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CVS block > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

How many people are living with heart and circulatory diseases in scotland?

A

Around 700,000

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2
Q

What % of scottish deaths is caused by heart and circulatory diseases?

A

29% - 50 people each day

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3
Q

What does the healing process of atherosclerosis entail?

A
  • Activation of platelets
  • Inflammatory cells - incorporation of cholesterol
  • Fibrous cap
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4
Q

What are antiplatelets used as?

A

Secondary prevention (i.e after cardiovascular disease is diagnosed)

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5
Q

How is aspirin (antiplatelets) administered ?

A

75mg - To all patients with stable angina

75 - 150mg - To previous Coronary artery bypass graft

300mg - First two weeks after a stroke or Transient
ischaemic attack

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6
Q

How is clopidogrel (antiplatelet) administered?

A

75mg - TIA/stroke patients after the initial acute phase of treatment

In combination with aspirin - following percutaneous coronary intervention in stable patient.

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7
Q

How is ticagrelor(antiplatelets) administered?

A

90mg 2x/day used in combination with aspirin in all patients with Acute coronary syndrome for upto 1 year in NHSG

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8
Q

What are the side effects of antiplatelets?

A

Bleeding

Roughly 0.25 to 1% annual risk of a significant bleed with a single agent

Synergistic effect when multiple agents used

Effect will last for up to 1 week

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9
Q

What do beta blockers do?

A

Reduce mortality in Ischemic heart disease and heart failure

Reduce frequency of symptomatic attacks of angina, Atrial fibrilation and Supraventricular tachycardia

Antihypertensive (2nd line now) - (multiple mechanisms of action both central and peripheral).

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10
Q

What are beta 1 receptors?

A

Predominant receptor in the heart - Sinoatrial, Atrioventricular nodes and myocardial cells.

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11
Q

What organ reduces secretion of renin?

A

Kidneys

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12
Q

What are the positive effects of beta 1 receptors?

A

Slows heart rate and conduction (negatively chronotropic (and dromotropic)), increases diastolic time

Reduces BP

Anti-arrhythmic protects heart from effects of catecholamines

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13
Q

What are the negative effects of beta 1 receptors?

A

Reduces contractility (negatively inotropic), high doses can lead to bradycardia and heart block

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14
Q

What are beta 2 receptors?

A

Present in Smooth muscle e.g airways, vascular

Present in Skeletal muscle

Present on myocardial cells

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15
Q

What are the positive effects of beta 2 receptors?

A

Reduces tremor

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16
Q

What are the negative effects of beta 2 receptors?

A

Bronchospasm in asthmatic

Vasoconstriction in Peripheral vascular disease.

17
Q

Example of beta 1 blockers

A

Bisoprolol

Atenolol

Carvediol

Metoprolol

18
Q

Example of beta 1 and beta 2

A

Propanolol

19
Q

Renin-angiotensin-aldosterone axis is a central hormonal axis that aids to the development of ___________

A

Heart failure

Liver failure

Kidney failure

20
Q

What does Renin-angiotensin-aldosterone axis do?

A

Preserves circulating volume to maintain perfusion of the vital organs.

21
Q

Why is renin enzyme released by the kidney?

A

In response to reduction in perfusion pressure.

22
Q

Where is ACE Endothelial enzyme found predominantly in?

A

The lungs

23
Q

What is angiotensinogen produced by?

A

Liver

24
Q

What does renin convert angiotensinogen to?

A

Angiotensin 1

25
Q

What does ACE convert angiotensin 1 to?

A

Angiotensin II

26
Q

What does angiotensin II act on?

A

It acts on the adrenals releasing aldosterone

27
Q

What do ACE inhibitors and angiotensin receptor antagonists do?

A

They are antihypertensive - First line in under 55 white/asian patient NICE 127

They reduce symptoms in heart failure

They prevent aberrant remodelling following Myocardial infarction

They reduce mortality and progression of disease in IHD, CVD and renal disease with proteinuria (particularly diabetic nephropathy)

28
Q

What does Angiotensin II do?

A

It acts as a potent vasoconstrictor in the peripheral vasculature

It regulates the function of the efferent arteriole of the glomerulus in the kidney

29
Q

What does Aldosterone do?

A

Plays a role in Retention of Na ( and therefore H2O) at the expense of K in the DCT of the Kidneys (sweat glands, Gut)

30
Q

What are the positive effects of ACE inhibitors and ARBS?

A

Reduce blood pressure

Reduce afterload on heart

Prevents aberrant remodelling after MI

Reduces proteinuria

31
Q

What are the negative effects of ACE inhibitors and ARBS?

A

Reduces perfusion pressure in glomerulus leading to renal impairment

Hyperkalaemia via effect on aldosterone levels: cough, orthostatic hypotension

32
Q

What are examples of ACE inhibitors?

A

Ramipril

Lisinopril

Captopril

Perindopril

CVS block (17 decks)

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