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DEN303 - IHD > Pharmacology and Drugs for Cardiovascular Disease > Flashcards

Pharmacology and Drugs for Cardiovascular Disease Flashcards

1
Q

Common CV conditions requiring drug therapy

A

Hypertension
Arrhythmia
Heart failure
Ischaemic heart disease and other atheromatous diseases

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2
Q

Hypertension

A

Most conditions are asymptomatic
CV morbidity and mortality can be reduced by BP reduction
Early detection = better risk management and treatment

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3
Q 
End organ damage
Brain
Heart
Kidney 
Eyes
A

Brain - thrombosis, thromboembolism and haemorrhagic stroke, multi infarct dementia, hypertensive encephalopathy
Heart - LVH, LV failure, coronary artery disease
Kidney - renal failure
Eyes - hypertensive retinopathy

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4
Q

Prognosis of hypertension

A

Related to systolic and diastolic BPs
Age, sex and other risk factors
Improved with antihypertensive therapy

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5
Q

Non pharmacological treatment of hypertension

A 
Weight reduction 
Reduce salt intake
Reduce fat intake
Reduce alcohol intake
Exercise 
Smoking cessation
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6
Q

Common antihypertensive drugs

A 
Thiazide diuretics
ACE inhibitors
Angiotensin II receptor antagonists
Beta blockers
Calcium channel blockers
Alpha blockers
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7
Q

thiazide diuretics

side effects

A

Inhibit reabsorption of NaCL in proximal and early distal
tubules of nephron
Lost in urine
Cheap
Bendroflumethiazide is most common
Metolazone
Electrolyte disturbance, rash, postural hypotension post standing up

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8
Q

Mechanism of RAAS system - what happens when BP drops

A

Decreased BP
Renin released
Renin converts angiotensinogen to angiotensin 1
ACE converts AG1 to AG2
AG2 stimulates aldosterone release which increases reabsorption of Na+ ions
Leads to increased ECF therefore BP back to normal

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9
Q

ACE inhibitors - side effects

A

ACE inhibitors inhibit conversion of AG1 to AG2

Infrequent side effects except for dry cough, rash, hyperkalaemia, renal failure, angioedema, loss of taste function

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10
Q

ACE inhibitor mechanism

A

Inhibits angiotensin converting enzyme

Also inhibit breakdown of bradykinin leading to prolonged vasodilation to reduce BP further

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11
Q

Angiotensin II receptor antagonists (ARBs)

A

Similar effects to ACE inhibitors but do not influence bradykinin metabolism so do not cause dry cough

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12
Q

Beta blockers Beta adrenoceptor antagonists
Contraindications
Side effects

A

Reduce heart rate, BP and CO
Asthma, heart failure, bradycardia
Fatigue, hypotension, cold peripheries, bronchospasm, impotence.

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13
Q

Autonomous NS

A

Involved in vasoconstriction in lower half of body

Effect of beta blockers on blood supply to legs

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14
Q

Calcium channel antagonists
Main types
Side effects

A

Vasodilators - reduce systemic vascular tone
Two types
Verapamil and diltiazem
Amlodipine,,,dipine
Oedema, flushing, headaches, dizziness, hypotension

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15
Q

Alpha blockers and other vasodilators

Side effects

A

Variety of other vasodilators used to treat hypertension
Hydrazine
Methyldopa
Hypotension, headache, tachycardia, oedema

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16
Q

Ischaemic heart disease

Progression

A

Atherosclerosis of coronary arteries

Spectrum of presentation

17
Q

Antianginal drugs

A

Beta blockers
Nitrates
Calcium channel blockers
Potassium channel activators

18
Q

Anti-anginal drugs: Beta blockers

A

Lower O2 demand by reducing heart rate, BP and myocardial contractility
May make cardiac failure worse and peripheral vas disease

19
Q

Anti-anginal drugs: Nitrates

Side effects

A

GTN tabs/sorays, nitric oxide on endothelial surface -> vascular smooth muscle relaxation and art./venus
Reduce myocardial oxygen demand and gradual increase supply (coronary vasodilation)
Headaches, flushing, postural hypotension

20
Q

Anti-anginal drugs: Calcium antagonists

A

Lower myocardial demand by reduced BP and increasing oxygen supply

21
Q

Anti-anginal drugs: Potassium channel activators

Side effects

A

Nicorandil
Arterial and venous dilating properties
No problems with tolerance as seen with nitrates

Can cause mucocutaneous ulceration – relegated to second-line therapy

22
Q

Anti platelet drugs

A

Aspirin most common
Targets COX1 and blocks production of thromboxane A2
CPT used with aspirin

23
Q

Bleeding time in healthy volunteers

A

Less bleeding time in those given med

24
Q

Interaction between anticoagulants and anti platelets

A

Anticoagulant drugs prevent coagulation (driven by thrombin)

Thrombin initiates clotting
Thrombin also drives platelet formation

25
Q

Statins
What are they - mechanism
Reduce risk of?

A

HMG CoA reductase inhibitors
Lower LDL cholesterol and may increase HDL cholesterol
Reduce risks of MI, stroke

26
Q

Heart failure

A

When heart cannot maintain an adequate cardiac output

Pulmonary/peripheral oedema due to high atrial pressures

27
Q

Drug treatment for chronic heart failure

A 
Diuretics
ACE inhibitors
AgII receptor antagonists 
Beta blockers 
Aldosterone antagonists 
Digoxin 
PDE inhibitors
28
Q

Thiazides for HF

A

Inhibit active exchange of Cl-Na
in the cortical diluting segment of the
ascending loop of Henle

K-sparing
Inhibit reabsorption of Na in the
distal convoluted and collecting tubule
Low potassium can lead to rhythm defects

Loop diuretics
Inhibit exchange of Cl-Na-K in
the thick segment of the ascending
loop of Henle

29
Q

Aldosterone inhibitors - therefore have three types of effects:

A

Aldosterone inhibitors

  • Diuretic effect, which is most noticeable when fluid retention and increased levels of aldosterone are present.
  • Antiarrhythmic effect, mediated by the correction of hypokalemia and hypomagnesemia.
  • Antifibrotic effect. This effect, demonstrated in animal models, can contribute to a decrease in the progression of structural changes in patients with heart failure.
30
Q

TAchyarrhythmia

A

Different types
AF
SVT
VT

31
Q

Tachyarrhythmia treatment

A

Digoxin - blocks Na+ / K+ ATPase => Ca+ +

increases Vagal tone – slows conduction in atrial fibrillation

32
Q

Oral antiarrhythmics

Drugs for controlling tachyarrhythmia

A

Class Ia,b,c – disopyramide, flecainide, procainamide
Class II – beta blockers
Class III – amiodarone, dronedarone, sotalol
Class IV – calcium antagonists (verapamil, diltiazem) - photosensitivity

DEN303 - IHD (58 decks)

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