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Pharmacology > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Numbers for High Blood Pressure

A

140/90

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2
Q

Sites that maintain blood pressure

A

arterioles
postcapillary venules
heart
kidneys

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3
Q

Decreasing HR

A

parasympathetic

Ach at M2

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4
Q

Increasing HR

A

sympathetic

NE at B1

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5
Q

Contracting blood vessels

A

symp

NE at a1

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6
Q

Relaxing blood vessels

A

symp- NE at B2

para- Ach at M3

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7
Q

Kidney and Blood Vessels

A

symp (B1) or decreased arterial pressure causes renin release

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8
Q

Baroreceptor and low arterial pressure

A

triggers increase in symp and decrease para to constrict vessels

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9
Q

Baroreceptor Adaption

A

when change in blood pressure lasts beyond a few minutes, reflex response decreases
ex: exercise- increase BP with increase HR

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10
Q

RAAS

A

renin released
renin makes angiotensin 1
ACE converts angiotensin 1 to 2
angiotensin 2 constricts blood vessels

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11
Q

ADH

A

released due to baroreceptor reflex

enhances water retention

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12
Q

Non-pharmacological Treatments of HTN

A

diet
exercise
relieve stress
sleep more

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13
Q

First line treatment of HTN

A

thiazide diuretics
ACE Inhibitors or ARBs
Calcium channel blockers (CCBs)
many times combine 2

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14
Q

Diuretics

A

reduce fluid volume by increasing water and electrolyte excretion

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15
Q

What happens after a week of treatment on diuretics?

A

urinary excretion, CO, blood volume return to normal

blood pressure remains reduced

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16
Q

Diuretics are typically used in what patients?

A

black and elderly

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17
Q

MoA of Diuretics

A

decrease vascular reactivity to NE

hyperpolarization of sm causing vasodilation

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18
Q

Adverse Effects of Diuretics

A

potassium depletion (except in K sparing diuretics)

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19
Q

Never use diuretics in patients with….

A

chronic arrhythmias

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20
Q

Examples of Diuretics

A 
chlorothalidone
hydrochlorothiazide (HTZD)- most common
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21
Q

MoA of Calcium Channel Blockers

A

blocks Ca entry into L type Ca channels in heart and smooth muscle of vessels

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22
Q

CCB Effects

A

relaxation and dilation of arterioles

slows HR

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23
Q

Adverse Effects of CCBs

A

constipation

gingival hyperplasia- red swollen gums

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24
Q

Examples of CCBs

A

verapamil
diltiazem
amlodipine

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25
Q

Verapamil

A

CCB

works on cardiac calcium channels

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26
Q

Amlodipine

A

CCB

works on vascular calcium channels

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27
Q

Diltiazem

A

CCB

works well on both heart and vasculature

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28
Q

ACE Inhibitors

A

blocks ACE- angiotensin 1 from converting to 2

decrease bradykinin inactivation

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29
Q

Effect of ACEI

A

vasodilation

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30
Q

Bradykinin

A

causes vasodilation

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31
Q

Angiotensin 2

A

causes vasoconstriction

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32
Q

ACEI is used on what patients?

A

young, white people
chronic heart failure
diabetic nephropathy

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33
Q

Adverse Effects of ACEI

A

dry cough
angioedema- swelling of nose, throat, mouth, lips, tongue soon after dose
teratogenic

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34
Q

Do not use ACEI in patients with….

A

bilateral renal artery stenosis

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35
Q

Examples of ACEI

A

captopril

lisinopril

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36
Q

ACEI and Kidneys

A

stops Ang2
both sides of glomerulus dilates
lowers GFR
less work for kidneys

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37
Q

Maxing GFR

A

dilated afferent

constricted efferent

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38
Q

Angiotensin 2 Receptor Antagonists

ARBs

A

inhibit ang 2 receptors which blocks actions of ang 2

does not affect bradykinin

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39
Q

Effects of ARBs

A

vasodilation

prevention of aldosterone secretion

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40
Q

Adverse effects of ARBs

A

teratogenic

acute renal failure (bilateral RAS)

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41
Q

Examples of ARBs

A

losartan

“sartan”

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42
Q

Patients with chronic kidney disease and HTN should be given….

A

ACEI
ARBs
improves kidneys

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43
Q

Example of Renin Inhibitor

A

Aliskiren

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44
Q

Renin Inhibitor

A

directly inhibits renin

stops conversion of angiotensin to Ang 1

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45
Q

Adverse Effects of Renin Inhibitors

A

teratogenic

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46
Q

B Blockers

A

blocks B1 receptors at heart to decrease CO and JGA cells to inhibit renin release
decreases blood pressure

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47
Q

B Blockers most useful in what type of patients?

A

young white patients

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48
Q

What type of B blockers should be used in HTN?

A

B1 selective

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49
Q

Black patients have a better initial response to which HTN meds?

A

diuretics

CCBs

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50
Q

Adverse effects of B blockers

A

nonspecific block B2 causing bronchoconstriction

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51
Q

Examples of B blockers

A

atenolol
metaprolol
(a-m B1 specific)

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52
Q

a Blockers

A

block a receptors causing vasodilation- decrease bp

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53
Q

Adverse Effects of a Blockers

A

postural hypotension

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54
Q

Examples of a Blockers

A

prazosin

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55
Q

a2 Agonists

A

act on a2 receptors to reduce symp outflow

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56
Q

Adverse Effects of a2 Agonists

A

sedation
sudden discontinuation causes hypertension
fatigue
hemolytic anemia

57
Q

Examples of a2 Agonists

A

methyldopa

58
Q

Labetalol and Carvedilol

A

blocks a1, B1, B2

decrease peripheral resistance w/o reflex tachycardia

59
Q

Nebivolol

A

B1 blocker

vasodilates via nitric oxide release

60
Q

Drugs used to treat CHF

A

ACEI / ARBs
B blockers
diuretics
digoxin

61
Q

First line therapy for CHF

A

ACEI

ARBs

62
Q

ACEI / ARB Effects on CHF

A

reduce preload and afterload

reduce remodeling- reduce mortality

63
Q

B Antagonist Effects on CHF

A

decrease remodeling- decrease mortallity
fewer arrythmias
should be combined with another drug

64
Q

Dosing B Blockers for CHF

A

start with low initial dose and titrate up

high dose could be lethal

65
Q

Examples of Diuretics

A

HCTZ (thiazide)
furosimide (loop)
Spironolactone, Eplerenone (K sparing, not potent)

66
Q

Effects of Diuretics on CHF

A

decreases preload

67
Q

Sacubitril

A

neprilysin inhibitor- prevents degrading of atrial and brain natriuretic peptides- reduce BV (preload))
increases bradykinin

68
Q

Adverse Effects of Sacubitril

A

cough and angioedema

amyloid plaques

69
Q

Ivabradine

A

blocks funny Na channels that are upregulated in CHF patients
decreases HR at SA node w/o affecting contractility

70
Q

Ivabradine is used on which patients?

A

in sinus rhythm
resting HR 70
taking max dose B blockers

71
Q

CCB Effect on CHF

A

little effect because they provide no mortality benefit

72
Q

Digoxin

A

glucosides bind to Na/K pump and block it which increases intracellular Na, causing overaction of Na/Ca pump which increases intracellular Ca and increases force of contraction

73
Q

Adverse Effects of Digoxin

A

TI <2
severe arrhythmia
nausea, vomiting, headache
blurred vision- yellow halos

74
Q

Digoxin should not be used in patients with….

A

hypokalemia

75
Q

B agonists and CHF

A

improves cardiac performance

only used in acute failure due to rapid tolerance

76
Q

Dobutamine

A

B agonist acting on B1 to enhance contractility

77
Q

Inamrinone

A

phosphodiesterase inhibitor
used in acute heart failure
increases mortality with long term use

78
Q

PR Interval

A

corresponds to atrial conduction

79
Q

QRS Interval

A

corresponds to ventricular depolarization

80
Q

QT Interval

A

corresponds to ventricular conduction

81
Q

T

A

ventricles repolarize

82
Q

Na Channel Blockers

A

Fast response

increase QRS interval

83
Q

K Channel Blockers

A

Fast Response

increase QT interval

84
Q

Fast Response

A

at ventricles
heart muscles and purkinje fibers
Na and K blockers to treat ventricular arrythmias

85
Q

Slow Response

A

above ventricles
SA and AV nodes
Ca channel and B blockers to treat SVT

86
Q

Ca Channel Blocker and Arrhythmias

A

Slow response

increase PR by slowing atrial conductance

87
Q

B Blockers and Arrhythmias

A

slow response
decreases Ca
increases PR by slowing atrial conductance

88
Q

Supraventricular Arrhythmias

A

Atrial fibrillation and PVST

not deadly

89
Q

Ventricular Tachycardia

A

3+ repetitive PVCs

90
Q

Monomorphic V-Tach

A

consistent QRS

91
Q

Polymorphic V-Tach

A

varying QRS

torsade de pointes

92
Q

Ventricular Fibrillation

A

from V-tach
electrical anarchy causing no CO and cardiovascular collapse
death

93
Q

Classes of Antiarrhythmic Drugs

A

C1- sodium channel blockers
C2- B blockers
C3- potassium channel blockers
C4- calcium channel blockers

94
Q

Class 1a

A

Na and K channel blockers

widens QRS and QT interval, increases HR

95
Q

Adverse Effects of Class 1a

A

increases mortality in non threatening arr

torsades from K block

96
Q

Example of Class 1a

A

Quinidine

97
Q

Class 1b

A 
Na channel blocker
for ventricular arr
given IV (first pass)
98
Q

Example of Class 1b

A

Lidocaine

99
Q

Class 1c

A

Na channel blocker

prevent a-fib and PVST

100
Q

Do not give Class 1c to patients with…..

A

ventricular arr

increases mortality

101
Q

Example of Class 1c

A

Flecainaide

102
Q

Class 2

A

B blockers
decrease phase 4 and 0
decreaes automaticity at SA node, prolong AV, decrease HR and contractility
prolong PR

103
Q

Class 3

A

blocks K channels

causes torsades

104
Q

Sotalol

A

C3
blocks K channels and B receptors
used for SVT

105
Q

Adverse Effects of Sotalol

A

bradycardia, dyspnea, fatigue, torsades

106
Q

Amiodarone

A

C3
containes iodine
can block all channels
long half life

107
Q

Dronedarone

A

C3
no iodine
can block all channels
shorter half life

108
Q

Adverse Effects of Class 3

A

liver, lung, eye issues

109
Q

Class 4

A

Ca channel blockers

decrease Phase 4/0 at SA and AV node

110
Q

Digoxin

A

increases contractility and decreases HR

A-fib and SVTs

111
Q

Adenosine

A

drug of choice for acute superventricular tachycardia
IV
decreases HR

112
Q

Angina

A

chest pain caused by inadequate oxygen supply to the heart

113
Q

Stable Angina

A

obstruction of large coronary vessels

pain after mild exercise

114
Q

Vasospastic Angina

A

result of coronary vasospasms

115
Q

Unstable Angina

A

change in character, frequency, duration of pain

clot- medical emergency

116
Q

Treating Stable Angina

A

Nitrates
B blockers
CCBs

117
Q

Treating Vasospastic Angina

A

Nitrates

CCBs

118
Q

Treating angina patients with diabetes

A

add ACEI

119
Q

Nitroglycerin

A

relaxes vessels
converts nitrite to nitric oxide
NO activates guanalyl cyclase, increases cGMP, relaxation

120
Q

Nitroglycerin for acute vs prophylaxis

A

sublingual

patch

121
Q

Adverse Effects of Nitroglycerin

A

headaches

reflex tachycardia

122
Q

Nitroglycerin Tolerance

A

patch only at times when active, takes 6-8 hours to restore sensitivity

123
Q

Isosorbide mononitrate and dinitrate

A

prevent angina attacks
long duration of action- take in morning
acts same as nitroglycerin

124
Q

Nitrates + phosphodiesterase 5 inhibitors

A

“fils”- ED

extreme hypotension and death

125
Q

Most common drug type to prevent stable angina

A

B blockers

126
Q

CCB and Angina

A

block L type channels
verapamil and diltiazem for stable
dipines for vasospastic

127
Q

Treating Raynaud’s Phenomenon

A

CCBs

128
Q

Ranolazine

A

adjunct to other angina meds
prolongs QT interval
torsades

129
Q

HMG Co-A Reductase Inhibitors

A

block rate limiting step in synthesis of cholesterol

clears LDL, lowers TG, raises HDLs

130
Q

Examples of HMG Co-A Reductase Inhibitors

A

Statins

131
Q

Adverse Effects of Statins

A

muscle pain

caution with grapefruit juice

132
Q

Fenofibrate

A

activates PPAR-a that increases lipoprotein lipase

clears TG

133
Q

Fenofibrate is often paired with….

A

statin

134
Q

Niacin

A

reduces VDL synthesis- lowers LDLs
decrease free fatty acid and TG
decrease metabolism of HDL

135
Q

Adverse Effects of Niacin

A

cutaneous flushing
itching
pretreat with NSAIDs

136
Q

Cholestyramine

A

binds to bile salts to decrease their recycling, forcing the liver to make more via LDLs

137
Q

Ezetemibe

A

decreases GI uptake of cholesterol

138
Q

Alirocumab

A

prevents enzyme from degrading LDL receptors- lowers LDLs

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Pharmacology (12 decks)

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