Pharmacology

Question 1

Hypertension should be considered if BP is measured at what value?

Answer 1

140/90mmHg or higher

Question 2

Which lifestyle modifications should be considered for hypertensive patients?

Answer 2

Weight, smoking, alcohol, exercise, diet

Question 3

Anti-hypertensive drugs should be given to people

Answer 3

Target organ damage
Established CV disease
Renal disease
Diabetes

Question 4

What classes of drugs can be used to treat hypertension?

Answer 4

ACE-I (ramipril, perinodipril, enalapril)
Angiotensin receptor blockers (valsartan, candesartan, losartan)
Calcium channel blocker (amlodipine, nifedipine, verapamil, diltiazem)
Beta-adrenoceptor-blockers (bisoprolol, carvedilol, propanolol, metoprolol, atenolol)
Aldosterone antagonist (doxazosin)
Renin inhibitors (aliskiren)
Centrally acting drugs (methyldopa, moxonidine)
Diuretics

Question 5

How do ACE-I work?

Answer 5

Block production of angiotensin two by inhibiting ACE

Question 6

What are the main adverse effects of ACE-I?

Answer 6

Reduced angiotensin II - hypotension, acute renal failure, hyperkalaemia
Increased kinin production - cough, rash, anaphylactoid reactions

Question 7

What are the main adverse effects of angiotensin II receptor blockers?

Answer 7

Symptomatic hypotension
Hyperkalaemia
Potential for renal dysfunction
Rash
Angio-oedema
Contraindicated in pregnancy - congenital abnormalities in children

Question 8

What are the 3 types of L-type calcium channel blockers?

Answer 8

Dihydropyridine (nifedipine, amlodipine, felodipine) - peripheral arterial vasodilators
Phenylalkylamines (verapimil) - reduces HR and force of contraction
Benzothiazipines (diltiazem) - intermediate

Question 9

What are the main adverse effects of calcium channel blockers?

Answer 9

Peripheral vasodilation - flush, headache, oedema, palpitations
Negatively chronotropic effects - bradycardia, atrioventricular block
Inotropic effects - worsening cardiac failure
Verapimil causes constipation

Question 10

How do calcium channel blockers work?

Answer 10

Smooth muscle contraction > peripheral vessels control peripheral resistance > calcium causes contraction > blocking calcium channels stops constriction

Question 11

How do beta-adrenoceptor-blockers work?

Answer 11

Block receptor > reduce activation from SNS > force of contraction reduced

Question 12

Name the beta-1 selective and non-selective drugs

Answer 12

Beta-1 selective - metoprolol, bisoprolol

Non-selective - propranolol, nadolol, carvedilol

Question 13

What are the main adverse effects of beta-adrenoceptor-blockers?

Answer 13

Fatigue, headache, sleep disturbances/nightmares
Bradycardia, hypotension, cold peripheries, erectile dysfunction
Worsening of - asthma or COPD, PVD (claudication/Raynaud’s), heart failure

Question 14

Name the 4 classes of diuretics and where they act

Answer 14

Thiazides - distal tubule (bendroflumethiazide)
Loop diuretics - loop of henle (furosemide, blumetanide)
Potassium-sparing diuretics (spironolactone, eplerenone, amiloride)
Aldosterone antagonists

Question 15

What are the main adverse effects of diuretics?

Answer 15

Hypovolaemia
Hypotension 
Hypokalaemia
Hyponatraemia
Low serum magnesium/calcium
Raised uric acid (gout)
Erectile dysfunction
Impaired glucose tolerance

Question 16

What are the four treatment steps for hypertension in

Answer 16

1 - ACE-I or ARB
2 - ACE-I/ARB +CCB
3 - ACE-I/ARB + CCB + thiazide-like diuretic
4 - referral to specialist > spironolactone, high dose thiazide-like diuretic

Question 17

What is the change in treatment steps for hypertension in >55 or Afro-Caribbean of any age?

Answer 17

Step 1 - CCB instead of ACE-I/ARB

Question 18

Which therapy for heart failure provide the best benefit?

Answer 18

Vasodilator therapy via neurohumoral blockade (RAAS - SNS)

Question 19

How do nitrates work?

Answer 19

Arterial and venous dilators; reduction of preload and after load; lower BP

Question 20

What are the main adverse effects of nitrates?

Answer 20

Headache, GTN syncope causes collapse as BP is lowered too quickly

Question 21

What treatments are used for chronic stable angina?

Answer 21

Anti-platelet therapy - aspirin of clopidrogrel
Lipid-lowering therapy - statins (simvastatin, atorvastatin, pravastatin)
Short acting nitrate - GTN spray for acute attack

Question 22

What is the first line of treatment for chronic stable angina?

Answer 22

Beta-blocker of calcium channel blocker

Question 23

What therapies are used for acute coronary syndromes?

Answer 23

Pain relief - GTN spray or opiates (diamorphine)
Dual anti-platelet therapy - aspirin + ticagrelor or praugrel or clopidogrel
Antithrombin therapy - fondaparinux
Lipid-lowering therapy - statins

Question 24

Which drugs make up the 4 classes in the Vaughan Williams classification for anti arrhythmic drugs?

Answer 24

1 - sodium channel blockers
2 - beta adrenoceptor antagonists
3 - prolong action potential
4 - calcium channel blockers

Question 25

How does digoxin work?

Answer 25

Inhibits Na/K pump

Question 26

What are the main effects on the heart with digoxin?

Answer 26

Bradycardia
Slowing of AV conduction
Increased ectopic activity
Increased force of contraction

Question 27

When is digoxin used?

Answer 27

In atrial fibrillation to reduce ventricular rate response

In severe heart failure as it is positively inotropic