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Cardiovascular Disease Flashcards

Cardiovascular conditions; CVD risk factors; ACS diagnosis; MI; Antiplatelets; Beta blockers; Statins; Renin angiotensin system; ACE inhibitors; ARBs; Angina; Nitrates; CCBs; Anticoagulants; Parental anticoagulants; Oral anticoagulants; Direct oral anticoagulants. (123 cards)

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1
Q

9 CVD conditions

A 
Angina 
MI 
Heart valve disease 
Vascular disease 
Arrythmias 
Cardiomyopathy 
Congenital heart failure 
Heart failure 
Pericardial disease
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2
Q

10 risk factors for CVD

A 
Smoking 
Obesity 
Family history 
Diabetes 
Hypertension 
Inactive lifestyle 
Drugs 
Electrolyte imbalance 
Hyperlipidaemia
Increased age
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3
Q

Process of ACS diagnosis

onset of what symptom, type of MI or painful condition called…based on what feature of ECG + test result

A

Pt admitted with chest pain
Diagnosed with ACS
Continuing ST elevation = STEMI
Abnormal ST/T wave with increased/decreased troponin levels = NSTEMI or Unstable angina
Normal ECG with increased/decreased troponin = Stable angina

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4
Q

What occurs in myocardial infarction?

what tissue, lack of what leading to what

A

Myocardial/cardiac muscle ischaemia leading to necrosis of myocardium

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5
Q

What leads to MI?

pathophysiology of clot formation

A

Rupture or erosion of artherosclerotic plaque within tunica intima layer of artery.
Dislodged plaque results in thrombus formation.
Thrombus partially or fully occludes artery decreasing or cutting off blood supply to myocardium.

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6
Q

What 3 generic tests are carried out to diagnose MI?

3 blood tests for diagnosis

A

ECG
Blood chemistry: U&Es, FBC, Troponin
Chest X-ray

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7
Q

What 4 groups of drugs should patients following MI be prescribed?

A 
BARS: 
Beta blocker 
Anti-platelet 
Renin angiotensin system blocker
Statin
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8
Q

What are the 2 types of MI and describe their cause, what they occlude?
(thrombus)

A

NSTEMI - Atheromatous plaque with partially occluding thrombus, may cause occlusion of small coronary arteries due to platelet aggregation.
STEMI - artheromatous plaque that completely occludes coronary artery.

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9
Q

Which 2 hormones are involved in the mechanism of platelets and do they stimulate/inhibit aggregation?

A

Thromboxane - activates platelet aggregation

Prostacyclins - inhibits platelet aggregation

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10
Q

Name 4 mechanisms of platelets in clotting

A

Adhesion
Shape change
Secretion
Aggregation

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11
Q

What is a drug interaction and ADR of all anti-platelets?

A

Interaction - SSRIs as seritonin is involved in platelet formation
ADR - GIT bleeds

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12
Q

What is the function/mechanism of asprin?

enzyme, hormone, inhibits ? in regards to platelets

A

Non-selective COX1 inhibitor

Inhibits production of thromboxane thus preventing platelet aggregation

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13
Q

What is an ADR of asprin and how is it caused?

A

GIT irritation
Caused by inhibition of cytoprotective prostaglandins resulting in decreased stomach acid secretion and unregulated blood flow. Increasing risk of GIT ulcer formation.

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14
Q

5 contraindications of asprin use

A 
Dyspepsia 
Active GIT ulcer 
Under 16 yrs 
Hypersensitivity 
Severe hepatic impairment
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15
Q

2 drug interactions of asprin

A

Anticoagulants

NSAIDs

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16
Q

Name 3 anti platelet drugs

A

Asprin
Clopidogrel
Ticagrelor

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17
Q

What is the function/mechanism of clopidogrel?

binds to what preventing what

A

Inhibits platelet aggregation

Acts as a ADP receptor antagonist preventing the binding of fibrin with platelets = no aggregation.

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18
Q

What organ is clopidogrel metabolised by?

A

Liver

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19
Q

5 ADRs of clopidogrel

A 
Nausea/vomiting 
GIT discomfort 
Rash 
Thrombocytopenia (low thrombocyte count <150000 mc/L) 
GIT bleeds
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20
Q

3 drug interactions of clopidogrel

A

NSAIDs
Anticoagulants
PPIs

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21
Q

3 contraindications for the use of clopidogrel

A

Hypersensitivity
Active bleed
Severe hepatic impairment

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22
Q

How does ticagrelor work?

A

Inhibits platelet aggregation

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23
Q

What does ticagrelor do to liver enzymes?

A

Reversibly inhibits liver enzymes

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24
Q

Which one of the 3 antiplatelet medications requires a loading dose of 180mg before BD doses?

A

Ticagrelor

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25
4 ADRs of ticagrelor
Dysponea Nausea/vomiting Rash Bruising
26
4 drug interactions of ticagrelor and the reason for them
``` Clarythromycin Simvastatin Digoxin Rifampicin Caused by drug being metabolised/inhibiting liver enzymes ```
27
3 contraindications for ticagrelors use
Active bleed Pregnancy Moderate-severe hepatic impairment
28
How do beta blockers work?
Reduce oxygen requirement of cardiac muscle cells
29
True or false, beta blockers require titrating to a max tolerated dose?
True
30
4 mechanisms of how beta blockers work
Slow heart rate Decrease heart contractility Decrease blood pressure Improve coronary oxygenation
31
4 ADRs of beta blockers
Fatigue Bradycardia Hypotension Bronchospasm
32
4 contraindications for beta blockers use
Acute heart failure Symptomatic bradycardia/ hypotension Severe asthma/ COPD Hypersensitivity
33
4 drug interactions with beta blockers
Veranapril NSAIDs Topical beta blockers Anti-hypertensives
34
What is the function of statins?
Lower concentration of lipids in circulation
35
5 mechanisms of statins
``` Inhibit HMG-CoA enzyme Stabilise plaque Decrease cholesterol by improving clearance of LDL Improve endothelial function Prevent thrombus formation ```
36
2 ADRs of statins
Myopathy (muscle disease) | Hepatoxicity
37
What 3 interactions occur with statins? | eat, enzyme
Grapefruit Metabolised by CYP enzymes check BNF Amylodapine
38
4 management interventions for NSTEMI
Angiogram Angioplasty Coronary artery bypass grafting (CABG) Percutaneous coronary intervention (PCI)
39
2 types of stent
Metal stent | Drug emitting
40
4 functions of renin angiotensin system
Regulation of BP and volume, blood sodium and water concentration
41
Where is renin produced and what does it stimulate where?
Kidneys | Stimulates angiotensin production in liver
42
Where is angiotensin produced and what does it stimulate where?
Liver | Stimulates the release of aldosterone from the adrenal cortex
43
Where is aldoserone produced and what does it stimulate where?
Adrenal cortex | Stimulates the uptake of sodium and water in the kidneys
44
What stimulates the release of atrial natriuretic hormone and what is it's function?
Release stimulated by increased blood volume Negatively feeds back into RAAS to inhibit aldosterone production causing maintenance of blood water and sodium concentration
45
2 classes of drugs involved in the renin angiotensin aldosterone system
Angiotensin converting enzyme (ACE) inhibitors | Angiotensin receptor blockers (ARBs)
46
Explain mechanism of ACE inhibitors | system involved in, what stage, which hormone
Renin angiotensin aldosterone system | Intercepts at lungs preventing conversion of angiotensin I to angiotensin II
47
What two things should be monitored when taking ACE inhibitors?
Kidney function and BP
48
Explain the mechanism of ARBs | which system, where by doing what
Renin angiotensin system | Acting as competative angiotensin II receptor antagonists
49
4 ADRS of ACEIs and ARBs
Dry cough Dizziness Hyperkalaemia Angiodema
50
3 drug interactions with ARBs and ACEI
NSAIDs K sparing diuretics K supplements
51
4 contraindications for ACEI and ARBs use
Pregnancy Renal stenosis Hereditary angiodemia Hypersensitivity
52
What 5 drugs may be given to someone with angina?
``` Asprin Angiotensin converting enzyme inhibitors Calcium channel blockers Statins Nitrates ```
53
What is angina and what is it caused by?
Chest pain felt due to ischaemia of coronary arteries reducing oxygen supply to cardiac muscle cells, caused by coronary artery disease
54
What are 2 events that may bring on symptoms of angina?
Physical activity | Obstruction of blood flow
55
What do drugs for angina aim to stimulate?
Smooth muscle relaxation
56
4 types of angina
Stable Unstable Variant Microvascular
57
3 features of stable angina | ?expected, trigger, duration, relief with?
Predictable, able to be reproduced Triggered by emotional/physical stress Short in duration Relief with rest
58
3 features of unstable angina | ?expected, trigger, duration
Unexpected, change in stable angina Spontaneous, can occur at rest Duration >30mins
59
4 features of variant angina | ?expected, trigger, duration, causes what
Sudden onset, no warning No identified trigger, can occur at rest Duration >15mins Causes lasting heart damage
60
3 features of microvascular angina | ?expected, trigger, duration
Unpredictable No identified trigger >10-30 mins
61
Explain the mechanism of nitrates for angina | chemical, conversion to which substrate, for which enzyme, to convert to which substance, which stimulates what
Convert nitrate ions into nitric oxide Nitric oxide is the substrate for guanylate cyclase enzyme Guanylate cyclase converts nitric oxide into guanosine monophosphate cGMP cGMP stimulates smooth muscle relaxation
62
What is GTN spray used for?
Relief of angina chest pain | Secondary prevention for angina related to exercise
63
What does GTN stand for?
Glyceryl trinitrate
64
6 ADRs of nitrates
``` Postural hypotension Flushing Reflex tachycardia Tolerance Headache Nausea ```
65
2 drug interactions with nitrates
Phosphodiesterase type 5 inhibitors (pulmonary hypotension) | Anti-hypertensives
66
How does GTN work?
Stimulates vasodilation, widening lumen of coronary arteries improving blood supply to coronary arteries
67
5 steps f GTN spray use
``` Chest pain occurs Stop, sit, rest Spray GTN sublingually - wait 5 mins Chest pain persists = spray GTN sublingually again - wait 5 minutes Pain persists = call 999 ```
68
4 ADRs of GTN
Headache Dizziness Nausea/vomiting Low BP
69
What is the action of nicorandil?
Dual action as a nitrate and potassium channel agonist
70
Explain the mechanism of nicorandil | binds to what, stimulates what having what overall effect
Binds to potassium channels - indirectly blocking calcium channels + directly stimulating increase in coronary perfusion and vasodilation Nitrate aspect binds to calcium channels on smooth muscle - lowing ventricular filling pressure and SVR Both increase blood supply and oxygen to cardiac muscle
71
4 ADRs of nicorandil
Headache Nausea Diziness Fatigue
72
2 drug interactions with nicorandil
Antihypertensives | Phophodiesterase type 5 inhibitors
73
2 contraindications of nicorandil's use
Low BP/pulmonary oedema
74
How do calcium channel blockers work?
Relax smooth muscle and decrease HR
75
What are calcium channel blockers and alternative medication to?
Beta blockers
76
Explain mechanism of calcium channel blockers | where is the receptor located, what do they stop, what effect do they have
Bind to calcium channels on smooth muscles Block influx of calcium ions Results in smooth muscles remaining relaxed
77
Name 3 classes of calcium channel blockers
Benzothiazepines Dihydropyridines Phenyalkylamines
78
Action of dihydropyridines | selective to what, used for treatment in what, cause what
Selective to smooth muscles Used to treat hypertension Cause reduction in stroke volume
79
Action of phenylalkylamine | selective to what, cause what
Selective to myocardium | Cause vasodilation
80
Action of benziorhiazepines | selective to what, cause what
Selective to cardiac muscle | Cause vasodilation
81
5 ADRs of calcium channel blockers
``` Oedema Hypotension Bradycardia Headache Constipation ```
82
3 drug interactions with calcium channel blockers
Amlodipine enzyme inducers/inhibitors Anti-hypertensives Verapamil
83
What 2 parts of the clotting cascade to be aware of?
Factor Xa | Thrombin
84
What 2 parts of the clotting cascade is factor Xa involved in?
Intrinsic and extrinsic pathway
85
What is thrombin what does it produce and what is that required for? (clotting cascade)
Enzyme that produces the protein fibrin required for binding to platelets allowing their aggregation
86
9 ideal features of anticoagulants
``` Wide therapeutic range No food or drug ADRs Oral administration Rapid onset/offset of action Predictable effect with weight determined dosing No routine monitoring Reversible Cost effective Suitable for pts with renal/hepatic impairment ```
87
Name two parenteral anticoagulants
Heparin | Low molecular weight heparin
88
What is protamine used for?
Reversal agent for heparin
89
Explain heparin's mechanism of action in preventing clotting (binds to what, inactivates what, preventing what 2 conversions)
Binds to antithrombin Inactivates factor Xa Prevents conversion of prothrombin to thrombin, fibrogen to fibrin preventing clotting
90
Via what route and method is heparin administered?
IV via continuous infusion
91
What is the half life of heparin?
1-2 hours
92
Via what organ is heparin cleared from the body?
Liver
93
What is the name of the monitoring that is required when pt is on heparin? (aPPT)
Activation partial thromboplastin time (aPPT)
94
What is activation partial thromboplastin time a measure of?
Time it takes the blood to clot
95
What is a normal activation thromboplastin time? | in secs
60-70secs
96
Why is a aPPT activator added to heparin?
To narrow the reference range
97
Define 'the reference range' | heparin
Time taken for a pt on heparins blood to clot
98
What is an ideal reference range for someone on heparin? | in secs
30-40secs
99
Above how many seconds for aPPT and PPT does spontaneous bleeding occur?
``` aPPT= >70seconds PPT= >100 seconds ```
100
Explain the mechanism of action of low molecular weight heparin as an anticoagulant (binds to what, effecting what in the clotting cascade)
Binds to antithrombin | Effecting factor Xa
101
Give 7 reasons why low molecular weight heparin is preferred to heparin (dosing, half life, monitoring- in which pts, clearance, effect on platelets, reduces risk of what)
Given OD/ BD Half life: 5-7 hours Monitoring: only in certain pts - children with poor renal function/low weight; pts with creatinine clearance <30ml/min Less inhibition of platelets Lower risk of heparin induced thrombocytopenia (HIT)
102
What is vitamin K and what is it needed for? | solubility, clotting cascade
Fat soluble vitamin | Needed for the production of clotting factors in the clotting cascade
103
What is the mechanism of action of direct oral anticoagulants? (act on what in clotting cascade)
Direct effect on thrombin and factor Xa in clotting cascade
104
Name 4 main direct oral anticoagulants
Apixaban Dabigatran Endoxaban Rivaroxaban
105
Which 1 of the 4 direct oral anticoagulants effects thrombin?
Dabigatran
106
Which 3 of the 4 oral anticoagulants effect factor Xa?
Apixaban Endoxaban Rivaroxaban
107
How does dabigatran interfere with the clotting cascade? What type of drug is it? (clue: what does it require to become active)
Interferes with thrombin | It is a prodrug needing first pass metabolism to be activated.
108
What is praxbind the reversal drug for?
Dabigatran
109
What is an ADR of dabigatran?
Dyspepsia
110
2 interactions of dabigatran
ATP inhibitor/inducer | Anti-platelets
111
7 contraindications for dabigatran's use
``` Hypersensitivity Possit box Creatinine clearance <30ml/min Active bleed Surgery Hepatic impairment Prosthetic heart valve ```
112
What is the mechanism of rivaroxaban, apixaban, endoxaban in the clotting cascade? (inhibits what, interupting what, stopping what)
Inhibit factor Xa Interrupt intrinsic and extrinsic pathway of clotting cascade Stop formation of thrombin preventing the development of thrombi.
113
What is andexXa a reversal drug for?
Factor Xa inhibiting drugs
114
9 ADRs of rivaroxaban, apixaban, endoxaban
``` Nausea/vomiting Diarrhoea Jaundice Alopecia Rash Hepatic impairment Pyrexia Headache Haemorrhage ```
115
5 contraindications for rivaroxaban, apixaban, endoxaban's use
``` Hypersensitivity Pts with poor adherence Bleeding complications Creatinine clearance of <15ml/min Active bleed ```
116
What type of anticoagulant is warfarin?
Oral anticoagulant
117
What is warfarin's mechanism of action? | enzyme it effects, vit ...
Inhibits vitamin K reductase that activates vitamin K
118
Where does warfarin metabolism occur?
Liver CYP enzymes
119
True or false the effects of warfarin can last after the end of dose?
True
120
What monitoring test is required when a patient is on warfarin?
International normalised ratio
121
4 ADRs of warfarin
Bleeding Nausea/vomiting Liver dysfunction Jaundice
122
5 contraindications of warfarin
``` Pregnancy Haemorrhagic stroke Hypersensitivity Active bleed Surgery <72 hrs ```
123
What 2 groups of drugs interact with warfarin?
Anti-coagulants | Non-prescription drugs - herbal remedies, vitamins, alternative medicines, OTCs

Pharmacology (10 decks)

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