CV Medication

What is the MOA of ACE inhibitors?

Blocks the conversion of angiotensin I to angiotensin II by inhibiting the Angiotensin Converting Enzyme (ACE) - angiotensin II is a potent vasoconstrictor so less of this will dilate blood vessels and reduce BP

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What effect can ACE inhibitors have on potassium levels?

Increase - increases risk of hyperkalaemia

2 of 86

Why is persistent dry cough a potential side effect of ACE inhibitors?

ACE also breaks down bradykinin so inhibition increases bradykinin levels which can cause a dry cough

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Why are ACEi/ARBs used in management of HF?

Reduces stress on the heart

4 of 86

What other class of drug are they used with to reduce stress on heart?

Beta-blockers

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ACEi/ARBs are nephroprotective in diabetic patients.
T/F?

True

6 of 86

Can ACE/ARBs be used in pregnancy?

No

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What substance does a C1 Esterase Inhibitor Deficiency cause a patient to already have an increased amount of in the body?

Bradykinin

8 of 86

Why is this?

Because there is less C1 Esterase Inhibitor to inhibit bradykinin production

9 of 86

Therefore, the use of ACEi/ARBs are contraindicated in this condition.
T/F?

True

10 of 86

U&Es need to be re-checked after 2-4 weeks of initiation or dose change.
T/F?

False - 1-2 weeks after

11 of 86

What is the MOA of Angiotensin Receptor Blockers (ARBs)?

They block angiotensin II receptors which means this cannot have its vasoconstrictive effect and so reduces BP

12 of 86

Why is an ARB a good alternative to ACEi when a patient develops a dry cough?

It has the same effects on BP but they don't affect bradykinin due to ACE still being produced and able to break down bradykinin

13 of 86

Why are ACEi/ARBs are contraindicated in chronic kidney disease (CKD)?

They reduce blood volume so can reduce perfusion at the kidney which can worsen kidney function

14 of 86

Which other kidney disease - characterised by the narrowing of both renal arteries - is contraindicated because of decreased perfusion of kidneys?

Bilateral Renal Artery Stenosis

15 of 86

What drug can ACEi/ARBs decrease the elimination of?

Lithium

16 of 86

When should the first dose be administered and why?

Bedtime - reduce risk of falls as first dose can cause postural hypotension

17 of 86

Beta-blockers mimic the natural effects of noradrenaline/adrenaline on the body.
T/F?

False - blocks adrenergic receptors so does the opposite

18 of 86

Which organs have B1 receptors?

Heart and kidney

19 of 86

What effect do beta blockers have on the heart?

Reduce heart rate and contractility

20 of 86

Oxygen demand of the heart decreases with the use of beta-blockers.
T/F?

True

21 of 86

Therefore, which conditions are these used to treat by reducing oxygen demand?

Coronary artery disease (MI and angina)
and
Heart failure

22 of 86

What do beta blockers decrease the production of in the kidneys?

Renin

23 of 86

Why are beta blockers such as timolol used as eye drops for conditions such as glaucoma?

Reduced intra-ocular pressure

24 of 86

What can beta blockers mask symptoms of in diabetic patients?

Hypoglycaemia

25 of 86

Why can beta-blockers possibly cause diarrhoea?

Increase GI motility by blocking B2 receptors which would normally slow GI motility when NA/A binds

26 of 86

Why should beta blockers be used with caution in asthma/COPD patients?

They can cause bronchospasm by blocking B2 receptors in airways

27 of 86

What beta blockers should be used in preference for patients with asthma/COPD?

Cardioselective

28 of 86

1st generation are selective for B1 receptors.
T/F?

False - 1st generation are non-selective for B1 and B2 receptors

29 of 86

Name 3 1st gen beta blockers.

Timolol
Propranolol
Sotalol

30 of 86

Which generation beta blocker is selective for B1 receptors?

2nd generation

31 of 86

High conc. of 2nd gen beta blockers may bind to B2 receptors aswell as B1.
T/F?

True

32 of 86

Name 4 2nd gen beta blockers.

Bisoprolol
Atenolol
Metoprolol
Acebutolol

33 of 86

What receptors do 3rd generation beta blockers bind to?

B1, B2 and alpha 1

34 of 86

Which beta blocker is safe in pregnancy?

Labetalol

35 of 86

What are the 2 3rd gen beta blockers?

Labetalol
Carvedilol

36 of 86

Why is carvedilol good for use in HF/HTN?

It has anti-oxidant properties that in turn reduce atherosclerosis

37 of 86

What type of beta blocker is a good alternative if there are side effects such as sleep disturbance/nightmares and why?

Water-soluble because it does not cross the BBB as easily

38 of 86

What way can you remember the water soluble beta blockers?

CANS mnemonic
C - celiprolol
A - atenolol
N - nadolol
S - sotalol

39 of 86

Which beta blocker is most likely to prolong QT interval?

Sotalol

40 of 86

Which beta blocker is commonly used for treatment of anxiety?

Propranolol

41 of 86

Propranolol is also commonly prescribed for which other condition?

Migraine prophylaxis

42 of 86

Beta blockers can be used in patients with thyrotoxicosis because increased T3 and T4 can increase sensitivity to __________ nervous system.

Sympathetic

43 of 86

What are the 2 classes of calcium channel blockers (CCBs)?

Dihydropyridine
Non-dihydropyridine

44 of 86

Name some dihydropyridine CCBs.

Amlodipine
Nifedipine
Nicardipine

45 of 86

What does calcium naturally cause in smooth muscle cells?

Contraction

46 of 86

Calcium channel blockers stop calcium from entering smooth muscle cells which inhibits contraction.
T/F?

True

47 of 86

How do dihydropyridine CCBs reduce BP?

Block calcium channels on smooth muscle cells of arteries to reduce contraction and cause vasodilation of these blood vessels

48 of 86

Vasodilation of arterial blood vessels reduce _____ ________ ________ and so reduces the pressure the heart needs to eject the blood during ventricular contraction.

Total peripheral resistance

49 of 86

What is a common side effect of amlodipine that can affect lower extremities?

Oedema

50 of 86

Why do CCBs potentially cause oedema?

Vasodilation causes an increase in capillary permeability which can allow fluid to leak into the interstitial space.

51 of 86

?What are the 2 non-dihydropyridine CCBs?

Verapamil
Diltiazem

52 of 86

Verapamil works on both cardiac tissue and vascular smooth muscle whereas diltiazem works primarily on cardiac tissue.
T/F?

False
Verapamil - cardiac tissue only
Diltiazem - Both cardiac tissue and vascular smooth muscle

53 of 86

Non-dihydropyridine CCBs exert their effects where in the heart?

SA node and AV node

54 of 86

Non-dihydropyridine CCBs reduce heart rate (via SA node) and AV conduction as well as reduce ________ by inhibiting cardiac myocyte contraction.

Contractility

55 of 86

Non-dihydropyridine CCBs are used in management of _____ _________ by blocking electrical impulses and giving the heart time to reset.

Atrial fibrillation

56 of 86

CCBs may be used in stable angina when beta blockers are not tolerated.
T/F?

True

57 of 86

CCBs can be used in management of _________ phenomenon in which blood vessels in digits undergo vasoconstriction which limits blood supply, especially in cold temperatures and when stressed.

Raynaud's

58 of 86

Which CCB would be most commonly used in Raynaud's phenomenon?

Nifedipine

59 of 86

_________ may be used for cluster headaches.

Verapamil

60 of 86

Why is flushing a side effect of CCBs?

Caused by vasodilation of blood vessels close to the skin

61 of 86

Which oral side effect may be most commonly caused by amlodipine?

Gingival hyperplasia

62 of 86

Which GI side effect may CCBs cause?

Constipation

63 of 86

Which hormonal conditions may be caused with the use of verapamil?

Gynecomastia (moobs)
Galactorrhoea (menstrual irregularities)

64 of 86

Which syndrome is CCBs contraindicated in where an additional conduction pathway is present in the heart?

Wolf Parkinsons White Syndrome

65 of 86

Which CCBs should never be prescribed with beta blockers?

Non-dihydropyridine CCBs
verapamil and diltiazem

66 of 86

CCBs should never be prescribed in a patient with heart block.
T/F?

True

67 of 86

Why should the use of non-dihydropyridine CCBs in unstable angina be restricted to those who cannot tolerate beta-blockers?

Because they do not reduce the risk of MI in unstable angina unlike beta blockers

68 of 86

Which unpleasant condition can be topically treated with CCBs?

Anal fissures

69 of 86

How do CCBs help to heal anal fissures?

They relax blood vessels and so increase blood flow to the anal fissure which promotes healing and reduces pressure/pain

70 of 86

What 2 CCBs come as an ointment for this indication?

Diltiazem
Nifedipine
(both come as ointments)

71 of 86

Thiazide diuretics inhibit _______ resorption at the distal convoluted tubule.

Sodium

72 of 86

Name 3 thiazide diuretics.

Bendroflumethiazide
Chlorothiazide
Hydrochlorothiazide

73 of 86

Name 3 thiazide-like diuretics.

Indapamide
Metolazone
Chlorthalidone

74 of 86

Thiazide diuretics pull calcium out of the kidney tubule which helps to prevent which condition?

Kidney stones

75 of 86

Thiazide diuretics increase resorption of calcium and so what other condition would this be useful for?

Osteoporosis

76 of 86

Name a potassium sparing diuretic?

Spironolactone

77 of 86

Diuretics can cause hypokalaemia. In turn, this can lead to _____________ due to a decrease in positive charge inside pancreatic beta cells leading to less insulin being released into the bloodstream.

Hyperglycaemia

78 of 86

Thiazide diuretics can also inhibit the transporter that allows excretion of uric acid from blood into the kidney tubule and so may exacerbate or increase risk of developing which condition?

Gout

79 of 86

Name the 6 imbalances associated with diuretics?
3 hypo
3 hyper

Hyponatraemia
Hypochloraemia
Hypokalaemia
Hypercalcaemia
Hyperuricaemia
Hyperglycaemia

80 of 86

Thiazide-like diuretics contain a ______ group because they are sulfonamide derivatives.

Sulfur

81 of 86

What condition can thiazide-like diuretics cause that comprise of a classic triad of symptoms due to a reaction from the sulfa component?

Acute interstitial nephritis

82 of 86

What are the 4 signs/symptoms?

Arthralgias
AKI
Rash
Increased eosinophils

83 of 86

Loop diuretics such as furosemide and bumetanide can cause toxicity of which 2 narrow therapeutic index drugs?

Lithium
Digoxin

84 of 86

Name 3 signs of digoxin toxicity.

Dizziness
Visual impairment - blurring, yellow vision
GI disturbances
Nausea & vomiting
Arrythmias
Rash

85 of 86

Digoxin increases the force of myocardial ___________ and reduces conductivity within the __ node.

Contraction
AV

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CV Medication

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