CVS

Question 1

Digoxin

Answer 1

Cardiac glycoside, inhibits Na/K ATPase, mainly in the myocardium. This increases intracellular Na+, leading to a reversal in 3Na+/Ca2+ channel, which now exports Na+ and imports Ca2+ instead of ti’s usual. This lengthens phase 0 and phase 4 of the cardiac action potential, leading to a lower heart rate.

Question 2

Bendroflumethiazide

Answer 2

Thiazide diuretic, therefore blocks Na/Cl co-transporter in the DCT. Used mainly in hypertension as it also has vasodilatory effect

Question 3

Indapamide

Answer 3

Thiazide like diuretic

Question 4

Amioderone

Answer 4

K+/type three anti-arythmic, used in AF (as the rhythm control) in conjunction with propranolol as the rate control

Question 5

amlodipine

Answer 5

Ca2+/type 3

Question 6

verapamil

Answer 6

Ca2+/type 3, could be used in place of BB propranolol as as the rate controlling part of of rate and rhythm controlling part of how to deal with AF, unless there’s heart block

Question 7

Amiloride

Answer 7

Enac inhibitor - K+ sparing (as Na+ isn’t going out, meaning you don’t need to swap if for a K+ to keep the electroneutrality)

Question 8

flecanide

Answer 8

Na+, 1C, can’t be used if there’s structural damage

Question 9

adenosine

Answer 9

chemical cardioversion, really short half life, flush in with saline so it doesn’t get broken down before it reaches the heart, it stops the SAN and the AVN

Question 10

Alteplase

Answer 10

thrombolysis, good for ischaemic stroke, can lead to haemorragic stroke somewhere else in the brain as clotting is disabled

Question 11

propanolol

Answer 11

BB, used as the rate controlling part of of rate and rhythm controlling part of how to deal with AF

Question 12

What stimulates RAAS?

Answer 12

Sympathetic activity and low NaCl

Question 13

why is amlodapine the only Ca2+ blocker you can give for HF?

Answer 13

it’s action is specific to vascular smooth muscle

Question 14

what is the order for HF?

Answer 14

ACE Diuretics, Amioderone, Ca2+, anticoag and aspirin if Hx of thrombotic, IV ionotropes for acute heart failure

Question 15

Why is verapamil given for AF, but not amlodapine?

Answer 15

as amlodapine only affects vascular smooth muscle, would have no affect on the heart

Question 16

which first given hypertension?

Answer 16

ACEi, unless over 55/black, Ca2+ - if doesn’t work the other one, if still not working thiazide, then if still not working spironolactone (this is an aldosterone receptor antagonist)

Question 17

why dry cough if on ACEi?

Answer 17

angiotensin 2 breaks down bradykinin, there will be less angiotensin to break down bradykinin - which causes a dry cough

Question 18

what could you give if the patient had a dry cough on an ACEi?

Answer 18

Angiotensin 2 receptor blocker

Question 19

orlistat

Answer 19

anti obesity drug, inhibits pancreatic lipase - like an acarbase but for fat rather than sugar - prevents onset of type 2 DM in fatties

Question 20

GTN - glyceryltrinitrate

Answer 20

Simple Angina - metabolised to NO, venodilator, (reduce preload, therefore reduces oxygen demand of the heart as it’s not having to pump as hard) and vasodilator (reduces after load). ADRs; postural hypotension/dizziness (this happens as the blood is in the veins so is susceptible to gravity) - also give secondary prevention of CVS disease - statins, aspirin, ACEi if they have angina and diabetes, antihypertensives if they have hypertension

Question 21

Angina treatment

Answer 21

Beta blocker or Ca2+ channel blocker (amlodapine) + GTN for when necessary - for unstable you can consider stenting

Question 22

MI treatment

Answer 22

For STEMI; percutaneous coronary intervention - this is a stent, has to be done within 2 hours, if later than that thrombolise

Question 23

Statins

Answer 23

HMG - CoA reductase blocker, this is used in the production of cholesterol

Question 24

unstable angina/NSTEMI treatment

Answer 24

Aspirin and clopidagrel

Question 25

clopidagrel

Answer 25

anti platelet - stops activation of platelets by stopping ADP binding to them

Question 26

DVT treatment

Answer 26

IVC filter (if recurrent), LMWHeparin (until INR down to 2), then three months of warfarin

Question 27

PE

Answer 27

If large; morphine, Alteplase, and LMWHeparin,

LMWHeparin if it’s not that large

Question 28

Protamine Sulphate

Answer 28

heparin reversal

Question 29

PT is affected by what?

Answer 29

Vit K dependant, Extrinsic, Warfarin affects this

Question 30

What’s INR?

Answer 30

PT/normal person’s PT

Question 31

APTT

Answer 31

intrinsic pathway, affected by heparin

Question 32

Do aspirin or clopidarel affect PT/INR or APTT?

Answer 32

Neither as these are anti-platlet drugs not to do with clotting time

Question 33

Why give heparin at the start when you’re giving warfarin?

Answer 33

Warfarin is initially pro-thrombotic and takes a while to get the INR to 2, which is when you come off heparin.