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PPE Drugs - CVS > Anti-Hypertensives/Heart Failure/Angina > Flashcards

Anti-Hypertensives/Heart Failure/Angina Flashcards

1
Q

What are the 4 first-line classes of drug therapy used in hypertension?

A

ACE inhibitors
Angiotensin II Receptor Blockers
Calcium channel blockers
Diuretics

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2
Q

Who would be better suited to a calcium channel blocker or diuretic as opposed to an ACE inhibitor?

A

People aged 55 or older

Black patients

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3
Q

What is the mechanism of action of ACE inhibitors?

A

Competitively inhibit angiotensin converting enzyme - therefore reduce formation of angiotensin II, a potent vasoconstrictor, and also decrease aldosterone levels.

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4
Q

Do ACE inhibitors act mainly in arteries or veins?

A

Arteries

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5
Q

List 4 ADRs of ACE inhibitors

A

Dry cough
Angioedema
Renal failure
Hyperkalaemia

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6
Q

Give 2 examples of ACE inhibitors

A

Ramipril

Lisinopril

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7
Q

Give 2 examples of Angiotensin receptor blockers

A

Losartan

Candesartan

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8
Q

What is the mechanism of action of angiotensin receptor blockers?

A

Bind to angiotensin AT1 receptors

Inhibit action of angiotensin II

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9
Q

Why is there no dry cough with angiotensin receptor blockers?List 2 important ADRs that may occur.

A

No build up of bradykinin
Hyperkalaemia
Renal failure

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10
Q

What is the mechanism of action of calcium channel blockers?

A

Bind to L-type calcium channels in the heart and smooth muscle of coronary/peripheral arterioles
Reduces calcium entry into cell - prevents contraction and hence constriction
Therefore vasodilates arteries (no effect on veins) - lowers TPR and improves blood supply to heart

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11
Q

List 3 examples of calcium channel blockers

A

Verapamil
Diltiazem
Amlodipine

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12
Q

Give 4 ADRs of Verapamil

A
  • Constipation
  • Bradycardia
  • 1st degree heart block
  • Negative inotropy
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13
Q

Give 2 side effects of Diltiazem

A
  • Small risk of bradycardia

- Some negative inotropy

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14
Q

Give 4 ADRs of Amlodipine

A

Any 4 of:

  • Baroreceptor-mediated tachycardia/palpitations
  • Flushing
  • Sweating
  • Throbbing headache
  • Oedema
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15
Q

List some secondary classes of drug used to treat hypertension

A
  • Alpha-adrenoreceptor blockers
  • B-blockers
  • Renin inhibitors
  • Centrally acting agents
  • Vasodilators
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16
Q

Give an example of an alpha-adrenoreceptor blocker

A

Doxazosin

17
Q

Give 4 ADRs of Doxazosin

A

Postural hypotension
Dizziness
Headache
Oedema

18
Q

What is the mechanism of action of B-blockers?

A
  • Block B-adrenoreceptors in heart - reduce cardiac output

- Block renin release in kidney - down-regulate RAAS

19
Q

Which B-blocker is not selective for B1 receptors?

Why is this significant?

A

Propranolol

Contraindicated in asthma. The others can be used with caution.

20
Q

List 4 ADRs of B-blockers

A
  • Lethargy
  • Bradycardia
  • Impaired glucose tolerance
  • Raynaud’s
21
Q

Name a renin inhibitor

A

Aliskiren

22
Q

Name 4 B-blockers

A

Propranolol
Bisoprolol
Atenolol
Sotalol

23
Q

What are the mechanisms by which drugs act to improve prognosis in heart failure?
Which other drugs are used purely for symptom control?

A
  • RAAS antagonism
  • B-blockers
  • Positive inotropes - cardiac glycosides, B agonists
  • Diuretics
24
Q

Name a cardiac glycoside.

State its mechanism of action

A

Digoxin
Blocks Na+/K+-ATPase - reduces Na+ extrusion from cells, therefore reduces conc gradient down which Na+ flows into cell via NCX. Hence less Ca2+ leaves cell via NCX - more for contraction –> positive inotropy.

25
Q

When might you use a B-agonist in heart failure?

Name one

A

Acute reversible heart failure
Cardiogenic shock
Example = dobutamine

26
Q

What are organic nitrates used to treat?

What other drug classes are used to treat this condition?

A

Angina
Calcium channel blockers
B blockers

27
Q

Give 2 examples of organic nitrates

A 
Glyceryl trinitrate (GTN)
Isosorbide mononitrate
28
Q

What is the mechanism of action of organic nitrates?

A

React with thiols in vascular smooth muscle to release NO2 - then reduced to NO.
NO increases cyclic GMP therefore decreases Ca2+ - less contraction - vasodilation

29
Q

Where do organic nitrates act?

How does this produce a negative inotropic effect?

A

In the VENOUS system

Decreased venous pressure = decrease preload = decreased filling = negative inotropy

PPE Drugs - CVS (5 decks)

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