5. HTN & Antianginal

Question 1

What is the key diuretic?

Answer 1

HCTZ

Question 2

What is HCTZ?

Answer 2

Diuretic

Question 3

Effects of HCTZ? Uses? Adverse effects?

Answer 3

Acutely decreases blood volume (baroreflex nuetralizes this effect long term)
Chronic Na depletion leads to decreased PR

Mild HTN or combo to prevent tolerance

K loss (drowsiness) & arrhythmia

Question 4

Effects of beta blocker (or partial beta agonist)?

Answer 4

Decreased HR
Decreased renin release

partial ag has smaller effect

Question 5

Effects of alpha antag?

Answer 5

Decrease PR

May increase blood volume due to decrease perfusion of kidney

Question 6

What are the ACE inhibitors? Difference between them?

Answer 6

Captopril (active)

Enalapril (prodrug)

Question 7

What is Captopril?

Answer 7

ACE inhib

Question 8

What is Enalapril?

Answer 8

ACE inhib

Question 9

Effects of ACE inhibitor?

Answer 9

LEss Ang II –> decreaser PR & less aldosterone (lower blood volume)

Bradykinin buildup –> decreased PR [y works even in people with low renin levels]

Question 10

ACE inhibitors are still effective on some individual who are shown to have low renin levels. How?

Answer 10

Buildup of bradykinin –> decreased PR

Question 11

What is the key Ang II receptor blocker?

Answer 11

Losartan

Question 12

What is losartan? Effects?

Answer 12

Ang II blocker

Decreased PR

Question 13

What are the Ca Channel blockers? Difference?

Answer 13

Nifedipine
Diltiazem
Verapamil

Nife doesn’t effect the heart like the other 2

Question 14

What are the effects of Ca channel blockers?

Answer 14

Decreased PR
Decreased HR (not nife)

Question 15

What is the key vasodilators? Difference?

Answer 15

Hydralazine (effects arteries more)

Nitroproside (effects arteries & veins the same)

Question 16

What is hydralazine? Effects?

Answer 16

Vasodilator

Decrease PR mainly in the arterioles (less so in the venoules)
Reflex increase in blood volume & CO

Question 17

Mechanisms of vasodilators?

Answer 17

NO release –> cGMP

Question 18

What is the adrenergic neuron blocker?

Answer 18

Reserpine

Question 19

What are the CNS acting drugs?

Answer 19

Alpha methyl dopa

Clonidine

Question 20

How is coronary circulation different than systemic circulation?

Answer 20

Flow during diastole instead of systole

Heart already extracts all O2 from blood, so during strenuous situations the blood flow must increase a lot to meet demand

Question 21

What % of CO goes to coronary circulation during rest? During stress?

Answer 21

5%

15%

Question 22

What determines O2 demand of heart? Supply?

Answer 22

how much work the heart is doing (= Contracility, HR, preload & afterload)

Coronary patency, diastolic BP, blood O2 capacity & collateral circulation

Question 23

What are the 3 types of Angina Pectoris?

Answer 23

Stable/typical
Unstable/Atypical
Variant/Prinzmetal

Question 24

How does stable/typical angina present? Cause? Best treatment?

Answer 24

Heavy substernal discomfort on exertion

Artherosclerotic narrowing (always narrow)

Nitro

Question 25

How does unstable/atypical angina present? Cause?

Answer 25

Discomfort no matter what Plaque rupture & thrombosis

Question 26

What is Nitroglycerin? How does it work?

Answer 26

Selective venodilator Venous dilation --> decreased cardiac return --> decreased preload --> decreased EDV --> decreased O2 demand Smaller effect = coronary dilation --> more blood supply

Question 27

How is nitroglycerin administered? Why?

Answer 27

Sublingual or trandermal Can't be taken orally cuz metabolized really fast

Question 28

What is the effect of high dose of Nitro?

Answer 28

Big decreased in CO --> Reflex tachycardia to compensate --> increased O2 demand off sets desired decrease in O2 demand

Question 29

What is the normal nitro pathway? Pathway during NO administration?

Answer 29

Ach or histamine --> activation of nitro oxidase in endothelial cell --> Arginine split into NO & arginine No diffuses into smooth muscle --> guanyl cyclase --> GTP --> cGMP --> muscle relaxation Administered NO goes straight to smooth muscle cell

Question 30

How does Varient/Prinzmetal angina present? Cause? Best treatment?

Answer 30

"Random" chest pain Coronary vasospasm due to autonomic stimulation or underlying plaque Ca Channel blocker

Question 31

Uses of Isosorb mono-dinitrate?

Answer 31

oral prophylaxis for angina

Question 32

Adverse effects of nitrates?

Answer 32

headache, hypotension, tachycardia

Question 33

How is nitrate tolerance prevented

Answer 33

8 hour free period If take patch, take it off while sleep

Question 34

Nitroglycerin uses?

Answer 34

Acute angina

Question 35

Beta blocker usage for angina?

Answer 35

Prophylaxis

Question 36

Drug combos for angina?

Answer 36

Nitrates plus beta blocker (decreased )2 demand without relfex tachycardia) Nitrates & verapamil/diltazem (decrease O2 demand & increase supply) Nitrates & nifedipine (hypotension & tachycardia) Beta blocker & verapamil/diltazem (enhacned cardiac suppression) Beta Blocker & nifedipine (blunter reflex)