Quiz2.Hyperlipidaemia,absorp,HF,massspec

Question 1

What is aspirin?

Answer 1

An irreversible COX enzyme inhibitor

Question 2

What is abciximab?

Answer 2

A glycoprotein 2b/3a receptor antagonist which decreases platelet aggregation

Question 3

Give three examples of ADP receptor agonists

Answer 3

Clopidogrel, ticagrelor, prasugrel

Question 4

How do statins exert their effect?

Answer 4

• inhibit HMG-coA reductaae
  -which leads to a decrease in cholesterol synthesis in the liver

Question 5

Give an example of a bile acid sequestrant and explain how they work

Answer 5

Colestyramine is a bile acid sequestrant and it works by
-binding to bile acid
-which prevents enteropathic cycling
-which reduces hepatic cholesterol

Question 6

What is exetimibe and how does it work?

Answer 6

Exetimibe is a selective cholesterol re absorption inhibitor.
It works by
-reducing delivery of cholesterol to liver therefore less uptake
-therefore increased LDL clearance

Question 7

What is 1st line prevention for CVD?

Answer 7

Atorvastatin 20mg once daily

Question 8

What is measured for ALL patients starting a statin?

Answer 8

1. Thyroid function
2. Full lipid profile
3. Liver function test
4. Renal function

SOME patients will require creatinine kinase testing

Question 9

What are some statin interactions and why do they occur?

Answer 9

Statins are prone to toxicity:
- clarithromycin and grapefruit juice and enzyme inhibitors therefore can increase statin levels causing myalgia
- simvastatin capped at 20mg when given with diltiazem or amlodipine

Question 10

Which drug admini method does not require passing of biological membrane?

Answer 10

IV

Question 11

What characterises the symptoms of chronic heart failure?

Answer 11

They are slow and insidious in their onset

Question 12

What are clinical features of left sided HF?

Answer 12

Pulmonary oedema and able oedema

Question 13

What are clinical features of right sided HF?

Answer 13

Peripheral cyanosis, elevated JVP

Question 14

How are ions separated in a mass spectrometer?

Answer 14

Via a mass to charge ratio

Question 15

What are 4 tests done in HF diagnosis?

Answer 15

1. Natriuretic peptides
2. ECG
3. Echocardiogram
4. Chest X-ray (to look for left ventricular dysfunction)

Question 16

What are the two treatment branches for HF? What would you prescribe for each of these?

Answer 16

Symptom relief and prevention of progression.

For symptom relief- diuretics, ionotropes, vasodilators
For prevention of progression- ACEi, BB/ARB, aldosterone antags, ARNIS

Question 17

Give an example of an ARNI

Answer 17

Entresto- sacubitril and valsartan

Question 18

How do loop diuretics work? Give an example

Answer 18

Furosemide is a loopD and it works by inhibiting exchange of sodium potassium and chloride ions in the thick segment of the ascending loop of Henle

Question 19

How do thiazide and thiazide like diuretics work?

Answer 19

They work by inhibiting exchange of sodium and chloride ions in the distal convoluted tubule eg bendroflumethiazide

Question 20

How do carbonic anhydrase inhibitors work?

Answer 20

Eg acetazolomide
- Inhibit carbonic anhydrase
- leads to renal loss of bicarbonate
- therefore urine is alkalised and inc diuresis

Question 21

How does spironolactone work?

Answer 21

Spironolactone, eplerenone are potassium sparing diuretics eg aldosterone antagonists.
-work by inhibiting reabsorption of Na+ in distal convoluted tubule and collecting tubule.

Question 22

What is mannitol?

Answer 22

Mannitol is a osmotic diuretic
- increases osmolarity of the tubular fluid
- therefore increasing urinary volume

Question 23

What is the link between entresto and ACEi/ARBS?

Answer 23

ACEi/ARB should be discontinued 36 hours before starting entresto due to angiodema risk