Drug Treatment for Cardiovascular Disease

Question 1

b receptors molecular action

Answer 1

Gs-protein dependent activation of AC –> increases cAMP –> activates pKA –> increases/decreases intracellular calcium –> increases contractility of cardiac muscle and decreases the contractility of arterial smooth muscle and bronchial smooth muscle

Question 2

examples of beta blocker drug and their indications

Answer 2

propnol- non selective beta blocker- effective for angina, HTN, arrhthymias, migraine, tremor
bisoprolol-commonly in the UK- selective b1 blocker
heart: decreases force and rate of contraction-> reduces BP
lungs: bronchoconstriction
arterioles: decreases blood supply to muscles, skin, penis

Question 3

side effects of beta blockers

Answer 3

heart: fatigue, bradycardia
lungs: breathlessness, exacerbations of asthma
arterioles: fatigue, claudication, cold hands/feet, erectile dysfunction

Question 4

contraindication of beta blockers

Answer 4

hypoglycaemia and beta blockers

• low blood glucose activates Adr release (mobilises glucose from the liver-gluconeogenesis)
• causes tremor, palpitations, sweat
• symptoms blocked by beta blockers
• patients need to be able to recognise hypoglycaemia
• beta blockers contraindicated in diabetic pts with recurrent hypoglycaemia

Question 5

Mechanism of action of thiazide diuretics

Answer 5

BENDROFLUMETHIAZIDE-blocks Na+/Cl- symporter on the lumenal side of the epithelial cells
-inhibits reabsorption of Na and Cl and increases excretion of Na+/Cl- and water which lowers BP
INDAPAMIDE-arterioles (K-ATP): decreases BP

Question 6

side effects of thiazides

Answer 6

kidney: hyponatraemia, hypokalaemia, alkalosis, hypercalcaemia, hypermagnesaemia, increase in urate
insulin resistance: increase in glucose (diabetes)
liver: increase in lipids (arterial disease)

Question 7

other indications of thiazide diuretics

Answer 7

oedema, UT stones, nephrogenic diabetes insipidus

Question 8

core thiazide drug

Answer 8

bendroflumethiazide

Question 9

alpha blockers mechanism of action

Answer 9

a1 receptors acts via the Gq protein to increase IPA levels and further release of Ca2+ from the sarcoplasmic reticulum

Question 10

a-blocker drug

Answer 10

doxazosin- decreases Ca2+ release in arteriolar smooth muscle

Question 11

other indications of a-blockers

Answer 11

prostatic hypertrophy to relax bladder outflow sphincter

Question 12

side effects of alpha blockers

Answer 12

palpitations (reflex tachycardia), postural hypotension

Question 13

calcium channel blocker mechanism of action

Answer 13

• blocks the L-type voltage gates Ca2+ channel
• decreases intracellular Ca2+
• arterioles: smooth muscle relaxation
• heart: decreased force of contraction
• SA and AV node: decreased heart rate

Question 14

other indications of calcium channel blocker

Answer 14

Raynaud’s syndrome, angina, arrhythmias

Question 15

core calcium channel blockers

Answer 15

amlodipine, ditiazem, verapamil

Question 16

side effects of calcium channel blockers

Answer 16

preferential dilation of pre-capillary arteriole -impaired function of the capillary sphincter -increased hydrostatic pressure -net filtration -palpitations (reflex tachycardia) -constipation -flushing -headache -exacerbation of HF (D&V)

Question 17

ACE inhibitor mechanism of action

Answer 17

ACE converts AngI to AngII. ACE breaksdown Bradykinin (vasoactive peptide) -> ACE-Inhibitors decrease Ang-II production and increases bradykinin breakdown

Question 18

core ACE inhibitor

Answer 18

rampiril

Question 19

side effects of ACE inhibitors

Answer 19

dry cough (accumulation of bradykinin in lungs- bronchial irritation), renal impariment- esp with renal artery stenosis, hyperkalaemia- commonly given with diuretic

Question 20

other indications of ACE inhibitors

Answer 20

HF

Question 21

aldosterone antagonist mechanism of action

Answer 21

-blocks the upregulation of sodium channels in the DCT by aldosterone

Question 22

core aldosterone antagonist

Answer 22

Spironolactone- usually used as an add on in resistant HTN

Question 23

other indication of aldosterone antagonist

Answer 23

hyperaldosteronism

Question 24

spironolactone side effects

Answer 24

impaired renal function, hyperkalaemia, gynaecomastia (oestrogen-androgen imbalance)

Question 25

Ang-II receptor antagonists mechanism of action

Answer 25

blocks action of AT-II on the AT receptor, similar physiological effects to ACE-I’s

Question 26

side effects of AR antagonists

Answer 26

similar side effect profile to placebo, does not cause dry cough like ACE-I’s

Question 27

core AR antagonist

Answer 27

losartan

Question 28

stage 1 BP according to NICE guidance

Answer 28

BP>140/90mmHg- treat if end-organ damage or diabetic

Question 29

stage 2 BP according to NICE guidance

Answer 29

BP>160/100mmHg- treat once confirmed on 24 hr reading

Question 30

stage 3 BP according to NICE guidance

Answer 30

Systolic BP >180 mmHg- treat immediately

Question 31

lifestyle management in HTN

Answer 31

decrease weight, decrease salt intake, decrease alcohol intake, increase exercise

Question 32

treatment targets for age and diabetics as per NICE

Answer 32

age less than 80=140/90
age more than 80= 150/90
diabetics= 135/85

Question 33

NICE treatment for hypertension for people younger than 55 and assume patient not of black ethinicity

Answer 33

1. ACE-I or AR2B
2. ACE-I+ Ca2+ channel blocker OR ACE-I + thiazide diuretic
3. ACE-I+ Ca2+ channel blocker+thiazide diuretic
4. Add a further diuretic, a-blocker, beta blocker. consider specialist advice

Question 34

NICE treatment for hypertension for people older than 55 or of black ethinicity

Answer 34

1. Ca2+ channel blocker OR Thiazide diuretic
2. ACE-I+ Ca2+ channel blocker OR ACE-I + thiazide diuretic
3. ACE-I+ Ca2+ channel blocker+thiazide diuretic
4. Add a further diuretic, a-blocker, beta blocker. consider specialist advice