Drug treatment for complex heart disease

Question 1

Define myocardial infarction

Answer 1

Irreversible necrosis of heart muscle secondary to prolonged ischaemia

Question 2

4 particularly prevelant risk factors for MI

Answer 2

High blood pressure
High blood cholesterol
Diabetes
Family history of premature CAD

Question 3

Function of thrombolytics

Answer 3

Clot buster

Question 4

What is tissue plasminogen activator

Answer 4

Fibrinolytic agent found in endothelial cells
Exhibits significant fibrin specificity and affinity binding of tpa and plasminogen to fibrin induces conformational change
faciliates conversion of plasminogen to plasmin clot dissolves

Question 5

What inhibits conversion of plasminogen to plasmin

Answer 5

Plasminogen activator inhibitor 1 (PAI 1)

Question 6

What activates conversion of plasminogen to plasmin

Answer 6

tissue plasminogen activate t-PA

Question 7

What inhibits conversion of plasmin to fibrin

Answer 7

Thrombin activatable fibrinolysis inhibitor (TAFI)

Question 8

What inhibits conversion of fibrin to thrombin

Answer 8

FDPs

Question 9

Simple mechanism of aspirin

Answer 9

Irreversible inhibitor of COX
Platelets cannot make new proteins as lack nucleus
Stops thromboxane production

Question 10

What is thromboxane

Answer 10

Potent platelet stimulator

Question 11

How are side effects minimised when a low dose of aspirin is gievn

Answer 11

Low dose inhibits platelets in portal blood so is rapidly destroyed in systemic circulation

Question 12

When is aspirin contraindicated

Answer 12

Children <16 y old

Small risk of fulminant liver failure

Question 13

When is aspirin cautioned

Answer 13

Bleeding diathesis

Severe hypertension

Question 14

Why is aspirin given to pregnant women and what are potential side effects

Answer 14

To reduce risk of pre-eclampsia

Small risk of closure of DA which could lead to PPHN

Question 15

Can you use aspirin when breast feeding

Answer 15

Small amounts get into breast milk- avoid due to risk of Reyes syndrome

Question 16

Can you give aspirin to patients with liver disease?

Answer 16

Avoid due to bleeding risk

Often auto-anticoagulated due to reduced clotting factors

Question 17

Can you given aspirin to patients with renal disease

Answer 17

Increased risk of bleeding

Salt and water retention

Question 18

Why are beta blockers used for patients with AMI?

Answer 18

BBs reduces infarct size and early mortality when started early
Lowers risk of death when continued long term

Question 19

Where are beta 1 receptors found

Answer 19

Heart and kidney

Question 20

Where are beta 2 receptors found

Answer 20

Lungs, peripheral blood vessels, skeletal muscle

Question 21

Action of beta blockers on the kidney?

Answer 21

Blocks beta 1 receptors
Inhibits renin release
Reduces RAAS

Question 22

Action of beta blockers of the heart

Answer 22

Blocks beta 1 receptors on SAN reduces heart rate (negative chronotrophic effect(
blockage of beta 1 in myocardium reduces contractibility (negative inotropic effect(

Question 23

Action of beta blockers on the central and peripheral nervous system

Answer 23

Blockage of beta-receptors in the brainsteam and of prejunctional beta receptors in the periphery inhibits release of neurotrasmitters and decreases sympathetic nervous system activity

Question 24

Give three examples of cardioselective beta blockers

Answer 24

atenolol
bisoprolol
metoprolol

Question 25

Name a beta blocker which acts as a local anaesthetic and anti-arrhythmic effect

Answer 25

sotalol

Question 26

Name a beta blocker with partial agonist activity

Answer 26

Pindolol

Question 27

What risks are associated with a mother using beta blockers during pregnancy?

Answer 27

Intra-uterine growth restriction Neonatal hypoglycaemia Bradycardia

Question 28

Can you be on beta blockers as a breast feeding mother?

Answer 28

Infants should be monitored as small chance of toxicity. However, usually too small amount to affect infants

Question 29

Can you use beta blockers if you have renal disease

Answer 29

Sometimes | Some beta blockers are renally excreted and accumulate in renal failure

Question 30

What is the rate limiting step in cholesterol synthesis

Answer 30

HMG-coA

Question 31

What are statins

Answer 31

Competitive natural or synthetic inhibitors of HMG-coA

Question 32

What is propranolol and where does it act

Answer 32

Beta antagonist | Acts to prevent renin release

Question 33

Where does aliskiren act?

Answer 33

Conversion of angiotensinogen to angiotensin 1 | anti hypertensive

Question 34

Where does captopril act?

Answer 34

Angiotensin 1 to angiotensin 2 (ACE inhibitor) | anti hypertensive

Question 35

Where does losartan act?

Answer 35

Blocks AT1 receptors | anti hypertensive

Question 36

How do ACE inhibitors work?

Answer 36

Competitive inhibitor of plasma ACE enzyme, preventing conversion of angiotensin 1 to active 2 leads to vasodilation by preventing ang 2 constriction effects greatest when RAAS ssytem is up

Question 37

True or false- most ACE inhibitors are pro drugs that require conversion to active form

Answer 37

TRUE

Question 38

Describe the events that occur after an MI which can lead to ventricular remodelling and myocardial dysfunction

Answer 38

- Survivors of MI have significant risk of future cardiovascular events - Infarct expansion due to thinning and stretching of infarct zone - Significant left ventricular dilation can begin within 3 hours - Remodelling process begins with myocyte necrosis and formation of fibrotic scar. - Followed by elongation of infarcted segment and then dilation and hypertrophy of border zone ventricular myocardium

Question 39

Basic mechanism of clopidogrel?

Answer 39

P2Y12a inhibitor | Further inhibits platelet aggregation

Question 40

What is the role of thrombolytics?

Answer 40

Immediately stop ongoing infusion of thrombolytic drug | Stop all antiplatelet and anticoagulant therapies

Question 41

7 side effects of ADRs

Answer 41

``` Bronchospasm Bradycardia Hypotension Memory Diabetogenis Erectile dysfunction Worsens psoriasis ```

Question 42

What is the main affect of ACE inhibitors

Answer 42

Dry irritant cough