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Pharmacology > (2) Cardiovascular pharmacology > Flashcards

(2) Cardiovascular pharmacology Flashcards

1
Q

What is the diagnostic blood pressure for Hypertension

A

130/80

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2
Q

hypertension increases the risk of…

A

Stroke
Myocardial Infarction
Atherosclerosis

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3
Q

What three things do antihypertensive drugs aim to do

A
  1. reduce cardiac output
  2. reduce plasma volume
  3. reduce peripheral resistance
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4
Q

What are the Major antihypertensive drug types

A
  1. Diuretics
  2. ACE inhibitors
  3. Angiotensin II blockers
  4. Direct renin inhibitors (aliskiren)
  5. Beta blockers
  6. Alpha 1-blockers
  7. Ca channel blockers
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5
Q

How do diuretics decrease blood pressure

A
  1. decrease plasma volume (which also decreases cardiac output)
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6
Q

What are the important players in the Renin-Angiotensin-Aldosterone System

A
  1. Angiotensinogen in the blood
  2. renin converts it to angiotensin 1
  3. ACE enzyme converts angiotensin 1 to angiotensin 2
  4. Angiotensin 2 acts in various ways that increase blood pressure
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7
Q

what are the 4 ways in which angiotensin 2 causes blood pressure to increase

A
  1. causes vasoconstriction of arterioles
  2. stimulates cardiovascular control center in medulla
  3. causes release of vasopressin (ADH)
  4. causes release of aldosterone (increase Na reabsorption)
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8
Q

What are the antihypertensive drugs that lower blood pressure by disrupting the RAAS

A
  1. ACE inhibitors
  2. Angiotensin II blockers
  3. Direct renin inhibitors
  4. Beta blockers
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9
Q

how does the retention of Na affect blood pressure

A

increased Na in the plasma = increased fluid intake = increased blood volume = increased blood pressure

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10
Q

How do ACE inhibitors work to treat hypertension

A

they inhibit the formation of angiotensin 2 from angiotensin 1. this prevents aldosterone release and Na reabsorption = less blood volume

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11
Q

What are the common ACE inhibitors (and the suffix)

A

Lisinopril
Enalapril
Enalaprilat
Captopril

-pril

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12
Q

what is a common side effect of ACE inhibitors

A

persistent cough
(ACE breaks down bradykinin, more bradykinin = cough)
hyperkalemia (if used with K+ sparing diuretics)
Angioneurotic edema

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13
Q

how do angiotensin II receptor blockers decrease blood pressure

A

they are potent vasodilators (decrease peripheral resistance)

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14
Q

What are common angiotensin II receptor blockers (and the suffix)

A

Losartan
Valsartan
Candesartan

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15
Q

how do aldosterone antagonists decrease blood pressure

A

they are potent vasodilators (decrease peripheral resistance)

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16
Q

What are common aldosterone antagonists

A

spironolactone

eplerenone

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17
Q

Beta blockers and RAAS?

A

Inhibits renin release (don’t know how)

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18
Q

How do diuretics decrease blood pressure

A

increase Na and fluid loss = decrease plasma volume

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19
Q

How do beta blockers decrease blood pressure

A

block the effects of the sympathetic nervous system = slows heart rate, causes vasodilation

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20
Q

What are common beta blockers (and whats the suffix)

A 
propranolol
pindolol
nadolol
Timolol
Metoprolol
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21
Q

How do alpha adrenergic receptor antagonists treat hypertension

A

A1 selective receptor agonists treat hypertension by blocking norepinephrine receptors on smooth muscle and thus cause vasodilation

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22
Q

What are common alpha adrenergic receptors and what is the suffix

A

doxazosin
prazosin
terazosin

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23
Q

What are the adverse affects of alpha adrenergic receptor antagonists

A

hypotension and syncope (first dose effect)
tachycardia
nasal congestion
dry mouth

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24
Q

How do Calcium channel blockers decrease blood pressure

A

they block the contraction of smooth muscle which leads to vasodilation which lowers blood pressure

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25
Q

What are common Ca channel blockers

A

Verapamil
Diltiazem
Nifedipine

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26
Q

What are the adverse affects associated with Ca channel blockers

A

flushing
headaches
hypotension
gingival hyperplasia

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27
Q

What class of hypertension drugs can cause gingival hyperplasia

A

Ca channel blockers

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28
Q 
What are these following drugs taken for
nitroprusside
sildenafil
Clonidine
a-Methyldopa
Guanabenz
guanfacine
A

Hypertension

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29
Q

What are the 5 mentioned hypertensive emergency drugs

A 
nitroglycerine
nitroprusside
fenolodopam
labetalol
hydralazine
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30
Q

What method of administration is used for nitroglycerine and why

A

oral administration

because you have to avoid hepatic metabolism

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31
Q

how does nitroprusside affect hypertension

A

peripheral vasodilation

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32
Q 
What are these drugs taken for
epoprostenol
Bosentan
Ambrienten
sildenafil
tadalafil
A

pulmonary hypertension

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33
Q

What are drugs are taken for pulmonary hypertension

A 
epoprosentol
Bosentan
Ambrienten
sildenafil
tadalfil
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34
Q

What are diuretics used to treat

A

Hypertension
Heart Failure
Edema

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35
Q

What is the affect of diuretics

A

decrease plasma and extracellular fluid volume
= decreased preload, cardiac output, and total peripheral resistance
= decreased workload on heart and decreased blood pressure

36
Q

Where do thiazide diuretics act

A

on the distal tubule of the kidney nephron

37
Q

where do loop diuretics act

A

on the ascending loop of the kidney nephron

38
Q

what transporters in the distal tubule are decreased by thiazide diuretics

A

Na+ and Cl-

39
Q

what transports in the ascending loop tubule are decreased by loop diuretics

A

Na+, Cl-, and K+

40
Q

What are amiloride and triamterene used for

A

they are diuretics that block na channels in the late distal tubule.
used for hypertension, edema, heart failure

41
Q

What is spironolactone used for

A

diuretic that blocks aldosterone receptor in the late distal tubule
used for hypertension, edema, heart failure

42
Q

What are common thiazide diuretics

A

benzothiazide
hydrochlorothiazide
chlorthalidone

43
Q

Are thiazide diuretics K sparing

A

nope

44
Q

What is the problem with thiazide diuretics not being K+ sparing

A

they can cause hypokalemia

45
Q

What are common loop diuretics

A

furosemide
bumetanide
Torsemide

46
Q

Do thiazide or loop diuretics have a higher ceiling

A

loop diuretics

47
Q

Do thiazide or loop diuretics cause hyponatremia

A

both can cause hyponatremia

48
Q

What is the effect of thiazide diuretics on Ca excretion

A

thiazide diuretics decrease Ca excretion

49
Q

What is the effect of loop diuretics on Ca excretion

A

loop diuretics increase Ca excretion

50
Q

What are the side effects of loop diuretics

A 
hyponatremia
Excessive fluid loss
hyperuricemia
tinnitus
hearing loss
51
Q

Amiloride and Triamterene are diuretics, what are their qualities

A

They are K+ sparing

They are often used with other diuretics in order to prevent hypokalemia

52
Q

What is a risk associated with amiloride and triamterene

A

hyperkalemia

53
Q

Spironolactone and Eplerenone are diuretics that are similar to amiloride and triamterene, what is the difference?

A

they are true antagonists of the aldosterone receptor

54
Q

What are Drug interactions common to diuretics

A 
antidiabetic drugs
corticosteroids
Digoxin
Lithium
NSAIDS
55
Q

What is the common complication when taking diuretics and antidiabetic drugs

A

increased glucose levels

56
Q

what is the common complication when taking diuretics and corticosteroids

A

hypokalemia

57
Q

what is the common complication when taking diuretics and Digoxin

A

digoxin toxicity secondary to hypokalemia

58
Q

what is the common complication when taking diuretics and lithium

A

lithium toxicity

59
Q

what is the common complication when taking diuretics and NSAIDS

A

decreased diuretic activity

60
Q

How does warfarin prevent coagulation (anticoagulant)

A

it inhibits the vitamin K dependent synthesis of factors 2, 7, 9, and 10

61
Q

How quickly does warfarin work

A

it takes several days to reach its full effect

62
Q

what is the antidote for warfarin

A

Vitamin K (phytonadione)

63
Q

how does heparin prevent coagulation

A

it simulates antithrombin 3 which blocks the action of factors 2a and 10a

64
Q

how quickly does heparin work

A

immediately

65
Q

what is the antidote for heparin

A

protamine

66
Q

What drugs are classified as Low molecular weight heparins

A

Enoxaparin
Dalteparin
Tinzaparin

67
Q

how do the low molecular weight heparins work

A

they stimulate antithrombin 3 which blocks the action of factors 2a and 10a (LMWH mostly blocks 10a, not 2a)

68
Q

how quickly do the low molecular weight heparins work as anticoagulants

A

immediately

69
Q

What is the antidote for low molecular weight heparins

A

protamine will partially antagonize

70
Q

What is the method of action for Fondaparinux as an anticoagulant

A

binds to antithrombin 3, which blocks the action of Xa

71
Q

does protamine antagonize the action of fondaparinux as an anticoagulant

A

nope

72
Q 
What type of drugs are the following
lepirudin
bivalirudin
argatroban
dabigatran
rivaroxaban
A

anticoagulants (direct thrombin inhibitors)

73
Q

What are the common antiplatelet drugs

A

aspirin (COX inhibitor)

Dipyramidole (phosphodiesterase inhibitor)

74
Q

What does INR stand for

A

international normalized ratio

75
Q

what does INR measure

A

the effect of warfarin (how “thin” or less likely to clot the blood is)

76
Q

What is the normal INR range

A

0.8 to 1.2

77
Q

What is the target INR for low intensity anticoagulant therapy

A

2 - 3

78
Q

what is the target INR for high intensity anticoagulant therapy

A

2.5 - 3.5

79
Q

Why is it important to know a patients INR as a dentist

A

the higher the INR the higher the risk of excessive bleeding

80
Q

how quickly after stopping taking warfarin does the INR return to normal levels and why

A

several days because the body has to synthesize new clotting factors

81
Q

What do plasminogen activators do

A

they stimulate fibrinolysis and break down clots

82
Q

What are the plasminogen activator drugs

A 
alteplase (tissue plasminogen activator) TPA
tenecteplase
reteplase
streptokinase
Urokinase
83
Q

What does a plasminogen inhibitor do

A

inhibits clot breakdown (fibrinolysis)

84
Q

What is the plasminogen inhibitor we discussed

A

aminocaproic acid

85
Q

What does aminocaproic acid do

A

inhibits clot breakdown

Pharmacology (8 decks)

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