D7.iii · Antihypertensives

This viva will explore your knowledge of the thyroid physiology and beta-blockers. What is the fate of dietary iodine?

This viva will explore your knowledge of the anatomy of the cardiac ventricles and pharmacology of beta-blockers. Can you describe the structure of the left ventricle?

This viva tested knowledge of the measurement of arterial blood pressure and the pharmacology of beta blocking drugs.

This viva tested knowledge of the renal handling of water and pharmacology of antihypertensive drug, in particular those the interact with the renin/ angiotensin system.

This Viva tested knowledge on cardiovascular pharmacology and pharmacodynamics. It explored the pharmacology of betablockers and pharmacodynamic concepts around agonist and antagonist drugs.

This Viva will test your knowledge of common β-blockers, and their pharmacology. How would you classify β Blockers? .../12 12. Subsequent questions explored knowledge of haemodynamic properties, receptor mediated effects, esmolol pharmacokinetics and sotalol as an antiarythmic drug. Following which, candidates were asked about the Pressure-Volume loop of the cardiac cycle and changes in that loop following administration of esmolol and labetalol.

This Viva will discuss the pharmacology and the physiology of the peripheral circulation During the reading time, candidates were also shown a figure of SNP, and were asked if they recognised it. The viva then went on to discuss the pharmacology of SNP. This was generally well done. For the latter half of the viva, candidates were tested on their knowledge of the physiology of the peripheral circulation. Areas of weakness were, the understanding of the physiology of the endothelium, substances it secretes (eg prostacyclin, EDRF and endothelin), as well knowledge of the vasomotor centre.

This station will explore knowledge of beta adrenoreceptor antagonists A 50 year-old man is admitted to intensive care after a suspected myocardial infarction while undergoing gastrectomy for carcinoma of the stomach. Cardiologists have recommended metoprolol 50 mg orally bd. Describe the pharmacokinetics of metoprolol. What parenteral dose would you use for this patient? Candidates were provided with a clinical scenario of a patient unable to take oral formulation of metoprolol and asked to describe the pharmacology associated with an alternative, intravenous preparation, and contrast it with the oral preparation. Candidates were also asked to discuss metoprolol associated adverse effects and their knowledge of agonist – antagonists relationships. Candidates struggled most with applying, and explaining the relevance of, basic pharmacological principles to account for fundamental clinical applications. Dose response curves were also not covered well.

of this drug. Candidates were expected to discuss administration, bioavailability, metabolism, excretion and half life of captopril. Candidates were then asked to compare it to the longer acting ACE inhibitors and discuss their advantages and/or disadvantages in ICU patients. The Viva then explored the candidate’s knowledge of dosing intervals, plasma concentration times curves and effect time curves in relation to ACE inhibitors. Candidates were expected to know why these curves differed, (avid enzyme binding), and thus why the dosing intervals for ACE inhibitors are so long in relation to their half lives. The concepts of Emax, EC50 and Therapeutic index were required. Candidates were then asked to discuss the mechanism of action of ACE inhibitors and their cardiovascular, endocrine, renal and CNS effects. Drug interactions and adverse effects were expected knowledge. Syllabus, General Pharmacology I and II, ACE inhibitors, C2b2f. References : Katzung B.G.'s'Basic and Clinical Pharmacology' Brunton L.L. Goodman and Gilman’s ' The pharmacological basis of Therapeutics'.