2 - Vasoactive and Antiplatelet Agents Flashcards
(135 cards)
1
Q
Patients with Raynaud’s phenomenon have a deficiency of perivascular calcitonin gene related peptide-containing neurons
A
True
2
Q
Pentoxifylline is known to reduce blood viscosity in the microcirculation
A
True
3
Q
The endothelium produces prostacyclin which inhibit platelet activation and acts as a vasodilator
A
True
4
Q
Endothelin-1 (ET-1) is a potent vasoconstrictor
A
True
5
Q
Diffusion of nitric oxide (NO) from endothelial cells results in vascular smooth muscle relaxation and vasodilatation
A
True
6
Q
Calcium channel blockers are well absorbed orally
A
True
7
Q
Bioavailability varies between the calcium channel blocker drugs
A
True
8
Q
Bioavailability for nifedipine (50-70%) and amlodipine (50-88%) are similar
A
True
9
Q
Bioavailability for diltiazem is 20-40%
A
True
10
Q
Calcium channel blockers are largely protein bound
A
True
11
Q
Amlodipine reaches peak plasma level at 7-8 hours
A
True
12
Q
Diltiazem reaches peak plasma level at 30 mins
A
True
13
Q
Nifedipine reaches peak plasma levels at 1-2 hours
A
True
14
Q
The dihydropyridine calcium channel blockers nifedipine, isradipine and amlodipine are principally excreted via the kidney
A
True
15
Q
The non-dihydropyridine calcium channel blocker diltiazem is excreted via the faeces after extensive deacetylation
A
True
16
Q
The plasma half life for nifedipine and diltiazem is 4 hours
A
True
17
Q
The plasma half life for amlodipine is 35 hours
A
True
18
Q
Amlodipine reaches peak plasma levels later than diltiazem and nifedipine
A
True
19
Q
Amlodipine has a longer plasma half life than diltiazem and nifedipine
A
True
20
Q
Calcium channel blockers prevent the transport of calcium across the plasma cell membrane of smooth muscle cells
A
True
21
Q
Calcium channel blockers inhibit excitation contraction coupling and muscle constriction
A
True
22
Q
Some calcium channel blockers I.e. Verapamil have varying effects on atrioventricular conduction and heart rate
A
True
23
Q
Verapamil is predominantly used for dysrhythmias and not for cutaneous vascular diseases
A
True (verapamil is a strong depressor of AV conduction)
24
Q
Beta1 adrenergic effect is vasodilatation
A
True
25
Alpha1 adrenergic effect is vasoconstriction
True
26
Alpha2 adrenergic effect is vasoconstriction
True
27
Thromboxane A2 induces vasoconstriction
True
28
Capsaicin induces vasodilatation
True (mediated by nitric oxide)
29
Calcitonin gene related peptide induces vasodilatation
True (mediated by nitric oxide)
30
Substance P induces vasodilatation
True (mediated by nitric oxide)
31
The calcium channel blocker agent of choice for Raynaud's phenomenon is nifedipine
True
32
Nifedipine is superior to diltiazem in the treatment of recalcitrant chilblains
True
33
Nifedipine has in vivo anti platelet effects
True (in patients with systemic sclerosis)
34
The non-dihydropyridine calcium channel blocker verapamil is ineffective in treating Raynaud's phenomenon
True
35
The non-dihydropyridine calcium channel blocker diltiazem may be useful in the treatment of calcinosis cutis
True (especially in patients with CREST syndrome)
36
Intralesional verapamil (non-dihydropyridine calcium channel blocker) has been used with some success in keloids and hypertrophic scars
True (and Peyronie's disease)
37
Dihydropyridine Calcium channel blockers i.e. Nifedipine and isradipine are the first line for managing cyclosporine-induced hypertension due to renal blood flow preservation and no CYP 3A4 inhibition
True (CsA is a substrate of CYP3A4)
38
Dihydropyridine Calcium channel blockers i.e. Amlodipine and nicardipine and the non-dihydropyridine calcium channel blockers diltiazem and verapamil have been shown to increase levels of cyclosporine via CYP 3A4 inhibition
True (CsA is a substrate of CYP3A4)
39
Dihydropyridine Calcium channel blockers i.e. Amlodipine and nicardipine and the non-dihydropyridine calcium channel blocker diltiazem may reduce the necessary dose of cyclosporine
True (these calcium channel blockers have been shown to increase levels of cyclosporine via CYP 3A4 inhibition)
40
Calcium channel blockers rarely need to be ceased due to the adverse effects
True (although adverse effects are frequent, these rarely lead to cessation of therapy as dose reduction is typically sufficient to reduce the adverse effect)
41
Adverse effects are frequent in calcium channel blockers
True
42
Calcium channel blockers adverse effects are typically due to vasodilatation
True
43
Calcium channel blockers may cause dizziness
True (due to vasodilatation)
44
Calcium channel blockers may cause headaches
True (due to vasodilatation)
45
Calcium channel blockers may cause peripheral oedema
True (due to vasodilatation)
46
Calcium channel blockers may cause nausea
True (due to vasodilatation)
47
Calcium channel blockers may cause flushing
True (due to vasodilatation)
48
Symptomatic hypotension is uncommon in patients on calcium channel blockers
True
49
Nifedipine has more severe side effects than amlodipine
True
50
Nifedipine has more severe side effects than diltiazem
True
51
Calcium channel blockers may cause gingival hyperplasia
True (diltiazem > verapamil > nifedipine)
52
Calcium channel blockers may cause facial and truncal telegiectasia
True (vasodilatation)
53
Calcium channel blockers may cause new onset or exacerbation of psoriasis
True
54
Diltiazem may cause photodistributed hyperpigmentation particularly in African American women
True
55
Long term use of calcium channel blockers is associated with the development of chronic eczematous reactions in the elderly
True
56
Calcium channel blockers may cause gynaecomastia
True
57
Calcium channel blockers may cause oral ulcers
True
58
Propanolol is a lipophilic beta blocker with a short half life and readily cross the blood brain barrier
True
59
Carvedilol is a lipophilic beta blocker with a short half life and readily cross the blood brain barrier
True
60
Metoprolol is a lipophilic beta blocker with a short half life and readily cross the blood brain barrier
True
61
Propranolol is metabolised by the liver (lipophilic)
True
62
Carvedilol is metabolised by the liver (lipophilic)
True
63
Atenolol is a hydrophilic beta blocker with a longer half life and do not cross the blood brain barrier
True
64
Sotalol is a hydrophilic beta blocker with a longer half life and do not cross the blood brain barrier
True
65
Atenolol is excreted by the kidneys (hydrophilic)
True
66
Sotalol is excreted by the kidneys (hydrophilic)
True
67
Blockage of beta1-adrenergic receptor is cardio selective
True
68
Metoprolol is a cardio selective beta blocker
True
69
Atenolol is a cardio selective beta blocker
True
70
Blockage of beta2-adrenergic receptor by non-selective agents I.e. Propranolol interferes with dilation of bronchioles and blood vessels
True
71
Blockage of beta2-adrenergic receptor by non-selective agents I.e. Propranolol causes lipolysis
True
72
Blockage of beta2-adrenergic receptor by non-selective agents I.e. Propranolol causes glycogenolysis
True
73
Non-selective beta blocker I.e. Sotalol also possesses class III antiarhythmic features and increased risk of cardiac arythmias
True (not suitable for use in dermatology)
74
Non-selective beta blocker I.e. Labetalol and Carvedilol also have alpha-adrenergic activity result in vasodilatation and further reducing blood pressure
True
75
The non-selective beta blocker Propanolol (beta2-adrenergic reception blockade) has been successfully used to treat infantile haemangiomas
True (interferes with dilation of bronchioles and blood vessels)
76
Non-selective beta blockers I.e. Propanolol and Carvedilol have been used in flushing with mixed success
True
77
Bradycardia is a common side effect of beta blockers
True
78
Hypotension is a common side effect of beta blockers
True
79
Bronchospasm is a common side effect of beta blockers
True
80
Fatigue is a common side effect of beta blockers
True
81
Hypoglycaemia is a side effect of beta blockers reported in some paediatric patients undergoing treatment for infantile haemangioma
True
82
Beta blockers have been associated with lichenoid drug, eczematous and psoriasiform eruptions
True
83
Beta blockers may induce or worsen psoriasis
True (same as calcium channel blockers) - though more guttate psoriasis
84
Salicylates I.e. Aspirin is rapidly absorbed and widely distributed
True
85
Salicylates I.e. Aspirin reach peak plasma levels after 2 hours and slowly decline
True
86
Salicylates I.e. Aspirin are mainly protein bound (50-80%) to plasma albumin and only the free drug is active
True
87
Salicylates I.e. Aspirin is metabolised by the liver
True
88
The amount of salicylates I.e. Aspirin metabolised by the liver is dependant on the rate of urinary excretion
True
89
The rate and amount of salicylates I.e. Aspirin excreted in the urine depends on urinary pH
True (greater excretion in alkaline urine as salicylates are acidic)
90
The urinary excretion of salicylates I.e. Aspirin is greater in alkaline urine
True
91
Low dose aspirin acetylates platelet enzymes which are responsible for the synthesis of thromboxane A2
True
92
Higher dose aspirin inhibits synthesis of prostacyclin (endogenous inhibitor of platelet aggregation)
True (this reverses the anti platelet effect of prostacyclin)
93
Salicylates may cause exacerbation of asthma
True
94
Hypersensitivity reactions I.e. Angioedema, urticaria, rhinitis may occur with salicylates
True
95
Dyspepsia, peptic ulcer disease and upper GI bleeding are potential complications of aspirin therapy
True
96
Dipyridamole is largely bound to plasma proteins
True
97
Dipyridamole is metabolised in the liver
True
98
Dipyridamole is excreted in the bile
True
99
Dipyridamole inhibits platelet aggregation
True
100
Dipyridamole is a vasodilator
True
101
Dipyridamole has pro-fibrinolytic quality
True
102
Dipyridamole may cause gastric upset
True
103
Dipyridamole may cause worsening of coronary heart disease
True (causes tachycardia)
104
Dipyridamole is contraindicated after recent myocardial infarction and in rapidly worsening angina
True (contraindicated as may cause worsening heart disease with tachycardia)
105
Dipyridamole may cause dizziness
True (vasodilation)
106
Dipyridamole may cause headache
True (vasodilation)
107
Dipyridamole may cause hypotension
True (vasodilation)
108
Dipyridamole may cause tachycardia
True (Contraindicated in recent myocardial infarction and rapidly worsening angina)
109
Pentoxifylline is a non-specific phosphodiesterase inhibitor
True
110
Pentoxifylline is a methyl-xanthine derivative
True
111
Pentoxifylline is well absorbed
True
112
Pentoxifylline undergoes extensive first pass metabolism in the liver
True
113
Pentoxifylline is excreted in the urine
True
114
Pentoxifylline reaches peak plasma levels within 2 hours
True
115
Pentoxifylline has a half life of 4-6 hours
True
116
Pentoxifylline reduces blood viscosity in the microcirculation
True
117
Pentoxifylline has been used for the treatment of Raynaud's phenomenon
True (reduces blood viscosity in the microcirculation)
118
Pentoxifylline has been used for the treatment of venous insufficiency with ulcers
True (reduces blood viscosity in microcirculation)
119
Pentoxifylline should be used with caution in patients with severe cardiac disease
True
120
The dose of Pentoxifylline should be reduced in significant renal impairment
True (renal excretion)
121
Sildenafil (Viagra) is a phosphodiesterase-5 inhibitor
True
122
Sildenafil (Viagra) causes an increase in cyclic-GMP in the vasculature resulting in vasodilatation
True
123
Sildenafil (Viagra) is metabolised in the liver primarily by CYP 3A4 and to a lesser extent by CYP 2C9
True
124
Sildenafil (Viagra) has been used in systemic sclerosis associated Raynaud's phenomenon
True
125
Sildenafil (Viagra) is contraindicated with nitrates or nitric oxide donors
True
126
Headache is a common adverse effect of sildenafil (Viagra)
True
127
Flushing is a common adverse effect of sildenafil (Viagra)
True
128
Nasal congestion is a common adverse effect of sildenafil (Viagra)
True
129
Dyspepsia is a common adverse effect of sildenafil (Viagra)
True
130
Sildenafil (Viagra) must be used cautiously in patients with history of risk factors for myocardial infarction and unstable angina
True
131
Sildenafil (Viagra) must be used cautiously in patients with history of hypotension
True
132
Sildenafil (Viagra) must be used cautiously in patients with history of hypertension
True
133
Iloprost is a prostacyclin analog and a vasodilator
True
134
Iloprost causes vasodilation and is used in Raynaud's phenomenon
True
135
Iloprost inhibits skin fibrosis
True
