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PMCOL 343 > 6-cardio > Flashcards

6-cardio Flashcards

1
Q

why can diuretics be good for heart failure (3)

A

relieve oedema, reduce work load, may have vasodilatory action

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2
Q

name two diuretics used in heart failure

A

thiazides, furosemide

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3
Q

what do thiazides do

A

diuretic, cause K+ loss

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4
Q

how does furosemide work

A

diuretic, causes K+ loss

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5
Q

what type of diuretic is furosemide

A

“high ceiling”, aka loop diuretics

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6
Q

what is spironolactone

A

K+ sparing diuretic

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7
Q

how does spironolactone work

A

aldosterone antagonist

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8
Q

where is aldosterone released from

A

adrenal cortex

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9
Q

what are the net effects of aldosterone

A

renal K+ loss, Na+ retention, water retention

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10
Q

what are the net effects of spironolactone

A

renal K+ retention, renal Na+ loss, renal water loss

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11
Q

what are the 3 major effects of a vasodilator on a NORMAL patient

A

dilate veins, dilate arterioles, increased heart rate

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12
Q

why does heart rate increase when vasodilators are given to normal patients (mechansim)

A

veinous dilation causes decreased preload which leads to decreased CO. dilation of arterioles leads to decreased arterial presure and decreased afterload. net effect: decreased CO and arterial pressure decreases BP, activating baroreceptors and increased HR

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13
Q

what is amyl nitrate (poppers)?

A

a recreational drug that is a fast acting NO donor, resulting in vasodilation

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14
Q

what is the net effect on BP and HR with vasodilators (in healthy subject)

A

hypotension and tachycardia

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15
Q

why does afterload increase during heart failure

A

compensatory sympathetic reflexes + increased angiotension = arteriolar constriction

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16
Q

what does high afterload do to output of a failing heart

A

it may limit output

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17
Q

why does CO increase when heart failure patients are given vasodilators?

A

less afterload so the heart will have an easier time pumping out blood

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18
Q

what happens to BP and HR when heart failure patients are given vasodilators? why?

A

BP doesn’t fall, no reflex tachycardia since the decreased peripheral resistance is balanced out by increased CO

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19
Q

where is angiotensinogen released

A

liver

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20
Q

where is renin released

A

kidneys

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21
Q

where does angiotensin converting enzyme come from

A

lungs

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22
Q

what does ACE do

A

convers angiotensin 1 into angiotensin2

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23
Q

what does renin do

A

converts angiotensinogen into andgiotension 1

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24
Q

what are the two major effects of angiotensin II

A

increase aldosterone release, vasocontriction

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25
Q

what are 4 main effects of ACE inhibitors

A

vasodilation
decreased aldosterone production
K+ retention
H2O and Na+ loss

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26
Q

what do ACE inhibitors do to bradykinin

A

prevents its catabolism

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27
Q

what is the role of bradykinin

A

potent activator of NO release from endothelium, resulting in vasodilation

28
Q

list 3 side effects of ACE inhibitors

A

dry cough, angioedema and tase disturbances

29
Q

what causes side effects of ACE inhibitors

A

they prevent breakdown of bradykinin which causes dry cough when acting in lungs

30
Q

name 2 ACE inhibitors

A

enalapril and captopril

31
Q

what is the mechanism of enalapril and captopril

A

ACE inhibitor, stop AG2 synthesis, increased Na+ and water loss

32
Q

what are the physiological effects of ACE inhibitors

A

lower afterload, lower preload, incrased CO. also relieve edema by encouraging NA+/H2O loss

33
Q

what receptor does SARS-CoV-2 use to gain entry to cells

A

ACE2 receptor

34
Q

why are ACE inhibitors and ARBs speculated to worsen COVID-19 disease progression?

A

ACE inhibitors and ARBs tend to upregulate ACE2 expression

35
Q

what are 2 drugs classes that are often combined to treat heart failure

A

ACE inhibitor and diuretic

36
Q

why is it good to use low doses of both ACE inhibitor and diuretic instead of a high dose of one drug?

A

you get additive therapeutic effects and less side effects (sometimes side effects cancel out)

37
Q

which side effects cancel out with ACE inhibitor and diuretics?

A

thiazide diuretics promore K+ loss and ACE inhibitors promote K+ retention, resulting in normal K+

38
Q

name 3 angiotensin 1 receptor blockers (ARBs)

A

losartan, candesartan, telmisartan

39
Q

which have more side effects: ACE inhibitors or ARBs?

A

ACE inhibitors

40
Q

why do ARBs have less side effects than ACE inhibitors?

A

ARBs do not result in increased bradykinin levels

41
Q

what class of drugs are amrinone and milrinone

A

phosphoriesterase inhibitors

42
Q

what are the physiological effects of amrinone and milrinone

A

increase contraction of the heart, reduce contraction of smooth muscle

43
Q

how do beta agonists work on cardiac muscle

A

cAMP, PKA, increase Ca++ through L type

44
Q

is myocin light chain kinase in heart

A

no

45
Q

how do B2 agonists cause vascular smooth muscle relaxation

A

elevated cAMP inactivates MLCK by phosphorylating it so then it cant contract

46
Q

what is hypertension

A

elevated peripheral resistance resulting in a resting BP of 140/90

47
Q

what can hypertension lead to

A

heart failure, strok, kidney damage

48
Q

what are 4 therapeutic approaches to high BP

A
  • diuretics
  • sympatholytic agents
  • direct vasodilators
  • ACE inhibitors/ARBs (drugs that block angiotensin)
49
Q

how can diuretics be used to treat hypertension

A

promote hypertension
depleting Na+ reduces blood vessel stiffness
vasodilatory action

50
Q

thiazides inhibit reabsorption of which ions? where?

A

NaCl in the distal convoluted tubule

51
Q

what is propanolol

A

beta 1 and 2 receptor antagonist

52
Q

what is metoprolol

A

b1 selective antagonist

53
Q

why can metoprolol be better than propranolol

A

acute vasodilatory action from b2 receptors may reduce effectiveness ( you dont wanna block those )

54
Q

what are 4 main things that beta blockers do

A
  • inhibit renin release by NA
  • inhibit presynaptic beta receptors that increase NA release
  • reduce sympathetic outflow (possible actions in CNS)
  • slows HR during exercise and stress
55
Q

name 4 vasodilators used to treat hypertension

A

hydralazine
nitroprusside
verapamil
nifedipine (DHPs)

56
Q

what does hydralazine do (3)

A

arteriolar vasodilation, lowers BP and reflex tachycardia

57
Q

what do you usually combine with hydralazine and why

A

beta blocker to help prevent the reflex tachycardia

58
Q

what is nitroprusside? when is it used?

A

powerful arteriolar and venous vasodilator used in hypertension emergencies

59
Q

name two Ca2+ channel blockers used to treat hypertension

A

verapamil
nifedipine (and other DHPs)

60
Q

what are 3 agents that block the production or action of angiotensin

A

captopril
enalapril
losartan

61
Q

what is captopril

A

ACE inhibitor

62
Q

what is enalapril

A

ACE inhibitor

63
Q

what is losartan

A

angiontensin receptor blocker

64
Q

does captopril make the dry cough

A

yes

65
Q

does enalapril make the dry cough

A

yes

66
Q

does losartan make the dry cough

A

no

PMCOL 343 (31 decks)

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