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Pharmacology > Drugs Acting on the Heart > Flashcards

Drugs Acting on the Heart Flashcards

0
Q

What condition is it where the heart is temporarily deprived of oxygen?

A

Angina

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1
Q

What is a pro-drug?

A

One that needs to be metabolised to a different form in order to become active

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2
Q

What happens when the heart rhythm is disturbed?

A

Dysrhythmia

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3
Q

What condition is where the heart is deprived of oxygen?

A

Heart Attack (MI)

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4
Q

What happens when the heart doesn’t pump properly?

A

Heart Failure

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5
Q

What is coronary heart disease?

A

Thinning of coronary arteries due to fatty plaques

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6
Q

What are the consequences of coronary artery disease?

A

It slows and restricts blood flow to the cardiac muscle. As it depends on oxygen and glucose, the muscle does not work properly, resulting in pain.
If this occurs for too long = heart muscle dies

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7
Q

What 3 things can reduce coronary artery disease?

1 lifestyle, 2 are drugs

A

Lifestyle - diet, exercise, stopping smoking
Medication to reduce BP
Statins to reduce cholesterol

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8
Q

What is the key drug to reduce cholesterol, to reverse the effects of coronary artery disease in its EARLY stages?

A

Statins

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9
Q

What condition is a crushing pain in the chest that may radiate to arm, neck, or jaw and feel like a strangling of the chest, that only lasts short time?

A

Angina Pectoris

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10
Q

What does the pain in angina pectoris result from?

A

Cardiac ischaemia - not enough oxygen reaching the heart to meet its demands

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11
Q

What do you call angina experienced when exercising?

A

Angina of effort

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12
Q

What are the 2 solutions for solving the problem of angina (too little oxygen getting to the cardiac muscle)?

A

Reducing oxygen demand (reduce workload)

Increasing oxygen supply (improve blood flow)

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13
Q

What is an effective vasodilator that reduces the cardiac workload?

A

GTN/Glyceryl Trinitrate (nitroglycerin)

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14
Q

Why can GTN not be taken orally?

A

It is a prodrug that needs to be converted to its active form.
This must be done close to the site of action - in the blood stream

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15
Q

What is GTN/nitroglycerin converted to in the body?

A

Nitro oxide

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16
Q

What do vasodilators do in relation to the heart/why is it useful that they dilate the peripheral blood vessels?

A

Heart does not have to push as hard

Less blood is returned to the heart: lower force of contraction

It DECREASES RESISTANCE and REDUCES WORKLOAD

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17
Q

What is the best treatment for angina?

A

GTN

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18
Q

What does GTN do?

A

Converts to nitro oxide and dilates peripheral blood vessels. Good for angina as decreases resistance of blood flow, thereby reducing cardiac workload and output.

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19
Q

Name a beta-blocker beginning with A that improves blood supply to the heart, thereby reducing cardiac workload:

A

Atenolol

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20
Q

Where does atenolol act in the heart?

A

B1 adrenoceptors

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21
Q

Atenolol blocks the action of the sympathetic nervous system on the SA node. What does this achieve?

A

It stops the heart from pumping more forcefully and thus requiring more oxygen when the patient’s SNS is activated

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22
Q

Which phase does atenolol prolong?

A

The diastole phase. This is when the heart is relaxed, so it gives the heart longer for the blood and oxygen to flow round the body before it contracts again

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23
Q

What 2 mechanisms of action does atenolol have?

A

It acts on B1 adrenoceptors in the heart -

blocking SNS activation and prolonging the diastole phase

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24
Q

What is similar to angina but with prolonged pain?

Why is the pain prolonged.

A

A heart attack. It hurts because the cardiac muscle is dying

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25
Q

What is the process called where part of the cardiac muscle dies due to lack of oxygen?

A

Ischaemia

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26
Q

What are the 5 types of heart dysrhythmia?

A 
Atrial Fibrillation
Supra-ventricular Tachycardia
Ventricular Tachycardia
Heart Block
Ventricular Fibrillation
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27
Q

What are the 2 best drugs for a heart attack that reduce workload and oxygen demand, improve blood flow through coronary arteries and reduce pain?

A

GTN and propranolol

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28
Q

What is a tissue plasminogen activator?

In what time scale should it be used?

A

A ‘clot busting drug’ used during a heart attack to unblock an artery.
It needs to be used within a few hours

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29
Q

What is the name of a procedure where a vessel is reopened using a tiny balloon and stent?

A

Angioplasty

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30
Q

What is heart failure?

A

When the heart does not pump efficiently enough to supply the body

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31
Q

What are the two solutions for heart failure?

A

Reduce blood pressure to reduce demands on the heart

Make the heart pump faster

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32
Q

Name a positive intropic agent beginning with D

A

Digoxin

33
Q

What is a positive inotropic agent?

A

A drug that increases cardiac output/force of contraction

34
Q

Name a drug that increases cardiac output/force of contraction that is used for patients with heart failure, atrial fibrillation or for a very long time in sinus rhythm:

A

Digoxin

35
Q

What are the first 2 types of drugs that should be given to a patient with sinus rhythm before giving digoxin?

A

An ACE inhibitor and a diuretic

36
Q

Does digoxin reduce the mortality of patients with heart problems?

A

No

37
Q

What drug improves the symptoms, exercise tolerance and need for hospitalisation in patients with heart failure/atrial fibrillation?

A

Digoxin

38
Q

What does digoxin inhibit and increase?

What is the molecular mechanism of digoxin

A

It inhibits the Na/K ATPase - i.e. Sodium/Potassium pump

Increases the Calcium in stores

39
Q

Digoxin inhibits the sodium/potassium pump and increases calcium stores in which cells in the body?

A

Every single one = TOXIC

40
Q

What is the physiological effect of digoxin?

A

It increases the force of contraction (positive inotropic effect) without increasing oxygen consumption

41
Q

Why would digoxin not be the first choice drug?

A

Lots of interactions with other drugs
Very toxic

Better to reduce demands on heart than increase output

42
Q

What is a cardiac arrhythmia?

A

LACK of rhythm in the heart

43
Q

What is a cardiac dysrhythmia?

A

A disturbance of rhythm in the heart

44
Q

What are the 3 potential sites of origin for a cardiac dysrhythmia?

A

Atrial
Supra-ventricular/Junctional
Ventricular

45
Q

What is a true arrhythmia?

A

A very disorganised cardiac rhythm

46
Q

What is tachycardia?

A

Where the heart beats too fast

47
Q

What is the term for when the heart beats too slow?

A

Bradycardia

48
Q

What is the term for when cardiac tissue other than the SA node initiates heart beats?

A

Ectopic Pacemaker

49
Q

What is the term for a build up of calcium in cells that lead to a train of action potentials causing dysrhythmia in the heart?

A

Delayed after depolarisation

50
Q

What is the term used for tissue damage/abnormality causing action potentials to travel in circles in the heart?

A

Re-entry circuits

51
Q

What are additional conducting pathways connecting atria and ventricles in the heart?

A

Congenital abnormalities

52
Q

What is a HEART BLOCK?

A

Damage to conducting pathways in the heart disrupting atrial-ventricular signalling

53
Q

What disrupts atrial-ventricular signalling as a result of damage to conducting pathways?

A

Heart Block

54
Q

People with coronary heart disease, heart valve disorders and blood chemistry disorders (e.g. thyroid) are more at risk of what?

A

Cardiac DYSRHYTHMIA

55
Q

Beta blockers, psychotropics, sympathomimetics, caffeine, amphetamines, cocaine and some anti-dysrhythmic drugs can sometimes cause what?

A

Cardiac dysrhythmia

56
Q

What does ectopic focus look like on an ECG?

A

Extra P Waves. The atrial muscle is trying to initiate heart beats from another bit of tissue as well as the SA node = tachycardia

57
Q

When would you see extra P waves and no QRS wave on an ECG (bradycardia)

A

Atrio-ventricular block = impulse not going to ventricles

58
Q

What may require an electric shock to restore function and results in no QRS wave on an ECG?

A

Ventricular fibrillation

59
Q

What are the 3 treatment types for dysrhythmia?

A

Drug, Electrical, Surgery

60
Q

What classification system is flawed because:

  • it does not allow for drugs with multiple mechanisms of action
  • does not allow for drug action differing between diseased and healthy tissue
  • it excludes some potential sites of drug action?
A

The Vaughn-Williams classification

61
Q

What classification system do most clinic use for classifying anti-dysrhythmic drugs?

A

By clinical utility

62
Q

What are the 3 classification groups for classifying dysrhythmic drugs by clinical utility?

A

Supra-ventricular origin
Supra-ventricular OR ventricular origin
Ventricular origin

63
Q

What are the 5 classification groups in the Vaughn-Williams classification system?

A 
Sodium Channels
Beta 1 Adrenoceptor
Potassium Channels
Calcium Channels
Unclassified

Vaughan Said Bullying Peter Causes Upset

64
Q

Where does Lidocaine target when used for a heart condition?

A

Sodium Channels

65
Q

Where does Atenolol target?

A

Beta 1 adrenoceptors

66
Q

Where does amiodarone target?

A

Potassium channels

67
Q

Where does verapamil target?

A

Calcium channels

68
Q

What category in the VW classification system does Adenosine and digoxin fit into?

A

Unclassified. It has more than one mechanism of action.

69
Q

What do V-W class 1 drugs target?

A

Sodium Channels

70
Q

What do Class 2 V-W drugs target?

A

Beta 1 Adrenoceptors

71
Q

What do Class 3 V-W drugs target?

A

Potassium Channels - prolonging action potentials

72
Q

What do Class 4 V-W drugs target?

A

Calcium channels

73
Q

Digoxin is used to treat cardiac failure. It is also a positive inotropic agent.
True or False?

A

True

74
Q

Organic nitrates such as nitroglycerin are useful in the treatment of what?

A

Angina

75
Q

The component of the cardiac cycle during which blood flow to cardiac muscle occurs is:

A

diastole

76
Q

An abnormality in the atria that can produce extra P waves in an ECG and that can result the heart rate speeding up is:

A

An ectopic focus

77
Q

Lidocaine exerts its antidysrhythmic action by blocking:

a. calcium channels
b. chloride channels
c. potassium channels
d. sodium channels

A

Sodium channels

78
Q

Atenolol exerts its therapeutic effect in angina by:

a. decreasing the force of heart contraction
b. improving blood supply to the heart
c. slowing the heart rate
d. all of the above

A

All of the above

79
Q

Select a pro-drug

a. atenolol
b. glyceryl trinitrate
c. lidocaine
d. verapamil

A

GTN

80
Q

Select a drug that is usually given in a sublingual, buccal spray or patch form:

a. atenolol
b. glyceryl trinitrate
c. lidocaine
d. verapamil

A

GTN

81
Q

Digoxin acts on:

a. beta adrenoceptors
b. calcium channels
c. sodium channels
d. sodium potassium ATPase

A

Sodium Potassium Pump

Pharmacology (13 decks)

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