Cardiovascular

Focus

Summary

Goal of Therapy

Reduce blood pressure and cardiovascular risk; prevent complications (e.g. MI, stroke, HF). Manage underlying conditions (lipids, rhythm, clot risk).

Main Drug Classes (Hypertension & HF)

1.    ACE Inhibitors (-pril)  

2.   ARBs (-sartan)  

3.   Calcium Channel Blockers (-dipine)

4.   Thiazide Diuretics (-thiazide)

Mechanisms of Action

- ACEI: Inhibit conversion of angiotensin I → II → ↓ vasoconstriction & aldosterone.

- ARBs: Block angiotensin II receptor (AT₁).

- CCBs: Block calcium influx in vascular smooth muscle → vasodilation.

- Thiazides: Inhibit Na⁺/Cl⁻ reabsorption in distal tubule → mild diuresis & ↓ BP.

Key Indications

- HTN (first-line): ACEI/ARB, CCB, Thiazide.

- HF: ACEI/ARB improve survival; diuretics relieve fluid overload.

- Post-MI / Diabetes: ACEI/ARB for renal & cardiac protection.

Contraindications / Cautions

- ACEI/ARB: Pregnancy, history of angioedema, renal artery stenosis

- CCB: Heart block, caution in HF (non-DHP types like verapamil).

- Thiazides: Gout (↑ uric acid), hyponatraemia, dehydration.

Comparative Advantages

- ACEI/ARB: Renal & cardiac protection, ↓ mortality in HF.

- CCB: Effective in elderly & African descent, minimal metabolic effects.

- Thiazide: Cheap, long-acting, synergistic with ACEI/ARB.

Common ADRs

- ACEI: Dry cough, hyperkalaemia, hypotension.

- ARB: Hyperkalaemia (no cough).

- CCB: Ankle oedema, flushing, headache

.- Thiazide: ↓ K⁺, ↑ uric acid & glucose.

Counselling Points

- Rise slowly from sitting (postural hypotension).

- Report persistent cough (ACEI).

- Avoid potassium supplements with ACEI/ARB.

- Monitor electrolytes and renal function.

High-Yield Suffixes

-pril = ACEI  -sartan = ARB  -dipine = CCB  

-thiazide = Thiazide diuretic

Focus

Summary

Goal of Therapy

Control ventricular rate and prevent symptoms or complications (e.g. palpitations, heart failure) in atrial fibrillation.

1st Line Drug Classes

1.   Beta Blockers (-olol)  

2.    Non-dihydropyridine CCBs (Verapamil, Diltiazem)

Mechanism of Action

- Beta Blockers: Block β₁ receptors → ↓ heart rate & contractility.

- Non-DHP CCBs: Block calcium influx in cardiac tissue → slow AV node conduction & ↓ HR.

Indications / Use

- 1st line: Rate control in atrial fibrillation or flutter.

- If LVEF ≤ 40% (heart failure): Use HF-specific beta blocker (e.g. bisoprolol, carvedilol).- Avoid verapamil/diltiazem if LVEF ≤ 40%.

2nd Line Drugs

- Digoxin: Slows AV node conduction via vagal stimulation; for sedentary or heart failure patients when 1st line inadequate.

- Amiodarone: Broad antiarrhythmic; used only if others fail due to long-term toxicity (thyroid, liver, lung).

Contraindications / Cautions

- Beta Blockers: Asthma, severe bradycardia, heart block.

- Non-DHP CCBs: Avoid in LV dysfunction or with β-blockers (↑ risk of heart block).

- Digoxin: Monitor renal function & serum levels

- Amiodarone: Long-term toxicity — avoid as 1st line.

Comparative Advantages

- Beta Blockers: Improve survival post-MI, good for tachyarrhythmias.

- CCBs: Useful if beta blockers contraindicated.

- Digoxin: Effective in sedentary HF patients.

- Amiodarone: Most potent rate + rhythm control (last resort).

Common ADRs

- Beta Blockers: Bradycardia, fatigue, bronchospasm.

- CCBs: Bradycardia, constipation (verapamil).

- Digoxin: Nausea, visual halos, arrhythmia (toxicity).

- Amiodarone: Photosensitivity, thyroid/liver/lung toxicity.

High-Yield Suffixes

-olol = Beta blocker  (no suffix) = Non-DHP CCBs (Verapamil, Diltiazem) (no suffix) = Digoxin / Amiodarone