Pharmacology

Question 1

The purpose of vagal maneuvers is to increase _________ output

Answer 1

Parasympathetic

Question 2

What type of arrhythmia are vagal maneuvers used in?

Answer 2

Supraventricular - A. fib and Atrial flutter

Question 3

Vagal maneuvers suppress the conduction through the __ node

Answer 3

AV

Question 4

When are vagal maneuvers first line treatment?

Answer 4

When the patient (with SVT) is haemodynamically stable

Question 5

What are the 2 commonly used vagal maneuvers?

Answer 5

Valsalva maneuver

Carotid massage

Question 6

What does the valsalva manoeuvre involve?

Answer 6

Breathing out while having the mouth closed, and pinching the nose

Question 7

What is activated by the valsalva manoeuvre?

Answer 7

The aortic baroreceptors

Question 8

Where exactly is massaged in carotid massage?

Answer 8

The bifurcation of the carotids

Question 9

What is stimulated during carotid massage?

Answer 9

The carotid sinus baroreceptors

Question 10

Give an example of an ACEI

Answer 10

Lisinopril

Question 11

State the mechanism of action of an ACEI

Answer 11

Blocks conversion of angiotensin I -> angiotensin II

Question 12

State the 2 pharmacodynamic effects of ACEIs

Answer 12

Causes veno- and vasodilation (decreased preload and afterload => decreased BP and Cardiac load)

Reduces the release of aldesterone => greater loss of Na+ and H2O

Question 13

What are the 2 situations in which ACEI are most effective?

Answer 13

When a patient’s renin secretion is enhanced (diuretics)

In hypertensive patients

Question 14

What group of people are ACEIs less effective in?

Answer 14

Afro-Carribean

Question 15

What are the 3 situations in which you would prescribe ACEIs?

Answer 15

Hypertension
Cardiac failure
Post MI

Question 16

Why are ACEI effective in cardiac failure?

Answer 16

Decreased vascular resistance and increased Na+ and H2O secretion

(=> lowering BP)

Question 17

What are the 4 side effects of ACEIs?

Answer 17

Initial hypotension (esp. in diuretic patients)
Dry cough
Hyperkalaemia
Angioedema

Question 18

What are the 2 contraindications for ACEIs?

Answer 18

Pregnancy

Bilateral renal artery stenosis

Question 19

What should be monitored while taking ACEIs?

Answer 19

Kidney function

Question 20

What is the common ending for ARBs?

Answer 20

-startan

Question 21

What is the common name ending for ACEIs?

Answer 21

-pril

Question 22

State the mechanism of action of ARBs

Answer 22

Competitive inhibition of angiotensin II at the AT1 receptor

Question 23

What are the 2 situations in which ARBs would be used instead of ACEI?

Answer 23

Can be used in Afro-caribeans

In those suffering with a dry cough

Question 24

Calcium Channel blocker examples:
_____ (cardiac selective)
_____(Smooth muscle selective)
_____(Intermediate selectivity)

Answer 24

Verapamil - cardiac selective
Amlodipine - smooth muscle selective
Diltiazem - intermediate selectivity

Question 25

State the mechanism of action of Ca++ channel blockers

Answer 25

Prevent the L-type Ca++ channels from opening (=> limiting the increase in [Ca++])

Question 26

What are the 2 pharmacodynamic effects of Ca++ channel blockers?

Answer 26

Reduced rate of AV conduction | Reduced force of contraction (decreased phase 2 ventricular AP)

Question 27

What are the 3 situations in which you would prescribe a Ca++ channel blocker?

Answer 27

Hypertension Angina Arrhythmias

Question 28

What is the normal CCB prescribed in hypertension?

Answer 28

Amlodipine (smooth muscle selective)

Question 29

Why are CCBs good in hypertension?

Answer 29

They cause arterial dilation (=> decreased TPR and MAP)

Question 30

CCBs are used as ____ treatment in angina

Answer 30

Prophylactic

Question 31

What is the situation in which CCBs are used to treat angina?

Answer 31

In combination with GTN, when Beta Blockers are contraindicated

Question 32

Why are CCBs good for use in angina? (2)

Answer 32

Decreases afterload => decreased myocardial O2 requirement | Increased coronary dilation

Question 33

What CCB is best to use in angina treatment and why?

Answer 33

Amlodipine, as it has a small cardiac effect and is long acting

Question 34

What class of anti-arrhythmic are CCBs?

Answer 34

Type IV

Question 35

Which CCB specifically is used in arrhythmia treatment?

Answer 35

Verapamil

Question 36

Verapamil provides ___ control in __ arrhythmias

Answer 36

Rate control in SV arrhythmias

Question 37

Why are CCBs effective in SV arrhythmia control?

Answer 37

They decrease AV node conduction

Question 38

A high dose of CCBs can cause ___ ___

Answer 38

Heart block

Question 39

Verapamil is mainly used for arrhythmia ____, but is mainly being replaced by ____

Answer 39

Prophylaxis | Adenosine

Question 40

When should CCBs not be used, and especially not in combination with what?

Answer 40

Heart failure | Beta blockers

Question 41

What are the key side effects of CCBs (in lecture)

Answer 41

Hypotension Flushing Ankle swelling

Question 42

What are the 5 side effects of verapamil?

Answer 42

``` Heart failure Constipation Hypotension Bradycardia Flushing ```

Question 43

What are the 4 side effects of diltiazem?

Answer 43

Heart failure Hypotension Bradycardia Ankle swelling

Question 44

What are the 3 side effects of Amlodipine?

Answer 44

Flushing Headache Ankle swelling

Question 45

Minoxidil and Nicorandil are examples of __ __ __

Answer 45

Potassium channel openers

Question 46

What is the mechanism of action of Potassium channel openers?

Answer 46

Antagonism of intracellular ATP on K-ATP (normally closes) - > Opening of K+ channels - > Cell hyperpolarisation - > CCB switched off

Question 47

What is the pharmacodynamic effect of Potassium channel openers?

Answer 47

Relaxation of arteries

Question 48

What are the 2 clinical uses of Potassium channel openers?

Answer 48

Severe hypertension | Refractory angina

Question 49

What are the 2 adverse effects that make Minoxidil a last resort in hypertension treatment?

Answer 49

``` Causes tachycardia (prevented by beta-blocker) and Na+/H2O retention ```

Question 50

What is the key GI side effect of nicorandil?

Answer 50

Ulcers

Question 51

What are prazosin and doxazosin examples of?

Answer 51

Alpha1 - Adrenoceptor Antagonists

Question 52

What is the mechanism of action of Alpha1-adrenoceptor antagonists?

Answer 52

Blockage of vascular alpha 1 receptors => vasodilation

Question 53

What are alpha1-adrenoceptors used for?

Answer 53

Hypertension

Question 54

What is the extra effect of alpha1-adrenoceptors?

Answer 54

Symptomatic relief from enlarged prostate

Question 55

What are the 4 adverse effects of alpha1-adrenoceptor antagonists?

Answer 55

Postural hypotension Drowsiness Dyspnoea Cough

Question 56

Give an example of a thiazide-like diuretic

Answer 56

Bendroflumethiazide

Question 57

Give an example of a loop diuretic

Answer 57

Furosemide

Question 58

What is the mechanism of action of thiazide-like diuretics?

Answer 58

Inhibit NaCl reabsorption in the distal tubule (via Na/Cl co-transporter blockage)