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Pharma From Sure Success > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

1
Q

Renin is secreted by

A

JG cells of macula densa of affereent arteriole

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2
Q

Organs that angiotensin 2 acts (6)

A

Heart: increase force,rate,velocity
Bv: vasoconstriction
Kidney : sodium,water retention
Adrenal : aldosterone secretion
Brain: increase ADH, increasing thirst receptors —> plasma expansion
Peripheral nerves: activation of sympathetic system

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3
Q

ACEI …….TPR
Preload ,after load

A

Decreases
Decreases

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4
Q

All are carboxyl groups except

A

Captopril -sulfhydryl
Fosinopril: phosphinate

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5
Q

All are prodrug except …

A

Captopril
Lisinopril

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6
Q

Max and min bioavailability of ACEI

A

Max :70%: captopril
Min : 25%: lisinopril

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7
Q

All are excreted by kidney except

A

Fosinopril: liver:kidney = 50/50

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8
Q

Uses of ACEI and ARB

A

Home Care Makes Patient Definitely Strong
HTN
CHF
MI
PX of MI
DN
Scleroderma crisis

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9
Q

Use of aliskiren

A

Only HTN

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10
Q

Adverse effects of captopril

A

CAPTOPRIL
Cough
Angioneurotic Edema
Potassium high
Tetatogenic, taste prob
Other: fatigue,headache
Proteinuria-rare
Renal impairment
Itch
Low Bp -first dose hypotension- give 1/2 dose for 1st week then from 2nd week onwards full dose

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11
Q

C/I of captopril

A

Pregnancy
Allergy
Renal artery stenosis : u/l or b/l
Hyperkalemia

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12
Q

Antihypertensive that is also antidiabetic

A

Telmisartan - has PPAR gamma activating property
Known as cardio metabolic Sartan

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13
Q

Losartan in anticoagulation

A

Blocks thromboxane A2 , inhibit plt aggregation

( losartan activity is similar to aspirin, hence it’s also a uricosuric drug)

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14
Q

Adverse effects of aliskiren (4)

A

Angioneurotic edema
Hyperkalemia
Teratogenic
Hypotension

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15
Q

MOA of digoxin w.r.to HR

A

Decrease HR without decreasing myocardial oxygen consumption

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16
Q

Name 4 cardiac glycosides

A

Digoxin
Digitoxin
Ouabain
Strophanthin

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17
Q

Where are digitalis obtained from

A

Digoxin: Digitalis Lanata
Digitoxin: Digitalis purpura

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18
Q

Actions of digitalis (4)

A
  1. Heart:
    Increase force of contraction
    Increase excitability
    Decrease velocity —> decrease HR
  2. Blood vessels: vasodilation
  3. Kidney: diuresis
  4. CNS: activate CTZ —> N/V
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19
Q

Elimination of digitoxin vs digoxin

Oral availability

A

Digitoxin: hepatic
Digoxin: renal

Digitoxin: 90-100%
Digoxin: 60-80%

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20
Q

Plasma protein binding for digitoxin vs digoxin

Toxicity of digitoxin vs digoxin

A

Digitoxin: 95%
Digoxin: 25%

Digitoxin: >35ng/ml
Digoxin: >2ng/ml

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21
Q

Toxicity of digitalis

A

Hypokalemia
Hypercalcemia

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22
Q

Adverse effects of digitalis (3)

A

N/V
Yellow vision
Gynecomastia

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23
Q

ECG finding of digitalis (4)

A

Increase PR
Decrease QT
T wave inversion
ST depression

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24
Q

Antidote of digitalis

A

Anti-dig Fab fragments

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25
Q

Nitrates MOA (2)

A

Increase in CGMP which
1. Inhibit calcium channel
2. Inhibit MLCK phosphorylation

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26
Q

Uses of nitrates (6)

A

A: Angina pectoris
B: biliary colic
C : cyanide poisoning
D: dil ka daura: MI
E: esophageal spasm
F: failure : HF

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27
Q

How does nitrates work for cyanide poisoning?

A
  1. Hb—-> methb ( sodium nitrite)
  2. Methb——-> cyanohb ( cyanide)
  3. Cyanohb——-> methb + sodium thiocyanate (sodium thiosulfate)

Sodium thiocyanate gets excretes in urine

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28
Q

Adverse effects of nitrates

A

T: tolerance
D: dependence
S: skin rashes
R: reflex tachycardia
O: orthostatic hypotension
M: methb

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29
Q

C/I of nitrates (3)

A
  1. Right ventricular infarction
  2. Sildenafil
  3. HOCM
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30
Q

All nitrates undergo first pass metabolism except

Shortest acting nitrate:
Longest acting nitrate :

A

Isosorbide mononitrate

Shortest: GTN / Amyl nitrite
Longest: Pentaerythitol

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31
Q

MOA of nicorandil (2)

A
  1. K channel opener : hyperpolarizes smooth muscle membrane and relaxes it.
  2. Acts as nitric oxide donor- relaxes blood vessels by increasing cGMP
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32
Q

How does nicorandil exert cardio protective action?

A

Stimulates ischemic preconditioning —as a result of mitochondrial K ATP channels

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33
Q

Uses of nicorandil (2)

A
  1. 2nd line antianginal drug
  2. Resistant asthma
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34
Q

MOA of ivabradine

A

Blocks HCN channel responsible for pacemaker funny current - which regulates heart rate.

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35
Q

Another name for ivabradrine

A

Pure heart rate blocker
As it only blocks funny currents.

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36
Q

Uses of ivabradine (3)

A
  1. Stable angina
  2. Sinus tachycardia
  3. Stable with symptomatic chronic HF with resting HR >70bpm
    Those on max tolerated beta blockers
    Have c/I to beta blockers
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37
Q

Moa of ranolazine

A

Inhibit late inward sodium current.
Reduces diastolic wall tension and oxygen consumption

Not affect HR contractility.

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38
Q

Uses of ranolazine

A

Angina refractory to other therapies

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39
Q

Adverse effects of ranolazine (5)

A

Constipation
Dizziness
Headache
Nausea
Qt prolongation

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40
Q

MOA of trimetazidine. Use

A

Inhibits mitochondrial LC3KAT, responsible for fatty acid oxidation

Use: add on therapy in angina and post Mi

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41
Q

Different between dihydropyridines and non dihydropyridines

A

Dihydro: act on smooth muscle
More potent, lipophilic

Non dihydro: act on heart
Negative chrono,iono,dromo

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42
Q

MOA of CCB

A

Block voltage dependent calcium L type channels.

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43
Q

Use of nimodipine

A

Subarachnoid hemorrhage- prevent cerebral vasospam

44
Q

Uses of non DHP (2)

A

Antiarrythmic - atrial flutter,atrial fib
HTN

45
Q

Other than CCB action, action of
1. Nifedipine
2. Verapamil

A
  1. Tocolytic
  2. HOCM
46
Q

Adverse effects of CCB
Specific effects of DHP and non dhp

A

Gum hyperplasia
Dhp: flushing,
peripheral edema,
dizziness

Non dhp:
Av block
Constipation
Hyper prolactinemia
CHF due to cardiac depression-verapamil

47
Q

C/I of digitalis

A

C/I: carditis-myocarditis
In: increased calcium
Weak : WPW syndrome
H: hypokalemia,hypomagnesemia
E: elderly
A: AV block
R: renal failure
T: thyroid: hypo/hyper.

48
Q

High ceiling diuretics (2)

A

Furosemide
Bumetanide

49
Q

Name the ionotropic drugs classification

A
  1. Cardiac glycosides:
    Digoxin, Ouabain
  2. Sympathomimetics:
    dopamine, dobutamine
  3. PDE 3 inhibitor:
    Amrinone, Milrinone
50
Q

MOA of hydralazine

A

Directly acting vasodilator: Increases cGMP, reduce TPR , reduce after load

51
Q

Uses of hydralazine (3)

A
  1. HTN emergency
  2. HTN in pregnancy
  3. Coadministered with beta blockers to prevent reflex tachycardia
52
Q

Main S/E of hydralazine

Others (2)

A

Drug induced SLE

  1. Reflex tachycardia ( flushing, throbbing headache)
  2. Fluid retention
53
Q

Rapidly acting vasodilator with brief duration of action (2-5 mins) when given iv

A

Sodium nitroprusside.

54
Q

MOA of sodium nitro Prusside

A

Endothelial cells and RBC split nitroprusside to relax vascular smooth muscle through cGMP.

55
Q

Main problem with sodium nitroprusside

A

Can release cyanide- cyanide toxicity

56
Q

Bp and Hr with clonidine

A

Fall in bp
Fall in HR( bradycardia )

57
Q

Adverse effects of clonidine (6)

A
  1. Sedation
  2. Mental depression
  3. Sleep disturbance
  4. Dryness of mouth,nose,eyes
  5. Postural hypotension
  6. Withdrawal syndrome
58
Q

Other uses of clonidine besides rx HTN (4)

A
  1. Opioid withdrawal
  2. Analgesic
  3. Menopausal syndrome- to attenuate vasomotor symptoms
  4. Control loose motions in diabetic neuropathy
59
Q

Alpha methyldopa is converted to ….

A

MethylNA - selective alpha 2 agonist

60
Q

S/e of methyl dopa

A

Coomb’s positive haemolytic anemia

61
Q

Methyldopa is DOC for …..

A

HTN in pregnancy

62
Q

S/e of spironolactone (3)

A

Gynecomastia
Erectile dysfunction
Menstrual prob

63
Q

Anti HtN with sexual side effects (4)

A
  1. Thiazides
  2. Beta blockers
  3. Clonidine
  4. Prazosin
64
Q

Drugs with SLE symptoms

A

SHIP
Sulfalazine
Hydralazine
INH
Procainamide

They are slow acetylators

65
Q

MOA of diazoside

A

K+ channel opener
Arterial dilation-decrease bp
On pancreas: decrease insulin release-DM

66
Q

Diuretics that cause hyperlipidemia (3)

A

Thiazides
Furosemide
Beta blockers

67
Q

AntiHtN good for dyslipidemia

A

Alpha blockers : decrease LDL,TG

68
Q

Chronic HTN, Ortho static hypotension is maximum with …..

A

Guanethidine

69
Q

Anti htn drug that can’t cause bradycardia

A

Hydralazine- reflex tachycardia
* all drugs that block sympathetic nervous system have bradycardia.

70
Q

HTN emergency is defined as ….

A

> 180/120 with end organ damage

71
Q

Htn with end organ damage DOC is …(3)

A
  1. Nicardipine
  2. Labetalol
  3. Claridipine
72
Q

Drug indicated for PIH

A

Mild-moderate: labetalol (oral) >methyldopa>DHP

HTN crisis: iv labetalol > hydralazine

73
Q

Antihtn to be avoided in pregnancy (4)

A
  1. ACEI/ARB
  2. Diuretics- placental hypoperfusion
  3. Nitroprusside: cyanide
  4. Atenolol: LBW
74
Q

Drugs that decrease plasma renin (2)

A
  1. Beta 1 blockers
    Clonidine
  2. NSAIDS
75
Q

Drugs that decrease plasma renin activity

76
Q

Eg of ARNI
Use

A

Sacubitril
ARB + Neprilysin inhibitor

Use: CHF

77
Q

MOA of action of sacubitril

A

BNP ———-> broken down ( neprilysin)
( neutral endopeptidase)

Neprilysin also breaks bradykinin, AT1

78
Q

Drug interaction of sacubitril

A

If given along with ACEI; excessive increase in bradykinin —> severe angioedema

79
Q

Losartan is a ……drug
HTN with DM and b/L renal artery stenosis , DOC…

A

Uricosuric

Amlodipine

80
Q

Drugs which prolong qt interval

A

Class 1a, class 3
Class 1a:
Queen: quinidine
Protects: procainamide
Discopyramide: disopyramide

Class 3:
A: amiodarone
I: ibutilide
D: dofetilide
S: Sotalol

81
Q

S/e of quinidine (5)

A
  1. Increase QT interval —> TdP
  2. Salicylism
  3. Cinnchonism
  4. Release of insulin—> hypoglycaemia
  5. Anticholinergic action : causes A. Fib
    —> paradoxical tachycardia
82
Q

S/E of lignocaine

A

Non cardiotoxic but neurotoxic
Early signs:
Nystagmus, Ataxia
Paresthesias

Late signs: Seizures
Coma

83
Q

Drugs that cause AV block

A

ABCD
A: Adenosine
B: beta blockers
C: CCB
D: Digoxin
Lithium
Antiarrhythmic class 1a, class 3

84
Q

MOA of adenosine

A

Hyperpolarization of AV node —> AV conduction decrease

Adenosine acts on adenosine A1 receptors and cause bronchoconstriction of lungs , thus theophylline, which is adenosine antagonist is given.

85
Q

Medical defibrillator is ….

86
Q

All antiarrythmics are category C except ….

A

Amiodarone- category D - also phenytoin,atenolol

87
Q

S/e of adenosine

S/e of sotalol

A

Cough, flushing

Bronchospasm-beta blocker effect

88
Q

MOA of ezetimibe

A

In the presence of statins, cholesterol level in the liver decreases, liver gets GIT to increase cholesterol absorption via NPC1L1.
Ezetimibe is NPC1L1 inhibitor.

89
Q

S/E of statins

A

Increased risk of myalgia when given along with
1. CYP3A4 inhibitors
Azoles,macrolides,warfarin,amiodarone,ritonavir

  1. Niacin
  2. Gemfibrozil
90
Q

Moa of gemfibrozil

A

PPAR alpha agonist
Increase LPL—> hydrolysis of TG
( break down VLDL, CM)
Decrease TG levels

91
Q

Mc s/e of fibrates is ….
C/I in …..

A

Gall stones

Renal failure

92
Q

MOA of bile acid resins

A

Bind to bile acid in the intestine and excrete it in stool, thus preventing enterohepatic circulation.
Decrease liver synthesis of cholesterol will cause increase in LDL-R, which decreases plasma LDL.

93
Q

S/e of bile acid resins (5)

A
  1. Bad taste
  2. Low efficacy
  3. Interfere with absorption of ADEK
  4. Increase TG
  5. Gi sm:
    constipation, dyspepsia,flatulence
94
Q

MOA of nicotinic acid

A

Inhibit lipolysis (hormone sensitive lipase) in adipose tissue

95
Q

S/e of niacin

A

Flushing - to be given with aspirin to decrease flushing
Hyperuricemia
Hyperglycaemia

96
Q

Drug which
1. Max decrease LDL
2. Max decrease TG
3. Max increase HDL

A
  1. PCSK9 > statins
  2. Fibrate
  3. Niacin
97
Q

Antihypolipidemic safe in pregnancy

A

Resin»>Fish oil

98
Q

MOA of lomitapide

A

Microsomal TG transfer protein inhibitor
Decrease VLDL production

99
Q

S/e of lomitapide
Use

A

N/V
Increase hepatic fat

Homozygous familial hypercholesterolemia

100
Q

ApoB inhibitor is …..
S/e

Use

A

Mipomersen

Injection site reaction
Flu-like symptoms

Homozygous familial hypercholesterolemia

101
Q

Moa of PCSK9 inhibitor

A

Pcsk 9 from blood binds to LDLr and cause degradation.
PCSK9 inhibitor inhibits that.

Eg: Alirocumab,Evolucumab

102
Q

S/e of PCSK9 inhibitor

Use of PCSK9 inhibitor

A

Myalgia
Dementia
Delirium

Use : heterozygous familial hyper cholesterolemia

103
Q

Drug inhibiting PCSK9 synthesis

A

Inclisiran

104
Q

Most potent statin
Statin with highest bioavailability

A

Rosuvastatin

Pitavastatin

105
Q

When should statins be taken?

A

Rosuvastatin -19hrs
Atorvastatin-17hrs
Pitavastatin- 12 hrs

Can be taken at any time during the day

All others at bedtime, as HMGCOA reductase activity is max at night.

106
Q

Statins are usually given for children > 10 years except …..

A

Pravastatin -> 8 years

107
Q

Prophylaxis of hyperlipidemias (2)

A
  1. Gugulipid
  2. Fish oil (omega 3 FA)

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