CV drugs

Question 1

What are the drug classes used in treatment of hypertension?

Answer 1

1. Vasodilators (ACE Inhibitors, ARBs, Alpha-antagonists)
2. Calcium channel blockers
3. Diuretics
4. Beta-blockers

Question 2

How do ACE inhibitors work?

Answer 2

-block conversion of angiotensin I to angiotensin II

Question 3

ACEI used?

Answer 3

Lisinopril

side effects: dry cough, hypotension (precipitated by diuretics)

Question 4

Angiotensin Receptor Blockers’ mode of action?

Answer 4

Competitive antagonists of AT1 receptor. ARBs cause venous and arteriolar dialation

Question 5

ARB prescribed?

Answer 5

Losartan

Question 6

CCBs’ mode of action?

Answer 6

Antagonists of the L-type Ca channels. Reduced Ca entry into smooth muscle causes reduced contraction/constriction and TPR

Question 7

CCBs prescribed?

Answer 7

Amplodipine (a dihydropyridine)

Verpamil and Diltiazem

Question 8

CCB side effects?

Answer 8

ankle oedema
hypotension
dizziness

Amlodipine is more selective for vascular smooth muscle - less side effects on myocardium.

Do NOT use CCB with Beta-blockers.

Question 9

How do Thiazide-like diuretics work?

Answer 9

Promote Na excretion by inhibiting its reabsorption from the loop of Henle.

Question 10

Thiazide diuretic prescribed?

Answer 10

Bendroflumethiazide

side effects:

• hypokalaemia (tiredness, arrhythmias)
• hyperglycaemia (diabetes)
• hyperuricaemia (gout)
• impotence

Question 11

Used in resistant hypertension?

Answer 11

Spironolactone

Side effect: hyperkalaemia

Question 12

Classes of anti-thrombolytic drugs?

Answer 12

Antiplatelet
anticoaggluants
fibrinolytics

Question 13

Antiplatelet drugs prescribed?

Answer 13

Aspirin
Clopidogrel
Tricagrelor
Prasugrel

use: angina, MI, TIA, stroke

Side effects: haemorrhage

Question 14

Anticoagulats prescribed?

Answer 14

Prevent new thrombosis
Warfarin (blocks clotting factors)
Heparin
Rivaroxaban (inhibits clotting factor Xa)
Dabigatran (inhibits factor IIa - thrombin)

side effects: haemorrhage

Question 15

Fibirnolytic prescribed?

Answer 15

Streptokinase

• (dissolves formed clots)
• use in STEMI, PE

Question 16

Classes of anti-cholsterol drugs?

Answer 16

statins
fibrates
ezetimibe
bile binding resins

Question 17

Statins used? Mode of action?

Answer 17

Simvastatin, Atorvastatin

Block the HMG CoA reductase, reducing LDL produciton in the liver.

Use in: hypercholesteraemia, angina/MI, TIA

Question 18

Side effects of statins?

Answer 18

myopathy
rhabdomyolysis
renal failure

NOT in pregnancy

Question 19

Fibrates used? Mode of action?

Answer 19

Bezafibrate, Gemifibrozil

Lower the trigylceride, LDL levels

Use for: hypertriglyceridaemia
low HDL cholesterol

Question 20

How does Ezetimibe work?

Answer 20

Inhibits cholesterol absorption in the duodenum.

Used with statins.

Question 21

Bile acid binding resins?

Answer 21

Colestyramine

Promote bile secretion, leading to increased conversion of cholsterol to bile components.

Question 22

Anti-anginal drug classes?

Answer 22

• β Blockers
• Ca2+ Channel Blockers
• Nitrates
• K+ channel Openers

Question 23

Examples of CCBs?

Mode of action?

Answer 23

Amlodipine,
Verapamil, Diltiazem

Inhibit calcium entry into vascular smooth muscle, causing peripheral arteriolar dilatation.

Question 24

CCB side effects?

Answer 24

ankle oedema
hypotension
dizziness

Question 25

β Blocker (cardioselective) prescribed?

Answer 25

Atenolol Recuces heart rate and force, reducing the Oxygen requirement of the myocardium.

Question 26

β Blockers' (Atenolol) side effects?

Answer 26

cold peripheries bradycardia fatigue Long term - heart failure Do NOT use in asthma.

Question 27

Nitrates used in angina? | How do they work?

Answer 27

GTN (glycerylnitrate) Releases NO, which relaxes smooth muscle. Dilates collateral arterioles in angina, directing blood to ischaemic zones. Side effects: postural hypotension, tolerance

Question 28

Potassium Channel Opener used in angina?

Answer 28

Nicorandil Promotes K+ efflux, causing hyperpolarisation, leading to muscle relaxation and coronary vasodilation. Side effects: hypovolaemia (low BP).

Question 29

What are the antiarrhythmic drug classes?

Answer 29

Class I (IA, IB, IC) Class II Class III Class IV

Question 30

How do Class I antiarrhytmic drugs work? Examples?

Answer 30

Block voltage-activated Na+ channels Disopyramide (IA) Lignocaine (IB) Flecanide (IC)

Question 31

How do Class II antiarrhytmic drugs work? Example?

Answer 31

Antagonists of β-adrenoreceptors, slow down depolarisation in the SA and AV nodes. Metaprolol

Question 32

How do Class III antiarrhytmic drugs work? Example?

Answer 32

Block voltage-activated K+ channels, increasing the duration of the action potential. Amiodarone

Question 33

How do Class IV antiarrhytmic drugs work? Example?

Answer 33

Block voltage-activated Ca2+ channels, decreasing the force of contraction. Verapamil

Question 34

Side effects of antiarrhythmic drugs?

Answer 34

phototoxicity pulmonary fibrosis thyroid abnormalities

Question 35

How do Inotropic drugs work? Examples?

Answer 35

Modify the force or speed of contraction: - Digoxin - β-Adrenoceptor Agonists - Cakcium-sensitizers

Question 36

How does Digoxin work? Side effects?

Answer 36

Blocks atrial-ventricular conduction, causing an AV delay. Side effects: It increases ventricular irritability, causing ventricular arrhythmias. Nausea, vomiting, bradycardia.

Question 37

What is the mode of action of β-adrenoceptor agonists? Example? When is it used?

Answer 37

Increase force and rate of contraction. Adrenaline (use in anaphylactic shock and cardiac arrest) side effect: arrhythmias

Question 38

Example of Calcium-sensitizers? When is it used?

Answer 38

Levosimedan Binds to troponin C, sensitizing it to Calcium ions. Use in: acute decompensated heart failure

Question 39

What is Atropine's mode of action? When is it used?

Answer 39

A non-selective muscarinic Ach receptor antagonist. Increases HR at >600mg doses Use for: first line in severe Bradycardia