57 topics with concise reviews: definitions, key facts, and class questions.
This section covers the pharmacology of drugs used to treat arterial hypertension, coronary artery disease (CAD), and heart failure. The study begins with fundamentals — the physiological mechanisms of blood pressure regulation and myocardial contraction, allowing a smooth transition to drug mechanisms of action.
Material is grouped by major clinical tasks. You will study antihypertensive agents of all lines (from ACE inhibitors, ARBs, and diuretics to centrally acting and myotropic drugs), antianginal drugs (organic nitrates, calcium channel blockers, beta-blockers), and cardiotonics (cardiac glycosides and non-glycoside drugs). Also included are agents for cerebral circulation disorders and hypertensive agents.
What is most frequently asked in class and exams? Traditional "hits" include the mechanisms of action and adverse effects of RAAS blockers (captopril, enalapril, losartan), the fundamental differences between dihydropyridine calcium antagonists (amlodipine) and cardioselective ones (verapamil), as well as the symptoms and emergency care for digitalis toxicity. Be sure to note the principles of modern pharmacotherapy for acute coronary syndrome and CHF — this is the foundation of clinical thinking.
What is the essence of the pharmacodynamic interaction of blockers?
It is realized at the level of the mechanism of action and effect, rather than substance concentration. Usually, this is competition between stimulators (agonists) and blockers (antagonists) for the same receptors.
Why can vessels not provide blood flow during physical exertion in atherosclerosis?
Distal to the atherosclerotic plaque, vessels are already in a state of maximum dilation due to tissue hypoxia and adenosine accumulation. There is simply no reserve for further dilation when oxygen demand increases.
Why is nitroglycerin placed under the tongue during an attack instead of being swallowed?
Upon sublingual administration, the drug is absorbed into the systemic circulation, bypassing the liver. If the tablet is swallowed, about 40% of the substance is inactivated during the "first pass" through the liver, and the effect will occur too late.
What is the difference between sublingual and oral routes of administration?
With sublingual administration, the onset is faster (in 2–5 minutes) with a bioavailability of 60%. Oral administration yields an effect in 15–40 minutes, and bioavailability drops to 20% due to first-pass hepatic metabolism.
To which pharmacological group does Isosorbide mononitrate belong?
The drug belongs to the class of organic nitrates and is an active metabolite of isosorbide dinitrate (isosorbide-5-mononitrate).
Why is the drug not used for the emergency relief of an angina attack?
Because it is a prodrug. It requires time for gastrointestinal absorption (bioavailability 60–70%) and multi-step hepatic metabolism to form active metabolites SIN-1 and SIN-1A, which release NO. The main purpose of the drug is prophylaxis.
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