CV Drugs 1

Question 1

What is the main cause of CV disease?

Answer 1

Atherosclerosis

Question 2

Draw the CV disease continuum, showing the relationship bw each other

Answer 2

Other risk factors -> endothelial dysfunction HTN -> stroke
| /
Atherosclerosis -> thrombosis
| | \
Angina. ACS. —> HF
| |
Arrhythmias & sudden C death

Question 3

What’s the main effect of statins?

Mechanism of action?

Answer 3

Important in lowering cholesterol - driver of Atherosclerosis

In the liver, Statins block the rate-limiting enzyme (HMG-CoA reductase) involves in synthesis of cholesterol

(Also as a result causes Chol to be taken up into the liver from plasma)

Question 4

Atorvastatin drug profile

Answer 4

• Rapid absorption & high 1st pass metabolism; some metabolites are also active against HMG-CoA reductase
• reaches its peak plasma conc in 1-2 hrs, and almost entirely bound to proteins in blood
• Half life ~ 14hrs, but activity against enzyme lasts 20-30hrs
• Excreted mainly into the bile

Question 5

What is HTN?

Answer 5

An elevation of systolic and/or diastolic BP to the point where it increases the risk of CV disease.

~30% of population

Question 6

Name the different stages

Answer 6

PreHTN: 80-90 and/or 130-139
Stage 1: 90-99 and/or 140-159
Stage 2:
Stage 3: > 110 and/or > 180

Question 7

Major risk factors as a result of HTN?

Answer 7

Stroke
CAD
cHF

Very important to treat high BP because could also could damage to target organs

Question 8

Diagnosis + assessment of HTN

Answer 8

Measure BP using Sphygmomanometer

Question 9

Types of HTN

Answer 9

Primary - no identifiable cause in the patient (majority of cases)

Secondary - cause can be identified (minority)

Hypertensinogenic factors: primary or secondary?
-obesity, insulin resistance

Question 10

Pathophysiology of primary HTN.

What is it that drives your BP up?

Answer 10

A lot of what increases these factors is driven by

Sympathetic and renin/ angiotensin/ aldosterone systems

Question 11

BP formula

Answer 11

BP = CO*TPR

HTN represents a disorder of the processes which regulate long-term BP

Question 12

Normal feedback control of Arterial BP

Answer 12

Regulatory systems:
Decrease in Firing of sympathetic neurons
Inhibition of RAAS

Renal component…

Vascular component…

Question 13

What is the implication of the current concepts of long term BP regulation?

Answer 13

Successful lowering of BP requires the sustained reduction of blood volume and/or vascular tone.

All of the drugs used do one or the other. All (except b1 receptor blockers) have vasodilation effect and all (except a1 receptor blockers? + K+ channel agonists) have natriuretic effect.

Some have direct Decrease of CO effect (b1 receptor blockers + some Ca channel blockers)