Cardiac Adrenergics/Diuretics/antihypertensives Flashcards
What is cardiac output
Stroke volume X hr = amount of blood pumped out of heart per minute / measured in liters (L/min)
Explain the functional link between urinary output and end diastolic function
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
When body senses blood volume is low it will activate what
Raas system, renin angiotensin aldosterone system
What is produced by the ventricles in response to volume overload
B type natriuretic peptide (BNP)
What is happening to produce ANP atrial natriuretic peptide
Atrial stretch do to volume overload
Higher bnp levels indicate what
Heart failure. Fluid overload
Nitric oxide is a
Vasodilator
Endothelian is a
Vasoconstrictor
When do beta antagonists work the best for pts
When htn is related to high stress
What are the adrenergic drugs used in treatment of htn
Beta antagonists, alpha 1 antagonists, alpha 2 agonists, methylDOPA
Beta ar antagonist
Propranolol, metaprolol block beta 1
Standard of care to reduce rhythm disorders following an MI
Alpha 2 agonist
Clonidine
Methyl dopa
Alters catacholamine synthesis. Makes a false neurotransmitter
Why use an ace or an arb in a diabetic patient ?
They are protective to kidneys
What are first line meds for htn?
Diuretics . Thiazide, loop, potassium sparing, carbonic Anydrase inhibitor
What are the primary therapeutic effects of diuretics
Increase urinary output, reduce blood volume, co, tpr, and BP
Path of kidney
Bowman’s capsule, proximal tubule, descending tubule, loop of henle, ascending tubule, distal tubule, and collecting duct
Where do loop diuretics work and what are their names
Loop of henle, furosemide, block the passive and active transport of chloride and passive transport of sodium.
Amiloride works how ?
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
What type of diuretic is mannitol
Osmotic. Will work even if there is no blood pressure to kidney.
Carbonic anhydrase inhibitor
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.
What types of diuretics can induce hypokalemia that cause muscle cramping, cardiac dysrhythmias, cns confusion
Thiazide and loop (furosemide)
Photophobic, increase toxicity of lithium, ototoxic effects of nsaids and aminoglycoside antibiotics, pregnancy b/c warning
Pharmatoxicity of diuretics
Example of thiazide diuretic and moa
Hydrochrothiazide, blocks sodium atpase in upper end of ascending loop of henle and first segment distal tubule
Examples and MOA of vasodilators
Verapamil-calcium channel blocker
Hydralazine- k channel and myosin light chain phosphatase activate
NO- guanylyl cyclase, myosin lc phase activator
Moa of nitroprusside
Stimulates NO production and directly activates guanylyl cyclase that induces coronary vasodilation and increases oxygen delivery to the myocardium
Ethnic diversity in drug responses
Hydralazine and nitrates are especially effective in African American patients
Aliskiren
Blocks renin. Not very effective because your body learns to produce more renin. Better in combo
Captopril
Ace inhibitor (angiotension converting enzyme
Losartan
Angiotension ii receptor blockers (arbs ) not blocking angiotension, you’re blocking the receptors
Nesiritide and bosentan
Nesiritide- agonist of atrial natriuretic peptide, treatment of decompressed congestive heart failure
Bosentan- endothelia receptor antagonist, treats pulmonary htn
