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Pharmaceuticals Flashcards

1
Q

Name some modifiable causes of hypertension

A

Too much alcohol consumption, smoking, overweight, not enough exercise, too much salt in your diet

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2
Q

Name some causes of secondary hypertension

A

Abnormal hormone production, kidney disease, diabetes, medications

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3
Q

What is the main concern regarding hypertension?

A

It can lead to CVD

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4
Q

What is classified as stage 1 hypertension?

A

> 140/90 clinical or >135/85 ABPM

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5
Q

What is classified as stage 2 hypertension?

A

> 160/100 clinical or >150/95 ABPM

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6
Q

What is classified as stage 3 hypertension?

A

> 180/110

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7
Q

What needs to happen if a patient is categorised as a stage 3 hypertension patient?

A

They need immediate referral

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8
Q

If a patient presents with very high BP what do you need to be assessing for?

A

End organ damage

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9
Q

What type of tests should you be thinking of carrying out if your patient presents with really high BP?

A

Urinalysis, 12 lead ECG, U & E, lipid profile, HbA1c, ECHO and fundoscopy

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10
Q

What’s stage of hypertensive patients require treatment?

A

2 and 3

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11
Q

What are the 4 main medications that we use to treat hypertension?

A

ACE inhibitors or angiotensin 2 receptor blockers
Beta blockers
Calcium channel blockers
Diuretics

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12
Q

What is a common side effect of an ACE inhibitor, and why is this?

A

A persistent dry cough due to a build up of bradykinin

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13
Q

What patients should NOT be given ACE inhibitors?

A

Patients with hypotension, hypokaelaemia and renal artery stenosis

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14
Q

What drugs can be prescribed instead of ACE inhibitors if they patient can’t tolerate the side effects?

A

Angiotensin 2 receptor blockers

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15
Q

What is a very common side effect of calcium channel blockers?

A

Swollen ankles / oedema

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16
Q

What are the two different classes of calcium channel blockers?

A

Dihydropyridines and non-dihydropyridine

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17
Q

Do diuretics need to be prescribe in high or low doses?

A

Low doses

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18
Q

What drug class are the second line treatment to treat hypertension?

A

Beta blockers

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19
Q

What patients can be prescribed beta blockers as a first line treatment for hypertension?

A

Pregnant women or women of child baring age

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20
Q

Who should we not prescribe beta blockers to, and why?

A

Asthmatic patients because these drugs cause bronchospasms

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21
Q

What is the definition of coronary heart disease?

A

Any disease that affects the heart and coronary blood vessels

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22
Q

What causes angina?

A

Insufficient oxygen delivery to the heart muscles that leads to ischaemia.

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23
Q

what are the 2 different types of angina?

A

Stable and Unstable angina

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24
Q

When will you experience the symptoms of stable angina?

A

When your body is exerted eg when you have just done exercise

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25
When will you experience the signs of unstable angina?
Very suddenly and the episodes can not be predicted
26
If a patient shows a change of ECG when presenting with chest pain, what is their diagnosis?
STEMI
27
If a patient has no ECG changes but has an increase trop level, what is their diagnosis?
NSTEMI
28
If a patient has no ECG changes or no increased trop levels, what is their diagnosis?
Unstable angina
29
Whats the difference between a STEMI and an NSTEMI in terms of the plaque?
In a STEMI the plaque has ruptured and you have irreversible necrosis of the heart. With a NSTEMI the plaque has not ruptured but it can progress to rupturing if you do not act quickly.
30
What is the best example of a nitrate used for coronary artery disease?
Glycerol Trinitrate (GTN spray)
31
Where should the patient be spraying the GTN spray and why?
Under their tongue, this is the fastest route of administration.
32
What is the MOA for GTN?
It is a vasodilator and decreases the myocardial workload
33
When would you prescribe GTN spray?
In angina and acute heart failure
34
What are the side effects of GTN spray?
Headache, hypotension, facial flushing
35
What patients shouldnt you prescribe GTN to?
Acute circulatory heart failure, head trauma, severe hypotension
36
What are the main anti-platelet drugs that are used?
Aspirin, Ticagrelor and Clopidogrel
37
How do anti-platelets work?
They disrupt the platelet activation mechanism.
38
How many days can anti-platelets last in your system?
8-10 days
39
What are the side effects of anti-platelets?
Bronchospasm, GI bleeds, tinnitus and increased bleeding time
40
When should you not prescribe anti-platelets?
When the patient is at high risk of bleeding, if they have a low platelet count
41
Whats the loading dose of aspirin?
300mg
42
Whats the loading dose for Ticagrelor?
180mg
43
Whats the loading dose of Plasurgrel?
60mg STAT
44
How do glycoprotein 2b/3a work?
They inhibit the final common pathway that is involved in platelet aggregation.
45
How would you prescribe glycoprotein 2b/3a?
Via an IV infusion
46
Why might you prescribe glycoproteins 2b/3a for patients undergoing a PCI?
They prevent any ischaemic cardiac complications
47
What are some of the side effects of glycoprotein 2b/3a?
Bleeding, back pain, fever and headache
48
What patients should NOT be prescribed glycoprotein 2b/3a?
~Patients that have active internal bleeding ~If they have hypertensive retinopathy ~If they have had major surgery in the past 2 months
49
How do anti-coagulant drugs work?
They prevent the blood from clotting by stopping the synthesis of clotting factors
50
What type of things would you prescribe anticoagulants for?
NSTEMI, STEMI, DVT, pulmonary embolus and unstable angina
51
What is the most common anti-coagulant that is prescribed?
Heparin
52
What are the 3 different types of heparin?
~Low molecular weight heparin ~Unfractionated ~Synthetic heparin
53
What are the side effects of anti-coagulants?
Increased bleeding, hyperkaelamia
54
What patients should not be prescribed anti-coagulants?
~After major surgery ~If they have a peptic ulcer ~If they have severe hypertension
55
What is the MOA of Nicorandil?
It is a K+ channel activator
56
Nicorandil is similar to another type of drug, what is this typeof drug?
Nitrates (GTN)
57
What is the most common side effect of Nicorandil?
A severe headache, but it will become tolerable over time
58
What patients should not be prescribed Nicorandil?
If they have severe hypotension or if they have acute pulmonary oedema
59
If a patient has LV failure what drug should they not be prescribed?
Nicorandil
60
Does Ranolazine effect HR or BP?
No
61
What is the effect of Ranolazine?
It facilitates myocardial relaxation
62
When should you not prescribe Ranolazine?
If the patient has a severe renal impairment
63
What are the main side effects of Ranolazine?
Headache and dizziness
64
How does the drug Ivabradine work?
It lowers HR by acting on the SA node
65
Does Ivabradine have an effect on BP or contraction?
No
66
What are the main side effects associated with Ivabradine?
GI disturbance and nausea
67
When should you NOT prescribe Ivabradine?
If the patient has a HR that's less than 75
68
How do statins work?
1. Tells the liver to slow down the cholesterol production 2. Sticks the plaque to the walls to stabilise it and prevent any getting into the small blood vessels 3. Slow down the progression of disease and lowers cholesterol
69
When should we prescribe statins?
In both primary and secondary prevention of cardiovascular events
70
What are the main side effects of statins?
Muscle aches and pain and myopathy
71
What patients should not be prescribed statins?
If they have liver disease
72
How do thrombolytics work?
They activate plasminogen into plasmin which degrades the fibrin clot and breaks up the thrombus
73
What are the risk associated with prescribing thrombolytics?
Cerebral bleeds
74
What does PCI stand for?
Percutaneous Coronary Intervention

Cardiovascular System (8 decks)

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