Cardiovascular therapeutics

Question 1

What pharacological interventions can be offered for smoking cessation? What must we be cautious of?

Answer 1

Nicotine replacement therapy can be offered by patches. Must be cautious in severe coronary artery disease as this can cause coronary artery spasm
The main alternative to this is bupropion, this is a non selective dopamine reuptake inhibitor.

Question 2

What must BP be above to treat with nice guidelines?

Answer 2

160/100 best diagnosed through 24 hour ambulatory blood pressure monitoring

Question 3

What are the stages of treatment of hypertension?

Answer 3

The first step is ACE inhibitor in under 55 e.g. ramipril, it is calcium channel blocker in over 55 and african ethnicity e.g. amlodipine.
The second step is to use a thiazide diuretic.
Final step is a beta blocker e.g. propanolol

Question 4

How do calcium channel blockers work in the heart?

Answer 4

They prevent calcium entry through the voltage gated L type channels. This causes AV block and slows the heart

Question 5

How do thiazide diuretics work?

Answer 5

Act on the Na/Cl pump and prevent Na reabsoption so this prevents as much water reabsorption occuring

Question 6

What are some side effects of thiazide diuretics?

Answer 6

Diuresis, hyponatraemia and hypokalaemia, erectile dysfunction, gout, and an association with diabetes

Question 7

What are three examples of RAS modulating drugs?

Answer 7

Renin inhibitors (aliskiren) -safety concerns
ACE inhibitors (ramipril)
ATII receptor antagonists (candesartan)

Question 8

In which group of people are beta blockers contraindicated?

Answer 8

Asthmatics because they can cause bronchoconstriction

Question 9

How do statins work to lower LDLs?

Answer 9

They work by upregularing the LDL receptor on hepatocytes, this causes them to be broken down more

Question 10

What is a side effect of statins?

Answer 10

myositis and in severe cases can cause rhabdomyolysis

Question 11

What drugs other than statins can be used to lower LDls?

Answer 11

Fibrates (benzafibrate)

Question 12

What are the four main types of anticoagulant and how do they work?

Answer 12

Aspirin and clopidogrel work as antiplatelet drugs and stop platelets working properly
DOACS (rivaroxiban) and warfrin function at the coagulation cascade

Question 13

What is the mechanism of aspirin? What are its side effects?

Answer 13

It works as an irreversible COX inhibitor, this prevents the production of thromboxane in platelets. Common side effects are Gi bleeds and dyspepsia

Question 14

What is the mechanism of clopidogrel?

Answer 14

It blocks ADP which is required for platelet aggregation, causes an additive effect with aspirin

Question 15

What the mechnism of warfarin?

Answer 15

Blocks Vitamin K so prevents clotting from happening properly

Question 16

What is the mechanism of the DOACS?

Answer 16

block activated factor X in the clotting cascade

Question 17

How is angina typically treated?

Answer 17

Treated with vasodilation this includes calcium channel blockers and nitrates
Beta blockers reduce work of heart

Question 18

What are the four ways that nitrates work?

Answer 18

They cause ventricular relaxation, causes venorelaxation to lower preload, dilate coronary arteries and cause arterial dilation to reduce afterload

Question 19

What are some common side effects of nitrates?

Answer 19

Postural hypotension and headaches

Question 20

What is the management for MI?

Answer 20

Diamorphine for pain, metoclopramide for nausea, aspirin, herpain and clopidogrel to thin the blood
Thrombolysis or PCI must be performed.
Thrombolysis is done through tissue plasminogen activator

Question 21

How is heart failure treated?

Answer 21

Largely through loop diuretics such as furosemide to reduce strain on heart