Cardiovascular drugs

Question 1

Give examples of organic nitrates and their methods of administration

Answer 1

GTN - sublingual, spray, IV, transdermal patch

Isosorbide mononitrate - PO

Question 2

How do organic nitrates work

Answer 2

Relaxation of vascular smooth muscle cells

• venorelaxation (reduces preload)
• arteriolar dilatation (reduces afterload)
• improves coronary blood flow via collateral vessels (increased perfusion of ischaemic zones)

Question 3

indications of organic nitrates

Answer 3

angina

ACS

Question 4

unwanted effects of organic nitrates

Answer 4

tolerance
postural hypotension
headaches

Question 5

Give examples of vasodilating chemicals

Answer 5

bradykinin
ADP
5HT
nitric oxide

Question 6

Give examples of vasoconstricting substances

Answer 6

adrenaline, angiotensin II and ADH produce endothelin which causes vasoconstriction

Question 7

Give examples of endothelin antagonists and their indication

Answer 7

bosentan and ambrisentan

pulmonary hypertension

Question 8

What is RAAS

Answer 8

renin angiotensin aldosterone system

- Na excretion and vascular tone

Question 9

where are the following produced and released from:
angiotensinogen
renin
angiotensin converting enzyme (ACE)

Answer 9

angiotensinogen - liver
renin - kidneys
ACE - lungs

Question 10

What does renin do

Answer 10

convert angiotensinogen to angiotensin 1

Question 11

what does ACE do

Answer 11

convert Ag1 to Ag2

Question 12

what are the actions of angiotensin 2

Answer 12

act on AT1 receptors to cause 
vasoconstriction
ADH increase
increase thirst 
release more aldosterone (retains Na therefore water)
All of these help to increase MABP

Question 13

how do you calculate MABP

Answer 13

MABP = CO x SVR

Question 14

How do you calculate MAP

Answer 14

MAP = 1/3diastolic + PP

MAP = (2x diastolic) + systolic
———————————
3

Question 15

how do ACE inhibitors work

Answer 15

they inhibit the action of ACE and prevent conversion of Ag1 to Ag2
they cause venodilatation and arteriolar dilatation
they reduce the release of aldosterone
no effect on cardiac contractility

Question 16

Side effects of ACEI

Answer 16

dry cough (from bradykinin)
postural hypotension
RARE - angioedema

Question 17

indications for ACEI + ARBs

Answer 17

hypertension
cardiac failure
post MI

Question 18

How do ARBs work

Answer 18

angiotensin receptor blocker

inhibit the actions of Ag2

Question 19

what can you do if a patient develops a dry cough on ACEI

Answer 19

switch to ARB

Question 20

Contraindications for ACEI + ARBs

Answer 20

pregnancy
allergy
bilateral renal artery stenosis

Question 21

what are the functions of the following adrenoceptors when their agonist binds:
a1
B1
B2

Answer 21

a1 - vasoconstriction (vessels)
B1 - ^ HR, force, AVN conduction (heart)
B2 - bronchodilatation (lungs)

Question 22

indications of B blockers

Answer 22

heart failure
angina
hypertension (3rd/4th line)

Question 23

mechanism of B blockers

Answer 23

decrease myocardial requirement
increase time in diastole
decrease time in systole

Question 24

give examples of selective B blockers

which receptor does it block

Answer 24

atenolol
bisoprolol
metoprolol
B1

Question 25

give an example of a non-selective B blocker | which receptors does it block

Answer 25

propranolol | B 1+2

Question 26

What type of receptors do CCB block and where can these be found

Answer 26

L type Ca channels | heart and vessels

Question 27

what CCB acts on the heart and what is its effect

Answer 27

verapamil reduces heart rate and AVN conduction reduces cardiac contractility

Question 28

what CCB acts on smooth muscle cells in vessels and what is its effect

Answer 28

amlodipine | arteriolar dilatation reducing SVR (little/no effect on veins)

Question 29

which CCB is used in hypertension and why

Answer 29

amlodipine | less effect on the heart

Question 30

Why is amlodipine good for angina

Answer 30

causes coronary vasodilatation and reduce afterload | good as prophylaxis alongside GTN if B blockers are contraindicated

Question 31

side effects of amlodipine

Answer 31

ankle oedema hypotension dizziness flushing

Question 32

which CCB has intermediate effects

Answer 32

diltiazem

Question 33

diltiazem and verapamil has positive/negative inotropic effects

Answer 33

negative inotropic effects

Question 34

which CCB is used in arrhythmias

Answer 34

verapamil

Question 35

what should you never give with verapamol

Answer 35

B blocker | Verapamil + B blocker = verapakill

Question 36

examples of K channel openers and their function

Answer 36

nicorandil minoxidil vascular smooth muscle cell relaxation

Question 37

how do alpha1 blockers work

Answer 37

block a1 receptors to cause vasodilatation and therefore reduced BP

Question 38

examples of alpha blockers

Answer 38

prazosin | doxazosin

Question 39

what is an additional effect of alpha blockers

Answer 39

provide relief in benign prostatic hyperplasia

Question 40

side effects of alpha blockers

Answer 40

postural hypotension

Question 41

mechanism of action of thiazide diiuretics

Answer 41

inhibit NaCl reabsorption in distal tubule by blocking Na/Cl cotransporter

Question 42

mechanism of action of loop diuretics

Answer 42

inhibit NaCl reabsorption in ascending loop of henle by blocking Na/K/2Cl cotransporter

Question 43

side effects of thiazide and loop diuretics

Answer 43

hypokalaemia

Question 44

what is isoprenaline

Answer 44

B agonist | positive inotrope