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CardioRespiratory Year 1 > Drug treatment of Cardiovascular diseases > Flashcards

Drug treatment of Cardiovascular diseases Flashcards

1
Q

what is the role of vascular endothelium

A
  • Role in regulation of vascular tone
  • Controls tissue blood flow
  • Inflammatory responses
  • Maintain blood fluidity
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2
Q

what happens when there is damage to vascular endothelium

A

creates risk to cardiovascular disease

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3
Q

what are the types of cardiovascular disease

A
  • Coronary heart disease
  • Stroke and TIAs
  • Peripheral arterial disease
  • Aortic disease
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4
Q

what is disease pathophysiology

A

loss of normal physiological function

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5
Q

how do you treat disease pathophysiology

A
  • Treatment rationale; direct disease pathology back towards normal function, for example if a person has high blood pressure you want to return the blood pressure to within a normal range
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6
Q

why is it important to treat hypertension

A
  • This is because high blood pressure causes an increase risk in cardiovascular disease
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7
Q

how do you manage hypertension

A

lifestyle and medication

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8
Q

what changes in lifestyle can reduce hypertension

A
  • Environment/lifestyle are very important
  • Salt and smoking especially
  • Salt minimisation benefit is that entire family/household benefits – good practice for life
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9
Q

how do you treat hypertension with drugs

A
  • Multiple options directed at modulating physiological pathways affecting BP
  • Evidence base for order of drug choices in different populations (age and race based)
  • Many people need >1 drug targeting different contributing pathways
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10
Q

what anithypertensive drugs should those aged under 55 be given firstly

A

ACE inhibitors

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11
Q

what anithypertensive drugs should those aged over 55 be given firstly

A

calcium channels blockers

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12
Q

what does it mean when the individual has resistant hypertension

A
  • If the individual has resistant hypertension which means they have good adherence to the antihypertensive drugs then you consider diuretics and beta blockers
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13
Q

what are ACE inhibitor side effects

A
  • Cough
  • Angioedema
  • Potassium retention
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14
Q

what is given instead of ACE inhibitors

A
  • Angiotensin receptor blockers (ARBs) have similar BP effects but are less likely to cause cough
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15
Q

describe the steps in renin angiotensin aldosterone BP regulation

A
  1. sympathetic nerve activation (acting through β1-adrenoceptors)
  2. renal artery hypotension (caused by systemic hypotension or renal artery stenosis)
  3. decreased sodium delivery to the distal tubules of the kidney
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16
Q

what is the mechanism of action of ACE inhibitors

A
  • inhibit angiotensin II leads to vasodilation of small resistance arteries reduces the SVR and reduces the blood pressure
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17
Q

name the antihypertensive agents

A
  • loop diuretics
  • thiazides
  • potassium sparing diuretics
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18
Q

describe the mechanism of action of loop diuretics

A
  • inhibition of sodium potassium and 2 chloride symporter in the thick ascending limb of the loop of Henle, this inhibits the reabsorption of sodium potassium and chloride
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19
Q

name an example of loop diuretic

A
  • furosemide – mainly used in heart failure
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20
Q

describe the mechanism of action of thiazides

A
  • inhibit reabsorption of sodium and chloride ions for the distal convoluted tubules, block the sodium/chloride symporter
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21
Q

what is the first drug choice of thiazide

A
  • first drug of choice is indapamide
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22
Q

what is bendroflumethiazide

A

Thiazides

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23
Q

describe the mechanism of action of bendroflumethiazide

A
  • decrease intravascular volume reducing the cardiac output
  • domaininat site of action is the distal tubule
  • causes vasodilation and reduces the systemic vascular resistance
24
Q

what is the mechanism of action of potassium sparing directions

A
  • used in conjunction with other diuretics to prevent hypokalaemia
25
Q

describe the mechanism of action of calcium channel blockers

A
  • block calcium entry to vascular smooth muscle and myocardial cells this interrupts excitation and contraction coupling

dihydroprydine CCBs
- vasodilate dominant therefore reducing systemic vascular resistance

26
Q

what is an example of an calcium channel blockers

A

amlodipine

27
Q

what are side effects of calcium channel blockers

A

flushing headaches, odema

28
Q

what is the action of non-dihydropyridine

A
  • reduces heart rate, contractibility conduction – negative ionotropes and chronotropes
29
Q

what is an example of a non-dihydropyridine

A
  • example dilitiaxzem
30
Q

what is a side effect of non-dihydropyridine

A

may worsen heart failure

31
Q

what is the mechanism of action of NTG

A
  • NTG causes nitrates to be taken up
  • This causes increased production of nitric oxidise
  • Leads to produce of GTP which actives cyclic GMP
  • Leas to a lost of a phosphate from myosin
  • This leads to vasodilation
32
Q

what are the side effects of NTG

A
  • Headache
  • Dizziness
  • Reflex tachycardia
33
Q

what do low doses of NTG do

A
  • Reduce preload

- Red myocardial oxygen demand

34
Q

what do high doses of NTG do

A
  • Reduce afterload

- Reduces myocardial oxygen demand

35
Q

what is used to treat angina

A

beta blockers

36
Q

what is the mechanism of action of beta blockers

A
  • B1 RECEPOT ANTAGONIST
  • Reduces heart rate and negative inotropic effect, this reduces blood pressure and myocardial oxygen demand
  • These drugs work on multiple different pharmalogical receptors
37
Q

what are the side effects of beta blockers

A

increases end diastolic volume and increases ejection time

38
Q

what is the definition of after load

A
  • Afterload: systemic vascular resistance (SVR), is the amount of resistance the heart must overcome to open the aortic valve and push the blood volume out into the systemic circulation
39
Q

what are the symptoms of heart failure

A
  • Breathlessness
  • Ankle swelling
  • Fatigue
40
Q

what are the sings of heart failure

A
  • Elevated jugular venous pressure
  • Pulmonary crackles
  • Peripheral oedema caused by structural and or functional cardiac abnormality resulting in a reduction in cardiac output and an +/- increase intracardiac pressures at rest or stress
41
Q

what are the 3 types of heart failure

A
  • Heart failure with reduce ejection fractions
  • heart failure with mid range ejection fractions
  • heart failure with preserved ejection fraction
42
Q

what is an ejection fraction

A

Ejection fraction is a measurement of the percentage of blood leaving your heart each time it contracts

43
Q

describe heart failure with reduce ejection fractions

A

there is a significant reduction of the left ventricular ejection function

44
Q

describe heart failure with mid range ejection fractions

A
  • Heart failure with mid range ejeulation fraction between 40-49%
45
Q

describe heart failure with preserved ejection fraction

A
  • Heart failure with preserved ejection fraction greater or equal to 50%
46
Q

how did you work out the ejection fraction

A
  • Amount of blood pumped out/total amount of blood in the chamber
47
Q

what is the heart failure treat goal

A

The goals of treatment in patients with HF are to improve their clinical status, functional capacity & quality of life, prevent hospital admission & reduce mortality

48
Q

how do you treat Heart failure with preserved/mid-range ejection fraction

A
  • Screen patients for cardiovascular and non-cardiovascular comorbidities
  • If present should be treated with effective interventions to improve symptoms
49
Q

How do you treat Heart failure with reduced ejection fraction

A
  • Use an ACE inhibitor
  • Use an beta blocker – symptomatic patients
  • Reduces the risk of hospitalisation due to heart failure and mortality
50
Q

what are the three types of drugs used in heart failure

A
  • positive inotropic drugs
  • vasodilators
  • miscellaneous drugs for chronic failure
51
Q

name examples of positive inotropic drugs

A

cardiac glycosides
beta agonists
PDE inhibitors

52
Q

name examples of vasodilators

A

PDE inhibitors
Nitroprusside Nitrates hydralazine
loop diuretics, ACE inhibitors

53
Q

what are the two most common drugs used to treat angina

A
  • vasodilators

- cardiac depressants

54
Q

what are the two vasodilators

A

nitrates

calcium blockers

55
Q

what are the 2 cardiac depressants

A

calcium blockers

beta blockers

CardioRespiratory Year 1 (28 decks)

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