Cardiac Adrenergics/Diuretics/antihypertensives

Question 1

What is cardiac output

Answer 1

Stroke volume X hr = amount of blood pumped out of heart per minute / measured in liters (L/min)

Question 2

Explain the functional link between urinary output and end diastolic function

Answer 2

If urine output is normal, your blood volume is normal, venous return is normal and your end diastolic volume is normal, stroke volume normal, cardiac output normal

Question 3

When body senses blood volume is low it will activate what

Answer 3

Raas system, renin angiotensin aldosterone system

Question 4

What is produced by the ventricles in response to volume overload

Answer 4

B type natriuretic peptide (BNP)

Question 5

What is happening to produce ANP atrial natriuretic peptide

Answer 5

Atrial stretch do to volume overload

Question 6

Higher bnp levels indicate what

Answer 6

Heart failure. Fluid overload

Question 7

Nitric oxide is a

Answer 7

Vasodilator

Question 8

Endothelian is a

Answer 8

Vasoconstrictor

Question 9

When do beta antagonists work the best for pts

Answer 9

When htn is related to high stress

Question 10

What are the adrenergic drugs used in treatment of htn

Answer 10

Beta antagonists, alpha 1 antagonists, alpha 2 agonists, methylDOPA

Question 11

Beta ar antagonist

Answer 11

Propranolol, metaprolol block beta 1

Standard of care to reduce rhythm disorders following an MI

Question 12

Alpha 2 agonist

Answer 12

Clonidine

Question 13

Methyl dopa

Answer 13

Alters catacholamine synthesis. Makes a false neurotransmitter

Question 14

Why use an ace or an arb in a diabetic patient ?

Answer 14

They are protective to kidneys

Question 15

What are first line meds for htn?

Answer 15

Diuretics . Thiazide, loop, potassium sparing, carbonic Anydrase inhibitor

Question 16

What are the primary therapeutic effects of diuretics

Answer 16

Increase urinary output, reduce blood volume, co, tpr, and BP

Question 17

Path of kidney

Answer 17

Bowman’s capsule, proximal tubule, descending tubule, loop of henle, ascending tubule, distal tubule, and collecting duct

Question 18

Where do loop diuretics work and what are their names

Answer 18

Loop of henle, furosemide, block the passive and active transport of chloride and passive transport of sodium.

Question 19

Amiloride works how ?

Answer 19

Inhibits sodium atpase that is indirectly linked to potassium and hydrogen exchange in the distal tubule. Prevents development of hypokalemia. Often combined with other diuretics

Question 20

What type of diuretic is mannitol

Answer 20

Osmotic. Will work even if there is no blood pressure to kidney.

Question 21

Carbonic anhydrase inhibitor

Answer 21

Acetazolamide, used as diuretic and to treat glaucoma. It blocks carbonic anhydrase so it prevents reabsorption of bicarb in the renal tubule. So bicarb stays in tubule.

Question 22

What types of diuretics can induce hypokalemia that cause muscle cramping, cardiac dysrhythmias, cns confusion

Answer 22

Thiazide and loop (furosemide)

Question 23

Photophobic, increase toxicity of lithium, ototoxic effects of nsaids and aminoglycoside antibiotics, pregnancy b/c warning

Answer 23

Pharmatoxicity of diuretics

Question 24

Example of thiazide diuretic and moa

Answer 24

Hydrochrothiazide, blocks sodium atpase in upper end of ascending loop of henle and first segment distal tubule

Question 25

Examples and MOA of vasodilators

Answer 25

Verapamil-calcium channel blocker
Hydralazine- k channel and myosin light chain phosphatase activate
NO- guanylyl cyclase, myosin lc phase activator

Question 26

Moa of nitroprusside

Answer 26

Stimulates NO production and directly activates guanylyl cyclase that induces coronary vasodilation and increases oxygen delivery to the myocardium

Question 27

Ethnic diversity in drug responses

Answer 27

Hydralazine and nitrates are especially effective in African American patients

Question 28

Aliskiren

Answer 28

Blocks renin. Not very effective because your body learns to produce more renin. Better in combo

Question 29

Captopril

Answer 29

Ace inhibitor (angiotension converting enzyme

Question 30

Losartan

Answer 30

Angiotension ii receptor blockers (arbs ) not blocking angiotension, you’re blocking the receptors

Question 31

Nesiritide and bosentan

Answer 31

Nesiritide- agonist of atrial natriuretic peptide, treatment of decompressed congestive heart failure
Bosentan- endothelia receptor antagonist, treats pulmonary htn