ANS Pharm: ACEIs, ARBs, Anesthetic Agents

Question 1

dry cough from ACEI

Answer 1

Question 2

Which effects of the volatiles are:
ANS mediated?
spinal cord mediated?

Answer 2

• ANS: amnesia, sedation, unconsiousness
• spinal cord: immobility (MAC)

Question 3

Which locals are antiarrhythmics?

Answer 3

1A: procainamide
1B: Lidocaine

Question 4

RAAS starts with renin secretion by renal cortical juxtaglom. cells. What causes this?

Answer 4

decreased renal perfusion d/t hemorrhage or SNS activation

Question 5

synthesizes angiotensinogen

Answer 5

liver

Question 6

renin acts on ___ to produce ___

Answer 6

cleaves angiotensinogen to produce angiotensin 1

Question 7

Angiotensin 2 is a potent vasoconstrictor of kidney and mesenteric arterioles via its action on….

Answer 7

the angiotensin receptor, type 1 (AT 1).

Question 8

angiotensin receptor, type 2 (AT2)

Answer 8

regulates vascular response, cardiac growth response, and fibrotic response in other tissues

type 1: angiotensin 2 acts there to vasoconstrict

Question 9

RAAS
role in HTN

Answer 9

• HTN involves RAAS dysfxn
• RAAS modules NT release (influences SNS outflow)

Question 10

Actions of angiotensin II

Answer 10

• triggers release of norepi & epinephrine from the adrenal medulla
• acts on renal tubules to decrease both Na & water elimination while increasing K excretion.
• stimulates Aldosterone production (amplifies Na retention & K excretion)

Question 11

T/F:
The result of RAAS is an elevation of venous blood pressure and an increased intravascular volume.

Answer 11

false
arterial BP

Question 12

RAAS

Which hormones come from the adrenal cortex vs the medulla

Answer 12

cortex: aldosterone

medulla: epi, norepi

Question 13

T/F:
Angiotensin 1 and 2 cause vasoconstriction.

Answer 13

False
only 2

Question 14

Although ACEi drugs are potent, they are devoid of the many side effects of other antihypertensives such as…

Answer 14

bradycardia, bronchospasm, and rebound hypertension when acutely discontinued

Question 15

ACEi drugs are best for HTN from increased renin & are first-line therapy for…

Answer 15

HTN, CHF, mitral regurgitation, LV dysfunction

Question 16

ACEI effects

Answer 16

• Decrease angiotensin (↓ aldosterone)
• Reduce LV afterload
• reduce arterial tone
• ↓ water and Na retention
• decrease bradykinin breakdown (endogenous vasodilator)
• lowers LDL
• Do not impair baroreceptors, thus orthostatic hypotension is not an issue.
• renal protection in diabetics

Question 17

ACEI prevent bradykinin breakdown. This contributes to 2 important side effects

Answer 17

cough
angioedema

Question 18

ACEIs + vasodilating GA can cause hypoTN that is not responsive to …., so use ___

Answer 18

neo, ephedrine, norepi

use vaso (V1)

Question 19

ACEIs can cause renal dysfxn and this electrolyte imbalance

Answer 19

hyperK

my also see fatigue

Question 20

Which ACEI is a prodrug?

Answer 20

Question 21

Which ACEI is excreted unchanged in the urine?

Answer 21

lisinopril

Question 22

T/F:
Angioedema from ACEIs is thought t be genetically linked.

Answer 22

True
Black people 4.5x more likely

Question 23

the only ACEI available IV

Answer 23

enalapril

Question 24

Why do ARBs have less SEs than ACEIs?

Answer 24

ACEI impair activity at both AT 1 & AT 2 receptors

ARBs only AT1 receptor (more selective)

ARBS have similar SE to ACEi but milder and no dry cough
primary outcome is also similar

Question 25

ARBs receptor activity

Answer 25

* great affinity for AT1r * inhibit angiotensin 2 @ AT1r * better at inhibiting angiotensin 2 than ACEi

Question 26

T/F: ACEi provides renal protection for DM, unlike ARBs.

Answer 26

False both can

Question 27

T/F: Volatiles have anti-seizure activity.

Answer 27

True

Question 28

primary inhibitory & excitatory NT in CNS

Answer 28

GABA glutamate

Question 29

common anesthetics that enhance GABA

Answer 29

* volatiles * prop * etomidate * BZDs * Barbs

Question 30

What explains the CV, respiratory and neuroendocrine effects of anesthetics?

Answer 30

they alter neurotransmission

Question 31

GABAr structure

Answer 31

ligand gated ion channel Cl- influx hyperpolarizes = inhibits neuronal cells

Question 32

ANS modification by volatile inhaled agents:

Answer 32

* ↓ BP, CO, Cl, SVR * ♡ depressant & vasodilates (Alters Ca fxn) * Depress baroreceptor reflex (HD instability) * Antagonizes SA node automaticity (nodal rhythm) & prolong QT interval (inhibition K efflux which repolarizes) * Impairs ventilatory response to CO2 and O2. Low Minute ventilation for a given blood gas tension. * Uncoupling of cerebral blood flow autoregulation (> 0.5 MAC).

Question 33

Volatiles primary receptor target

Answer 33

GABA**A**

Question 34

Volatiles uncouple CBF autoregulation, usually above 0.5 MAC. What does this mean?

Answer 34

* blood flow will be higher than metabolic need * the ability to maintain a consistent blood flow despite changes in blood pressure is disrupted

Question 35

Which anesthetics target GABA A?

Answer 35

* volatiles * Propofol * Etomidate * BZDs

Question 36

T/F: Etomidate blocks the SNS response to laryngoscopy.

Answer 36

True

Question 37

How does etomidate affect CBF?

Answer 37

cerebral vasoconstrictor reduces CBF & ICP

Question 38

Ketamine is a/w CV stability and works to treat depression and pain. What are the limiting SEs?

Answer 38

* emergence delirium * secretions * nystagmus * hallucinations

Question 39

Precedex can decrease MAC by how much?

Answer 39

over 90%

Question 40

Lidocaine is a class 1B antiarrhythmic. How do they work?

Answer 40

1. suppress automaticity by increasing stimulation threshold of the ventricle & His-Purkinje 1. inhibiting spontaneous depolarization during diastole

Question 41

longest doA LAs

Answer 41

bupi & ropi

Question 42

most potent LA

Answer 42

tetracaine followed by chloroprocaine, bupi, ropi

Question 43

What rhythms can lidocaine treat?

Answer 43

* AFIB * PVCs * VTach

Question 44

fast onset LAs

Answer 44

* lidocaine * chloroprocaine * cocaine

Question 45

Why is cocaine unique as a LA?

Answer 45

increases endothelin (vasconstrictor) & impairs nitric oxide production

Question 46

Answer 46

renin