Drug treatments for CVD

Question 1

Describe which meds you would prescribe for whom in hypertension

Answer 1

Question 2

describe the roles of the vascular endothelium (5)

Answer 2

angiogenesis
metabolism
thrombosis
platelet activation
lymphocytes traffic
VSMC (vascular smooth muscle cells) proliferation
inflammation
vascular tone

Question 3

name 4 main types of CVD

Answer 3

stroke and tia (mini stroke)
coronary heart disease
peripheral arterial disease
aortic disease

Question 4

what is optimal and normal bp

Answer 4

O: <120, <80
N: <130, <85

Question 5

first line hypertension pharmacotherapy <55 and not black pt

Answer 5

Ace inhibitor

Question 6

first line hypertension pharmacotherapy >55 and/or black pt

Answer 6

calcium channel blocker

Question 7

when would you use an Ace inhibitor for a black pt

Answer 7

other risks factors eg coronary ht disease or CKS

Question 8

what is the first step of the RAAS pathway

Answer 8

activation of JG cells - prorenin turns to renin

Question 9

what does renin do?

Answer 9

converts angiotensinogen (liver) to angiotensin I

Question 10

how is angiotensin I turned to Angiotensin II

Answer 10

ACE

Question 11

where do you find ACE

Answer 11

lungs and kidneys

Question 12

what does A II do in teh proximal tubule

Answer 12

promotes Na+ reuptake

Question 13

what does A II do in the adrenal cortex

Answer 13

promotes release of aldosterone

Question 14

what does aldosterone do?

Answer 14

promotes Na+ reabsorption in distal tubule

Question 15

what does A II bind to in teh vascular system

Answer 15

GPCR

Question 16

which hormonw causes vasoconstriction in systemic vasculature

Answer 16

A II

Question 17

in which vessels does most vasoconstriction happen

Answer 17

arterioles

Question 18

what does A II stimulate in the brain?

Answer 18

ADH release

Question 19

what is natriuresis

Answer 19

excretion of Na+ in the urine

Question 20

what are the two angiotensin related antihypertensives

Answer 20

ACE inhibitors and angiotensin II receptor antagonists (losartan)

Question 21

what do Ca2+ channel blockers do

Answer 21

decrease vasoconstriction

Question 22

what are the 2 types of diuretics

Answer 22

loops and thiazide

Question 23

what do thiazide diuretics do

Answer 23

inhibit NaCl cotransporter in distal CT therby causing naturesis

Question 24

what to loop diuretics do

Answer 24

inhibit Na-K-Cl cotransporter in loop of Henle causing naturesis

Question 25

what are some dangers of loop diuretics

Answer 25

loss of calcium, loss of K

Question 26

what is the name of a dihydropyridine CCB and what are some side effects

Answer 26

amlodipine | flushing, oedema, headaches

Question 27

name a non-dihydropyridine CCB

Answer 27

diltiazem

Question 28

when should you not use diltiazem

Answer 28

heart failure

Question 29

why is diltiazen contraindicated

Answer 29

in heart failure because is negative chrono and ionotrope

Question 30

what is the first line treatment for angina

Answer 30

lower cholestrerol, dietary changes

Question 31

what pharmacotherapy an you use for angina

Answer 31

GTN spray, B blockers, ACE inhibitors

Question 32

what does GTN do?

Answer 32

ultimately venodilation - converts to NO, increases cyclic GMP, diminished actin-myosin cross bridges

Question 33

which medicine is absolutely contraindicated with GTN and why

Answer 33

viagra - severely low bp

Question 34

what is decreased with low doses of GTN

Answer 34

preload

Question 35

what receptors does adrenaline bind to

Answer 35

BETA 1!!!

Question 36

what is a beta blocker

Answer 36

BETA 1 and2 receptor antagonist

Question 37

what is angina

Answer 37

heart ischaemia caused by problems with coronary arteries

Question 38

how do calcium channel blockers help angina

Answer 38

decrease afterload decrease SVR increase O2 supply to coronary arteries by dilating them (so more blood comes)

Question 39

signs/symptoms of heart failure

Answer 39

oedema (peripheral and/or pulmonary) dyspnoea lack of energy raised JVP pulmonary crackles

Question 40

what is the cardiac result of heart failure(2)

Answer 40

reduced CO increased intracardiac pressure

Question 41

what is the critical measurement in the diagnosis of types of heart failure

Answer 41

ejection fraction

Question 42

what are the 3 EF versions

Answer 42

>50 preserved >40-50 borderline <40 reduced

Question 43

with preserved ejection fraction HF what should you prescribe

Answer 43

diuretics

Question 44

with reduced EF what should you prescribe

Answer 44

ACE- i and B blocker, then MRA (mineralocorticoid receptor antagonist)

Question 45

what is an MRA

Answer 45

Mineralocorticoid receptor antagonist eg spiranolactone. Diuretic

Question 46

how does GTN reduce preload

Answer 46

vasodilation - increases capacitance in the body so less blood goes back to the heart

Question 47

what is the difference between low and high doses of gtn

Answer 47

low - decreased preload high - decreased preload AND afterload bc arteries also dilated