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OV3017 Eye Disease > 21 - Systemic drugs 1: cardiovascular > Flashcards

21 - Systemic drugs 1: cardiovascular Flashcards

1
Q

modifiable risks of cardiovascular disease

A

-smoking
- hypertension
-hyperlidaemia
-diet+exercidse

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2
Q

non modifiable risks of CVD

A
  • age
  • gender
  • genetics
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3
Q

lifestyle measures to reduce risk of CVD

A
  • stop smoking
  • normal BMI 20-25
  • reduce salt intake to <6g
  • limit alcohol consumption <14 a week
  • 5 a day
  • reduce intake of total and saturated fat
  • regular excerie
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4
Q

hypertension is a major risk factor for

A
  • stroke
    -myocaridal infarction
  • heart failure
  • chronic kidney disease
  • cognitive decline
  • premature death
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5
Q

what can untreated hypertension cause

A
  • vascular and renal damage
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6
Q

diagnosing hypertension

A

if clinic bp higher than 140/90

offer bp monitoring at home to confirm diagnosing

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7
Q

stage 1 HTN

A
  • clinic BP is 140/90 or above and ABPM or HBPM average is 135/85 or above
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8
Q

stage 2 HTN

A

clinic BP > 60/100
and
ABPM/HBPM > 150/95

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9
Q

stage 3 HTN

A
  • clinic bp is 180 >
    or
    clinic diastolic bp is >110
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10
Q

why do we treat HTN

A
  • reduces cerebeovascular disease by 40-50%
  • reduces myocardial infarction by 16-30%
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11
Q

how do we treat HTN

A

stepped approach
- low doses of several drugs

minimises adverse events + maximises patient compliance

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12
Q

what is the aim of treatment

A
  • reduce diastolic BP <90
  • reduce systolic BP <140
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13
Q

younger 55 and stage 1 - which type of drug

A

ACE

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14
Q

Over 55 stage 1/ or black patients of any age - which drug

A
  • calcium channel blocker
  • diuretic
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15
Q

if px becomes stage 2

A

do not inrease dose of ACE - it can increase side effects

instead - add low doses of other drugs

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16
Q

suffix of ace inhibitors

A

PRIL

e.g ramipril

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17
Q

kidney produces renin, what is it and what does it do

A

an enzyme that converts angiotensin to angiotensin I, catalysing conversion

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18
Q

what is antigensin I the substrate for

A

angiotensin converting enzyme (ACE)

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19
Q

what does the angiotensin coverting enzyme do

A

converts angitotensin I to active angiotensin II

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20
Q

what is angiotensin II

A
  • potent vasoconstrictor
  • constricts blood vessels: increasing peripheral resistance + increasing blood volume

we want to STOP vasoconstriction as that will increase blood pressure

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21
Q

side effects of ace inhibtors

A
  • persistent dry cough
  • taste disturbance
  • angiodema
    -1st dose hypotension
  • hyperkalaemia
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22
Q

angiotensin II receptor antagonist

A
  • they completley inhibit the receptor at which angiotensin II acts

-fewer side effects than ACE

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23
Q

Angiotensin II receptor antagonists examples

A
  • candesartan
  • losartan
  • valsartan

TAN SUFFIX

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24
Q

calcium channel blockers

A

CCB 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 the vascular smooth muscle

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25
what do CCB affect - and cause as a result
- cardiac contractability causes vasodilation - cause vasodilation of large and small arteries and also reduce cardiac output
26
what are calcium channel blockers useful in the treatment of
hypertension and angina
27
examples of CCB
- Nifedipine, - Amlodipine - Verapamil - Diltiazem
28
what do diuretics promote
- excretion of water and salt: this is done by increasing urine production and increasing salt consumption
29
how do diuretics reduce the re uptake of salt
- increase the amount of urine thereby reducing blood volume - thus lowering blood pressue
30
3 main classes of diuretics and where do they mainly work
distal convulated tube - thiazides - loop diuretic - potassium sparing
31
what are thiazides commonly used for
blood pressure
32
Ignore
33
how do thiazides work
- inhibit absorbtion of Na in the DCT - can lead to K deficiency
34
how do thiazides reduce BP
- vasodilation - reduction in blood volume
35
examples of thiazides
bendrofluazide, Hydrochlorothiazide Indapamide
36
what do loop diuretics do
- inhibit absorption of sodium and potassium in TAL of loop of henle - fast acting
37
when are loop diuretics used
- renal failure + heart failure
38
examples of loop diuretcs
Furosemide, Bumetanide
39
where does potassium sparing act
DCT
40
What do potassium sparings do
- retain potassium - used in conjunction with thiazide and loop diuretics
41
examples of potassium s-paring
- amiloride - spironolactone
42
when are beta blockers used
treatment of angina - increased risk of side effects
43
examples of beta blockers
- atenolol - metoprolol - propanolol
44
what does the mechanism of beta blockers involve
- reduction of heart rate + force of contraction - reduction of peripheral resistance - ihibition of renin release reduce sympathetic activity
45
less commonly used in anti-hypertensive agents
used when other drugs are not bringing down blood pressure that easily even with combination drugs. Or if the patient had bad side effects with some drugs. -Alpha-adrenoceptor antagonists Doxazosin -Centrally acting agents Methyldopa Moxonidine -Vasodilators Hydralazine Minoxidil
46
other cardiovascular disease
- ischaemic heart disease - cardiac failure - cardiac arrythmias
47
Ischaemic heart disease: Angina pectoris
-presents with intermittent chest pain on excretion or stress (stable angina) -caused by insufficient oxygen supplied to cardiac muscle due to narrowing of coronary arteries
48
how is angina pectoris treated
-->single acute attack (Glyceryl trinitrate-potent vasodilator) -->Prophylaxis (Sublingual GTN, Aspirin, Beta- blockers, calcium channel blockers). All patients should receive lipid lowering therapy. stent inserted to widen blood vessel.`
49
what is atheroma
- Atheroma deposited in the wall of blood vessels - Atheroma is problematic because it narrows the blood vessels Also linked to formation of clots
50
Ischaemic heart disease: Myocardial infarction
-ST elevation on ECG Immediate: -Analgesia, Thrombolysis, Aspirin Prophylaxis: - Beta blockers -ACE inhibitors - Aspirin - Lipid lowering therapy
51
Heart failure - due to what
-Usually the result of damage to the myocardium e.g. MI, Myocardiomyopathy, heart valve damage -results in poor tissue perfusion and eodema of the lungs or peripheral tissue
52
treatment of heart failure
- Diuretics - ACE inhibitors - Nitrates - Beta blockers - Ionotropic drugs e.g. Digoxin
53
Cardiac arrythmias
too long and confusing to write] Just know causes changes in the cardiac action potential
54
what is lipid modification
- cholesterol and triglycerdes transported in the blood from the liver in association with lipoproteins
55
what is low density lipoprotein LDL
bad cholestrol
56
what is high density lipoprotein HDL
good cholesterol
57
what is LDL cholesterol associated with
atheroma and cardiovascular disease
58
what are statins used for
to lower cholesterol
59
Enzyme: HMG-CoA
rate limiting step in the synthesis of cholestrol in liver
60
what do statins do to this Enzyme: HMG-CoA
inhibit this enzyme increasing uptake of LDL from blood
61
statin examples
-Simvastatin - Atorvastatin - Pravastatin
62
by inhibiting cholesterol synthesis in the liver
you get more uptake of LDL cholesterol

OV3017 Eye Disease (19 decks)

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