Cardiovascular medication

Question 1

When are antihypertensive drugs prescribed?

Answer 1

When diet and physical activity changes are not successful or practical

Question 2

How do antihypertensive drugs generally work?

Answer 2

Relaxing and dilating blood vessels or acting on the kidneys to help increase urination

Question 3

What is considered hypertensive?

Answer 3

140/90

Question 4

How is blood pressure calculated?

Answer 4

Cardiac output x systematic vascular resistance

Question 5

What factors do antihypertensive act on?

Answer 5

Blood volume
Contractility
Heart rate
Systemic vascular resistance

Question 6

How do thiazide diuretics work?

Answer 6

Reducing sodium reabsorption at the distal convoluted tubule

Question 7

What are the most commonly prescribed diuretics alongside an antihypertensive?

Answer 7

Bendeoflumethiazide
Indapamide

Question 8

Why do patients on thiazide diuretics need to have potassium levels checked?

Answer 8

Thiazide diuretics aren’t potassium sparing and higher levels of potassium will be excreted

Question 9

How do loop diuretics work?

Answer 9

They increase sodium excretion in the loop of Henle

Question 10

What are the most powerful and fastest acting types of diuretics?

Answer 10

Loop diuretics

Question 11

What are potassium sparing diuretics?

Answer 11

Diuretics which do not waste potassium

Question 12

How do potassium sparing diuretics work?

Answer 12

By blocking the sodium potassium pumps in the last part of the distal tubule and the start of the collecting duct

Question 13

What do ACE inhibitors do?

Answer 13

Stop angiotensin 1 turning into angiotensin 2

Question 14

What patients are given ACE inhibitors?

Answer 14

Patients with:
Hypertension
Heart failure
ACS
Chronic kidney disease

Question 15

What are ARBs?

Answer 15

Angiotensinogen II receptor blockers

Question 16

How do calcium channels blockers work?

Answer 16

Inhibition of muscle contraction and nerve transmission

Question 17

What tissues do Nifedipine and Amlodipine have their main effect on?

Answer 17

Vascular smooth muscle

Question 18

What tissues does Verapamil have its main effect on?

Answer 18

Conductive tissue

Question 19

What tissues does Diltiazem have its main effect on?

Answer 19

Coronary vasculature

Question 20

What do beta blockers inhibit?

Answer 20

Adrenaline and noradrenaline

Question 21

Are atenolol and bisoprolol selective or non selective beta blockers?

Answer 21

Selective

Question 22

Are propranolol and labetalol selective or non selective beta blockers?

Answer 22

Non-selective

Question 23

What are non-selective beta-blockers prescribed for?

Answer 23

Cardiac arrhythmias, anxiety and migraines

Question 24

What are HMG-CoA reductase inhibitors?

Answer 24

Statins - Drugs that lower cholesterol

Question 25

How do statins lower cholesterol?

Answer 25

Interrupting the **cholesterol synthesis pathway** in the liver, **inhibiting HMG-CoA reductase**, preventing **mevalonic acid** from forming and activating its pathway which leads to **reduced cholesterol synthesis**

Question 26

How do statins affect the levels of LDLs and HDLs in the body?

Answer 26

Reduces LDLs Increases HDLs (promotes production)

Question 27

What is the difference between LDLs and HDLs?

Answer 27

LDL cholesterol (“bad” cholesterol) **makes up most of your body’s cholesterol.** LDLs form plaque and cause atherosclerosis. High levels of LDL cholesterol **raise** your risk for heart disease and stroke. HDL cholesterol (“good” cholesterol) **absorbs cholesterol in the blood** and **carries it back to the liver.** The liver then flushes it from the body. High levels of HDL cholesterol can **lower** your risk for heart disease and stroke.

Question 28

What are the 4 classes of anti-arrhythmic medications?

Answer 28

Class I - Sodium channel blockers Class II - Beta blockers Class III - Potassium channel blockers Class IV - Calcium channel blockers

Question 29

What are class I anti arrhythmic medications?

Answer 29

Sodium channel blockers (end in -dipine)

Question 30

What are class I anti-arrhythmic medications used to treat?

Answer 30

Atrial fibrillation and supra-ventricular tachycardias

Question 31

What are the two most common cardiac specific sodium channel blockers?

Answer 31

Flecainide Propafenone

Question 32

What effect at low and high doses does Sotalol have?

Answer 32

At low doses it acts as a beta-blocker and at higher doses it acts as a sodium channel blocker

Question 33

What are class II anti arrhythmic medications?

Answer 33

Beta blockers (end in -olol)

Question 34

How do class II anti-arrhythmic medications work?

Answer 34

Blocking the **beta receptors** in the **SA and the AV node** -**extending the action potential**

Question 35

What are class II anti-arrhythmic medications used to treat?

Answer 35

AF, SVTs, VTs

Question 36

What are class III anti-arrhythmic medications?

Answer 36

Potassium channel blockers

Question 37

What do class III anti-arrhythmic medications do?

Answer 37

Prolong the QT

Question 38

Which patients should not be given class III anti-arrhythmic medications?

Answer 38

Patients with prolonged QTs such as patients with Brugada's syndrome

Question 39

Why should you be mindful of potassium channel blocker overdoses?

Answer 39

Patients may take low doses of non-cardiac specific potassium channel blockers for other conditions, usually having no effect on the heart. During an overdose higher levels of these drugs may cause arrhythmias

Question 40

What are class IV anti-arrhythmic drugs and what are they used to treat?

Answer 40

Calcium channel blockers - primarily SVTs (can also treat VTs but potassium channel blockers shown to be much more effective)

Question 41

What are the two types of class IV anti-arrhythmic drugs and how do they differ?

Answer 41

**Dihydropyridines (DHPs)** e.g. nifedipine and amlodipine **Non-dihydropyridines (Non-DHPs)** e.g. diltiazem and verapamil. The two classes both help to relax and widen arteries but **non-dihydropyridines have an additional effect on the heart’s conduction system** and can help to control certain fast heart rhythms (such as atrial fibrillation). This is because **non-dihydropyridines also block calcium going into the conducting cells in the heart**, which has the effect of slowing down the heart rate.

Question 42

What are thrombocytes?

Answer 42

Platelets

Question 43

Where are platelets produced?

Answer 43

The bone marrow

Question 44

What is the lifespan of platelets?

Answer 44

7-10 days

Question 45

What do platelets do once activated?

Answer 45

Become 'sticky' and release clotting mediators

Question 46

What are the three parts of haemostasis?

Answer 46

Adhesion Activation Aggregation

Question 47

What stage of haemostasis do anti-platelets usually act on?

Answer 47

Activation