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Systems drugs
Fichas del conjunto (64)
- 1lovastatin/atorvastatinused in angina prevention.inhibits HMG CoA reductase. causes decreased liver cholesterol synthesis and increase VLDL and LDL receptor synthesis = less LDL in blood
- 2fibratesangina prevention. PPAR agonist. causes
-increased beta oxidation by liver,
-decreased hepatic trigyceride secretion,
-increased LPL activity
-increased HDL - 3bile acid binding agents (cholestipol, cholestyramine)angina prevention. bind bile acid in the gut. causes
- decreased enterohepatic recirculation
- increased hepatic production of bile salt
- decreased liver cholesterol (cholesterol is needed for bile salts)
-increased LDL receptor expression= decreased LDL in blood - 4beta blockers angina treatmentfirst line therapy for chronic stable angina.
- 5differences between phenylalkylamines, benzothiazepines, dihydropyridines in treating anginaaim is to reduce myocardial oxygen demand and increase coronary perfusion in angina.
phenylalkylamines (verapamil) are very myocardial selective therefore very little peripheral effect seen
Dihydropyridines have lots of peripheral vasodilator action (not wanted for angina treatment because of sympathetic reflex)(also not used for antiarrythmia treatment)(however, useful for treatment of hypertension)
Benzothiazepines are a bridge between the two (both cardiac depressant and vasodilator action- able to reduce arterial pressure without having too much of a sympathetic reflex) - 6why give low dose aspirin in angina treatmentinactivates cox in platelets but not in endothelial cells. cox have no nucleus and cannot resynthesise TXA2
- 7thiazides give alternative nameshydrochlorothaizide, bendroflumethazide, chlorthalidone, metolazone. mild diuretic effect. direct vasodilator action. Act at the DCT. Blocks the sodium/chloride transporter at collecting duct. Causes increased potassium loss and reduced uric acid. used to treat hypertension
- 82 phases of effect in ACE inhibitors-rapid due to anti ANG 2 effect
-Slower due to blood volume effect and control of thirst - 9Quinidineclass 1a antiarrythmia. causes an increase in APD and ERP. Moderate reduction in phase 0 slope. binds to inactive sodium channel in a use dependent manner. slow unbinding and binding from receptor - shlows phase 4 depolarisation and automaticity suppression.
Uses - ventricular tachyarrythmias, prevention ofparoxysmal reuccrent atrial fib - 10lidocaineclass 1b antiarrythmia. Decrease in APD and ERP. Small reduction in phase 0 upslope. Uses:
-During and immediately after MI
-Ventricular tachycardias - 11flecainideclass 1c antiarrythmia. Large reduction in phase 0 upstroke and no change in ERP and APD. Suppresses automaticity. Uses:
-WPW syndrome
-CPVT
-Recurrent tachyarrythmias arising in abnormal conduction system.
CONTRAINDICATED POST MI BECAUSE CAN DECREASE CONTRACTILITY - 12Atenolol (antiarrythmia)Class II antiarrythmia. Suppress automaticity (mostly through reduction of sympathetic drive). Reduces rate, conduction and exciteability. Uses:
Mainly used in supraventricular tachyarrythmias - 13AmiodaroneClass III antiarrythmia, potassium channel blocker. Delays repolarisation and lengthens AP and ERP. Uses:
-WPW
-Ventricular tachycardias and atrial fibrilation - 14Diltiazem antiarrythmiaclass IV antiarrythmia calcium channel blocker. most effective in nodal tissue. Reduced rate and conduction. Blocks AV node therefore useful for supraventricular tachyarrythmia. Uses:
- Prevent recurrence of paroxysmal supraventricular tachycardia
- reduce ventricular rate in patients with atrial fib - 15warfarrininhibits vit k reductase and stops carboxylation of coagulation factors in the liver. taken orally and rapidly digested by the GI tract. metabolised in the liver T1/2 = 40 hours
- 16heparinanticoagulant. binds antithrombin III. binds both factor IIa and Xa but more potent at factor IIa.
- 17LMW heparinanticoagulant. binds antithrombin III. only binds factor Xa. better because can be given subcutatenously
- 18hirudin, hirugen, bivaldurinAT3 independent anticoagulants. Have fewer bleeding problems than heparin.
- 19ticagrelorreversible P2Y12 receptor antagonist
- 20clopidogrelirreversible p2y12 antagonist. prodrug. given orally. effective in reducing ischaemic strokem MI and vascular death
- 21prasugrelirreversible p2y12 antagonist. faster onset than clopidogrel and greater efficacy
- 22ticlopidineirreversible p2y12 antagonist. slow onset
- 23abciximab/tirfibanIIb/IIa receptor antagonist. used in high risk angioplasty patients with heparin and aspirin
- 24tirofiban/eptifibatideIIb/IIa receptor antagonist. cyclic peptides which resemble IIb/IIa ligands. IV admin
- 25epoprostenolIIb/IIa receptor antagonist. drug version of prostacyclin
- 26dipyridamoleIIb/IIa receptor antagonist. cAMP phosphodiesterase inhibitor. increseases camp levels in platelets
- 27streptokinasefibrinolytic. promotes conversion of plasminogen.
- 28alteplase/duteplasefibrinolytic. promotes conversion of plasminogen. short half life so can give IV infusion
- 29reteplasefibrinolytic. promotes conversion of plasminogen. longer half live so given as IV bolus
- 30tranexamic acidantifibrinolytic. Oral or IV admin. used when risk of eg dental extraction
- 31aprotininanti fibrinolytic. proteolytic enzyme inhibitor of plasmin/kallikrein. used after open heart surgery
- 32compactinhmg coa reducatase inhibitor. lowers cholesterol
- 33mevinolinhmg coa reducatase inhibitor. lowers cholesterol
- 34digoxinheart failure treatment. fast onset and short half life, hypdrophilic - low affinity for serum proteins. inhibitor of the sodium potassium ATPase. causes an increase in CICR. Increased force and exciteability, decreased AV conduction and rate. can also be used as an antiarrythmia to convert atrial flutter to atrial fib
- 35dobutaminebeta 1 agonist. MUST BE GIVEN IV. used for reversible HF
- 36Milrinone amrinonesympathomimetic used to treat heart failure. phosphodiesterase inhibitor causes increase in cAMP and increased pka activity.
- 37spironolactonepotassium sparing diuretic. weak diuretics. used to treat HF.acts at CT. antagonises aldosterone
- 38furesomideloop diuretic used to treat HF. strong. acts at thick ascending loop of henle.
- 39amiloridepotassium sparing diuretic. used to treat heart failure. weak action.
- 40triamterenepotassium sparing diuretic used to treat heart failure. blocks a sodium channel
- 41denosumabtreatment of osteoporosis. RANKL antibody that inhibits that maturation of osteoclasts
- 42dronatesbisphosphonates that inhibit resorption of bone. treatment of osteoporosis
- 43sulphasalazinecheap and commonly first choice of DMARD used to treat RA. sulphapyridine mixed with salicylate. hydrolysed by gut to form sulphapyridine and 5 aminosalicylate. -reduces absorption of antigens from the colon that may promote joint inflammation.
-reduces the synthesis of inflammatory mediators - 44goldused as a dmard to treat RA
- 45methotrexateDMARD used in the treatment of RA. accumulation of adenosine. inhibits activation of t cells. supression of adhesion molecule on surface
- 46glucocorticoidsintraarticular injections used to treat RA. inhibit transcription of pro inflammatory cytokines. supresses phospholipase a2 and hence inhibits production of eicosanoids
- 47probenecidtreatment of gout. increases uric acid secretion
- 48sulphinpyrazonetreatment of gout. increases uric acid secretion
- 49colchicineused to treat gout. inhibits leukocyte migration into joints
- 50tenecteplase (TNK-tPA)fibrinolytic useful in STEMI but may be dangerous in unstable angina or NSTEMI. causes activation of plasminogen to break down fibrin
- 51metaclopramideused after an MI - relieves nausea
- 52what is the characteristic x ray appearance of aortic dissectionwidening of the mediastinum
- 53fluspirilinecalcium channel blocker that may be useful in treating angina
- 54ranolazineused to treat angina. blocks late sodium entry. increases QT interval
- 55losartanAT1 blocker used to treat hypertension. Angiotensin II receptor antagonist. Side effects include hyperkalaemia, diarrhoea, dizziness, tiredness
- 56minoxidil/pinacidilK+ channel activators that cause hyperpolarisation. treatment of hypertension
- 57alpha methyl dopatreatment of hypertension. converted in vesicles to alpha methyl NA. false transmitter at the alpha 1 receptors and binds with more affinity to alpha 2 receptors. reduces renin secretion. not metabolised by MAO
- 58guanendreltreatment of hypertension. normally reserved for uncontrolled hypertension. competes with NA for uptake into vesicles. ganglion blocker
- 59magnesiumanti-arrythmia. prevents calcium entry through the sarcolemma.
- 60adenosineanti arrythmia. used for SVT, enhances k+ current in atrial tissue
- 61Ca2+ channel blockersNifedipine, amlodipine. Hypetension treatments. Side effects include peripheral oedema and dizziness.
- 62Ace inhbiitorsprils.
- 63a1 adreno receptor blockersPrazosin and doxasozin, treatment of hypertension. alpha 1 receptors constrict vascular smooth muscle.
- 64K+ channel activators.Minoxidil and pinacidil. K+ channel activators leads to hyperpolarisation of the cardiac smooth muscle cells, leads to less exciteability.