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Flashcards in systemic drugs: cardiovascular Deck (107):
1

for what 2 reasons will you need to know what systemic drugs a patient is taking during history and symptoms in an eye exam

- to get some extra information about the patients general health
- certain medications that people are taking have ocular adverse reactions

2

what are the 2 most prescribed categories for treating

- cardiovascular disease
and
- central nervous system

3

what are the highest % categories of conditions where drugs are reported as causing ocular adverse effects

- cardiovascular disease
and
- central nervous system

4

what are the 2 most common causes of death

- Cardiovascular disease (eg angina, MI)
and
- Cerebrovascular disease (stroke)

5

what risk factors of cardiovascular diseases and cerebrovascular disease are non-modifiable

- age
- gender
- family history (genetic predisposition)

6

what risk factors of cardiovascular diseases and cerebrovascular disease are modifiable

- smoking (lifestyle issue)
- hypertension (can be modified pharmacologically)
- hyperlipidaemia/raised cholesterol (can be modified pharmacologically)

7

what is a normal BMI required in order to avoid cardiovascular diseases and cerebrovascular disease

20-25 Kg/m2

8

what is the required exercise type and frequency required to avoid cardiovascular diseases and cerebrovascular disease

regular aerobic physical exercise (brisk walking rather than weight lifting) for 30 minutes per day, ideally on most of days of the week but at least on three days of the week

9

what is the maximum required salt intake required to avoid cardiovascular diseases and cerebrovascular disease

6g/day

10

at what clinic blood pressure value systolic/diastolic required ambulatory blood pressure monitoring

140/90 mmHg or higher

11

what is ambulatory blood pressure monitoring

issuing someone with a 24 hour blood pressure monitor as this will periodically check blood pressure and monitor it over 24 hours before making a prescribing decision
this is done in order to confirm the diagnosis of hypertension

12

when must you act upon controlling someones blood pressure immediately

if the blood pressure causes damage to organ tissues

13

what does the national clinical guidance centre NCGC on hypertension clinical guideline contain

an algorithme structure on the diagnosis of hypertension and how to monitor that patient

14

what are the only 2 bits if information needed to determine someones risk of having a CV event in the next 10 years

- the systolic BP
and
- the ratio between total cholesterol and HDL cholesterol

15

what does total cholesterol contain

three types of lipid measurements
- LDL
- HDL &
- Triglycerides

16

which is the bad lipid

LDL

17

which is the good lipid

HDL

18

which is the in-between LDL and HDL lipid

triglycerides

19

what are the 2 main reasons for treating hypertension

- Reduce cerebrovascular disease by 40-50%
- Reduce MI by 16-30%

20

by how much does hypertension treatment reduce cerebrovascular disease by

40-50%
these are relative risk reductions so if your chance of developing a heart attack within 10 years is 5% the its going to take your risk from 5% down to 2.5%

21

by how much does hypertension treatment reduce MI by

16-30%

22

which 2 ways is best to treat hypertension and why

- Stepped approach: start with a first line drug and if that does work then combine the drugs

- Use low doses of several drugs

This approach minimises adverse events and maximises patient compliance

23

what is the main aim of hypertension treatment

- To reduce diastolic BP to

24

what do the NICE guidelines on hypertension state about those who have it aged below 55 y/o

they must be put straight on ACE inhibitor

25

what do the NICE guidelines on hypertension state about those who have it aged above 55 y/o

they must be put on a calcium channel blocker and a thiazide type diuretic

26

what do the NICE guidelines on hypertension state about those who are of black ethnicity and have it

they must be put on Thiazide which is a type of diuretic
as ACE inhibitors are contraindicated in black people

27

why are black people who have hypertension put on Thiazide which is a type of diuretic

as ACE inhibitors are contraindicated in black people

28

what do the NICE guidelines suggest if individual drugs don't work

use an adaptive approach

29

which is the most common drug to treat hypertension

ACE inhibitors

30

how do ACE inhibitors work in treating hypertension

by competitively inhibiting the angiotensin converting enzyme (ACE)

31

what does the angiotensin converting enzyme (ACE) do

it converts angiotensin I to active angiotensin II

32

what is angiotensin II

it is a potent vasoconstrictor therefore it raises blood pressure

therefore you want to prevent the formation by blocking the enzyme that converts into this in order to lower BP

33

name 4 examples of ACE inhibitor drugs

- Captopril
- Enalapril
- Lisinopril
- Ramipril

all end in pril

34

which drugs all end in 'pril'

ACE inhibitor drugs - to reduce hypertension

35

list 5 side effects of ACE inhibitor drugs

- Cough (15% of patients)
- Taste disturbance
- Angiodema
- First-dose hypotension (lowers BP too much)
- Hyperkalaemia (raised potassium)

36

how do Angiotensin II receptor antagonists (blockers) reduce hypertension

by competitively inhibit the receptor at which angiotensin II acts
it achieves its effects by binding onto a Angiotensin II receptor

37

what is the advantage of Angiotensin II receptor antagonists (blockers) drugs

it has fewer side effects than ACE inhibitors

38

name 3 examples of Angiotensin II receptor antagonists (blockers) drugs

- Candesartan
- Losartan
- Valsartan

all end in 'artan'

39

what do all of Angiotensin II receptor antagonists (blockers) drugs end in

'artan'

40

how do calcium channel blockers reduce hypertension

they all inhibit inward movement of calcium ions through the slow L-type calcium channels in active membranes: - Cells of the myocardium
- Cells within the His-Purkinje system of the heart
- Cells of vascular smooth muscle

and
- Cause vasodilation of large and small arteries and also reduce cardiac output/total peripheral resistance


this affects cardiac contractility and causes vasodilation

41

which three active membranes do calcium channel blockers inhibit the inward movement of calcium ions through the slow L-type calcium channels

- Cells of the myocardium
- Cells within the His-Purkinje system of the heart
- Cells of vascular smooth muscle (reduces vasoconstriction)

42

what 2 things are calcium channel blockers useful in the treatment of

hypertension and angina

43

name 4 examples of calcium channel blockers

- Nifedipine
- Amlodipine
- Verapamil
- Diltiazem

44

how do diuretics reduce hypertension

by promoting the excretion of water

45

where in the body do diuretics act on

on the kidney and in particular at different sites of the nephron by blocking the ion channels

at the nephron is where ions are taken out of the system and whenever you move ions, water follows with it and this is how urine is less watery and more concentrated

46

what happens if you were to block the ion channels which is what diuretics do

the water is retained and not moved out with the ions, so there is more water and more excretion of urine which reduces the blood volume
= the drug has a two fold action

47

name 3 classes of diuretic

- Thiazides
- Loop diuretic
- Potassium sparing

48

how does the thiazides class of diuretic work

Inhibit absorption of sodium in the DCT

49

what can the class of diuretics, thiazides lead to

potassium deficiency

50

how does the class of diuretics, thiazides reduce BP

by:
- Vasodilation
- Reduction in blood volume

51

name 3 examples of class of diuretics, thiazides

- Bendrofluazide
- Hydrochlorthiazide
- Indapamide

all end in 'azide' mostly

52

what do most diuretics, thiazides end in

'azide'

53

which is the most commonly used diuretic

thiazides

54

how does the loop class of diuretic work

Inhibit absorption of sodium and potassium in TAL of loop of Henle

55

what is an advantage of the loop class of diuretic

it is fast acting

56

when is loop class of diuretic mostly used

in renal failure and heart failure

57

give 2 examples of loop class of diuretic

- Furosemide
- Bumetanide

58

as diuretics tend to cause potassium depletion, name a class of diuretic that retains potassium

potassium sparing

59

were do potassium sparing class of diuretics act

at DCT

60

what is potassium sparing class of diuretics used in conjunction with and why

thiazide and loop diuretic classes, incase potassium levels become a problem

61

name 2 examples of potassium sparing class of diuretics

- Amiloride
- Spironolactone

62

which drug performs the least well than other drugs for hypertension

beta blockers

63

what are beta blockers used in the treatment of

angina

64

what do beta blockers have increased risk of

side effects

65

name 2 examples of beta blockers

- Atenolol
- Metoprolol

end in 'ol'

66

what do beta blocker drugs tend to end in

'ol'

67

how do beta blockers work

Mechanism of action is unknown but may involve:
- Reduction of heart rate and force of contraction
- Reduction in peripheral resistance
- Inhibition of renin release
- Central actions to reduce sympathetic activity

68

list 3 classes of drugs less commonly used as anti-hypertensive agents

- Alpha-adrenoceptor antagonists
Doxazosin

- Centrally acting agents
Methyldopa
Moxonidine

- Vasodilators
Hydralazine
Minoxidil

69

list 3 other types of cardiovascular disease

- Ischaemic heart disease
- Cardiac failure
- Cardiac arrythmias

70

what is another name for ischaemic heart disease

Angina Pectoris

71

what symptoms does ischaemic heart disease (Angina Pectoris) present with

intermittent chest pain on exertion or stress (‘stable’ angina)

at rest, there are no symptoms, but get chest pain on exertion e.g. climbing up the stairs etc

72

what is ischaemic heart disease (Angina Pectoris) caused by

by insufficient oxygen supplied to cardiac muscle due to narrowing of coronary arteries

73

how is a single acute attack of ischaemic heart disease (Angina Pectoris) treated

by a Glyceryl trinitrate-potent vasodilator

given in patch form absorbed across the skin, or put tablet under tongue so its absorbed by oral mucosa

74

why is Glyceryl trinitrate-potent vasodilator used to treat a single acute attack of ischaemic heart disease (Angina Pectoris) not given in tablet form

because once the drug is given in tablet form they're broken down before they get into the blood stream and then the drug is inactivated

so is given as patch form absorbed across the skin, or put tablet under tongue so its absorbed by oral mucosa

75

what is given as a prophylaxis for ischaemic heart disease (Angina Pectoris) and what else should all patients receive along with this

- Sublingual GTN
- Aspirin
- Beta- blockers
- calcium channel blockers

All patients should receive lipid lowering therapy (to avoid atheroma formation)

76

what are the signs of Ischaemic Heart Disease:Myocardial Infarction

ST elevation on ECG

ST = flat segment on an ECG, follows the S wave and before the start of the T wave

77

what are the 3 immediate treatments used for Heart Disease:Myocardial Infarction

- Analgesia
- Thrombolysis
- Aspirin

78

why is thrombolysis given immediately after a Myocardial Infarction

to avoid damage of myocardial tissue, given as an injection to immediately dissolve the clot and limit any damage caused

79

why is aspirin given immediately after a Myocardial Infarction

as it stops platelet aggregation

80

why is analgesia given immediately after a Myocardial Infarction

to control the chest pain

81

what 4 drugs are given as prophylaxis for Ischaemic Heart Disease:Myocardial Infarction

- Beta blockers
- ACE inhibitors
- Aspirin
- Lipid lowering therapy

then they're put on maintenance therapy, not to treat the heart attack, but to prevent a subsequent one

82

what is heart failure the result of

damage to the myocardium e.g. MI, myocardiomyopathy, heart valve damage

83

what does heart failure result in

poor tissue perfusion and oedema of the lungs or peripheral tissues

84

what are the 5 treatments for heart failure

- Diuretics
- ACE inhibitors
- Nitrates
- Beta blockers
- Ionotropic drugs e.g. Digoxin

85

what happens in oedema in the lungs

it is from pulmonary oedema
where it retains fluid within the lungs and also when the heart valves don't work efficiently

86

what are cardiac Arrhythmias and why do they happen

- they're heart rhythm disorders - arterial fibrillation is a major risk factor for heart attacks

- it happens because the atria don't contract fully and small clots form which when expelled from the heart, they go onto block blood vessels in the heart or brain

87

what 2 drug therapies is used to treat Supraventricular tachycardia

- Adenosine
- Verapamil

88

what 3 drug therapies is used to treat Arrhythmias caused by Wolf-Parkinson-White Syndrome

- Amiodarone
- Disopyramide
- Flecainide

89

what 3 drug therapies is used to treat Atrial fibrillation

- Digoxin
- Disopyramide
- Amiodarone

90

what 2 drug therapies is used to treat Ventricular tachycardia

- Lidocaine
- Amiodarone

91

what do all the different drugs taken for Cardiac Arrhythmias result in

changes in the cardiac action potential

92

what drug will many patients over 50 be taking

statins

93

what 2 drugs will every T2 diabetic patient be taking

- statins
and
- BP lowering medications

94

where are cholesterol and triglycerides are transported

in the blood from the liver in association with lipoproteins:
- Very low density lipoprotein (VLDL)
- Low density lipoprotein (LDL)
- High density lipoprotein (HDL)

95

what is LDL cholesterol particularly associated with

atheroma and cardiovascular disease

96

which lipoproteins do statins target

LDLs

97

what does lowering LDL cholesterol by 1mm/ol result in

reduces CVD events by 21% and total mortality by 12%

98

what is the Lipid modification: NICE guidance and what does it tell you

- its an algorithm for lipid control
- tells you what to do if a px falls into a category

99

what produces cholesterol in the body

HMG-CoA reductase - enables the cell to make cholesterol
cholesterol is then released into the blood

100

how do cholesterol lowering statins work

by inhibiting HMG-CoA reductase
cholesterol levels is blocked, lowering levels of cholesterol in the blood by increased uptake of LDL from the by the cell (which takes on more of the cholesterol)

101

name 3 examples of statins

- Simvastatin
- Atorvastatin
- Pravastatin

102

explain the mechanism of how lower intracellular levels of LDL occur

by taking in more LDL from the blood
this is done by blocking the enzyme 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase = the rate-limiting step in cholesterol biosynthesis, causing lower LDL levels whereby the cell puts more LDL receptors on its surface and pulls all of the cholesterol out of the blood/plasma

103

other than statins, name 4 other lipid lowering drugs

- Fibrates
- Anion exchange resins
- Ezetimibe
- Nicotinic acid

104

list all the 6 main drug categories involved in lowering the risk of cardiovascular disease/cerebrovascular disease

- ACE inhibitors
- Angiotensin II receptor antagonists
- Calcium Channel blockers
- Diuretics
- Beta blockers
- Statins

105

what is the maximum alcohol consumption required for men to avoid cardiovascular diseases and cerebrovascular disease

106

what is the maximum alcohol consumption required for women to avoid cardiovascular diseases and cerebrovascular disease

107

list the 9 lifestyle measures needed to avoid cardiovascular disease

- stop smoking
- maintain normal weight for adults (BMI 20-25kg/m2)
- reduce salt intake to 30 mins per day, atleast 3 days per week
- consume atleast 5 portions/day of fresh fruit and veg
- reduce intake of total saturated fat