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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
Why should Loop Diuretics be used with extreme caution when given with Aminoglycosides?
- Ototoxicity | - Nephrotoxicity
26
Suggest 4 ADRs of Loop Diuretics
- Ototoxicity - Nephrotoxicity - Hypokalaemia - Metabolic acidosis (due to low [K]) - Hyperlipidaemia & Hyperglycaemia (due to low [K} -> -Insulin) - Hypotension
27
Suggest 4 ADRs of Thiazide Diuretics.
- Hypokalaemia - Metabolic acidosis (due to low [K]) - Hyperlipidaemia & Hyperglycaemia (due to low [K} -> -Insulin) - Hyperuricaemia -> Gout - Hypotension
28
Why should Thiazide Diuretics be used with extreme caution when given with Steroids or Digoxin?
High risk of Hypokalaemia
29
Why should Loop Diuretics be used in caution when given with Beta blocker?
- Hypokalaemia - Metabolic acidosis (due to low [K]) - Hyperlipidaemia & Hyperglycaemia (due to low [K} -> -Insulin)
30
Suggest 2 types of Potassium Sparing Diuretics.
- Aldosterone Antagonist: Spironolactone | - Amiloride
31
Where at the sites of actions of Aldosterone Antagonist?
- inhibits ENaC & NaKATPase on Principal cell in late DCT & CD - reduce peripheral vasoconstriction
32
Suggest 3 indications for Spironolactone.
- Hypertension - Fluid overload e.g. oedema/liver failure - Cushing's Syndrome
33
Suggest 2 ADRs of Spironolactone
- Hyperkalaemia | - Gynaecomastia
34
Why should Spironolactone be used with extreme caution when given with ACE-inhibitor?
- Hyperkalaemia -> Cardiac Arrhythmia

(5) Pharmacology (16 decks)

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