Cardio pharmacology Flashcards
1
Q
Why is it important to treat hypertension?
A
It is an important preventable cause of premature morbidity and mortality
2
Q
Name some conditions that hypertension is a risk factor for
A
- Stroke (ischaemic and haemorrhagic)
- MI
- Heart failure
- Chronic renal disease
- Cognitive decline
- Premature death
- Increased risk of atrial fibrillation which is an independent risk for stroke
3
Q
What level of clinical blood pressure is a diagnostic level for hypertension?
A
140/90mmHg or higher
4
Q
What test can be used to confirm a diagnosis of hypertension?
A
Ambulatory blood pressure monitoring (ABPM) over 24hrs
5
Q
How is RAAS involved in increasing blood pressure?
A
- Angiotensin II is an extremely potent vasoconstrictor and increases peripheral resistance
- Angiotensin II -> aldosterone -> increased Na+ -> increased water reabsorption -> increased blood volume and BP
6
Q
How is the sympathetic nerverous system involved in increasing blood pressure?
A
- Causes renin release
- • Noradrenaline (NA) released in response to BP decrease
• NA -> vasoconstriction and increased contractility of the heart -> increased peripheral resistance and cardiac output -> increased BP
7
Q
What does ACE stand for in ACE inhibitors?
A
Angiotensin converting enzyme
8
Q
What are ACE inhibitors indicated for?
A
- Hypertension
- Heart failure
- Diabetic nephropathy
9
Q
Give some examples of ACE inhibitors
A
- Ramipril
- Enlarpril
- Perindopril
- Trandolapril
10
Q
What are the two different areas of ACE inhibitor side effects?
A
- Related to angiotensin II formation
* Related to kinin production
11
Q
What are the main adverse side effects of ACE inhibitors?
A
- Hypotension, acute renal failure, hyperkalaemia, teratogenic effects
- Chronic dry cough, rash, anaphylactoid reaction
12
Q
What does ARB stand for?
A
Angiotensin II receptor blockers
13
Q
What are ARBs inhibitors indicated for?
A
When ACE-i are contraindicated:
• Hypertension
• Diabetic neuropathy
• Heart failure
14
Q
What do ARBs act on
A
AT-1 receptor (angiotensin receptor)
15
Q
Give some examples of ARBs
A
- Candesartan
- Losartan
- Valsartan
- Irbesartan
- Telmisartan
16
Q
What are the main adverse side effects of ARBs?
A
- Symptomatic hypotension
- Hyperkalaemia
- Potential renal dysfunction
- Rash
- Angio-oedema
- Contraindicated in pregnancy
17
Q
What does CCB stand for?
A
Calcium channel blocker
18
Q
What are CCBs inhibitors indicated for?
A
- Hypertension
* IHD e.g. angina and arrhythmia
19
Q
What are the 2 different types of CCBs based on their action?
A
- Vasodilators
2. Affecting electrical conductivity
20
Q
Give some examples of CCBs
A
- Vasodilator CCBs: amlodipine, nifedipine, felodipine, lacidipine
- Electrical conductivity effectors: diltiazem, verapamil
21
Q
What are the 4 different areas of CCB side effects?
A
- Due to peripheral vasodilation
- Due to negatively chronotropic effects (HR)
- Due to negatively inotropic effects (force of contractility)
- Miscellaneous
22
Q
What are the main adverse peripheral side effects of CCBs?
A
- Flushing
- Headache
- Oedema
- Palpitations
23
Q
What are the main adverse chronotropic side effects of CCBs?
A
- Bradycardia
- AV block
- Postural hypotension
24
Q
What is the main adverse inotropic side effect of CCBs?
A
Worsening of cardiac failure
25
What is the main adverse miscellaneous side effect of CCBs?
Verapamil causes constipation
26
What are the main types of heart failure?
* Due to impaired contractility of the heart – left ventricular systolic dysfunction (LVSD)
* With preserved ejection fraction (HFPEF) aka diastolic failure
27
How does oedema usually differ between acute and chronic heart failure?
* Acute = pleural oedema
| * Chronic = ankle oedema and abdominal ascites
28
What is the most common cause of heart failure?
Coronary artery disease
29
In heart failure, what would you use for symptomatic treatment of congestion?
Diuretics, usually loop diuretics e.g. furosemide
30
What drugs would you use to inhibit the RAAS in heart failure?
ACE inhibitors and ARBs
31
What drugs would you use to inhibit the sympthetic nervous system in heart failure and why?
Beta blockers (e.g. bisoprolol) - they are effective at blocking reflex sympathetic responses which stress the failing heart
32
What is the 1st line treatment in heart failure?
Low dose and slow uptitration ACE inhibitors (e.g. ramapril) and beta-blockers (e.g. bisoprolol)
33
What is the 2nd line treatment in heart failure?
Aldosterone antagonists - ARBs (e.g. candesartan) if intolerant to ACE-i
34
What could you give to treat heart failure if they were intolerant to ACE-i and ARBs?
Hydralazine/nitrate combination - peripheral vasodilators
35
What are the 2 types of cardiac natriuretic peptides?
* Atrial natriuretic peptide (ANP) – for the atria
| * B-(brain) natriuretic peptide (BNP) – for the ventricles (found in the brain and heart)
36
What causes the release of cardiac natriuretic peptides?
* Stretching of atrial and ventricular muscle cells
* Raised atrial or ventricular pressures
* Volume overload
37
What metabolises cardiac natriuretic peptides?
Neutral endopeptidase (NEP/neprilysin)
38
What does NEP inhibition do?
Increases natriuretic peptide levels
39
In heart failure, give 3 drugs which are based around influencing cardiac natriuretic peptide levels?
* Sacubitril – neprilysin inhibitor
* Valsartan – ARB
* Entresto –combination of Sacubitril and Valsartan and it is very effective in heart failure
40
What do nitrates do in cardiac disease?
* They are atrial and venous dilators
* Reduce preload and afterload
* Lower BP
41
What are nirates indicated for?
IHD – angina and heart failure
42
Give 3 examples of nitrate treatment
* Isosorbide mononitrate
* GTN spray
* GTN infusion
43
What are the main adverse effects of nitrate treatment?
* Headache
* GTN spray syncope
* Potential tolerance to the drug
44
What does GTN stand for?
Glyceryl trinitrate
45
What are the 1st line treatments for chronic stable angina?
* Beta blocker
* Calcium channel blocker
* Combine if angina persists on just one
46
What are the antiplatelet treatments for chronic stable angina?
Aspirin or clopidogrel (if aspirin intolerant)
47
What are the lipid lowering therapy treatments for chronic stable angina?
Statins
48
What is the short acting nitrate treatment for chronic stable angina?
GTN spray for acute attack
49
How should chronic stable angina be treated if the patient is intolerant to the usual therapies or the angina remains uncontrolled?
Consider a monotherapy or combination with a long acting nitrate e.g. ivabradine, nicorandil, ranolazine
50
What pain relief can be given in acute coronary syndromes?
* GTN spray
| * Opiates e.g. diamorphine
51
What types of therapy would you usually give to manage acute coronary syndromes?
* Pain relief
* Dual antiplatelet therapy
* Anti-thrombin therapy
* Background angina therapy
* Lipid lowering therapy
* Therapy for LVSD/heart failure as required
52
What would you give in high risk cases of acute coronary syndromes?
IV glycoprotein IIb/IIIa inhibitor e.g. tirofiban, eptifbatide, abciximab
53
What is dual antiplatelet therapy for acute coronary syndromes?
Aspirin + oral P2Y12 inhibitor e.g. ticagrelor, clopidogrel
54
What is an anti-thrombin therapy and give an example of a drug?
Low molecular weight heparin e.g. fondaparinux (injection)
55
How do beta blockers relieve angina pain?
* They reduce oxygen demand by slowing hear rate and reducing myocardial contractility
* They improve oxygen distribution by slowing heart rate
56
What is the classification for anti-arrhythmic drugs?
Vaughan Williams classification
57
What do the classes of anti-arrhythmic drugs do?
* Class 1 & 3 = rhythm control
| * Class 2 & 4 = rate control
58
What are Class 1 anti-arrhythmic drugs and what are some examples?
• Sodium channel blockers
1a: disopyramide, quinidine, procainamide
1b: lidocaine, mexiletine
1c: flecainide, propafenone
59
What is the most commonly used Class 1 anti-arrthythmic drug?
Flecainide
60
What are Class 2 anti-arrhythmic drugs and what are some examples?
• Beta adrenoceptor antagonists
Non-selective: propranolol, nadolol, carvedilol
β-1 selective: bisoprolol, metoprolol
61
How do Class 3 anti-arrhythmic drugs work and what are some examples?
* Prolong the action potential – increase QT interval
| * e.g. amiodarone, sotalol
62
What are Class 4 anti-arrhythmic drugs and what are some examples?
* Calcium channel blockers
| * e.g. verapamil, diltiazem
63
Give an example of an α-blocker
Doxazosin
64
Give examples of an ACE inhibitor
* Ramipril
* Enlarpril
* Perindopril
* Trandolapril
65
Give examples of an ARB
* Candesartan
* Losartan
* Valsartan
* Irbesartan
* Telmisartan
66
Give examples of antiplatelet therapies
* COX-1 inhibitor: aspirin
| * P2Y12 inhibitor: Ticagrelor, Clopidogrel
67
Give an example of an anti-thrombin therapy
Low molecular weight heparin e.g. fondaparinux
68
Give examples of beta blockers
* Propranolol
* Bisoprolol
* Atenolol
69
Give examples of a calcium channel blocker
* Amlodipine
* Felodipine
* Diltiazem
* Verapamil
70
Give examples of centrally acting anti-hypertensives
* Moxonidine
| * Methyldopa
71
Give examples of a Class 1a Na channel blocker
* Disopyramide
* Quinidine
* Procainamide
72
Give examples of a Class 1b Na channel blocker
* Lidocaine
| * Mexiletine
73
Give examples of a Class 1c Na channel blocker
* Flecainide (most commonly used)
| * Propafenone
74
Give examples of a Class 3 anti-arrhythmic drug
* Amiodarone
| * Sotalol
75
Give an example of a direct renin inhibitor
Aliskiren
76
Give examples of a thiazide diuretic
* Bendroflumethiazide
* Hydrochlorothiazide
* Chlorthalidone
77
Give examples of a loop diuretic
* Furosemide
| * Bumetanide
78
Give examples of a potassium-sparing diuretic
* Spironolactone
| * Eplerenone
79
Give examples of a glycoprotein IIb/IIIa inhibitor
* Tirofiban
* Eptifbatide
* Abciximab
80
Give an example of a neprilysin inhibitor
Sacubitril
81
Give an example of an opiate
Diamorphine
82
Give examples of a long-acting nitrate
* Isosorbide mononitrate
* Ivabradine
* Nicorandil
* Ranolazine
83
Give an example of a short-acting nitrate
Glyceryl trinitrate (GTN)
84
Give an example of a statin
Simvastatin
