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VASCULAR SYSTEM AND MEDICAL EMERGENCIES 303 > Pharmacology and Drugs for Cardiovascular Disease > Flashcards

Pharmacology and Drugs for Cardiovascular Disease Flashcards

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USMLE® Step 1 flashcards
1
Q

What end organ damage can hypertension cause?

A

Brain: thrombotic, thromboembolic, hemorrhagic stroke
Heart: LVH, LV failure, coronary artery disease
Kidney: renal failure
Eyes: hypertensive retinopathy

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2
Q

Major risk factors for cerebrovascular atherosclerosis?

A 
Hypertension
Smoking
Diabetes
Hyperlipidemia
Obesity
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3
Q

What does the prognosis of hypertension depend on?

A

Level of systolic and diastolic BP
Age, sex, diabetes
Worse if evidence of end-organ damage
Improved with antihypertensive therapy

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4
Q

Non-pharmacological treatment of hypertension?

A

Weight reduction
Reduce salt, alcohol and fat intake
Exercise
Smoking cessation

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5
Q

List the common antihypertensive drugs?

A 
Thiazide diuretics
ACE inhibitors
Angiotensin II receptor antagonists
Beta blockers
Ca channel blockers
Alpha blockers
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6
Q

How to thiazide diuretics work?

A

Inhibit reabsorption of NaCl in proximal and early distal tubules of nephron

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7
Q

What is the most common thiazide?

Which one is used for severe congestive heart failure?

A

Bendroflumethiazide

Metolazone in combo with loop diuretics

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8
Q

Side effects of thiazide diuretics?

A

Electrolyte disturbance
Rash
Postural hypotension

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9
Q

What is the renin angiotensin system?

A

Angiotensinogen - angiotensin 1 - ACE - angiotensin II - Aldosterone from adrenal gland = decrease ECF, BP or Na = Renin released from juxtaglomerular cells

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10
Q

What do ACE inhibitors do?

A

Inhibit the conversion of angiotensin I to angiotensin II

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11
Q

Side effects of ACE inhibitors?

A

Dry cough, hypotension, rash, hyperkalaemia, renal failure, angioedema

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12
Q

What do angiotensin II receptor antagonists (ARBs) do?

A

Similar effects to ACE inhibitors but do NOT inhibit bradykinin metabolism = do not cause dry cough
e.g. Losartan, valsartan

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13
Q

What do beta blockers (beta-adrenoceptor antagonists) do?

A

Reduce HR, BP and CO

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14
Q

Contraindications of beta blockers?

A

Asthma, uncontrolled heart failure, bradycardia

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15
Q

Side effects of beta blockers?

A

Fatigue, hypotension, cold peripheries, bronchospasm

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16
Q

What do calcium channel antagonists do?

A

Vasodilators - reduce systemic vascular tone

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17
Q

Types of calcium channel antagonists?

A

Verapamil and diltiazem - cause bradycardia, inhibit AV node conduction
Amlodipine, lercanidipine - may cause a reflex tachycaradia

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18
Q

Side effects of calcium channel antagonists?

A 
Oedema
Flushing
Headache
Dizziness
Hypotension
19
Q

Name the vasodilators used to treat hypertension

A 
Alpha blockers: doxazosin
Hydralazine
Methyldopa (can be used in pregnancy)
20
Q

Side effects of vasodilators treating hypertension?

A

Hypotension
Headache
Tachycardia
Oedema

21
Q

What is ischaemic heart disease?

A

Atherosclerosis of coronary arteries that may lead to stenosis and arterial thrombosis

22
Q

How does atherosclerosis progress?

A

Fatty streak - fibrous plaque - atherosclerotic plaque = angina, transient ischaemic attack = plaque rupture/fissure and thrombosis = MI, ischaemic stroke, critical leg ischaemia, CV death

23
Q

List anti-anginal drugs

A

Beta blockers
Nitrates
Ca channel blockers
Potassium channel activators

24
Q

What to beta blockers do?

A

Lower myocardial oxygen demand by reducing HR, BP and myocardial contractility
May exacerbate cardiac failure and peripheral vascular disease and cause bronchospasm

25
Q

What may beta blockers exacerbate?

A

May exacerbate cardiac failure and peripheral vascular disease and cause bronchospasm

26
Q

What can abrupt withdrawal of beta blockers do?

A

Arrhythmia, worsening angina or MI

27
Q

How can nitrates be taken?

A

Oral, sublingual, buccal, transdermal, intravenous

28
Q

What do nitrates provide? How?

A

Symptomatic relief of angina
Produce nitric oxide at the endothelial surface leading to vascular smooth muscle relaxation and arteriolar and venous dilation

Reduce myocardial oxygen demand and increase myocardial oxygen supply

29
Q

Side effects of nitrates?

A

Headache, flushing, postural hypotension

30
Q

What do calcium antagonists do?

A

Lower myocardial oxygen demand by reducing blood pressure and myocardial contractility and increase myocardial oxygen supply by dilating coronary arteries

31
Q

What calcium antagonists should be avoided in heart failure?

A

Verapamil and Diltiazem

32
Q

How do potassium channel activators work?

A

They have arterial and venous dilating properties

33
Q

What can potassium channel activators cause?

A

Mucocutaneous ulceration

34
Q

How do antiplatelet drugs work?

A

Inhibit platelet aggregation and arterial thrombus formation = prevent heart attack, stroke and CV death

35
Q

Give examples of antiplatelet drugs and how do they work?

A

Aspirin - blocks COX11 and production of thromboxane A2 (platelet activating substance)
Clopidogrel, prasugrel, ticagrelor - platelet P2Y12 receptor inhibitors, used in combo with aspirin or alone
Dipyridamole - in combo with aspirin to prevent stroke

36
Q

What are statins? What do they do?

A

HMG CoA reductase inhibitors
Lower LDL cholesterol and may increase HDL cholesterol
Reduce risk of MI, stroke and CV death

37
Q

Examples of statins?

A

Simvastatin, pravastatin, atorvastatin

38
Q

What is heart failure?

A

The state that develops when the heart cannot maintain an adequate cardiac output or can do so only at the expense of an elevated filling pressure

39
Q

How to treat chronic heart failure?

A

Diuretics, ACE inhibitors, Beta blockers, Aldosterone antagonists

40
Q

How do diuretics work on the kidney?

A

Thiazides - inhibit Cl-Na active exchange in the ascending loop of Henle

K-sparing = inhibit reab of Na in the collecting tubule

Loop diuretics = acts on medulla, inhibit Cl-Na-K exchange in the thick segment of the ascending loop of Henle

41
Q

What are Tachyarrhythmias? Types?

A

Abnormal heart rhythm
Atrial fibrillation or atrial flutter with rapid ventricular rate response (AF)
Supraventricular tachycardia (SVT)
Ventricular tachycardia (VT)

42
Q

What does digoxin (digitalis) do?

A

Blocks Na/K ATPase => Ca

Increase vagal tone - slows conduction in atrial fibrillation

43
Q

Classification of oral antiarrhythmics?

A

Class Ia,b,c – disopyramide, flecainide, procainamide
Class II – beta blockers
Class III – amiodarone, dronedarone, sotalol
Class IV – calcium antagonists (verapamil, diltiazem)

VASCULAR SYSTEM AND MEDICAL EMERGENCIES 303 (3 decks)

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