PHARMACOLOGY Flashcards
1
Q
mechanism of ivabradine
A
selective blocker of HCN channels
2
Q
effect of ivabradine on the pacemaker potential
A
reduces the slope
3
Q
ivabradine effect
A
slows HR
reduces oxygen consumption
4
Q
ivabradine uses
A
angina
tachycardia
mild to moderate chronic heart failure
5
Q
side effects of ivabradine
A
arrhythmias
hypotension
6
Q
name B-adrenoreceptor agonists
A
dobutamine
adrenaline
noradrenaline
7
Q
which channels is dobutamine selective for?
A
B1
8
Q
mechanisms of B-adrenoreceptor agonists
A
results in stimulation of adenylyl cyclase and production of cAMP which generates protein kinase A
phosphorylation increases Ca++ influx and release of Ca++ from the SR
9
Q
effect of B-adrenoreceptor agonists
A
increase contractility, force and rate
decrease cardiac efficiency
10
Q
use of B-adrenoreceptor ligands
A
infarction cardiogenic shock cardiomyopathies inotropic support heart failure (dobutamine) asthma emergency (adrenaline) anaphylactic shock
11
Q
side effects of B-adrenoreceptor agonists
A
arrhythmias
acute MI
12
Q
name B blockers
A
propranolol
metoprolol
atenolol
13
Q
which of the B blockers is non selective?
A
propranolol
14
Q
which of the B blockers are selective for B1?
A
metoprolol
atenolol
15
Q
effect of B blockers
A
decrease in heart rate, contractility, MAP and O2 consumption
16
Q
use of B blockers
A
angina
hypertension
heart failure
17
Q
side effects of B blockers
A
asthma fatigue cold peripheries heart failure bradycardia (heart block) hypoglycaemia
18
Q
which patients could have heart failure as a side effect of beta blockers?
A
in patients who rely on sympathetic drive to maintain CO
19
Q
name the muscarinic antagonist which is non selective for M2 receptors
A
atropine
20
Q
effect of atropine (muscarinic antagonist)
A
increase in heart rate
21
Q
use of atropine (muscarinic antagonist)
A
reverse bradycardia following an MI
22
Q
side effects of atropine
A
arrhythmias
hallucinations
confusion
23
Q
name the cardiac glycoside
A
digoxin
24
Q
mechanism of action of digoxin
A
competes with K+ and at alpha subunit blocks the Na/K ATPase pump
25
effect of digoxin
increase in contractility, force and CO
indirect- increased vagal discharge and slows SA node discharge
shortens action potential and refractory period
26
when are the effects of digoxin dangerously enhanced?
hypokalaemia
27
use of digoxin
heart failure
| atrial fibrillation
28
side effects of digoxin
heart block
dysrhythmias
myocarditis
29
name the calcium sensitiser
levosimendan
30
mechanism of levosimendan
binds to troponin C in myocytes, sensitising them to Ca2+
31
effect of levosimendan
increase in contractility
32
use of levosimendan
acutely decompensated congestive heart failure
33
side effects of levosimendan
headaches
arrhythmias
hypokalaemia
34
class I anti arrhythmic drug
```
A = disopyramide
B = lignocaine
C = flecainide
```
35
mechanism of class I
voltage activated Na+ channels
| reduces Na+ channel current
36
use of class I
rhythm control
37
side effects of class I
negative inotropic effects
38
class II anti arhythmic drug
B-blockers eg propranolol
39
use of class II
rate control
40
class III anti arhythmic drug
amiodaron sotalol
41
mechanism of amiodaron sotalol
voltage activated K+ channels
| action potential prolongation
42
use of amiodaron sotalol
rhythm control
43
class IV anti arrhythmic drug
Ca2+ channel antagonist eg verapamil
44
use of class IV
rate control
45
name nitrates
isosobide mononitrate
| GTN spray
46
mechanism of nitrates
```
mimic the effect of endothelium
produce nitric oxide
NO causes efflux of Ca++ producing hyperpolarisation and relaxation
cGMP is also produced which regulates protein kinase G activity causing relaxation
endothelin is also produced
venorelaxation
arteriolar dilatation
increase in coronary blood flow
```
47
name ACE inhibitors
prills eg ramipril
48
mechanism of ACE inhibitors
block the conversion of angiotensin I to angiotensin II so aldosterone and ADH are not stimulated
49
effect of ACE inhibitors
vasodilation and arterial dilation
50
use of ACEis
hypertension
| heart failure
51
side effects of ACEis
renal dysfunction
oedema
dry cough
52
when are ACEi and ARBs contraindicated?
pregnancy
53
name the ARBs
tans eg losartan
54
mechanism of ARBs
blocks angiotensin II receptors
55
use of ARBs
hypertension
heart failure
intolerance of dry cough of ACEi
56
side effects of ARBs
renal dysfunction
| oedema
57
name calcium antagonists
amlodipine
verapamil
diltiazem
58
mechanism of calcium antagonists
decrease conduction at SA and AV node
59
effect of calcium antagonists
decrease in heart rate
60
use of calcium antagonists
hypertension
angina
supraventricular arrhythmias
61
side effects of calcium antagonists
ankle oedema
| bradycardia (caution when using beta blockers)
62
name the main alpha blocker
doxazosin
63
mechanism of alpha blockers
block alpha adrenoreceptors to cause vasodilation
64
use of alpha blockers
hypertension
| prostatic hypertrophy
65
side effect of alpha blockers
postural hypertension
66
name potassium channel openers
DILS
minoxidil
nicroandil
67
mechanism of potassium channel openers
causes hyper polarisation which switches off calcium channels
mediated by ATP
68
effect of potassium channel openers
relaxation of vascular smooth muscle
69
use of potassium channel openers
severe hypertension
| angina
70
side effects of potassium channel openers
tachycardia
| salt and water retention
71
name a thiazide diuretic
bendrofluazide
72
name a loop diuretic
furosemide
73
mechanism of thiazide diuretics
inhibit NaCl reabsorption in distal tubules by blocking NaCl co-transporter
74
mechanism of loop diuretics
inhibit NaCl reabsorption in the thick ascending limb of the loop of henle
75
use of diuretics
hypertension
| heart failure
76
effect of diuretics
increase in excretion of Na, Cl and water
77
side effects of diuretics
```
hypokalaemia
arrhythmias
fatigue
hyperglycaemia
increase in uric acid = gout
```
78
name statins
simvastatin
| atorvastatin
79
mechanism of statins
blocks HMG coA reductase which inhibits the formation of cholesterol
80
effect of statins
decrease in LDL and total cholesterol inflammation
| stabilised atherosclerotic plaque and decreases thrombosis
81
use of statins
hypercholesterolemia
82
side effects of statins
used in caution with hypothyroidism and history of liver disease
myalgia, myopathy, myositis
83
name fibrates
bezafibrate
| gemfibrozil
84
mechanism of action of fibrates
agonist of nuclear receptors which enhances transcription of lipoprotein lipase which hydrolyses triglycerides to fatty acids and glycerol
85
use of fibrates
high triglyceride levels
86
side effect of fibrates
myositis
87
name bile acid binding resins
colestyramine
colestipol
colsevelam
88
mechanism of bile acid binding resins
cause the excretion of bile salts resulting in more cholesterol to be converted to bile salts
bile resins bind bile in the intestine so it is not absorbed in the duodenum
liver uses metabolises cholesterol to compensate for its lost
89
use of bile acid binding resins
decreased absorption of triglycerides
| increased LDL receptor expression
90
side effect of bile acid binding resins
GI tract irritation
91
mechanism of action of ezetimibe
inhibits transport proteins and reduces absorption of cholesterol
92
use of ezetimibe
to lower LDL cholesterol
93
side effects of ezetimibe
diarrhoea
abdominal pain
headache
94
when is ezetimibe contraindicated?
in breast feeding
95
name anticoagulants
warfarin
heparin
LMWH
orally active inhibitors
96
mechanism of action of warfarin
acts as a vitamin K antagonist which prevents production of mature coagulation factors
97
use of anticoagulants
DVT
PE
NSTEMI
AF
98
side effect of warfarin
haemorrhage anywhere
| reversed by vitamin K
99
mechanism of action of anticoagulants (except warfarin)
binds to antithrombin III, increasing its affinity for serine proteases to greatly increase their rate of inactivation
100
side effects of anticoagulants
haemorrhage
osteoporosis
hypoaldosteronism
hypersensitivity reactions
101
name anti platelets
aspirin
| clopidogrel
102
mechanism of action of anti platelets
prevent new thrombosis
blocks COX, inhibiting formation of TXA2 which causes cross linking of platelets
blocks ADP from binding to P2Y12 receptor and formation of fibrin
103
use of anti platelets
angina
acute MI
cerebral vascular incident (CVA) and TIA
patients at risk of above
104
side effects of anti platelets
haemorrhage
peptic ulcer
aspirin sensitivity -> asthma
105
name fibrinolytic drugs
streptokinase
tissue plasminogen activator
alteplase duteplase
106
mechanism of fibrinolytic drugs
fibrinolytic cascade opposes coagulation cascade
| activate formation of plasmin from plasminogen which lysis fibrin into fibrin fragments causing lysis of the clot
107
use of fibrinolytics
STEMI
PE
stroke
reopen acclude arteries
108
side effect of fibrinolytics
haemorrhage risk (controlled by tranexamic acid which inhibits plasminogen activation)
