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Flashcards in Vascular system Deck (105)
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1

Pharmacology and drugs in cardiovascular disease: What common cardiovascular conditions require drug therapy

hypertension
ischaemic heart disease and other atheromatous diseases
Heart failure
Arrhythmia

2

Pharmacology and drugs in cardiovascular disease: What are most cases of hypertension caused by?

Essential hypertension - no secondary cause

3

Pharmacology and drugs in cardiovascular disease: What sort of end organ damage can happen as a result of hypertension?

Brain: thrombotic, thromboembolic and haemorrhagic stroke, multi-infarct dementia, hypertensive encephalopathy
Heart: LVH, LV failure, coronary artery disease
Kidney: renal failure
Eyes: hypertensive retinopathy

4

Pharmacology and drugs in cardiovascular disease: What are the major risk factors for cerebrovascular atherosclerosis?

Hypertension
smoking
diabetes
hyperlidimedia
obesity

5

Pharmacology and drugs in cardiovascular disease: What is the prognosis of hypertension related to and how can it be improved?

Related to level of systolic and diastolic blood pressures
Related to age, sex and other risk factors such as hyperlipidaemia and diabetes
Worse if there is evidence of end-organ damage
Improved with antihypertensive therapy

6

Pharmacology and drugs in cardiovascular disease: What non pharmacological treatments of hypertension are there?

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

7

Pharmacology and drugs in cardiovascular disease: What common antihypertensive drugs are there?

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

8

Pharmacology and drugs in cardiovascular disease: What do thiazide diuretics do?

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

9

Pharmacology and drugs in cardiovascular disease: What is the most commonly used thiazide?

Bendroflumethiazide most commonly used thiazide

10

Pharmacology and drugs in cardiovascular disease: Which thiazide Is used in combo with loop diuretics for severe congestive heart failure?

Metolazone

11

Pharmacology and drugs in cardiovascular disease: Which drug is cheap and recommended for first line use?

thiazides

12

Pharmacology and drugs in cardiovascular disease: What are the side effects of thiazide diuretics?

Side effects include electrolyte disturbance, rash and postural hypotension- risk of low blood pressure on standing up

13

Pharmacology and drugs in cardiovascular disease: What sort of system is a cardiovascular drug system?

positive feedback

14

Pharmacology and drugs in cardiovascular disease: What do ACE inhibitors do and what are the side effects?

e.g. ramipril - most commonly used now, ramipril reduced risk of CV event in HOPE study

Inhibit the conversion of angiotensin I to angiotensin II

Relatively infrequent side effects except for dry cough: hypotension, rash, hyper-kalaemia, renal failure (especially in the presence of renal artery stenosis), angioedema, ageusia

15

Pharmacology and drugs in cardiovascular disease: What can be an effect of ACE inhibitors?

Bradykinin build up (as ACE causes bradykinin degradation) causing the dry cough

16

Pharmacology and drugs in cardiovascular disease: What are angiotensin II receptor antagonists used for?

Similar effects to ACE inhibitors but do not influence bradykinin metabolism so do not cause dry cough

Examples:
Losartan, valsartan, candesartan, irbesartan

17

Pharmacology and drugs in cardiovascular disease: What do beta blockers do and what are the side effects?

Reduce heart rate, blood pressure and cardiac output

Variable selectivity for cardiac b1 receptors to target just the heart receptors

Relative contraindications: asthma (beta receptors involved in bronchoconstriction so beta blockers can affect this), uncontrolled heart failure, bradycardia

Side effects: fatigue, hypotension, cold peripheries, bronchospasm, impotence. can also increase blood sugar

18

Pharmacology and drugs in cardiovascular disease: What do calcium channel antagonists do and what are the side effects?

Vasodilators – reduce systemic vascular tone

Two main types:
- Verapamil and diltiazem – cause bradycardia, inhibit AV node conduction, negative inotropes
- Amlodipine, lercanidipine …dipine – may cause a reflex tachycardia

Side effects: oedema, flushing, headache, dizziness, hypotension

19

Pharmacology and drugs in cardiovascular disease: What is stable angina?

CV episodes brought on predictably by increased stress/exercise

20

Pharmacology and drugs in cardiovascular disease: how can you treat an episode of angina?

Beta blockers
Nitrates
Calcium channel blockers
Potassium channel activators

21

Pharmacology and drugs in cardiovascular disease: How do beta blockers treat angina and what problems are there if there is cardiac failure or abrupt withdrawal?

Lower myocardial oxygen demand by reduce heart rate, blood pressure and myocardial contractility
May exacerbate cardiac failure (need to be introduced slowly) and peripheral vascular disease (claudication), and cause bronchospasm
Abrupt withdrawal may lead to arrhythmia, worsening angina or myocardial infarction

22

Pharmacology and drugs in cardiovascular disease: How do nitrates work to treat angina and what are the side effects?

Oral, sublingual (GTN tabs/spray), buccal, transdermal and intravenous forms used commonly
Symptomatic relief of angina
Produce nitric oxide at the endothelial surface leading to vascular smooth muscle relaxation and arteriolar and venous dilatation
Reduce myocardial oxygen demand (lower preload and afterload) and increase myocardial oxygen supply (coronary vasodilatation)
Side effects: headache, flushing, postural hypotension

23

Pharmacology and drugs in cardiovascular disease: How do calcium antagonists treat angina and which ones should be avoided in heart failure?

Lower myocardial oxygen demand by reducing blood pressure and myocardial contractility and increase myocardial oxygen supply by dilating coronary arteries and lateral arteries
Verapamil and diltiazem should be avoided in heart failure

24

Pharmacology and drugs in cardiovascular disease:How do potassium channel activators treat angina and what are the side effects?

Nicorandil
Arterial and venous dilating properties
No problems with tolerance as seen with nitrates

Can cause mucocutaneous and anal ulceration – relegated to second-line therapy

25

Pharmacology and drugs in cardiovascular disease: What do anti-platelet drugs do?

Inhibit platelet aggregation and arterial thrombus formation, thus preventing heart attack, stroke and CV death

26

Pharmacology and drugs in cardiovascular disease: What anti-platelet drugs exist and what do they do?

Aspirin – blocks platelet cyclo-oxygenase (COX1) and the production of thromboxane A2, a platelet activating substance
Clopidogrel, prasugrel and ticagrelor – platelet ADP (P2Y12) receptor inhibitors; used alone or, more often, in combination with aspirin
Dipyridamole – mainly used in combination with aspirin to prevent stroke

27

Pharmacology and drugs in cardiovascular disease: What are statins and what do statins do? Give some examples of statins

Hydroxymethyl-glutaryl (HMG) CoA reductase inhibitors

Lower LDL cholesterol and may increase HDL cholesterol

Examples:
Simvastatin, pravastatin, atorvastatin, rosuvastatin, …..statin

Reduce risks of myocardial infarction, stroke and CV death

28

Pharmacology and drugs in cardiovascular disease: What is heart failure?

an imprecise term describing 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

29

Pharmacology and drugs in cardiovascular disease: Why does pulmonary and/or peripheral oedema develop?

due to high atrial pressures and salt/water retention caused by impaired renal perfusion and secondary aldosteronis

30

Pharmacology and drugs in cardiovascular disease: What are some symptoms of heart failure?

Shortness of breath, swelling of feet and legs, chronic lack of energy, difficulty sleeping due to breathing problems, confusion and or impaired memory, increased urination at night, cough with frothy sputum, swollen or tender abdomen with loss of appetite