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UKMLA Prep > Cardiovascular Pharmacology > Flashcards

Cardiovascular Pharmacology Flashcards

1
Q

What are ACE inhibitors primarily used for?

A

First-line treatment for hypertension in younger patients and treatment of heart failure

ACE inhibitors are also used for diabetic nephropathy and secondary prevention of ischaemic heart disease.

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2
Q

What is the mechanism of action of ACE inhibitors?

A

Inhibits conversion of angiotensin I to angiotensin II, leading to vasodilation and reduced blood pressure

This also decreases aldosterone release, reducing sodium and water retention.

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3
Q

What are the common side effects of ACE inhibitors?

A
  • Cough
  • Angioedema
  • Hyperkalaemia
  • First-dose hypotension

Cough occurs in about 15% of patients and may develop up to a year after starting treatment.

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4
Q

What should be monitored in patients taking ACE inhibitors?

A

Urea and electrolytes, especially creatinine and potassium levels

Acceptable changes include a creatinine increase of up to 30% and potassium up to 5.5 mmol/L.

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5
Q

Which patients should avoid ACE inhibitors?

A
  • Pregnant or breastfeeding women
  • Patients with renovascular disease
  • Patients with aortic stenosis
  • Patients with hereditary angioedema

Specialist advice is needed for patients with high potassium levels.

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6
Q

What is adenosine primarily used for?

A

Termination of supraventricular tachycardias

Its effects are enhanced by dipyridamole and blocked by theophyllines.

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7
Q

What is the mechanism of action of adenosine?

A

Causes transient heart block in the AV node by increasing outward potassium flux

It acts as an agonist of the A1 receptor.

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8
Q

What are common examples of ADP receptor inhibitors?

A
  • Clopidogrel
  • Prasugrel
  • Ticagrelor
  • Ticlopidine

These agents inhibit platelet activation mediated by ADP.

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9
Q

What is the recommended dual antiplatelet treatment for ACS according to NICE guidelines?

A

Aspirin (75mg daily) and Ticagrelor (90mg twice daily) for 12 months

Alternatively, aspirin with either prasugrel or clopidogrel can be used.

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10
Q

What are the notable adverse effects of ticagrelor?

A

Dyspnoea

This is due to impaired clearance of adenosine.

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11
Q

What is amiodarone primarily used for?

A

Treatment of atrial, nodal, and ventricular tachycardias

It is a class III antiarrhythmic agent.

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12
Q

What are the side effects of amiodarone?

A
  • Thyroid dysfunction
  • Corneal deposits
  • Pulmonary fibrosis
  • Liver fibrosis
  • Peripheral neuropathy
  • Photosensitivity
  • Bradycardia
  • Slate-grey appearance

Adverse effects can be long-term and require monitoring.

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13
Q

What is the mechanism of action of angiotensin II receptor blockers?

A

Block effects of angiotensin II at the AT1 receptor

They are used when patients do not tolerate ACE inhibitors.

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14
Q

What are examples of angiotensin II receptor blockers?

A
  • Candesartan
  • Losartan
  • Irbesartan

These are used with caution in patients with renovascular disease.

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15
Q

What is atropine primarily used for?

A

Symptomatic bradycardia and treatment of organophosphate poisoning

IV atropine is the first-line treatment for bradycardia with adverse signs.

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16
Q

What are the physiological effects of atropine?

A
  • Tachycardia
  • Mydriasis

Atropine may trigger acute angle-closure glaucoma in susceptible patients.

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17
Q

What are the indications for beta-blockers?

A
  • Angina
  • Post-myocardial infarction
  • Heart failure
  • Arrhythmias
  • Hypertension
  • Thyrotoxicosis
  • Migraine prophylaxis
  • Anxiety

Beta-blockers improve symptoms and mortality in heart failure.

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18
Q

What are common side effects of beta-blockers?

A
  • Bronchospasm
  • Cold peripheries
  • Fatigue
  • Sleep disturbances
  • Erectile dysfunction

These effects can impact patient compliance.

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19
Q

What is bivalirudin used for?

A

As an anticoagulant in the management of acute coronary syndrome

It is a reversible direct thrombin inhibitor.

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20
Q

What is the mechanism of action of dabigatran?

A

Direct thrombin inhibitor

It is an oral anticoagulant that does not require regular monitoring.

21
Q

What are the contraindications for dabigatran?

A

Use is contraindicated in patients with prosthetic heart valves

This was advised after the RE-ALIGN study showed increased bleeding and thrombotic events.

22
Q

What is the mechanism of action of dipyridamole?

A

Inhibits phosphodiesterase, elevating platelet cAMP levels

This reduces intracellular calcium levels and has additional actions on adenosine uptake.

23
Q

What are examples of glycoprotein IIb/IIIa receptor antagonists?

A
  • Abciximab
  • Eptifibatide
  • Tirofiban

These agents are used in acute coronary syndrome management.

24
Q

What is the mechanism of action of hydralazine?

A

Increases cGMP, leading to smooth muscle relaxation

It is less commonly used today but may be used in hypertension during pregnancy.

25
Q

What are the adverse effects of hydralazine?

A
  • Tachycardia
  • Flushing
  • Fluid retention
  • Headache
  • Drug-induced lupus

These side effects can limit its use.

26
Q

What is ivabradine used for?

A

Reducing heart rate in angina treatment

It acts on the If ion current in the sinoatrial node.

27
Q

What are common adverse effects of ivabradine?

A
  • Visual effects
  • Headache
  • Bradycardia
  • Heart block

Visual effects include luminous phenomena.

28
Q

What is Ivabradine and its primary mechanism of action?

A

Ivabradine is a class of anti-anginal drug that works by reducing the heart rate by acting on the If (‘funny’) ion current in the sinoatrial node.

29
Q

What are common adverse effects of Ivabradine?

A
  • visual effects (luminous phenomena)
  • headache
  • bradycardia
  • heart block
30
Q

What is the mechanism of action for loop diuretics?

A

Loop diuretics inhibit the Na-K-Cl cotransporter (NKCC) in the thick ascending limb of the loop of Henle, reducing NaCl absorption.

31
Q

What are the indications for loop diuretics?

A
  • heart failure (acute and chronic)
  • resistant hypertension, particularly in patients with renal impairment
32
Q

List some adverse effects of loop diuretics.

A
  • hypotension
  • hyponatraemia
  • hypokalaemia
  • hypomagnesaemia
  • hypochloraemic alkalosis
  • ototoxicity
  • hypocalcaemia
  • renal impairment
  • hyperglycaemia
  • gout
33
Q

What was Minoxidil originally developed for?

A

Minoxidil was initially developed as an antihypertensive.

34
Q

What is the primary use of Minoxidil today?

A

Minoxidil is now mainly used in the treatment of androgenic alopecia.

35
Q

What is the mechanism of action of Nicorandil?

A

Nicorandil is a potassium-channel activator that causes vasodilation through activation of guanylyl cyclase, leading to increased cGMP.

36
Q

What are common adverse effects of Nicorandil?

A
  • headache
  • flushing
  • skin, mucosal and eye ulceration
  • gastrointestinal ulcers including anal ulceration
37
Q

What is the primary indication for Nitrates?

A

Nitrates are primarily indicated for the management of angina and the acute treatment of heart failure.

38
Q

What is the mechanism of action of Nitrates?

A

Nitrates cause the release of nitric oxide in smooth muscle, activating guanylate cyclase, which converts GTP to cGMP, leading to reduced intracellular calcium levels.

39
Q

What are common side effects of Nitrates?

A
  • hypotension
  • tachycardia
  • headaches
  • flushing
40
Q

What is a major concern with nitrate tolerance?

A

Many patients develop tolerance to nitrates, reducing efficacy. The BNF advises adjusting dosing schedules to maintain effectiveness.

41
Q

What enzyme do Statins inhibit?

A

Statins inhibit the action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis.

42
Q

List some adverse effects of Statins.

A
  • myopathy (myalgia, myositis, rhabdomyolysis)
  • liver impairment
  • increased risk of intracerebral haemorrhage
43
Q

Who should receive a Statin?

A
  • individuals with established cardiovascular disease
  • those with a 10-year cardiovascular risk >= 10%
  • patients with type 2 diabetes mellitus
  • patients with type 1 diabetes diagnosed over 10 years ago or aged over 40
44
Q

What is the mechanism of action of Thiazide diuretics?

A

Thiazide diuretics inhibit sodium reabsorption at the beginning of the distal convoluted tubule by blocking the thiazide-sensitive Na+-Clˆ’ symporter.

45
Q

What are common adverse effects of Thiazide diuretics?

A
  • dehydration
  • postural hypotension
  • hypokalaemia
  • hyponatraemia
  • hypercalcaemia
  • gout
  • impaired glucose tolerance
46
Q

What is the mechanism of action of Warfarin?

A

Warfarin inhibits epoxide reductase, preventing the reduction of vitamin K to its active form, affecting clotting factors II, VII, IX, and X.

47
Q

What are the indications for Warfarin?

A
  • mechanical heart valves
  • venous thromboembolism
  • atrial fibrillation
48
Q

What factors may potentiate the effect of Warfarin?

A
  • liver disease
  • P450 enzyme inhibitors (e.g., amiodarone, ciprofloxacin)
  • cranberry juice
  • NSAIDs
49
Q

List some side effects of Warfarin.

A
  • haemorrhage
  • teratogenic effects
  • skin necrosis
  • purple toes

UKMLA Prep (48 decks)

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