Cardiovascular Disease

Question 1

What are the irreversible risk factors for cardiovascular disease?

Answer 1

Age
Sex- more common in males, due to protection from female sex hormones, but this is lost during menopause.
Family history

Question 2

What are the reversible risk factors for cardiovascular disease, that relate to the patient?

Answer 2

Smoking
Obesity
Diet
Exercise

Question 3

What are the reversible risk factors for cardiovascular disease, that relate to medical?

Answer 3

Hypertension
Hyperlipidaemia
Diabetes

Question 4

What is primary prevention?

Answer 4

Stopping a disease before it happens.

Exercise, smoking cessation, better diet.

Question 5

What is the action of statins?

Answer 5

HMG co-A reductase inhibitors.

They inhibit cholesterol synthesis in the liver.

Question 6

What are the possible side effects of statins?

Answer 6

Myositis.
If in doubt, check the BNF.

Question 7

What drug must not be prescribed to someone taking statins?

Answer 7

Fluconazole.
Nystatin would be used instead.

Question 8

What is a Beta-blocker?

Answer 8

Block the activity of beta-adrenergic receptors.
The drug determines which beta receptors are blocked.

Question 9

What is the action of a beta-blocker?

Answer 9

B1 blocker- reduce heart rate by reducing heart muscle excitability and reduced heart efficiency.
B2 blocker- beta 2 receptors blocked in the lungs, so smooth muscle remains constricted?

Question 10

Why should propranolol not be taken in someone with asthma?

Answer 10

Blocks beta 2 receptors in the lungs- so no relief is given when someone takes salbutamol during an asthma attack.

Question 11

What is a diuretic?

Answer 11

Increase salt and water loss in the kidney.
- reduce plasma volume and reduce the cardiac workload.

Question 12

Give examples of different types of diuretics.

Answer 12

Loop diuretic- frusemide.
Thiazide diuretic- bendroflumethiazide.

Question 13

What is the action of nitrates?

Answer 13

Dilate veins to reduce cardiac preload
Dilate resistance arteries to reduce cardiac after load
Dilate colateral coronary artery supply to reduce anginal pain

Question 14

Give examples of short acting and long acting nitrates.

Answer 14

Short acting- glyceryl trinitrate (GTN)
Long acting- isosorbide mononitrate.

Question 15

How should nitrates be administered?

Answer 15

Sublingually, transdermal or intravenously.

Metabolised by first pass metabolism, so if it was taken orally, then none of the drug would make it to the circulatory system.

Question 16

What are the side effects of nitrates?

Answer 16

Headache, hypotension.

Question 17

What is the mode of action of calcium channel blockers?

Answer 17

Blocks calcium channels in smooth muscles.
Causes relaxation and vasodilation- amlodipine, nifedipine.
Slow conduction of pacing impulses directly in the heart- verapamil.

Question 18

What are some of the side effects of calcium channel blockers?

Answer 18

Gingival hyperplasia.
Patients on calcium channel blockers must keep good OH.

Question 19

What is the action of ACE inhibitor?

Answer 19

Inhibit angiotensin I to angiotensin II.
Prevents aldosterone dependent reabsorption of salt and water.
So blockage of angiotensin II causes vasodilation and reduction in plasma by preventing water and fluid reabsorption.

Question 20

Give examples of ACE inhibitors

Answer 20

Enalapril
Ramapril
Lisinopril

Question 21

What are some of the side effects if ACE inhibitors?

Answer 21

Angio-oedema
Lichenoid reactions.

Question 22

What other medications may be indicated if the patient has a bad reaction to ACE inhibitors?

Answer 22

Angiotensin II blockers- losartan.

Question 23

What is Atrial Fibrillation?

Answer 23

Electrical impulses in the atria of the heart fire irregularly and chaotically.

Causes them to quiver or twitch.

Patients may say their heart beat feels irregular or that they feel it fluttering.

Question 24

What medication might someone be on if they have AF?

Answer 24

Anti-coagulants- Warfarin, DOAC