Cardio VII Flashcards by tcarlso 3

Q

What are the three broad groups of ACEIs?

A

Sulfhydryl
Dicarboxyl
Phosphorus

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Q

The sulfhydryl group of ACEI are structurally related to what drug?

A

Captopril

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Q

The dicarboxyl group of ACEI are structurally related to what drug?

A

Enalapril

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Q

The phosphorus group of ACEI are structurally related to what drug?

A

Fosinopril

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Q

What is the MOA of ACEIs?

A

Decreased production of angiotensin II, causing decreased vasoconstriction, decreased aldosterone, and decreased Na reuptake

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Q

What is the special advantage that ACEIs confer to DM pts?

A

slowing the development of diabetic retinopathy

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Q

How do ACEIs slow chronic renal disease formation?

A

slow glomerulosclerosis, which causes HTN

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Q

What is the relationship between ACEIs and CAD, LV dysfunction, and ischemic stroke?

A

Improves ventricular dysfunction, and reduce morbidity/mortality

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Q

What is the effect of ACEIs on bradykinin?

A

Inhibits its breakdown, causing vasodilation

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Q

Drug that has an -opril or -april suffix is what kind of drug?

A

ACEI

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Q

True or false: you should never combine ACEIs with diuretics

A

False–very commonly used together

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Q

What organ is responsible for most of the clearance of ACEIs? What disease, then, do you have to reduce the dose for?

A

Kidneys

Renal disease

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Q

What should you do in pts with high plasma renin levels?

A

Reduce doses

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Q

What are the absolute contraindications for ACEIs?

A

Pregnancy
Bilateral artery stenosis
h/o angioedema

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Q

What disease is there a potentially favorable effect of using ACEIs?

A

Prediabetes

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Q

What are the two situations in which there may be a potentially unfavorable effect of ACEIs?

A

Hyperkalemia

Volume depletion

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Q

Why should you not give ACEIs to a pt with bilateral renal artery stenosis?

A

GFR is maintained by angII’s effects to increase resistance in the post-glomerular arteriole

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Q

Why are ACEIs contraindicated with hyperkalemia?

A

Stopping aldosterone decreases K loss

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Q

What is the most common adverse effects of ACEIs?

A

Dry coughing

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Q

Angioedema is an adverse effect of what drugs?

A

ACEIs

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Q

What is the MOA of losartan?

A

Block angiotensin type I receptor

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Q

What is the MOA of valsartan?

A

Block angiotensin type I receptor

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Q

What is the MOA of candesartan?

A

Block angiotensin type I receptor

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Q

What is the MOA of irbesartan?

A

Block angiotensin type I receptor

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Q

What is the MOA of telmisartan?

A

Block angiotensin type I receptor

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Q

What is the MOA of olmesartan?

A

Block angiotensin type I receptor

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Q

What is the MOA of eprosartan?

A

Block angiotensin type I receptor

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Q

What is the effect of blocking the angiotensin type I receptor?

A

Decreased angiotensin II effects (vasoconstriction, aldosterone secretion, Na/water retention)

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Q

What is the effect of angiotensin II on smooth muscle contraction?

A

increased

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Q

What is the effect of angiotensin II on thirst?

A

Increased

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Q

What is the effect of angiotensin II on vasopressin release?

A

Increased

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Q

What is the effect of angiotensin II on aldosterone secretion?

A

Increased

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Q

What is the effect of angiotensin II on release of adrenal catecholamines?

A

Increased

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Q

What is the effect of angiotensin II on noradrenergic neurotransmission?

A

Increased

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Q

What is the effect of angiotensin II on sympathetic tone?

A

Increased

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Q

Drugs with -artan suffix = ?

A

angiotensin antagonist

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Q

What is the drug of choice for treating HTN in pts with intolerance to ACE inhibitors?

A

Angiotensin receptor antagonists

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Q

ARBs are not used in the treatment of HTN in pts with what previous condition?

A

Stroke

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Q

What are the absolute contraindications for ARBs?

A

Pregnancy

Bilateral artery stenosis

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Q

What are the diseases that have benefits with ARBs?

A

pre DM

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Q

What are the two situations that have unfavorable effects with ARBs?

A

Hyperkalemia

Volume depletion

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Q

What types of drug is nifedipine?

A

dihydropyridine Ca channel blocker

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Q

What type of drug is amlodipine?

A

dihydropyridine Ca channel blocker

Q

What type of drug is felodipine?

A

dihydropyridine Ca channel blocker

Q

What are the two conditions where DHP Ca channel blockers may be an add on therapy for treating HTN?

A

DM

CAD

Q

DHP Ca channel blockers are an alternative to what in CAD?

A

Beta blockers

Q

What condition absolutely contraindicates DHP Ca channel blockers?

A

left ventricular dysfunction

Q

What diseases do DHP Ca channel blockers have a potentially beneficial effect?

A

Reynaud syndrome

elderly pts with isolated systolic HTN

Q

What are the situations in which DHP Ca channel blockers have a potentially unfavorable effect?

A

Tachycardia

Q

NDHP drugs are used as an alternative to beta blockers in which disease?

A

CAD

Q

What disease should you avoid using NDHP to treat HTN?

A

Left ventricular dysfunction

Q

What are the three situations in which NDHP for HTN are favorable?

A

Migraine HA
Arrhythmias
tachycardia

Q

What is the situation in which NDHPs have a potentially unfavoarble effect?

A

Low normal HR

Q

What is the MOA of verapamil?

A

NDHP

Q

What is the MOA of diltiazem?

A

NDHP

Q

Thiazide diuretics are first line therapy for what conditions?

A

Left ventricular dysfunction

Previous ischemic stroke

Q

Why is there a favorable effect of treating HTN with thiazide diuretics in pts at risk of osteoporosis?

A

Increases Ca absorption

Q

Why are thiazide diuretics contraindicated in pts with pre-DM?

A

Causes hyperglycemia

Q

Is Propranolol a selective, nonselective, beta blocker?

A

Selective (for beta 1)

Q

What are the first generation beta blockers? Are these selective or nonselective?

A

Propanolol
Nadolol
timolol
Pindolol

Nonselective

Q

What are the second generation beta blockers? What is the receptor affinity for these?

A

Atenolol
Metoprolol
Esmolol
Beliprolol
Acebutolol

B1&raquo_space;»> B2

Q

What are the third generation beta blockers? What is the receptor affinity?

A

Labetalol
Carvedilol

B1 = B2 > a1 > a2

Q

Beta blockers are first line therapy for HTN what?

A

CAD

LVD

Q

What is the MOA of spironolactone?

A

Aldosterone antagonist

Q

What is the MOA of eplerenone?

A

Aldosterone antagonist

Q

What are the three characteristics of “other” drugs used to treat HTN?

A

Effective in lowering BP
Are approved for HTN
Have not been shown to reduce CV events

Q

What is the MOA of prazosin?

A

Alpha 1 receptor antagonist

Q

What is the MOA of doxazosin?

A

Alpha 1 receptor antagonist

Q

What is the MOA of terazosin?

A

alpha 1 receptor antagonist

Q

What is the basis for using alpha 1 receptor antagonists in treating BP?

A

Block vasoconstrictive effects of alpha 1 on vessels

Q

What are the adverse effects of alpha 1 antagonists (e.g. prazosin) in treating BP?

A

reflex tachycardia

Sexual dysfunction

Q

What is the MOA of clonidine?

A

Alpha 2 agonists

Q

What is the basis for using alpha 2 agonists (e.g. clonidine) in treating HTN?

A

Decrease sympathetic outflow

Q

What is the MOA of alpha methyldopa?

A

Alpha 2 agonist

Q

What is the MOA of apraclonidine?

A

Alpha 2 agonist

Q

What is the MOA of brimonidine?

A

alpha 2 agonist

Q

What are the adverse effects of alpha 2 agonists?

A

Anticholinergic effects

Q

What is the potential issue of stopping an alpha 2 receptor agonist abruptly?

A

Rebound HTN

Q

What other drug is used in combination with alpha 2 receptor agonist?

A

Diuretic

Q

What specific condition is alpha-methyldopa used to treat HTN in?

A

Gestational HTN

Chronic HTN in pregnancy

Q

What is the MOA of hydralazine?

A

Decreases IP3 / Ca in arteries, causing vasodilation

Q

What is hydralazine used for? (3)

A

Add on for resistant HTN
Severe chronic kidney disease
Gestational HTN

Q

What are the adverse effects of hydralazine?

A

induces SLE with long term use

Tachycardia d/t Na retention

Q

What are the two drugs that should be added when using hydralazine?

A

beta blocker and diuretic

Q

What is the MOA of minoxidil?

A

Opens K channels, causing vasorelaxation

Q

What is the role of minoxidil in antiHTN therapy?

A

Only for severe, refractory HTN

Q

What drugs should be combined with minoxidil?

A

beta blockers and diuretics

Q

What is the major adverse effect with minoxidil?

A

Reflex increase in myocardial contractility

Q

What is the MOA of sodium nitroprusside?

A

donates NO, cGMP mediated Ca sequestration

Q

What is the effect of sodium nitroprusside on the heart?

A

Decreases afterload and preload

Q

How is sodium nitroprusside administered?

A

IV

Q

What are the adverse effects of sodium nitroprusside?

A

CN poisoning

Methemoglobin

Q

What is the MOA of aliskiren?

A

Direct renin inhibitor

= prevents it from cleaving angiotensinogen

Q

What should you use aliskiren for?

A

monotherapy in HTN

Q

What are the drugs that should be used in combination with aliskiren?

A

ACEIs, thiazide or ARB

Q

What is the MOA of reserpine?

A

Blocks VMAT in catecholamine synapses

Q

The most effective use of reserpine is in combination with what other type of drug?

A

Thiazide diuretic

Q

What are the side effects of reserpine?

A

Strong sympatholytic effect

increased parasympathetic activity

Q

Rauwolfia alkaloid = what drug?

A

Reserpine

Q

Why are diuretics a good choice for second line therapy in RHTN?

A

Most pts are fluid overloaded

Q

What is the major diuretic to treat RHTN?

A

Chlorthalidone

Q

Which aldosterone receptor antagonist is used in the treatment of RHTN?

A

Spironolactone

Q

Which alpha 2 blocker is used in the treatment of RHTN?

A

Doxazosin

Q

Which epithelial Na channel blocker is used in the treatment of RHTN?

A

Amiloride

Q

To lower BP, do you want to cut the sympathetic or parasympathetic tone from the kidneys?

A

lower sympathetic tone