Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiology > cardio pharmacology > Flashcards

cardio pharmacology Flashcards

1
Q

Complications of chronic HTN

A

Major risk factor for:
Stroke – ischaemic and haemorrhagic
Myocardial infarction
Heart failure
Chronic renal disease
Cognitive decline
Premature death

Increases the risk of:
Atrial fibrillation (independent stroke risk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how to diagnosis of HTN and stages

A

People with suspected hypertension are offered ambulatory blood pressure monitoring (ABPM) to confirm a diagnosis of hypertension.

The 4 stages of hypertension are:
Elevated blood pressure levels between 120-129/less than 80. …
Hypertension stage 1 is 130-139/80-89 mmHg.
Hypertension stage 2 is 140/90 mmHg or more.
Hypertensive crisis is higher than 180/120 or higher.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

mechanisms of BP control

A

the targets for therapy are:

1.Cardiac output and Peripheral Resistance

  1. Interplay between:
    a. Renin-Angiotensin-Aldosterone system
    b. Sympathetic nervous system (noradrenaline)
  2. Local vascular vasoconstrictor and vasodilator mediators
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

summary or Renin system

A

angiotensin 2:
increases vascular growth ( hyperplasia and hypertrophy,
salt retention ( aldosterone release and increases tubular sodium reabsorbtion
angiotensin 2 can act on sympathetic nerve end to increase peripheral resistance and cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

actions of SNS on BP

A

Alpha receptors - peripheral resistance
beta receptors - cardiac output
sns also acts to potentiate renin activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

potential drug targets of BP

A

RENIN system:
ACE inhibitors
ARB - angiotensin receptor blocker
Renin Inhibitor
Aldosterone antagonist

SNS:
Alpha blocker,
Beta Blocker
calcium channel blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Clinical indications - ACE Inhibitors, state examples

A

Main clinical indications

Hypertension
Heart failure
Diabetic nephropathy

examples: ramipril, perindopril, enalapril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Adverce effects of ACEi

A

Main adverse effects

  1. Related to reduced angiotensin II formationa. Hypotension
    b. Acute renal failure
    c. Hyperkalaemia
    d. Teratogenic effects in pregnancy - CANT GIVE TO PREGGOS
  2. Related to increased bradykinin production
    Bradykinin is involved in plasma extravasation, bronchoconstriction, nociception, vasodilation, and inflammation Burch et al (1990)
    ACE breakdown bradykinin into inactive products
    a. Cough
    b. Rash
    c. Anaphylactoid reactions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

clinical indications of ARB angiotensin 2 receptor blocker

A

Main clinical indications

Hypertension
Diabetic nephropathy
Heart failure (when ACE-I contraindicated)

e.g cadesartan, valsartan, losartan, irbesartan, telmisartan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

side effects of ARB

A

Symptomatic hypotension (especially volume deplete patients)
Hyperkalaemia
Potential for renal dysfunction
Rash
Angio-oedema

Contraindicated in pregnancy - NO PREGGOS
Generally very well tolerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

indication for CCB and E.G

A

Hypertension
Ischaemic heart disease (IHD) – angina
Arrhythmia (tachycardia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

difference in groups of CCB

A

Effect: L-type calcium chanel blocker

  1. Dihydropyridines: nifedipine, amlodipine, felodipine, lacidipinePreferentially affect vascular smooth muscle
    Peripheral arterial vasodilators
  2. Phenylalkylamines: verapamilMain effects on the heart
    Negatively chronotropic (rate), negatively inotropic (force of contraction)
  3. Benzothiazepines: diltiazemIntermediate heart/peripheral vascular effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Adverse Effects of CCB

A

Due to peripheral vasodilatation (mainly dihydropyridines)
Flushing
Headache
Oedema
Palpitations

Due to negatively chronotropic effects (mainly verapamil/diltiazem)
Bradycardia
Atrioventricular block

Due to negatively inotropic effects (mainly verapamil)
Worsening of cardiac failure so cant use for heart failure obviously

Verapamil causes constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

clinical indications for beta blockers

A

Ischaemic heart disease (IHD) – angina
Heart failure
Arrhythmia
Hypertension

e.g bisoprolol, propranolol , metoprolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Drug selection of beta receptors: B1 vs B2

A

there is no cardioselective beta blocker, but BB have different affinities. this can be affected by the concentration of the drug. relative to some factors.

B1 receptors are found in the heart
B2 recepotrs are found in the lungs, but 40% of hearts are b2

BB in asthmatic contradictions can worsen condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

adverse effects of BB

A

Fatigue - worsen effects in active people who regularly have adrenaline boosting activities
Headache
Sleep disturbance/nightmares

Bradycardia
Hypotension
Cold peripheries
Erectile dysfunction

Worsening of:
Asthma (may be severe) or COPD
PVD – Claudication or Raynaud’s
Heart failure – if given in standard dose or acutely, if heart failure is chronic BB should be given slow and dosage should be titrated

17
Q

Diuretics Clinical Indication and Types with examples

A

Hypertension
Heart failure

Classes

Thiazides and related drugs (distal tubule):
Bendroflumethiazide, hydrochlorothiazide
these are more commonly used for HTN

Loop diuretics (loop of Henle)
furosemide (fast acting), bumetanide
These are more commonly used for Heart failure

Potassium-sparing diuretics:
AMILORIDE

Aldosterone antagonists these swapped potassium sparing diuretics. also as acting on RENIN sysem can eb considered Disease MODIFYING AGENTS
spironolactone,

18
Q

Adverse effects of diuretics

A

Hypovolaemia (mainly loop diuretics)
Hypotension ( “ )

Low serum potassium (hypokalaemia)
Low serum sodium (hyponatraemia)
Low serum magnesium (hypomagnesaemia)
Low serum calcium (hypocalcaemia)

Raised uric acid (hyperuricaemia – gout)

Erectile dysfunction 		(mainly thiazides)
Impaired glucose tolerance	(             “              )
19
Q

other hypertensive

A

Alpha 1 Adrenorecptors - Doxazosin
centrally acting anti-HTN - MOXONIDINE
Direct renin inhibitor - Aliskiren

20
Q

treatment rubric for HTN

A
21
Q

what is and Types of Heart Failure

A

Heart failure is a complex clinical syndrome of symptoms and signs that suggest the efficiency of the heart as a pump is impaired.
It is caused by structural or functional abnormalities of the heart. Most common cause is coronary artery disease

Heart failure due to left ventricular systolic dysfunction - LVSD

Heart failure with preserved ejection fraction (diastolic failure) – HFPEF

Acute heart failure
Chronic heart failure

22
Q

why is it bad to use heart performance drugs with heart failure

A

when the heart is impaired, feedback system works to try to perserve circulation. these resposne such as sympathetic responses are needed. thus treatment looks at modifying this sympathetic response (cardiac output + peripheral resistance) instead of modifying heart activity

23
Q

armamentarium of Heart failure

A
  1. Symptomatic treatment of congestion:
    Diuretics (usually loop)
  2. Disease influencing therapy – neurohumoral blockade
    Inhibition of renin-angiotensin-aldosterone system Inhibition of the sympathetic nervous system

a. First line:
1st ACE inhibitors and
2nd Dual therapy: beta blocker therapy both sides of heart performance systems - RENIN & SNA

Low dose and slow uptitration

b. Aldosterone antagonists - Spironlactone - can cause gynecomastia

c. ACE-I intolerant: Angiotensin receptor blocker

d. ACE-I and ARB intolerant: Hydralazine/nitrate combination

e. Consider digoxin or ivabradine

23
Q

Types of CAD

A

Coronary Artery Disease

  1. Chronic stable angina
    Anginal chest pain
    Predictable
    Exertional
    Infrequent
    Stable
    ****
  2. Unstable angina / acute coronary syndrome (NSTEMI)
    Unpredictable
    May be at rest
    Frequent
    Unstable
    ****
  3. ST elevation Myocardial Infarction (STEMI)
    Unpredictable
    Rest pain
    Persistent
    Unstable

Cardiology (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions