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1
Q

Examples of ACE inhibitors

A

Ramipril
Lisinopril
Quinapril

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2
Q

How does Ramipril work?

A

Inhibit ACE conversion of angiotensin I to angiotensin II.

Angiotensin II is a vasoconstrictor, therefore ACE Inhibitors reduce blood pressure secondary to vasodilatation.

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3
Q

When to use an AC inhibitor such as Lisinopril

A 
Combined with thiazide-like diuretics and CCBs as anti-hypertensive agents
In patients under 55.
Heart failure
Left ventricular dysfunction
Post MI or CHD
Stroke prevention
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4
Q

Side effects of ACE inhibitors

A 
Dry, irritant cough 
(due to accumulation of bradykinin)
- Angioedema
- Hyperkalaemia (due to potassium retention, mediated by reduction of aldosterone)
-Renal dysfunction
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5
Q

Contraindications for durgs like Ramipril

A
  • Renal dysfunction in patients with renal artery stenosis

- Avoid in women with child bearing potential due to danger of foetal renal maldevelopment

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6
Q

Why would you prescribe an ARB instead of an ACE inhibitor?

A

If a patient suffers from the side effect of a dry cough as a consequence of taking an ACE inhibitor

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7
Q

Give examples of ARBs

A

Losartan
Valsartan
Eprosartan

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8
Q

What is the mechanism of action of losartan and valsartan?

A

Antagonise angiotensin II. Prevents vasoconstriction, aldosterone release and sympathetic activation.
Results in BP reduction secondary to vasodilation.

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9
Q

When to use an ARB

A

Combined with thiazide-like diuretics and CCBs as anti-hypertensive agents under 55.
ACEI intolerance
Type 2 Diabetic nephropathy

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10
Q

Side effects of drugs like eprosartan

A

Hyperkalaemia due to potassium retention mediated by reduction of aldosterone

  • Impairment of renal function
  • Dizziness and syncope
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11
Q

Contraindications of ARBs

A
  • Renal dysfunction in patients with renal artery stenosis

- Avoid in women with child bearing potential due to danger of foetal renal maldevelopment

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12
Q

Verapamil and dilitizem and examples of?

A

Rate limiting calcium channel blockers

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13
Q

How do rate limiting calcium channel blockers such as verapamil work?

A

Vasodilators with balance of actions as such that these drugs have noticeable cardiac effects including reduced heart rate

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14
Q

When to use verapamil/dilitizem

A

Anti-hypertensives in combination with ACEIs/ARBs
Anti-arrhythmic:
Tachyarrhythmias such as AF
Post myocardial infarction

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15
Q

Side effects of rate limiting calcium channel blockers

A
  • Bradycardia and AV conduction delay

- Constipation with verapamil

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16
Q

Contraindications of rate limiting calcium channel blockers like verapamil

A
  • Negatively chronotropic and inotropic, so should be used with caution in combination with beta-blockers
  • Heart block and heart failure
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17
Q

Examples of calcium channel blockers that are dihydropyridines

A

Amlodipine
Nifedipine
Felodipine

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18
Q

How do dihydropyridine calcium channel blockers work?

A

Anti-hypertensive with pronounced peripheral vasodilator properties and reflex cardiac stimulation overcomes any direct cardiac effects

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19
Q

When to use drugs such as amlodipine

A

Anti-hypertensives in combination with ACEIs/ARBs
Hypertension in the elderly
Angina

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20
Q

Side effects of amlodipine

A
  • Headache and flushing
  • Tachycardia and palpation (due to reflex activation of sympathetics)
  • Ankle oedema (and occasionally hands)
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21
Q

GTN is an example of?

A

Nitrates

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22
Q

How does GTN work?

A

Relax all types of smooth muscle (via metabolism to nitric oxide)

Cause veno-relaxation (decreasing preload), arteriolar dilation (decreased afterload), and increased coronary blood flow

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23
Q

Use of GTN

A

Angina – reduces myocardial oxygen requirement
Sublingual spray or tablet (short-acting/first-pass metabolism)
Can be used in acute angina attack or prophylactically
In combination with aspirin in acute coronary syndrome

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24
Q

Side effects of nitrates like GTN

A

Postural hypotension headaches

GTN Syncope can cause dizziness

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25
Isosorbide mononitrate is an example of?
Nitrates
26
How does isosorbide mononitrate work?
Relax all types of smooth muscle (via metabolism to nitric oxide) Cause veno-relaxation (decreasing preload), arteriolar dilation (decreased afterload), and increased coronary blood flow
27
Use of isosorbide mononitrate
Oral administration for angina for sustained effect (long-acting/resistance to first-pass metabolism)
28
Side effects of isosorbide mononitrate
Postrural hypotension, headaches
29
Examples of potassium channel openers
Minoxidil, nicorandil
30
How does minoxidil
Cause hyperpolarization, switching off L-type Ca channels. Acts on arterial smooth muscle, resulting in relaxation.
31
When to use minoxidil
in severe hypertension
32
Side effects of minoxidil
Reflex tachycardia, (prevented by beta-blocker) and salt and water retention (alleviated by diuretic)
33
How does nicorandil work?
Cause hyperpolarization, switching off L-type Ca channels. Acts on arterial smooth muscle, resulting in relaxation.
34
When to use nicorandil
used in angina refractory to other treatments
35
Side effects of alpha 1 adrenoreceptor antagonists
Postural hypotension
36
Prazosin and doaxazosin are to be used when?
Indicated for hypertensive patients with prostatic hyperplasia
37
How do alpha 1 adrenoreceptors work?
Cause vasodilation by blocking vascular adrenoceptors. | Reduced sympathetic transmission results in decreased MABP.
38
Examples of selective B1 beta blockers
Atenolol Bisoprolol Metroprolol
39
How do drugs like atenolol work?
Blocks B1 adrenoceptors on SAN Slows heart rate, decreases workload on heart muscle.
40
Use of selective beta blockers
Angina Hypertension Heart failure
41
Side effects of bisoprolol and other drugs of its kind
Tiredness Can worsen heart failure in short term Cold peripheries
42
When should you be cautious when using selective B1 adrenoreceptor blockers?
Insulin-dependent diabetes – beta-blockers can mask hypos and their symptoms (as sympathetic nervous system is repressed)
43
An example of a non-selective beta blocker
Propanolol
44
How does propranolol work?
Decreases rate of depolarization in SAN and AVN
45
When to use propanolol
Anti-arrhythmic | Thyrotoxicosis
46
Side effects on non-selective beta blockers
Worsening of claudication (stops vasodilation in skeletal muscle vessels) Bronchospasm in asthmatics Cold peripheries Tiredness
47
Why might you be cautious about using propranolol?
Insulin-dependent diabetes – beta-blockers can mask hypos and their symptoms (as sympathetic nervous system is repressed) COPD patients may not be able to use treatment
48
Digoxin works by?
Stimulates vagal activity on the heart | Slows conduction and prolongs refractory period in AV node
49
When might you give digoxin?
IV or oral for atrial fibrillation
50
What can occur if too high a dose of digoxin is prescribed?
Heart block
51
Adenosines mechanism of action?
Activates A1-adenosine receptors. Opens ACh-sensitive K+ channels Hyperpolarizes the AVN, suppressing impulse conduction
52
Use for adenosine
Used to terminate paroxysmal supraventricular tachycardia (PSVT)
53
An example of a thiazide diuretic
Bendroflumethiazide
54
Bendroflumethazides mechanism
Increase secretion of Na, Cl and water, decreasing blood volume and the MABP. Inhibits reabsorption in the distal tubule of NaCL
55
When to use bendroflumethiazide
Anti-hypertensive -Moderate diuresis Mild or congestive heart failure Hypertension Severe resistant oedema (with a loop agent)
56
Side effects of thiazide diuretic like bendroflumethiazide
``` Hypokalaemia (tired) Arrhythmias Hyperglycaemia Increased uric acid (gout) – due to greater attraction o uric than OACS Impotence ```
57
Why might you be cautious about bendroflumethiazide?
Loss of potassium can cause hypokalaemia Avoid in patients with gout history Avoid in diabetic patients
58
Examples of a loop diuretic
Furosemide and spironolactone
59
Mechanism of furosemide
Increase secretion of Na, Cl and water, decreasing blood volume and the MABP. Inhibits reabsorption of NaCl in the loop of Henle.
60
When to use furosemide
Anti-hypertensive - Strong diuresis Acute pulmonary oedema (IV) Chronic or congestive heart failure
61
Spironolactone mechanism
Aldosterone blocker. Therefore blocks sodium and re-abosorption.
62
When to use spironolactone
Anti-hypertensive
63
Side effects of furosemide
``` Hypokalaemia (tired) Arrhythmias Hyperglycaemia Increased uric acid (gout) – same reason as thiazides Impotence ```
64
Why would you swap a thiazide diuretic for a loop?
Hypokalaemia causing tiredness in a patient - loop is potassium sparing. Specifically swap for spironolactone not furosemide.
65
Side effects of spironolactone
Hyperkalaemia | ‘Moobs’ - Gynaecomastia
66
Why might you be cautious when using furosemide - a loop diuretic?
Loss of potassium can cause hypokalaemia Avoid in patients with gout history Avoid in diabetic patients
67
Warfarin is?
Anti-coagulant
68
How does warfarin work?
Structually related to vitamin K, prevents its action of conversion. Factors remain inactive.
69
When to use an anti-coagulant such as warfarin
Treatment of DVT or PE, transient ischaemic attacks and prophylaxis of embolization
70
Side effects of warfarin
It drug interactions
71
Why should you be cautious when prescribing warfarin to a patient?
Risk of haemorrhage at high dose (low therapeutic index) | Dietary vitamin K can decrease warfarin action
72
As well as warfarin, give a further four examples of anti-coagulants.
Heparin, LMWHs, rivaroxiban, and dabigatran.
73
How does heparin work?
Heparin inhibits factor Xa and thrombin IIa. LMWHs inactivate factor Xa.
74
When to use heparin
Heparin is preferred in renal failure patients due as LMWHs are excreted via renal excretion.
75
Side effects of heparin and LWMHs
Haemorrhage Osteoporosis Hypoaldosteronism Hypersensitivity reactions
76
How does rivaroxiban work?
Xa inhibitor
77
When to use rivaroxiban and dabigatran
Oral administration for prophylaxis of venous thromboembolism, or treatment of PE or DVT. Usually used after hip or knee replacement
78
Side effects of rivaroxiban
Haemorrhage and renal impairment
79
Contraindications of rivaroxiban
Avoid in liver disease with coagulopathy | NO WAY OF REVERSING if patients are actively bleeding
80
Action of dabigatran
Thrombin inhibitor
81
Side effects of dabigatran
Haemorrhage and anaemia
82
Contraindications for dabigatran
Do not use in patients under 50kg
83
Examples of anti-platelets
Aspirin Clopidogrel Tirofiban
84
Mechanism for anti-platelets such as clopidogrel
Irreversibly blocks cycloygenase (COX) in platelets, preventing TXA2 synthesis.
85
When to use anti-platelets
Aspirin - Used orally main for thrombo-prophylaxis in patients with high cardiovascular risk Copidogrel – in aspirin-intolerant patients Tirofiban – preventative of MI in unstable angina patients
86
Side effects of anti-platelets
GI bleeding and ulceration
87
Fibrinolytic examples
Alteplase Duteplase Streptokinase
88
Action of streptokinase and other drugs of its kind
Opposes the coagulation cascade. Reopen occluded arteries in acute MI or stroke. Dissolve clots via activation of plasminogen.
89
When to administer fibrinolytics
Administered IV in as short a period as possible of the event More beneficial with aspirin
90
Side effects of alteplase and drugs derived from the same family
Do not cause allergic reactions | Haemorrhage
91
Specifically, what is the common action between clopidogrel and aspirin
They both prevent platelet aggregation
92
Aspirin specifically is used when
Immediate STEMI or ACS with NSTEMI Treatment: 300mg, chewable. Preventative of athero-thrombotic events
93
Aspirin can cause
Bronchospasm, GI irritation , haemorrhage
94
Contraindications for aspirin
Asthma and uncontrolled hypertension
95
When specifically should you prescribe clopidogrel
Immediate STEMI or ACS with NSTEMI Treatment: 300mg Preventative of athero-thrombotic events (it is the same as aspirin)
96
Side effect of clopidogrel
haemorrhage
97
What should be prescribed alongside morphine
anti-emetic
98
Give a property of morphine
It has vasodilator properties
99
When to administer morphine
Administered to relieve pain and anxiety, reducing the tachycardia caused by MI.
100
Examples of statins
Atrovastatin Fluvastatin Pruvastatin
101
Mechanism of statins
HMG CoA reductase inhibitors | Lower total and LDL cholesterol
102
When to prescribe statins
Reduce cardiovascular disease events – used in primary and secondary prevention
103
Side effect of statins
Myopathy - rare
104
Contraindications for statins
Avoid in pregnancy – cholesterol is essential for normal foetal development

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