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Year 3 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What pharmacological strategies can be used to treat hypertension?

A

Reduce volume overload:

  • Diuretics: decrease blood volume by increasing the volume of water excreted in the urine

Reduce sympathetic outflow from the brain:

  • Clonidine: is an agonist at a2 receptors. Clonidine inhibits further release of the sympathetic agonist, noradrenaline, and inhibits sympathetic outflow from the brain.

Block adrenergic receptors in the heart:

  • Atenolol: is a ß1 adrenergic receptor antagonist that reduces hear rate and myocardial work

Dilate blood vessels:

  • Prazosin: blocks a1 adrenergic receptors, causing vasodilation
  • Nifedipine: blocks calcium entry into smooth muscle cells of arterial walls, preventing contraction.
  • Hydralazine: relaxes arterioles
  • Captropril: reduces production of angiotension II, causes vasodilation.
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2
Q

What pharmacological strategies can be used to treat stable angina?

A

Reduce work of heart and imrpove cardiac circulation:

  • Nitroglycerin: reduces preload by venodilation
  • Atenolol: decreases myocardial work (ß1 antagonist)
  • Diltiazem: decreases blood pressure through vasoodilation, by blocking calcium entry.
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3
Q

What pharmacological strategies can be used to treat unstable angina?

A

Reduce work of heart and imrpove cardiac circulation:

  • Beta blockers: reduce heart rate and myocardial work
  • Aspirin: prevents platelet aggregation in myocardial arteries
  • Heparin: inhibits clotting in myocardial arteries
  • Nitroglycerin: reduced preload
  • Eptifibatide or Tirofiban: inhibit platelet aggregation
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4
Q

What pharmacological strategies can be used to treat myocardial infarction?

A

Reperfuse ischemic tissue:

  • Streptokinase: converts plasminogen to plasmin. Plasmin digests fibrin and fibrinogen, thus dissolving clots

Antianginal agents - reduce work of heart and imrpove cardiac circulation:

  • Nitroglycerin: reduces preload by venodilation
  • Atenolol: decreases myocardial work (ß1 antagonist)
  • Diltiazem: decreases blood pressure through vasoodilation, by blocking calcium entry.
  • Beta blockers: reduce heart rate and myocardial work
  • Aspirin: prevents platelet aggregation in myocardial arteries
  • Heparin: inhibits clotting in myocardial arteries
  • Eptifibatide or Tirofiban: inhibit platelet aggregation

Not nifedipine, which is dangerous in setting of myocardial infarction

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5
Q

What pharmacological strategies can be used to treat heart failure?

A

Reduce workload:

  • Diuretics: decrease blood volume
  • Captorpil: causes vasodilation
  • Atenolol (ß blocker): reduces heart rate and work load
  • Nitroglycerin: reduces venous tone (it also dilates coronary arteries, enhancing blood delivery to the heart).
  • Hydralazine and Nitroprusside: relax arterioles

Improve myocardial contractility:

  • Digoxin: increases calcium influx into myocardial cells
  • Amirnone: inhibits cAMP degradation
  • Dobutamine: increases cAMP production by stimulating ß1 adrenergic receptors
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6
Q

What pharmacological strategies can be used to in the treatment og vascular occlusion?

A

Prevent coagulation:

  • Heparin and warfarin: inhibit coagulation pathway

Prevent clot formation:

  • Aspirin: inhibits platelet aggregation
  • Ticlopidine: inhibits platelet binding to fibrinogen.

Destroy clots that have already formed:

  • Streptokinase: converts plasminogen to plasmin
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7
Q

What class of drug is Chlorothiazide?

What is its mechanism of action?

What are the indications of use?

A
  • Class: Thiazide
  • Mechanism of action: inhibits sodium and chloride reabsorption in the distal tubule. Loss of K+, Na+ and Cl- causes increase in urine output. Sodium loss results in ↓ GFR.
  • Indications: Ideal starting agent for hypertension, chronic oedema, idiopathitc hypercalcuria.
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8
Q

What class of drugs is Furosemide?

What is its mechanism of action?

What are the indications for use?

A
  • Class: Loop diuretic
  • Mechanism of action: Inhibits Cl- reabsorption in thick ascending loop of Henle. High loss of K+ in urine.
  • Indications: Preferred diuretic in patients with low GFR and in hypertensive emergencies. Also, oedema, pulmonary oedema and to mobilse large volimes of fluid. Sometimes used to reduce serum potassium levels.
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9
Q

What class of drugs is Amiloride?

What is its mechanism of action?

What are the indications of use?

A
  • Class: Potassium Sparing Diuretic
  • Mechanism: Directly increases NA+ excretion and decreases K+ secretion in distal convoluted tubule.
  • Indications: Used with other diuretics because K+ sparing effects lessen hypokalemic efects. May correct metabolic alkalosis.
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10
Q

What class of drug is Spironolactone?

What is its mechanism of action?

What is its indication of use?

A
  • Class: Potassium sparing diuretic
  • Mechanism: Antagonist of aldosterone (aldosterone causes Na+ retention). Also had actions similarto amiloride.
  • Indications: Used with thiazides for oedema (in congestive heart failure), cirrhosis, and nephrotic syndrome. Also to treat or diagnose hyperaldosteronism.
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11
Q

What class of drugs of is Mannitol?

What is its mechanism of action?

What are the indications of use?

A
  • Class: Osmotic diuretic
  • Mechanism: Osmotically inhibits sodium and water reabsorption. Initially increases plasma volume and blood pressure.
  • Indication: acute renal failure, acute closed angle glauscome, brain oedema, to remove overdose of some drugs.
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12
Q

What class of drugs are Atenolol, Betaxolol, Carteolol, Penbutolol, Bisoprolol, Metroprolol?

What are their mechanism of action?

What are the indications of use?

A
  • Class: ß blocker (ß adrenergic anatagonist)
  • Mechanism: Preferetnially blocks ß1 adrenergic receptors. decreases heart rate and output and ↓ renin release. Less bronchoconstriction than agents which bind to ß2 receptors.
  • Indications: Good starting therapy for mild to moderate hypertension
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13
Q

What class of drugs are Captopril, Lisinopril, Enalapril, Ramipril, Benazepril, Fosinopril, etc?

What are their mechanism of actions?

What are the indications of use?

A
  • Class: ACE inhibitor
  • Mechanism: Inhibits angiotension converting enzyme (ACE) in the lung, which reduces synthesos fo the vasoconstrictor, angiotensin II. Suppresses aldosterone, resulting in natriuresis. Potentiates other vasodilators (e.g. bradykinin, prostaglandins)
  • Indications: Hypertension. Particularly useful for high-renin hypertension. Preferred drug for hypertensive patients with diabetic nephropathy because glucose levels are not affected. Heart failure - used with diuretics and digitalis. Myocardial infarction - to enhance heart reperfusion.
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14
Q

What class of drugs are Losartan, Valsartan, Irbesartan, Candesartan, Telmisartan?

What are their mechanism of action?

What are their indications of use?

A
  • Class: Angiotensin II anatagonists
  • Mechanism: Antagonist at angiotensin II receptor of vascular muscle.
  • Indications: Hypertension
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15
Q

What class of drug is Amlodipine?

What is its mechanism of action?

What are the indications of use?

A
  • Class: Calcium channel blocker
  • Mechanism: Peripheral vasodilation, enhanced myocardial contractility and output
  • Indications: Hypertension, chronic stable angina, vasospastic angina.
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16
Q

What class of drug is Lovastatin, Pravastatin, Simvastatin, Atorvastatin, Cerevastatin?

What are their mechanism of action?

What are their indications of use?

A
  • Class: Statin - lipid lowering
  • Mechanism: Inhibits HMG-CoA reductase in liver. This enzyme catalyses the rate-limiting step in cholesterol synthesis
  • Indication: LDL > 190 mg/dl (160 with 2 risk factors) provided that 6 months trial of low lipid diet has failed.
17
Q

What is the mechanism of action of Heparin?

A

Binds to antithrombin III. This complex then binds to and inhibits activated clotting factors to prevent conversion of fibrinogen to fibrin.

18
Q

What is the mechanism of action of Warfarin?

A

Antagonise vitamin K. Interfere with the synthesis of vitamin K-dependent clotting factors (II, VII, IX, X)

19
Q

What is the mechanism of action of aspirin and ibuprofen as an antithrombotic drug?

A

Inhibits cyclooxygenase. Thus prevents formation of thromboxane A2 and prostaglandins (which induce platelet aggregation).

20
Q

What class of drugs is clopidogrel?

What is its mechanism of action?

What are the indications of use?

A
  • Class: antithrombotic
  • Mechanism: Blocks platelet aggregation by inhibiting ADP receptor.
  • Indications: Redution of atherosclerotic events.

Year 3 (11 decks)

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