Cardiovascular system

Question 1

list some alpha blockers? (3)

Answer 1

doxazosin

tamsulosin

alfuzosin

Question 2

common indications for alpha blockers? (2)

Answer 2

1. improve symptoms in benign prostatic enlargement
2. add on therapy in resistant hypertension

Question 3

MOA of alpha blockers?

Answer 3

most are highly selective for alpha 1 adreoreceptor found in smooth muscle i.e. blood vessels and urinary tract

stimulation causes constriction so therefore,

blockade with alpha1 blockers cause vasodilation and a fall in BP and reduced resistance to bladder outflow

Question 4

adverse effects of alpha blockers?

Answer 4

postural hypotension

dizziness

syncope

Question 5

alpha blockers should be avoided in what pt group?

Answer 5

those with existing postural hypotnesion

Question 6

which of the alpha blockers doxazosin or tamsulosin are licensed for benign prostatic enlargement only?

Answer 6

tamsulosin

doxasozin is licensed for benign prostatic enlargement and hypertension

Question 7

when in the day should doxasozin be taken?

Answer 7

at night time due to the BP lowering effect (at least initially)

Question 8

how could you communicate the use of alpha blockers to the pt?

Answer 8

treatment for their urinary symptoms/ blood pressure

advise that it may cause dizziness when standing (particularly after first dose) so should take at night time

Question 9

in hypertension doxasozin is typically reserved for pts who do not respond to other drug classes.

why in some men is it considered a lot earlier in treatment?

Answer 9

many men with hypertension also have benign prostatic enlargement

can treat both with a single drug

Question 10

adenosine is the first line diagnostic and therapeutic agent in which heart condition?

Answer 10

supreventricular tachycardia (SVT)

Question 11

MOA of adenosine?

Answer 11

agonist of adeonsine receptors

increases AV node refractoriness- this breaks re-entry circuit allowing normal depolarisations from SAN to resume normal HR (cardioversion)

when circuit does not involve AVN i.e. Atrial flutter adenosine will not induce cardioversion

Question 12

adverse effects of adenosine?

Answer 12

bradycardia

asystole

(sinking feeling in chest, breathlessness and impending doom described by the patient however this feeling in only breif )

Question 13

pts with which medical conditions cannot be given adenosine?

Answer 13

hypotension

coronary ischameia

decompensated HF

asthma/COPD

heart transplant

Question 14

which antiplatelet agent can block the uptake of adenosine?

Answer 14

dipyramidole (dose of adeonsine must be halved)

Question 15

how is adenosine prescribed?

Answer 15

IV followed by sodium chloride flush

only by expereinced doctors

Resus should be on stand by

Question 16

how could you communicate adenosine use to the pt?

Answer 16

treatment to hopefully ‘reset’ their heart back to normal rythym

will feel horrible but will only last 30 seconds

continue to talk to pt during administration

Question 17

following administratioin of adenosine how should the pt be monitored?

Answer 17

continous cardiac rythym strip

Question 18

adrenaline is also known as?

Answer 18

epinephrine

Question 19

common indications for adrenaline? (3)

Answer 19

1. cardiac arrest
2. anaphylaxis
3. local vasoconstriction in tissues

Question 20

MOA of adrenaline?

Answer 20

potent agonist of alpha 1, 2 and Beta 1, 2 adrenoreceptors

vasoconstriction of vessels supplying skin/mucosa (a1) whilst increasing HR and contraction force (B1). vasodilation of blood vessels supplying heart (B2) also bronchodilatioin

Question 21

treatment with which drug can result in widespread vasoconstriction if given adrenaline?

Answer 21

B- blockers

(a1 vasoconstricting effect of adrenaline is not opposed by B2 medicated vasodilation)

Question 22

adrenaline is given after the third shock in which cardiac arrest rhythms?

Answer 22

Ventricular fibrillation (VF) or pulseless Ventricular tachycardia (VT)

Question 23

how should adrenaline be administered in 1) cardiac arrest and 2) anaphylaxis?

Answer 23

1. pre-filled syringe IV followed by flush of sodium chloride
2. IM injection into thigh halfway between hip and knee

Question 24

name aldosterone antagonists?

Answer 24

spironolactone, eplerenone

Question 25

common indications for aldosterone antagonists? (3)

Answer 25

1. ascites and oedema due to liver cirrhosis 2. chronic heart failure 3. primary hyperaldosteronism

Question 26

MOA of aldosterone antagonists?

Answer 26

inhibit the effect of aldosterone by **competitively binding to the aldosterone recpetor** _increases sodium and water excretion and potassium retention_

Question 27

adverse effects of aldosterone antagonists?

Answer 27

**hyperkalaemia** → muscle weakness, arrhythmias gynaecomastia (spironolactone)

Question 28

aldosterone antagonists are contraindicated in pts with which exisiting medical conditions? (3)

Answer 28

severe renal impairment hyperkalaemia addisons disease

Question 29

are aldosterone antagonists safe in pregnancy?

Answer 29

can cross the placenta and appear in breast milk so should be avoided in pregnant or lactating women

Question 30

which drugs can increase the risk of hyperkalaemia if used with aldosterone antagonists?

Answer 30

potassium elevating drugs i.e. ACE inhibitors and ARBs

Question 31

how should aldosterone antagonists be monitored?

Answer 31

symptos and clinical findings potassium levels and renal function should be regularly checked with FBC

Question 32

why is spironolactine usually prescribed in combination with a loop or thiazide diuretic?

Answer 32

it is a relatively weak diuretic and can take several days to start havign an effect

Question 33

common indications for amiodarone?

Answer 33

tachyarrhythmias including AF, SVT, VT and VF used when other drugs or cardioversion are ineffective or innapropriate

Question 34

MOA of amiodarone?

Answer 34

blockade of Na, Ca and K channels and antagonism of alpha and beta receptors interferes with AVN reducing ventricular rate in AF and atrial flutter may break the circuit in SVT

Question 35

amiodarone should be avoided in pts with which conditions?

Answer 35

severe hypotension heart block active thyroid disease

Question 36

how could you communicate use of amiodarone to the pt?

Answer 36

offering a treatment to try and correct their fast or irregular heart rhythm

Question 37

what should pts be told to avoid in their diet following amiodarone?

Answer 37

grapefruit juice

Question 38

when prescribing amiodarone why should you not just repeat the previous prescription?

Answer 38

this could have been a loading dose- need to check if on lonterm therapy and should be a maintanence dose

Question 39

list ACE inhibitors?

Answer 39

ramipril lisinopril perindopril

Question 40

common indications for ACE inhibitors? (4)

Answer 40

1. hypertension 2. chronic HF 3. Ischaemic heart disease 4. diabetic nephropathy and CKD with proteinuria

Question 41

MOA of ACE inhibitors?

Answer 41

**prevent conversion of angiotensin I to angiotensin II** angiotensin II is a vasoconstrictor and stimulates aldosterone secretion (blocking it therefore reduces BP and dilates efferent glomerular arteriole, reducing intraglomerular pressure slowing CKD progression)

Question 42

common adverse effects of ACE inhibitors? (4)

Answer 42

hypotension persistnet dry cough hyperkalaemia worsen renal failure

Question 43

ACE inhibitors shoul dbe avoided in pts with which conditions?

Answer 43

renal artery stenosis acute kidney injury (AKI) pregnancy/ breastfeeding

Question 44

ACE inhibitors should not be prescribed alongisde which other drugs?

Answer 44

potassium elevating drugs i.e. aldosterone antagonists

Question 45

how could you explain the use of ACE inhibitors to the patient?

Answer 45

offering Tx to improve BP and reduce strain on their heart need to come in for blood tests to monitor their kidney function and potassium advise to avoid ibuprofen due to risk of kidney damage

Question 46

how should ACE inhibitors be monitored?

Answer 46

symtpoms and BP renal function

Question 47

why should ACE inhbitors be started at a low dose and titrated up?

Answer 47

can cause profound hypotension following first dose especially if on other diuretics

Question 48

list some ARBs (3)

Answer 48

losartan candesartan irbesatran

Question 49

common indications for ARBs? (4)

Answer 49

1. hypertension 2. chronic heart failure 3. ischaemic heart disease 4. diabetic nephropathy and CKD with proteinuria

Question 50

MOA of ARBs?

Answer 50

block the action of angiotensin II on the angiotensin type 1 receptor similar effects as ACE inhibitor (low BP, slow CKD prgression)

Question 51

adverse effects of ARBs?

Answer 51

hypotension hyperkalaemia renal failure

Question 52

what causes the dry cough in ACE inhbitors but not with ARBs?

Answer 52

bradykinin

Question 53

ARBs should be avoided in pts with which conditions?

Answer 53

renal artery stenosis AKI pregnancy/breastfeeding

Question 54

what drugs should be avoided when prescribing ARBs?

Answer 54

other potassium elevating drugs i.e. aldosterone antagonsits

Question 55

antimuscarinics used in cardio (3)

Answer 55

atropine hyoscine butylbromide glycopyrronium

Question 56

common indications for antimuscarinics in cardio? (2)

Answer 56

1. atropine used to treat bradycardia 2. care of dying pt (hyoscine butylbromide is useful fro reducing respiratory secretions

Question 57

MOA of antimuscarinic drugs?

Answer 57

competitive inhibitor of acetylcholine increase heart rate, reduce smooth muscel tone and reduce secretions from resp and gi tract

Question 58

adverse effects of antimuscarinics?

Answer 58

tachycardia dry mouth constipation can cause urinary retention in those with BPE blurred vision due to pupillary dilation

Question 59

antimuscarinics should be used with caution in pts with which conditions?

Answer 59

those susceptible to angle-closure glaucoma risk of arrhythmias

Question 60

atropine is the preffered treatment for which cardiac symtpom?

Answer 60

bradycardia

Question 61

why must the initial dose of atropine be no less than 600mcg?

Answer 61

low-dose atropine may transiently slow HR