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Cardiovascular > Pharmacology > Flashcards

Pharmacology Flashcards

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1
Q

Statins and Fibrates

A

Anti Cholesterol drugs

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2
Q

Anticoagulant

A

warfarin

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3
Q

Streptokinase tPA

A

Fibrionolytic- used to dissolve a clog which is already there

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4
Q

Aspirin and Clopidogrel

A

antiplatelet drugs

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5
Q

What class of drugs block Na reabsorption in kidneys?

A

diuretics

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6
Q

Furosemide

Bendorfluazide

A
  1. Thiazide diuretics (mild)- hypertension

2. Loop diuretics (stronger)- heart failure

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7
Q

Name some side effects of diuretics

A

K lost from urine- hypokalaemia- tired and arrhythmias

Hyperglycaemia- diabetes

Increased blood sugar levels, increased uric acid- gout

Impotence

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8
Q

Name the 2 classes of beta blockers- which receptors do they block?

A

Cardioselective blocks only B1 receptors

Non selective B blockers blocks B1 and B2

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9
Q

Give an example of each Beta blocker and why they are used

A

B1- atenolol used in angina, hypertension and heart failure

B1+2- used less frequently to block tremor of overactive thyroid

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10
Q

Why should you never use Beta blockers in asthma?

A

Tired,heart failure and cold peripheries

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11
Q

Why are Beta blockers good in long term but not short term?

A

They can worsen heart failure in short term

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12
Q

Name some drugs in Dihyropydrine Ca anatagonists and Rate limiting Ca antagonists

A

Amlodipine

Verapamil, Diltiazem

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13
Q

What does the alpha blockers Doxazosin do and when is it used?

A

blocks alpha adrenoceptors to cause vasodilatation- sed in hpyertension and prostatic hypertrophy but can cause postural hypotension

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14
Q

What is the action of an ACE inhibitor?

A

blocks angiotensin 1 from becoming angiotensin II

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15
Q

Give an example of an ACE inhibitor and what is their typical suffix?

A

Lisinopril and -PRIL

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16
Q

What are the benefits of ACE inhibitors?

A

Hypertension, renal dsyfunction, good for kidneys in diabetic nephtopathy, back for kidneys in renal stenosis

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17
Q

What are the side effects of ACE inhibitors?

A

Dry cough, renal dysfunction, angioneurotic oedema- NEVER GIVE TO A PATIENT WHO HAS HAD LARYNX ODEMA IN PAST

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18
Q

In which patients should ACE inhibitors never be used?

A

Pregnant women and women of child bearing age

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19
Q

What side effect can be avoided by prescribing an Angiotensin Receptor Blocker (ARB) instead of an ACE inhibitor

A

Dry cough

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20
Q

Give an example of an ARB and its generic suffix

A

Losartan -ARTAN

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21
Q

What class of drugs does Isosorbide mononitrate belong to and what is it used it?

A

Nitrates

Angina and ACUTE heart failure

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22
Q

In what class of drugs is tolerance common and how should this be tackled?

A

Nitrates- prescribe during the day but not at night. 8hr periods at a time

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23
Q

What class does these drugs belong to?

A

Aspirin, Clopidogrel, Ticgrelor, Prasugrel

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24
Q

What is the major risk of anti platelet drugs?

A

Haemorrhage

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25
What class is Bezafibrate and what can it be used in?
hypertiglyceridaemia, low HDL cholesterol
26
What are the following drugs used in: Amiodarone, beta blockers, fecainide?
Ventricular arthymias
27
What is digoxin?
A cardiac glycoside that increases contractility of the heart
28
What does Digoxin do to AV conduction?
It causes a degree of AV conduction delay
29
Why is digoxin useful in heart failure?
Reduces SV hence reduces CO
30
Why is digoxin good in AF?
It reduces the ventricular rate of beating to half the rate
31
What does digoxin do to the ventricles?
Increases ventricular irritability which produces ventricular arrythmias
32
What is If current and how is it carried?
Funny current carried by Na influx- "long current"
33
Name a molecular entity targeted by drugs to decrease heart rate
HCN
34
Name an If blocker and what is it useful in?
Ivabradine in angina
35
Describe the mechanism of Digoxin
3Na is kicked up and 2K goes back in...3Na goes back in and 1 Ca is kicked out
36
What opens HCN channels?
cAMP
37
What are the standard limb leads?
I- RA-LA II- RA-LL III- LA-LL
38
What are the augmented limb leads?
aVL, aVR, aVF
39
What are the 7 questions that should be asked in an ECG analysis?
1. Is electrical activity present? 2. Is the rhythm regular or irregular? 3. What is the HR? 4. P waves present? 5. What is the PR interval (needs to be less than 0.1s) 6. Is each P wave followed by QRS? 7. Is QRS duration normal?
40
What does an ECG not include?
MI, Intermittent Rhythm Disturbance and stable angina
41
What does HDL do?
Reverses cholesterol transport by transporting it back to the liver by "scavenger receptor"
42
What are the components of an arterial thrombus and what occurs as a result?
It is a "white thrombus" which is mainly platelets in a fibrin mesh and it detaches from its site of origin e.g. left heart/carotid artery. It can lodge in an artery in the brain causing a stroke
43
What are the components of an venous thrombus and what occurs as a result?
Red thrombus: white head and jelly like tail, fibrin rich. If detaches forms an embolus that usually lodges in the lung (PE)
44
Once the endothelial is damaged, what are the 2 main pathways concerned?
Platelet reactions and blood coagulation
45
In the blood coagulation cascade, what is the series of events?
Platelets release preformed mediators such as ADP or synthesise others such as TXA2 which activate other platelets, causing an activation cascade
46
What pathway activates prothrombin then thrombin
X--> Xa--> II--> IIa
47
What does Vitamin K activate?
carboxylase enzyme which mediates gamma carboxylation
48
What does Warfarin do pharmacologically?
It prevents reduced forms of vitamin K from forming which are needed or the activation cascade
49
Name the glycoprotein precursors
VII, IX, X
50
Name the serine proteases
VIIa, IXa, Xa
51
What can anticoagulants be used to prevent and treat?
Venous thrombosis NOT arterial
52
What can anticoagulants prevent and treat and what is the risk?
DVT, post op thrombosis, patients with artificial heart valves, AF Risk of haemorrhage
53
What factors does Warfarin block?
II, VII, IX, X
54
How can the mechanism of warfarin be reversed?
Through administration of vitamin K or concentrate clotting factors
55
How can the coagulation cascade be prevented from spinning out of control?
By Antithrombin III which along with heparin prevents antithrombin X from becoming Xa and II from becoming IIa
56
What is the mechanism of heparin?
IIt binds to antithrombin III and increases its affinity for serine protease clotting factors (Xa and IIa) to increase their rate of deactivation
57
When should low molecular weight heparins not be used and why?
In renal failure as elimination occurs via excretion
58
Give 2 examples of LMWH
Enoxaparin and dalteparin
59
How is heparin and LMWH given?
Heparin- IV or subcubcutaneously | LMWH- subcutaneously
60
What order of kinetics does heparin and LMWH follow?
Heparin- zero order | LMWH- first order
61
What are some of the adverse side effects associated with heparin and LMWH?
haemorrhage, osteoporosis, hypercalcaemia (hypoalosteronism), hypersensitity reactions
62
What factors drive platelet aggregation and what does it allow?
ADP, 5H-T as well as TXA2 from the enzyme cycle-oxygenase (COX) Allows: fibrinogen to bind and platelets to link
63
What mechanisms do anti platelet drugs block?
Clopidogrel blocks ADP on P2Y12 receptor Tirofiban blocks on GPIIb/IIIa receptor Aspirin blocks COX- synthesis pathway of TXA2
64
What is Clopidogrel, what is its mechanism and when/how should it be given?
Links to P2Y12 by a disulphide bond production irreversible inhibition More often in patients intolerant of aspirin Orally Antiplatelet
65
What is Tirofiban and when/how should it be given?
Antiplatelet | Given IV in short term to prevent Mi in high risk patients with unstable angina (with aspirin and heparin)
66
What opposes the coagulation cascade?
The Fibrinolytic cascade
67
How is Plasminogen converted into Plasmin?
By Streptokinase, alterplase and duptxplase
68
Why are fibrinolytic used?
to reopen occluded arteries in acute MI, stroke, venous thrombosis or PE
69
What is the mechanism of clot formation?
Plasminogen--> Plasmin--> Fibrin--> Fibrin fragments--> Clot lysis
70
What is Streptokinase and what does it do?
A protein extracted from cultures of streptococci Reduces mortality in MI, but action blocked after 4 days by generation of antibodies and not given after this time May cause allergic reactions and should not be given to patients with recent Streptococcal infections
71
What are Alteplase and Duteplase and what do they do?
Recombinant tissue plasminogen activator (rt-PA) Effective on fibrin bound plasminogen and are selective for clots Do not cause allergic reactions Short HL, given IV
72
What are the major side effects of fibrinolytics and how can it be controlled?
Haemorrhage | Controlled by Tranexamic acid which inhibits plasminogen activation
73
What are the classes of drugs used to treat hypertension?
diuretics- loop and thiazides, beta blockers, Ca antagonists, ACE, ARB, Peripheral alpha 1 antagonists, central alpha 2 antagonists, direct vasoldilators (rare)
74
What is the first line initial treatment for hypertension in hypertension?
Thiazides
75
What is the 1st line treatment for patients with hypertension and diabetes?
ACE and angiotensin II receptor blockers

Cardiovascular (8 decks)

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