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Human Diseases > 16.1 Cardiovascular disease and drugs > Flashcards

16.1 Cardiovascular disease and drugs Flashcards

1
Q

What is the difference between pharmacokinetic variability and pharmacodynamic variability?

A
  • Pharmacokinetic variability: what the body does to the drug
  • Pharmacodynamic variability: what the drug does to the body
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2
Q

What are the 2 main types of adverse drug reaction?

A
  • Type A: dose dependent, predictable from the known pharmacology of the drug
  • Tybe B: bizarre/idiosyncratic, dose-independent, rare, unpredictable
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3
Q

What are the 3 common cardiac drug types?

A
  • Drugs which affect the blood vessels: the endothelium or tunica media
  • Drugs which affect the autonomic nervous system
  • Drugs which affect the renin-angiotensin-aldosterone process e.g. ACE inhibtors
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4
Q

Explain the renin-angiotensin-aldosterone system.

A
  • Drop in blood pressure causes renin release from kidneys
  • Renin converts angiotensinogen to angiotensin I
  • ACE (angiotensin converting enzyme) secreted (mostly from the lungs)
  • ACE converts angiotensin I to angiotensin II
  • Angiotensin II is a potent vasoconstrictor, increases blood pressure
  • Angiotensin II also increases aldosterone synthesis, increasing BP
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5
Q

What 3 drugs are most commonly used to treat hypertension?

A
  • ACE inhibitors
  • Calcium channel blockers
  • Thiazide-like diuretics
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6
Q

What BP is classed as hypertension?

A

140/90
High risk = 130/80

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7
Q

How is blood pressure determined?

A

Cardiac output x total peripheral resistance

Examples of factors which affect BP

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8
Q

What is the relationship between blood pressure and age?

A
  • As we age, systolic BP tends to increase (top number)
  • Diastolic tends to increase until around 60 and then decreases
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9
Q

What is the order of drug choice for treatment of hypertension?

A

Majority of people with hypertension require 2 agents

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10
Q

What is the first line therapy for hypertension in a non-black patient under 55?

A

ACE inhibitor

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11
Q

Name ACE inhibitors.

A
  • Ramipril
  • Lisinopril
  • Captopril

Different ACE inhibitors have different half lives. Ramipril is the most common.

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12
Q

When are ACE inhibitors used?

A
  • Hypertension
  • Heart failure
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13
Q

When are ACE inhibitors contraindicated?

A

Pregnancy, affects foetal development.

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14
Q

Other than ACE inhibitors, what other drug targets the renin-angiotensin-aldosterone system?

A

Angiotensin II receptor blockers
Used to treat hypertension and heart failure.
Blocking receptors decreases aldosterone synthesis and reduces vasoconstriction thus reducing BP.

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15
Q

Name angiotensin II receptor blockers.

A
  • Losartan
  • Candesartan
  • Irbesartan
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16
Q

What are the possible adverse effects of ACE inhibitors and angiotensin II receptor blockers?

A
  • Hyperkalaemia (high potassium)
  • Acute kidney injury
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17
Q

What are the 3 groups of calcium channel blockers?

A
  • Dihydropyridines e.g. amlodipine, nifedipine. Suitable for most patients.
  • Benzothiazepines e.g. diltiazem
  • Phenylalkylamines e.g. verapamil. Not suitable in majority of cases.
18
Q

What type of drug are calcium channel blockers?

A
  • Antagnosists
  • L-type calcium channel blockers
19
Q

Describe the action of calcium channel blockers.

A
  • Act on smooth muscle cells and cardiac myocytes to cause vasodilation
  • Reduces blood pressure

Also used to treat angina.

20
Q

What cautions are there for calcium channel blocker use?

A
  • They are metabolised by CYP3A4 enzymes so patients may have interacting drugs
  • Patients must avoid grapefruit
21
Q

What are thiazide diuretics?

A
  • Drug used to treat hypertension and mild heart failure
  • Sulphonamide derivatives
  • Side effects: hyponatremia (low sodium), hypokalaemia, erectile dysfunction
22
Q

What are alpha blockers?

A
  • Cause vasodilation
  • Treats hypertension and benign prosthetic hypertrophy
  • Side effects: mild postural hypotension
  • E.g. Doxazosin
23
Q

Which alpha blocker is rarely used nowadays?

A

Clonidine
- Large range of side effects including bradycardia, dry eyes, sedation, withdrawal syndrome

24
Q

Which drugs are used for patients with resistant hypertension?

A

Aldosterone antagonists
- Act in the nephron
- Block the action of aldosterone to reduce BP

25
Q

Name 2 aldosterone antagonists.

A
  • Spironolactone
  • Eplerenone
26
Q

What are the causes of resistant hypertension?

A
  • Sub-optimal drug regimes
  • Non-adherence
  • Secondary hypertension: an underlying cause of high BP e.g. other medication, target organ damage, Conn’s disease, Cushing’s
27
Q

What is ischaemic heart disease?

A

Aka. coronary heart disease
- Where the myocardial demand for oxygen exceeds the supply of oxygen to the heart by the coronary arteries
- Reduced blood flow to the heart

28
Q

Describe the blood flow to the heart.

A
  • The coronary arteries arise from the base of the aorta via the coronary sinuses

The 3 principle epicardial arteries are:
- Right coronary artery
- Left anterior descending artery
- Circumflex artery

29
Q

What factors cause decreased oxygen supply?

A

-Extreme anaemia, reduced Hb thus reducing oxygen
- Atherosclerosis (blockages)
- Coronary artery spasm, caused by inflammation, temporary constriction
- Hypoxia
- Hypovolaemia
- Tachydysrhythmia

30
Q

What factors cause increased oxygen demand?

A
  • Beriberi disease
  • Left ventricular hypertrophy
  • Paget’s
  • Tachydysrhythmia
31
Q

What is atherosclerosis?

A
  • Cholesterol plaques building up in the arteries
  • Can cause unstable angina (angina when resting)- central chest pain
  • Plaque rupture can lead to an acute coronary syndrome
  • If pt is in pain GTN spray is used, if it lasts for 30 minutes or more it is advised that the pt visits hospital
32
Q

What is the difference between ischaemia and infarction?

A
  • Reduced blood flow = ischaemia
  • No blood flow = infarction
33
Q

How is stable angina managed?

A
  • Beta blockers or calcium channel blockers
  • If this is unsuccessful, they should be used in combination
  • Next option: addition of a long acting nitrate
34
Q

What are the range of acute coronary syndromes?

A
  • NSTEMI = partial blockage of blood supply to heart
  • STEMI = complete blockage
    Diagnosed through elevated troponins.

Both are heart attacks. Unstable angina is not but can lead to heart attack.

35
Q

What is the emergency management for an acute coronary syndrome?

A
  • Morphine
  • Oxygen
  • Nitrates (e.g. GTN spray)
  • Aspirin, 300mg
  • Antiplatelet, clopidogrel
  • Anticoagulant, rivaroxaban
36
Q

Which drugs are used post MI?

A
  • ACE inhibitors
  • Beta blockers
  • Statins
37
Q

When are beta blockers used?

A
  • Post MI (not if pt has cardiogenic shock or asthma)
  • Left ventricular failure
  • Tachyarrhythmia
  • Portal hypertension

Side effects: bradycardia, erectile dysfunction

38
Q

What is ivabradine?

A

A relatively new drug used to treat stable angina and heart failure.
Targets the SA node to reduce heart rate.
- Risk of bradycardia, contraindicated if heart rate is less than 60bpm

39
Q

Heart disease can be managed through the modification of risk factors, what are these?

A
  • Smoking
  • Hypertension
  • Hyperlipidaemia (raised triglycerides, cholesterol)
  • Diabetes Mellitus
  • Family history
  • Inflammatory conditions
40
Q

How does chronic inflammatory disease increase ischameic heart disease risk?

A

Diseases like COPD and rheumatoid arthritis are associated with increased risk.

Human Diseases (47 decks)

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