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Baz: Semester 2 > Pharmacology: Cardiovascular Drugs > Flashcards

Pharmacology: Cardiovascular Drugs Flashcards

1
Q

First line treatment for high blood pressure, when do you give ACEi/ARBs and when do you give CCBs?

A

ACEi/ARB:

  • Hypertension with diabetes
  • Hypertension without diabetes, < 55 and not of african decent

CCBs:

  • Hypertension without diabetes, >55 or of african decent
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2
Q

So you’ve tried someone on ACEi/ARBs and CCBs for hypertension and it’s still not working. What is the next step?

A

Thiazide-like diuretic

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3
Q

How do ACEi work?

A

They block the conversion of angiotensin 1 into angiotensin 2

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4
Q

How does angiotensin II contribute to high blood pressure?

A

It cause vasoconstriction.

It causes an increase in blood volume by more H2O from vassopressin release and more Na+ from aldosterone release.

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5
Q

What is a side effect of blocking angiotensin converting enzyme using ACEi?

A

The enzyme also breaks down bradykinin so blocking it leads to a build up.

Bradykinin not only contributes to vasodialation but also makes vessels leaky leading to odema

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6
Q

Examples of ACEis

A

Ramipril
Lisinopril
Perindopril
Enalapril

Pril - April - Albie - ACE

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7
Q

How to ARBs work?

A

Angiotensin II receptor blockers

They block angiotensin II from acting therfore having the same effect as ACEi but without the bradykinin buildup

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8
Q

Examples of ARBs

A

Losartan
Candesartan
Valsartan
Irbesartan

‘Artan - Tartan
ARB - arbeleser - french
Ald alliance

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9
Q

How do calcium channel blockers work?

A

Smooth muscle needs external calcium to contract

By blocking these channels it decreases contractability of the smooth muscles therefore cause vasodilation and decreases stroke volume of the heart.

It also slows conduction of the heart therefore decreasing heart rate

All of these lead to lower BP

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10
Q

Three ways CCBs contribute to a lower BP?

A
  • Vasodilation
  • Cardiac muscle contractibility
  • Lowers heart rate
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11
Q

Example of a CCB

A

Amlodapine

Pine - no pines on The Downs - with pines there no calium (chalk)

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12
Q

How do thiazide and thiazide like diuretics work?

A

They act to inhibit the co transport of Na+ and Cl- in the distal convoluted tubule of the kidney

This causes there to be more Na+ in the urine therefor the urine will absorb more water. More Na+ and H2O are excreted resulting in lower blood pressure

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13
Q

Why are thiazide diuretics capped at retaining 5-10% of filtered Na+?

A

Because they only act on the distal convoluted tube where active transport occurs

Majority of Na+ transport accurs passively in the promimal convoluted tubule

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14
Q

How do potassium sparing diuretic work?

A

They block aldosterone receptors which exchange Na+ for K+ thus increasing Na+ and H2O secretion

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15
Q

Main difference of thiazide diuretic and potassium sparing diuretics?

A

Thiazide diuretics cause a decrease in potassium also because there is more Na+ to exchange with

Potassium sparing increase potassium

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16
Q

How to remember if a drug is a thiazide diuretic?

A

Its name will end in thiazide e.g. bendroflumethiazide

Thiazide-like one don’t end in thiazide - these are all different so bun remembering

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17
Q

How to remember if a drug is a potassium sparing diuretic?

A

The end in ‘one and they block aldosterone e.g. spironolactone

18
Q

Last drug family that can also be used for hypertension?

A

Beta blockers

19
Q

How to remember if a drug is a beta blocker?

A

They all end in ‘olol e.g. atenolol

Beta - lol - olol

20
Q

Decribe broadly the treatment for each of these stages of cardiac ischemia

A
21
Q

What are nitrates?

A

The are precursors for nitric oxide which is a vasodialator

22
Q

When are nitrates used?

A

Heart failure

23
Q

An example of a nitrate?

A

Glycerol Trinitrate (GTN) “nitroglycerin”

24
Q

With regard to cardiovascular when might you use a beta blocker?

A

With angina - reduces work heart has to do

25
Q

What is the purpose of using raas drugs when treating heart ischemia?

A

Mostly to decrease afterload (blood pressure) and venous return

26
Q

In what way does vasodilation from nitrates help with cardiac failure?

A

It most act ont he venous side not arterial. By dilateing the viens it decreases venous return and thus how much the heart has to work though prevent pooling and odema

27
Q

How to statins work?

A

They inhibit the production of cholesterol

28
Q

How does aspirin have anti-thrombitic effects?

A

It inhibits cox1 which in turn inhibits the production of thromboxane A2 which is a platelet activator

Aspirin is a anti-platelet not an anticoagulant, it prevents clotting not coagulation

29
Q

What is dalteparin

A

A low molecular weight heparin

It is a standard prophylactic against DVT or other thrombitic diseases

30
Q

Where does heparin act?

A

It directly blocks factor Xa which is central for the coagulation cascade

It also inhibits thrombin or factor IIa which converts fibrinogen into fibrin

31
Q

Naming of DOACs

A

dabigatran, apixaban and rivaroxaban

aban or atran

a ban on a tran (train)

32
Q

What is DOACs mechanism of action?

A

The bans directly block factor 10a

The trans block thrombin

33
Q

Warfarin mechanism of action

A
34
Q

describe the extrinsic pathway of the coagulation cascade up to Xa

A

It goes XII->XIIa

XI->XIa

IX->IXa

Both IXa and VIII are required for X->Xa

X -> Xa

35
Q

describe the intrinsic pathway of the coagulation cascade up to Xa

A

VII->VIIa

VIIa plus tissue factor convert X->Xa

36
Q

Decribe the coagulation cascade from Xa onwards (common pathway)

A

Xa converts
Prothrombrin->Thrombrin (factor IIa)

Thrombrin converts
Fibrinogen->Fibrin(factor Ia)

At the end factor XIII is also thrown in for good measure

37
Q

What is a common side effect of an ACEi?

A

Cough

It also blocks the breaks down of bradykinin causing build up in the blood

Bradykinin induces sensitization of airway sensory nerves via rapidly adapting stretch receptors and C-fiber receptors that releases neurokinin A and substance P. This causes airway smooth muscle to constrict leading to bronchoconstriction and cough.

38
Q

A 65yo man of african-caribbean heritage has hypertension. No pmh and is a non-smoker

What would be the first line drug of choice?

ACEi

Thiazide diuretic

Potassium sparing diuretic

CCB

A

CCB

e.g. amlodipine

39
Q

What effect would a beta2 agonist have on serum potassium level?

A

Decrease serum potassium

Increase intracellular potassium

40
Q

What effect would a beta2 agonist have on serum calcium level?

A

Increase serum calcium

Decrease intracellular calcium (needed for contraction) by pumping it out and by pumping it into the SR

Baz: Semester 2 (42 decks)

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