Cardiac and renal phamacology

Question 1

Tetracaine

Answer 1

Anaesthetic blocking NaV

More anaesthetic at higher pH as more drug in unprotonated form

Question 2

Lidocaine

Answer 2

Anaesthetic blocking NaV

Use dependent

Question 3

Benzocaine

Answer 3

Anaesthetic not affect by pH as neutral

Question 4

Tetrodotoxin

Answer 4

Mainly acts on nerve NaV

Question 5

L type channels

Answer 5

Node and heart tissue
Sensitive to dihydropyridines
Slowly inactivating
Needs large depolarisation

Question 6

T type channels

Answer 6

Mainly found in node

Insensitive to dihydropyridines

Question 7

Phenylalkylamines (Verapamil)

Answer 7

Blocks L type Ca channels from inside

Question 8

Dihydropyridines (Amlodipine)

Answer 8

Blocks L type channels from inside

Question 9

Benzothiapines

Answer 9

Block Ca channels from outside and alter dihydropyridine binding

Question 10

Sulfonurea drugs (Glibenclamide)

Answer 10

Mimics ATP to close kATP channel, depolarise and cause insulin release

Question 11

Long QT1 and 2

Answer 11

Kv mutations

Question 12

Long QT3

Answer 12

Nav mutations

Question 13

Isoprenaline

Answer 13

Beta agonst
Raises cAMP to act on HCN
Used for bradycardia

Question 14

ACh on nodes

Answer 14

Acts via M2
Causes decreased cAMP so less HCN
betagamma coupled to GIRK1 to hyperpolarise

Question 15

Adr on heart

Answer 15

Via beta1
Increases cAMP so stimulates HCN
+ PKA opens Ca2+ channels

Question 16

Quinidine

Answer 16

Blocks NaV
Class 1a antidysrhythmic
Use dependent (higher affinity for activated channels)

Question 17

Lidocaine

Answer 17

Blocks NaV
Class 1b antidysrhythmic
Use dependent

Question 18

Propenalol and Atenolol

Answer 18

Beta1 selective blockers (anti-dysrhythmic)

Class II

Question 19

Amiodarone

Answer 19

Class 3 antidysrhythmic
Prolongs AP
Blocks Ina or Ik depending

Question 20

Verapamil

Answer 20

Cardioselective Ca2+ channel blocker

Class IV antidysrhthmic

Question 21

Digoxin

Answer 21

Binds K+ site of Na/K+ ATPase to raise Na intracellularly by 1.5mmol/l
So less Na+ gradient for Ca2+ removal
For heart failure

Question 22

Dobutamine

Answer 22

Beta 1 agonists for circulatory shock or during heart surgery

Question 23

Bisoprolol/Carvedillol

Answer 23

Beta blockers to stop damaging effect of chronic stimulation in heart failure

Question 24

Pimobendam

Answer 24

Ca2+ sensitiser

Can cause long QT syndrome

Question 25

Milrinone

Answer 25

PDE3 inhibitors for heart failure | Can cause dysrhythmias

Question 26

Methyxanthanes

Answer 26

Non specific PDE inhibitor and A1/2 antagonist

Question 27

Streptokinase

Answer 27

Binds plasminogen activator to activate

Question 28

Alteplase

Answer 28

Tissue plasminogen activator that acts preferentially in clots

Question 29

Clobidogrel

Answer 29

Inhibits platelet aggregation via inhibiting ADP binding

Question 30

Eptifibatide/Abciximab/Tirofiban

Answer 30

Inhibitor of IIb/IIIa complex to stop cross linking

Question 31

Heparin

Answer 31

Activates antithrombin III which inactive thrombin and X

Question 32

Warfarin

Answer 32

Inhibits vit K epoxide reductase so can't make clotting factors

Question 33

Dabigatran

Answer 33

Inhibits thrombin

Question 34

Loop diuretic; Furosemide

Answer 34

Blocks Na+/K+/2Cl- on TAL Rapid venodilation Gout, hypokalaemia

Question 35

Thiazide diuretics; Hydrochlorothazide, Bendroflumethiaziole

Answer 35

Blocks Na+/Cl- on TAL/distal tubule | hypokalaemia, gout

Question 36

Amiloride

Answer 36

Blocks epithelial Na+ channels on apical side | K+ sparing diuretic

Question 37

Spironolactone

Answer 37

Aldosterone antagonist to increase expression of Na+ channels

Question 38

Acetazolamine

Answer 38

``` Carbonic anhydrase inhibitor Blocks H+ provision for Na+ reabsoption For glaucoma Less effective Alkaline urine ```

Question 39

Enalapril, Ramipril

Answer 39

ACE inhibitor | For heart failure and hypertension

Question 40

Losartan

Answer 40

AT1 blocker

Question 41

Salarsan

Answer 41

AT1 partial agonist