Pharmacology Flashcards by Ryan Quek

What is Hypertension?

The blood pressure level above which investigation and treatment do more good than harm

How well did you know this?

Not at all

Perfectly

What is Grade 1 Hypertension?

Systolic Pressure 140-159

Diastolic Pressure: 90-99

How well did you know this?

Not at all

Perfectly

What is Grade 2 Hypertension?

Systolic Pressure 160-179

Diastolic Pressure 100-109

How well did you know this?

Not at all

Perfectly

What is Grade 3 Hypertension?

Systolic Pressure >180

Diastolic Pressure >110

How well did you know this?

Not at all

Perfectly

What are the classes of drugs used to treat Hypertension?

ACE Inhibitors
Angiotensin/Angiotensin II Blockers
Beta Blockers
Calcium Channel Blockers
Diuretics
Alpha Blockers

How well did you know this?

Not at all

Perfectly

What is Angina?

Mismatch between myocardial oxygen supply and demand–> results from Ischaemia

How well did you know this?

Not at all

Perfectly

What is the difference between stable, unstable and variant angina?

Stable- No change in symptoms in previous weeks, associated with obstructive coronary disease
Unstable- Abrupt pattern change in symptoms, associated with plaque rupture
Variant- Usually stress-related, patients develop coronary spasm

How well did you know this?

Not at all

Perfectly

What are the symptoms of Angina?

Retrosternal discomfort
Pressure-like heart pain
Occurs with exertion, relieved by rest
Pain may radiate down arm

How well did you know this?

Not at all

Perfectly

What are the classes of drugs used to treat Angina?

Nitrates
Beta Blockers
Calcium Channel Blockers
ACE Inhibitors

How well did you know this?

Not at all

Perfectly

What is Heart Failure?

Heart failure is the pathological state in which the heart is unable to pump enough blood for the needs of metabolising tissues

How well did you know this?

Not at all

Perfectly

What is Heart Failure with Reduced Ejection Fraction?

Heart failure where the patient has systolic dysfunction–> Impaired Contractile Function

How well did you know this?

Not at all

Perfectly

What is Heart Failure with Preserved Ejection Fraction?

Heart failure where the patient has diastolic dysfunction–> Impaired Ventricular Filling due to stiffness or hypertrophy

How well did you know this?

Not at all

Perfectly

What are the classes of drugs used in the treatment of Heart Failure?

Diuretics
ACE Inhibitors
Angiotensin II Antagonists
Hydralazine/Nitrates
Beta Blockers
Inotropes

How well did you know this?

Not at all

Perfectly

What is Arrhythmias?

Usually associated with structural abnormality of myocardium, Due to Iscahemia, Heart Failure and Hypertrophic Obstructive Cardiomyopathy

How well did you know this?

Not at all

Perfectly

What are the classification of Arrhythmias?

Classic
Ventricular
Supra-ventricular

In Electrophysiology: Wide vs Narrow QRS Complex

How well did you know this?

Not at all

Perfectly

What is Wolfe Parkinson White Syndrome?

When the Electrical Impulse Bypasses the AV node

How well did you know this?

Not at all

Perfectly

What is important about Long QT Syndrome?

Drugs that prolong the QT interval in ECG can precipitate Arrhythmias

How well did you know this?

Not at all

Perfectly

What is Brugada Syndrome?

ST segment elevation in right heart leads–> Susceptible to Ventricular Tachycardia–> Treat with ICD

How well did you know this?

Not at all

Perfectly

What is an ICD?

Implantable Cardioverter Defibrillator–> effectively end most episodes of ventricular tachycardia or fibrillation

How well did you know this?

Not at all

Perfectly

What are the drugs used in the treatment of Arrhythmias?

Class 1a. Disopyramide, Quinidine, Procainamide
Class 1b. Lignocaine, Mexiletine
Class 1c. Propafenone, Flecainide
Class 2: Beta Blockers
Class 3. Amiodarone, Bretylium, Sotalol
Class 4. Calcium Channel Blockers

How well did you know this?

Not at all

Perfectly

How do Class 1a drugs work?

Quinidine and similar drugs–> They prolong QT interval and depress conduction that promote re-entry–> Proarrhythmic

How well did you know this?

Not at all

Perfectly

How do Class 1b drugs work?

Lignocaine–> Treatment for Ventricular arrhythmias associated with AMI and cardiac surgery by acting on ischaemic myocardium

How well did you know this?

Not at all

Perfectly

What are the side effects of Lignocaine?

Drowsiness
Paresthesia
Seizure activity

How well did you know this?

Not at all

Perfectly

How do Class 1c drugs work?

They block the fast Sodium Channels–> Treatment for both SVT and Ventricular Arrhythmias (in life threatening situations)

How well did you know this?

Not at all

Perfectly

What is the Major Side Effect of Flecanide?

Proarrythmic--> only given by electrophysiologist

What is the side effect of Propafenone?

Exacerbation of lung disease due to partial beta blocking action

How do Class 3 drugs work?

They slow depolarisation, prolonging the action potential duration--> Used in life threatening cases of both SVT and Ventricular Arrhythmias

What are the side effects of Class 3 drugs?

1. Thyroid Disorder 2. Photosensitivity 3. Liver damage 4. Pulmonary Alveolitis

What is the side effect of Bretylium?

Hypotension

When is Bretylium used?

In ICU setting in patients who have recurrent and refractory ventricular tacharrhythmias

How does Sotalol work in the treatment of Arrhythmias?

Non-specific Beta Blocker that prolongs depolarisation--> used to treat ventricular arrhythmias

What is the main side effect of Sotalol?

Prolong QT interval Heart Block Heart Failure Bronchoconstriction

How does Digitals (Digoxin) work in the treatment of Arrhythmias?

1. Increases Central Vagal Activity | 2. Slows conduction through the AV Node and Bundle of His

How do ACE Inhibitors work?

1. They inhibit the formation of Angiotensin II 2. Reduce the Breakdown of Bradykinin 3. Inhibit RAAS--> Decrease Retention of Fluid--> Decrease Blood Volume

What are the Side Effects of ACE Inhibitors?

1. Cough 2. Renal Failure 3. Hyper Kalaemia

What are examples of ACE Inhibitors?

Ramipril, Enalapril

How do Beta Blockers work?

They block the Beta adrenoreceptors, Causing Decreased Heart Rate and Decreased Cardiac Contractility

What are the side effects of Beta Blockers?

1. Bronchoconstriction 2. Negative Inotrophy 3. Fatigue 4. Heart Block 5. Heart Failure

What are examples of Beta Blockers?

Cardioselective--> Atenolol, Metoprolol | Non-Selective--> Propanolol, Timolol

What are the different types of Calcium Channel Blockers?

Dihydropyrimidine Calcium Channel Blockers and Non-Dihydropyrimidine Calcium Channel Blockers

What are the actions of Calcium Channel Blockers?

Dihydropyrimidine--> Causes Vasodilation in smooth muscle | Non-Dihydropyrimidine--> Prevents Supraventricular Tachyarrhythmias

What are the Side Effects of Calcium Channel Blockers?

1. Arterial Dilation 2, Reduced Cardiac Contractility 3. Heart Block and Bradycardia

What are examples of Calcium Channel Blockers?

Dihydropyrimidine--> Amlodipine, Vifedipine | Non-Dihydropyrimidines--> Dilitazem, Verapamil

How do Diuretics work?

Inhibit Na+ reabsorption and thus DecreaseWater retention--> Decrease Blood Volume/ get rid of Fluid--> decrease Blood Pressure

What are the side effects of Diuretics?

1. Fatigue 2. Low Electrolytes 3. Possible Arrhythmias 4. Hyperglycaemia

What are the 2 types of Diuretics?

1. Loop Diuretics | 2. Thiazide Diuretics

What is Spirolactone?

Antagonist of Aldosterone receptor--> used in Heart Failure

What are the Side effects of Spirolactone?

1. Hyperkalaemia | 2. Gynaecomastia

What are the actions of Nitrates in the treatment of Heart Failure/Angina?

They vasodilate both arterial and venous smooth muscle

What are the Side Effects of Nitrates?

1. Headache | 2. Hypotension

What are examples of Nitrates?

1. Nitroglycerin (sublingual) | 2. Isosorbide Dinitrate (Oral)

What are the actions of Hydralazines in the treatment of Heart Failure?

Relax the smooth muscle of precapillary resistance vessels--> but must be used together with Nitrates to be effective

What are the Positive Inotropes used in the treatment of Heart Failure?

1. Phosphodiesterase Inhibitors (short term increase of cardiac output) 2. Beta1 Adrenoreceptor Agonists (short term use)

What is a positive inotropic effect?

Inhibition of Na+/K+ ATPase--> Increase in intracellular Na+--> Increase in Intracytoplasmic Ca2+--> Increase Contractility of the Heart--> Increase Cardiac Output

What are the 2 types of drugs used in the treatment of Asthma?

1. Bronchodilators | 2. Anti-Inflammatories

What are the Bronchodilator Drugs used in Asthma treatment?

1. Beta-2 Adrenoreceptor Agonists 2. M3 Muscarinic Receptor Antagonists 3. Xanthines

What are the Anti-Inflammatory Drugs used in Asthma treatment?

1. Glucocorticoids 2. Cromones 3. Leukotriene Modifiers

What are the actions of ß2 Adrenoreceptor Agonists?

1. Cause Bronchodilation by increasing cAMP | 2. Inhibits mediator release from Mast Cells

What are the Side Effects of ß2-Adrenorecptor Agonists?

1. Tremor 2. Arrhythmias 3. Hypokalaemia 4. Muscle Cramps

What are examples of ß2-Adrenoreceptor Agonists?

Short-acting--> Salbutamol | Long-Acting--> Salmeterol

What are the actions of M3 Muscarinic Antagonists?

Inhibit actions af Acetylcholine, causing Bronchodilation and reduced mucus secretions

What are the side effects of M3 Muscarinic Antagonists?

1. Dry Mouth | 2. Urinary Retention

What are examples of M3 Muscarinic Antagonists?

1. Ipratropium | 2. Tiotropium

What are the actions of Xanthines?

Inhibit phosphodiesterase which increase cAMP and cGMP

What are the Side Effects of Xanthines?

1. Arrhythmias | 2. Nausea

What are examples of Xanthines?

Theophylline, Aminophylline

What are the actions of Glucocorticoids?

Inhibits the transcription of Genes coding for the cytokines involved in inflammation

What are the side effects of Glucocorticoids?

1. Dysphoina | 2. Thrush

What are examples of Glucocorticoids?

1. Beclomethasone | 2. Budesonide

What are the actions of Cromones?

Stabilise the Mast Cell and Inhibits Eosinophil accumulation in the lung

What are the side effects of Cromones?

Cough and Wheezing

What are examples of Cromones?

Nedocromil

What are the actions of Leukotriene Modifiers?

1. Counteract the release of Leukotrienes | 2. Inhibit LOX

What are examples of Leukotriene Modifiers?

LOX Inhibitor--> Zileuton | Leukotriene Receptor Antagonists--> Montelukast