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C. Year 3: Core Drugs > Cardiac Random (vasodilators, nitrates, vasopressin) > Flashcards

Cardiac Random (vasodilators, nitrates, vasopressin) Flashcards

1
Q

There are 3 key layers that surround the lumen of blood vessels:

  • tunica intima
  • tunica media
  • tunica externa

Which of these layers is responsible for causing vasodilation and vasoconstriction?

A
  • tunica media
  • tunica intima (endothelial cells)
  • tunica media (smooth muscle cells and sheets of elastin)
  • tunica externa (loosely woven fbres of collagen)
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2
Q

What enzyme is present in the endothelial cells that is important for vasodilation?

1 - glutathione peroxidases
2 - thioredoxin reductases
3 - nitrix oxide synthase
4 - nitric oxide reductase

A

3 - nitrix oxide synthase

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3
Q

The enzyme nitrix oxide synthase is present in the endothelial cells that is important for vasodilation. In combination with oxygen, which amino acid is used to synthisise nitric oxide (NO)?

1 - l-arganine
2 - histidine
3 - isoleucine
4 - leucine

A

1 - l-arganine

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4
Q

Once the enzyme nitrix oxide synthase synthasises nitric oxide (NO) from oxygen and l-arganine the NO diffuses from the tunica intima to the tunica media and into the smooth muscle cells. What enzyme does NO bind with in smooth muscles?

1 - adenlyly cyclase
2 - phospholipase C
3 - guanylyl cyclase (GC)
4 - diacylglycerol acyltransferases

A

3 - guanylyl cyclase (GC)

  • GC converts GTP into cyclic guanosine monophosphate (cGMP)
  • cGMP is a 2nd messenger that induces vasodilation of smooth muscle by reducing intracellular Ca2+
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5
Q

Which of the following drugs is our core drug that is a direct acting vasodilator?

1 - Sodium Nitroprusside
2 - Glyceryl trinitrate
3 - Isosorbide mononitrate
4 - Terlipressin

A

1 - Sodium Nitroprusside

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6
Q

Sodium nitroprusside, is a direct acting vasodilator. What is the mechanism of action of this medication?

1 - inhibits Ca2+ channels in blood vessels
2 - reduces sympathetic activity
3 - activates guanylyl cyclase (GC) and increases cyclic guanosine monophosphate (cGMP)
4 - inhibits alpha receptors

A

3 - activates guanylyl cyclase (GC) and increases cyclic guanosine monophosphate (cGMP)

  • prodrug so must 1st be metabolised into NO in the mitochondria
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7
Q

How is Sodium nitroprusside administered?

1 - orally
2 - IV
3 - SC
4 - rectal

A

2 - IV

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8
Q

Which of the following is NOT an indicator for prescribing Sodium nitroprusside?

1 - Severe refractory hypertension
2 - Malignant hypertension
3 - Hypertensive emergencies
4 - odeamatous conditions

A

4 - odeamatous conditions

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9
Q

Which of the following is NOT a common adverse event of Sodium nitroprusside?

1 - hypotension
2 - headaches/dizziness
3 - bradycardia
4 - palpitations
5 - oedema

A

3 - bradycardia

  • typically causes tachycardia due to postual hypotension
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10
Q

Common side effects of Sodium nitroprusside include, hypotension, headaches/dizziness, tachycardia, palpitations and oedema. Which 2 classes of the following drugs can be used in combination with Sodium nitroprusside to counteract the adverse events?

1 - beta blockers
2 - antiarrhythmics
3 - diuretics
4 - ACE inhibitors

A

1 - beta blockers
- counter tachycardia and palpitations

3 - diuretics
- counter oedema

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11
Q

Which 2 of the following drugs are our core drug that are classed as nitrates?

1 - Sodium Nitroprusside
2 - Glyceryl trinitrate
3 - Isosorbide mononitrate
4 - Terlipressin

A

2 - Glyceryl trinitrate
3 - Isosorbide mononitrate

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12
Q

Sodium nitroprusside, is a direct acting vasodilator. What is the mechanism of action of this medication?

1 - inhibits Ca2+ channels in blood vessels
2 - reduces sympathetic activity
3 - activates guanylyl cyclase (GC) and increases cyclic guanosine monophosphate (cGMP)
4 - inhibits alpha receptors

A

3 - activates guanylyl cyclase (GC) and increases cyclic guanosine monophosphate (cGMP)

  • prodrug so must 1st be metabolised into NO in the mitochondria
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13
Q

Direct acting vasodilators and nitrates are able to vasodilate the veins and arteries. What does vasodilation of the veins causes?

1 - increased preload
2 - decreased preload
3 - increased afterload
4 - decreased afterload

A

2 - decreased preload

  • preload volume of blood heart must eject/contraction
  • reduces workload on heart
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14
Q

Direct acting vasodilators and nitrates are able to vasodilate the veins and arteries. What does vasodilation of the arteries causes?

1 - increased preload
2 - decreased preload
3 - increased afterload
4 - decreased afterload

A

4 - decreased afterload

  • afterload pressure heart must contract against to eject blood
  • reduces SVR and therefore reduces workload on heart
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15
Q

Direct acting vasodilators and nitrates are able to vasodilate the veins and arteries. In doing so they are able to reduce preload (blood ejected/contraction) and afterload (pressure heart must contract against) and in doing so reduce cardiac workload and O2 demand. How else do these medication help cardiac tissue?

1 - increase perfusion of O2
2 - decrease V/Q mismatch
3 - reduce sympathetic acticity of the heart
4 - vasodilate coronary arteries, increasing blood flow and O2 delivery to cardiac tissue

A

4 - vasodilate coronary arteries, increasing blood flow and O2 delivery to cardiac tissue

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16
Q

When comparing the 2 core drug that are classed as nitrates:

  • Glyceryl trinitrate
  • Isosorbide mononitrate

Which one is short and which is long acting?

A
  • Glyceryl trinitrate = short acting
  • Isosorbide mononitrate = long acting
17
Q

Why are short acting nitrates like Glyceryl trinitrate indicated in angina and chest pain associated with acute coronary syndrome (ACS)?

1 - able to reduce workload of blood vessls
2 - able to reduce sympathetic activity on blood vessels
3 - able to vasodilate blood vessels
4 - able to increase para-synpathetic activity on blood vessels

A

3 - able to vasodilate blood vessels

  • increased blood and O2 delivery
  • reduces cardiac workload and O2 requirements
18
Q

Which of the following is indicated as a prophylaxis in a patient with angina where B-blockers or Ca2+ channel blockers are inaffective or not tolerated?

1 - Sodium Nitroprusside
2 - Glyceryl trinitrate
3 - Isosorbide mononitrate
4 - Terlipressin

A

3 - Isosorbide mononitrate

19
Q

Which of the following is NOT a common method of how nitrates are administered?

1 - SC
2 - IV
3 - sublingual
4 - transdermal

A

1 - SC

20
Q

Nitrates are indicated and administered IV to treat all of the following EXCEPT:

1 - acute coronary syndrome (ongoing ischamia)
2 - pulmonary oedema
3 - hypertensive emergancies
4 - haemorrhage

A

4 - haemorrhage

21
Q

All of the following are common adverse events of nitrates, EXCEPT which one?

1 - hypotension
2 - kidney damage
3 - headaches/dizziness
4 - flushing

A

2 - kidney damage

  • all other adverse events are due to the vasodilatory effect of the drugs
22
Q

Nitrates should be avoided in patients with severe aortic stenosis. Why is this?

1 - increase pressure on valve
2 - increase afterload
3 - fixed pressure required to maintain cardiac output
4 - increase preload

A

3 - fixed pressure required to maintain cardiac output

  • abrupt vasodilation can cause cardiovascular collapse
23
Q

Which of the following drug classes should nitrates not be taken with?

1 - ACE-I
2 - ARB-II
3 - Phosphodiesterase inhibitors
4 - Glucocorticoids

A

3 - Phosphodiesterase inhibitors (PDE)

  • PDE prevent the breakdown of cGMP and cAMP
  • more cGMP would amplify and extend the effects of nitrates
24
Q

Glyceryl trinitrate is generally adminstered as a sublingula spray. What does does the spray typically come in?

1 - 1mg/ml
2 - 5mg/ml
3 - 10mg/ml
4 - 20mg/ml

A

1 - 1mg/ml
- comes in 50mg that is diluted into 50ml giving 1mg/ml

25
Q

Glyceryl trinitrate is generally adminstered as a sublingula spray. Should patients be advised to stand up or sit down when taking this?

A
  • sit down
  • due to risk of postural hypotension
26
Q

If nitrates are administered IV, how often should the BP be monitored?

1 - every 15 mins
2 - every 30 mins
3 - every 2-4 hours
4 - every 5 hours

A

1 - every 15 mins

  • dosage can be increased until sympotoms are relieved, providing SBP >90mmHg
27
Q

Which of the following drugs is our core drug that is classed as vasopressin analogue?

1 - Sodium Nitroprusside
2 - Glyceryl trinitrate
3 - Isosorbide mononitrate
4 - Terlipressin

A

4 - Terlipressin

28
Q

Terlipressin, commonly referred to as antidiuretic hormone is the core drug that is classed as vasopressin analogue which act to vasoconstrict blood vessels in response to hypotenson, such as shock. What is the mechanism of action of this drug?

1 - prodrug for lypressin (also known as lysine vasopressin) that is a vasoconstrictor and antidiuretic agent.
2 - reduces sympathetic activity
3 - once metabolised released nitric oxide
4 - converted in mitochondria by aldehyde dehydrogenase in smooth muscle cells to nitric oxide

A

1 - prodrug for lypressin (also known aslysine vasopressin) that is a vasoconstrictor and antidiuretic agent

  • binds to V1 (vasopressin) receptors
  • lots of V1 receptors in the splanchnic system causing vasoconstriction
29
Q

Terlipressin, commonly referred to as antidiuretic hormone, is the core drug that is classed as vasopressin analogue which act to vasoconstrict blood vessels in response to hypotenson, such as shock. Which of the following is Terlipressin indicated for?

1 - septic shock
2 - hypotension
3 - oesophagela varices
4 - chronic heart failure

A

3 - oesophagela varices

  • enlarged veins in the oesophagus that can cause signifiant upper GI bleed
30
Q

Terlipressin, commonly referred to as antidiuretic hormone is the core drug that is classed as vasopressin of taking the analogue vasopressor which acts to vasoconstrict blood vessels in response to hypotenson, such as shock. Which of the following is NOT a common adverse event of taking Terlipressin?

1 - Abdominal cramps
2 - arrhythmias
3 - diarrhoea
4 - headache
5 - hypotension/hypertension
6 - peripheral oedema

A

6 - peripheral oedema

  • can cause peripheral ischamia
31
Q

Which of the following is NOT a caution to be used with when prescribing Terlipressin?

1 - Arrhythmia
2 - elderly
3 - electrolyte and fluid disturbances
4 - history of QT-interval prolongation
5 - hypotension
6 - vascular disease

A

5 - hypotension

  • generally hypertension, as this medication can further vasoconstrict blood vessels
32
Q

Should Terlipressin, commonly referred to as antidiuretic hormone be used in pregnant women or women breastfeeding?

A
  • no
  • drug can cross placenta and be found in breast milk

C. Year 3: Core Drugs (125 decks)

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