CVR Pharmacology
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Questions and Answers

What is the primary goal of asthma treatment?

  • Increase mucus production
  • Reduce overall lung capacity
  • Narrow the airways
  • Improve airflow (correct)
  • Which medication is typically used in Step 1 for quick relief during an asthma attack?

  • Long-acting muscarinic antagonist
  • Low-dose corticosteroid inhaler
  • Leukotriene receptor antagonist
  • Short-acting B2 agonist (correct)
  • What is the purpose of adding a leukotriene receptor antagonist in asthma treatment?

  • To enhance mucus production
  • To reduce inflammation (correct)
  • To replace corticosteroids
  • To increase airway tightening
  • What role does theophylline play in asthma treatment?

    <p>Provides long-term bronchodilation (A)</p> Signup and view all the answers

    Which receptors does adrenaline primarily activate to achieve bronchodilation?

    <p>B2 receptors (C)</p> Signup and view all the answers

    What characterizes Step 5 in the management of severe asthma?

    <p>Introduction of oral corticosteroids (A)</p> Signup and view all the answers

    What is the function of long-acting muscarinic antagonists in asthma therapy?

    <p>Prevent airway tightening (A)</p> Signup and view all the answers

    What is the primary mechanism by which ACE inhibitors lower blood pressure?

    <p>By inhibiting angiotensin converting enzyme (D)</p> Signup and view all the answers

    Which of the following medications is considered a thiazide diuretic?

    <p>Hydrochlorothiazide (B)</p> Signup and view all the answers

    What differentiates Angiotensin Receptor Blockers (ARBs) from ACE inhibitors in terms of side effects?

    <p>ARBs do not cause a dry cough like ACE inhibitors (B)</p> Signup and view all the answers

    What is the role of beta blockers in the treatment of hypertension?

    <p>Decrease cardiac output and peripheral vascular resistance (A)</p> Signup and view all the answers

    Which of the following statements about potassium-sparing diuretics is true?

    <p>They help to prevent hypokalemia caused by other diuretics (B)</p> Signup and view all the answers

    What primarily causes the inside of the cardiac myocyte to become more negative during repolarization?

    <p>Potassium channels open and potassium exits (B)</p> Signup and view all the answers

    Which phase of the cardiac nodal action potential is characterized by pacemaker depolarization occurring without a stable resting state?

    <p>Phase 4 (Pacemaker Depolarization) (B)</p> Signup and view all the answers

    Which receptor type is involved in increasing the heart rate through sympathetic stimulation?

    <p>β1/2 adrenergic receptors (B)</p> Signup and view all the answers

    What term describes the property of heart cells to generate spontaneous action potentials?

    <p>Automaticity (C)</p> Signup and view all the answers

    What causes tachycardias according to the information provided?

    <p>Excess calcium inside the cell (A)</p> Signup and view all the answers

    During which phase does potassium leave the cell, helping to prepare the cell for the next action potential?

    <p>Phase 3 (Repolarization) (C)</p> Signup and view all the answers

    Which of the following mechanisms slows down the pacemaker potential, leading to a slower heart rate?

    <p>Vagal stimulation (D)</p> Signup and view all the answers

    What is the mechanism by which re-entry tachycardia occurs?

    <p>Electrical signal loop re-exciting already activated heart tissue (C)</p> Signup and view all the answers

    What defines the resting phase of a cardiac myocyte?

    <p>Stable negative charge maintained by the sodium potassium pump (B)</p> Signup and view all the answers

    What is the primary function of angiotensin converting enzyme (ACE)?

    <p>Convert angiotensin 1 to angiotensin 2 (B)</p> Signup and view all the answers

    How does angiotensin 2 primarily increase blood pressure?

    <p>Through vasoconstriction of blood vessels (B)</p> Signup and view all the answers

    What role do AT1 receptors play in fluid balance?

    <p>They stimulate aldosterone release to increase sodium retention (B)</p> Signup and view all the answers

    What effect does the activation of AT1 receptors have on the sympathetic nervous system?

    <p>It leads to the release of noradrenaline (A)</p> Signup and view all the answers

    What is a key feedback mechanism involved in regulating renin secretion?

    <p>Negative feedback as blood pressure and fluid levels rise (C)</p> Signup and view all the answers

    What physiological action does aldosterone have following its release?

    <p>It increases sodium reabsorption and water retention (C)</p> Signup and view all the answers

    In which part of the body does the angiotensin converting enzyme primarily act?

    <p>In the lungs and kidneys (C)</p> Signup and view all the answers

    What hormone is promoted by the activation of angiotensin 2 in the hypothalamus?

    <p>Antidiuretic hormone (ADH) (D)</p> Signup and view all the answers

    Which of the following is NOT a result of angiotensin 2 action?

    <p>Vasodilation of blood vessels (C)</p> Signup and view all the answers

    What effect do calcium channel blockers have on heart rhythms?

    <p>They block L-type voltage-gated calcium channels. (A)</p> Signup and view all the answers

    Which type of β-blockers primarily targets the heart?

    <p>β1-selective β-blockers (C)</p> Signup and view all the answers

    What is a common side effect of β-blockers on blood pressure?

    <p>Low blood pressure (D)</p> Signup and view all the answers

    Which of the following drugs has class III effects on heart repolarization?

    <p>Sotalol (B)</p> Signup and view all the answers

    How do non-selective β-blockers affect asthma symptoms?

    <p>They may worsen asthma symptoms. (A)</p> Signup and view all the answers

    What is one of the main uses of β-blockers after a heart attack?

    <p>To prevent death and reduce arrhythmias. (D)</p> Signup and view all the answers

    What impact do β-blockers have on action potentials in nodal tissues?

    <p>They lengthen the action potential duration. (D)</p> Signup and view all the answers

    Which condition can β-blockers help control in patients?

    <p>Atrial fibrillation (D)</p> Signup and view all the answers

    What condition is Sotalol used cautiously for due to the risk of Torsades de Pointes?

    <p>Atrial fibrillation (B)</p> Signup and view all the answers

    What negative effect do β-blockers have on heart contractions?

    <p>They reduce calcium, leading to weaker contractions. (A)</p> Signup and view all the answers

    Flashcards

    Asthma Treatment Goal

    Improve airflow, measured by PEF (Peak Expiratory Flow).

    Bronchodilation

    Relaxation of smooth muscles around bronchioles, widening airways and improving airflow.

    Anti-inflammatory Therapy

    Reduces inflammation causing airway thickening, edema, and mucus production, preventing narrowing.

    Step 1 Asthma Treatment

    Short-acting beta-2 agonist (SABA) inhaler (like salbutamol) for quick relief during attacks.

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    Step 2 Asthma Treatment

    Low-dose corticosteroid inhaler added daily to reduce inflammation and prevent future symptoms.

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    Step 3 Asthma Treatment

    Adding a Leukotriene Receptor Antagonist (like montelukast) for persistent symptoms.

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    Adrenaline's effect on bronchioles

    Adrenaline causes bronchodilation (opening up of the bronchioles) due to its effect on Beta-2 receptors.

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    Repolarization

    The phase where a cardiac cell returns to its resting state. Potassium exits the cell, making the inside more negative.

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    Sodium-Potassium Pump

    A protein that actively pumps sodium out of the cell and potassium into the cell, maintaining the negative resting potential.

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    Cardiac Nodal Action Potential

    The process of electrical signals in pacemaker cells that initiate and regulate heartbeats.

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    Depolarization (Cardiac Nodal Cells)

    Calcium influx into the pacemaker cell makes the inside more positive, triggering the action potential.

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    Sympathetic Stimulation

    Increases heart rate by accelerating the pacemaker potential, leading to faster action potential generation.

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    Vagal (Parasympathetic) Stimulation

    Slows down heart rate by slowing the pacemaker potential, leading to slower action potential generation.

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    Chronotropic Effect

    Altering the rate of the heart.

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    Inotropic Effect

    Altering the strength of heart contraction.

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    Automaticity (Heart Cells)

    The ability of heart cells to generate spontaneous action potentials.

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    Angiotensin 1 Conversion

    Angiotensin 1 is converted to angiotensin 2 (the active form) by angiotensin-converting enzyme (ACE) in the lungs and kidneys.

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    Angiotensin 2's Role

    Angiotensin 2 regulates blood pressure and fluid balance through its actions on various organs and systems.

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    AT1 Receptors

    Receptors responsible for the major effects of angiotensin 2 on regulating blood pressure and fluid balance.

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    Vasoconstriction (Angiotensin 2)

    Angiotensin 2 causes blood vessels to narrow by binding to AT1 receptors, leading to increased blood pressure.

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    Aldosterone Secretion (Angiotensin 2)

    Angiotensin 2 stimulates aldosterone release from the adrenal cortex, causing the kidneys to retain sodium (and water) for increased blood volume.

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    Sympathetic Nervous System Activation (Angiotensin 2)

    Angiotensin 2 enhances the sympathetic nervous system, leading to increased heart rate, further vasoconstriction, and higher blood pressure.

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    Antidiuretic Hormone (ADH) Release (Angiotensin 2)

    Angiotensin 2 promotes ADH release from the hypothalamus, which causes water retention in the kidneys, further contributing to fluid volume increase.

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    Negative Feedback Regulation (Angiotensin)

    As blood pressure and fluid levels rise, the body reduces the release of renin, which initiates the angiotensin cascade, to maintain balance.

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    Class IV Antiarrhythmics

    Drugs that block L-type voltage-gated calcium channels, mainly used for atrial tachycardias and post-MI arrhythmias.

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    β-blockers effect on heart rate

    β-blockers reduce heart rate by slowing down the electrical signals in the heart's conduction system.

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    β1-selective β-blockers

    These drugs mainly target the heart, making them safer for most people. Examples: atenolol, bisoprolol, metoprolol.

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    Non-selective β-blockers

    These β-blockers affect both the heart and other organs, including the lungs. Example: propranolol.

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    Sotalol's special effect

    Sotalol is a β-blocker that also has class III effects, meaning it can prolong heart repolarization to control certain arrhythmias.

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    β-blockers and action potentials

    β-blockers reduce the strength of the action potential (AP) and prolong its duration, increasing the refractory period.

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    β-blockers' effect on heart contractions

    β-blockers reduce calcium entry into heart cells, causing weaker contractions (negative inotropic effect).

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    β-blockers' effect on blood vessels

    Non-selective β-blockers can cause vasoconstriction, narrowing blood vessels and making hands and feet feel cold.

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    β-blockers and asthma

    Non-selective β-blockers can worsen asthma symptoms by affecting the lungs, so they should be avoided in patients with asthma.

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    Sotalol's potential risk

    Sotalol can increase the risk of Torsades de Pointes (TdP), a dangerous heart rhythm problem.

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    ACE Inhibitors: How they work

    ACE inhibitors block the enzyme ACE, which normally narrows blood vessels, raising blood pressure. Blocking ACE leads to blood vessel relaxation and lower blood pressure.

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    ACE Inhibitors: Side Effects

    Common side effects of ACE inhibitors include dry cough, angioedema (swelling around the heart), hyperkalemia (high potassium), and teratogenicity (harmful during pregnancy).

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    Beta Blockers: Action in the Heart

    Beta blockers, particularly B1-selective ones, slow down the heart rate and reduce the force of contraction, leading to lower blood pressure.

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    Diuretics: Types and Actions

    Diuretics help reduce fluid buildup by promoting water loss. Loop diuretics are powerful but not commonly used for high blood pressure alone. Thiazide diuretics are the most popular for high blood pressure. Potassium-sparing diuretics are weak and often added to prevent potassium loss caused by other diuretics.

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    Thiazide Diuretics: Mechanism

    Thiazide diuretics work in the distal tubule of the kidney. They inhibit a protein that reabsorbs sodium and chloride back into the bloodstream causing water to follow leading to lower blood pressure.

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    Study Notes

    Drugs and Asthma

    • Asthma treatment focuses on bronchioles to improve airflow, measured by peak expiratory flow (PEF).
    • Treatment aims at bronchodilation (relaxing airway muscles) and anti-inflammation (reducing airway thickening, edema, and mucus).

    Drug Treatment of Asthma

    • Step 1: Intermittent Reliever Therapy: Short-acting beta-2 agonists (SABAs) like salbutamol are used to quickly relax airway muscles during asthma attacks.
    • Step 2: Regular Preventer Therapy: Low-dose corticosteroids via inhaler are used daily to prevent future asthma symptoms by reducing inflammation.
    • Step 3: Initial Add-In Therapy: Oral leukotriene receptor antagonists like montelukast are added if symptoms persist to reduce inflammation further.
    • Step 4: Additional Controller Therapy: Long-acting beta-2 agonists (LABAs) and/or long-acting muscarinic antagonists (LAMAs) are used with or instead of inhaled corticosteroids to provide sustained bronchodilation and prevent airway tightening. Theophylline is another option.
    • Step 5: Continuous Oral Corticosteroids: Used for severe, uncontrolled asthma for long-term control. Monoclonal antibodies (targeting anti-IgE or anti-IL5) are sometimes used for severe asthma.

    SABA Drugs (Salbutamol, Terbutaline)

    • Modified from adrenaline, targeting beta-2 receptors solely for bronchodilation, avoiding cardiac side effects.
    • They last longer than adrenaline due to improved chemical structure, providing better relief.
    • They activate G proteins, boosting cAMP levels, leading to smooth muscle relaxation and reduced intracellular calcium for bronchodilation.

    Adverse Effects of Salbutamol

    • Tachycardia (fast heart rate)
    • Muscle tremors
    • Hypokalemia (low potassium)
    • Tolerance (decreased effectiveness over time due to downregulation of beta-2 receptors).
    • Tolerance can be affected by genetic polymorphisms (variations in Beta-2 receptor genes).

    Regular Preventer Therapy

    • Corticosteroids, similar to cortisol, used via inhaler to reduce inflammation and suppress the immune system.
    • Examples: Beclometasone, Fluticasone, Budesonide.
    • Low-dose administration minimizes the risk of fungal infections (oral thrush).

    Initial Add-In Therapy

    • Leukotriene Receptor Antagonists (e.g., montelukast) block inflammatory chemicals and reduce inflammation.
    • These are oral medications.

    Additional Controller Therapy

    • Long-acting beta-2 agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are used for ongoing bronchial relaxation.
    • Theophylline can also be taken for airway relaxation.

    Continuous Steroid Therapies

    • Oral corticosteroids like prednisolone are used when asthma remains uncontrolled.
    • They reduce inflammation and control the immune response. Can cause adrenal suppression, which needs to be managed carefully.
    • There are monoclonal antibodies which target immune cells, used in severe cases to control inflammation.

    Arrhythmias

    • Cardiac synctium: network of interconnected cells with gap junctions facilitating rapid action potential spreading.
    • Cardiac myocyte action potential has 4 phases (depolarization, partial repolarization, plateau, repolarization, rest) triggered by sodium, potassium, and calcium ions.
    • Pacemaker cells (e.g., sinoatrial (SA) and atrioventricular (AV) nodes) continuously depolarize, initiating action potentials.
    • Sympathetic stimulation (β1/β2 adrenergic receptors) increases heart rate, while parasympathetic stimulation (muscarinic acetylcholine receptors) slows it down.
    • Common causes of tachycardias include rapid action potentials, re-entry (looping signals), or ectopic pacemaker activity.
    • There are many types and classifications of arrhythmias that can be treated with different medicines.

    Adverse Effects of Drugs

    • Potential side effects like tachycardia, hypokalemia, and tremor.
    • Important considerations for patients with cardiovascular issues to avoid potential adverse effects.

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    This quiz explores the various drug therapies used in the treatment of asthma, including both reliever and preventer medications. Learn about the steps for managing asthma symptoms effectively and the roles of different classes of drugs in improving airflow and reducing inflammation.

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