Pharm CVS Flashcards
SBA: What is the primary equation for calculating blood pressure?
Answer: Blood pressure = Cardiac output × Peripheral resistance.
SBA: What is the role of baroreceptors in blood pressure regulation?
Answer: Detect changes in arterial pressure and signal the brainstem to adjust heart rate and vascular tone.
SBA: Which part of the brain regulates cardiovascular responses to blood pressure changes?
Answer: Medulla and pons (cardiovascular center).
SBA: What is the primary vasoconstrictor in the renin-angiotensin-aldosterone system (RAAS)?
Answer: Angiotensin II.
SBA: What triggers the release of erythropoietin (EPO)?
Answer: Hypoxia in the kidneys.
SBA: Which adrenergic receptor subtype increases heart rate and force of contraction?
Answer: Beta-1 adrenergic receptors.
SBA: What is the function of atrial natriuretic peptide (ANP) in blood pressure control?
Answer: Promotes sodium and water excretion, reducing blood volume and pressure.
SBA: Which hormone is released in response to hypovolemia to retain water?
Answer: Antidiuretic hormone (ADH, also known as vasopressin).
SBA: What is the physiological impact of systemic vasodilation on blood pressure?
Answer: Decreases peripheral resistance and lowers blood pressure.
SBA: What is the key feature differentiating primary from secondary hypertension?
Answer: Primary hypertension has no identifiable cause, while secondary hypertension has an underlying condition or drug-related cause.
EMQ: Match the blood pressure regulation mechanism to its function.
Baroreflex: Short-term blood pressure regulation.
RAAS: Long-term blood pressure regulation.
Autoregulation: Maintains consistent perfusion at the tissue level.
EMQ: Match the hormone to its action in blood pressure regulation.
Angiotensin II: Vasoconstriction and aldosterone release.
ADH: Increases water reabsorption and vasoconstriction.
ANP: Promotes sodium and water excretion.
EMQ: Match the symptom to the blood pressure condition.
Severe headache and vision problems: Hypertension.
Lightheadedness and fainting: Hypotension.
Chronic fatigue and chest pain: Hypertension or low cardiac output.
EMQ: Match the blood pressure target to the treatment strategy.
Decrease cardiac output: Beta-blockers.
Decrease peripheral resistance: Calcium channel blockers.
Increase blood volume: Fluid therapy or ADH.
EMQ: Match the risk factor to the cardiovascular disease continuum.
Hypertension: Atherosclerosis and heart failure.
Dyslipidaemia: Coronary artery disease.
Smoking: Endothelial dysfunction and thrombosis.
Describe the role of the RAAS in blood pressure regulation.
Answer: Renin converts angiotensinogen to angiotensin I, which is converted to angiotensin II by ACE. Angiotensin II causes vasoconstriction and aldosterone release, increasing sodium and water reabsorption. (2 marks)
What are the main triggers for baroreceptor activation?
Answer: Changes in arterial pressure, such as hypotension or hypertension. (2 marks)
List three pharmacological approaches to treat hypertension and their mechanisms.
Answer:
Beta-blockers: Decrease heart rate and cardiac output.
ACE inhibitors: Block angiotensin II formation, reducing vasoconstriction.
Calcium channel blockers: Dilate blood vessels by inhibiting calcium influx. (3 marks)
What is the physiological response to hypotension due to hypovolemia?
Answer: ADH release, vasoconstriction, and increased water retention. (2 marks)
How does autoregulation maintain perfusion during ischemia?
Answer: Local metabolic factors like low oxygen and high CO2 levels cause vasodilation to restore blood flow. (1 mark)
SBA: What blood pressure reading in a clinic suggests the need for further investigation with ABPM or HBPM?
Answer: Clinic BP >140/90 mmHg.
SBA: What is the first-line pharmacological treatment for hypertension in patients under 55 years of age?
Answer: ACE inhibitors (e.g., Ramipril).
SBA: Which hypertension drug class is contraindicated in asthmatic patients?
Answer: Beta-blockers.
SBA: What lifestyle modification is recommended for sodium intake in hypertension management?
Answer: Reduce salt intake to below 6 g/day.
SBA: Which drug class reduces blood pressure by blocking angiotensin II receptors?
Answer: ARBs (e.g., Losartan).
SBA: What side effect is most commonly associated with dihydropyridine calcium channel blockers like Amlodipine?
Answer: Peripheral oedema.
SBA: What is the target BP for patients under 80 years with hypertension?
Answer: <140/90 mmHg.
SBA: Which electrolyte imbalance is a common side effect of thiazide-like diuretics?
Answer: Hypokalaemia.
SBA: What is the mechanism of action of spironolactone in hypertension management?
Answer: Blocks aldosterone receptors, promoting sodium excretion and potassium retention.
SBA: What is the significance of a >15 mmHg difference between arms when measuring BP?
Answer: Use the higher reading for future measurements and investigate for vascular disease.
EMQ: Match the antihypertensive drug to its side effect.
ACE inhibitors: Dry cough.
Beta-blockers: Bradycardia.
Calcium channel blockers: Flushing.
Thiazide diuretics: Hyperglycaemia.
Spironolactone: Gynaecomastia.
EMQ: Match the hypertension drug to its monitoring requirement.
ACE inhibitors: Renal function and potassium.
ARBs: Renal function and potassium.
Thiazide diuretics: Sodium and potassium levels.
Beta-blockers: Heart rate.
Spironolactone: Potassium levels.
EMQ: Match the patient group to their recommended first-line antihypertensive therapy.
Under 55 years: ACE inhibitors or ARBs.
Over 55 years or Black patients: Calcium channel blockers.
Resistant hypertension: Spironolactone or Alpha-blockers.
EMQ: Match the BP measurement method to its application.
Clinic BP: Initial diagnosis.
Ambulatory BP monitoring (ABPM): Confirming diagnosis.
Home BP monitoring (HBPM): Alternative to ABPM.
Manual BP measurement: Pulse irregularity.
EMQ: Match the lifestyle modification to its cardiovascular benefit.
Exercise: Reduces resting blood pressure.
Weight loss: Improves BP control.
Salt reduction: Lowers BP by reducing water retention.
Smoking cessation: Reduces cardiovascular risk.
Describe the initial steps for BP measurement.
Answer: Measure BP in a relaxed environment, both arms, and document the higher reading. If >140/90 mmHg, confirm with ABPM or HBPM. (2 marks)
What assessments are made alongside BP measurement?
Answer: Assess cardiovascular risk (e.g., QRISK3), target organ damage (e.g., kidneys, heart, eyes), and perform relevant blood tests. (2 marks)
What are the key lifestyle modifications recommended?
Answer: Reduce salt intake, increase exercise, achieve a healthy BMI, and limit alcohol consumption. (2 marks)
Describe the stepwise pharmacological treatment for hypertension.
Answer:
Step 1: ACE inhibitors or ARBs (under 55 years); Calcium channel blockers (over 55 years or Black patients).
Step 2: Combine ACE inhibitors/ARBs with Calcium channel blockers or Thiazide-like diuretics.
Step 3: Triple therapy with ACE inhibitors/ARBs, Calcium channel blockers, and Thiazide-like diuretics.
Step 4: Add Spironolactone or Alpha-blockers for resistant hypertension. (3 marks)
What is the target BP for patients under and over 80 years?
Answer: <140/90 mmHg (under 80 years) and <150/90 mmHg (over 80 years). (1 mark)
SBA: What is the first-line pharmacological treatment for primary prevention of CVD in patients with a QRISK3 score ≥10%?
Answer: Atorvastatin 20 mg daily.
SBA: What is the main treatment goal in lipid modification therapy?
Answer: Achieve a ≥40% reduction in non-HDL cholesterol levels.
SBA: What condition is characterized by high cholesterol levels due to a defective gene?
Answer: Familial hypercholesterolaemia.
SBA: Which statin intensity category is atorvastatin 80 mg classified under?
Answer: High-intensity statin.
SBA: What non-statin medication inhibits intestinal cholesterol absorption?
Answer: Ezetimibe.
SBA: What is the role of PCSK9 inhibitors in hyperlipidaemia treatment?
Answer: Increase LDL receptor recycling, enhancing LDL cholesterol clearance.
Answer: Increase LDL receptor recycling, enhancing LDL cholesterol clearance.
Answer: Liver function tests and lipid profile.
SBA: What lifestyle modification is essential in hyperlipidaemia management to reduce saturated fat intake?
Answer: Limit saturated fat to <7% of total daily energy intake.
SBA: What is a common side effect of statins?
Answer: Myopathy or muscle pain.
SBA: Which medication is contraindicated in pregnancy for hyperlipidaemia treatment?
Answer: Statins.
EMQ: Match the condition to its associated hyperlipidaemia risk.
Familial hypercholesterolaemia: Genetic defect in LDL receptor.
Diabetes mellitus: Increased triglycerides and LDL cholesterol.
Chronic kidney disease: Dysregulation of lipid metabolism.
EMQ: Match the medication to its mechanism of action.
Statins: Inhibit HMG-CoA reductase.
Ezetimibe: Inhibits cholesterol absorption in the intestine.
Bempedoic acid: Inhibits ATP citrate lyase.
EMQ: Match the side effect to the lipid-lowering drug.
Muscle pain: Statins.
Gout: Bempedoic acid.
Injection site reactions: Inclisiran.
EMQ: Match the non-pharmacological intervention to its benefit.
Smoking cessation: Reduces cardiovascular risk.
Weight loss: Improves lipid profile and BP.
Exercise: Increases HDL cholesterol.
EMQ: Match the hyperlipidaemia drug to its indication.
Inclisiran: High-risk patients with LDL-C ≥4.0 mmol/L.
Atorvastatin: First-line for primary and secondary prevention.
Fibrates: Severe hypertriglyceridemia.
Describe lifestyle modifications for hyperlipidaemia management.
Answer:
Smoking cessation.
Reduce total fat intake (<30%) and saturated fat (<7%).
Increase intake of fruits, vegetables, and oily fish.
Exercise for at least 150 minutes/week.
Limit alcohol to ≤14 units/week. (3 marks)
What baseline tests are required before starting statin therapy?
Answer: Non-fasting lipid profile, liver function tests, renal function, HbA1c, creatine kinase, and thyroid-stimulating hormone (if indicated). (2 marks)
Answer: Non-fasting lipid profile, liver function tests, renal function, HbA1c, creatine kinase, and thyroid-stimulating hormone (if indicated). (2 marks)
Answer:
First-line: Atorvastatin 20 mg (primary prevention) or 80 mg (secondary prevention).
Add ezetimibe if LDL-C reduction is insufficient.
Consider bempedoic acid or PCSK9 inhibitors (e.g., Inclisiran) for high-risk patients. (3 marks)
What are the contraindications and monitoring requirements for statin use?
Answer: Contraindicated in pregnancy and active liver disease. Monitor liver function and lipid profile 3 months after initiation and annually. (2 marks)
SBA: What is the primary route of administration for most antihypertensive drugs?
Answer: Oral.
SBA: Which antihypertensive drug undergoes significant first-pass metabolism, reducing its bioavailability?
Answer: Propranolol.
SBA: What is the key enzyme involved in the metabolism of calcium channel blockers like amlodipine?
Answer: CYP3A4.
SBA: Which class of antihypertensive drugs is most affected by reduced renal function?
Answer: ACE inhibitors (e.g., Ramipril).
SBA: Why should grapefruit juice be avoided with calcium channel blockers?
Answer: Grapefruit juice inhibits CYP3A4, increasing plasma drug levels.
SBA: What is the mechanism of action of ARBs?
Answer: Block angiotensin II at the AT1 receptor.
SBA: What type of interaction occurs when NSAIDs reduce the efficacy of ACE inhibitors?
Answer: Pharmacodynamic interaction.
SBA: Which antihypertensive drug is a prodrug activated in the liver?
Answer: Enalapril.
SBA: What is the primary organ responsible for the excretion of ARBs?
Answer: Kidneys.
SBA: Which antihypertensive drug has the highest risk of causing bradycardia when combined with verapamil?
Answer: Beta-blockers (e.g., Atenolol).
EMQ: Match the antihypertensive drug to its absorption characteristic.
Captopril: Food reduces absorption.
Amlodipine: High oral bioavailability.
Propranolol: Significant first-pass metabolism.
EMQ: Match the antihypertensive drug class to its metabolism.
Beta-blockers (e.g., Metoprolol): CYP2D6.
CCBs (e.g., Verapamil): CYP3A4.
ACE inhibitors (e.g., Lisinopril): Active in administered form (no liver metabolism).
EMQ: Match the interaction type to the example.
Pharmacokinetic: Grapefruit juice with amlodipine.
Pharmacodynamic: Thiazide diuretics with ACE inhibitors causing severe hypotension.
Drug-food: Captopril with food reducing efficacy.
EMQ: Match the adverse effect to the antihypertensive drug class.
Hyperkalaemia: ARBs and potassium-sparing diuretics.
Hypokalaemia: Thiazide diuretics.
Peripheral oedema: Calcium channel blockers.
EMQ: Match the elimination route to the drug.
Renal: Losartan.
Hepatic: Amlodipine.
Mixed (renal and hepatic): Metoprolol.
Describe the absorption of antihypertensive drugs.
Answer: Most are orally administered; factors like food and gastric pH can influence bioavailability (e.g., captopril). (2 marks)
Explain the metabolism of ACE inhibitors and beta-blockers.
Answer:
ACE inhibitors: Most are prodrugs activated in the liver, except Lisinopril.
Beta-blockers: Metabolised by CYP2D6 enzymes. (2 marks
What is the impact of renal function on antihypertensive drug elimination?
Answer: Drugs like ACE inhibitors and ARBs rely on renal excretion, making dosage adjustments necessary in renal impairment. (2 marks)
List two examples of drug-drug interactions involving antihypertensive drugs.
Answer:
NSAIDs reduce the antihypertensive effect of ACE inhibitors.
Verapamil and beta-blockers increase the risk of severe bradycardia. (2 marks)
Why should patient education include warnings about grapefruit juice with certain antihypertensives?
Answer: Grapefruit juice inhibits CYP3A4, increasing the plasma concentration of calcium channel blockers and raising the risk of adverse effects. (2 marks)
SBA: What is the primary action of ACE inhibitors in hypertension?
Answer: Reduce the conversion of angiotensin I to angiotensin II, leading to vasodilation and reduced blood pressure.
SBA: What common side effect is associated with ACE inhibitors and caused by bradykinin accumulation?
Answer: Dry cough.
SBA: What is the mechanism of action of ARBs?
Answer: Block angiotensin II at AT1 receptors, preventing vasoconstriction and aldosterone release.
SBA: What class of drugs inhibits L-type calcium channels to manage hypertension?
Answer: Calcium channel blockers (CCBs).
SBA: What adverse effect is commonly associated with dihydropyridine CCBs like amlodipine?
Answer: Peripheral oedema.
SBA: What diuretic class is considered first-line in hypertension management?
Answer: Thiazide-like diuretics.
SBA: What is the mechanism of action of spironolactone in hypertension treatment?
Answer: Antagonizes aldosterone receptors, promoting sodium excretion and potassium retention.
SBA: What antihypertensive drug class is contraindicated during pregnancy?
Answer: ACE inhibitors and ARBs.
SBA: What type of beta-blocker is propranolol classified as?
Answer: Non-selective beta-blocker.
SBA: Which diuretic is most effective at reducing blood pressure by blocking sodium reabsorption in the distal convoluted tubule?
Answer: Thiazide-like diuretics (e.g., indapamide).
EMQ: Match the antihypertensive drug class to its adverse effect.
ACE inhibitors: Dry cough
Beta-blockers: Bradycardia
Calcium channel blockers: Flushing and headache
Thiazide diuretics: Hypokalaemia
EMQ: Match the drug to its primary mechanism of action.
Captopril: Inhibits ACE.
Losartan: Blocks AT1 receptors.
Amlodipine: Blocks L-type calcium channels.
EMQ: Match the clinical scenario to the most appropriate antihypertensive drug.
Hypertension with diabetes: ACE inhibitors (renal protection).
Resistant hypertension: Spironolactone.
Elderly patients: Calcium channel blockers.
EMQ: Match the antihypertensive drug class to its renal effect.
Thiazides: Reduce calcium excretion.
Potassium-sparing diuretics: Increase potassium retention.
ACE inhibitors: Reduce proteinuria.
EMQ: Match the contraindication to the drug.
Pregnancy: ACE inhibitors.
Bradycardia: Beta-blockers.
Bilateral renal artery stenosis: ARBs.
Describe the mechanism of action of ACE inhibitors and ARBs.
Answer:
ACE inhibitors block the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone release.
ARBs block AT1 receptors, preventing angiotensin II action. (2 marks)
List two common adverse effects of ACE inhibitors.
Answer: Dry cough and hyperkalaemia. (1 mark)
Explain the role of thiazide-like diuretics in hypertension.
nswer: Block sodium-chloride symporters in the distal convoluted tubule, reducing blood volume and lowering blood pressure. (2 marks)
What are the clinical considerations for prescribing beta-blockers?
Answer: Use caution in asthma, bradycardia, and in combination with calcium channel blockers (risk of severe bradycardia). (2 marks)
Discuss the monitoring requirements for patients on ACE inhibitors.
Answer: Regularly check renal function (serum creatinine) and potassium levels to prevent hyperkalaemia and renal impairment. (2 marks)
SBA: What is the primary mechanism of action of statins?
Answer: Inhibition of HMG-CoA reductase.
SBA: Which lipoprotein is referred to as “good cholesterol”?
Answer: High-Density Lipoprotein (HDL).
SBA: What is the main role of PCSK9 inhibitors in lipid management?
Answer: Increase LDL receptor recycling, reducing circulating LDL cholesterol.
SBA: What lipid parameter is targeted for ≥40% reduction in patients on statin therapy?
Answer: Non-HDL cholesterol.
SBA: What is the primary cause of familial hypercholesterolaemia?
Answer: Genetic mutations in LDL receptor or PCSK9.
SBA: Which lipoprotein is the main carrier of triglycerides in the bloodstream?
Answer: Very Low-Density Lipoprotein (VLDL).
SBA: What is the key characteristic of reverse cholesterol transport?
Answer: Movement of cholesterol from peripheral tissues back to the liver via HDL.
SBA: What is the main side effect of fibrates?
Answer: Myopathy, especially when combined with statins.
SBA: What is a contraindication for statin therapy?
Answer: Pregnancy.
SBA: Which lipid-lowering drug can cause flushing as a common side effect?
Answer: Niacin (nicotinic acid).
EMQ: Match the drug to its mechanism of action.
Statins: Inhibit HMG-CoA reductase.
PCSK9 inhibitors: Prevent LDL receptor degradation.
Ezetimibe: Inhibits cholesterol absorption in the intestine.
EMQ: Match the lipoprotein to its function.
LDL: Delivers cholesterol to peripheral tissues.
HDL: Mediates reverse cholesterol transport.
Chylomicrons: Transport dietary lipids from the intestine.
EMQ: Match the lipid-lowering drug to its adverse effect.
Statins: Myopathy.
Fibrates: Gallstones.
Niacin: Flushing.
EMQ: Match the lipid abnormality to the associated drug therapy.
Elevated LDL: Statins or PCSK9 inhibitors.
Elevated triglycerides: Fibrates or omega-3 fatty acids.
Mixed dyslipidaemia: Combination of statins and fibrates.
EMQ: Match the lipid-lowering drug to its clinical consideration.
Statins: Monitor liver function tests.
Fibrates: Avoid in severe renal impairment.
Niacin: Take aspirin to reduce flushing.
Explain the role of lipoproteins in lipid transport.
Answer:
Chylomicrons transport dietary triglycerides.
VLDL transports triglycerides synthesized in the liver.
LDL delivers cholesterol to peripheral tissues.
HDL mediates reverse cholesterol transport. (2 marks)
Describe the pathophysiology of atherosclerosis in dyslipidaemia.
Answer:
LDL oxidation in the arterial wall leads to foam cell formation.
Chronic inflammation results in plaque development and narrowing of arteries. (2 marks)
Outline the pharmacological management of dyslipidaemia.
Answer:
Statins: First-line therapy for LDL reduction.
PCSK9 inhibitors: Used in high-risk patients not achieving goals on statins.
Fibrates: Target elevated triglycerides.
Ezetimibe: Add-on therapy for further LDL reduction. (3 marks)
What lifestyle interventions support pharmacological treatment in dyslipidaemia?
Answer:
Diet low in saturated fats.
Regular physical activity.
Smoking cessation. (2 marks)
What are the monitoring requirements for statin therapy?
Answer:
Check lipid profile 3 months after initiation and then annually.
Monitor liver enzymes before starting and periodically. (1 mark)
SBA: What is the primary target of ACE inhibitors in the treatment of hypertension?
Answer: Angiotensin-Converting Enzyme (ACE).
SBA: What is the common side effect of ACE inhibitors due to bradykinin accumulation?
Answer: Dry cough.
SBA: Which functional group in captopril enhances binding to the zinc ion in ACE?
Answer: Sulfhydryl (SH) group.
Answer: Sulfhydryl (SH) group.
Answer: Sulfhydryl (SH) group.
SBA: Which ARB has a tetrazole ring to enhance metabolic stability and bioavailability?
Answer: Losartan.
SBA: Which drug class inhibits L-type calcium channels to manage hypertension?
Answer: Calcium channel blockers (CCBs).
SBA: What is the mechanism of action of HMG-CoA reductase inhibitors (statins)?
Answer: Inhibit the rate-limiting step in cholesterol biosynthesis.
SBA: What chemical feature allows atorvastatin to bind effectively to HMG-CoA reductase?
Answer: Open lactone ring mimicking the tetrahedral intermediate.
SBA: What adverse effect is commonly associated with statins?
Answer: Myopathy.
SBA: What is the primary site of action for thiazide-like diuretics?
Answer: Distal convoluted tubule.
EMQ: Match the antihypertensive drug to its mechanism of action.
ACE inhibitors: Block conversion of angiotensin I to angiotensin II.
ARBs: Block AT1 receptors.
CCBs: Block L-type calcium channels.
EMQ: Match the drug to its adverse effect.
Statins: Myopathy.
ACE inhibitors: Dry cough.
Thiazides: Hypokalaemia.
EMQ: Match the drug to its structural feature.
Losartan: Tetrazole ring.
Captopril: Sulfhydryl group.
Enalapril: Ester prodrug.
EMQ: Match the drug class to its therapeutic use.
ARBs: Hypertension in ACE inhibitor-intolerant patients.
Statins: Hyperlipidaemia.
Thiazides: First-line for hypertension.
EMQ: Match the calcium channel blocker to its subclass.
Nifedipine: 1,4-Dihydropyridine.
Verapamil: Phenylalkylamine.
Diltiazem: Benzothiazepine.
Describe the mechanism of action of ACE inhibitors.
Answer: Inhibit ACE, preventing conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone secretion.
Explain why enalapril is preferred over enalaprilat for oral administration.
Answer: Enalapril is a prodrug with superior bioavailability due to esterification, allowing absorption in the intestine. Enalaprilat is poorly absorbed due to its zwitterionic nature. (2 marks)
What is the role of the tetrazole ring in ARBs like losartan?
What is the role of the tetrazole ring in ARBs like losartan?
List two adverse effects of calcium channel blockers and the associated subclasses.
Answer: Peripheral oedema (1,4-dihydropyridines) and bradycardia (phenylalkylamines). (2 marks)
How do statins achieve their lipid-lowering effects?
Answer: Inhibit HMG-CoA reductase, reducing cholesterol synthesis and increasing LDL receptor expression for enhanced clearance of LDL cholesterol. (2 marks)
SBA: What is the primary diagnostic marker for myocardial infarction?
Answer: Troponin.
SBA: What is the first-line treatment for stable angina?
Answer: Glyceryl trinitrate (GTN) for symptom relief.
SBA: Which drug class is used for secondary prevention post-MI to reduce lipid levels?
Answer: Statins.
SBA: What is the gold standard treatment for STEMI if performed within 120 minutes of medical contact?
Answer: Percutaneous coronary intervention (PCI).
SBA: Which medication is contraindicated in acute MI due to its ability to increase heart rate?
Answer: Ivabradine.
SBA: What is the typical dose of aspirin given in the initial management of ACS?
Answer: 300 mg.
SBA: Which beta-blocker is commonly used for secondary prevention post-MI?
Answer: Bisoprolol.
SBA: What is the mechanism of action of fibrinolytics in STEMI management?
Answer: Activation of plasminogen to form plasmin, which breaks down fibrin clots.
SBA: What is the GRACE score used for in ACS management?
Answer: Predicts the 6-month mortality risk in patients with ACS.
SBA: Which medication is often used as a second-line treatment for angina if beta-blockers are contraindicated?
Answer: Calcium channel blockers (e.g., amlodipine).
EMQ: Match the ACS condition to its typical presentation.
Stable angina: Pain on exertion, relieved by rest.
Unstable angina: Pain at rest, unresponsive to GTN.
STEMI: Persistent chest pain with ST elevation on ECG.
EMQ: Match the medication to its role in ACS management.
Aspirin: Antiplatelet therapy.
Enoxaparin: Anticoagulation.
Ticagrelor: P2Y12 inhibitor for dual antiplatelet therapy.
EMQ: Match the drug to its contraindication in ACS.
ACE inhibitors: History of angioedema.
Beta-blockers: Severe bradycardia.
Nitrates: Severe hypotension.
EMQ: Match the diagnostic test to its role in ACS.
ECG: Identifies ischemic changes like ST elevation.
Troponin levels: Confirms myocardial necrosis.
GRACE score: Risk stratification.
EMQ: Match the lifestyle advice to the outcome in ACS management.
Smoking cessation: Reduces risk of recurrent MI.
Mediterranean diet: Improves lipid profile.
Physical activity: Enhances exercise capacity and reduces mortality.
List the key symptoms and diagnostic tests for STEMI.
Answer:
Symptoms: Severe chest pain, radiating to jaw/arm, nausea, sweating. (1 mark)
Tests: ECG showing ST elevation; raised troponin levels. (1 mark)
Describe the pharmacological treatment during initial STEMI management.
Answer:
Aspirin 300 mg STAT (antiplatelet). (1 mark)
Ticagrelor or prasugrel STAT (dual antiplatelet therapy). (1 mark)
Fondaparinux or enoxaparin for anticoagulation. (1 mark)
Outline the reperfusion therapy options for STEMI.
Answer:
PCI within 120 minutes of contact (gold standard).
Fibrinolysis (if PCI unavailable) using alteplase or streptokinase. (2 marks)
What lifestyle interventions are recommended post-STEMI?
Answer:
Smoking cessation.
Mediterranean diet.
Regular physical activity (20–30 mins/day). (2 marks)
What is the rationale for statin therapy in STEMI patients?
Answer:
Reduces LDL cholesterol, stabilizes plaques, and decreases the risk of recurrent events. (1 mark)
SBA: What is the most common cause of heart failure?
Answer: Left ventricular dysfunction following myocardial infarction.
SBA: Which peptide is used to confirm or rule out heart failure diagnosis?
Answer: NT-proBNP.
SBA: What is the first-line pharmacological therapy for heart failure with reduced ejection fraction (HFrEF)?
Answer: ACE inhibitor and beta-blocker.
SBA: What is the typical dose range for furosemide in managing oedema in heart failure?
Answer: Up to 80 mg/day, titrated as needed.
SBA: Which drug class reduces mortality and hospitalisation when added to ACE inhibitors and beta-blockers in HFrEF?
Answer: Mineralocorticoid receptor antagonists (MRAs).
SBA: Which heart failure medication is a combination of sacubitril and valsartan?
Answer: Entresto®.
SBA: What is a common side effect of digoxin that requires monitoring?
Answer: Digitalis toxicity (e.g., nausea, vomiting, confusion).
SBA: Which functional classification system is used to assess the severity of heart failure symptoms?
Answer: New York Heart Association (NYHA) classification.
SBA: What lifestyle advice should be given to a stable heart failure patient regarding exercise?
Answer: Regular, supervised exercise within functional limitations.
SBA: What is the role of SGLT2 inhibitors in heart failure?
Answer: Reduce cardiovascular death and hospitalisation for HFrEF patients.
EMQ: Match the drug to its mechanism of action.
ACE inhibitors: Inhibit conversion of angiotensin I to angiotensin II.
MRAs: Antagonise aldosterone receptors.
Digoxin: Inhibit Na+/K+ ATPase to increase contractility.
EMQ: Match the symptom to the heart failure feature.
Fatigue: Decreased cardiac output and oxygen delivery.
Peripheral oedema: Fluid retention.
Orthopnoea: Redistribution of fluid to the lungs when lying down.
EMQ: Match the drug to its specialist use in HFrEF.
Ivabradine: Patients with sinus rhythm and heart rate ≥75 bpm.
Entresto®: Alternative to ACE inhibitors for NYHA Class II-IV patients.
Hydralazine: Patients of African-Caribbean descent with persistent symptoms.
EMQ: Match the diagnostic test to its purpose in heart failure.
NT-proBNP: Confirms/rules out diagnosis.
Echocardiography: Assesses ventricular function.
ECG: Identifies underlying causes like arrhythmias or ischemia.
EMQ: Match the lifestyle advice to its benefit in heart failure.
Balanced diet: Maintains healthy weight and reduces strain on the heart.
Timed diuretic use: Improves sleep by reducing nocturia.
Smoking cessation: Reduces disease progression.
List the key symptoms and diagnostic tools for heart failure.
Answer:
Symptoms: Fatigue, breathlessness, oedema.
Diagnostics: NT-proBNP levels, echocardiography, ECG. (2 marks)
Describe the first-line pharmacological management for HFrEF.
Answer:
ACE inhibitor (e.g., Ramipril).
Beta-blocker (e.g., Bisoprolol).
Add MRA (e.g., Spironolactone) if symptoms persist. (3 marks)
What are the specialist treatment options for HFrEF?
Answer:
Ivabradine for patients with sinus rhythm and HR ≥75 bpm.
Entresto® as a substitute for ACE inhibitors.
Digoxin for severe cases. (2 marks)
What lifestyle advice should be provided to heart failure patients?
Answer:
Regular exercise within limits.
Balanced diet, reduced salt intake, and weight management.
Smoking cessation and limited alcohol consumption. (2 marks)
How is heart failure treatment monitored?
Answer:
Monitor renal function, electrolytes, and NT-proBNP levels.
Regular assessment of symptoms and medication compliance. (1 mark)
SBA: What is the most common sustained arrhythmia in clinical practice?
Answer: Atrial fibrillation (AF).
SBA: Which scoring system is used to assess stroke risk in patients with AF?
Answer: CHA₂DS₂-VASc score.
SBA: Which drug is a direct thrombin inhibitor used for anticoagulation in AF?
Answer: Dabigatran.
SBA: What is the mechanism of action of warfarin?
Answer: Vitamin K antagonist, inhibiting the synthesis of clotting factors II, VII, IX, and X.
SBA: Which type of AF resolves spontaneously within 48 hours?
Answer: Paroxysmal AF.
SBA: What is the first-line drug class for rate control in AF?
Answer: Beta-blockers (e.g., bisoprolol).
SBA: Which drug is recommended for pharmacological cardioversion in AF patients with structural heart disease?
Answer: Amiodarone.
SBA: What is the target INR range for patients on warfarin for stroke prevention in AF?
Answer: 2.0–3.0.
SBA: What is a contraindication for beta-blockers in AF management?
Answer: Severe bradycardia.
SBA: Which anticoagulant is associated with the risk of gastrointestinal bleeding but does not require INR monitoring?
Answer: Rivaroxaban (a DOAC).
EMQ: Match the type of AF to its definition.
Paroxysmal AF: Episodes terminate spontaneously within 48 hours.
Persistent AF: Lasts >7 days or requires treatment for termination.
Permanent AF: Continuous and unresponsive to treatment.
EMQ: Match the drug to its mechanism of action.
Dabigatran: Direct thrombin inhibitor.
Rivaroxaban: Factor Xa inhibitor.
Warfarin: Vitamin K antagonist.
EMQ: Match the AF treatment to the associated monitoring requirement.
DOACs: Renal function monitoring annually.
Warfarin: Regular INR checks.
Amiodarone: Thyroid and liver function monitoring.
EMQ: Match the risk stratification score to its purpose.
CHA₂DS₂-VASc: Stroke risk.
HAS-BLED: Bleeding risk.
ORBIT: Assessing overall anticoagulation safety.
EMQ: Match the patient scenario to the anticoagulant recommendation.
Male with CHA₂DS₂-VASc score of 0: No anticoagulation.
Female with CHA₂DS₂-VASc score of 2: DOAC or warfarin.
Patient with CrCl <30 mL/min: Warfarin (avoid DOACs).
List three common symptoms of AF.
Answer: Palpitations, breathlessness (dyspnoea), and fatigue. (1 mark)
What tests are used to diagnose AF?
Answer: ECG (to confirm arrhythmia), blood tests (e.g., thyroid function), and echocardiography (to assess ventricular function). (2 marks)
Explain the CHA₂DS₂-VASc scoring system for stroke risk in AF.
Answer: Includes factors like congestive heart failure, hypertension, age ≥75 years (2 points), diabetes, stroke/TIA (2 points), vascular disease, and sex (female = 1 point). (2 marks)
Outline pharmacological options for rate control in AF.
Answer:
Beta-blockers (e.g., bisoprolol): First-line therapy.
Calcium channel blockers (e.g., diltiazem): If beta-blockers are contraindicated.
Digoxin: For sedentary patients with non-paroxysmal AF. (2 marks)
Discuss the benefits of DOACs compared to warfarin in AF management.
Answer: DOACs have a fixed dose, no routine INR monitoring, and a lower risk of intracranial bleeding. (2 marks)
SBA: What is the most common mechanism for pharmacokinetic drug interactions?
SBA: What is the most common mechanism for pharmacokinetic drug interactions?
SBA: Which drug interaction resource provides the most detailed explanation for interaction mechanisms?
Answer: Stockley’s Drug Interactions
SBA: What is the primary clinical concern when combining NSAIDs with DOACs?
Answer: Increased risk of gastrointestinal bleeding.
SBA: Which enzyme does grapefruit juice inhibit, leading to increased drug plasma levels?
Answer: CYP3A4.
SBA: What is the effect of inducing CYP450 enzymes on drug metabolism?
Answer: Increased metabolism, leading to reduced plasma concentrations of the drug.
SBA: Which food component interacts with MAOIs and can cause a hypertensive crisis?
Answer: Tyramine.
SBA: What is the recommendation for administering levothyroxine with calcium-containing antacids?
Answer: Separate administration by 2-4 hours.
SBA: Which protein plays a major role in drug transport and can be inhibited by certain drugs like amiodarone?
Answer: P-glycoprotein.
SBA: What is a potential interaction when warfarin is combined with cranberry juice?
Answer: Increased bleeding risk due to CYP450 inhibition.
SBA: What characteristic of a drug increases the likelihood of protein binding interactions?
Answer: High protein-binding (>90%).
EMQ: Match the drug to the common interaction mechanism.
Warfarin: CYP450 inhibition by other drugs or food (e.g., cranberry juice).
Ciprofloxacin: Chelation with calcium-containing products.
Amiodarone: P-glycoprotein inhibition.
EMQ: Match the patient characteristic to the increased risk of drug interactions.
Elderly: Reduced renal and hepatic function.
Children: Underdeveloped metabolism.
Polypharmacy: Higher risk of adverse drug interactions.
EMQ: Match the pharmacodynamic interaction to the drug pair.
DOAC + NSAIDs: Increased bleeding risk.
Beta-blockers + Verapamil: Severe bradycardia.
Antihypertensives + Diuretics: Excessive hypotension.
EMQ: Match the resource to its feature.
Stockley’s: Detailed explanation of interaction mechanisms.
BNF paper: Pharmacodynamic interaction tables.
SPC: Scientific data from clinical trials.
EMQ: Match the interaction type to its management.
CYP450 induction: Consider dose increase of affected drug.
Chelation: Separate administration by a few hours.
P-glycoprotein inhibition: Monitor drug levels and side effects.
Differentiate between pharmacokinetic and pharmacodynamic drug interactions.
Answer:
Pharmacokinetic: Alter ADME (absorption, distribution, metabolism, excretion). (1 mark)
Pharmacodynamic: Additive, synergistic, or antagonistic effects at the receptor or physiological level. (1 mark)
Explain the clinical significance of CYP450 inhibitors and inducers.
Answer:
Inhibitors: Increase plasma drug levels, increasing toxicity risk (e.g., amiodarone).
Inducers: Reduce plasma drug levels, leading to therapeutic failure (e.g., carbamazepine). (2 marks)
List three examples of food-drug interactions and their outcomes.
Answer:
Grapefruit juice + simvastatin: Increased statin toxicity.
Green leafy vegetables + warfarin: Reduced anticoagulant effect.
Tyramine-rich foods + MAOIs: Hypertensive crisis. (3 marks)
Outline management strategies for drug interactions.
Answer:
Adjust dosing (e.g., when using enzyme inducers).
Monitor therapeutic drug levels (e.g., warfarin).
Counsel patients to avoid specific food-drug interactions. (2 marks)
What is the pharmacist’s role in minimizing drug interactions?
Answer:
Anticipate interactions using resources like BNF and Stockley’s.
Educate patients on signs of toxicity or reduced efficacy. (1 mark)
SBA: Which coronary artery supplies the sinoatrial (SA) node in most individuals?
Answer: Right coronary artery.
SBA: What is the primary pacemaker of the heart?
Answer: Sinoatrial (SA) node.
SBA: What ion influx is responsible for the depolarization phase in cardiac pacemaker cells?
Answer: Calcium (Ca²⁺)
SBA: What does the P wave on an ECG represent?
Answer: Atrial depolarization.
SBA: What is the normal duration of the PR interval on an ECG?
Answer: 0.12–0.20 seconds.
SBA: What is the most common cause of prolonged QT interval?
Answer: Hypocalcaemia.
SBA: Which part of the ECG corresponds to ventricular depolarization?
Answer: QRS complex.
SBA: What is the normal heart rate range for sinus rhythm?
SBA: What is the normal heart rate range for sinus rhythm?
SBA: What condition is characterized by a heart rate <60 beats per minute with regular rhythm?
Answer: Sinus bradycardia.
SBA: Which formula is used to calculate the corrected QT interval (QTc)?
Answer: Bazett’s formula.
EMQ: Match the cardiac rhythm to its ECG feature.
Sinus bradycardia: Heart rate <60 bpm, regular rhythm.
Sinus tachycardia: Heart rate >100 bpm, regular rhythm.
Atrial fibrillation: Irregular rhythm, absence of P waves.
EMQ: Match the ion to its effect on cardiac action potential.
Sodium (Na⁺): Rapid depolarization.
Calcium (Ca²⁺): Plateau phase in ventricular action potential.
Potassium (K⁺): Repolarization.
EMQ: Match the part of the ECG to its corresponding event.
P wave: Atrial depolarization.
QRS complex: Ventricular depolarization.
T wave: Ventricular repolarization.
EMQ: Match the condition to its ECG change.
Hypercalcaemia: Shortened QT interval.
Hypocalcaemia: Prolonged QT interval.
Myocardial infarction: ST elevation.
EMQ: Match the cardiac pacemaker to its intrinsic rate.
SA node: 60–100 bpm.
AV node: 40–60 bpm.
Purkinje fibers: 20–40 bpm.
Outline the key components of the ECG and their significance.
Answer:
P wave: Atrial depolarization.
PR interval: Time for electrical conduction from SA node to AV node (0.12–0.20 seconds).
QRS complex: Ventricular depolarization (<0.10 seconds).
ST segment: Isoelectric line; elevation indicates ischemia or infarction.
T wave: Ventricular repolarization. (2 marks)
Explain the role of the SA node in cardiac rhythm.
Answer: Primary pacemaker; generates impulses at 60–100 bpm. (1 mark)
What is the significance of QT interval prolongation?
Answer: Increased risk of ventricular arrhythmias, such as Torsades de Pointes. Causes include hypocalcaemia, medications (e.g., amiodarone), and genetic mutations. (2 marks)
How is heart rate calculated from an ECG strip?
Answer: Count the number of large boxes between consecutive R waves and divide 300 by this number. (1 mark)
List three factors that can alter the QT interval.
Answer: Plasma calcium levels (hyper/hypocalcaemia), medications (e.g., amiodarone), and genetic mutations (e.g., LQT1, LQT2). (2 marks)
What are the criteria for normal sinus rhythm on an ECG?
Answer:
Regular rhythm.
Heart rate of 60–100 bpm.
1 P wave for every QRS complex.
PR interval <0.20 seconds. (2 marks)
SBA: What is the hallmark ECG feature of atrial fibrillation?
Answer: Absence of P waves with an irregularly irregular rhythm.
SBA: What ion imbalance is most commonly associated with Torsades de Pointes?
Answer: Hypokalemia or hypomagnesemia.
SBA: Which arrhythmia presents with a sawtooth pattern on ECG?
Answer: Atrial flutter.
SBA: What is the ventricular rate in atrial fibrillation if not controlled?
Answer: 120–200 beats per minute.
SBA: What is the primary treatment for pulseless ventricular tachycardia?
Answer: Immediate CPR and defibrillation.
SBA: Which drug is used to manage symptomatic bradycardia?
Answer: Atropine.
SBA: What ECG feature differentiates ventricular tachycardia from supraventricular tachycardia?
Answer: Wide QRS complexes in ventricular tachycardia.
SBA: What is the most common cause of ventricular fibrillation?
Answer: Myocardial infarction.
SBA: What is the rate of the sinoatrial (SA) node under normal physiological conditions?
Answer: 60–100 beats per minute.
SBA: What arrhythmia can result in sudden cardiac death without immediate treatment?
Answer: Ventricular fibrillation.
EMQ: Match the arrhythmia to its ECG characteristic.
Atrial fibrillation: Irregular rhythm with no P waves.
Ventricular tachycardia: Wide QRS complexes, no P waves.
Atrial flutter: Sawtooth P wave pattern.
EMQ: Match the arrhythmia to its primary treatment.
Atrial fibrillation: Rate control with beta-blockers or digoxin.
Ventricular fibrillation: CPR and defibrillation.
Sinus bradycardia: Atropine.
EMQ: Match the arrhythmia to its cause.
trial fibrillation: Hypertension or heart failure.
Torsades de Pointes: Prolonged QT interval.
Supraventricular tachycardia: Reentrant circuit in AV node.
EMQ: Match the arrhythmia to its symptoms
Sinus bradycardia: Fatigue, lightheadedness.
Ventricular tachycardia: Syncope, dyspnea.
Atrial fibrillation: Palpitations, breathlessness.
EMQ: Match the arrhythmia to its associated risk.
Atrial fibrillation: Stroke.
Ventricular fibrillation: Sudden cardiac death.
Torsades de Pointes: Progression to ventricular fibrillation.
List the main mechanisms of arrhythmias.
Answer:
Disturbances in impulse formation.
Disturbances in impulse conduction.
Combination of both. (2 marks)
Outline the symptoms of supraventricular arrhythmias.
Answer:
Atrial fibrillation: Palpitations, breathlessness.
Atrial flutter: Chest discomfort, fatigue.
Supraventricular tachycardia: Dizziness, syncope. (2 marks)
What are the key differences in ECG features between ventricular and supraventricular arrhythmias?
Answer:
Ventricular: Wide QRS complexes, no P waves.
Supraventricular: Narrow QRS complexes, normal or absent P waves. (2 marks)
Describe the management of ventricular tachycardia.
Answer:
If pulseless: CPR and defibrillation.
If with a pulse: Antiarrhythmic drugs (e.g., amiodarone) or synchronized cardioversion. (2 marks)
Explain the risk of stroke in atrial fibrillation and its prevention.
Answer:
Irregular rhythm causes blood pooling in the atria, leading to thrombus formation.
Prevented with anticoagulants (e.g., warfarin or DOACs). (2 marks)
SBA: What is the primary mechanism of action for Class I antiarrhythmic drugs?
Answer: Sodium channel blockade.
SBA: Which Class I antiarrhythmic drug is contraindicated in ischemic heart disease?
Answer: Flecainide.
SBA: What is the primary effect of beta-blockers (Class II) on cardiac action potential?
Answer: Decrease conduction velocity through the AV node and reduce heart rate.
SBA: What is the effect of calcium channel blockers (Class IV) on pacemaker cells?
Answer: Decrease firing rate and conduction velocity in the SA and AV nodes.
SBA: Which Class III drug is used for both supraventricular and ventricular arrhythmias?
Answer: Amiodarone.
Answer: Decrease firing rate and conduction velocity in the SA and AV nodes.
Answer: Adenosine.
SBA: What is the Vaughan Williams classification based on?
Answer: Electrophysiological effects of drugs on cardiac cells.
SBA: Which drug class prolongs the refractory period by blocking potassium channels?
Answer: Class III.
SBA: What is the primary adverse effect of amiodarone due to its iodine content?
Answer: Thyroid dysfunction.
SBA: What is the role of magnesium sulfate in arrhythmias?
Answer: Used in Torsades de Pointes to stabilize cardiac repolarization.
EMQ: Match the drug to its mechanism of action.
Flecainide: Class I - Sodium channel blocker.
Propranolol: Class II - Beta-adrenergic antagonist.
Amiodarone: Class III - Potassium channel blocker.
Verapamil: Class IV - Calcium channel blocker.
EMQ: Match the class of drugs to their ECG effects.
Class I: Widen QRS complex.
Class III: Prolong QT interval.
Class IV: Prolong PR interval.
EMQ: Match the drug to its therapeutic indication.
Adenosine: Paroxysmal supraventricular tachycardia.
Amiodarone: Ventricular fibrillation.
Digoxin: Atrial fibrillation with heart failure.
EMQ: Match the antiarrhythmic drug to its contraindication.
Verapamil: AV block.
Flecainide: Structural heart disease.
Propranolol: Severe bradycardia.
EMQ: Match the phase of the cardiac action potential to the drug action.
Phase 0: Class I - Sodium channel blockers.
Phase 3: Class III - Potassium channel blockers.
Phase 4: Class IV - Calcium channel blockers.
List the Vaughan Williams classes and their primary mechanisms.
Answer:
Class I: Sodium channel blockers (e.g., flecainide).
Class II: Beta-adrenergic blockers (e.g., propranolol).
Class III: Potassium channel blockers (e.g., amiodarone).
Class IV: Calcium channel blockers (e.g., verapamil). (2 marks)
Provide two examples of arrhythmias treated by each class.
Answer:
Class I: Ventricular tachycardia, paroxysmal supraventricular tachycardia.
Class II: Atrial fibrillation, atrial flutter.
Class III: Ventricular fibrillation, atrial fibrillation.
Class IV: Supraventricular tachycardia, atrial flutter. (4 marks)
What is the mechanism of unclassified drugs like digoxin and adenosine?
Answer:
Digoxin: Increases vagal tone to slow AV node conduction.
Adenosine: Hyperpolarizes cells by activating potassium channels, rapidly terminating SVT. (2 marks)
List two common adverse effects of antiarrhythmic drugs.
Answer:
Amiodarone: Thyroid dysfunction, pulmonary toxicity.
Verapamil: Bradycardia, hypotension. (2 marks)
Answer:
Amiodarone: Thyroid dysfunction, pulmonary toxicity.
Verapamil: Bradycardia, hypotension. (2 marks)
Answer: Inhibits Vitamin K epoxide reductase (VKORC1), reducing activation of clotting factors II, VII, IX, and X.
SBA: Which anticoagulant directly inhibits Factor Xa?
Answer: Apixaban.
SBA: What is the primary adverse effect associated with SGLT2 inhibitors in heart failure management?
Answer: Genital fungal infections.
SBA: What is the therapeutic use of neprilysin inhibitors like sacubitril?
Answer: Enhances blood pressure-lowering peptides (e.g., natriuretic peptides) to treat chronic heart failure.
SBA: What functional group in aspirin irreversibly inhibits COX-1?
Answer: Acetyl group.
SBA: What is the mechanism of action of thrombolytic drugs like alteplase?
Answer: Activates plasminogen to plasmin, which degrades fibrin clots.
SBA: Which loop diuretic inhibits the Na+/K+/2Cl− symporter in the nephron?
Answer: Furosemide.
SBA: What is the clinical significance of the S-isomer of warfarin?
Answer: It is 4 times more potent than the R-isomer as an anticoagulant.
SBA: Which P2Y12 receptor antagonist is reversible?
Answer: Ticagrelor.
SBA: What does the hydrophobic interaction in Factor Xa inhibitors like rivaroxaban achieve?
Answer: Stabilizes binding to the S1 and S4 pockets of Factor Xa.
EMQ: Match the drug class to its mechanism of action.
Vitamin K antagonists: Inhibit VKORC1 (e.g., warfarin).
Factor Xa inhibitors: Directly inhibit Factor Xa (e.g., apixaban).
P2Y12 receptor antagonists: Inhibit ADP-induced platelet aggregation (e.g., clopidogrel).
EMQ: Match the drug to its therapeutic use.
Alteplase: Acute ischemic stroke.
Aspirin: Primary prevention of myocardial infarction.
Sacubitril: Chronic heart failure with reduced ejection fraction.
EMQ: Match the drug to its major adverse effect.
Warfarin: Bleeding risk.
SGLT2 inhibitors: Genital fungal infections.
Ticagrelor: Dyspnea.
EMQ: Match the drug to its molecular target.
Dabigatran: Direct thrombin (Factor IIa) inhibitor.
Rivaroxaban: Factor Xa inhibitor.
Aspirin: COX-1 inhibitor.
EMQ: Match the drug to its clinical consideration.
Warfarin: Requires INR monitoring.
Apixaban: No routine monitoring required.
Clopidogrel: Activated by CYP2C19.
Outline the primary pharmacological strategies for MI and stroke.
Answer:
MI: Restore blood flow using thrombolytics (e.g., alteplase) and prevent recurrence with antiplatelets (e.g., aspirin) and anticoagulants (e.g., DOACs).
Stroke: Use antiplatelets for secondary prevention, anticoagulants for cardioembolic stroke. (2 marks)
Describe the mechanism of action of aspirin and clopidogrel.
Answer:
Aspirin: Irreversibly inhibits COX-1, reducing thromboxane A2 synthesis and platelet aggregation.
Clopidogrel: Irreversibly inhibits P2Y12 receptors, preventing ADP-induced platelet aggregation. (2 marks)
Explain the differences between warfarin and DOACs.
Answer:
Warfarin: Narrow therapeutic index, requires INR monitoring, delayed onset.
DOACs: Fixed dosing, faster onset, fewer interactions, no routine monitoring. (2 marks)
Discuss the role of thrombolytics in acute MI and stroke.
Answer:
Activate plasminogen to plasmin, degrading fibrin clots. Used within 3–4.5 hours of symptom onset. (2 marks)
List three potential adverse effects of these drugs and their management strategies.
Answer:
Bleeding: Monitor and adjust dose (e.g., warfarin).
Dyspepsia: Use enteric-coated aspirin.
Drug interactions (e.g., warfarin with CYP inhibitors): Monitor INR closely. (2 marks)
SBA: What is the primary cause of stable angina?
Answer: Atherosclerosis leading to reduced coronary artery capacity.
SBA: Which type of angina is caused by coronary artery spasms?
Answer: Variant (Prinzmetal’s) angina.
SBA: What diagnostic marker is elevated in STEMI but not in unstable angina?
Answer: Troponin.
SBA: Which enzyme is activated in platelets by thrombin during clot formation?
Answer: Protease-activated receptor (PAR).
SBA: What is the mechanism of action of nitrates in angina management?
Answer: They increase nitric oxide levels, leading to vasodilation.
SBA: What does a prolonged occlusion of an epicardial coronary artery lead to?
Answer: Myocardial infarction.
SBA: Which drug class blocks the P2Y12 receptor to inhibit platelet aggregation?
Answer: P2Y12 receptor antagonists (e.g., clopidogrel).
SBA: What is the primary treatment for acute STEMI?
Answer: Percutaneous coronary intervention (PCI).
Answer: Percutaneous coronary intervention (PCI).
Answer: Von Willebrand factor.
SBA: What is the main diagnostic marker for fibrinolysis?
Answer: D-dimer.
EMQ: Match the type of angina to its features.
Stable angina: Exertion-induced chest pain, relieved by rest.
Unstable angina: Chest pain at rest with ST depression on ECG.
Variant angina: Transient chest pain with ST elevation on ECG.
EMQ: Match the drug class to its mechanism in angina.
Beta-blockers: Decrease heart rate and myocardial oxygen demand.
Calcium channel blockers: Reduce vascular resistance and prevent coronary spasms.
Nitrates: Reduce preload and afterload via vasodilation.
EMQ: Match the process in clot formation to its associated factor.
Platelet adhesion: Von Willebrand factor.
Platelet activation: Thromboxane A2.
Fibrin stabilization: Factor XIII.
EMQ: Match the drug to its specific use.
Clopidogrel: Prevent platelet aggregation in coronary artery disease.
Alteplase: Dissolve thrombi in acute MI.
GTN: Relieve acute angina attacks.
EMQ: Match the coronary artery pathology to its treatment.
STEMI: PCI or fibrinolytics.
Stable angina: Beta-blockers and nitrates.
Unstable angina: Dual antiplatelet therapy.
Outline the pathogenesis of CAD.
Answer:
Atherosclerosis due to endothelial dysfunction.
Fatty plaque formation reduces coronary artery capacity.
Plaque rupture leads to thrombosis, causing ischemia or infarction. (3 marks)
What are the clinical features of stable angina, unstable angina, and STEMI?
Answer:
Stable angina: Chest pain on exertion, relieved by rest.
Unstable angina: Chest pain at rest, no troponin elevation.
STEMI: Severe chest pain, troponin elevation, and ST elevation on ECG. (3 marks)
Describe the pharmacological management of stable angina.
Answer:
First-line: Beta-blockers (reduce heart rate).
Second-line: Calcium channel blockers or nitrates.
Adjunct: Aspirin and statins to prevent progression. (2 marks)
How is STEMI managed acutely?
Answer:
Percutaneous coronary intervention (PCI).
Thrombolytics if PCI unavailable.
Dual antiplatelet therapy and anticoagulants. (2 marks)
SBA: What is the mechanism of action of warfarin?
Answer: Inhibits Vitamin K epoxide reductase, reducing the synthesis of clotting factors II, VII, IX, and X.
SBA: Which drug is a direct and reversible inhibitor of Factor Xa?
Answer: Apixaban.
SBA: Which drug is used to reverse the effects of heparin-induced thrombocytopenia?
Answer: Danaparoid sodium.
SBA: What is the primary adverse effect of fibrinolytics like alteplase?
Answer: Hemorrhage.
SBA: Which glycoprotein IIb/IIIa inhibitor is a monoclonal antibody used in high-risk percutaneous coronary intervention?
Answer: Abciximab
SBA: Which anticoagulant binds to antithrombin III to inhibit thrombin activity?
Answer: Heparin.
SBA: What is the function of fibrinolytics in thromboembolic disease management?
Answer: Activate plasminogen to plasmin, which dissolves fibrin clots.
SBA: What is the primary clinical use of low molecular weight heparins (LMWHs)?
Answer: Prevention and treatment of deep vein thrombosis (DVT).
SBA: What is the advantage of direct oral anticoagulants (DOACs) over warfarin?
Answer: Fixed dosing and no routine INR monitoring.
SBA: What is the reversal agent for dabigatran?
Answer: Idarucizumab.
EMQ: Match the drug to its mechanism of action.
Warfarin: Inhibits Vitamin K epoxide reductase.
Apixaban: Direct Factor Xa inhibitor.
Dabigatran: Direct thrombin inhibitor.
EMQ: Match the anticoagulant to its clinical consideration.
Warfarin: Requires INR monitoring.
DOACs (e.g., rivaroxaban): No routine monitoring.
Heparin: Administered intravenously or subcutaneously.
EMQ: Match the antiplatelet drug to its target receptor.
Clopidogrel: P2Y12 receptor.
Aspirin: COX-1.
Abciximab: Glycoprotein IIb/IIIa receptor.
EMQ: Match the fibrinolytic to its property.
Alteplase: Fibrin-specific.
Streptokinase: Can induce antibody formation.
Tenecteplase: Longer half-life.
EMQ: Match the condition to the appropriate treatment.
STEMI: Alteplase or PCI.
DVT: LMWH or DOACs.
Pulmonary embolism: Fibrinolytics.
lassify antithrombotic drugs and give examples.
Answer:
Anticoagulants: Warfarin, DOACs (e.g., apixaban).
Antiplatelets: Aspirin, clopidogrel.
Fibrinolytics: Alteplase, streptokinase. (2 marks)
Describe the mechanism of action for warfarin and DOACs.
Answer:
Warfarin: Inhibits Vitamin K epoxide reductase.
DOACs: Directly inhibit Factor Xa or thrombin. (2 marks)
List two clinical indications for each drug class.
Answer:
Anticoagulants: DVT, atrial fibrillation.
Antiplatelets: Prevention of MI, stroke.
Fibrinolytics: Acute MI, pulmonary embolism. (3 marks)
Discuss major adverse effects and their management.
Answer:
Warfarin: Bleeding, managed with Vitamin K.
Heparin: HIT, managed with danaparoid.
Fibrinolytics: Hemorrhage, monitor closely. (3 marks)
SBA: Which beta-blocker is non-selective and inhibits both β1 and β2 receptors?
Answer: Propranolol.
SBA: What structural feature distinguishes aryloxypropanolamines from arylethanolamines in beta-blockers?
Answer: Presence of an aryloxypropanolamine side chain increases potency.
SBA: Which beta-blocker has cardio-selective β1 affinity and is hydrophilic?
Answer: Atenolol.
SBA: What functional group in norepinephrine binds ionically to the β-adrenoceptor at physiological pH?
Answer: Amine group.
SBA: What property allows lipophilic beta-blockers like propranolol to penetrate the CNS?
Answer: High partition coefficient (LogP).
SBA: Which beta-blocker exhibits mixed β1, β2, and α1 antagonistic effects?
Answer: Carvedilol.
SBA: What is the main mechanism of action of beta-blockers in hypertension management?
Answer: Decrease heart rate and myocardial contractility by blocking β1 receptors.
SBA: Why are hydrophilic beta-blockers less likely to cause CNS side effects?
Answer: They have a low partition coefficient and cannot easily cross the blood-brain barrier.
SBA: What is the mechanism of action of amiodarone?
Answer: Blocks potassium channels, prolonging the refractory period and action potential.
SBA: What structural modification in dronedarone reduces the risks of thyroid and neurotoxicity compared to amiodarone?
Answer: Removal of iodine groups and addition of a methylsulfonamide group.
EMQ: Match the beta-blocker to its property.
Atenolol: Cardio-selective β1 blocker, hydrophilic.
Propranolol: Non-selective β blocker, lipophilic.
Carvedilol: Mixed β1, β2, and α1 antagonist.
EMQ: Match the functional group to its binding site.
Amine group: Ionic bond with Asp113.
Catechol aromatic ring: Hydrophobic interaction with Phe290.
Alcohol group: Hydrogen bond with Asn293.
EMQ: Match the drug to its clinical use.
Amiodarone: Ventricular and supraventricular arrhythmias.
Atenolol: Hypertension and angina.
Dronedarone: Atrial fibrillation/flutter.
EMQ: Match the beta-blocker to its classification.
Timolol: Non-selective beta-blocker.
Bisoprolol: Cardio-selective beta-blocker.
Labetalol: Mixed alpha and beta antagonist.
EMQ: Match the structural modification to its effect.
Addition of bulky N-alkyl substituents: Increases selectivity for β-adrenoceptors over α-adrenoceptors.
Aryloxypropanolamine group: Increases β-blocker potency.
Methylsulfonamide group: Reduces lipophilicity and toxicity.
Explain the mechanism of action of beta-blockers.
Answer: Block β-adrenoceptors, reducing the effects of catecholamines (epinephrine and norepinephrine) on the heart. Leads to decreased heart rate, myocardial contractility, and renin secretion. (2 marks)
Differentiate between selective and non-selective beta-blockers.
Answer:
Selective: Target β1 receptors (e.g., atenolol).
Non-selective: Block both β1 and β2 receptors (e.g., propranolol). (2 marks)
What are the clinical applications of beta-blockers?
Answer: Hypertension, angina, myocardial infarction, arrhythmias, and heart failure. (2 marks)
Describe the SAR of beta-blockers.
Answer:
Lipophilicity increases CNS penetration (e.g., propranolol).
Hydrophilic groups reduce CNS effects (e.g., atenolol).
Bulky N-alkyl substituents increase β1 selectivity. (2 marks)
What are the structural differences between amiodarone and dronedarone?
Answer:
Amiodarone: Contains iodine groups, leading to thyroid toxicity.
Dronedarone: Lacks iodine and has a methylsulfonamide group, reducing lipophilicity and toxicity. (2 marks)
SBA: What is the key difference between crystalline and amorphous solids?
Answer: Crystalline solids have a long-range molecular order, while amorphous solids have a random molecular arrangement.
SBA: What is the main advantage of salt formation in drug development?
Answer: It increases the solubility and dissolution rate of acidic and basic drugs.
SBA: Which particle property most directly affects flowability during drug manufacturing?
Answer: Particle shape.
SBA: What does the term “hydrate” refer to in solid-state chemistry?
Answer: A crystalline structure that includes water molecules within its lattice.
SBA: What is the main application of co-crystals in pharmaceutical formulations?
Answer: Enhancing the dissolution rate and bioavailability of poorly water-soluble drugs.
SBA: What type of diameter is used to describe the equivalent volume sphere of a particle?
Answer: Volume-equivalent diameter.
SBA: Which theory is used to measure the surface area of irregular particles using gas adsorption?
Answer: Brunauer–Emmett–Teller (BET) theory.
SBA: How does a larger specific surface area affect drug dissolution rate?
Answer: Increases the dissolution rate due to greater contact with the dissolution medium.
SBA: What is the main drawback of amorphous drug formulations?
Answer: They are less stable and more prone to moisture sensitivity compared to crystalline forms.
SBA: Which equation describes the relationship between dissolution rate, surface area, and diffusion layer thickness?
Answer: Noyes-Whitney equation.
EMQ: Match the particle property to its impact on drug formulation.
Surface area: Dissolution rate.
Particle size: Content uniformity.
Particle shape: Flowability and mixing.
EMQ: Match the type of solid-state modification to its example.
Hydrate: Lisinopril dihydrate.
Solvate: Ethanolate of a drug.
Co-crystal: Sildenafil and aspirin co-crystal.
EMQ: Match the particle diameter to its application.
Aerodynamic diameter: Inhalation drug deposition.
Stokes’ diameter: Sedimentation properties.
Sieve diameter: Particle size distribution analysis.
EMQ: Match the solid-state form to its feature.
Crystalline: Higher stability, lower solubility.
Amorphous: Lower stability, higher solubility.
Polymorphic: Same chemical composition, different molecular packing.
EMQ: Match the method to its application in particle analysis.
Laser diffraction: Determines particle size distribution.
BET theory: Measures surface area of irregular particles.
Microscopy: Visualizes particle shape.
Explain the significance of particle size and surface area.
Answer:
Smaller particles have a larger surface area, increasing the dissolution rate and bioavailability (Noyes-Whitney principle).
Uniform particle size ensures content uniformity in formulations. (3 marks)
Describe the impact of particle shape on powder behavior.
Answer:
Spherical particles: Better flowability and mixing.
Irregular or flaky particles: Poor flowability and increased cohesiveness. (2 marks)
What are the roles of polymorphs and co-crystals in pharmaceutical formulations?
Answer:
Polymorphs: Allow control over stability and solubility.
Co-crystals: Enhance dissolution and bioavailability of poorly soluble drugs. (2 marks)
Discuss the practical implications of hydrates and solvates.
Answer:
Hydrates: Improved stability but lower solubility.
Solvates: Can alter dissolution behavior and bioavailability. (2 marks)
What is the role of BET theory in particle characterization?
Answer: Measures the surface area of irregular particles to predict dissolution and adsorption properties. (1 mark)
SBA: What is the key difference between normal and lognormal distributions in particle size analysis?
Answer: Normal distributions are symmetric with mean = median = mode, while lognormal distributions are positively skewed with a logarithmic scale normalizing the data.
SBA: What does D90/D10 represent in particle size analysis?
Answer: It represents the ratio of particle sizes at 90% and 10% undersize, indicating the degree of dispersion.
SBA: Which particle sizing method measures the aerodynamic diameter of particles?
Answer: Cascade impactor.
SBA: What type of diameter does laser diffraction measure?
Answer: Equivalent diameter based on the diffraction pattern.
SBA: Which particle sizing method uses Stokes’ Law to measure particle size?
Answer: Andreasen pipette (sedimentation).
SBA: What is the most significant limitation of microscopy in particle size analysis?
Answer: Non-representative selection of particles.
SBA: What does the Coefficient of Variation (CV%) indicate in particle size distribution?
Answer: It normalizes the standard deviation by dividing it by the mean, indicating the degree of variance.
SBA: How does sieving classify particles?
Answer: By sieve equivalent diameter, determined by the size of apertures in the sieve mesh.
SBA: What does photon correlation spectroscopy (dynamic light scattering) measure?
Answer: Hydrodynamic diameter of particles in suspension.
SBA: What is the main application of the D90/D10 ratio in pharmaceutical powders?
Answer: To assess polydispersity of powders for consistency in formulations
EMQ: Match the particle size analysis method to its application.
Sieving: Measures sieve equivalent diameter of powders.
Andreasen pipette: Determines Stokes’ diameter via sedimentation.
Cascade impactor: Measures aerodynamic diameter for inhalation products.
EMQ: Match the dispersion measure to its definition.
Standard deviation: Variation of particle sizes around the mean.
Coefficient of variation: Normalized standard deviation (%).
D90/D10: Ratio indicating dispersion irrespective of distribution model.
EMQ: Match the particle size technique to its limitation.
Laser diffraction: Struggles with non-spherical particles.
Microscopy: Non-representative selection of particles.
Photon correlation spectroscopy: Affected by aggregates or dust.
EMQ: Match the type of particle diameter to its definition.
Volume diameter: Measured by electrical sensing zone methods.
Aerodynamic diameter: Used in respiratory particle analysis.
Hydrodynamic diameter: Determined by dynamic light scattering.
EMQ: Match the type of distribution to its property.
Normal distribution: Mean = median = mode.
Lognormal distribution: Data normalized using a logarithmic scale.
Bimodal distribution: Has two distinct modes.
Explain the principles of particle size analysis.
Answer:
Represents the size distribution of particles in a sample.
Central tendency measures: mean, mode, median.
Dispersion measures: standard deviation, D90/D10 ratio. (2 marks)
Describe three particle sizing techniques and their applications.
Answer:
Sieving: Classifies powders based on sieve equivalent diameter.
Andreasen pipette: Measures Stokes’ diameter using sedimentation.
Cascade impactor: Analyzes aerodynamic diameter for inhalation products. (3 marks)
Discuss the limitations of particle sizing methods.
Answer:
Laser diffraction: Inaccurate for non-spherical particles.
Microscopy: Prone to sampling bias.
Dynamic light scattering: Sensitive to aggregates or dust. (2 marks)
What is the significance of D90/D10 and CV% in pharmaceutical formulations?
Answer:
D90/D10: Indicates polydispersity, essential for uniform drug delivery.
CV%: Compares variance across sample populations. (2 marks)
How are particle size distributions typically visualized?
Answer:
Histograms for incremental distributions.
Cumulative graphs for undersize/oversize percentages. (1 mark)
SBA: What is the primary purpose of granulation in pharmaceutical formulations?
Answer: To improve powder flowability and prevent segregation of constituents.
SBA: How does granulation reduce dust in powder formulations?
Answer: By aggregating fine powder particles into denser granules
SBA: What is the angle of repose used to measure in powder flowability?
Answer: The flowability of powders and granules.
SBA: Which liquid component is commonly used in wet granulation?
Answer: Water or ethanol.
SBA: What is a common binder used in wet granulation?
Answer: Polyvinylpyrrolidone (PVP).
SBA: What is the primary limitation of wet granulation for thermolabile drugs?
Answer: Potential degradation due to moisture and heat.
SBA: What is the main disadvantage of dry granulation?
Answer: High compaction force increases dust generation and cross-contamination risks.
SBA: Which equipment is used in wet granulation for spraying binder solutions?
Answer: Fluid-bed granulator.
SBA: What is the main difference between small granules and large granules?
Answer: Small granules (~0.2–0.4 mm) are used as intermediates, while large granules (~1–4 mm) are often final dosage forms.
SBA: What happens if the mass is too dry during wet granulation?
Answer: Granules will fall apart.
EMQ: Match the granulation process to its description.
Wet granulation: Uses a liquid binder to aggregate powder particles.
Dry granulation: Compacts powders under high pressure without liquid.
Extrusion-spheronization: Produces spherical granules for uniform dosing.
EMQ: Match the method to its equipment.
High-shear granulation: Impeller for mixing, densification, and agglomeration.
Fluid-bed granulation: Sprays binder onto a fluidized powder bed.
Sieve shaker: Separates granules by size.
EMQ: Match the limitation to the granulation process.
Wet granulation: Not suitable for moisture-sensitive drugs.
Dry granulation: Generates dust and potential cross-contamination.
Spray drying: High cost of equipment and energy.
EMQ: Match the granule property to its benefit.
Denser particles: Improves flowability.
Uniform granules: Prevents segregation.
Reduced dust: Minimizes toxic exposure.
EMQ: Match the particle characteristic to its measurement.
Angle of repose: Flowability of powders.
Tapped density: Compressibility of powders.
Bulk density: Volume occupied by powder under normal conditions.
Explain the purpose of granulation in pharmaceutical formulations.
Answer:
Prevents segregation of powder mix.
Improves flow properties and compressibility.
Reduces toxic dust. (2 marks)
Describe the process of wet granulation.
Answer:
Mix powders with a binder solution.
Pass moist mass through a sieve or extruder.
Dry granules to form solid bridges between particles. (2 marks)
Describe the process of dry granulation.
Answer:
Compact powder under high pressure to form slugs.
Mill and sieve slugs into granules. (2 marks)
What are the advantages and disadvantages of wet granulation?
Answer:
Advantages: Improves uniformity and reduces dust.
Disadvantages: Expensive, unsuitable for moisture-sensitive drugs. (2 marks)
Compare dry granulation to wet granulation.
Answer:
Dry granulation: Less expensive but generates dust.
Wet granulation: Better granule uniformity but costly and complex. (2 marks)
SBA: What is the primary mechanism of action for ACE inhibitors?
Answer: Inhibit ACE-mediated conversion of angiotensin I to angiotensin II, leading to vasodilation and reduced aldosterone secretion.
SBA: Why are ACE inhibitors associated with a persistent dry cough?
Answer: Due to bradykinin accumulation.
SBA: Which class of drugs is most commonly used in African-Caribbean patients for hypertension first-line therapy?
Answer: Calcium channel blockers.
SBA: What is the main adverse effect of thiazide diuretics?
Answer: Hypokalaemia.
SBA: Which enzyme do statins inhibit to reduce cholesterol?
Answer: HMG-CoA reductase.
SBA: Which drug class activates PPARα to treat hypertriglyceridemia?
Answer: Fibrates.
SBA: What is the first-line drug for stable angina?
Answer: Beta-blockers.
SBA: Which drug selectively inhibits the If current in the sinoatrial node?
Answer: Ivabradine.
SBA: What is the primary action of aspirin in thromboembolic disorders?
Answer: Irreversible inhibition of thromboxane synthesis in platelets.
SBA: What does an elevated troponin level indicate?
Answer: Myocardial ischemia or infarction.
SBA: Which ECG change indicates ST-elevation myocardial infarction (STEMI)?
Answer: ST elevation.
SBA: What type of arrhythmia is characterized by a saw-tooth pattern on the ECG
Answer: Atrial flutter.
SBA: Which drug is contraindicated in combination with statins due to increased risk of myopathy?
Answer: Fibrates.
SBA: What is the most common adverse effect of nitrates?
Answer: Headache.
SBA: What type of diuretic is spironolactone?
Answer: Aldosterone receptor antagonist.
SBA: What is the mechanism of action of ranolazine in angina?
nswer: Blocks late inward sodium currents.
SBA: What is the mechanism of action of nicorandil?
Answer: Activates ATP-sensitive potassium channels.
SBA: What does a prolonged QT interval on ECG indicate?
Answer: Risk of ventricular arrhythmias.
SBA: Why is grapefruit juice contraindicated with statins?
Answer: It inhibits CYP450 enzymes, increasing statin plasma levels.
SBA: What is the most common adverse effect of antiplatelet drugs like clopidogrel?
Answer: Bleeding.
EMQ: Match the antihypertensive drug to its mechanism.
ACE inhibitors: Blocks angiotensin II synthesis.
Beta-blockers: Reduce heart rate and cardiac output.
Thiazide diuretics: Promote sodium excretion in the distal tubule.
EMQ: Match the lipid-lowering drug to its effect.
Statins: Reduce LDL cholesterol.
Fibrates: Lower triglycerides, increase HDL.
Ezetimibe: Inhibits cholesterol absorption.
EMQ: Match the anti-anginal drug to its target.
Nitrates: Vascular smooth muscle.
Beta-blockers: Heart rate and contractility.
Ivabradine: Sinoatrial node.
MQ: Match the ECG finding to its diagnosis.
ST elevation: STEMI.
Inverted T wave: Ischemia.
Prolonged QT interval: Risk of torsades de pointes.
EMQ: Match the thromboembolic drug to its mechanism.
Aspirin: Inhibits thromboxane synthesis.
Heparin: Activates antithrombin.
Warfarin: Inhibits vitamin K-dependent clotting factors.
EMQ: Match the drug to its adverse effect.
ACE inhibitors: Dry cough.
Statins: Myopathy.
Nitrates: Headache.
EMQ: Match the cholesterol pathway to its description.
Exogenous: Dietary cholesterol absorption.
Endogenous: Cholesterol synthesis in the liver.
Reverse transport: HDL-mediated clearance.
EMQ: Match the arrhythmia to its treatment.
Atrial fibrillation: Warfarin or DOACs.
Ventricular tachycardia: Amiodarone.
Paroxysmal supraventricular tachycardia: Adenosine.
EMQ: Match the nitrate to its feature.
Isosorbide mononitrate: Oral, long-acting.
Glyceryl trinitrate: Sublingual, short-acting.
Sodium nitroprusside: IV, used in hypertensive crises.
EMQ: Match the anti-platelet to its mechanism.
Clopidogrel: P2Y12 receptor inhibitor.
Aspirin: Thromboxane inhibitor.
Abciximab: Glycoprotein IIb/IIIa inhibitor.
Define hypertension (1 mark).
Answer: Persistent elevation of blood pressure ≥140/90 mmHg.
List two classes of antihypertensives with examples (2 marks).
Answer: ACE inhibitors (ramipril), CCBs (amlodipine).
Explain why ACE inhibitors are less effective in African-Caribbean populations (2 marks).
Answer: Low renin activity, age-related nephron loss.
State one adverse effect of thiazide diuretics and its management (2 marks).
Answer: Hypokalaemia, managed with potassium supplements.
Outline lifestyle changes recommended in hypertension (3 marks).
Answer: Low-sodium diet, regular exercise, weight loss.
What is the mechanism of action of statins (2 marks)?
Answer: Inhibits HMG-CoA reductase, reducing cholesterol synthesis.
Why is grapefruit juice contraindicated (2 marks)?
Answer: Inhibits CYP450 enzymes, increasing myopathy risk.
Compare LDL and HDL particles (2 marks).
Answer: LDL carries cholesterol to tissues, HDL facilitates reverse cholesterol transport.
What is the primary indication for fibrates (2 marks)?
Answer: Hypertriglyceridemia.
Name one cholesterol absorption inhibitor (1 mark).
Answer: Ezetimibe.
State one adverse effect of statins (1 mark).
Answer: Myopathy.
List two drug classes used for angina (2 marks).
Answer: Nitrates, beta-blockers.
What is the mechanism of action of nitrates (2 marks)?
Answer: Release NO, causing vasodilation.
Why are long-acting nitrates preferred for chronic angina (2 marks)?
Answer: Sustained effect reduces episodes.
State two adverse effects of nitrates (2 marks).
Answer: Headache, hypotension.
What ECG changes indicate ischemia (2 marks)?
Answer: ST depression, T wave inversion.
Differentiate arterial and venous thrombi (2 marks).
Answer: Arterial: Platelet-rich; Venous: RBC-rich.
Outline aspirin’s mechanism of action (2 marks).
Answer: Irreversibly inhibits thromboxane synthesis in platelets.
Name one DOAC and its target (2 marks).
Answer: Apixaban, Xa inhibitor.
List one advantage of DOACs over warfarin (2 marks).
Answer: No routine INR monitoring.
What is the most common adverse effect of anticoagulants (2 marks)?
Answer: Bleeding.
