TWO

Question 1

Loop diuretic

Answer 1

Inhibit Na+ re-absorption from the proximal tubule

K+ loss from distal tubule

Can be given iv or orally

Potent – can lead to:
electrolyte abnormalities & hypovolaemia and diminished renal perfusion

Question 2

Mineralocorticoid Receptor Antagonist

Answer 2

Acts on distal tubule

Promotes Na+ excretion and K+ re-absorption

Reduces hypertrophy and fibrosis

Principle Side-Effects: Gynaecomastia (esp. Spironolactone) & Electrolyte (K+ high) and renal function abnormalities

Question 3

ACE inhibitor

Answer 3

Act on activated renin - angiotensin system

Given orally in small doses with slow titration

Block production of angiotensin:
Vasodilatation
BP lowering
Reduce cardiac work

Principle Side-Effects: cough, hypotension, renal impairment

Contraindicated in bilateral renal artery stenosis
May cause Hyperkalaemia (high potassium)
No adverse effects on serum glucose or lipids

Question 4

ARNI

Answer 4

Acts on activated renin - angiotensin system

Also blocks breakdown of ANP/BNP

Block production of angiotensin: Vasodilatation, BP lowering, reduce cardiac work

Promote natriuresis: sodium excretion, vasodilatation, reduce hypertrophy and fibrosis

Principle Side-Effects: hypotension, renal impairment

Block the actions of Ang II on AT1-R

Question 5

Beta blockers

Answer 5

Block the action of adrenaline and noradrenaline on adrenergic beta receptors
Slow HR, reduce BP
Given orally in small doses with slow titration
(treat arrhythmias)

Principle Side-Effects
Bronchospasm
Claudication

Selective: B1 Bisoprolol
Non-selective: Propanolol, B1 & B2

* Bronchoconstriction 
* Fatigue 
* Contraindicated in patients with peripheral vascular disease
* Potential bradycardia 

* Potential bronchoconstriction (moderate to severe asthma) 
* Vasoconstriction via blockade of b2-R
* Fatigue
* Increase blood lipids
* Hypoglycaemia
* CNS side effects (nightmares, impotence)
* Potentially not as efficacious in black African/Americans

Question 6

SA Node Blockade

Answer 6

Blocks the If channel within the SA node
Slow HR, no effect on BP
Given orally with dose titration

Principle Side-Effects
Visual aura
Bradycardia

Question 7

Digoxin

Answer 7

Increases myocardial contractility
Slows conduction at the AV node (use in AF)
Excreted by kidney - Toxicity important

Given:
Acute HF especially in AF
Chronic HF in selected cases

Question 8

Immediate treatment of Acute PO

Answer 8

High flow oxygen
IV Morphine
IV Nitrates
IV Frusemide

+/- Assisted Ventilation

Question 9

Definitive treatment of Acute PO

Answer 9

Identify Cause
Oral diuretics
Medical Therapy
Revascularisation if appropriate

Question 10

Non-Selective

Answer 10

Propanolol

B1 & B2

Question 11

Selective

Answer 11

Bisoprolol

B1

Question 12

Calcium channel blockers

Answer 12

Block L type channels in SAN and AVN - slow depolarisation and reduce AP generation

* Main class dihydropyridines (amlodipine)
* Target L-type Ca2+ channels on smooth muscle of blood vessel.
* Phenylalkylamines (e.g. verapamil) and benzothiazepines (e.g. diltiazem) target L-type channels in the heart and decrease the frequency and force of contraction, less used to treat hypertension.

* Flushing and headaches
* Combinations of Ca2+ channel antagonists not recommended
* Grapefruit juice enhances action (CYP3A4)

Question 13

Indapamide

Answer 13

Hyperpolarise smooth muscle cells -> relaxation/dilation of arterioles and decrease in TPR

Question 14

Tropinin

Answer 14

Elevated in NSTEMI & STEMI

Not elevated in angina

Question 15

Creatine Kinase

Answer 15

Necrosis

Question 16

C Reactive Protein

Answer 16

Inflammation marker

Question 17

Thiazide(like) diuretics

Answer 17

Some diuretic action but also acts via activation of KATP in smooth muscle of blood vessel to dilate arterioles and decrease BP

* Hypokalaemia
* Increase in urate
* Increase in glucose
* Increase in blood lipids
* E.g. bendroflumethiazide
* Newer recommended thiazide-like diuretics include indapamide
* Not good for patients with gout

Question 18

PSCK9 monoclonal antibodies

Answer 18

Evolocumab

Alirocumab

Question 19

Nitrate

Answer 19

Increase cGMP -> decrease calcium ions and venodilation
No dilates coronary arteries to increase O2 supply
• Postural hypotension
• Reflex tachycardia
• Headache
• Dizziness

Question 20

Ivabradine

Answer 20

•	Blocks the pacemaker current (Ih/f) in the nodal tissue of the heart.
	•	Side effects:
	◦	Luminous phenomena (Ih) in retina
	◦	Blurred vision
	◦	dizziness

Question 21

Nicorandil

Answer 21

◦ Decreases afterload

◦ Open potassium channel and depolarise smooth muscle

Question 22

Ranolazine

Answer 22

Reduce work done by heart

Question 23

Trimetazidine

Answer 23

◦ Rebalances energy metabolism in the cell

◦ Preferentially moves potassium in the heart muscle cells to use glucose and not fatty acids

Question 24

Isosorbide mononitrate

Answer 24

Decrease preload

Question 25

Tiotropium

Answer 25

Long acting bronchodilator
24 hr
M1-5 (mostly M3)

Question 26

Statins

Answer 26

Decrease the production of cholesterol in the liver by inhibiting the HMG CoA enzyme. This stimulates the liver cells to express LDL receptors and allows the liver cells to scavenge LDL cholesterol from the plasma. This reduces plasma LDL cholesterol levels.