Pharmacology and Drugs for Cardiovascular Disease

Question 1

Common CV conditions requiring drug therapy

Answer 1

Hypertension
Arrhythmia
Heart failure
Ischaemic heart disease and other atheromatous diseases

Question 2

Hypertension

Answer 2

Most conditions are asymptomatic
CV morbidity and mortality can be reduced by BP reduction
Early detection = better risk management and treatment

Question 3

End organ damage
Brain
Heart
Kidney 
Eyes

Answer 3

Brain - thrombosis, thromboembolism and haemorrhagic stroke, multi infarct dementia, hypertensive encephalopathy
Heart - LVH, LV failure, coronary artery disease
Kidney - renal failure
Eyes - hypertensive retinopathy

Question 4

Prognosis of hypertension

Answer 4

Related to systolic and diastolic BPs
Age, sex and other risk factors
Improved with antihypertensive therapy

Question 5

Non pharmacological treatment of hypertension

Answer 5

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

Question 6

Common antihypertensive drugs

Answer 6

Thiazide diuretics
ACE inhibitors
Angiotensin II receptor antagonists
Beta blockers
Calcium channel blockers
Alpha blockers

Question 7

thiazide diuretics

side effects

Answer 7

Inhibit reabsorption of NaCL in proximal and early distal
tubules of nephron
Lost in urine
Cheap
Bendroflumethiazide is most common
Metolazone
Electrolyte disturbance, rash, postural hypotension post standing up

Question 8

Mechanism of RAAS system - what happens when BP drops

Answer 8

Decreased BP
Renin released
Renin converts angiotensinogen to angiotensin 1
ACE converts AG1 to AG2
AG2 stimulates aldosterone release which increases reabsorption of Na+ ions
Leads to increased ECF therefore BP back to normal

Question 9

ACE inhibitors - side effects

Answer 9

ACE inhibitors inhibit conversion of AG1 to AG2

Infrequent side effects except for dry cough, rash, hyperkalaemia, renal failure, angioedema, loss of taste function

Question 10

ACE inhibitor mechanism

Answer 10

Inhibits angiotensin converting enzyme

Also inhibit breakdown of bradykinin leading to prolonged vasodilation to reduce BP further

Question 11

Angiotensin II receptor antagonists (ARBs)

Answer 11

Similar effects to ACE inhibitors but do not influence bradykinin metabolism so do not cause dry cough

Question 12

Beta blockers Beta adrenoceptor antagonists
Contraindications
Side effects

Answer 12

Reduce heart rate, BP and CO
Asthma, heart failure, bradycardia
Fatigue, hypotension, cold peripheries, bronchospasm, impotence.

Question 13

Autonomous NS

Answer 13

Involved in vasoconstriction in lower half of body

Effect of beta blockers on blood supply to legs

Question 14

Calcium channel antagonists
Main types
Side effects

Answer 14

Vasodilators - reduce systemic vascular tone
Two types
Verapamil and diltiazem
Amlodipine,,,dipine
Oedema, flushing, headaches, dizziness, hypotension

Question 15

Alpha blockers and other vasodilators

Side effects

Answer 15

Variety of other vasodilators used to treat hypertension
Hydrazine
Methyldopa
Hypotension, headache, tachycardia, oedema

Question 16

Ischaemic heart disease

Progression

Answer 16

Atherosclerosis of coronary arteries

Spectrum of presentation

Question 17

Antianginal drugs

Answer 17

Beta blockers
Nitrates
Calcium channel blockers
Potassium channel activators

Question 18

Anti-anginal drugs: Beta blockers

Answer 18

Lower O2 demand by reducing heart rate, BP and myocardial contractility
May make cardiac failure worse and peripheral vas disease

Question 19

Anti-anginal drugs: Nitrates

Side effects

Answer 19

GTN tabs/sorays, nitric oxide on endothelial surface -> vascular smooth muscle relaxation and art./venus
Reduce myocardial oxygen demand and gradual increase supply (coronary vasodilation)
Headaches, flushing, postural hypotension

Question 20

Anti-anginal drugs: Calcium antagonists

Answer 20

Lower myocardial demand by reduced BP and increasing oxygen supply

Question 21

Anti-anginal drugs: Potassium channel activators

Side effects

Answer 21

Nicorandil
Arterial and venous dilating properties
No problems with tolerance as seen with nitrates

Can cause mucocutaneous ulceration – relegated to second-line therapy

Question 22

Anti platelet drugs

Answer 22

Aspirin most common
Targets COX1 and blocks production of thromboxane A2
CPT used with aspirin

Question 23

Bleeding time in healthy volunteers

Answer 23

Less bleeding time in those given med

Question 24

Interaction between anticoagulants and anti platelets

Answer 24

Anticoagulant drugs prevent coagulation (driven by thrombin)

Thrombin initiates clotting
Thrombin also drives platelet formation

Question 25

Statins What are they - mechanism Reduce risk of?

Answer 25

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

Question 26

Heart failure

Answer 26

When heart cannot maintain an adequate cardiac output | Pulmonary/peripheral oedema due to high atrial pressures

Question 27

Drug treatment for chronic heart failure

Answer 27

``` Diuretics ACE inhibitors AgII receptor antagonists Beta blockers Aldosterone antagonists Digoxin PDE inhibitors ```

Question 28

Thiazides for HF

Answer 28

Inhibit active exchange of Cl-Na in the cortical diluting segment of the ascending loop of Henle K-sparing Inhibit reabsorption of Na in the distal convoluted and collecting tubule Low potassium can lead to rhythm defects Loop diuretics Inhibit exchange of Cl-Na-K in the thick segment of the ascending loop of Henle

Question 29

Aldosterone inhibitors - therefore have three types of effects:

Answer 29

Aldosterone inhibitors - Diuretic effect, which is most noticeable when fluid retention and increased levels of aldosterone are present. - Antiarrhythmic effect, mediated by the correction of hypokalemia and hypomagnesemia. - Antifibrotic effect. This effect, demonstrated in animal models, can contribute to a decrease in the progression of structural changes in patients with heart failure.

Question 30

TAchyarrhythmia

Answer 30

Different types AF SVT VT

Question 31

Tachyarrhythmia treatment

Answer 31

Digoxin - blocks Na+ / K+ ATPase => Ca+ + | increases Vagal tone – slows conduction in atrial fibrillation

Question 32

Oral antiarrhythmics | Drugs for controlling tachyarrhythmia

Answer 32

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