Cardiovascular

Question 1

ACE Inhibitors - Example, Mechanism and effects, Indications, Side Effects, Contraindications

Answer 1

Example - ‘pril’ e.g. Ramipril, captopril, lisinopril

Mechanism and effects - Stop conversion of angiotensin I to angiotensin II by ACE (angiotensin converting enzyme). Angiotensin II causes vasoconstriction so this is prevented. It also stimulates aldosterone production which causes salt (Na+) retention and increased BP so this is prevented.

Indications - All stages of heart failure

Side effects - Bradykinin cough, bronchospasm, hyperkalaemia, angio-oedema

Contraindications - Renal impairment, renal artery stenosis, pregnancy, hyperkalaemia, angio-oedema

Question 2

Beta Blockers - Example, Mechanism and effects, Indications, Side Effects, Contraindications

Answer 2

Example - ‘olol’ e.g. Bisoprolol, Metoprolol, Carvidilol

Mechanism and effects - Beta adrenoceptor antagonists which reduce sympathetic stimulation. Result in slowed heart rate

Indications - All stages of heart failure

Side effects - Bradycardia, heart block, hypotension, fluid retention, sleep disturbances, impotence (erectile dysfunction)

Contraindications - Asthma, severe bradycardia or heart block

Question 3

Spironolactone - Mechanism and effects, Indications, Side Effects, Contraindications

Answer 3

Mechanism and effects - An aldosterone (mineralocorticoid) receptor blocker, or ‘potassium sparing’ diuretic

Question 4

What type of drug is nifedipine and what is it used for?

Answer 4

Calcium channel blocker - causes smooth muscle relaxation on vasculature so causes vasodilation. Uses: angina, heart failure, Raynaud’s phenomenon

Question 5

What causes metabolism of nifedipine to be reduced and how?

Answer 5

Grapefruit Juice - It produces a molecule which inhibits cytochrome P450 enzymes and therefore decreases nifedipine metabolism

Question 6

True / False: Nifedipine is a dihydropyridine calcium channel blocker

Answer 6

TRUE - Nifedipine is a dihydropyridine calcium channel blocker. Also included in this list is amlodipine.

Examples of NON-dihydropyridine calcium channel blockers include verapamil, diltiazem

Question 7

Different calcium channels exert their effect on different tissues (smooth muscle). On which tissue does verapamil have an effect? On which tissue does nifedipine have an effect?

Answer 7

Verapamil = heart
Nifedipine = vessels

Question 8

Clopidogrel: Type of drug, mechanism of action

Answer 8

Anti-platelet drug

Prevents platelet aggregation by modifying the ADP receptors on the platelet surface

Question 9

Loop diuretic: Example and mechanism of action

Answer 9

Example: Furosemide, bumetanide
Mechanism: Reduces Na+ and Cl- reabsorption in ascending limb of loop of Henle

Question 10

Thiazide diuretic: Example and mechanism of action

Answer 10

Bendroflumethiazide

Mechanism: Reduces Na+ reabsorption in distal convoluted tubule

Question 11

Give an example of a potassium sparing diuretic

Answer 11

Amiloride

Question 12

What type of anti-arrhythmic drug is amiodarone?

Answer 12

Type III

Question 13

What type(s) of AF might be amenable to cardioversion?

Answer 13

Only persistent

Not paroxysmal or permanent.

Question 14

What is the treatment for permanent AF? 1st and 2nd line

Answer 14

1st line = beta blocker e.g. bisoprolol OR calcium channel blocker e.g. diltiazem, verapamil
2nd line = digoxin

Question 15

When is digoxin indicated?

Answer 15

Rate control in AF with left ventricular failure

Question 16

What is the mechanism of action of digoxin and what effect does this have?

Answer 16

Mechanism: Increases vagal tone
Effect: Slows AV node conduction

Question 17

Give 2 examples of non-dihydropyridine calcium channel blockers

Answer 17

Verapamil, diltiazem

Question 18

Which drug(s) can be used for acute cardioversion and maintaining sinus rhythm in a patient with a structurally normal heart?

Answer 18

Flecainide

Sotalol

Question 19

Which drug(s) can be used for acute cardioversion and maintaining sinus rhythm in a patient with a structurally abnormal heart?

Answer 19

Amiodarone

Question 20

What is adenosine and what is it used for?

Answer 20

A purine agonist, it causes a large AV blockade so is used to restore sinus rhythm in supra ventricular tachycardias.

Question 21

What are some key side effects of adenosine?

Answer 21

Bronchospasm, heaviness in the chest, flushing

Question 22

How is adenosine administered?

Answer 22

IV bolus in increasing amounts until AV block is achieved

Question 23

What is the termination for supra ventricular tachycardia (1st line and 2nd line)?

Answer 23

1st line: Vagal manoeuvres, carotid sinus massage, adenosine

2nd line: calcium channel blocker or beta blocker

Question 24

What is used for prevention of supra ventricular tachycardias?

Answer 24

Flecainide

Radiofrequency ablation

Question 25

List some side effects of furosemide

Answer 25

``` Hypokalaemia Hypomagnesia Hyperglycaemia Gout Tinnitus Hypocalaemia ```

Question 26

List 3 drugs which may cause tinnitus

Answer 26

Furosemide Gentamicin Vancomycin

Question 27

What effect does furosemide have on calcium levels? What effect does bendroflumethiazide have on calcium levels?

Answer 27

Furosemide = Hypocalcaemia | Thiazide diuretics = Hypercalcaemia

Question 28

What is the management process for acute pulmonary oedema?

Answer 28

``` Oxygen IV furosemide IV GTN CPAP Diamorphine Digoxin ```

Question 29

What is metolazone and when might it be used?

Answer 29

Acts like a thiazide diuretic, can be used in heart failure when patient on maximum dose of all other medications

Question 30

What dose of bumetanide corresponds to 120mg of furosemide?

Answer 30

120mg of bumetanide corresponds to about 3mg of furosemide

Question 31

What effect does metolazone have on potassium?

Answer 31

Causes hyPOkalaemia - thiazide diuretics are not potassium sparing Thiazide diuretics also cause hyponatraemia

Question 32

Which vessels does hydralazine dilate?

Answer 32

Arterial vessels

Question 33

Which vessels does isosorbide mononitrate effect?

Answer 33

Causes vasodilation in venous system

Question 34

What are the indications for use of flecainide?

Answer 34

Medical cardioversion and maintaining sinus rhythm in atrial fibrillation and DVTs. Used in young patients with structurally normal hearts as can cause arrhythmias.

Question 35

Which agents could you use for rate control of chronic atrial fibrillation in a patient with a structurally normal heart

Answer 35

Beta blocker e.g. bisoprolol | Calcium channel blocker e.g. diltiazem, verapamil

Question 36

Which agent would you use for rate control of chronic atrial fibrillation in a patient with heart failure?

Answer 36

Digoxin

Question 37

What is used for an overdose of beta blockers?

Answer 37

Glucagon infusion

Question 38

What is used for an overdose of calcium channel blockers?

Answer 38

IV calcium, then insulin is 2nd line