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(5) Pharmacology > (9.1+2) Heart Failure & Anti-hypertensives > Flashcards

(9.1+2) Heart Failure & Anti-hypertensives Flashcards

1
Q

What is hypertension?

A

BP >140/80mmHg

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2
Q

What is the mechanism of action of ACE inhibitor?

A
  • -ACE -> -Angiotensin II -> -Aldosterone -> -water retention & - peripheral vasoconstriction
  • -Bradykinin degradation -> +vasodilation or Efferent>Afferent arterioles
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3
Q

Suggest 3 ADRs of ACE inhibitors

A
  • Hyperkalaemia
  • Dry cough (from bradykinin)
  • Renal failure (reduced GFR)
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4
Q

What is the mechanism of action of Dihydropyradine?

A

Calcium channel blocker -> Vasodilation + Venodilation (different from Bendrothiazedine & Verapamil)

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5
Q

Suggest 1 ADR of Calcium Channel Blocker.

A
  • Constipation
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6
Q

Suggest 2 contraindications of ACE-inhibitor.

A
  • Renovascular hypertension

- Pregnancy

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7
Q

Suggest 2 contraindications of Beta blockers

A
  • COPD

- Asthma

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8
Q

What is the mechanism of action of Bendrothiazedine & Verapamil?

A

Calcium channel blocker -> reduced introphy & chrontrophy (different from Dihydropyradine)

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9
Q

Why does Angiotensin Receptor Blocker not cause dry cough?

A

Same actions as ACE-i without inhibiting degradation of Bradykinin (which causes smooth muscle relaxation)

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10
Q

What are the actions of Nitrate?

A
  • Primarily: Venodilation

- Secondarily: Vasodilation

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11
Q

Suggest 4 ADRs of Nitrates.

A
  • Hypotension
  • Flushes
  • Headache
  • Reflex tachycardia
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12
Q

What is the mechanism of action of Digoxin?

A

Inhibits NaKATPase -> reverse NCX -> +[Ca2+]i

  • > +introphy
  • >
    • relative recovery period at AVN -> -chrontrophy
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13
Q

Suggest 2 indications of Digoxin.

A
  • Worsened heart failure

- Supraventricular tachycardia

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14
Q

What is the pathway of treatment for a hypertensive patient who is

A
  1. ACE-i
    • CCB
    • Diuretics
    • Beta blocker
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15
Q

What is the pathway of treatment for a hypertensive patient who is >50 years old or black at any ages?

A
  1. CCB
    • ACE-i
    • Diuretics
    • Beta blocker
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16
Q

Define heart failure.

A

Inability of heart to provide sufficient blood supply to the body despite adequate filling pressure.

17
Q

Suggest 4 causes of heart failure.

A
  • Ischaemia (most common)
  • Hypertension
  • Valvular disease
  • Cardiomyopathies
18
Q

Suggest 2 causes of right sided heart failure.

A
  • Left sided heart failure

- Cor Pulmonale (cardiac alterations due to primary respiratory cause)

19
Q

Suggest 4 drugs used to treat heart failure

A
  • ACE-i (first line)
  • Aldosterone Antagonists/Angiotensin Receptor Blocker
  • Beta blockers
  • Nitrates
  • Gigoxin (if symptoms worsened)
  • Dihydropyrimidine (only if comorbidities: angina/hypertensive)
20
Q

When is Calcium channel blockers prescribed to heart failure?

A
  • If comorbidities: angina/hypertension

- Only give Dihydropyrimidine due to its vaso&venodilatory effects

21
Q

Suggest 2 indications of Loop Diuretics.

A
  • Heart failure (venodilatory effects)

- Fluid overload e.g. liver failure/oedema

22
Q

Suggest 2 indications of Thiazide Diuretics.

A
  • Heart failure (venodilatory effects)

- Hypertension

23
Q

What is the mechanism of action of Loop Diuretics?

A
  • NKCC2 on apical membrane in TAL -> prevent Na, K, Cl reabsoprtion
24
Q

Where is the site of action of Thiazide Diuretics?

A
  • NaCl symporter in early DCT
25
Q

Why should Loop Diuretics be used with extreme caution when given with Aminoglycosides?

A
  • Ototoxicity

- Nephrotoxicity

26
Q

Suggest 4 ADRs of Loop Diuretics

A
  • Ototoxicity
  • Nephrotoxicity
  • Hypokalaemia
  • Metabolic acidosis (due to low [K])
  • Hyperlipidaemia & Hyperglycaemia (due to low [K} -> -Insulin)
  • Hypotension
27
Q

Suggest 4 ADRs of Thiazide Diuretics.

A
  • Hypokalaemia
  • Metabolic acidosis (due to low [K])
  • Hyperlipidaemia & Hyperglycaemia (due to low [K} -> -Insulin)
  • Hyperuricaemia -> Gout
  • Hypotension
28
Q

Why should Thiazide Diuretics be used with extreme caution when given with Steroids or Digoxin?

A

High risk of Hypokalaemia

29
Q

Why should Loop Diuretics be used in caution when given with Beta blocker?

A
  • Hypokalaemia
  • Metabolic acidosis (due to low [K])
  • Hyperlipidaemia & Hyperglycaemia (due to low [K} -> -Insulin)
30
Q

Suggest 2 types of Potassium Sparing Diuretics.

A
  • Aldosterone Antagonist: Spironolactone

- Amiloride

31
Q

Where at the sites of actions of Aldosterone Antagonist?

A
  • inhibits ENaC & NaKATPase on Principal cell in late DCT & CD
  • reduce peripheral vasoconstriction
32
Q

Suggest 3 indications for Spironolactone.

A
  • Hypertension
  • Fluid overload e.g. oedema/liver failure
  • Cushing’s Syndrome
33
Q

Suggest 2 ADRs of Spironolactone

A
  • Hyperkalaemia

- Gynaecomastia

34
Q

Why should Spironolactone be used with extreme caution when given with ACE-inhibitor?

A
  • Hyperkalaemia -> Cardiac Arrhythmia

(5) Pharmacology (16 decks)

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