Cardiovascular and Renal

Question 1

Eptifibatide

Answer 1

Cyclic heptapeptide inhibitor

Antiplatelet drug

Glycoprotein IIb/IIIa receptor inhibitor

Used to prevent MI in patients with unstable angina

Question 2

Dabigatran

Answer 2

Thrombin inhibitor

Thromboembolism prophylaxis

Anticoagulant

Question 3

Saralasin

Answer 3

Angiotensin II partial agonist

Peptide

Not suitable for oral administration

Question 4

Clopidogrel

Answer 4

Inhibits platelet aggregation

Inhibits ADP binding to receptor on platelets

Question 5

Amiloride

Answer 5

Potassium-sparing diuretic

Blocks ENaC to prevent sodium reabsorption on apical membrane

Question 6

Warfarin

Answer 6

Anticoagulant

Inhibits synthesis of clotting factors II, VII, IX and X

Can be used as rodenticide

Can be taken orally

Question 7

Alteplase

Answer 7

Recombinant tissue plasminogen activator

Clot lysis

Localised to plasminogen bound to fibrin

Question 8

Acetazolamide

Answer 8

Carbonic anhydrase inhibitor

Diuretic

Treatment of episodic ataxia

Increases pH of urine

Causes metabolic acidosis

Question 9

Anistreplase

Answer 9

Thrombolytic

Plasminogen and anisoylated streptokinase

Question 10

Captopril

Answer 10

ACE inhibitor

Antihypertensive

Decreases pre- and afterload

Question 11

Heparin

Answer 11

Naturally-occurring anticoagulant

Binds to enzyme inhibitor antithrombin to inactivate thrombin

Not available orally - must be taken intravenously

Question 12

Hydrochlorothiazide

Answer 12

Thiazide diuretic

Blocks Na+/Cl- transport in distal tubule

Vasodilator effects

Question 13

Streptokinase

Answer 13

Thrombolytic

Binds to plasminogen activator to generate plasmin

Breaks down fibrin clots

Question 14

Triamterene

Answer 14

Potassium-sparing diuretic

Blocks ENaC in collecting tubule

Question 15

Tranexamic acid

Answer 15

Analogue of aminocaproic acid

Competitively inhibits plasminogen activation

Used to treat or prevent haemorrhage

Question 16

Pimobendan

Answer 16

Calcium sensitiser

Used to treat canine dilated cardiomyopathy and canine mitral valve regurgitation

Question 17

Ouabain

Answer 17

Cardiac glycoside

Treats hypotension

Blocks Na+/K+/ATPase

Too potent for clinical use

Question 18

Mannitol

Answer 18

Osmotic diuretic

Filtered but not reabsorbed so increases urine volume

Question 19

Furosemide

Answer 19

Loop diuretic

High ceiling

Sulphonamide

Actively secreted into proximal tubule by same mechanism as uric acid so decreases uric acid excretion leading to gout

Efficacy reduced by NSAIDs

Causes 15-25% of filtrate to be excreted

Blocks Na+/K+/2Cl- cotransport in apical membrane of TAL

Question 20

Enalapril

Answer 20

ACE inhibitor

Metabolised to enalaprilat in liver

Antihypertensive

Used in heart failure

Question 21

Digoxin

Answer 21

Cardiac glycoside

Na+/K+/ATPase pump inhibitor

Increases intracellular calcium

Increases heart contractility in heart failure

Question 22

Bisoprolol

Answer 22

β1 antagonist

Class II antidysrhythmic

Used in heart failure

Question 23

Amiodarone

Answer 23

Class III antidysrhythmic

Prolongs phase 3 of cardiac AP

Question 24

Aminocaproic acid

Answer 24

Chemically similar to lysine

Competitively inhibits plasminogen activation

Prevents severe bleeding

Question 25

α-Methylnoradrenaline

Answer 25

False transmitter Displaces NA from vesicle

Question 26

Tirofiban

Answer 26

Non-peptide glycoprotein IIb/IIIa inhibitor Anti-platelet drug Used to prevent myocardial infarction

Question 27

Rivaroxaban

Answer 27

Anticoagulant Factor Xa inhibitor

Question 28

Milrinone

Answer 28

PDE III inhibitor Inodilator used in heart failure Limited use due to pro-dysrhythmic effect

Question 29

Losartan

Answer 29

Non-peptide angiotensin II antagonist Acts on AT1 receptors

Question 30

Levosimendan

Answer 30

Calcium sensitiser Increases cardiac calcium binding efficiency Vasodilation via PDE III inhibition

Question 31

Abciximab

Answer 31

Glycoprotein IIb/IIIa receptor antagonist Inhibits platelet aggregation Monoclonal antibody against the receptor which also binds to the vitronectin receptor on platelets Used with coronary angioplasty for coronary artery thrombosis

Question 32

Amrinone

Answer 32

PDE III inhibitor Inodilator used in heart failure

Question 33

Carvedilol

Answer 33

Non-selective β1, β2 and α1 blocker Third-generation Used in stable heart failure

Question 34

Duteplase

Answer 34

Double chain recombinant human tissue plasminogen activator Greater activity on plasminogen bound to fibrin in clots, thus localising its action

Question 35

Spironolactone

Answer 35

Potassium-sparing diuretic Competitive aldosterone antagonist Metabolised to canrenone in the liver Slow rate of onset of diuresis due to dependence on turnover of sodium channels