CVM drugs

Question 1

ACE inhibitors are used for the treatment of

Answer 1

hypertension, heart failure, MI, nephropathy

Question 2

ACE inhibitor approved for use in nephropathy is

Answer 2

Captopril

Question 3

Name 3 side effects from the use of ACE inhibitors

Answer 3

first dose hypotension, cough, hyperkalemia, renal failure, angioedema

Question 4

why is cough a side effect of ACE inhibitors but not a side effect of ARBs

Answer 4

ACE inhibitors facilitate breakdown of bradykinin - causes increase sensitivity and cause cough. But ARBs do not

Question 5

What is the Frank Sterling law?

Answer 5

Increase filling of ventricles will increase in contractility of heart > Increase cardiac output (fill more, pump more)

Question 6

What are the 2 forms of heart failure?

Answer 6

Systolic heart failure (HFrEF) and diastolic heart failure (HFpEF)

Question 7

What is the mechanism of action of beta-blockers in treatment of heart failure?

Answer 7

• blocks B1 receptors on heart and decreases heart rate and contractility
• blocks B1 receptors on juxtaglomerular cells in the kidney > reduce renin production > reduce BP > reduce afterload
• blocks B1 receptors on juxtaglomerular cells in the kidney > reduce aldosterone production > reduce Na/H2o reabsorption > reduce plasma volume

Question 8

What is the mechanism of action of beta-blockers in treatment of angina

Answer 8

• blocks B1 receptors > decrease in HR and contractility > reduce O2 demand, increase diastolic filling time > increase flow to coronaries

Question 9

Name 2 non selective beta blockers and 2 B1 selective beta blockers

Answer 9

Non selective: propanolol, carvediol

Selective B1: Bisoprolol, metoprolol, atenolol

Question 10

Name the 3 beta blockers that have been shown to be effective in treatment of heart failure

Answer 10

Bisoprolol, metoprolol, carvediol

Question 11

Contraindications of use of ACE inhibitors and ARBs

Answer 11

Pregnancy (drugs are teratogenic)

Question 12

Name 3 medical conditions in which beta blockers are contraindicated

Answer 12

Asthma (due to B2 adrenoceptors - causing bronchoconstriction), diabetes (masking sympathetic effects during hypoglycemia), sick sinus syndrome/AV blocks

Question 13

Name 3 side effects of beta-blockers

Answer 13

Hypotension, AV nodal blocks, CNS effects (sedation, vivid dreams, rarely depression), asthma exacerbation

Question 14

What are the 2 types of calcium channel blockers?

Answer 14

Dihydropyridines and non-dihydropyridines

Question 15

Name 2 examples of dihydropyridines and 2 examples of non-dihydropyridines

Answer 15

DHP: Nifedipine, Amlodipine

Non DHP: Verapamil, Dilitiazem

Question 16

Why is Nifedipine not useful in the treatment of arrthymias?

Answer 16

Nifedipine is a non-dihydropyridines - does not act on the cardiac myocytes to decrease contractility

Question 17

Name 3 side effects of calcium channel blockers

Answer 17

Hypotension, cardiac suppression (bradycardia, AV blocks, heart failure), constipation, vasodilatory effects (flushing, dizziness, headache, peripheral edema)

Question 18

What medical conditions can calcium channel blockers be used to treat?

Answer 18

1) Arrthymias (Non DHP)
2) Hypertension (both DHP and non DHP)
3) Angina (both DHP and non DHP)

Question 19

What drugs will interact with loop diuretics?

Answer 19

NSAIDs

Loop diuretics induce renal synthesis of prostaglandins > increasing renal blood flow

Question 20

At which site of the nephron does loop diuretics work?

Answer 20

Thick ascending limb of loop of Henle

Question 21

Why are loop diuretics most efficacious?

Answer 21

It works at the thick ascending limb of loop of Henle where about 25% of Na reabsorption takes place

Question 22

Name 3 side effects of loop diuretics

Answer 22

Hypotension, Hypokalemia, Hypomagnesemia, ototoxicity, hyperuricemia

Question 23

Name 3 side effects of thiazides

Answer 23

Hypokalemia, Metabolic alkalosis, Hyperglycaemia, Hyperlipidemia, Hyponatremia, Hypercalcemia

Question 24

At which site of the nephron does thiazides work on? Name of cotransporter which they work on?

Answer 24

Distal convoluted tubule. Na/Cl cotransporter

Question 25

What is the site of action of potassium-sparing diuretics?

Answer 25

Collecting tubules

Question 26

What are the 2 mechanism of actions of potassium-sparing diuretics?

Answer 26

1) Act by inhibiting Na ion channels > decrease Na reabsorption 2) Competitive antagonists at aldosterone receptors > decrease in synthesis of intracellular proteins > inhibit opening of Na channels > decrease Na reabsorption

Question 27

Name 2 examples of potassium-sparing diuretics

Answer 27

Spironolactone, Amiloride

Question 28

What is the mechanism of action of Digoxin?

Answer 28

Inhibits Na/K ATPase, keeping Na+ in the cells > leads to Na/Ca exchanger pumping Na+ out of cell and bringing Ca2+ into the cells > CICR >contraction

Question 29

Name a serious adverse effect of digoxin

Answer 29

Arrthymias (due to increase in intracellular Ca > issues with automaticity, extrasystoles)

Question 30

Management of digoxin toxicity?

Answer 30

1) Discontinue 2) Correct electrolyte abnormalities 3) Anti-arrthymias 4) Digoxin antibody > to dilute levels of digoxin in body

Question 31

Name 2 classes of lipid lowering drugs that will work on reducing LDLs

Answer 31

Statins, Bile acid sequestrants, cholesterol absorption inhibitors, PCSK9 inhibitors

Question 32

Mechanism of action of statins

Answer 32

1) Inhibitors of HMG-CoA reductase which is the rate limiting enzyme of cholesterol biosynthesis > decrease cholesterol production 2) upregulate LDL receptors > increase LDL uptake 3) decrease VLDL production, increase HDL production