Cardiovascular pharmacology

Question 1

What is the difference between a white thrombus and a red thrombus?

Answer 1

arterial thrombi are usually referred as white, they mainly composed of platelet in a fibrin mesh. Venous thrombi, red thrombi, are composed of a fibrin meshwork trapping read and white blood cells.

Question 2

Name 3 anti platelet drugs.

Answer 2

Aspirin, clopidrogrel, and glycoprotein IIb/IIIa antagonists.

Question 3

What is the mechanism of action of aspirin as an anti-platelet drug?

Answer 3

Aspiring inhibit COX 1 & 2, preventing arachidonic acid to be converted to prostaglandin G2.

Question 4

Name the mechanism of action of clopidogrel.

Answer 4

Clopidogrel is a a prodrug that is activated by CYP enzyme and irreversible inhibits P2Y12 of ADP receptor, which is important in activation of the platelet and and eventual cross-linking by the protein fibrin.

Question 5

Name the mechanism of action of glycoprotein antagonist.

Answer 5

They block the final step of platelet activation.

Question 6

Name some examples of P2Y12 antagonist that are used to treat unstable coronary syndrome.

Answer 6

Clopidrogrel, prasugrel, ticagrelor is added to aspirin.

Question 7

Name two anticoagulant factors.

Answer 7

Warfarin nd heparin.

Question 8

Name the mechanics of action of warfarin.

Answer 8

Warfarin inhibits the vitamin K-dependent synthesis of biologically active forms of the clotting factor II, VII, IX and X and protein C and S. The proteins C and S require glutamic acid residues to allow he coagulation factor to bind to phospholipid surfaces inside blood vessels. The enzyme that carrier out carboxylation of glutamic acid is gamma-glutamyl carboxylase. The reaction will only proceed if vitamin K hydroquinone is converted to vitamin K epoxide. Warfarin inhibits epoxide reductase.

Question 9

Name the mechanism of action of heparin.

Answer 9

Heparin bind to enzyme inhibitor antithrombin III and activates it. Antithrombin III inactivates thrombin and factor Xa.

Question 10

Explain the mechanism of action of tPA.

Answer 10

tPA catalyses the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown.

Question 11

Name some non-pharmacological treatments for hypertension.

Answer 11

Weight reduction, DASH eating plan, Na restriction, physical activity, avoidance of tobacco and moderation of alcohol consumption.

Question 12

Which classes of drug can be used to treat hypertension?

Answer 12

Diuretics, aldosterone antagonist, calcio channel blockers, ACE inhibitor, Angiotensin II receptor blockers, beta blockers.

Question 13

Name the site of action of osmotic diuretics.

Answer 13

Proximal tubules, loop of henge, collecting duct

Question 14

Name the mechanism of action of Thiazide and give some examples of the drug.

Answer 14

Inhibition of Na+, K+, Cl, co- transporters. Bendroflumethiazide, Hydrochlorothiazide, Clorthalidone, Metolazone.

Question 15

What are the side effects of Thiazides?

Answer 15

Hypokalemia, increased glucose tolerance with beta cells less sensitive to high glucose levels, high levels of uric acid in the blood.

Question 16

What is the mechanism of action of loop diuretics? Give some examples.

Answer 16

Inhibition of Na+, K+, Cl, co- transporters. Bumetamide, Furosemide, Torasemide.

Question 17

What are the side effects of loop diuretics?

Answer 17

Potassium loss with arrhythmias, hypotension, hypokalaemia, high level of uric acid in the blood and increase risk of gout attacks,

Question 18

Give some examples of different types of diuretics used to treat hypertension.

Answer 18

Osmotic diuretics, Carbonic anhydrase inhibitor, loop diuretic, thiazide, K+ sparing diuretics.

Question 19

Give 3 examples of ACE-inhibitors.

Answer 19

Enalapril, ramipril, captopril.

Question 20

What are the side effects of ACE-inhibitors?

Answer 20

Taste disorders, impaired kidney function, nausea, headache, increase in liver enzymes, cough. (Should be avoided in patients with renal artery stenosis.

Question 21

What effect do beta blockers have on the body?

Answer 21

Decreased heart rate, decreased contractility vasodilation, increased NO bioavailability, decreased renin release from renal juxtaglomerular cells.

Question 22

What are the side effects of beta blockers?

Answer 22

Hypotension, cold hand and feet, central nervous effects, GI tract side effects, bronchospasm.

Question 23

What are the compensatory mechanism?

Answer 23

Increased heart rate, increased contractility, increased preload, decreased hypertrophy.

Question 24

Which classes of drug are used to treat heart failure?

Answer 24

Beta blockers, ACE-inhibitors, angiotensin II receptor blocker, diuretics, Digitalis and Ivabradin.

Question 25

What is the mechanism of action of digitalis?

Answer 25

Digitalis inhibits Na+/K+ATPase mainly in the myocardium. This leads to an increase in intracellular Na+ levels –> increase in intracellular Ca2+ and increased CO.

Question 26

What are the side effects of digitalis?

Answer 26

Overdose, blurred vision, cardiac arrhythmias, anorexia, nausea vomiting. hypokalaemia.

Question 27

What is the mechanism of action of Ivabradin?

Answer 27

Blocks ion channels in the sinus node.

Question 28

Name the tree types of angina pectoris.

Answer 28

Stable angina, unstable angina & variant angina.

Question 29

How do you treat stable angina pectoris?

Answer 29

With organic nitrates, calcium channel blockers & beta blockers.

Question 30

Give an example of an organic nitrate that is used to treat angina pectoris.

Answer 30

Isosirbide mononitrate.

Question 31

What are the side effects of CCBs?

Answer 31

Increased tendency to heart failure, blocking off the pulse line in the AV node can be pronounced. (Should not be combined with beta blockers)

Question 32

Which are the acute treatments of myocardial infarction?

Answer 32

Organic nitrates, morphine, oxygen, ASA, PCI, beta blockers.

Question 33

Which are the post-infarction treatments of myocardial infarction?

Answer 33

Statins, ASA, ACE-inhibitors or angiotensin II-receptor blockers, beta blockers.

Question 34

How do you treat hyperlipidemia?

Answer 34

Statins, resins, vibrates, cholesterol absorption inhibitors.

Question 35

What is the mechanism of action of statins?

Answer 35

Inhibit HMG-COA reductase, the rate limiting step in the mevalonate pathway.

Question 36

What is the mechanism of action of resins?

Answer 36

Bile acid sequestrants exchange anions such as chloride ions for bile acids. By doing so, they bind bile acids and sequester them from the enterohepatic circulation. The liver then produces more bile acids to replace those that have been lost. Because the body uses cholesterol to make bile acids, this reduces the level of LDL cholesterol circulating in the blood.

Question 37

What is the mechanism of action of fibrates?

Answer 37

Activates PPAR alpha that induces carbohydrate and lipid metabolism.