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Cardiology > cardiovascular pharmacology > Flashcards

cardiovascular pharmacology Flashcards

1
Q

what are the targets for therapy to manage BP control?

A
  1. Cardiac output and Peripheral Resistance
  2. Interplay between:
    a. Renin-Angiotensin-Aldosterone system
    b. Sympathetic nervous system (noradrenaline)
  3. Local vascular vasoconstrictor and vasodilator mediators
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2
Q

what are 4 Angiotensin Converting Enzyme (ACE) inhibitors?

A
  1. ramipril
  2. enalapril
  3. perindopril
  4. trandolapril
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3
Q

what are the main clinical indications that would result in a patient having ACE inhibitors?

A

Hypertension
Heart failure
Diabetic nephropathy

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4
Q

what are the main adverse effects of ACE inhibitors related to reduced angiotensin II formation?

A

a. Hypotension- can reduce BP too much
b. Acute renal failure- angiotensin 2 restrict efferent arteriole
c. Hyperkalaemia
d. Teratogenic effects in pregnancy

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5
Q

what are the main adverse effects of ACE inhibitors related to increased kinins?

A

a. Cough
b. Rash
c. Anaphylactoid reactions
( ace inhibitors prevent the conversion from angiotensin I to II but increases the conversion of bradykinin to inactive peptides)

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6
Q

what are the main clinical indications that would result in a patient taking Angiotensin II receptor blockers ( ARB)?

A

Hypertension
Diabetic nephropathy
Heart failure (when ACE-I contraindicated)

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7
Q

what are 5 examples of Angiotensin II receptor blockers ( ARB)?

A
  1. Candesartan
  2. Losartan
  3. valsartan
  4. irbesartan
  5. telmisartan
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8
Q

what are the main adverse effects of Angiotensin II receptor blockers ( ARB)?

A

Symptomatic hypotension (especially volume deplete patients)
Hyperkalaemia
Potential for renal dysfunction
Rash
Angio-oedema

Contraindicated in pregnancy
Generally very well tolerated

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9
Q

what are the main clinical indications that would result in a patient taking Calcium Channel Blockers ( CCB)?

A

Hypertension
Ischaemic heart disease (IHD) – angina
Arrhythmia (tachycardia)

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10
Q

What are 6 calcium channel blockers?

A
  1. Amlodipine
  2. Nifedipine
  3. Diltiazem
  4. Felodipine
  5. Lacidipine
  6. verapamil
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11
Q

what are 3 L-type calcium channel blockers?

A
  1. Dihydropyridines
  2. Phenylalkylamines
  3. Benzothiazepines
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12
Q

name 4 examples of Dihydropyridines

A

nifedipine, amlodipine, felodipine, lacidipine

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13
Q

what do Dihydropyridines do?

A

Preferentially affect vascular smooth muscle
Peripheral arterial vasodilators

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14
Q

name an example of a Phenylalkylamines

A

verapamil

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15
Q

what do Phenylalkylamines do?

A

Main effects on the heart
Negatively chronotropic, negatively inotropic

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16
Q

name an example of a Benzothiazepines

A

diltiazem

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17
Q

what do Benzothiazepines do?

A

Intermediate heart/peripheral vascular effects

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18
Q

what are the main adverse effects of CCB blockers due to peripheral vasodilatation (mainly dihydropyridines)
?

A

Flushing
Headache
Oedema
Palpitations

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19
Q

what are the main adverse effects of CCB blockers due to negatively chronotropic effects (mainly verapamil/diltiazem)?

A

Bradycardia
Atrioventricular block

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20
Q

what are the main adverse effects of CCB blockers due to negatively inotropic effects (mainly verapamil)?

A

Worsening of cardiac failure

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21
Q

what is an adverse effect of verapamil?

A

causes constipation

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22
Q

what are the main clinical indications that would result in a patient taking Beta- adrenoreceptor Blockers ( BB)?

A

Ischaemic heart disease (IHD) – angina
Heart failure
Arrhythmia
Hypertension

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23
Q

Name 6 beta- adrenoreceptor blockers

A
  1. Bisoprolol
  2. carvedilol
  3. propranolol
  4. metoprolol
  5. atenolol
  6. nadolol
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24
Q

describe the term cardioselective

A

often used to imply β-1 selectivity
This is a misnomer since up to 40% of cardiac β-adrenoceptors are β-2

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25
Q

what are the main adverse effects of Beta- adrenoreceptor blockers ( BB)?

A

Fatigue
Headache
Sleep disturbance/nightmares

Bradycardia
Hypotension
Cold peripheries

Erectile dysfunction

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26
Q

what three conditions do beta blockers worsen?

A
  1. Asthma (may be severe) or COPD
  2. PVD – Claudication or Raynaud’s
  3. Heart failure – if given in standard dose or acutely
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27
Q

what are the major clinical indications that would result in diuretics?

A

Hypertension
Heart failure

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28
Q

what are the 4 classes of diuretics?

A
  1. Thiazides and related drugs (distal tubule)
  2. Loop diuretics (loop of Henle)
  3. Potassium-sparing diuretics
  4. Aldosterone antagonists
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29
Q

name 3 thiazide related diuretics

A

1.BENDROFLUMETHIAZIDE
2. HYDROCHLOROTHIAZIDE
3. CHLORTHALIDONE

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30
Q

name 3 loop diuretics

A
  1. FUROSEMIDE
  2. BUMETANIDE
31
Q

name 4 potassium sparing diuretics

A
  1. SPIRONOLACTONE
  2. EPLERENONE
  3. AMILORIDE
  4. TRIAMTERINE
32
Q

what are main adverse effects of diuretics?

A

Hypovolaemia (mainly loop diuretics)
Hypotension ( “ )

Low serum potassium (hypokalaemia)
Low serum sodium (hyponatraemia)
Low serum magnesium (hypomagnesaemia)
Low serum calcium (hypocalcaemia)

Raised uric acid (hyperuricaemia – gout)
Impaired glucose tolerance (mainly thiazides)

Erectile dysfunction (mainly thiazides)

33
Q

name 1 α-1 adrenoceptor blockers

A

doxazosin

34
Q

name 2 centrally acting anti hypertensitives

A

MOXONIDINE
METHYLDOPA

35
Q

name 1 direct renin inhibitor

A

ALISKIREN

36
Q

what are 3 other antihypertensives?

A

α-1 adrenoceptor blockers
Centrally acting anti-hypertensives
Direct renin inhibitor

37
Q

what is LVSD?

A

Heart failure due to left ventricular systolic dysfunction

38
Q

What is HFPEF

A

Heart failure with preserved ejection fraction (diastolic failure)

39
Q

what does heart failure suggest?

A

the efficiency of the heart as a pump is impaired.

40
Q

what is heart failure caused by?

A

by structural or functional abnormalities of the heart.

41
Q

what is the most common cause of heart failure?

A

is coronary artery disease

42
Q

what does heart failure cause?

A

morbidity, mortality, hospital admissions and substantial cost

43
Q

what is the treatment with the most benefits for heart failure?

A

is with vasodilator therapy via neurohumoral blockade (RAAS - SNS) and not from LV stimulants

44
Q

what is a symptomatic treatment of congestion?

A

diuretics- usually loop

45
Q

what is disease influencing therapy and what does it do/ target?

A

neurohumoral blockade
Inhibition of renin-angiotensin-aldosterone system
Inhibition of the sympathetic nervous system

46
Q

what is the first line of treatment for heart failure ?

A

ACE inhibitors and beta blocker therapy
Low dose and slow uptitration

47
Q

what are

A

a. First line: ACE inhibitors and beta blocker therapy
Low dose and slow uptitration

b. Aldosterone antagonists

c. Consider ARNI – Aldosterone Receptor antagonist and Neprilysin Inhibitor
d. Consider SGLT2 inhibitor

e. ACE-I intolerant: Angiotensin receptor blocker
f. ACE-I and ARB intolerant: Hydralazine/nitrate combination

g. Consider digoxin or ivabradine

48
Q

what do nitrates do?

A

Arterial and venous dilators
Reduction of preload and afterload
Lower BP

49
Q

what is the main use of nitrates?

A

Ischaemic heart disease (angina)
Heart failure

50
Q

name three nitrate medications

A

ISOSORBIDE MONONITRATE
GTN SPRAY
GTN INFUSION

51
Q

describe chronic stable angina

A

Anginal chest pain
Predictable
Exertional
Infrequent
Stable

52
Q

describe Unstable angina / acute coronary syndrome (NSTEMI)

A

Unpredictable
May be at rest
Frequent
Unstable

53
Q

describe ST elevation myocardial infarction/ ( STEMI)

A

Unpredictable
Rest pain
Persistent
Unstable

54
Q

Whattwo types therapy are used to treat chronic stable angina ?

A
  1. Antiplatelet therapy
    Aspirin
    Clopidogrel if aspirin intolerant
  2. Lipid-lowering therapy
    Statins (simvastatin, atorvastatin, rosuvastatin, pravastatin)

(Comorbidities may determine which therapy)

55
Q

what short acting nitrate is used for chronic stable angina?

A

GTN spray for acute attack

56
Q

what is the first line of treatment for chronic stable agina?

A

Beta blocker or Calcium channel blocker
if intolerant switch
if not controlled combine

57
Q

with chronic stable angina - if intolerant or uncontrolled than combine BB or CCB with..?

A

Long acting nitrate
Ivabradine
Nicorandil
Ranolazine

58
Q

what pain relief is used in Acute coronary syndromes (NSTEMI and STEMI)?

A

GTN spray
Opiates – diamorphine

59
Q

what therapies are used In Acute coronary syndromes (NSTEMI and STEMI)?

A

Dual antiplatelet therapy: Aspirin plus ticagrelor or prasugrel or clopidogrel

Antithrombin therapy: Fondaparinux
.
Background angina therapy: beta blocker, long acting nitrate, calcium channel blocker

  1. Lipid lowering therapy: Statins
  2. Therapy for LVSD/heart failure as required: ACE-I, beta blocker, aldosterone antagonist
60
Q

in Acute coronary syndromes (NSTEMI and STEMI when would you Consider Glycoprotein IIb IIIa inhibitor/ which ones?

A

(high risk cases):
): tirofiban, eptifibatide, abciximab

61
Q

describe class I of Vaughan Williams Classification?

A

Sodium channel blockers

62
Q

describe class Ia of Vaughan Williams Classification

A

Ia - disopyramide, quinidine, procainamide

63
Q

describe class Ib of Vaughan Williams Classification

A

Ib - lidocaine, mexilitene

64
Q

describe class Ic of Vaughan Williams Classification

A

Ic - flecainide, propafenone

65
Q

describe class II of Vaughan Williams Classification

A

Beta adrenceptor antagonists - propranolol, nadolol, carvedilol (non-selective)
- bisoprolol, metoprolol (β1-selective)

66
Q

describe class III of Vaughan Williams Classification

A

Prolong the action potential - amiodarone, sotalol

67
Q

describe class IV of Vaughan Williams Classification

A

Calcium channel blockers - verapamil, diltiazem

68
Q

what is digoxin?

A

Cardiac glycoside

69
Q

what does digoxin do?

A

Inhibit Na/K pump

70
Q

what are the main effects of digoxin on the heart?

A

Bradycardia (increased vagal tone)
Slowing of atrioventricular conduction (increased vagal tone)
Increased ectopic activity
Increased force of contraction (by increased intracellular Ca)

71
Q

side effects of digoxin

A

Narrow therapeutic range
Nausea, vomiting, diarrhoea, confusion

72
Q

when is digoxin usually used?

A

Used in atrial fibrillation (AF) to reduce ventricular rate response
Use in severe heart failure as positively inotropic

73
Q

what are the adverse side effects of amiodarone ?

A

QT prolongation
Polymorphic ventricular tachycardia

Interstitial pneumonitis
Abnormal liver function
Hyperthyroidism / Hypothyroidism
Sun sensitivity
Slate grey skin discolouration
Corneal microdeposits
Optic neuropathy

Multiple drug interactions
Very large volume of distribution

Cardiology (17 decks)

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