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Pharm Test 3 > Anti-hypertensive/angina > Flashcards

Anti-hypertensive/angina Flashcards

1
Q

Acute coronary syndrome

A

Vasospasm

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2
Q

Stable angina

A

Narrowing of arteries

Ischemia w/ exertion

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3
Q

Unstable angina

A

Rupture atherosclerotic plaque,

Is this only way?????

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4
Q

Variant angina

Tx

A

Dilation of smooth muscle

CCB

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5
Q

Unstable angina

A

Reperfusion

+ antiplatelet (aspirin) + lipid lowering (statin)

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6
Q

How to reduce ischemia?

A
  • Decrease heart O2 demand = decrease HR

* less wall tension = less O2 demand

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7
Q

Heart impeding it’s blood flow during

A

Systole

Diastolic pressure gives blood flow

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8
Q

NO = Venodilate, preload will

A

Decrease

Volume down—> tension down——> less O2 demand —> less ischemia

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9
Q

NO does

A
  • dilates VENULES
  • Decreases preload
  • Vasodilates large epicardial coronary arterioles ONLY not all small downstream arteries (only ischemic area gets higher flow - it is sending out K+/adenosine signals to dilate)
  • Decrease LV pressure, so MORE DIASTOLIC pressure
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10
Q

Nitro chewable

A

Isosorbide dinitrate (2-3 hours

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11
Q

Sublingual route

A

Avoid 1st pass, therapeutic levels in few mins

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12
Q

Tolerance

A

High, take breaks (none at night) = ORGANIC NITRATE FREE TIME

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13
Q

Nitro

S.e.

A

Headache
Dizziness
Weakness

NOT w/in 24 hours of sildenafil

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14
Q

CCB

Rx

A

Veramamil
Diltiazem

DIHYDROPYRIDINES

  • Nifedipine
  • Nimodipine
  • Amlodipine
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15
Q

CCB

Mech

A
  • Ca influx/ release from SR
  • Ca binds to calmodulin
  • Up myosin light chain kinase
  • Myosin phosphorylation
  • up contraction ARTERIOLES/VENULES
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16
Q

Dihydropiridines greater effect on

A

Vessels>Heart

Baroreceptor reflex kicks in, Reflex tach risk

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17
Q

Nifedipine DIHYDROPYRIDINE

A
  • Coronary vasodilation = UP alot
  • Peripheral vasodilation = UP alot
  • HR= reflex UP
  • Contractility = reflex UP
  • Recovery rate of Ca channels = no change
  • AV conduction = no change
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18
Q

Verapamil

A
  • Coronary vasodilation = UP
  • Peripheral vasodilation = UP
  • HR = DOWN
  • Contractility = DOWN
  • Recovery rate of Ca channels = DOWN
  • AV conduction = slows
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19
Q

Dihydropyridine - angina

Short-acting risk

A

*MI

Better to give long-acting

Good when bradycardic, increase HR

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20
Q

Lower Vasospasm / mortality after subarachnoid hemorrhage?

A

Nimodipine

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21
Q

Inhibit central symp activity?

A

Diltiazem

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22
Q

CCB

S.E.

A
  • depression
  • cardiac arrest
  • bradycardia
  • **constipation
  • AV block
  • congestive heart failure
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23
Q

CCB

Contraindication

A

Heart failure

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24
Q

Variant angina?

A

CCB

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25
Q

BBlocker uses

A

HTN

Angina

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26
Q

BBlocker mech

A

Reducing contraction/contractility = less O2 demand

Reduce HR

Preload increases = need combo therapy, must decrease preload

27
Q

Bblocker improve mortality over CCB w/ angina?

A

No

28
Q

BBlockers improve mortality in

A

Hypertension

Prior MI

29
Q

B2 only activated when

A

In high epi release from adrenaline, so no reg hypertension from B2

30
Q

Nitrate w/ ED in emergency

A

*just give it and monitor

31
Q

How to decrease BP?

A
  • DOWN CO = down SV

* DOWN TPR = relaxation of vessels

32
Q

Decrease preload (volume)?

A

HCTZ

33
Q

HTCZ

Mech

A
  • Inhibits Na-Cl co-transport in DCT, pee alot

* UP vascular resistance, down afterload

34
Q

HCTZ

Contraindication/SE

A

*impaired renal

SE:

  • sexual impotence
  • UP K loss (arrythmia, fibrillation)
35
Q

HCTZ

K+ effect?

A

Loss in collecting duct, exchange w/ Na+

36
Q

K-sparring

A

Amiloride

+ HCTZ

37
Q

Block venous tone? =(down preload)

A 
ACE inhibitor (catopril)
*less angiotensin 2

ARBs (losartan)

AT1 receptor

38
Q

ACE inhibitor

S.E.

A

ACE also breaks down bradykinin = build up —->

Dry cough

Risk: Angioedema
Contraindicated : preg, bilateral renal stenosis

39
Q

ACE inhibitors use

A
  • Regress LV hypertrophy
  • Prevent/delay HF + MI
  • slow renal dz = DM patients
40
Q

ARB

Contraindications

A

No pregger

No bilateral renal artery stenosis

41
Q

CCB - anti-HTN

Mech

A

Down HR, contractility

42
Q

Low renin populations w/ HTN? AA/ elderly

A

CCBs

NOT BBlocker

43
Q

Direct vasodilators (aterial) (HTN)

Rx

A
  • Hydralazine
  • Minoxidil
  • Sodium Nitroprusside

RISK: reflex tach, renin, fluid retension = ischemia

44
Q

Reduce TPR = a1 blocker

A

Prazosin

S.E.= 1st dose phenomenon, Na/water retention, not good monotherapy

ALSO - good in prostatic hyperplasia/bladder obstruction

45
Q

A2 agonists (HTN)

Rx

A
  • methydopa
  • clonidine

REDUCE BRAINSTEM ACTIVITY CONTROLLING SYMPATHETIC

46
Q

BBlocker (HTN)

Mech

A
  • Lower HR+contractility (B1) = DOWN SV = DOWN CO = Down BP

* Lower renin secretion = DOWN Ang II

47
Q

BBlocker (htn)

Rx

A

Propranolol

48
Q

Guanethidine/Reserpine
Adrenergic inhibitors

Mech

A

Down TPR

49
Q

Guanethidine

S.E.

A
  • Postural HypoTN
  • Retrograde ejaculation
  • diarrhea
50
Q

Reserpine

S.E.

A

CNS

  • sedation
  • inability to concentrate
  • severe depression
51
Q

Methyldopa/Clonidine

S.E.

A
  • Methyldopa = immunological abnormalities
  • BOTH Methyldopa/Clonidine = dizziness, reduced libido, sedation, depression

POOR COMPLIANCE

52
Q

Pregnancy w/ HTN?

A

Methyldopa

NO ACEI, AngII receptor blockers

53
Q

Spironolactone?

A

Aldosterone blocker - Tx HTN

54
Q

Initial Rx choice

Systolic HTN

A

Diuretic

55
Q

Initial Rx choice

heart failure

A

ACEI

+ Uncomplicated HTN = Diuretic

NO CCBs

56
Q

Initial Rx choice

MI

A

BBlocker
ACEI

+ Uncomplicated HTN = BBlocker

57
Q

Initial Rx choice

Angina

A

BBlocker
CCB

+ Uncomplicated HTN = BBlocker

58
Q

Initial Rx choice

Tach (arrhythmia)/Fibrillation

A

BBlocker
CCB (not DHP)

+ Uncomplicated HTN = BBlocker

59
Q

Initial Rx choice

Ischemic heart Dz

A

BBlocker
CCB

+ Uncomplicated HTN = BBlocker

60
Q

Initial Rx choice

DM + HTN

A

ACEI + CCB

61
Q

Initial Rx choice

Cardiac Hypertrophy

A

ACEI

62
Q

Contraindicated :

Asthma

A

BBlocker

63
Q

Contraindicated :

Depression

A

BBlocker

Alpha 2 ags

64
Q

Contraindicated:

Bilateral Renal stenosis

A

ACEI

ARBs

Pharm Test 3 (11 decks)

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