Drug Treatments for Complex Heart Conditions

Question 1

What preventative drugs may be given as prophylaxis for coronary heart disease?

Answer 1

Calcium channel blockers, ACE inhibitors, ARBs, thiazides and beta blockers

Question 2

What is the polypill?

Answer 2

Medication used in individuals that are at a higher risk of developing CHD in order to reduce their risk factors

Question 3

What drugs are present in the polypill?

Answer 3

A statin, BP reducing drug (thiazide, ARB or calcium channel antagonist), antiplatelet drug (e.g. aspirin) and folic acid to lower homocysteine levels

Question 4

In the first instance, after lifestyle advice, what drug would be given to treat hypertension in someone under 55?

Answer 4

ACE inhibitor or ARB

Question 5

In the first instance, after lifestyle advice, what drug would be given to treat hypertension in someone over 55 or African/Caribbean origin?

Answer 5

Calcium channel blocker

Question 6

What is the second line of drug treatment for hypertension (if unresponsive to first line)

Answer 6

ACE inhibitor/ARB

AND

calcium channel blocker

Question 7

What is the third line of drug treatment for hypertension (if unresponsive to first and second-line)

Answer 7

ACE inhibitor/ARB
\+
Calcium channel blocker
\+ 
Thiazide-like diuretic

Question 8

Explain how calcium antagonists work to reduce blood pressure? Are there any side effects?

Answer 8

These drugs block calcium channels which prevents calcium influx into smooth muscle cells and therefore prevents contraction leading to systemic vasodilatation.

This can also cause flushing and oedema as side-effects.

Question 9

Explain how ACE inhibitors work to reduce blood pressure? Are there any side effects?

Answer 9

These prevent the conversion of angiotensin II from angiotensin I and therefore prevent the action of the RAAS system –> vasodilation and reduced blood volume

Side-effects include a cough and low blood pressure

Question 10

Explain how ARBs work to reduce blood pressure? Are there any side effects?

Answer 10

These block the action of angiotensin II which prevents aldosterone section from the adrenal gland and systemic vasodilatation

Side-effects include hypotension

Question 11

Explain how thiazide diuretics work to reduce blood pressure? Are there any side effects?

Answer 11

Thiazide diuretics increase the excretion of salt and water and therefore reduce blood volume –> decreased blood pressure

Side-effects include impotence and hypokalaemia

Question 12

Explain how beta blockers work to reduce blood pressure? Are there any side effects?

Answer 12

They act on the beta 1 receptors in the heart to reduce myocardial contractility and heart rate leading to a reduced blood pressure.

Side-effects include lethargy and bronchospasm

Question 13

How is hypertension managed in diabetes?

Answer 13

Thiazide diuretics and beta blockers can worsen glucose control and therefore these aren’t used, but RAAS blockage from drugs can delay the onset of diabetes in at-risk individuals and may also reduce renal damage in diabetics