Pharmacology and Drugs for Cardiovascular Disease

Question 1

What end organ damage can hypertension cause?

Answer 1

Brain: thrombotic, thromboembolic, hemorrhagic stroke
Heart: LVH, LV failure, coronary artery disease
Kidney: renal failure
Eyes: hypertensive retinopathy

Question 2

Major risk factors for cerebrovascular atherosclerosis?

Answer 2

Hypertension
Smoking
Diabetes
Hyperlipidemia
Obesity

Question 3

What does the prognosis of hypertension depend on?

Answer 3

Level of systolic and diastolic BP
Age, sex, diabetes
Worse if evidence of end-organ damage
Improved with antihypertensive therapy

Question 4

Non-pharmacological treatment of hypertension?

Answer 4

Weight reduction
Reduce salt, alcohol and fat intake
Exercise
Smoking cessation

Question 5

List the common antihypertensive drugs?

Answer 5

Thiazide diuretics
ACE inhibitors
Angiotensin II receptor antagonists
Beta blockers
Ca channel blockers
Alpha blockers

Question 6

How to thiazide diuretics work?

Answer 6

Inhibit reabsorption of NaCl in proximal and early distal tubules of nephron

Question 7

What is the most common thiazide?

Which one is used for severe congestive heart failure?

Answer 7

Bendroflumethiazide

Metolazone in combo with loop diuretics

Question 8

Side effects of thiazide diuretics?

Answer 8

Electrolyte disturbance
Rash
Postural hypotension

Question 9

What is the renin angiotensin system?

Answer 9

Angiotensinogen - angiotensin 1 - ACE - angiotensin II - Aldosterone from adrenal gland = decrease ECF, BP or Na = Renin released from juxtaglomerular cells

Question 10

What do ACE inhibitors do?

Answer 10

Inhibit the conversion of angiotensin I to angiotensin II

Question 11

Side effects of ACE inhibitors?

Answer 11

Dry cough, hypotension, rash, hyperkalaemia, renal failure, angioedema

Question 12

What do angiotensin II receptor antagonists (ARBs) do?

Answer 12

Similar effects to ACE inhibitors but do NOT inhibit bradykinin metabolism = do not cause dry cough
e.g. Losartan, valsartan

Question 13

What do beta blockers (beta-adrenoceptor antagonists) do?

Answer 13

Reduce HR, BP and CO

Question 14

Contraindications of beta blockers?

Answer 14

Asthma, uncontrolled heart failure, bradycardia

Question 15

Side effects of beta blockers?

Answer 15

Fatigue, hypotension, cold peripheries, bronchospasm

Question 16

What do calcium channel antagonists do?

Answer 16

Vasodilators - reduce systemic vascular tone

Question 17

Types of calcium channel antagonists?

Answer 17

Verapamil and diltiazem - cause bradycardia, inhibit AV node conduction
Amlodipine, lercanidipine - may cause a reflex tachycaradia

Question 18

Side effects of calcium channel antagonists?

Answer 18

Oedema
Flushing
Headache
Dizziness
Hypotension

Question 19

Name the vasodilators used to treat hypertension

Answer 19

Alpha blockers: doxazosin
Hydralazine
Methyldopa (can be used in pregnancy)

Question 20

Side effects of vasodilators treating hypertension?

Answer 20

Hypotension
Headache
Tachycardia
Oedema

Question 21

What is ischaemic heart disease?

Answer 21

Atherosclerosis of coronary arteries that may lead to stenosis and arterial thrombosis

Question 22

How does atherosclerosis progress?

Answer 22

Fatty streak - fibrous plaque - atherosclerotic plaque = angina, transient ischaemic attack = plaque rupture/fissure and thrombosis = MI, ischaemic stroke, critical leg ischaemia, CV death

Question 23

List anti-anginal drugs

Answer 23

Beta blockers
Nitrates
Ca channel blockers
Potassium channel activators

Question 24

What to beta blockers do?

Answer 24

Lower myocardial oxygen demand by reducing HR, BP and myocardial contractility
May exacerbate cardiac failure and peripheral vascular disease and cause bronchospasm

Question 25

What may beta blockers exacerbate?

Answer 25

May exacerbate cardiac failure and peripheral vascular disease and cause bronchospasm

Question 26

What can abrupt withdrawal of beta blockers do?

Answer 26

Arrhythmia, worsening angina or MI

Question 27

How can nitrates be taken?

Answer 27

Oral, sublingual, buccal, transdermal, intravenous

Question 28

What do nitrates provide? How?

Answer 28

Symptomatic relief of angina Produce nitric oxide at the endothelial surface leading to vascular smooth muscle relaxation and arteriolar and venous dilation Reduce myocardial oxygen demand and increase myocardial oxygen supply

Question 29

Side effects of nitrates?

Answer 29

Headache, flushing, postural hypotension

Question 30

What do calcium antagonists do?

Answer 30

Lower myocardial oxygen demand by reducing blood pressure and myocardial contractility and increase myocardial oxygen supply by dilating coronary arteries

Question 31

What calcium antagonists should be avoided in heart failure?

Answer 31

Verapamil and Diltiazem

Question 32

How do potassium channel activators work?

Answer 32

They have arterial and venous dilating properties

Question 33

What can potassium channel activators cause?

Answer 33

Mucocutaneous ulceration

Question 34

How do antiplatelet drugs work?

Answer 34

Inhibit platelet aggregation and arterial thrombus formation = prevent heart attack, stroke and CV death

Question 35

Give examples of antiplatelet drugs and how do they work?

Answer 35

Aspirin - blocks COX11 and production of thromboxane A2 (platelet activating substance) Clopidogrel, prasugrel, ticagrelor - platelet P2Y12 receptor inhibitors, used in combo with aspirin or alone Dipyridamole - in combo with aspirin to prevent stroke

Question 36

What are statins? What do they do?

Answer 36

HMG CoA reductase inhibitors Lower LDL cholesterol and may increase HDL cholesterol Reduce risk of MI, stroke and CV death

Question 37

Examples of statins?

Answer 37

Simvastatin, pravastatin, atorvastatin

Question 38

What is heart failure?

Answer 38

The state that develops when the heart cannot maintain an adequate cardiac output or can do so only at the expense of an elevated filling pressure

Question 39

How to treat chronic heart failure?

Answer 39

Diuretics, ACE inhibitors, Beta blockers, Aldosterone antagonists

Question 40

How do diuretics work on the kidney?

Answer 40

Thiazides - inhibit Cl-Na active exchange in the ascending loop of Henle K-sparing = inhibit reab of Na in the collecting tubule Loop diuretics = acts on medulla, inhibit Cl-Na-K exchange in the thick segment of the ascending loop of Henle

Question 41

What are Tachyarrhythmias? Types?

Answer 41

Abnormal heart rhythm Atrial fibrillation or atrial flutter with rapid ventricular rate response (AF) Supraventricular tachycardia (SVT) Ventricular tachycardia (VT)

Question 42

What does digoxin (digitalis) do?

Answer 42

Blocks Na/K ATPase => Ca | Increase vagal tone - slows conduction in atrial fibrillation

Question 43

Classification of oral antiarrhythmics?

Answer 43

Class Ia,b,c – disopyramide, flecainide, procainamide Class II – beta blockers Class III – amiodarone, dronedarone, sotalol Class IV – calcium antagonists (verapamil, diltiazem)