logbooks

Question 1

Stable angina is

Answer 1

• Fixed narrowing of coronary arteries so fixed threshold for symptoms
• Narrowing by a plaque - thick fibrous cap and small lipid core
• Endothelial dysfunction caused by atheroma
• -> reduced release of NO + Prostacyclin
• –> reduced anti-thrombotic properties of endothelium

Question 2

GTN mech

Answer 2

Increases NO in vascular smooth muscle
–> leads to increase in cGMP which stimulates smooth muscle relaxation –> vasodilation

• reduces preload
• reduces afterload
• improves cardiac perfusion

Question 3

Examples of Ca channel blockers?

Answer 3

Amlodipine, nifedipine

Question 4

MOA of Ca CBs

Answer 4

Block L-type calcium channels in smooth muscle cells of coronary arteries and systemic vasculature

• -> dilation
• -> reduces afterload

Question 5

contraindications of Ca CBs

Side effects of Ca CBs

Answer 5

• Unstable angina
• Cardiogenic shock
  Significant aortic stenosis
• dizziness
• flushing
• headache
• nausea

Question 6

dihydrocodeine?

Answer 6

Opoid

metabolised to hydromorphine which works on miu receptors

CI: - resp depression
- head injury

Interactions: Alcohol, Diazepam, Gabapentin - CNS depressant effects

Question 7

Clopidogrel

Answer 7

-Anti-platelet
Blocks the ADP receptors on platelets which prevents their activation and fibrin cross-linking

CI: active bleeding
SE: bleeding, bruising, GI disturbances

Question 8

Ramipril?

Answer 8

-ACE inhibitor
ACE used to convert angiotensin I to angiotensin II which normally causes:
1. Vasoconstriction
2. Increases HR + contractility
3. Increased Na+ reabsorption and water retention

CI: pregnancy, renal impairment
SE: Dry cough, hypotension, hyperkalaemia

Question 9

Candesartan/Losartan?

Answer 9

• Angiotensin Receptor Blockers
  Antagonise effects of angiotensin II which normally causes vasoconstriction at peripheries, increases HR and contractility

Question 10

Amlodipine

Answer 10

Ca Channel blocker

Question 11

Bisoprolol

Answer 11

• Beta-blocker
  Blocks beta adrenergic receptors
• This reduces SA and AV node conduction –> reduced HR + contractility

Question 12

Atorvastatin

Answer 12

Statin
- Inhibit a coenzyme A reductase which is needed for synthesis of cholesterol.
Also improve endothelial function by stabilising plaques and inhibiting thrombogenic response

CI: liver disease, pregnancy
SE: muscle aches, GI disturbances, headache

Question 13

Aspirin

Answer 13

Anti-platelet
Non-selective COX inhibitor which prevents platelet aggregation by inhibiting production of thromboxane A2

CI: active bleeding
SE: bleeding, bruising, GI disturbances

Question 14

Amiodarone

Answer 14

K+ channel blockers
Given in VF, AF, AFlutter

• Block K+ ion channels responsible for sustaining the plateau and repolarisation
• -> Increase refractory period to decrease re-entry

CI: severe conduction disturbances
SE: arrhythmias, hepatic disorders, hyperthyroidism

Question 15

Furosemide

Answer 15

Loop diuretic
- inhibits water reabsorption in the nephron by blocking the Na+-K+-Cl- cotransporter in the ascending part of the loop of Henle

SE: hyponatraemia + hypokalaemia

Question 16

Warfarin

Answer 16

Anti-coagulant
- Inhibits synthesis of vitamin K dependent clotting factors (2, 7, 9 and 10)

CI: haemorrhagic stroke, active bleeding

Question 17

Colchicine

Answer 17

Anti-gout agent
- Depolarisation of microtubules –> inhibition of granulyte and lymphocyte migration and lymphocyte division

CI: blood disorders
SE: abdominal pain, nausea vomiting