Flashcards in CVS drugs - Anti-hypertensives and anti-clotting Deck (47)
What are three indications for ACE inhibitors?
Give three contraindications for ACE inhibitors
Give four ADRs of ACE inhibitors
Dry cough due to bradykinin
What is the mechanism of action of an ACE inhibitor?
Inhibition of angiotensin converting enzyme
Reduced bradykinin breakdown
How do ACE inhibitors lower BP? (3)
- Decreased sympathetic drive
- Peripheral vasodilation
- Decreased aldosterone
Give a DDI of ACE inhibitors
Beta blockers - both lower blood blood pressure
Aspirin, at a push?
What is the indication for angiotensin receptor blockers?
Give three situations in which it would be unwise to give an angiotensin blocker
- Renovascular disease
- Aortic stenosis
Give two ADR of angiotensin receptor blockers
What is the mechanism of action of angiotensin receptor blockers
Antagonism of angiotensin 2 receptor => AT1R
What are four indications for B blockers?
Hypertension, especially in younger patient
Give five contra-indications for B blockers
Asthma (non-selective only)
Congestive heart failure
Give 7 ADRs of beta blocekrs
Hypotension and bradycardia
Death in diabetic hypoglycaemia
Give two DDIs of B blockers
Prevents salbutamol actions
Verapamil -> both –ve inotropes
What is the mech of action of B blockers
Antagonise β1 receptors => negative ionotropic and chronotropic effect
What is the indication for direct renin inhibitor
Give four ADRs for direct renin inhibitors
What is the mechanism of action of direct renin inhibitors
Antagonises Renin, preventing the conversion of Angiotensinogen Angiotensin I.
Reduces plasma renin activity by 50-80%
40h t ½
Elimination in faeces
Give the general 3 indications for calcium channel blockers
Hypertension (2nd line and in over 55/black)
Give three contraindications for calcium channel blocker
AV node block
What is the mechanism of action of calcium channel blockers?
Block specific alpha subunit of L-type calcium
reduce calcium entry
Vasodilation of arteries
Give four ADRs to calcium channel blockers
Hypotension, bradycardia, heart failure, heart block
What is an indication for a thiazide diuretic?
Oedema secondary to congestive cardiac failure, liver disease or nephrotic syndrome
What is the mechanism of action of thiazide diuretics?
Thiazide diuretics inhibit the Na+/Cl- co-transporter in the luminal membrane in the distal tubule of the kidney. This blocks the reabsorption of Na+ and therefore water. Result is lower blood volume and pressure
Give some adverse drug reactions of thiazide diuretics
Hypokalaemia, hyperuricaemia, impaired glucose tolerance, Hyponatraemia, hypermagnesemia, Hypercalcaemia, metabolic alkalosis
What do calcium channel blockers dilate?
Peripheral, coronary and pulmonary arteries
What are some ADRs of nifedipine?
Sympathetic nervous system activation – tachycardia and palpitations
Flushing, sweating, throbbing headache
Aside from vasodilating effects, what do verapamil do?
depresses SA node and slows A-V conduction by impeding calcium transport across myocardial and vascular smooht muscle cell membrane
What are three ADRs for verapamil?
Risk of bradycardia
Reduced myocardial contractility (-‘ve inotrope) so can worsen heart failure
What are four indications for streptokinase?
ife-threating venous thrombus
What are 6 contraindications for streptokinase
ife-threating venous thrombus
What is mech of action of streptokinase?
Converts plasminogen to plasmin, which breaks down fibrinogen
What are three ADRs of streptokinase
Give two indication for tPa
What are three ADRs for tPAs?
What are three ADRs for warfarin?
What DDIs does warfarin have?
CYP450 inducers and inhibitors
What is the mech of action of warfarin?
Inhibits vit k epoxide reductase, reducing vit K and thus vit K dependent clotting factors 2,7,9 and 10 from being formed
Give four ADRs of heparin
Bleeding, bruising, thrombocytopenia, osteoporosis
What is the mechanism of heparin?
Binds to ant-thrombin 3 and inactivates factor 10 and (thrombin: unfractionated only)
What are 3 ADRs for aspirin
Reye's syndrome, GI haemorrhage
Why should aspirin not be used with warfarin?
Displaces it, increasing warf conc
How does aspirin work as an anti-platelet
COX inhibitor and ↓ thromboxane A2 production
150g post MI decreases mortality
What is clopidogrel used for?
Secondary prevention of CVS and CVA
Give to ADRs for clopidogrel
What is the advantage of clopidogrel over aspirin
Works with warfarin