Pharmacology

Question 1

GTN

Answer 1

Vasodilator
Works by NO, but as a venous and arterial hypotension
Can cause GTN syncope

Question 2

Drugs for angina

Answer 2

1. GTN spray

B blockers, Ca2+ channel blockers, long acting nitrates, K/ATP channel openers, Ivabradine, Ranolazine

Question 3

Ca2+ channel blockers side effects

Answer 3

Ankle oedema

Question 4

ACE inhibitor

Answer 4

Heart failure activates the angiotensin system

Question 5

Digoxin

Answer 5

Na/K main effects are on the AV node: really useful/good in atrial fibrillation

Question 6

Anti-coagulants

Answer 6

Prevent clots forming in the atria as a result of stasis (comes from atria not contracting properly)

Question 7

ACEI side effects

Answer 7

Dry cough
- Use ARBTs
Ankle oedema, adverse effect on renal function esp. in renal artery stenosis

Question 8

Spironolactone side effects

Answer 8

Hyperkalaemia

Gynaecomastia

Question 9

Treatment in Heart Failure

Answer 9

1. Sit the patient up
2. IV Furosemide
3. High flow oxygen (not COPD)
4. IV Diamorphine (not in COPD)
5. IV GTN (nitrate would reduce blood pressure, don’t use in those with low blood pressure)

Question 10

Why sit the patient up in heart failure?

Answer 10

Reduced pre-load and afterload to heart

Reduces the atrial filling pressure

Question 11

Caution with oxygen?

Answer 11

In those with COPD/Type II Resp Failure

- They need the hypoxic drive

Question 12

Furosemide side effects

Answer 12

Renal angle pain due to diuresis

Question 13

Diamorphine side effects

Answer 13

Nausea and vomiting

Question 14

GTN side effects

Answer 14

Hypotension

Question 15

Uses of Sacubitril-Valsartan

Answer 15

When still symptomatic on a comprehensive treatment programme for heart failure

Question 16

Opiates side effects

Answer 16

Nausea
Sedation
Hypoventilation

Question 17

Nitrates side effects

Answer 17

Hypotension

Question 18

Beta Blockers side effects

Answer 18

Bradycardia
Cardiac failure
Bronchospasm (asthma and chronic bronchitis)
Hypotension

Question 19

Disopyramide

Answer 19

Type Ia

Used in the prevention of recurrent ventricular arrhytmias

Question 20

Procainamide

Answer 20

Type Ia

Used IV for ventricular arrhythmias following MI

Question 21

Flecainide

Answer 21

Type Ic
Negative Inotrope
Used for the prophylaxis of paroxysmal atrial flutter
RISK: triggering ventricular arrhythmias

Question 22

Propranolol

Answer 22

Type II

Surpression of AVN conduction and excessive sympathetic drive

Question 23

Amiodarone and Sotalol

Answer 23

Slow repolarisation and so increases action potential duration and refractory period

Question 24

When may Ivabradine be indicated?

Answer 24

If heart rate is in FAST sinus rhythm despite the use of maximum dose beta blockers

Question 25

Types of Calcium Antagonists

Answer 25

1. Dihydropyridines | 2. Rate Limiting Calcium Antagonists

Question 26

Dihydropyridines

Answer 26

Used in hypertension and angina | Side effect is ankle oedema

Question 27

a1 receptors

Answer 27

Constriction of vessels (smooth muscles in vessels)

Question 28

b1 receptors

Answer 28

Increased; Cardiac rate Cardiac force AV node conduction velocity

Question 29

b2 receptors

Answer 29

Increased relaxation of vessels and bronchial tree

Question 30

Use of B-adrenoceptor antagonists in angina pectoris

Answer 30

Not used in variant angina Decrease the myocardial oxygen requirement (lower heart rate/stroke volume, reduced work) Counter-acts elevated sympathetic activity associated with ischaemic pain Increased amount of time spent in diastole (better perfusion)

Question 31

Action of Calcium Antagonists

Answer 31

Prevent the opening of L type channels in excitable tissues - Upstroke of the AP in the SA and AV nodes (can reduce the rate and conduction through the AVN) - Can reduce the force of contraction

Question 32

Use of calcium antagonists in hypertension

Answer 32

Generalised arteriolar dilation and reduced TPR and MABP - Drugs with selectivity for smooth muscle L-type channels are preferred (avoid adverse effects on cardiac muscle) - Especially useful in those who suffer from both angina and hypertension

Question 33

Use of calcium antagonists in dysrhythmias

Answer 33

-Ventricular rate in atrial fibrillation reduced by supression of conduction through the AV node

Question 34

Alpha Blockers

Answer 34

Block a adrenoceptors to cause vasodilation | Used in hypertension and prostatic hypertrophy

Question 35

Digoxin Toxicity

Answer 35

``` Nausea Vomiting Bradycardia Heart Block Ventricular Arrhythmias ```