Drugs Used in Treatment of the CVS

Question 1

Name two types of Ischaemic heart disease.

Answer 1

Angina
MI (myocardial infarction)

Question 2

Give two examples of cerebrovascular disease.

Answer 2

Transient ischaemic attack
Thrombotic stroke

Question 3

Give an example of an arrhythmia.

Answer 3

Atrial fibrillation

Question 4

What is atheroclerosis?

Answer 4

Narrowing of arteries making it difficult for blood to flow through them

Question 5

What can cause atheroclerosis?

Answer 5

Smoking and high wall stress can cause vessel damage and therefore can result in atherosclerosis.
High BP

Question 6

Discuss the cell’s healing process in terms of atheroclerosis.

Answer 6

Activation of platelets
Releases inflammatory cells
Inflammatory cells incorporate w cholesterol and form a fibrous cap

Question 7

Give some examples of anti-platelet drugs.

Answer 7

Aspirin
Clopidogrel/ Ticagrelor

Question 8

What does aspirin inhibit the production of?

Answer 8

Thromboxane A2

Question 9

What do Clopidogrel/ Ticagrelor inibit?

Answer 9

Block a specific ADP receptor on the surface on the platelet

Question 10

When are antiplatelets used if referring to primary prevention?

Answer 10

Before cardiovascular disease is diagnosed.

Question 11

When are antiplatelets used if referring to secondary prevention?

Answer 11

After CV disease diagnosis.

Question 12

When may a person be started on anti-platelet drugs for primary prevention?

Answer 12

If they are at high risk- diabetes etc

Question 13

Which drug with you give alongside clopidogrel/ Ticagrelor?

Answer 13

Aspirin

Question 14

Who and when would you give aspirin?

Answer 14

-Patients w stable angina
-Patients w previous CABG (coronary artery bypass graft).
-For two weeks after a patient has had a stroke or TIA (Transient ischemic attack)

Question 15

When would you give a patient clopidogrel?

Answer 15

TIA/Stroke patients after the initial acute phase of treatment
Combination with Aspirin- following Percutaneous Intervention in stable patient

Question 16

When would you give a patient ticagrelor?

Answer 16

In combination with Aspirin in all patient with ACS for upto 1 year in NHSG

Question 17

What is the main side effect of antiplatelets?

Answer 17

Bleeding

Question 18

Which conditions can beta blockers reduce mortality rates in?

Answer 18

IHD and Heart failure

Question 19

Which conditions can beta blockers reduce symptoms in?

Answer 19

Angina, atrial fibrillation and SVT (Supraventricular tachycardia)

Question 20

List some examples of beta blockers.

Answer 20

Bisoprolol
Carvediol
Atenolol
Metoprolol
Propranolol

Question 21

How do beta blockers work?

Answer 21

Via beta receptors

Question 22

Where would you find beta 1 receptors?

Answer 22

Predominant receptor in the Heart- SA, AV Nodes and myocardial cells.

Question 23

Where would you find beta 2 receptors?

Answer 23

Smooth muscle eg Airways, Peripheral vasculature
Skeletal muscle cells

Question 24

What do Beta 1 receptors in the kidneys do?

Answer 24

Reduce secretion of renin

Question 25

What are the positive effects beta 1 receptor blockers?

Answer 25

Slows heart rate and conduction Increases Diastolic Time Reduces BP ]Protects heart from effects of Catecholamines (stress hromones)

Question 26

What are the negative effects of beta 1 receptor blockers?

Answer 26

Reduces contractility High doses can lead to bradycardia and heart block

Question 27

What are the positive effects of beta 2 receptor blockers?

Answer 27

Reduces tremor

Question 28

What are the negative effects of beta 2 receptor blockers?

Answer 28

Potentially lethal bronchospasm in asthmatics Can cause vasoconstriction

Question 29

Give examples of beta blockers which are mediated by beta 1 receptors.

Answer 29

Atenolol Bisoprolol Carvediol Metoprolol ABC (idk if this helps)

Question 30

Give an example of a beta blocker which is mediated by both beta 1 and 2 receptors.

Answer 30

Propanolol

Question 31

What is the purpose of the Renin- Angiotensin- aldosterone axis?

Answer 31

Preserves circulating volume to maintain perfusion of the vital organs

Question 32

Renin- Angiotensin- aldosterone axis is central to the development of what?

Answer 32

Heart failure Liver failure Kidney failure

Question 33

Where is angiotensin produced?

Answer 33

Liver

Question 34

What happens to angiotensin?

Answer 34

Converted to Angiotensin 1 by Renin

Question 35

What converts angiotensin I into angiotensin II?

Answer 35

ACE- an Endothelial enzyme found predominantly in the lungs

Question 36

What does angiotensin II do?

Answer 36

Acts on the adrenals leading to the release of aldosterone

Question 37

Which two classifications of drug block the hormone system of Renin- Angiotensin- aldosterone?

Answer 37

Angiotensin converting enzyme inhibitors and angiotensin receptor antagonists (ARBS)

Question 38

ARBS are the first line antihypertensive treatments for which individuals?

Answer 38

Under 55 white or Asian patients

Question 39

What can ARBS do?

Answer 39

Reduction in mortality and progression of disease in IHD, CVD and renal disease with proteinuria Prevent aberrant remodelling following MI Reduction in symptoms in heart failure

Question 40

What is the mechanism of angiotensin II?

Answer 40

Potent vasoconstrictor

Question 41

What can aldosterone help to do?

Answer 41

Retention of Na (and therefore H20) at the expense of K in the DCT of the kidneys

Question 42

Give some examples of ACE inhibititors.

Answer 42

Ramipril Lisinopril Captopril Perindopril

Question 43

What are the positive effects of ACE inhibitors?

Answer 43

Reduce blood pressure Reduce afterload on heart Prevents aberrant remodelling after MI Reduces proteinuria

Question 44

What are the negative effects of ACE inhibitors?

Answer 44

Reduces perfusion pressure in glomerulus leading to renal impairment

Question 45

Give some examples of ARBS.

Answer 45

Losartan Candersartan

Question 46

What are the positive effects of ARBS?

Answer 46

Reduce blood pressure Reduce afterload on heart Prevents aberrant remodelling after MI Reduces proteinuria

Question 47

What are the negative effects of ARBS?

Answer 47

Reduces perfusion pressure in glomerulus leading to renal impairment

Question 48

Give two examples of aldosterone agonists.

Answer 48

Spironolactone and eplenerone

Question 49

What do Spironolactone and eplenerone do?

Answer 49

Enhanced diuretic effect, vasodilation Reduces mortality in IHD and Heart failure

Question 50

What are some of the side effects of aldosterone agonists like spironolactone and eplenerone?

Answer 50

Renal impairment, hyponatraemia, hyper kalaemia Gynaecomastia

Question 51

What is Entresto?

Answer 51

Combination of Valsartan and Sacubitil Company name

Question 52

What does sacubitil do>

Answer 52

Inhibits breakdown natriuretic peptides eg. ANP and BNP

Question 53

What can entresto not be presecribed alongside?

Answer 53

ACE inhibitors Increased risk of angioedema

Question 54

What can sacubitil do?

Answer 54

Increase diuresis, natriuresis and vasodilation

Question 55

Calcium channel blocker are used as what?

Answer 55

Antihypertensive agent

Question 56

Which conditions can calcium channel blockers reduce symptoms of?

Answer 56

Angina- both dihydropyridine and non dihydropyridine AF/SVT- Non dihydropyridine only

Question 57

Name the two subdivions of calcium channel blockers.

Answer 57

Dihydropyridine Non-Dihydropyridine

Question 58

What does Dihydropyridine do?

Answer 58

Block calcium entry into smooth muscle Cause vasodilation Less effect in pacemaking tissue

Question 59

What are the side effects of dihydopyridine?

Answer 59

Postural hypotension, peripheral oedema, tachycardia

Question 60

What does non-Dihydropyridine do?

Answer 60

Block calcium entry to smooth muscle Blocks calcium entry in the myocardial pacemaking tissue Slow SA node function Slow AV conduction

Question 61

What are some of the side effects of non-dihydopyridine?

Answer 61

Bradycardia, heart block (particularly if prescribed with beta blocker), postural hypotension, peripheral oedema

Question 62

Give some examples of types of dihydopyridine

Answer 62

Amlodipine, felodipine, nifedipine

Question 63

Give some examples of types of non-dihydopyridine

Answer 63

Verapamil and Diltiazem