UNIT VIII.

CARDIOVASCULAR DRUGS

DISCUSSION POINTS

1. Reflect on the following questions:

a. What do the images draw your attention to?

b. How much do you really know about your heart’s health?
c. Can you name any cardiovascular drugs?

2. Agree or disagree with the following statements, give arguments to support your
opinion.
1. I’m too young to worry about heart disease.
2. I’d know if I had high blood pressure because there would be warning signs.
3. Heart disease runs in my family, so there’s nothing I can do to prevent it.
4. I don’t need to have my cholesterol checked until I’m middle-aged.
5. My heart is beating really fast. I must be having a heart attack.

3. Work in groups. Analyze the graphic organizers, reflect and discuss about
cardiovascular drugs.

antiplatelet
anticoagulants agent
diuretics

beta blockers

CARDIOVASCULAR
digoxin
DRUGS

vasodilators
calcium
channel angiotensin-
blockers angiotensin converting
receptor enzyme
blockers inhibitors
 CARDIOVASCULAR
DRUGS

AFFECTING AFFECTING AFFECTING

THE HEART THE BLOOD THE BLOOD
VESSELS

Rate and Arrhythmias Vasoconstrictors Vasodilators Anticoagulants

force (e.g. (e.g. (e.g. Epinephrine, (e.g. Nitrites, (e.g. Heparin,
Digitalis, Quinidine, Vasopressin) Diuretics, Coumadin)
Glycosides) Propranolol) Sympatholytic)

Vocabulary
To constrict /kənˈstrɪkt/ – to become tighter or narrower.
Angina pectoris – chest pain or pressure, usually due to not enough blood flow to the heart muscle.
Heart failure – is a syndrome that causes a reduction in the heart's ability to pump blood.
Arrhythmia – irregular heartbeat.
Atherosclerosis – is a disease in which the inside of an artery narrows due to the buildup of plaque.
Inotropic agents, or inotropes – are medicines that change the force of your heart’s contractions.
Cardiac output – is the amount of blood ejected by the heart in a minute.
Foxglove – a tall plant with purple or white flowers that are like bells in shape growing up its stem.
Pacemaker – an electronic device that is put inside a person’s body to help their heart beat regularly.
Ectopic heartbeats – extra heartbeats that occur just before a regular beat. Ectopic beats are normal
and usually not a cause for concern, though they can make people feel anxious.
Dobutamine -– a medication used in the treatment of cardiogenic shock and severe heart failure.
Tachycardia-– heart rate that exceeds the normal resting rate.
Quinidine –a medication that acts as a class I antiarrhythmic agent (Ia) in the heart.
Procainamide – a medication of the antiarrhythmic class used for the treatment of cardiac arrhythmias.
Embolus/ˈembələs/pl emboli /ˈembəlaɪ/–a blood clot, air bubble, or small object that causes
an embolism.
Thrombus /ˈθrɒmbəs/pl. thrombi /θrɒmbaɪ/–a clot of coagulated blood that forms within a blood
vessel or inside the heart and remains at the site of its formation, often impeding the flow of blood.

4. Make up 5 sentences using the new vocabulary

1. _________________________________________________________________________

2__________________________________________________________________________

3_________________________________________________________________________

4_________________________________________________________________________

5_________________________________________________________________________
5. Match the words with their definitions

1. Tachycardia a. chest pain or pressure, usually due to not enough blood flow to
the heart muscle;
2. Atherosclerosis b. a disease in which the inside of an artery narrows due to the buildup
of plaque;
3. Ectopic
c. extra heartbeats that occur just before a regular beat;
heartbeats d. heart rate that exceeds the normal resting rate;
e. a syndrome that causes a reduction in the heart's ability to pump
4. Embolus blood;
f.a clot of coagulated blood that forms within a blood vessel
5. Cardiac output or inside the heart and remains at the site of its formation,
6. Angina pectoris often impeding the flow of blood;
7. Thrombus g. the amount of blood ejected by the heart in a minute;
h. a blood clot, air bubble, or small object that causes an embolism;
8. Heart failure
i. a tall plant with purple or white flowers that are like bells in shape
9. Pacemaker growing up its stem;
j. an electronic device that is put inside a person’s body to help their
10. Foxglove heart beat regularly.

6. What's Your Diagnosis?

Case Study
This seven-year-old boy presents with fever, sore throat, runny nose, and persistent fatigue
[feeling of being tired all the time]. Physical examination reveals multiple bruises
[contusions] /kənˈtjuːʒn/ of his lower extremities and arms, an erythematous [red] pharynx
[throat] with white plaques on the tonsils, and pale gums, lips. CBC [complete blood count]
was performed. Increasing fever prompted immediate admission to the children's ward of the
hospital.
During the course of admission, the patient's pharyngitis was monitored and subsided.
Tonsillitis was ruled out. Fatigue and contusions on his arms and legs were noted and
addressed with the parents while taking his social history. A lab hematologist reviewed the
high WBC [white blood cell] count, and a WBC differential [percentages of the various types
of these cells] shows immature cells. A bone marrow biopsy confirms the diagnosis of WBC
malignancy.

Using the information presented in this case study, what's your diagnosis?
A. Hyperthyroidism
B. Leukemia
C. Fever
D. Contusions—arms/legs
E. Leukocytosis

READING AND WRITING

 Cardiovascular drugs (CD).
CD are among the most widely used in medicine. They affect the function of the heart, blood vessels
and heart and can be classified according to the tissues they act on and the specific actions they
produce. Thus, there are drugs that act on the heart, distinguished further by their ability to alter either
the frequency of heartbeat, the force of contraction of the heart muscle, or the regularity of the
heartbeat and there are also a number of drugs that act on the blood vessels, typically causing the
vessels to constrict or to relax. Examples of disorders in which such drugs may be useful
include hypertension, angina pectoris, heart failure, arrhythmias or atherosclerosis.
Drugs affect the function of the heart in three main ways. They can affect the force of contraction of
the heart muscle (inotropic effects); they can affect the frequency of the heartbeat, or heart rate
(chronotropic effects); or they can affect the regularity of the heartbeat (rhythmic effects).
Inotropic agents are drugs that influence the force of contraction of cardiac muscle and thereby
affect cardiac output. Drugs have a positive inotropic effect if they increase the force of the heart’s
contraction.The two compounds most often used therapeutically are digoxin and digitoxin. The cardiac
glycosides, substances that occur in the leaves of the foxglove (Digitalis purpurea) and other plants, are
the most important group of inotropic agents. Cardiac glycosides also have a tendency to produce an
abnormal cardiac rhythm by causing electrical impulses to be generated at points in the heart other than
the normal pacemaker region, the cells that rhythmically maintain the heartbeat. These irregular
impulses result in ectopic heartbeats, which are out of sequence with the normal cardiac rhythm.
Occasional ectopic beats are harmless, but if this process continues to a complete disorganization of the
cardiac rhythm (ventricular fibrillation), the pumping action of the heart is stopped, and death occurs
within minutes unless resuscitation is performed. Because the margin of safety between the therapeutic
and the toxic doses of glycosides is relatively narrow, they must be used carefully. The second type of
inotropic agents that increase the force of cardiac muscle contraction includes dobutamine.
Administered intravenously in moderate doses, dobutamine will increase contractility without
affecting blood pressure or heart rate. There are a number of drugs that are useful in
treating abnormalities in heart rate. Reentrant rhythm and ectopic pacemakers cause abnormally high
heart rates (tachycardia), and they require treatment with drugs that slow the heart and reduce the
electrical excitability of the muscle cells. Reentrant rhythms can be eliminated by increasing the
refractory period of the cells, which is the interval following transmission of an electrical impulse
during which the cell cannot be reexcited by another impulse. Increasing the refractory period has the
effect of reducing the frequency at which impulses can be transmitted. Quinidine, procainamide,
lidocaine, and phenytoin exert their antiarrhythmic effects by reducing electrical excitability. Quinidine
and procainamide have the disadvantage that they reduce the force of contraction of the heart and tend
to lower blood pressure. They are also liable to cause side effects such as nausea and skin
rashes. Lidocaine, which is also used as a local anesthetic, has a very short duration of action and must
be given intravenously; its main use is in the prevention of ventricular arrhythmias
following acute occlusion (blockage) of a coronary artery.
Verapamil and diltiazem reduce the influx of calcium ions through the cell membrane, which
normally occurs when the cell is depolarized. This movement of calcium ions across the membrane
appears to be important in the genesis of reentrant rhythms and ectopic heartbeats. Inhibiting the influx
of calcium ions is effective in controlling many types of arrhythmia. Since calcium entry is essential for
initiating the contraction of heart muscle cells, calcium channel blockers tend to impair muscle
contractility. Since calcium entry is also important in the contraction of blood vessel smooth muscle,
these drugs cause vasodilation and tend to lower arterial blood pressure.
All the antiarrhythmic drugs discussed so far impair the conduction of the impulse for contraction
from atria to ventricles and therefore can cause heart block. Antiarrhythmic drugs should be used
carefully to avoid the various hazards and side effects that they may produce. Heart block causes a
pathological slowing of the heart and is not usually treated with drugs, although beta-adrenoceptor
agonists such as isoproterenol are sometimes used in emergencies. An artificial
electrical pacemaker device is usually fitted to provide effective long-term control.
7. Give the antonyms for the following words and word combinations

1. contraction__________________ 6. short duration___________________

2. increase_____________________ 7. important examples_______________
3. useful ______________________ 8. narrow _________________________
4. eliminated___________________ 9. effective_________________________
5. impair______________________ 10. entry__________________________

8. Tell whether the following statements are true or false according to the texts. Correct
those that are false.

1. Examples of disorders in which cardiovascular drugs may be useful

include hypertension, angina pectoris, heart failure, arrhythmias or atherosclerosis. T/F
2. Antiarrhythmic drugs should be used carefully to avoid the various hazards and side effects
that they may produce. T/F
3. An artificial electrical pacemaker device is usually fitted to provide effective short-term
control. T/F
4. Quinidine, procainamide, lidocaine, and phenytoin exert their antiarrhythmic effects by
increasing electrical excitability. T/F
5. There are a number of drugs that are useful in treating abnormalities in heart rate. T/F

9. Answer the questions.

1. What do cardiovascular drugs act on?

2. What are inotropic agents?
3. What are the disadvantageous side effects of cardiac glycosides?
4. How can reentrant rhythms be eliminated?
5. What do antiarrhythmic drugs impair?

10. Express in one word

Definition Word

1. Redness of the skin, usually occurring in patches, caused by a) cheilitis

irritation or injury to the tissue; b) erythema
2. Actinic damage to the lips;
c) xerostomia
3. A marked thickening of the epithelium;
4. Abnormal lack of saliva; dryness of the mouth; d) neoplasm
5. Any abnormal new growth of tissue; tumour. e) leukoplakia

11. Entitle the text. Paraphrase the emphasized words and phrases
 TITLE:
Drugs may also affect the blood itself, such as by activating
or inhibiting enzymes involved in the formation of clots within blood
Synonyms vessels. Thrombi form when blood vessels are damaged, such as by wounding
or by the accumulation of harmful substances (e.g., fat, cholesterol,
Thrombi=clots inflammatory substances) on the inner walls of vessels. Thrombi are further
defined by their adherence to vessel walls, which in the case of a condition such
Wounding=injuring as atherosclerosis can give rise to thrombosis, in which the thrombus partially
impedes the flow of blood through the vessel. When a portion of a thrombus
Harmful=damaging breaks off, the circulating clot becomes known as an embolus. An embolus
travels in the bloodstream and may become lodged in an artery, blocking blood
Inner=internal flow. This can lead to heart attack. Anticoagulants, antiplatelet drugs,
and fibrinolytic drugs all affect the clotting process to some degree; these classes
Impedes=obstructs of drugs are distinguished by their unique mechanisms of actions.
Other drugs that act on the blood include the hypolipidemic drugs and
Blocking=occluding the antianemic drugs. The former are used in the treatment hyperlipidemia which
frequently is associated with elevated cholesterol, examples include the widely
Heart attack= stroke prescribed statins. Antianemic agents increase the number of red blood cells or
the amount of hemoglobin in the blood, deficiencies that underlie anemia.
Erythrocytes=red Drugs affect blood vessels by altering the state of contraction of the
smooth muscle in the vessel wall, altering its diameter and thereby regulating the
blood cells volume of blood flow. Such drugs are classified as vasoconstrictors when they
cause the smooth muscle lining to contract and vasodilators when they cause it to
Amount=quantity relax. Drugs may act directly on the smooth muscle cells, or they may act
indirectly—for example, by altering the activity of nerves of the autonomic
Changing=altering nervous system that regulate vasoconstriction or vasodilation. Another type of
indirect mechanism is the action of vasodilator substances that work by releasing
Bloodstream=blood a smooth muscle relaxant substance from the cells lining the interior of the
vessel. Some drugs mainly affect arteries, which control the resistance to blood
flow flow in the vascular system, an important determinant of the arterial blood
pressure; others mainly affect the veins, which control the pressure of blood
Affect=influence flowing back to the heart and hence the cardiac output.
Apart from the actions of the autonomic nervous system, several other
Control=monitor physiological mechanisms regulate vascular smooth muscle. Of particular
pharmacological importance are the renin-angiotensin system and locally acting
vasodilator substances, such as histamine, bradykinin, prostaglandins, and nitric
oxide. Renin is an enzyme that is released into the bloodstream by
the kidney when the blood pressure falls. It acts on a plasma protein to produce a
peptide, angiotensin I, which consists of a chain of 10 amino acids. This in turn is
acted on by angiotensin converting enzyme (ACE) to produce an eight-amino-
acid peptide, angiotensin II (a potent vasoconstrictor), which raises the blood
pressure. ACE inhibitors, which block the formation of angiotensin II, are used
in treating hypertension, which is produced by excessive constriction of the small
arteries. Drugs that block the binding of angiotensin II to its receptor can also be
used.

12. Work in groups. Study the chart, organize „Teacher/Student” questionnaire trying
to remember the information related to Cardiovascular drugs.
A wide range of medications are used to treat various heart conditions. Summary of the most
common medicines used in cardiovascular medicine include:
Anticoagulants or blood thinners - These agents prevent coagulation or clotting of the
blood. Injectable forms of anticoagulants include dalteparin, enoxaparin, tinzaparin and
heparin. Warfarin is a commonly used blood thinner that can be taken in the form of a tablet.
These drugs do not dissolve existing blood clots but are preventive agents in patients who
have had a heart attack.
Antiplatelet agents - platelets play an important role in blood clotting and the formation of
platelet plugs that prevent bleeding. Examples of antiplatelet medications include aspirin,
ticlopidine, lopidogrel and dipyridamole. They are used as preventive agents in patients who
have had a heart attack.
Thrombolytic agents - These agents are used to break up blood clots that have formed and
examples include streptokinase, reteplase and altepase.
Angiotensin-converting enzyme (ACE) inhibitors - These agents expand blood vessels by
lowering levels of angiotensin II, a potent vasoconstrictor that drives blood pressure up. ACE
inhibitors are used to treat high blood pressure, heart failure and heart attacks. Examples of
agents in this class include captopril, enalapril, fosinopril and lisinopril.
Angiotensin II receptor blockers (ARBs) - These agents prevent angiotensin II from having
any effects on the heart and blood vessels by blocking the receptors it usually binds to. These
agents are useful in the treatment of high blood pressure, heart failure and heart attacks.
Examples of drugs in this class include candesartan, irbesartan, losartan.
Beta blockers or beta-adrenergic blocking agents - These agents decrease the heart rate and
the final cardiac output. This lowers blood pressure and heart rate. Beta blockers are useful
therapies in high blood pressure and some types of arrhythmia. Agents in this class include
atenolol, bisoprolol, metoprolol, propranolol and sotalol.
Calcium channel blockers - Calcium channel blockers stop the movement of calcium into
the cells of the heart and blood vessels. This relaxes the vessels and reduces blood pressure.
Calcium channel blockers are useful therapies in high blood pressure, angina, and some forms
of arrhythmia. Examples of drugs in this class include amlodipine, felodipine, nifedipine and
verapamil.
Diuretics - Diuretics increase the excretion of water and sodium in the urine, therefore
decreasing the total blood volume. This reduces blood pressure and the heart's workload.
Examples of agents in this class include chlorothiazide, amiloride, furosemide, bumetanide,
indapamide and spironolactone.
Vasodilators - These drugs relax the blood vessels and cause blood pressure to fall. They are
useful in the treatment of high blood pressure, heart failure, angina and heart attacks.
Examples include isosorbide, dinitrate and hydralazine.
Digoxin - This agent is used to stimulate a heartbeat in some cases of heart failure.
Statins - These agents reduce the synthesis of blood cholesterol in the liver. High blood
cholesterol is one of the major causes of atherosclerosis. Some of the most well known
examples include atorvastatin, lovastatin and simvastatin. Drugs that are used to regulate an
abnormal heart rhythm include quinidine, lidocaine, amiodarone, sotalol, verapamil,
diltiazem, dofetilide and adenosine.
 13. Complete the chart. The first example has been done for you.

1. Anticoagulants (also called blood thinners) help to prevent harmful clots from forming in
your blood vessels and may prevent clots from becoming larger and causing more serious
problems.
Examples Uses

 Dalteparin, enoxaparin, tinzaparin and heparin 
These are prescribed for people who are at
risk of blood clots or stroke, where blood
clots form in the heart and travel to the brain
(usually due to an irregular heart rhythm
known as atrial fibrillation).

2.____medicines stop blood clots from forming by preventing blood platelets from sticking
together.
Examples Uses

 ::::::::::::::::::::  These are prescribed for people who have had a heart attack, or
chest pain (angina), strokes, TIA (transient ischemic attacks, or
'little strokes') and other forms of cardiovascular disease. They
are also used for people who have plaque build up in their blood
vessels but do not as yet have a large obstruction in the artery
3.______________inhibitors expand blood vessels and allow blood to flow more easily. This
reduces heart's workload and makes the heart work more efficiently.
Examples Uses

 :::::::::::::::::::::  These are prescribed for people with high blood pressure or heart
failure.
4. ____________expand blood vessels and allow blood to flow more easily. This reduces
heart's workload and makes the heart work more efficiently. ARBs are also called 'sartans'.
Examples Uses

 :::::::::::::::::::::::::::  These are prescribed for people with high blood pressure or heart
failure
5. _______________ decrease the heart rate. This lowers blood pressure and makes the heart
beat more slowly and with less force.
Examples Uses

 ::::::::::::::::::::::::::  These are prescribed for people with high blood pressure, irregular
heart beat (abnormal heart rhythms) or chest pain (angina). They
are also used to prevent future heart attacks in people who have had
a heart attack.
14. Paraphrase the underlined words and word combinations

Diuretics make the body lose extra water and salts through passing urine____________.
They are commonly called 'water pills'. Diuretics are used to treat conditions like high blood
pressure ____________and swelling ___________in your feet, ankles and stomach caused
by heart failure__________, kidney failure or liver failure. By decreasing the build up_____
of fluid_________ in your lungs and other parts of your body, diuretics_________ improve
breathing___________, reduce swelling and help to relieve___________ the load on your
heart. There are a few different types____________ of diuretics. Different diuretics remove
__________fluid at different rates and through different methods__________. Other drugs
used in the treatment __________of hypertension include methyldopa and clonidine, which
work at the level of the central nervous system; adrenoceptor-blocking drugscalcium channel
blockers and nitrates Hypotensive drugs, particularly nitroglycerine tablets_________ and
calcium channel blockers, are often used __________to relieve angina pectoris. Angina often
is the result of partial occlusion ___________of the coronary vessels by fatty
deposits__________ or blood clots. Hypotensive drugs reduce_________ arterial blood
pressure and cardiac output __________and thereby lower the work
and oxygen consumption of the heart. They also have some effect on the coronary vessels
themselves, and many direct blood toward the regions in which the flow is impaired.
Most antihypertensive drugs have a variety of unwanted effects, such as drowsiness,
dizziness__________ on standing impotence, and allergic reactions. Though often fairly
minor, side effects are a serious problem because of the long-term nature of antihypertensive
therapy, and better drugs are constantly being sought.

15. Use the made word combinations to fill in the gaps bellow

A B
allergic anaesthetic
balanced attack
bedside clock
biological death
bone diet
brain intervention
clinical manner
digestive marrow
general practitioner
general reaction
heart surgery
malignant system
plastic tooth
primary trial
surgical tumour
1. A condition in which the heart has a reduced blood supply because one of the arteries
becomes blocked by a blood clot, causing myocardial ischaemia and myocardial infarction
heart attack
2. A substance given to make someone lose consciousness so that a major surgical operation
can be carried aut._________________
3. Soft tissue in cancellous bone._______________
4. The treatment of disease or other condition by surgery._______________
5. Any one of the first twenty teeth which develop in children between about six months and
two-and-a-half years of age, and are replaced by the permanent teeth at around the age of
six._____________
6. Surgery to repair damaged or malformed parts of the body.________________
7. A condition in which the nerves in the brain stem have died, and the person can be certified
as dead, although the heart may not have stopped beating.______________
8. The way in which a doctor behaves towards a patient, especially a patient who is in
bed.___________
9. An effect produced by a substance to which a person has an allergy, such as sneezing or a
skin rash._____
10. A trial carried out in a medical laboratory on a person or on tissue from a
person._____________
11. A tumour which is cancerous and can grow again or spread into other parts of the body,
even if removed surgically.____________
12. A doctor who provides first-line medical care for all types of illness to people who live
locally, refers them to hospital if necessary and encourages health promotion._________
13. The rhythm of daily activities and bodily processes such as eating, defecating or sleeping,
frequently controlled by hormones, which repeats every twenty-four hours.___________
14. The set of organs such as the stomach, liver and pancreas which are associated with the
digestion of food.____________
15. A diet that provides all the nutrients needed in the correct proportions._________

16. Summarise the information on Cardiovascular drugs using the following introductory
phrases:

The text deals with …

It is said that …
I'd like to note / to point out that …
I'd like to draw your attention to the fact that …
I wouldn't go into detail, but the main idea is ...
In addition I'd like to mention that …
Summing it up …
In conclusion I'd like to say that ...
It may be concluded that ...

17. Project work. Chose one category of Cardiovascular drugs, research the elected topic,
be ready to present it to your colleagues. (150 words)
 LISTENING

1. Warm-up: Think-Pair-Share
 Think of appropriate approaches used by drug developers in the production of safe
cardivascular medicines.
 Focus on effective cardiovascular drugs manufacture. Point out some facts that should
be taken into consideration by researchers so that people have less/no side-effects
while using cardiovascular drugs.

Video: Pharmacogenomics in Cardiac Drugs.

https://www.youtube.com/watch?v=EaFDLiS5GMs

2. Pre-listening: Reflect and Discuss:

 Pharmacogenomics uses information about a person's genetic makeup, or genome, to
choose the drugs and drug doses that are likely to work best for that particular person.
This new field combines the science of how drugs work, called pharmacology, with
the science of the human genome, called genomics.
 Until recently, drugs have been developed with the idea that each drug works pretty
much the same in everybody. But genomic research has changed that "one size fits all"
approach and opened the door to more personalized approaches to using and
developing drugs.
 Depending on person’s genetic makeup, some drugs may work more or less
effectively for smb than they do in other people. Likewise, some drugs may produce
more or fewer side effects in smb than in someone else. In the near future, doctors will
be able to routinely use information about the genetic makeup of a person to choose
those drugs and drug doses that offer the greatest chance of helping smb.
 Pharmacogenomics may also help to save time and money. By using information
about genetic makeup, doctors soon may be able to avoid the trial-and-error approach
of giving you various drugs that are not likely to work for amb until they find the right
one.
 Researchers are now using genomic information to find or design drugs aimed at
subgroups of patients with specific genetic profiles. In addition, researchers are using
pharmacogenomic tools to search for drugs that target specific molecular and cellular
pathways involved in cardiovascular diseases.
VOCABULARY
Pharmacogenomics /ˌfɑːməkəʊdʒɪˈnɒmɪks/- the study of human genetic variability in relation to drug action and
its application to medical treatment.
Statin /ˈstætɪn/- any of a class of drugs, including atorvastatin and simvastatin, that lower the levels of low
density lipoproteins in the blood by inhibiting the activity of an enzyme involved in
the production of cholesterol in the liver.
To turn out (phrasal verb) to be discovered to be; to prove to be; to develop or end in a particular way.
Phrasal verb /ˌfreɪzl ˈvɜːb/- a verb combined with an adverb or a preposition, or sometimes both, to give a new
meaning, for example go in for, win over.
Impact /ˈɪmpækt/-the powerful effect that something has on somebody/something.
Heartburn /ˈhɑːtbɜːn/- a pain that feels like something burning in your chest caused by acid coming back up from
your stomach.
Scattered /ˈskætəd/- spread far apart over a wide area or over a long period of time.
ongoing /ˈɒnɡəʊɪŋ/- continuing to exist or develop.
To bring up (phrasal verb) - to mention a subject or start to talk about it.
Evidence /ˈevɪdəns/- the facts, signs or objects that make you believe that something is true.
To warrant /ˈwɒrənt/- to make something necessary or appropriate in a particular situation.
Robust /rəʊˈbʌst/- strong and determined; showing that you are sure about what you are doing or saying.
Alternative /ɔːlˈtɜːnətɪv/- a thing that you can choose to do or have out of two or more possibilities.
Aware /əˈweə(r)/- knowing or realizing something.
Endpoints /ˈɛndˌpɔɪnt/ - a point of termination or completion, the point of furthest progress, advancement,
Highlight /ˈhaɪlaɪt/- emphasize something, especially so that people give it more attention.
To randomize /ˈrændəmaɪz/- to use a method in an experiment, a piece of research, etc. that gives every item an
equal chance of being considered.
Outcome /ˈaʊtkʌm/- the result or effect of an action or event.
Hallmark /ˈhɔːlmɑːk/- a feature or quality that is typical of somebody/something.
Research /ˈriːsɜːtʃ/-a careful study of a subject, especially in order to discover new facts or information about it.
Prospective /prəˈspektɪv/- expected to do something, to become something, to happen soon.

3. Vocabulary: Match the words with their definitions

1. Pharmacogenomics a. a pain that feels like something burning in your chest caused
by acid coming back up from your stomach.
2. Heartburn b. the study of human genetic variability in relation to drug action
and its application to medical treatment.
3. Outcome c. the result or effect of an action or event.
d. the powerful effect that something has on
4. Statin somebody/something.
e. any of a class of drugs, including atorvastatin and simvastatin,
that lower the levels of low-density lipoproteins in
5. Impact the blood by inhibiting the activity of an enzyme involved in
the production of cholesterol in the liver.

Listening:
Listening for the Main Idea: What is the talk mainly about?
Listening for Details: Take notes of the ideas about Pharmacogenomics in Cardiac Drugs.
https://youtu.be/EaFDLiS5GMs
Be ready to answer the questions.
1. What did Peter O’Donnell and Matthew Sorrentino learn?
2. What made the researchers individualize the patient care?
3. What is the article they talked about?
4. What were they interested in?
5. Why did they want to assess the quantity and quality of evidence for
pharmacogenomics around cardiac drugs?