemia.
Amiodarone
Wide spectrum anti-arrhythmic used for supraventricular and ventricular tachyarrhythmias. Prolongs cardiac action potentials.
Adverse effects - accumulation in body (long half life) causes photosensitive skin rashes, hypo-/hyper-thyroidism, pulmonary fibrosis, corneal deposits, Neuro and gastro disturbances. Potent inhibitor of Phenytoin (antiepileptic) metabolism.
Glyceryl trinitrate
Angina- often administered sublingually, transdermal patch is longer acting
Organic nitrate that releases NO into smooth muscle causing vasodilation
Short half life ~5minutes
Prolonged use associated with tolerance.
Minoxidil
Anti hypertensive vasodilator that also slows/prevents hair loss.
Potassium channel opener causing hyperpolarisation.
Doxazosin
HTN and used as a coronary vasodilator
SE: postural hypotension
Associated with increased rates of CHF by ALLHAT study
Competitive Alpha-1 adrenoceptor blocker
Sumitriptan
Migraines- CI if coronary artery disease
Constricts large arteries and inhibits trigeminal nerve transmission.
5HT 1D R agonist
Streptokinase
Thrombolytic - converts plasminogen to plasmin (natural fibrin protease).
Bacterial product of streptococci hence tolerance develops after first admin.
Used in the treatment of MI and possible use in CVA
Alteplase
Thrombolytic - converts plasminogen to plasmin (natural fibrin protease). Recombinant plasmin activator. Used in the treatment of acute MI and ischaemic stroke. Must be given within 12 hrs symptom onset.
Warfarin
Anticoagulant - Vitamin K antagonist. Long delay of onset (~5days) narrow therapeutic window, unpredictable pharmacokinetics and numerous drug interactions. Protein binding interactions most clinically significant with warfarin. Phenytoin (antiepileptic) increases clearance.
Heparin
Anticoagulant - activates Antithrombin-III (LMWHs also inhibit factor Xa). Short half life ~1hr, LMWHs longer.
Aspirin
Antiplatelet activator - irreversible non-specific cyclo-oxygenase inhibitor (but binds COX-1 more avidly) - prevents platelet production of thromboxane A2. At higher doses also inhibits endothelial COX preventing production of protective prostacyclin PGI2 (COX-2). Major side effects - gastric irritation + ulceration, bronchospasm in asthmatic (pseudoallergy), prolonged bleeding times, nephrotoxicity. Can displace other drugs from albumin increasing their free conc. Preferentially absorbed in stomach (acid pH) but majority in gut.Analgaesic - inhibiting prostanoid (PG) synthesis prevents sensitisation of nociceptors thus increases threshold for pain.
Clopidogrel
Antiplatelet activator - ADP/P2Y receptor antagonist.
Abciximab
Antiplatelet activator - Glycoprotein IIb/IIIa receptor antagonist. GPIIb/IIIa receptor plays important role in platelet aggregation. Used for treatment of thrombotic disorders.
Simvastatin
HMG-CoA reductase inhibitor. Lipid lowering drug. Used to treat dyslipidemia and to prevent CVD. Grapefruit juice inhibits cytochrome P450 thus inhibits metabolism. Side effects - rhabdomyolysis.
Ibuprofen
Typical non-selective NSAID. Inhibits COX reversibly. Has anti-inflammatory, analgesic and anti-pyretic actions.
Celecoxib
Selective COX-2 inhibitor. Get fewer ulcers than with non-selective NSAIDs. Increased risk to CVS however - MIs