Cardiac and vascular pharma

Question 1

Nifedipine

Answer 1

• Ca2+ antagonist - selective blocker for L type Ca2+ in vascular smooth muscle
• Direct vasodilator (hypertensive), treatment of CHF (indirect)
• Adverse effects: hypotension, headache, flushing and tachycardia, dizziness

Question 2

Enalaprin

Answer 2

• ACE inhibitor, inhibit renin-angiotensin pathway -> vasodilation and reduced oedema
• Treatment of CHF (indirecy), antihypertensive
• Side effect: block breakdown of bradykinin -> cough

Question 3

Diuretics

Answer 3

• Treatment of CHF (indirect)

- Function: reduce acclamation of water, reduce oedema in lungs, loss of Na+ and water reduced preload

Question 4

Angiotensin II and III

Answer 4

• Treatment of CHF (indirect)

- Stimulate aldosterone secretion, retention of sodium and water

Question 5

Dobutamine

Answer 5

• Treatment of CHF (direct)
• Beta-1 agonist
• Effect: increases intracellular cAMP
• Administration: intravenous

Question 6

Cardiac glycosides e.g. digitoxin

Answer 6

• Treatment of CHF (indirect)
• Effect: inhibits Na+/K+-ATPase. Prevents fibrillation
• Toxic action: ectopic beats and dysrhythmias (due to increased Ca2+)

Question 7

CHF tratment

Answer 7

• Increase force of contraction - indirect or direct

Question 8

Carvedilol

Answer 8

• beta1 and alpha1 antagonist

- treatment of heart failure, reducing sympathetic stimulation of heart

Question 9

Bisoprolol

Answer 9

• beta1 antagonist

- treatment of heart failure, reducing sympathetic stimulation of heart

Question 10

Prazosin

Answer 10

• alpha1 antagonist
• antihypertensive (indirect vasodilator)
• effect: blocks effect of sympathetic stimulation

Question 11

Ganglion-blocking drugs

Answer 11

• antihypertensive (indirect vasodilator)

Question 12

alpha2 agonists

Answer 12

• antihypertensives (decreased sympathetic outflow)

- NA negative feedback (activation of pre-junctional alpha2)

Question 13

Clonidine

Answer 13

• antihypertensive (indirect vasodilator)

Question 14

alpha-methyl DOPA

Answer 14

• prodrug of alpha-metyl NA (false transmitter)
• antihypertensive (indirect vasodilator)
• used mainly in pregnancy

Question 15

Indirect vasodilators (antihypertensives)

Answer 15

• alpha antagonists
• ganglion-blocking drugs
• alpha2 agonists

Question 16

Direct vasodilators (antihypertensives)

Answer 16

• K(ATP) channel openers
• Ca2+ antagonists
• beta antagonists
• ACE inhibitor
• Angiotensin AT1 receptor antagonists

Question 17

Minoxidil

Answer 17

• anti-hypertensive (direct vasodilator)
• blocks ability of ATP to bind to K(ATP) channel
• only in severe hypertension
• side effect: hypertrichosis

Question 18

Atenolol

Answer 18

• anti-hypertensive (direct vasodilator), treatment of angina
• beta antagonist (unknown mechanism)
• side effects: bradycardia, cold peripheries, fatigue and bronchospasm

Question 19

Organic nitrates e.g. GTN

Answer 19

• treatment of angina, non-specific vasodilation
• administration: oral, transcutaneous and intravenous
• duration: 10-20 min (rapidly metabolised by liver)
• side effects: headache, hypotension with risk of fainting

Question 20

Angina treatment

Answer 20

• organic nitrates

- beta antagonists

Question 21

Coronary artery disease treatment

Answer 21

• aspirin
• statins
• heparins
• glycotprotein IIa/IIb inhibitors

Question 22

Aspiring

Answer 22

• coronary artery disease treatment
• anti-platelet agent
• administration: oral
• adverse effects: GI haemorrhage and bronchospasm

Question 23

Simvastatin

Answer 23

• statin
• mechanism: inhibition of enzyme HMG-CoA reductase
• coronary artery disease treatment, underlying athermatous disease
  administration: oral

Question 24

Heparin

Answer 24

• coronary artery disease treatment
• mechanism: activation of antithrombin III -> inhibition of coagulation
• administration: intravenous or subcutaneous
• adverse effects: haemorrhage and thrombocyopaenia

Question 25

Abciximab, tirofiban

Answer 25

- coronary artery disease treatment - glycoprotein inhibitors, anti-platelet agents - administration: intravenous