Cariology year 2

Define angina

Angina is chest pain or discomfort that occurs when the heart muscle doesn't receive enough oxygen-rich blood.

What are some of the risk factors associated with angina pectoris?

High bp high cholesterol diabetes smoking, obesity, , family history and age

Describe what angina pain feels like and where can this spread too?

A tight heavy crushing pain that can radiate to the jaw neck, shoulders, and arms.

What are nitrates used for in angina?

Treat and prevent angina by relaxing blood vessels and improving blood flow to the heart.

Nitrates allow for venodialation in the heart what is this and how does it help a person suffering with angina?

Venodilation refers to the widening of veins, which decreases venous return to the heart. This reduces the heart's workload and oxygen demand, alleviating angina symptoms.

What is the moa of nitrates in the heart for angina relief?

In the body, nitrates are converted into nitric oxide, a vasodialator. Nitric oxide increases levels of cyclic GMP (cGMP) in smooth muscle cells.cGMP causes vasodilation, especially veins. By dilating veins, nitrates reduce the amount of blood returning to the heart → this lowers heart workload and oxygen demand.Less work for the heart + better blood flow = relief from angina (chest pain).

What are some common nitrate drugs for angina

Glyceryl nitrate

Isosorbide mononitrate

What is the long term nitrate tablets used to treat angina

isosorbide mononitrate, long term precaution and a slow release

Why do patients on nitrates need to have nitrate free periods?

To prevent dependance tolerance and the THIOL grouos get used up and nitrates need thio too to maintain their effectiveness. Nitrate-free periods allow the body to restore the availability of thiol groups, ensuring that nitrates continue to provide relief from angina.

How should nitrate tablets be stores

Airtight and away from direct sunlight to avoid the drug loosing potency

Name the 5 types of angina and briefly state what they are

1- stable angina: triggered by stress and exercise when the blood supply is not meeting its demand

2- Unpredictable angina: caused by rupture of atherosclerotic plaque

3- prinzmetals angina: spasm due to buildup

4- decubitus angina: when lying down

5- nocturnal angina: during sleep

Beta blockers also treat angina how?

They reduce heart rate and decrease myocardial oxygen demand, helping to alleviate angina symptoms.

Define preload and after load

• Preload = How much the heart fills.

• Afterload = How hard the heart has to push. The resistance it has to overcome

Define a heart attack

The coronary artery becomes blocked so reduced O2 to the heartleading to damage or death of heart muscle tissue.

Define stroke volume

The amount of blood ejected by the heart with each beat.

Define starlings law

A stretched elastic band – the more you stretch it, the harder it snaps back.
So, more blood in = stronger heartbeat out (but only up to a healthy limit).

Define heart failure

A condition where the heart is unable to pump sufficient blood to meet the body's needs, leading to symptoms like fatigue and shortness of breath.

What is the difference between diastolic and systolic heart failure

Diastolic heart failure occurs when the heart cannot fill adequately during diastole, while systolic heart failure happens when the heart cannot contract strongly enough during systole.

What is the difference between a right side heart attack and left

Right = swollen legs

Left= fluid in lungs so breathlessness especially lying down

Define some modifiable factor in cardiovascular disease

Smoking obesity lack of physical activity (increased ldl and decrease hdl) chronic stress

Define some non modifiable risk factors of cardiovascular disease

genetics age sex ethnicity( asian and black)

Define the process of atherosclerosis and how this will eventually result in a heart attack

The activation of endothelial cells results in increase of permeability allowing lipids to enter arterial cell wall, LDL oxidises attracting monocytes into macrophages. These engulf the LDL resulting in foam cells, resulting in fatty caps that can rupture and cause thrombus formation, leading to a blockage in blood flow and ultimately resulting in a heart attack.

what is the function of the lipoprotein VLDL

Transports triglycerides from the liver to peripheral tissues. and converts vldl to ldl

what is the function of the lipoprotein

Transports cholesterol from liver to tissue BAD cholesterol that can contribute to atherosclerosis.

what is the function of the lipoprotein HDL

removes excess cholesterol from the blood

What is the difference between primary and secondary lipidaemia?

Primary: Caused by inherited (genetic) conditions.

• Example: Familial hypercholesterolaemia – your body makes too much cholesterol even if your lifestyle is healthy.

• Often runs in families and can show up early in life.

  Sceondary: Caused by another condition or lifestyle factor.

• Examples:

  • Diabetes

  • Obesity

  • Alcohol use

  • Hypothyroidism

  • Certain medications (e.g., corticosteroids, antipsychotics)

What are the main classes of lipid lowering drugs

statins

fibrates

bile acid sequestrants

Ezetimibe

Niacin

Name some examples of statins

Atorvastatin Simvastatin and Rosuvastatin.

What is the MOA of statins like simvastatin and atorvastatin

Inhibit HMG COA reductase to decrease cholesterol synthesis in the liver.

Resulting in decreased LDL in the bloodstream

What are some common side effects of statins and what is advice to patients taking them

GI disturbances, muscle breakdown and feeling weak

Take at night and avoid grapefruits

What is the moa of fibrates and name a few

Fibrates, such as fenofibrate and gemfibrozil, activate peroxisome proliferator-activated receptors (PPARs), which lead to increased fatty acid oxidization and decreased triglyceride levels.

What is the moa of bile acid sequestrants and name an example

Bind to bile acid in the intestine preventing reabsorption, decreasing cholesterol levels, as cholesterol is used to make more bile acid. An example is cholestyramine. (vit defficiency and gi disturbances may occur)

What is the moa of ezetimibe

Inhibits cholesterol absorption at the small intestine therefore reducing cholesterol levels in the blood

what is the moa of niacin and what are some side effects

Decreases the breakdown of fat so the liver makes less VLDL to LDL and increases HDL levels. Common side effects include flushing, itching, and gastrointestinal disturbances.

Define hypertension

High blood pressure that can lead to other health conditions like a stroke or heart disease, usually higher than 140/90-160/95

What are some risk factors of hypertension?

Risk factors for hypertension include obesity, lack of physical activity, excessive salt intake, alcohol consumption, age, genetics, and chronic stress.

What are ACE inhibitors used to manage?

ACE inhibitors are used to manage hypertension and heart failure by relaxing blood vessels, lowering blood pressure, and improving heart function.

What is the name of some ACE inhibitors -PRIL

Examples include lisinopril, enalapril, and ramipril.

What is the moa of ace inhibitors

Inhibits the conversion of angiotensin 1 to angiotensin 2 and reduces the production of aldosterone ( a hormone that retains salt and water increasing BP) resulting in vasodilation and decreased blood pressure.

What are some side and monitoring effects of ACE inhibitors?

1st dose hypertension so should be taken before bed, dry cough and swelling under the skin, monitor the renal function and potassium levels

Startan is a angiotensin receptor antagonist what is its moa and what are names of the sartan drugs?

Blocks the action of angiotensin 2 on its receptors as (A2 raises bp by narrowing blood vessels) E.g losartan valsartan

Compare arteriosclerosis and atherosclerosis

Arteriosclerosis is the general thickening and stiffening of artery walls increasing resistance and worsening HT, while atherosclerosis specifically involves the buildup of plaques within the arterial walls, leading to reduced blood flow.

What is the moa of calcium channel blockers and name some

drugs that inhibit the influx of calcium ions into the heart and vascular smooth muscle, leading to decreased heart rate and vasodilation because of hyperpolarisation. Examples include amlodipine, diltiazem, and verapamil.

How do dihydropyridines like nifedipine and amlodipine work and what are some of their side effects

Decrease the BP no direct effect on the heart and some side effects may be headache and flushing due to vasodilation.

How do non hydrapyrimidies like veramipril work and what are some side effects?

Non-dihydropyridines like verapamil decrease heart rate and contractility by blocking calcium channels in the heart, leading to reduced myocardial oxygen demand. Some side effects may include constipation and bradycardia.

What is the moa of alpha adrenoreceptor antagonists like doxsozin and what are some side effects

Alpha adrenoreceptor antagonists like doxazosin work by blocking alpha-1 adrenergic receptors, leading to vasodilation and decreased blood pressure. Some side effects may include orthostatic hypotension and dizziness.

What are some lifestyle changes for people with hypertension

Loose weight, decrease salt and alcohol intake stop smoking have healthy foods

What is the pharmacological lines of treatment for a person with hypertesnion

Ace inhibitors then combo then triple therapy including diuretics and calcium channel blockers.

What are the immediate effects of beta 2 blockers and what is there moa

reduce heart rate cardiac output and blood pressure by blocking beta-2 adrenergic receptors, leading to bronchodilation and reduced peripheral vascular resistance.

Name a non slecetive b2 blocker

propanol

Name cardio selective b2 blockers

Atenolol and bisoprololare examples of cardioselective beta-2 blockers that primarily affect the heart, reducing heart rate and cardiac output.

What are some side effects and cautions in those taking b2 blockers

SE: bronchospasm in asthmatics, fatigue cold and flu

What is the caution for diabetics taking b2 blockers

Diabetics can hide the signs of low blood pressuresuch as tachycardia and tremors, which are critical for recognizing hypoglycemia.

what is the calculation for cardiac output

Cardiac output is calculated by multiplying stroke volume by heart rate (CO = SV x HR). It represents the amount of blood the heart pumps in one minute.

what is the general moa of diuretics

Increase urine production,which helps to reduce blood volume and lower blood pressure.

Name a thiazide diuretic and its moa and side effects

A common thiazide diuretic is hydrochlorothiazide, inhibiting NaCl reabsorption therefore the amount of salt and water leaving increases, now less fluid less bp and increased vasodialation

Furosemide is a loop diuretic what is its moa what is it used for and what are some side effects?

Furosemide, a loop diuretic, inhibits the reabsorption of sodium and chloride in the ascending loop of Henle, leading to increased urine production. It is used to treat edema associated with heart failure and hypertension, but can cause electrolyte imbalances, dehydration, and hypotension.

Amlioride is a postassium sparing diuretic what is its moa and what is it used in combo with

Amiloride is a potassium-sparing diuretic that works by inhibiting sodium channels in the distal nephron, leading to increased sodium excretion while conserving potassium. It is often used in combination with thiazide diuretics to prevent hypokalemia.

What is the moa of centerally acting drugs (calm the brrain calm the bp) and name some

Centrally acting drugs, such as clonidine and methyldopa, lower blood pressure by stimulating alpha-2 adrenergic receptors in the brain, which inhibits sympathetic nervous system (fight or flight) activity. This results in decreased heart rate and vasodilation.

What is the moa of hydralazine and how does it decrease a high blood pressure?

Hydralazine is a vasodilator that works by relaxing the smooth muscle in blood vessels, leading to decreased peripheral resistance and lower blood pressure. It is primarily used to treat hypertension.

How does minoxidil work to decrease blood pressure hypertension

Minoxidil is a potent vasodilator that relaxes smooth muscle in blood vessels, resulting in decreased peripheral resistance and lower blood pressure. It is often used in cases of severe hypertension, typically in combination with a diuretic and a beta-blocker to manage side effects.