Drugs in Cardiovascular Disease

Question 1

What disease are thiazide diuretics used in?

Answer 1

Hypertension.

Question 2

What disease are loop diuretics used in?

Answer 2

Heart failure.

Question 3

Give an example of a thiazide and a loop diuretic.

Answer 3

Thiazide - bendrofluazide.

Loop - furosemide.

Question 4

What are the side effects of diuretics?

Answer 4

Hypokalaemia (tiredness, arrhythmias), hyperglycaemia (diabetes), increase in uric acid (causes gout), impotence.

Question 5

Give an example of a cardioselective B-blocker and a non-selective B blocker.

Answer 5

Cardioselective - atenolol. Non-selective - Propanolol.

Question 6

What are cardioselective B blockers used in?

Answer 6

Angina, hypertension and heart failure.

Question 7

What are non-selective beta blockers used in?

Answer 7

Thyrotoxicosis (excessive quantities of thyroid hormone).

Question 8

What are the side effects of beta blockers?

Answer 8

Asthma (never used in established asthma), tiredness, heart failure (good in medium to long term but can worsen in short term), cold peripheries.

Question 9

What are the 2 types of calcium antagonists?

Answer 9

Dihydropyridines and rate limiting calcium antagonists.

Question 10

Give one example of a dihydropyridine and 2 examples of a rate limiting calcium antagonist.

Answer 10

Amlodipine. Verapamil and diltiazem.

Question 11

What are both types of calcium channel blockers used in?

Answer 11

Hypertension and agina.

Question 12

What else are rate limiting calcium antagonists used in?

Answer 12

Supraventricular arrhythmias.

Question 13

What are the side effects and contraindications of dihydropyridines and rate limiting calcium antagonists?

Answer 13

Dihydropyridines: ankle odema (cosmetic not serious).

Rate limiting calcium antagonists: avoid use with beta blockers.

Question 14

Give an example of an alpha blocker.

Answer 14

Doxazosin.

Question 15

What are the side effects of an alpha blocker?

Answer 15

Postural hypotension.

Question 16

Give an example of an ACE inhibitor.

Answer 16

Lisinopril.

Question 17

What are ACEIs used in?

Answer 17

Hypertension and heart failure.

Question 18

When are ACEIs good and bad for the kidneys?

Answer 18

Good in diabetic nephropathy, bad in renal artery stenosis.

Question 19

What are the side effects of ACEIs?

Answer 19

Dry cough, renal dysfunction, angioneurotic oedema (life-threatening, skin gets blotchy and swollen, if larynx gets swollen then people can’t breathe).

Question 20

When should you never use ACEIs?

Answer 20

In pregnancy induced hypertension (can cause damage to the foetus).

Question 21

Give an example of an angiotensin receptor blocker?

Answer 21

Losartan.

Question 22

What are side effects of ARBs?

Answer 22

Renal dysfunction, no cough.

Question 23

When are nitrates used?

Answer 23

In angina and acute heart failure.

Question 24

What are the side effects of ntirates?

Answer 24

Headache, hypotension/collapse.

Question 25

How do you prevent people getting tolerance to nitrates?

Answer 25

Leave 8hrs a day nitrate free.

Question 26

Give 4 examples of antiplatelet agents.

Answer 26

Aspirin, clopidogrel, ticagrelor, prasugrel.

Question 27

When are antiplatelet agents used?

Answer 27

In angina, acute MI, CVA/TIA (stroke). Patients at high risk of MI and CVA.

Question 28

What are the side effects of antiplatelet drugs?

Answer 28

Haemorrhage anywhere, peptic ulcer (stomach ulcer) could become a haemorrhage, aspirin sensitivity can cause asthma.

Question 29

How are heparin and warfarin given?

Answer 29

Heparin - IV. Warfarin - oral.

Question 30

How do heparin and warfarin work?

Answer 30

Block clotting factors 2, 7, 9 and 10.

Question 31

How do you control the dose of heparin and warfarin?

Answer 31

Use the international normalised ratio.

Question 32

Give 2 examples of direct oral anticoagulants and what factor they inhibit.

Answer 32

Rivaroxaban - factor Xa. Dabigatran - factor IIa (thrombin).

Question 33

Give 2 examples of fibrinolytic drugs.

Answer 33

Streptokinase, tissue plasminogen activator (tPA).

Question 34

When should you avoid giving fibrinolytic drugs?

Answer 34

Recent haemorrhage, trauma, bleeding tendencies, severe diabetic retinopathy, peptic ulcer.

Question 35

What are the 2 classes of anticholesterol drugs?

Answer 35

Statins and fibrates.

Question 36

Give an example of a statin and a fibrate.

Answer 36

Statin - simvastatin/atorvastatin. Fibrate - bezafibrate.

Question 37

What enzyme do statins inhibit?

Answer 37

HMG CoA reductase.

Question 38

What are statins used in?

Answer 38

Hypercholesterolaemia, diabetes, angina/MI, CVA (cerebrovascular accident)/TIA (transient ischaemic attack), high risk of MI/CVA.

Question 39

What are the side effects of statins?

Answer 39

Myopathy (muscle pain), rhabdomyolysis (muscle breakdown), renal failure.

Question 40

When are fibrates used?

Answer 40

In hypertriglycerideaemia or low HDL cholesterol.

Question 41

What drug would you use for acute supraventricular arrhythmias?

Answer 41

Adenosine.

Question 42

What drugs would you use to treat long term ventricular/supraventricular arrhythmias?

Answer 42

Amiodarone (long acting), beta blockers, flecainide (sodium channel blocker).

Question 43

What are the side effects of amiodarone?

Answer 43

Photoxicity (skin sensitive to sunlight), pulmonary fibrosis, thyroid abnormalities (hypo or hyper).

Question 44

If digoxin is given in toxic conecntrations, what are the side effects?

Answer 44

Nausea/vomiting, yellow vision, bradycardia/heart block, ventricular arrhythmias.

Question 45

What are the 2 effects of digoxin on the body (one is sometimes bad, the other is always bad)?

Answer 45

1. Delays conduction in AV node (good in AF, too much causes bradycardia and heart block).
2. Increases ventricular irritability which produced ventricular arrhythmias.