pharmacology (mainly hypertension)

Question 1

cardiovascular drugs Targets for therapy

Answer 1

Cardiac output and Peripheral Resistance

2. Interplay between:
   a. Renin-Angiotensin-Aldosterone system
   b. Sympathetic nervous system (noradrenaline)
3. Local vascular vasoconstrictor and vasodilator mediators

Question 2

ACE inhibitor Main clinical indications (3)

Answer 2

Hypertension
Heart failure
Diabetic nephropathy

Question 3

ACE inhibitor Main drug used and suffix

Answer 3

RAMIPRIL - main one
all end in “PRIL”

Question 4

adverse effects of ACE inhibitors and what they’re related to.

Answer 4

Related to reduced angiotensin II formation

a. Hypotension
b. Acute renal failure
c. Hyperkalaemia
d. Teratogenic effects in pregnancy – don’t give it to patients trying to conveive

Question 5

Angiotensin II Receptor Blockers (ARB) uses

Answer 5

Hypertension
Diabetic nephropathy
Heart failure
same as ACE inhibitors

Question 6

contrast ARBs and ACEs and when theyre switched

Answer 6

patients always put on ACE first as there is more evidence of effectiveness

moved to ARBs when cough is too much for patients on ACE - because ulike ACE, ARBs dont effect bradykinin breakdown

cant use either in pregnancy

Question 7

ARB suffix

Answer 7

-sartan

Question 8

ARB Main adverse effects

Answer 8

Symptomatic hypotension (especially volume deplete patients)
Hyperkalaemia
Potential for renal dysfunction
Rash
Angio-oedema

Contraindicated in pregnancy
Generally very well tolerated

Question 9

CCB Main clinical indications

Answer 9

Hypertension
Ischaemic heart disease (IHD) – angina
Arrhythmia (tachycardia)

Question 10

CCB different drug types, suffix and actions.

Answer 10

1. Dihydropyridines: nifedipine, amlodipine, felodipine, lacidipinePreferentially affect vascular smooth muscle
   Peripheral arterial vasodilators
2. Phenylalkylamines: verapamilMain effects on the heart
   Negatively chronotropic (red HR), negatively inotropic
3. Benzothiazepines: diltiazemIntermediate heart/peripheral vascular effects

Question 11

what channels do CCB block?

Answer 11

L-type calcium

Question 12

CCB Adverse effects

Answer 12

Due to peripheral vasodilatation (mainly dihydropyridines)
Flushing
Headache
Oedema
Palpitations

Due to negatively chronotropic effects (mainly verapamil/diltiazem) (SA node)
Bradycardia
Atrioventricular block

Due to negatively inotropic effects (mainly verapamil) (heart contractability)
Worsening of cardiac failure

Verapamil causes constipation

Question 13

BB Main clinical indications

Answer 13

Ischaemic heart disease (IHD) – angina
Heart failure
Arrhythmia
Hypertension

Question 14

BB -suffix

Answer 14

-lol

Question 15

some beta-blockers are selective and some are non-selective what is meant by this

Answer 15

• selective - only target B1 receptors in the heart and kidneys (not B2 in the lung)
• non-selective - target both B1 receptors in the heart and B2 in the lungs, vasc and smooth muscle

selective can be used in those with lung conditions as it doesn’t affect the lungs

Question 16

name the BB drugs which are selective and those which arent.

Answer 16

selective:
- metoprolol
- bisoprolol

non-selective:
- propranolol
- nadolol
- carvedilol

Question 17

BB Main adverse effects

Answer 17

Fatigue
Headache
Sleep disturbance/nightmares

Bradycardia
Hypotension
Cold peripheries

Erectile dysfunction

Worsening of:
- Asthma (may be severe) or COPD
- PVD – Claudication or Raynaud’s
- Heart failure – if given in standard dose or acutely

Question 18

diuretics Main clinical indications

Answer 18

Hypertension
Heart failure

Question 19

diuretic classes

Answer 19

Thiazides and related drugs (inhibit Na/Cl in distal tubule) - mild

Loop diuretics (loop of Henle) - potent

Potassium-sparing diuretics

Aldosterone antagonists

Question 20

Thiazide and related diuretics drugs

Answer 20

BENDROFLUMETHIAZIDE
HYDROCHLOROTHIAZIDE
CHLORTHALIDONE

Question 21

loop diuretics drugs

Answer 21

FUROSEMIDE
BUMETANIDE

Question 22

Potassium-sparing diuretics drugs

Answer 22

SPIRONOLACTONE
EPLERENONE
AMILORIDE
TRIAMTERINE

Question 23

diuretics Main adverse effects

Answer 23

• Hypovolaemia - (mainly loop diuretics) - decrease in blood volume
• Hypotension
• Low serum potassium (hypokalaemia)
• Low serum sodium (hyponatraemia)
• Low serum magnesium (hypomagnesaemia)
• Low serum calcium (hypocalcaemia)
• Raised uric acid (hyperuricaemia – gout)
• Impaired glucose tolerance (mainly thiazides)
• Erectile dysfunction (mainly thiazides)

Question 24

Other antihypertensives

Answer 24

α-1 adrenoceptor blockers:
- DOXAZOSIN

Centrally acting anti-hypertensives:
- MOXONIDINE
- METHYLDOPA

Direct renin inhibitor
- ALISKIREN

Question 25

treatment steps for hypertension - flowcart write it