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cardiology > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

name some examples of ACEi

A
  • ramipril
  • lisinopril
  • captopril

look for “pril” ending

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2
Q

describe the mechanism of action ACEi

A
  1. angiotensin converting enzyme (ACE) is found in the pulmonary circulation and endothelium of blood vessels
  2. ACE converts angiotensin I to angiotensin II, thereby increasing the blood pressure
  3. ACEi block this conversion and reduces blood pressure

reduces the activity of the renin-angiotensin-aldosterone system (RAAS)

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3
Q

describe the effects fo angiotensin II

A

increase blood pressure
* vasoconstriction
* vascular smooth muscle hypertrophy
* ventricular remodelling
* hypertrophy
* aldosterone and vasopressin release

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4
Q

what are the indications for an ACEi?

A
  • hypertension
  • angina
  • post-MI
  • symptomatic heart failure
  • diabetic nephropathy
  • prevention of cardiovascular events
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5
Q

describe ACEi side-effects

A

CAPTOPRIL
* Cough - caused by an increase in bradykinin levels
* Angio-oedema
* Proteinuria
* Taste disturbance/teratogenic in 1st trimester
* Other (fatigue, headache)
* Potassium increased
* Renal impairment
* Itch
* Low BP (1st dose)

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6
Q

what are the contra-indications to ACEi use?

A
  • pregnancy and breast feeding
  • aortic stenosis
  • renovascular disease
  • idiopathic angioedema
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7
Q

what U&Es need to be monitored while on ACEi?

A
  • creatinine - increase of 30% = acceptable
  • potassium - increased to 5.5mmol/L = acceptable
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8
Q

name some thiazide-like diuretics

mineralocorticoid antagonists

A
  • spironolactone
  • eplerenone
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9
Q

describe the mechanism of action of thiazide-like diuretics

mineralocorticoid antagonists

A
  1. mineralocorticoids are synthesized in the adrenal glands
  2. bind to mineralocorticoid receptors in the cells in the renal tubule
  3. leads to increased sodium reabsorption and potassium excretion in the distal tubule and collecting duct
  4. via the formation of more Na-K-ATPase pumps and epithelial sodium channels (ENaC)
  5. thiazide-like diuretics block this mechanism
  6. leads to potassium reabsorption and sodium excretion
  7. this results in water excretion which decreases blood pressure
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10
Q

what are the indications for thiazide-like diuretics?

A
  • ascites in liver cirrhosis
  • congestive heart failure
  • nephrotic syndrome
  • resistant hypertension
  • primary hyperaldosteronism
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11
Q

what are the side-effects of thiazide-like diuretics?

A
  • increased urination
  • nausea and vomiting
  • stomach cramps
  • hyperkalaemia
  • diarrhoea
  • gynaecomastia
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12
Q

what are the contra-indicatiosn to thiazide-like diuretics?

A
  • addison’s disease
  • anuria
  • hyperkalaemia
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13
Q

what classic of medication is isoprenaline?

A

selective beta-adrenoceptor agonist

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14
Q

describe the mechanism of action of isoprenaline

A
  1. stimulation of b1-adrenoceptors leads to positive inotropic and chronotropic effects
  2. leads to an increase in cardiac force and rate
  3. stimulation of b2-adrenoceptors leads to vasodilatation
  4. reduces peripheral resistance and blood pressure
  5. mean arterial pressure falls
  6. this hypotension leads to reflex tachycardia due to the baroreceptor reflex
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15
Q

describe the mechanisms of action of digoxin

A
  1. inhibits the Na/K ATPase ion pump in the myocardium
  2. also has parasympathetic effects on the AV node
  3. negatively chronotropic and positively ionotropic
  4. slows heart rate but increases contractility
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16
Q

what effects does digoxin have on an ECG?

A
  • downslopping ST depression
  • T-wave changes (inversion)
  • biphasic/flattened and shortened QT interval
  • slight PR interval prolongation
  • prominent U-waves

morphology of the QRS complex/ST segment = slurred/sagging and resembling a reverse tick

17
Q

what are the features of digoxin toxicity?

A
  • nausea/vomiting
  • diarrhoea
  • blurred vision
  • yellow/green discolouration of vision
  • haloes in vision
  • confusion
  • fatigue
  • palpitations
  • syncope
18
Q

name some examples of statins

A
  • simvastatin
  • atorvastatin
  • pravastatin
19
Q

describe the mechanism of action of statins

A
  1. statins inhibit the action of hydroxy beta-methylglutaryl-CoA (HMG-CoA) reductase which is the rate-limiting enzyme in hepatic cholesterol synthesis
  2. means less cholesterol is produced by the liver so the levels in the blood will decrease
20
Q

what time of day should statins be taken?

A

at night - because this is when most cholesterol synthesis takes place

21
Q

what are the indications for statins?

A

primary prevention
* anyone with a 10-year cardiovascular risk (Qrisk) >= 10%
* type 1 diabetes mellituse diagnosed for >10 years or aged >40 years or with concurrent nephropathy

secondary prevention
* stoke/TIA
* ischaemic heart diseae
* peripheral arterial disease

22
Q

what are the side-effects of statins?

A
  • myalgia
  • myositis
  • rhabdomyolysis
  • hepatic impairment
23
Q

what are the contra-indications to statins?

A
  • macrolides (erythromycin, clarithromycin)
  • pregnancy
24
Q

what is the most serious acute side-effect in statins?

A

myositis in the form of rhabdomyolysis

25
Q

what blood test should be monitored when on statins?

A

checking LFTS at baseline and at 3 and 12 months after starting treatment

26
Q

what enzyme is responsible for regulating the rate of cholesterol synthesis?

A

HMG-CoA reductase

27
Q

name some calcium-channel blockers

A

dihydropyridine (DHP) - nifedipine, amlodipine
non-dihydripyridine (non-DHP) - verapamil, diltiazem

28
Q

describe the mechanism of action of calcium-channel blockers?

A

block L-type voltage-gated calcium channels

29
Q

what is the role of L-type voltage-gated calcium channels?

A
  • excitation-contraction coupling of all muscle types
  • conduction of cardiac electrical signals
  • regulation of aderenal gland secretion of aldosterone and cortisol
30
Q

what impacts do calcium-channel blockers have on the body?

A
  • arteriodilation
  • reduced contractility of the heart
  • decreased heart rate
  • reduced aldosterone production (decreasing blood pressure)
31
Q

what are the indications for calcium-channel blockers?

A

DHP
* hypertension
* raynaud’s syndrome
* angina

non-DHP
* angina
* arrhythmias (verapamil only)

32
Q

what are the side-effects of calcium-channel blockers?

A
  • hot flushes
  • bradycardia
  • ankle oedema
  • headache
  • hypotension
  • constipation
33
Q

what are the contra-inducations for calcium-channel blocker use?

A
  • sick sinus syndrome
  • severe hypotension
  • concurrent beta blocker use
  • heart failure
34
Q

what is the only calcium-channel blocker which can be used in heart failure?

A

amlodipine

cardiology (17 decks)

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