Case 5

Question 1

What is Aspirin?

Answer 1

Pain killer, anti inflammatory, antipyretic
Taken in low doses as an anti platelet drug

Question 2

What is the active agent in aspirin

Answer 2

Salicylic acid

Question 3

What does aspirin treat

Answer 3

Pain, headaches, fever, heart attacks and strokes

Question 4

Mechanism of action of aspirin

Answer 4

Suppresses production of prostaglandins and thromboxane, carried out by irreversible inactivation of cyclooxygenase (COX) enzyme
COX responsible for formation of prostaglandins and thromboxane

Question 5

Prostaglandins

Answer 5

Inhibition of prostaglandin production has anti inflammory effects

Question 6

Thromboxane

Answer 6

Thromboxane A2 produced by activated platelets
Stimulates activation of new platelets
Increases platelet aggregation
Leads to formation of blood clots
Irreversibly blocking formation of thromboxane A2 in platelets produces inhibitory effects on platelet aggregation

Question 7

Side effects of aspirin

Answer 7

Irritation of stomach lining, nausea, vomiting, abdominal pain, bleeding, Reye’s syndrome

Question 8

What is Bisoprolol?

Answer 8

B1 adrenergic receptor antagonist
Used to treat angina pectoris, hypertension and heart failure
Administered by mouth

Question 9

Mechanism of action of bisoprolol

Answer 9

Blocks B1 adrenergic receptors
Decreases adrenergic stimulation of heart muscle and pace maker cells

Question 10

Side effects of bisoprolol

Answer 10

Breathing difficulties, fatigue, cold extremities, sleep disturbances, hypotension, bradycardia

Question 11

What is Ticagrelor?

Answer 11

Anti platelet drug
Used in prevention of thrombosis in myocardial infarction with ST elevation
Usually given in combination with aspirin

Question 12

Mechanism of action of ticagrelor

Answer 12

Platelet aggregation inhibitor
Blocks adenosine diphosphate (ADP) receptors of platelets. ADP used in activation and aggregation of platelets

Question 13

Side effects of ticagrelor

Answer 13

Dyspnea, various types of bleeding

Question 14

What is atrovastatin?

Answer 14

A statin used for lower blood cholesterol levels
Stabilises plaque and prevents stroke through anti inflammation

Question 15

Mechanism of action of atrovastatin

Answer 15

Competitive inhibitor of HMG-CoA reductase enzyme (enzyme found in liver and involved in catalysis of hepatic cholesterol biosynthesis)
Inhibition of this enzyme decreases cholesterol synthesis increasing expression of LDL receptors on hepatocytes
Increases LDL uptake by hepatocytes, decreasing LDL cholesterol in blood

Question 16

Side effects of atrovastatin

Answer 16

Weakness, dizziness, headache, raised concentration of hepatic enzymes

Question 17

What is glyceryl trinitrate

Answer 17

Also known as nitroglycerin
Used to treat heart failure and prevent and treat angina
Vasodilator

Question 18

Mechanism of action of glyceryl trinitrate

Answer 18

Prodrug, must be denitrated in liver to produce active metabolite nitric oxide
Nitric oxide increases levels of cGMP (cyclic guanosine monophosphate)in smooth muscle cells of blood vessels
Causes activation of Intracellular protein kinases in response
Cause relaxation of vascular smooth muscles, leading to vasodilation and increased blood flow

Question 19

Side effects of glyceryl trinitrate

Answer 19

Large doses may cause flushing, headache and fainting

Question 20

What is ramipril?

Answer 20

ACE inhibitor (angiotensin-converting enzyme inhibitor)
Used to treat high blood pressure, fluid retention and heart failure

Question 21

Mechanism of action of ramipril

Answer 21

ACE inhibitors act by interfering with action of enzyme that converts inactive angiotensin 1 to powerful artery constrictor angiotensin 2
Absecence of ACE allows arteries to widen and blood pressure decreases

Question 22

Side effects of ramipril

Answer 22

Dry cough

Question 23

What is HMG-CoA reductase enzyme?

Answer 23

Enzyme found in liver involved in catalysis of hepatic cholesterol biosynthesis