Cardiovascular Disease Flashcards
What are the irreversible risk factors for cardiovascular disease?
Age
Sex- more common in males, due to protection from female sex hormones, but this is lost during menopause.
Family history
What are the reversible risk factors for cardiovascular disease, that relate to the patient?
Smoking
Obesity
Diet
Exercise
What are the reversible risk factors for cardiovascular disease, that relate to medical?
Hypertension
Hyperlipidaemia
Diabetes
What is primary prevention?
Stopping a disease before it happens.
Exercise, smoking cessation, better diet.
What is the action of statins?
HMG co-A reductase inhibitors.
They inhibit cholesterol synthesis in the liver.
What are the possible side effects of statins?
Myositis.
If in doubt, check the BNF.
What drug must not be prescribed to someone taking statins?
Fluconazole.
Nystatin would be used instead.
What is a Beta-blocker?
Block the activity of beta-adrenergic receptors.
The drug determines which beta receptors are blocked.
What is the action of a beta-blocker?
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?
Why should propranolol not be taken in someone with asthma?
Blocks beta 2 receptors in the lungs- so no relief is given when someone takes salbutamol during an asthma attack.
What is a diuretic?
Increase salt and water loss in the kidney.
- reduce plasma volume and reduce the cardiac workload.
Give examples of different types of diuretics.
Loop diuretic- frusemide.
Thiazide diuretic- bendroflumethiazide.
What is the action of nitrates?
Dilate veins to reduce cardiac preload
Dilate resistance arteries to reduce cardiac after load
Dilate colateral coronary artery supply to reduce anginal pain
Give examples of short acting and long acting nitrates.
Short acting- glyceryl trinitrate (GTN)
Long acting- isosorbide mononitrate.
How should nitrates be administered?
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.
What are the side effects of nitrates?
Headache, hypotension.
What is the mode of action of calcium channel blockers?
Blocks calcium channels in smooth muscles.
Causes relaxation and vasodilation- amlodipine, nifedipine.
Slow conduction of pacing impulses directly in the heart- verapamil.
What are some of the side effects of calcium channel blockers?
Gingival hyperplasia.
Patients on calcium channel blockers must keep good OH.
What is the action of ACE inhibitor?
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.
Give examples of ACE inhibitors
Enalapril
Ramapril
Lisinopril
What are some of the side effects if ACE inhibitors?
Angio-oedema
Lichenoid reactions.
What other medications may be indicated if the patient has a bad reaction to ACE inhibitors?
Angiotensin II blockers- losartan.
What is Atrial Fibrillation?
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.
What medication might someone be on if they have AF?
Anti-coagulants- Warfarin, DOAC
