Cardiovascular drugs

Question 1

What are three drug classes that modify cardiac rate and force?

Answer 1

B-adrenoreceptor ligands

Non-selective muscarinic ACh receptor antagonists

Cardiac glycosides

Question 2

What are the two classes of B-Adrenoreceptor ligands?

Answer 2

Antagonists

Agonists

Question 3

What are three exapmles of B-Adrenoreceptor agonists?

Answer 3

Dopamine

Adrenaline

Noradrenaline

Dobutamine

Question 4

What do B-Receptor agonist ligands do?

Answer 4

Increase

Force of contraction

Rate of contraction

Cardiac output

Decrease

Cardiac efficiency

Question 5

What is an adverse affect of B adrenoreceptor ligand agonists?

Answer 5

May cause arrhythmias

Question 6

What can adrenaline be administered for?

Answer 6

Anaphylactic shock

Cardiac arrest

Question 7

What is dobutamine administered for?

Answer 7

Heart failure

Question 8

What are three examples of B-adrenoreceptor antagonists?

Answer 8

Propanolol

Bisoprolol

Atenolol

Question 9

Explain selectivity of B-adrenoreceptor antagonists?

Answer 9

They can selectively block B₁ receptors (atenolol and bisoprolol)

OR

They can block B₁ and B₂ receptors non-selectively (propanolol)

Question 10

What do B-adrenoreceptor ligand antagonists do?

Answer 10

Decrease

Heart rate

Force of contraction

AV conduction velocity

Question 11

When are B-adrenoreceptor ligand antagonists useful?

Answer 11

Arrythmias

AF or SVT

Angina

Heart failure

Hypertension

Question 12

Name a non-selective muscarinic ACh receptor antagonist?

Answer 12

Atropine

Question 13

What does atropine do?

Answer 13

Increases heart rate

Question 14

When should atropine be prescribed?

Answer 14

Useful in bradycardia

e.g. post MI

Question 15

Give an example of a cardiac glycoside?

Answer 15

Digoxin

Question 16

What does digoxin do?

Answer 16

Increases

contractility of the heart

cardiac output

Question 17

How does digoxin affect the Frank-Starling Curve?

Answer 17

It causes an upwards and leftwards shift.

Question 18

When is digoxin dangerous?

Answer 18

In hypokalaemia

Question 19

What does digoxin indirectly cause?

Answer 19

Increased

Vagal activity

therefore…

decreased

SA node discharge & AV node conduction

therefore…

increased refractory period

Question 20

What does digoxin do to the action potential?

Answer 20

It shortens it

Question 21

What are the classes of drugs affecting vasculature and BP?

Answer 21

Organic Nitrates

Angiotensin converting enzyme

Angiotensin I Receptor Blockers

Calcium Antagonists

Thiazide diuretics

Loop diuretics

Question 22

Name two organic nitrates?

Answer 22

GTN

Isosorbide Mononitrate

Question 23

What do organic nitrates do

Answer 23

They will relax all smooth muscle and thus cause veno-relaxation, arteriolar dilatation and increased coronary blood flow.

Question 24

What are organic nitrates used for?

Answer 24

Angina

reduce preload and afterload

May cause headaches

Question 25

What is an unwanted side effect of organic nitrates?

Answer 25

Headaches ## Footnote *tolerance can be built*

Question 26

Name and ACE inhibitor

Answer 26

Angiotensin Converting Enzyme -lisinopril **pril** is **ace**

Question 27

How do ACE inhibitors work?

Answer 27

Block the conversion of Angiotensin I to Angiotensin II in the RAAS system

Question 28

What do ACE inhibitors do?

Answer 28

Venous Dilatation Arteriolar Dilatation

Question 29

What is an unwanted side effect of ACE inhibitors?

Answer 29

Dry Cough

Question 30

What are ACE inhibitors used for?

Answer 30

Hypertension Cardiac Failure Post MI

Question 31

Give an example of an angiotensin I (AT₁) receptor blocker?

Answer 31

Losartan ## Footnote **ARTB=sartan**

Question 32

How to ATRBs work?

Answer 32

They block the agonist action of angiotensin II and AT₁ receptors in competitive manner

Question 33

When are ATRBs useful?

Answer 33

In patients who cannot tolerate ACEi dry cough

Question 34

Name three calcium antagonists?

Answer 34

Verampimil Amlodipine Dilatazem

Question 35

How do calcium antagonists work?

Answer 35

Prevent opening of L-type channels in excitable tissues in response to depolarisation

Question 36

What do calcium antagonists do?

Answer 36

They limit the conduction through the AV node **decrease** force of contraction and Ca²⁺ entry causing *arteriolar dilatation*

Question 37

What is the order of cardio-selectivity in calcium antagonists?

Answer 37

1. Amlodipine 2. Verapamil 3. Dilatazem

Question 38

What are calcium antagonists used for?

Answer 38

Angina *if B blockers are contraindicated* Atrial fibrillation

Question 39

Name a thiazide diuretic

Answer 39

Bendroflumithazide ## Footnote *longer name which means.....*

Question 40

How do thiazide diuretics work?

Answer 40

Inhibit NaCl reabsorption in distant tubule

Question 41

What do thiazide diuretics do?

Answer 41

Reduce MABP

Question 42

What are thiazide diuretics used in?

Answer 42

Heart failure Hypertension

Question 43

Name a Loop diuretic

Answer 43

Furosemide shorter name so....

Question 44

How do Loop diuretics work?

Answer 44

Inhibit NaCl absorbtion in loop of henle

Question 45

What do loop diuretics do?

Answer 45

Cause reabsorption of extracellular fluid

Question 46

What are loop diuretics used in?

Answer 46

Heart failure pulmonary oedema

Question 47

What must patients be given in addition to Loop diuretics or Thiazide diuretics

Answer 47

K⁺ supplements

Question 48

What are class one anti-arrhythmic drugs called?

Answer 48

Na⁺ channel blockers * lingocaine * flecainide **cain= first to kill= class I chanel blockers**

Question 49

What is lingocaine used for?

Answer 49

Ventricular arrythmias following MI

Question 50

What is Flecainide prescribed for?

Answer 50

Atrial fibrillation ## Footnote **MAY TRIGGER SERIOUS VENTRICULAR ARRYTHMIAS**

Question 51

How do class I anti-arrythmic drugs work?

Answer 51

They block Na⁺ channel blockers in their active state, then dissociate in resting state

Question 52

Name some class II receptor antagonists?

Answer 52

(**B-adrenoreceptor Ligands)** Atenolol Propanolol **Class II= Two L's= **_l_**o_l_**

Question 53

What do class II B-2 adrenoreceptor antagonists do?

Answer 53

Slow the rate of depolarisations in the AV node and SA node

Question 54

What are class two antiarrythmic drugs used for?

Answer 54

Rate control drugs Control **SVT**

Question 55

Name two Class III anti-arrythmic drugs?

Answer 55

**(K⁺ channel blockers)** Amiodarone Sotalol

Question 56

What do Class III anti-arrythmic drugs do?

Answer 56

Prolong action potential during increasing refractory periods

Question 57

What are Class III anti-arrhythmic drugs used for?

Answer 57

Rhythm control drugs Used in SVT and VT

Question 58

What are class IV antiarrythmic drugs called?

Answer 58

**Ca²⁺ channel blockers** verapamil

Question 59

What do class IV antiarrhythmic drugs do?

Answer 59

Slow conduction in SA and AV node reducing the force of contraction

Question 60

When are class IV antiarrhythmic drugs used?

Answer 60

Supraventricular arrythmias | (A fib/ flutter)

Question 61

What is the drug of choice to reduce LDL?

Answer 61

Statins

Question 62

Name two statins and their mechanism of action

Answer 62

Simvastatin atorvastatin *Act as a competitive inhibitor of HGM-CoA reductase (inhibiting cholesterol synthesis)*

Question 63

Name two fibrates

Answer 63

Benzafibrates Gemfibrozil

Question 64

How do fibrates work?

Answer 64

Agonists of PPAR alpha receptors They **increase HDL** and **decrease LDL**

Question 65

What is cholesevelam?

Answer 65

A bile acid binding resin

Question 66

How does cholesevelam work?

Answer 66

By increasing the excretion of bile salts, increasing the amount of cholesterol converted to bile salts and thus **lowering cholesterol**

Question 67

How does Ezetimbe work?

Answer 67

Inhibits the NPCL1L transporter protein, reducing the absorption of cholesterol It has little effect on HDL

Question 68

What do you do if statins are not sufficient?

Answer 68

Prescribe add on ezetimbe

Question 69

Why are anticoagulants prescribed?

Answer 69

Prevention of venous thrombosis and emoblism In patients with artificial valves and atrial fibrillation

Question 70

How does warfarin work?

Answer 70

Inhibits Vit K to render factors II, VIII, IX and X inactive

Question 71

What is the problem with warfarin?

Answer 71

It has a very low therapeutic index, slow onset with long half life. Not to worry overdose can be treated with Vit K

Question 72

How does heparin work?

Answer 72

It binds to antithrombin III to cause inactivation of factors Xa and IIa (thrombin)

Question 73

What is a warning associated with heparin

Answer 73

Haemorrhages

Question 74

What are some LMWHs

Answer 74

Dalteparin Enoxaparin **LMWH does not inhibit thrombin**

Question 75

How is heparin administered?

Answer 75

IV or SC

Question 76

What is rivaroxiban?

Answer 76

A new direct anticoagulant, it inhibits factor Xa. Administered orally

Question 77

When are antiplatelets used?

Answer 77

In arterial thrombosis

Question 78

What is the main antiplatelet agent and its mechanism of action?

Answer 78

Aspirin **Blocks COX** in platelets to prevent **TXA₂** synthesis

Question 79

What is an option for antiplatelet agent in a patient intolerable to aspirin? What is its mechanism of action?

Answer 79

Clopidogrel Blocks P2Y₁₂ receptor

Question 80

When are thrombolytics prescribed?

Answer 80

Acute MIs or Stroke ## Footnote *rarely PEs*

Question 81

Give some examples of thrombolytics

Answer 81

Duteplase Alteplase Streptokinase

Question 82

How are thrombolytics administered and what do they do?

Answer 82

IV only Activate plasminogen to plasmin initiating clot lysis