PHARMACOLOGY Flashcards
What shrinks the window for coronary flow?
- shortening diastole
- increased ventricular end-diastolic pressure
- reduced diastolic arterial pressure
Define angina.
chest pain due to inadequate supply of oxygen to the heart
What 3 factors can bring on angina?
- exercise
- cold
- excitement
What are the two classes of ischaemia causing angina, and what types of angina do they each include?
DEMAND ISCHAEMIA
chronic stable angina
SUPPLY ISCHAEMIA
unstable angina
Printzmetal (variant) angina
What are the causes for each of the 3 types of angina?
STABLE ANGINA
fixed narrowing of the coronary arteries
UNSTABLE ANGINA
thrombus around a ruptured atheromatous plaque without complete occlusion of vessel
VARIANT ANGINA
coronary artery spasm
What are the two main actions of beta blockers on the heart?
- slowing the heart
- anti-dysrhythmic
What are the 3 clinical uses of calcium-channel antagonists?
- treatment of pain in angina
- antidysrhythmic
- treatment of hypertension
What are the main side-effects of calcium-channel antagonists?
- headache
- constipation
- ankle oedema
What are the types of angina targeted by organic nitrates?
- stable angina
- unstable angina
What are organic nitrates used for other than management and prophylaxis of angina?
- acute heart failure
- chronic heart failure
Explain the mechanism of action of nicorandil.
activates potassium-ATP channels –> hyperpolarisation of vascular smooth muscle
+ nitrovasodilator actions
Give the name of two inhibitors of F-type Na+ channels used as anti-anginals.
- ivabradine
- ranolazine
Give 6 factors affecting drug distribution.
- cardiac output and blood flow
- plasma protein binding
- lipid solubility
- degree of ionization
- pH of compartments
- capillary permeability
What would cause hypoalbuminemia? What would be the consequences on free drug levels?
- burns
- renal disease
- malnutrition
- hepatic disease
increase in free drug level
What three factors affect capillary diffusion?
- surface area
- time
- nature of capillary (continuous, fenestrated, discontinuous
Name 4 types of specialized barriers to drug distribution.
- blood brain barrier
- chronic abscesses
- lung infection
- placenta
What types of drugs would you respectively find in extracellular fluid? plasma? total body water?
ECF
large water-soluble molecules
PLASMA
- highly plasma-bound molecules
- highly charged molecules
- very large molecules
TOTAL BODY WATER
small water-soluble molecules
How would you calculate the steady state plasma concentration?
rate of drug administered/clearance
How would you calculate the apparent volume of distribution of a drug?
total amount of drug in body / blood plasma concentration of drug
What are the two assumptions of the single compartment model of distribution?
- rapid mixing of drug in plasma
- drug in plasma in rapid equilibrium with drug in extravascular tissues
What are the factors that influence the volume of distribution of a drug?
- height
- weight
- age
- fluid accumulation
- accumulation of fat
What are the three goals of hypertension treatment?
- reduce arterial BP to recommended targets
- reduce the risk of end-organ damage
- reduce the risk of mortality due to CV disease
When are anti-hypertensive drugs indicated in people wit stage 1 hypertension?
one of:
- target organ damage
- established cardiovascular disease
- renal disease
- diabetes
- CV risk of 20% or greater
What is the BP treatment target for over 80yrs olds?
< 150/90mmHg
Name 3 ACE inhibitors and 3 ARBs used in treatment of hypertension.
ACE INHIBITORS
- ramipril
- lisinopril
- captopril
ARBs
- amlodipine
- felodipine
- lercanidipine
What is the aim of treatment of heart failure?
- relieve symptoms
- improve exercise tolerance
- reduce incidence of acute exacerbations
- reduce mortality rates
What are the 5 device therapies available for heart failure?
- pacing
- cardiac resynchronisation therapy
- implantable cardiac defibrillator
- coronary revascularisation
- heart transplant
What is step 1 of treatment of chronic heart failure?
diuretics if fluid overload + ACE inhibitors or ARBs + beta-blocker
What are Digoxin side-effects?
GI upset, dizziness, conduction abnormalities, blurred or yellow vision
