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Cardiology > Cardiac pharmacology > Flashcards

Cardiac pharmacology Flashcards

1
Q

Which cardiac drug is contraindicated in renal artery stenosis?

A

ACE inhibitors

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2
Q

Which drugs would you prescribe in angina?

A

Beta blockers
Calcium channel antagonists
Nitrates
Nicorandil

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3
Q

Which drugs would you prescribe in hypertension?

A 
ACE inhibitors
Beta blockers
Calcium channel antagonists
Diuretics
Spironolactone
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4
Q

Which drug is described as the “potassium sparing diuretic”?

A

Spironolactone

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5
Q

Which drugs would you prescribe in cardiac failure?

A

ACE inhibitors
Beta blockers
Diuretics
Spironolactone

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6
Q

Which side effect must you be wary of when using diuretics?

A

Hypokalaemia

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7
Q

Which part of the nephron do thiazide diuretics act on?

A

Distal tubule

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8
Q

How do diuretics work?

A

Inhibit NaCl absorption - as a result, H2O and NaCl excreted in urine
Blood volume is reduced, and so MABP decreases

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9
Q

Why are diuretics particularly useful in oedema?

A

They reduce blood volume and reduce arterioles and venules, allowing reabsorption of fluid into capillaries

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10
Q

Which part of the nephron do loop diuretics act on?

A

Ascending limb of the loop of henle

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11
Q

Which are stronger - loop diuretics or thiazide diuretics?

A

Loop

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12
Q

Which drug would be prescribed first (according to SIGN guidelines) in heart failure?

A

ACE Inhibitor

Beta blocker

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13
Q

Which drug can cause the regression of left ventricular hypertrophy?

A

ACE inhibitor

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14
Q

How do nitrates work?

A

Venorelaxation - decrease preload, decrease SV, decrease myocardial O2 requirement by reducing workload of the heart
Also causes dilatation of collateral arteries - blood flow redirected to ischaemic areas

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15
Q

What effect does NO have on cGMP?

A

Stimulates the conversion of more GTP to cGMP which stimulates relaxation of vascular smooth muscle

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16
Q

Which nitrate can be given to patients for short-term symptom management and prophylaxis before exercise?

A

GTN

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17
Q

Which cardiac drug is it possible to develop tolerance to?

A

Nitrates

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18
Q

What is the most common side effect of nitrates?

A

Headaches

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19
Q

Which chemical conversion do ACE inhibitors prevent?

A

Angiotensin 1 to angiotensin 2

20
Q

Why do ACE inhibitors cause an irritating dry cough?

A

They prevent the inhibition of bradykinin - a chemical which irritates the nerve endings

21
Q

What drug are patients converted to if they experience an irritating dry cough with ACE inhibitors?

A

ARBs e.g. losartan

22
Q

Where do ACE inhibitors have their greatest effect?

A

Angiotensin sensitive vascular beds e.g. in brain, heart kidney

23
Q

What effects do ACE inhibitors have on the vasculature?

A

Cause both venous and arteriolar dilatation, reducing preload, afterload and total peripheral resistance

24
Q

Other than dry cough, what is another adverse effect of ACE inhibitors initially?

A

Hypotension, especially in patients treated with diruetics

25
Q

Which cardiac drugs are contraindicated in pregnancy?

A

ACE inhibitors and ARBs

26
Q

Why are ACE inhibitors useful in cardiac failure?

A

They decrease vascular resistance i.e. afterload

Counter inappropriate activation of the RAAS

27
Q

Why are ACE inhibitors useful in hypertension?

A

Reduced TPR and MABP

28
Q

What does stimulation of the alpha 1 adrencoceptors enhance?

A

Vasoconstriction

29
Q

Why are beta blockers useful in angina?

A

Increase window for coronary blood flow by increasing length of diastole (HR overall slowed)
This allows better perfusion of left ventricle
Myocardial O2 requirement reduced - cardiac work load reduced due to decreased HR and SV

30
Q

Why are beta blockers useful in hypertension?

A

Reducing HR means CO decreased, thus MABP is decreased (MABP = CO x TPR)
Reduces renin release from kidney

31
Q

Why are beta blockers useful in cardiac failure?

A

Decreasing HR means ventricles have more time to fill, so SV increases, improving CO
Reduces renin release from kidney
Counters elevated sympathetic activity

32
Q

What two things do calcium channel antagonists reduce that are mediated by L-type channels?

A

Conduction and velocity through AVN

Contractility of the heart - affects phase 2 of action potential

33
Q

Which calcium antagonist acts selectively for cardiac L-type voltage channels?

A

Verapamil

34
Q

Which calcium antagonist acts selectively for smooth muscle L-type voltage channels?

A

Amlodipine

35
Q

Which calcium antagonist has intermediate selectivity for both cardiac and smooth muscle L-type voltage channels?

A

Diltiazem

36
Q

In hypertension, which type of calcium channel antagonist is preferred?

A

Smooth muscle selective i.e. amlodipine

37
Q

Why are calcium channel antagonists useful in hypertension?

A

Reducing calcium influx causes vasodilatation, reducing TPR and MABP

38
Q

What are some of the side effects of calcium antagonists?

A

Ankle swelling, flushing, hypotension and dizziness

39
Q

Which arrhythmia might verapamil be useful in and why?

A

Rapid atrial fibrillation, by suppression of conduction through the AV node

40
Q

Why are calcium antagonists useful in angina?

A

Cause peripheral arteriolar dilatation decreasing afterload and myocardial oxygen requirement – preload is not significantly changed

41
Q

In which condition is nicorandil used?

A

Angina

42
Q

What is nicorandil?

A

Potassium channel agonist that also shows nitrate properties

43
Q

What do potassium channel openers act on primarly?

A

Arteriolar smooth muscle causing relaxation

44
Q

What are two examples of alpha 1 receptor antagonists?

A

Prazosin

Doxazosin

45
Q

What can furosemide be used to treat acutely?

A

Can be used intravenously to reduce acute severe oedema

Cardiology (15 decks)

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