Give examples of, used in and side effects of ACEI.
In what situation should you not use ACEI
Examples: Ramipril, lisinopril How it works: Inhibits the enzyme 'angiotensin converting enzyme' and therefore angiotensin I cannot be converted to angiotensin II. Also cause venous dilation decreases preload. Used in: Hypertension and heart failure Side effects: Dry cough, renal dysfunction, angioneurotic oedema,
Give examples of, used in and side effects of ARBs (angiotensin receptor blockers).
Example: Losartan Used in Hypertension, heart failure How it works: Competitively blocks the action of angiotensin II at AT1 receptors. Therefore causes venous dilation (preload decreases) and arteriolar dilation (TPR decreases and so does MABP) Side effects: Renal dysfunction. Only used instead of ACEI due to a patient having a dry cough.
Give examples of, what they are used in and side effects of thiazide diuretics.
Example: Bendrofluazide (bendroflumethazide) How it works: Anti-hypertensive. Promotes Na+ and water excretion by inhibiting water reabsorption in the loop of Henle and distal tubules. Used in: Hypertension Side effects: Impotence Hypokalaemia – tired + arrhythmias
Give examples of, what they are used in and side effects of anticholesterol drugs.
Examples
Statins:Simvastatin
Fibrates: bezafibrate
Used in:
Hypercholesterolanaemia, diabetes, angina, MI, statin
Fibrates used in hypertriglyceridanaemia and low HDL levels
How they work:
Statins:
Block HMG coA reductase (competitive inhibition). Reduction of LDL production in the liver. Surface expression of LDL receptors increases causing increased clearance of LDL in the liver. Also reduces endothelial inflammation, reducing thrombosis.
Fibrates:
Decreased triglyceride levels and slight decrease in LDL and HDL. Due to a decrease in the livers production of the particle that carries them in the blood and by increasing rate of triglyceride removal
Side effects:
rhodomyolysis and myopathy
Give examples of, what they are used in and side effects of antiplatelet drugs.
Examples: Aspirin, clopidogrel Used in Angina, CVA/TIA, MI. Also used in risk of MI or CVA How it works: Prevent new thrombosis. Cyclo-oxygenase inhibitor prevents thromboxane formation. Clopidogrel inhibits P2Y12 an adenosine diphosphate (ADP) chemoreceptor. Side effects: Haemorrhage anywhere
Give examples of, what they are used in and side effects of anticoagulants.
Examples:
Warfarin, heparin, low MW heparin
Used in:
DVT, PE, NSTEMI, AF
How they work:
Heparin binds to antithrombin III, increasing its affinity for serene protease clotting factors (particularly factor Xa and IIa)
Low molecular weight heparin binds to antithrombin increasing its affinity for just factor Xa.
Warfarin blocks factor 2,7,9,10.
Side effects:
Haemorrhage anywhere, warfarin reversed by vitamin K.
Give examples of, what they are used in and side effects of fibrinolytics.
Examples: Streptokinase, tpa (tissue plasminogen activator) Used in: STEMI, PE, CVA How they work: Dissolve formed clots Side effects Haemorrhage, avoid in recent haemorrhage, trauma, bleeding tendencies and peptic ulcer
Give examples of, what they are used in and side effects of alpha-adrenergic blockers
Examples: Doxazosin Used in: Hypertension and prostatic hypertrophy How they work: Block vascular alpha 1 receptors, decrease TPR and MABP. Side effects: Postural hypertension
Give examples of, what they are used in and side effects of digoxin.
Examples:
Digoxin-controls cardiac rhythm by having a blocking effect between the atrium and the ventricles.
Used in:
Blocking AV conduction and produces delay (good in atrial fibrillation).
How they work:
Blocks atrio-ventricular conduction by prolonging AV nodal delay.
Side effects:
Bradycardia and heart block. Irritable to ventricles and can cause ventricular arrhythmias.
Can cause nausea, yellow vision and heart block (therefore plasma digoxin levels are measured closely)
Give examples of, what they are used in and side effects of nitrates.
Examples: Isosorbide nitrates GTN spray Used in: acute heart failure and angina. How they work: GTN- NO donor which relaxes all smooth muscle via their metabolism to nitrous oxide. In small doses increases venous relaxation. In larger doses decreases TPR and MABP. Isosorbibe mononitrates- increase coronary blood flow. Side effects Headache, hypotension, tolerance
Give examples of, what they are used in and side effects of non-selective muscarinic receptors.
Examples:
Atropine
Used in:
Increases heart rate to reverse bradycardia.
How they work
Competitive antagonist – Increases HR in normal subjects at all but low doses – no effect. No effect on the response to exercise. Always use >600mg.
First line in management of severe bradycardia
Give examples of, what they are used in and side effects of
potassium sparing diuretic.
Examples: Spiralactone Used in: Fluid retention Heart failure Hypokalaemia Side effects: Nausea, sickness, Postural hypotension ,Tiredness, fainting, Gynecomastia – male breasts
Give examples of, what they are used in and side effects of loop diuretic.
Examples: Furosemide Used in: Heart failure Side effects: Hyperglycaemia- diabetes, increase uric acid (gout), impotence.
Give examples of, what they are used in and side effects of potassium channel openers.
Examples: Nicorandil, Ivabridine Used in: Nicorandil: Stable Angina Effective in cases where nitrates are not working Ivabrudine: Chronic Heart Failure, Angina Pectoralis How they work: Nicorandil: ↓ The Ca2+ sensitivity of smooth muscle, Activates sarcolemma Ca2+ pump and promotes K+ efflux, causing hyperpolarisation → relaxation of the smooth muscle and coronary vasodilation Ivabrudine: Prolongs diastolic time by selectively and specifically inhibiting the If current - ↓ HR, ↑ SV, preserving BP Side effects: Hypovolaemia – low systolic BP Palpitations, Weakness Mouth ulcers Gastric fistula
Give examples of, what they are used in and side effects of sodium channel openers.
Examples: Lignocaine Used in: Class 1 anti arrhythmic Other anti arrhythmic drugs CLASS 2 BBLOCKERS CLASS 3 AMIODARONE, SOTALOL, DRONEDARONE CLASS 4 VERAPAMIL
Name the two types of calcium channel blockers. Give examples of each.
Dihydropryridines (amlodipine) and rate limiting calcium antagonists (diltiazem, verapamil)
How do dihydropyridines work?
Mostly systemic action. Block calcium entry into the cells causing decreased contraction. Causes arterial dilation (due to the relaxed muscle), which decreases the total peripheral resistance and the MABP.
How do rate limiting calcium channel blockers work?
More cardioselective than dihydropyridines. Stop the entry of calcium into the heart (this includes muscle cells and nodal cells). Therefore affects phase 0 of the nodal action potential and phase 2 of a myocyte action potential. This means that there is decreased contraction of the heart- reduction in myocardial oxygen demand and reverses coronary vasospasm.
Side effects of calcium channel blockers.
Prolonged use of rate limiting calcium channel blockers causes an intracellular increase in calcium which means you are more likely to develop a-fib Ankle oedema Hypotension Dizziness (DO NOT USE WITH BB)
What would you use calcium channel blockers in?
Angina, hypertension, arrhythmias
Name the two types of beta blockers and give examples of each of them.
Cardioselective e.g. atenolol
Non-cardioselective e.g. propanolol
How do cardioselective beta blockers work?
Block B1 adrenergic receptors. This means that the heart rate is decreased and so is the BP. Also they dilate coronary blood vessels which reduces oxygen demand of the heart. Also increase contractility.
How do non-cardioselective beta blockers work?
They block both B1 and B2 adrenergic receptors. This causes increased heart rate but also can cause bronchoconstriction.
Side effects of beta blockers?
Worsening heart failure
Tiredness
Cold peripheries
DO NOT USE IN PATIENTS WITH ASTHMA OR COPD
What are non-cardioselective beta blockers used in?
Thyrotoxicosis
What are cardioselective beta blockers used in?
Angina, heart failure, hypertension, arrhythmias.