Cardiovascular Drugs

Question 1

Name a loop diuretic?

Answer 1

Ferusomide

Question 2

How do loop diuretics work?

Answer 2

Inhibit action of Na/K/2Cl pump in ascending loop of Henle

Inhibits reabsorption of Na, K and water

Question 3

When is ferusomide indicated?

Answer 3

Pulmonary oedema
Chronic heart failure
Oliguria secondary to renal failure

Question 4

What risk is there when furosemide is used with aminoglycosides?

Answer 4

Ototoxicity

Question 5

Which diuretics are more effective?

Answer 5

Loop diuretics (ferusomide)

Question 6

Name a thiazide diuretic?

Answer 6

Bendroflumethiazide

Question 7

What are the indications for thiazide diuretics?

Answer 7

Hypertension
heart failure
Oedema
Prophylaxis of Ca containing renal stones

Question 8

How do thiazide diuretics work?

Answer 8

Inhibit Na/Cl reabsorption in distal tube

Increases Na/Cl/water excretion

Question 9

What is spironalactone?

Answer 9

A potassium sparing diuretic

Question 10

How does spironalactone work?

Answer 10

Aldosterone anatgonist

Question 11

Name a Beta blocker?

Answer 11

Atenolol

Question 12

How do Beta blockers work?

Answer 12

Act on B1 receptor in the heart to decrease heart rate and force of contraction, this reduces workload of the heart.
Reduces Rennin production by the kidneys to reduce blood pressure.
Decreases conduction/Ap initiation in the heart to give an antiarryhythmic effect

Question 13

When are beta blockers used?

Answer 13

hypertension
angina
Supraventricular dysrhythmias
MI prophylaxis
Migraine prophylaxis

Question 14

What are the contra-indications for Beta blocker use?

Answer 14

Asthma
HF
2nd/3rd degree heart block
Bradycardia
COPD

Question 15

What drug class is Diltiazem?

Answer 15

Calcium channel blocker

Question 16

How do calcium channel antagonists work?

Answer 16

Relaxation of vascular smooth muscle
Decrease myocardial contractility
Decrease conduction at AV node (increase refractory period)
Decrease afterload and heart rate (reduces 02 consumption)

Question 17

What are the indications for Calcium antagonists?

Answer 17

Angina treatment/prophylaxis
Hypertension
Dysrhythmias

Question 18

Severe bradycardia, heart failure, 2nd/3rd degree heart block and pregnancy/breast-feeding are contra-indications for what cardiovascular drugs class?

Answer 18

Calcium antagonist

Question 19

Name an ACE inhibitor?

Answer 19

Ramipril

Question 20

How do ACE inhibitors work?

Answer 20

Inhibiting the angiotensin converting enzyme results in decreased angiotensin 2 synthesis and increase in bradykinin accumulation. Reduced angiotensin 2 reduces peripheral resistance/fluid overload. Increased bradylinin causes peripheral vasodilation.

Question 21

Indications for ACE inhibitors?

Answer 21

Hypertension
Heart failure
Post MI
Diabetic nephropathy

Question 22

Common side effects of ACE-i?

Answer 22

Postural hypertension
Dry cough
Rash

Question 23

When should patients take their first dose of an ACE-i and why?

Answer 23

Before bed to avoid 1st dose hypotension

Question 24

What is losartan?

Answer 24

An angiotensin receptor blocker

Question 25

Why would a ARB blocker be used instead of an ACE-i?

Answer 25

No dry cough as associated with ACE-i

Question 26

What drug class is Isosorbide mononitrite?

Answer 26

Nitrate

Question 27

What is the mechansism of nitrates?

Answer 27

Vascular smooth muscle relaxation | Coronary artery/systemic vein vasodilation

Question 28

Indications for nitrate use?

Answer 28

Angina | Heart failure

Question 29

What is the most common cardiac glycoside?

Answer 29

Digoxin

Question 30

What does digoxin do?

Answer 30

Increases force of heart contraction by increasing intracellular Na concentration. Increases vagal activity

Question 31

Indications for digoxin?

Answer 31

``` Heart failure Supraventricular arrhythmias (especilly AF) ```

Question 32

Does digoxin improve symptoms or mortality in heart failure?

Answer 32

Symptoms not mortality

Question 33

What is amiodarone?

Answer 33

An anti-dysrhythmic

Question 34

How does amiodarone work?

Answer 34

Prolongs refractory period in all parts of conduction system. Reduces speed of conduction through the heart

Question 35

Indications for amiodarone?

Answer 35

Supraventricular/ventricular arrhythmias

Question 36

What is the most common antiplatelet agent?

Answer 36

Aspirin

Question 37

How does clopidogrel work

Answer 37

Inhibits platelet aggregation by preventing ADP release preventing activation of glycoprotein gp11b/11a complexes

Question 38

Indications for clopidopgrel?

Answer 38

Prevention of atherosclerotic events in acute coronary syndrome/peripheral arterial disease Post MI/ischaemic stroke

Question 39

How does aspirin work?

Answer 39

Inactivates COX by acetylating a serine residue in its active site Reduces TXA2 synthesis (substance that promotes platelet aggregation

Question 40

What is aspirin indicated for?

Answer 40

CVA/MI prophhylaxis

Question 41

Contra-indications for aspirin?

Answer 41

Active bleeding Peptic ulcer Haemophilia Breastfeeding

Question 42

What is streptokinase?

Answer 42

Thrombolytic

Question 43

When are thrombolytics indicated?

Answer 43

``` Acute MI Thromboembolitic events (DVT/PE/arterial thrombosis) ```

Question 44

When is streptokinase contra-indicated?

Answer 44

Recent haemorrhage/trauma/surgery Coagulation defects Aortic dissection/aneurysm Acute pancreatitis

Question 45

Why can streptokinase not be used used twice in the same year?

Answer 45

Body generates antibodies to streptokinase

Question 46

How soon after an MI should streptokinase be given?

Answer 46

Within 12 hours of MI (best effect within 3hrs)

Question 47

When is amiodarone contra-indicated?

Answer 47

``` Sinus bradychardia SA block Sinus node disease Thyroid dysfunction Iodine sensitivity (contains iodine) Pregnancy/breastfeeding ```

Question 48

Name a heparin (low molecular weight heparin)

Answer 48

Enoxaparin

Question 49

What is the mechanism of heparins?

Answer 49

Cause higher anti-factor Xa to antithrombin activities (anti-factor 2a) ration than heparin which may prevent thrombosis

Question 50

Indications for heparin

Answer 50

DVT PE MI Unstable angina

Question 51

What drug can be used to reverse heparin effect?

Answer 51

IV protamine sulphate

Question 52

Contra indications for heparin use?

Answer 52

``` Haemophilia/haemorrhagic disorders Thrombocytopenia Recent cerebral bleed Severe liver disease Peptic ulcer disease ```

Question 53

What is warfarin?

Answer 53

Oral anticoagulant

Question 54

How does warfarin work?

Answer 54

Inactivates vitamin K in hepatic microsomes | Interferes with formation of vitamin K dependent clotting factors (prothrombin, II, VII, IX and X)

Question 55

Why does warfarin have a delayed onset?

Answer 55

Long prothrombin half life (48-72 hours)

Question 56

Indications for warfarin?

Answer 56

Prophylaxis of embolism on AF, prosthetic heart valves, rheumatic heart disease Prophylaxis of DVT/PE TIAs

Question 57

When is warfarin contra-indicated?

Answer 57

``` Peptic ulcer Endocarditis Haemorrhagic stroke Sever hypertension Pregancy ```

Question 58

Name a commonly prescribed statin

Answer 58

simvastatin

Question 59

How do statins work?

Answer 59

Reversibly inhibits HMG CoA reductase, the rate limiting enzyme in cholesterol synthesis by the liver Liver responds by increasing LDL receptor expression taking in more LDL to reduce plasma cholesterol

Question 60

Contraindications to statin use?

Answer 60

Active liver disease/persistently deranged LFTs | Preganancy/breastfeeding