Cardio Pharmacology

Question 1

How does aspirin inhibit platelet aggregation?

Answer 1

Irreversibly acetylenes cyclo-oxygenase, preventing production of thromboxane A2, inhibiting platelet aggregation

Question 2

When are anti-platelets used?

Answer 2

Used in low dose for secondary prevention following MI, TIA/ stroke, and for patients with angina or peripheral vascular disease
Have a role in primary prevention

Question 3

Name some anticoagulants

Answer 3

Low molecular weight heparin, warfarin, fondaparinux (Xa inhibitor), and bivalirudin (thrombin inhibitor)

Question 4

What is warfarin the anticoagulant of choice for?

Answer 4

Mechanical valves

Question 5

Which drugs are used to treat AF and clots?

Answer 5

Direct oral coagulants (DOACs) e.g. Xa inhibitors and direct thrombin inhibitors

Question 6

When are beta blockers used?

Answer 6

Angina, hypertension, arrhythmia, post MI, heart failure

Question 7

What are some side effects of beta blockers?

Answer 7

Lethargy, ED, headache, sleep disturbance, hypotension

Question 8

Give 2 examples of beta blockers

Answer 8

Bisoprolol, propranolol

Question 9

When are ACE inhibitors used?

Answer 9

Hypertension, heart failure, post MI, diabetic nephropathy

Question 10

What are some side effects of ACE inhibitors?

Answer 10

Dry cough, urticaria, hypotension, acute renal failure (reduced angiotensin II formation), rash

Question 11

Give 2 examples of ACE inhibitors

Answer 11

Ramipril, captopril

Question 12

When are loop diuretics used?

Answer 12

Heart failure - inhibit the Na/2Cl/K co-transporter

Question 13

What are the side effects of loop diuretics?

Answer 13

Dehydration, low Na+, K+, Ca2+, hypovolaemia

Question 14

When are thiazides and thiazide-like diuretics used?

Answer 14

Hypertension and heart failure

Question 15

What are the side effects of thiazides and thiazide-like diuretics?

Answer 15

Low K+, raised Ca2+, low Mg2+, increased urate, impotence, impaired glucose tolerance

Question 16

When are vasodilators used?

Answer 16

Heart failure, IHD, hypertension

Question 17

Which vasodilators lower pre-load and how?

Answer 17

Nitrates dilate veins and the larger arteries, lowering filling pressure

Question 18

Which vasodilators lower after-load and how?

Answer 18

Hydralazine dilates the resistance vessels, lowering blood pressure

Question 19

How do calcium antagonists work?

Answer 19

Decrease cell entry of Ca2+ via voltage-sensitive channels in smooth muscle, thereby promoting coronary and peripheral vasodilation and reducing myocardial oxygen consumption

Question 20

What are the side effects of calcium antagonists?

Answer 20

Flushes, headaches, ankle oedema, lowered LV function, palpitations

Question 21

Give an example of a dihydropyridine and when it would be used

Answer 21

Amlodipine - used in hypertension and angina

Mainly peripheral vasodilators and cause a reflex tachycardia, so are often used with a beta blocker

Question 22

Give an example of a non-dihydropyridine and when it would be used

Answer 22

Verapamil - hypertension and angina and dysrhythmias

Slow conduction at the AV and SA nodes

Question 23

Give 2 examples of calcium channel blockers

Answer 23

Amlodipine, nifedipine, verapamil (unusual ending)

Question 24

How does Digoxin work?

Answer 24

Blocks the Na+/K+ pump

Question 25

When is digoxin used?

Answer 25

Anti-arrhythmic drug - To slow the pulse in fast AF

Question 26

What are the side effects of digoxin?

Answer 26

Nausea, decreased appetite, yellow vision, confusion

Question 27

How does amiodarone work?

Answer 27

Prolongs the cardiac action potential, reducing the potential for tachyarrhythmicas

Question 28

When is amiodarone used?

Answer 28

Anti-Arrhythmic - tachycardias (including cardiac arrest)

Question 29

What are the side effects of amiodarone?

Answer 29

Thyroid disease, liver disease, pulmonary fibrosis, QT prolongation (polymorphic ventricular tachycardia)

Question 30

What medications may be given for acute coronary syndromes?

Answer 30

Pain relief - GTN spray, diamorphine Dual anti platelet therapy - aspirin + clopidogrel Antithrombin therapy - fondaparinux Lipid lowering therapy - statins

Question 31

What medications may be given for chronic stable angina?

Answer 31

1st line - beta/calcium channel blocker Antiplatelet therapy - aspirin or clopidogrel Lipid lowering therapy - statins Short acting nitrates - GTN spray

Question 32

Name 2 angiotensin receptor blockers

Answer 32

Valsartan, losartan

Question 33

When are angiotensin receptor blockers used?

Answer 33

Hypertension, diabetic nephropathy, heart failure (used when cannot have ACEi)

Question 34

What are the side effects of angiotensin receptor blockers?

Answer 34

Symptomatic hypotension, hyperkalaemia, rash, angio-oedema, renal dysfunction