Cardiovascular Pharmacology

Question 1

Ace inhibitor Examples

Answer 1

Ramipril,Enalapril.

Question 2

Ace indications

Answer 2

• Hypertension
  Heart failure

Question 3

Ace mechanism of action

Answer 3

Inhibits the conversion of angiotensin I into angiotensin II.

Question 4

Ace Side Effects

Answer 4

• Cough, due to impaired bradykinin breakdown
• Hyperkalaemia
• First dose hypotension : more common with patients taking diuretics
  Angiodema swelling in the lower layer of the skin, usually involves face(eyelids,mouth),arms and legs

Question 5

Arb examples

Answer 5

• Candesartan
• Losartan
• Valsartan

Question 6

Arb indication

Answer 6

Heart Failure

Question 7

Arb MOA

Answer 7

Angiotensin II receptor type 1 (AT1) is acted on by AII leading to arteriolar vasoconstriction and aldosterone release. ARBs block this receptor

Question 8

ARB SIDE EFFECTS

Answer 8

• Hyperkalaemia
• Hypotension

Question 9

ARB Monitoring

Answer 9

U&Es need to be monitored
- Prior to starting treatment
- 1-2 weeks after starting treatment
- After dose titration
- At least annually after that
STOP ACE if:
- Creatnine rise by more than 30%
- eGFR falls by more than 25%
- K+ rises above 5.5 mol/L
Repeat test within 2 weeks if:
- Creatnine rises by more than 20%
- EGFR falls by more than 15%

Question 10

Loop Diuretics

Answer 10

-Furosemide
-Bumetanide
-Toresimide

Question 11

Loop Diuretics MoA

Answer 11

Inhibits the NKCC in the thick ascending limb of the loop of Henle, reducing absorption of Nacl and H20. Has been shown to also cause vasodilation - reduces MSFP(mean systolic filling pressure)

Question 12

LOOP Diuretic side effect

Answer 12

• Hypotension
• Low Na,K,Mg,Ca
• Decreased Uric acid excretion - gout
• Impaired glucose tolerance - hypokalaemia hyperpolarises beta cells reducing insulin release
• Renal impairment (from dehydration and direct toxic effects)
• Ototoxicity -tinnitus, hearing loss

Question 13

Thiazides

Answer 13

• Indapamide
  Chlortalidone

Question 14

Thiazides MoA

Answer 14

Act in the early distal tubule by blocking Na-CL co-transport

Question 15

Thiazides Side effects

Answer 15

• Hypotension
• Low Na,K,Mg
• Hypercalcaemia and hypocalciuria
• Decreased Uric acid excretion - gout
• Impaired glucose tolerance - hypokalaemia hyperpolarises beta cells reducing insulin release
• Renal impairment(from dehydration and direct toxic effect)
• Decreased libido,erectile dysfunction and difficulty ejaculating

Question 16

Aldosterone antagonists/ K+ sparring diuretics

Answer 16

• Sprinolactone
• Eplerenone

Question 17

Aldosterone antagonists/K+ sparing indication

Answer 17

Ascites, Heart Failure,Hypertension, primary Hyperaldosteronism