systemic drugs and ocular adverse reactions Flashcards
what are the non-modifiable risks of cardiovascular disease?
what are the modifiable risks of cardiovascular disease?
Non-modifiable risks: Can’t change some risk (age and ethnicity)
Modifiable risks (50%): smoking, hypertension, hyperlipidaemia, weight, diet (reduce salt, saturated fat), alcohol consumption
what is hypertension a risk factor for?
stroke, myocardial infarction, heart failure, chronic kidney disease, cognitive decline (vascular dementia) and premature death
how is hypertension diagnosed?
if blood pressure is above 140/90 mmHg, ambulatory blood pressure monitoring is offered or home blood pressure monitoring to confirm hypertension
what shouldn’t be used in black ethnicity to treat blood pressure?
ACE inhibitors
how to ACE inhibitors lower blood pressure?
how is angiotensin II produced ?
they inhibit enzyme ACE so angiotensin II isn’t produced.
kidney produces an enzyme called renin which catalyses conversion of angiontension I to angiotensin II.
angiontension I becomes substrate for ACE which converts it into asngiontension II.
angiotensin II is a potent vasoconstrictor.
constricts blood vessels which increases peripheral resistance and increased blood volume.
what are the side effects of ACE inhibitors?
15% of px develop a cough
Taste disturbance
Angioedema-swelling of lower extremities
First dose hypotension
Hyperkalaemia-raised potassium levels in blood
what types of drugs are used to treat hypertension?
ACE inhibitors
angiotensin II receptor antagonists
calcium channel blockers
diuretics
beta blockers
Name ACE inhibitors
end in PRIL
captopril
enalapril
lisinopril
ramipril
what do angiotensin II receptor antagonists do?
Name them
why are they better than ACE inhibitors?
block angiotensin II receptor
ends in ARTAN
candesartan, losartan, valsartan
fewer side effects
how do calcium channel blockers reduce blood pressure?
what are they used to treat?
name them
Inhibit inwards movement of calcium ions through the slow L-type calcium channels in active membranes:
-cells of the myocardium
-cells within the His-purkinje system of the heart
-cells of vascular smooth muscle
*Work by reducing contractability of smooth muscle cells around blood vessels
*Regulates blood pressure by changing contractibility of the heart or causing vasodilation and reducing peripheral resistance.Also reduces cardiac output.
hypertension, angina
nifedipine
amlodipine
verapamil
diltiazem
How do diuretics reduce blood pressure?
what are the different types?
promote excretion of salt and water by increasing urine production and increasing salt composition
prevent re-uptake of salt in kidney to reduce blood volume
thiazides
loop diuretics
potassium sparring
how do thiazides work?
what is the side effect?
name them
Inhibit re-absorption of sodium into distal tubule
Reduce BP by vasodilation and reduction in blood volume
Can lead to potassium deficiency
bendrofluazide
hydrochlorothiazide
indapamide
how do loop diuretics work?
what is the benefit of using them?
what are they used to treat?
name them
Inhibit reabsorption of sodium and potassium in the thick ascending limb (TAL) of Henle
fast acting
renal failure, heart failure
furosemide
bumetanide
how do potassium sparring diuretics work?
name them
Act at DCT (distal convoluted tubule)
Retain potassium
amiloride
spironolactone
how do beta blockers reduce blood pressure?
what are they used to treat?
Name them
Reduce heart rate and force of contraction
Reduce peripheral resistance
Inhibition of renal release
angina, people who have had a heart attack
atenolol
metoprolol
name less commonly used anti-hypertensive agents
- Alpha-adrenoceptor antagonists
- Doxazosin
- Centrally acting agents
- Methyldopa
- Moxonidine
- Vasodilators
- Hydralazine
- Minoxidil
what is angina pectoris?
how can it be treated pharmacologically?
insufficient oxygen supplied to cardiac muscles due to narrowing of coronary arteries (thrombi in them)
Single acute attack: glyceryl trinitrate potent vasodilator
Prophylaxis: sublingual GTN, aspirin, beta blockers, calcium channel blockers.
how can you pharmacologically treat a myocardial infarction?
Analgesia for pain relief
IV infusion to try and dissolve clot aspirin (blood thinner)
Prophylaxis: beta blockers, ACE inhibitors, aspirin, lipid lowering therapy
what is the treatment for heart failure?
- Diuretics
- ACE inhibitors
- Nitrates
- Beta blockers
- Ionotropic drugs e.g., Digoxin
what are the different cardiac arrhythmias and what drugs are used?
Supraventricular tachycardia e.g., Adenosine, Verapamil
Arrhythmias caused by Wolf-Parkinson-White Syndrome e.g., Amiodarone, Disopyramide, Flecainide
Atrial fibrillation (atria not fully contracting) e.g., Digoxin, Disopyramide, Amiodarone
Ventricular tachycardia e.g., Lidocaine, Amiodarone
what are the types of cholesterol?
- Low density lipoprotein (LDL)
- High density lipoprotein (HDL)
LDL cholesterol (bad cholesterol) is particularly associated with atheroma and cardiovascular disease
HDL is good cholesterol
how do statins work?
Liver cells synthesis cholesterol.
Sometimes people are producing excessive levels of cholesterol.
Statins target key enzyme in synthetic pathway to cholesterol. Enzyme is called HMG-CoA.
Cholesterol production is blocked.
Cell wants to absorb more cholesterol so increases number of receptors on its surface and cell just takes all the LDL out of the system which is normally circulating in the blood.
what is recommended for px with mild depression?
watchful waiting-may recover with no intervention
CBT: individual guided self-help base on principles of cognitive behavioural therapy
CCBT: computerised cognitive behavioural therapy
Structured group physical activity programme
who should antidepressants be considered for?
*a history of moderate or severe depression
*subthreshold depressive symptoms present for a long time
*subthreshold depressive symptoms or mild depression that persist(s) after other interventions.
