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cardiovascular pharmacology Flashcards

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1
Q

what are the targets for therapy to manage BP control?

A
  1. Cardiac output and Peripheral Resistance
  2. Interplay between:
    a. Renin-Angiotensin-Aldosterone system
    b. Sympathetic nervous system (noradrenaline)
  3. Local vascular vasoconstrictor and vasodilator mediators
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2
Q

what are 4 Angiotensin Converting Enzyme (ACE) inhibitors?

A
  1. ramipril
  2. enalapril
  3. perindopril
  4. trandolapril
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3
Q

what are the main clinical indications that would result in a patient having ACE inhibitors?

A

Hypertension
Heart failure
Diabetic nephropathy

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4
Q

what are the main adverse effects of ACE inhibitors related to reduced angiotensin II formation?

A

a. Hypotension- can reduce BP too much
b. Acute renal failure- angiotensin 2 restrict efferent arteriole
c. Hyperkalaemia
d. Teratogenic effects in pregnancy

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5
Q

what are the main adverse effects of ACE inhibitors related to increased kinins?

A

a. Cough
b. Rash
c. Anaphylactoid reactions
( ace inhibitors prevent the conversion from angiotensin I to II but increases the conversion of bradykinin to inactive peptides)

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6
Q

what are the main clinical indications that would result in a patient taking Angiotensin II receptor blockers ( ARB)?

A

Hypertension
Diabetic nephropathy
Heart failure (when ACE-I contraindicated)

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7
Q

what are 5 examples of Angiotensin II receptor blockers ( ARB)?

A
  1. Candesartan
  2. Losartan
  3. valsartan
  4. irbesartan
  5. telmisartan
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8
Q

what are the main adverse effects of Angiotensin II receptor blockers ( ARB)?

A

Symptomatic hypotension (especially volume deplete patients)
Hyperkalaemia
Potential for renal dysfunction
Rash
Angio-oedema

Contraindicated in pregnancy
Generally very well tolerated

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9
Q

what are the main clinical indications that would result in a patient taking Calcium Channel Blockers ( CCB)?

A

Hypertension
Ischaemic heart disease (IHD) – angina
Arrhythmia (tachycardia)

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10
Q

What are 6 calcium channel blockers?

A
  1. Amlodipine
  2. Nifedipine
  3. Diltiazem
  4. Felodipine
  5. Lacidipine
  6. verapamil
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11
Q

what are 3 L-type calcium channel blockers?

A
  1. Dihydropyridines
  2. Phenylalkylamines
  3. Benzothiazepines
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12
Q

name 4 examples of Dihydropyridines

A

nifedipine, amlodipine, felodipine, lacidipine

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13
Q

what do Dihydropyridines do?

A

Preferentially affect vascular smooth muscle
Peripheral arterial vasodilators

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14
Q

name an example of a Phenylalkylamines

A

verapamil

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15
Q

what do Phenylalkylamines do?

A

Main effects on the heart
Negatively chronotropic, negatively inotropic

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16
Q

name an example of a Benzothiazepines

A

diltiazem

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17
Q

what do Benzothiazepines do?

A

Intermediate heart/peripheral vascular effects

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18
Q

what are the main adverse effects of CCB blockers due to peripheral vasodilatation (mainly dihydropyridines)
?

A

Flushing
Headache
Oedema
Palpitations

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19
Q

what are the main adverse effects of CCB blockers due to negatively chronotropic effects (mainly verapamil/diltiazem)?

A

Bradycardia
Atrioventricular block

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20
Q

what are the main adverse effects of CCB blockers due to negatively inotropic effects (mainly verapamil)?

A

Worsening of cardiac failure

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21
Q

what is an adverse effect of verapamil?

A

causes constipation

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22
Q

what are the main clinical indications that would result in a patient taking Beta- adrenoreceptor Blockers ( BB)?

A

Ischaemic heart disease (IHD) – angina
Heart failure
Arrhythmia
Hypertension

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23
Q

Name 6 beta- adrenoreceptor blockers

A
  1. Bisoprolol
  2. carvedilol
  3. propranolol
  4. metoprolol
  5. atenolol
  6. nadolol
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24
Q

describe the term cardioselective

A

often used to imply β-1 selectivity
This is a misnomer since up to 40% of cardiac β-adrenoceptors are β-2

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25
what are the main adverse effects of Beta- adrenoreceptor blockers ( BB)?
Fatigue Headache Sleep disturbance/nightmares Bradycardia Hypotension Cold peripheries Erectile dysfunction
26
what three conditions do beta blockers worsen?
1. Asthma (may be severe) or COPD 2. PVD – Claudication or Raynaud’s 3. Heart failure – if given in standard dose or acutely
27
what are the major clinical indications that would result in diuretics?
Hypertension Heart failure
28
what are the 4 classes of diuretics?
1. Thiazides and related drugs (distal tubule) 2. Loop diuretics (loop of Henle) 3. Potassium-sparing diuretics 4. Aldosterone antagonists
29
name 3 thiazide related diuretics
1.BENDROFLUMETHIAZIDE 2. HYDROCHLOROTHIAZIDE 3. CHLORTHALIDONE
30
name 3 loop diuretics
1. FUROSEMIDE 2. BUMETANIDE
31
name 4 potassium sparing diuretics
1. SPIRONOLACTONE 2. EPLERENONE 3. AMILORIDE 4. TRIAMTERINE
32
what are main adverse effects of diuretics?
Hypovolaemia (mainly loop diuretics) Hypotension ( “ ) Low serum potassium (hypokalaemia) Low serum sodium (hyponatraemia) Low serum magnesium (hypomagnesaemia) Low serum calcium (hypocalcaemia) Raised uric acid (hyperuricaemia – gout) Impaired glucose tolerance (mainly thiazides) Erectile dysfunction (mainly thiazides)
33
name 1 α-1 adrenoceptor blockers
doxazosin
34
name 2 centrally acting anti hypertensitives
MOXONIDINE METHYLDOPA
35
name 1 direct renin inhibitor
ALISKIREN
36
what are 3 other antihypertensives?
α-1 adrenoceptor blockers Centrally acting anti-hypertensives Direct renin inhibitor
37
what is LVSD?
Heart failure due to left ventricular systolic dysfunction
38
What is HFPEF
Heart failure with preserved ejection fraction (diastolic failure)
39
what does heart failure suggest?
the efficiency of the heart as a pump is impaired.
40
what is heart failure caused by?
by structural or functional abnormalities of the heart.
41
what is the most common cause of heart failure?
is coronary artery disease
42
what does heart failure cause?
morbidity, mortality, hospital admissions and substantial cost
43
what is the treatment with the most benefits for heart failure?
is with vasodilator therapy via neurohumoral blockade (RAAS - SNS) and not from LV stimulants
44
what is a symptomatic treatment of congestion?
diuretics- usually loop
45
what is disease influencing therapy and what does it do/ target?
neurohumoral blockade Inhibition of renin-angiotensin-aldosterone system Inhibition of the sympathetic nervous system
46
what is the first line of treatment for heart failure ?
ACE inhibitors and beta blocker therapy Low dose and slow uptitration
47
what are
a. First line: ACE inhibitors and beta blocker therapy Low dose and slow uptitration b. Aldosterone antagonists c. Consider ARNI – Aldosterone Receptor antagonist and Neprilysin Inhibitor d. Consider SGLT2 inhibitor e. ACE-I intolerant: Angiotensin receptor blocker f. ACE-I and ARB intolerant: Hydralazine/nitrate combination g. Consider digoxin or ivabradine
48
what do nitrates do?
Arterial and venous dilators Reduction of preload and afterload Lower BP
49
what is the main use of nitrates?
Ischaemic heart disease (angina) Heart failure
50
name three nitrate medications
ISOSORBIDE MONONITRATE GTN SPRAY GTN INFUSION
51
describe chronic stable angina
Anginal chest pain Predictable Exertional Infrequent Stable
52
describe Unstable angina / acute coronary syndrome (NSTEMI)
Unpredictable May be at rest Frequent Unstable
53
describe ST elevation myocardial infarction/ ( STEMI)
Unpredictable Rest pain Persistent Unstable
54
Whattwo types therapy are used to treat chronic stable angina ?
1. Antiplatelet therapy Aspirin Clopidogrel if aspirin intolerant 2. Lipid-lowering therapy Statins (simvastatin, atorvastatin, rosuvastatin, pravastatin) (Comorbidities may determine which therapy)
55
what short acting nitrate is used for chronic stable angina?
GTN spray for acute attack
56
what is the first line of treatment for chronic stable agina?
Beta blocker or Calcium channel blocker if intolerant switch if not controlled combine
57
with chronic stable angina - if intolerant or uncontrolled than combine BB or CCB with..?
Long acting nitrate Ivabradine Nicorandil Ranolazine
58
what pain relief is used in Acute coronary syndromes (NSTEMI and STEMI)?
GTN spray Opiates – diamorphine
59
what therapies are used In Acute coronary syndromes (NSTEMI and STEMI)?
Dual antiplatelet therapy: Aspirin plus ticagrelor or prasugrel or clopidogrel Antithrombin therapy: Fondaparinux . Background angina therapy: beta blocker, long acting nitrate, calcium channel blocker 6. Lipid lowering therapy: Statins 7. Therapy for LVSD/heart failure as required: ACE-I, beta blocker, aldosterone antagonist
60
in Acute coronary syndromes (NSTEMI and STEMI when would you Consider Glycoprotein IIb IIIa inhibitor/ which ones?
(high risk cases): ): tirofiban, eptifibatide, abciximab
61
describe class I of Vaughan Williams Classification?
Sodium channel blockers
62
describe class Ia of Vaughan Williams Classification
Ia - disopyramide, quinidine, procainamide
63
describe class Ib of Vaughan Williams Classification
Ib - lidocaine, mexilitene
64
describe class Ic of Vaughan Williams Classification
Ic - flecainide, propafenone
65
describe class II of Vaughan Williams Classification
Beta adrenceptor antagonists - propranolol, nadolol, carvedilol (non-selective) - bisoprolol, metoprolol (β1-selective)
66
describe class III of Vaughan Williams Classification
Prolong the action potential - amiodarone, sotalol
67
describe class IV of Vaughan Williams Classification
Calcium channel blockers - verapamil, diltiazem
68
what is digoxin?
Cardiac glycoside
69
what does digoxin do?
Inhibit Na/K pump
70
what are the main effects of digoxin on the heart?
Bradycardia (increased vagal tone) Slowing of atrioventricular conduction (increased vagal tone) Increased ectopic activity Increased force of contraction (by increased intracellular Ca)
71
side effects of digoxin
Narrow therapeutic range Nausea, vomiting, diarrhoea, confusion
72
when is digoxin usually used?
Used in atrial fibrillation (AF) to reduce ventricular rate response Use in severe heart failure as positively inotropic
73
what are the adverse side effects of amiodarone ?
QT prolongation Polymorphic ventricular tachycardia Interstitial pneumonitis Abnormal liver function Hyperthyroidism / Hypothyroidism Sun sensitivity Slate grey skin discolouration Corneal microdeposits Optic neuropathy Multiple drug interactions Very large volume of distribution

Cardiology (17 decks)

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