Cardiovascular drugs

Question 1

Indication for Amlodipine?

Answer 1

First line for over 55 or Black African or African–Caribbean family origin AND not type 2 diabetes.

Question 2

All calcium channel blockers can be used to control symptoms in people with what? What is the main alternative?

Answer 2

Stable angina in people with ischaemic heart disease. Alternative is beta blocker.

Question 3

Indication of Diltiazem and Verapamil?

Answer 3

Are used to control heart rate in people with supra-ventricular arrhythmia, including supra-ventricular tachycardia, atrial flutter, and atrial fibrillation.

Question 4

What is mechanism of action (MOA) for CCB in hypertension management?

Answer 4

They decrease calcium ion (Ca2+) entry into vascular and cardiac cells, reducing intracellular calcium concentration. This causes relaxation and vasodilation in arterial smooth muscle, lowering arterial pressure.

Question 5

What is mechanism of action (MOA) for CCB in angina management?

Answer 5

They suppress cardiac conduction, particularly across the atrioventricular (AV) node, slowing ventricular rate. Reduced ventricular rate, contractility, and afterload reduce myocardial oxygen demand,preventing angina.

Question 6

What are the two types of CCB?

Answer 6

Dihydropyridines- Amlodipine, Nifedipine are more selective of the vasculature.
Non-dihydropyridines- Verapamil. Diltiazem are more selective of the heart.

Question 7

Which CCB is most cardio selective?

Answer 7

Verapamil. Diltiazem also has some effects on blood vessels.

Question 8

What are the common side effects of Amlodipine and Nifedipine?

Answer 8

Ankle swelling, flushing, headache, and palpitations, which are caused by vasodilation and compensatory tachycardia.

Question 9

What are the common side effects of Diltiazem and Verapamil?

Answer 9

Verapamil commonly causes constipation and less often, but more seriously, bradycardia, heart block,and cardiac failure. As Diltiazem has mixed vascular and cardiac actions,it can cause any of these adverse effects.

Question 10

Why should verapamil and Diltiazem be used in caution in people with poor left ventricular function?

Answer 10

Their use can precipitate or worsen heart failure.

Question 11

When should verapamil and Diltiazem be avoided?

Answer 11

In people with AV nodal conduction delay in whom they can provoke complete heart block.

Question 12

Why should Amlodipine and nifedipine be avoided in patients with unstable angina?

Answer 12

The vasodilation causes a reflex increase in contractility and tachycardia, which increases myocardial oxygen demand.

Question 13

What type of calcium channel blockers should not be prescribed with beta blocker and why?

Answer 13

Non-Dihydropyridines.
Both drug classes are negatively inotropic and chronotropic, and together may cause heart failure, bradycardia and even asystole.
They can be given together only under close specialist supervision.

Question 14

When should amlodipine nad nifedipine be avoided and why?

Answer 14

In severe aortic stenosis due to the risk of collapse.

Question 15

What should you communicate with the patient before prescribing them CCB?

Answer 15

1. Explain why the calcium channel blocker has been prescribed, as appropriate for the indication.
2. Discuss other measures to reduce cardiovascular risk, including smoking cessation.
3. Highlight common side effects, particularly ankle oedema if relevant.

Question 16

How would you monitor a patient taking CCB?

Answer 16

Regular BP to judge treatment efficacy.
Ask about chest pain, Pulse rate and rhythm for angina or do an ECG for arrhythmia.
Stopping gradually to prevent withdrawal angina.

Question 17

what class of drug is Clopidogrel?

Answer 17

Antiplatelet drug (Blood thinner)

Question 18

Clopidogrel Indications?

Answer 18

• Treatment of ACS in combination of Aspirin
• to Prevent Coronary Artery Stent occlusion
• Secondary prevention of major CVD events in patients at risk

Question 19

Clopidogrel mechanism of action?

Answer 19

• Clopidogrel is metabolised to its active form by carboxylesterase-1,3
• the active form is a platelet inhibitor that binds to P2Y12 ADP receptors on platelets.
• The binding prevents ADP binding to the P2Y12 receptors, activation of the glycoprotein GPllb/llla complex, and platelet aggregation

Question 20

Clopidogrel contradictions ?

Answer 20

Patients who are/have:
- Active GI bleeding
- Active Cranial bleeding
- Severe hepatic impairment
- Pregnancy
- Breastfeeding

Question 21

Clopidogrel caution?

Answer 21

patients at risk of increased bleeding from trauma, surgery, or other pathological conditions

Question 22

Clopidogrel side effects ?

Answer 22

• GI bleeding
• intracranial bleeding
• abdominal pain
• dyspepsia
• epistaxis
• Thrombocytopenia

Question 23

Clopidogrel interactions?

Answer 23

Clopidogrel is activated by hepatic CYP enzymes therefore efficacy me be reduced by CYP inhibitors such as
- omeprazole
- Ciprofloxcin
- erythromycin
- some antifungals
- some selective serotonin reuptake inhibitors
- grapefruit juice

Question 24

What are the common indications for aspirin?

Answer 24

1) Treatment of ACS (acute coronary syndromes) + acute ischaemic stroke
2) Prevention of major cardiovascular events (MI/ stroke)
3) Mild to moderate pain relief

Question 25

What is the mechanism of action for aspirin?

Answer 25

Anti-platelet drug - inhibits the cyclooxgenase (COX) enzyme - reduces platelet aggregation + risk of arterial occlusion

Question 26

What are common side effects of aspirin?

Answer 26

Asthmatic attack/ haemorrhage/ nausea

Question 27

Contraindications (aspirin) + interactions

Answer 27

Children under 16yrs (risk of reye’s syndrome)
Aspirin hypersensitivity
3rd trimester pregnancy

Interaction -
Anticoagulants - increased risk of bleeding

Question 28

what class of drug is Aspirin?

Answer 28

Anti-platelet