Cardiac Pharmacology

Question 1

What is usually seen in the ribs In case of aortic coarctation?
(birth defect of narrowing of aorta)

Answer 1

We see the Notching on the ribs (inferior side as the intercostal rteries run there)
the nothing is due to the increased pressure in the IC arteries due to the coarctation of aorta.

Question 2

What are the two types of hypertension?

Answer 2

Primary (idiopathic causes)
treatnment- lifestyle changes, low salt, lose weight,Excersise,

Secondary (some previous underlying cause)

Question 3

Name the classes of druugs used to treat Hypertension.

Answer 3

Sympatholytics

Direct Vasodilators

Calcium Channel blockers

RAAS modulators

Diuretics

Question 4

What is Fenoldopam?

fan of Dopamine) D1 receptor is a Gs GPCR (that means increase cyclic AMP

Answer 4

class - sympatholytic (peripheral acting)

Selective D1 partial agonists (dopamine receptor 1 agonists)
helps vasodilationused in hypertensive crisis

Question 5

What is a Partial agonist?

Answer 5

In pharmacology, partial agonists are drugs that bind to and activate a given receptor, but have only partial efficacy at the receptor relative to a full agonist.

Question 6

What is Reserpine

Answer 6

Class - Sympatholytic
Blocks VMAT. no epinehrine formation. no release

VC is prevented
Heart rate Can not go up
no release of renin from JG cells

Question 7

what do you mean by Sympatholytic drugs.

Answer 7

Sympatholytic drugs stops or oppose the physiological results of sympathetic nervous activity or of sympathomimetic drugs.

such as opposing vasoconstriction done by sympathetic NS.

Question 8

what is VMAT ?

Vesicular Monoamine transporter

Answer 8

Phenylalanine to tyrosine to dopa to dopamine.

once dopamine is formed into the sympathetic neuron it is then inserted into the vesicle through VMAT and then converted to Norepinephrine.

Question 9

What is the diffrence between centrally acting and peripheral acting sympatholytics?

Answer 9

central = Doesnt allow release of neurotransmitters
peripheral = transmitter released from synapse but inhibiting the receptors so the NT doesnt act

Question 10

What will happen if you Inhibit the sympathetic Nervous system?

Answer 10

centrally - sedation,drowsiness,depression and libido occurs
peripheral- alpha1 blocks=postural hypotension and low TPR (afterload)
(alpha1 is on vessels and Beta 2 is on heart muscle)
beta2 = decrease heart rate

now when sym is blocked parasym works more
that means doarrhoea, high secretion and high urination
high gastric acid secretion can worsen PUD

Question 11

what type of receptor is alpha 1?

Answer 11

Gq (calcium increase and vasoconstriction)

Question 12

Explain the Lipid lowering agents.

Answer 12

statins - HMG CoA reductase inhibitors
Fibrates- Lipoprotien lipase Activator
Cholsyramine- bile acid resins
Niacin- Hormone synthesis lipase inhibiot
Ezetimibe- Cholesterol uptake ing=hibitor
PCSK inhibiotrs
Bempedoic acid

Question 13

Explain metabolism of cholesterol :)o

Answer 13

Eat cheeseburger =Dietary cholesterol= stomach=intestine = gets absorbed= gets packed into chylomicrons=hets to lymph=goes to portal venous system= goes to liver= liver synthesize Cholesterol=secrete in systemic venous system

Question 14

Explain Niacin’s Two functions.

Answer 14

In lower doses - Vitamin B3

In Higher doses acts as anti-hyperlipidemic drug

Question 15

how many Lipoprotiens do we have?

lipid+protiens

Answer 15

chylomicrons (low protien high lipid)
vLDL (low Protien high lipid)
LDL (comparatively high protien but lipid ratio is still high)
HDL (ratio of both protiens and lipids are equal) (good cholesterol)

total cholesterpl = HDL+LDL + Triglycerides/5

Question 16

Explain Ezetimibe.

Answer 16

It doesnt let the cholesterol absorb through Intestine :)

Inhibits dietary cholesterol from getting absorbed.

it can cause Diarrhoea and greasy stool.

Question 17

How ezetimibe stops dietary cholesterol from getting absorbed into the intestine?

Answer 17

There is a cholesterol transporter in GIT and the Liver called the Niemann pick C1 like protien.

this drug inhibits this transporter

Question 18

How statins works? (HMG CoA reductase inhibitors)

Answer 18

HMg coa in liver is converted to the Mevalonic acid which then is further converted to cholesterol in liver.

by inhibiting the HMG Coa reductase these drugs stops the cholesterol formation within the liver.

low cholesterol in liver= liver cells increase the number of LDL transporter for compensation= more LDL comes to liver from blood= low cholesterol in blood.

side effect can include liver toxicity
and rhabdomyalisis (breakdown of muscle cell)

used in MI and prevention of Strokes

Question 19

why do we need cholesterol?

Answer 19

Cholesterol is a fat-like, waxy substance that helps your body make cell membranes, many hormones, and vitamin D. The cholesterol in your blood comes from two sources: the foods you eat and your liver. Your liver makes all the cholesterol your body needs.

Cholesterol and other fats are carried in your bloodstream as spherical particles called lipoproteins. The two most commonly known lipoproteins are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

Question 20

diff in vldl and ldl

Answer 20

The main difference between VLDL and LDL is that they have different percentages of the cholesterol, protein, and triglycerides that make up each lipoprotein.
VLDL contains more triglycerides. (fatty acids)
LDL contains more cholesterol.
VLDL and LDL are both considered types of “bad” cholesterol.

liver makes VLDL====gets converted to IDL=======gets converted to LDL=======plaques

Question 21

how Fibrates drugs help lower cholesterol?

Answer 21

Fibrates activates the LPL enzyme that converts vLDL to IDL.
since they increase the catabolism of vLDL and vldl are rich in triglycerides they are basically lowering the amount of tgs present

since the metabolism is increased these dugs can cause gallstones as the cholesterol after metabolism goes to the bile :)