Cardiovascular Flashcards
1
Q
Numbers for High Blood Pressure
A
140/90
2
Q
Sites that maintain blood pressure
A
arterioles
postcapillary venules
heart
kidneys
3
Q
Decreasing HR
A
parasympathetic
Ach at M2
4
Q
Increasing HR
A
sympathetic
NE at B1
5
Q
Contracting blood vessels
A
symp
NE at a1
6
Q
Relaxing blood vessels
A
symp- NE at B2
para- Ach at M3
7
Q
Kidney and Blood Vessels
A
symp (B1) or decreased arterial pressure causes renin release
8
Q
Baroreceptor and low arterial pressure
A
triggers increase in symp and decrease para to constrict vessels
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
10
Q
RAAS
A
renin released
renin makes angiotensin 1
ACE converts angiotensin 1 to 2
angiotensin 2 constricts blood vessels
11
Q
ADH
A
released due to baroreceptor reflex
enhances water retention
12
Q
Non-pharmacological Treatments of HTN
A
diet
exercise
relieve stress
sleep more
13
Q
First line treatment of HTN
A
thiazide diuretics
ACE Inhibitors or ARBs
Calcium channel blockers (CCBs)
many times combine 2
14
Q
Diuretics
A
reduce fluid volume by increasing water and electrolyte excretion
15
Q
What happens after a week of treatment on diuretics?
A
urinary excretion, CO, blood volume return to normal
blood pressure remains reduced
16
Q
Diuretics are typically used in what patients?
A
black and elderly
17
Q
MoA of Diuretics
A
decrease vascular reactivity to NE
hyperpolarization of sm causing vasodilation
18
Q
Adverse Effects of Diuretics
A
potassium depletion (except in K sparing diuretics)
19
Q
Never use diuretics in patients with….
A
chronic arrhythmias
20
Q
Examples of Diuretics
A
chlorothalidone hydrochlorothiazide (HTZD)- most common
21
Q
MoA of Calcium Channel Blockers
A
blocks Ca entry into L type Ca channels in heart and smooth muscle of vessels
22
Q
CCB Effects
A
relaxation and dilation of arterioles
slows HR
23
Q
Adverse Effects of CCBs
A
constipation
gingival hyperplasia- red swollen gums
24
Q
Examples of CCBs
A
verapamil
diltiazem
amlodipine
25
Verapamil
CCB
| works on cardiac calcium channels
26
Amlodipine
CCB
| works on vascular calcium channels
27
Diltiazem
CCB
| works well on both heart and vasculature
28
ACE Inhibitors
blocks ACE- angiotensin 1 from converting to 2
| decrease bradykinin inactivation
29
Effect of ACEI
vasodilation
30
Bradykinin
causes vasodilation
31
Angiotensin 2
causes vasoconstriction
32
ACEI is used on what patients?
young, white people
chronic heart failure
diabetic nephropathy
33
Adverse Effects of ACEI
dry cough
angioedema- swelling of nose, throat, mouth, lips, tongue soon after dose
teratogenic
34
Do not use ACEI in patients with....
bilateral renal artery stenosis
35
Examples of ACEI
captopril
| lisinopril
36
ACEI and Kidneys
stops Ang2
both sides of glomerulus dilates
lowers GFR
less work for kidneys
37
Maxing GFR
dilated afferent
| constricted efferent
38
Angiotensin 2 Receptor Antagonists
| ARBs
inhibit ang 2 receptors which blocks actions of ang 2
| does not affect bradykinin
39
Effects of ARBs
vasodilation
| prevention of aldosterone secretion
40
Adverse effects of ARBs
teratogenic
| acute renal failure (bilateral RAS)
41
Examples of ARBs
losartan
| "sartan"
42
Patients with chronic kidney disease and HTN should be given....
ACEI
ARBs
improves kidneys
43
Example of Renin Inhibitor
Aliskiren
44
Renin Inhibitor
directly inhibits renin
| stops conversion of angiotensin to Ang 1
45
Adverse Effects of Renin Inhibitors
teratogenic
46
B Blockers
blocks B1 receptors at heart to decrease CO and JGA cells to inhibit renin release
decreases blood pressure
47
B Blockers most useful in what type of patients?
young white patients
48
What type of B blockers should be used in HTN?
B1 selective
49
Black patients have a better initial response to which HTN meds?
diuretics
| CCBs
50
Adverse effects of B blockers
nonspecific block B2 causing bronchoconstriction
51
Examples of B blockers
atenolol
metaprolol
(a-m B1 specific)
52
a Blockers
block a receptors causing vasodilation- decrease bp
53
Adverse Effects of a Blockers
postural hypotension
54
Examples of a Blockers
prazosin
55
a2 Agonists
act on a2 receptors to reduce symp outflow
56
Adverse Effects of a2 Agonists
sedation
sudden discontinuation causes hypertension
fatigue
hemolytic anemia
57
Examples of a2 Agonists
methyldopa
58
Labetalol and Carvedilol
blocks a1, B1, B2
| decrease peripheral resistance w/o reflex tachycardia
59
Nebivolol
B1 blocker
| vasodilates via nitric oxide release
60
Drugs used to treat CHF
ACEI / ARBs
B blockers
diuretics
digoxin
61
First line therapy for CHF
ACEI
| ARBs
62
ACEI / ARB Effects on CHF
reduce preload and afterload
| reduce remodeling- reduce mortality
63
B Antagonist Effects on CHF
decrease remodeling- decrease mortallity
fewer arrythmias
should be combined with another drug
64
Dosing B Blockers for CHF
start with low initial dose and titrate up
| high dose could be lethal
65
Examples of Diuretics
HCTZ (thiazide)
furosimide (loop)
Spironolactone, Eplerenone (K sparing, not potent)
66
Effects of Diuretics on CHF
decreases preload
67
Sacubitril
neprilysin inhibitor- prevents degrading of atrial and brain natriuretic peptides- reduce BV (preload))
increases bradykinin
68
Adverse Effects of Sacubitril
cough and angioedema
| amyloid plaques
69
Ivabradine
blocks funny Na channels that are upregulated in CHF patients
decreases HR at SA node w/o affecting contractility
70
Ivabradine is used on which patients?
in sinus rhythm
resting HR 70
taking max dose B blockers
71
CCB Effect on CHF
little effect because they provide no mortality benefit
72
Digoxin
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
Adverse Effects of Digoxin
TI <2
severe arrhythmia
nausea, vomiting, headache
blurred vision- yellow halos
74
Digoxin should not be used in patients with....
hypokalemia
75
B agonists and CHF
improves cardiac performance
| only used in acute failure due to rapid tolerance
76
Dobutamine
B agonist acting on B1 to enhance contractility
77
Inamrinone
phosphodiesterase inhibitor
used in acute heart failure
increases mortality with long term use
78
PR Interval
corresponds to atrial conduction
79
QRS Interval
corresponds to ventricular depolarization
80
QT Interval
corresponds to ventricular conduction
81
T
ventricles repolarize
82
Na Channel Blockers
Fast response
| increase QRS interval
83
K Channel Blockers
Fast Response
| increase QT interval
84
Fast Response
at ventricles
heart muscles and purkinje fibers
Na and K blockers to treat ventricular arrythmias
85
Slow Response
above ventricles
SA and AV nodes
Ca channel and B blockers to treat SVT
86
Ca Channel Blocker and Arrhythmias
Slow response
| increase PR by slowing atrial conductance
87
B Blockers and Arrhythmias
slow response
decreases Ca
increases PR by slowing atrial conductance
88
Supraventricular Arrhythmias
Atrial fibrillation and PVST
| not deadly
89
Ventricular Tachycardia
3+ repetitive PVCs
90
Monomorphic V-Tach
consistent QRS
91
Polymorphic V-Tach
varying QRS
| torsade de pointes
92
Ventricular Fibrillation
from V-tach
electrical anarchy causing no CO and cardiovascular collapse
death
93
Classes of Antiarrhythmic Drugs
C1- sodium channel blockers
C2- B blockers
C3- potassium channel blockers
C4- calcium channel blockers
94
Class 1a
Na and K channel blockers
| widens QRS and QT interval, increases HR
95
Adverse Effects of Class 1a
increases mortality in non threatening arr
| torsades from K block
96
Example of Class 1a
Quinidine
97
Class 1b
```
Na channel blocker
for ventricular arr
given IV (first pass)
```
98
Example of Class 1b
Lidocaine
99
Class 1c
Na channel blocker
| prevent a-fib and PVST
100
Do not give Class 1c to patients with.....
ventricular arr
| increases mortality
101
Example of Class 1c
Flecainaide
102
Class 2
B blockers
decrease phase 4 and 0
decreaes automaticity at SA node, prolong AV, decrease HR and contractility
prolong PR
103
Class 3
blocks K channels
| causes torsades
104
Sotalol
C3
blocks K channels and B receptors
used for SVT
105
Adverse Effects of Sotalol
bradycardia, dyspnea, fatigue, torsades
106
Amiodarone
C3
containes iodine
can block all channels
long half life
107
Dronedarone
C3
no iodine
can block all channels
shorter half life
108
Adverse Effects of Class 3
liver, lung, eye issues
109
Class 4
Ca channel blockers
| decrease Phase 4/0 at SA and AV node
110
Digoxin
increases contractility and decreases HR
| A-fib and SVTs
111
Adenosine
drug of choice for acute superventricular tachycardia
IV
decreases HR
112
Angina
chest pain caused by inadequate oxygen supply to the heart
113
Stable Angina
obstruction of large coronary vessels
| pain after mild exercise
114
Vasospastic Angina
result of coronary vasospasms
115
Unstable Angina
change in character, frequency, duration of pain
| clot- medical emergency
116
Treating Stable Angina
Nitrates
B blockers
CCBs
117
Treating Vasospastic Angina
Nitrates
| CCBs
118
Treating angina patients with diabetes
add ACEI
119
Nitroglycerin
relaxes vessels
converts nitrite to nitric oxide
NO activates guanalyl cyclase, increases cGMP, relaxation
120
Nitroglycerin for acute vs prophylaxis
sublingual
| patch
121
Adverse Effects of Nitroglycerin
headaches
| reflex tachycardia
122
Nitroglycerin Tolerance
patch only at times when active, takes 6-8 hours to restore sensitivity
123
Isosorbide mononitrate and dinitrate
prevent angina attacks
long duration of action- take in morning
acts same as nitroglycerin
124
Nitrates + phosphodiesterase 5 inhibitors
"fils"- ED
| extreme hypotension and death
125
Most common drug type to prevent stable angina
B blockers
126
CCB and Angina
block L type channels
verapamil and diltiazem for stable
dipines for vasospastic
127
Treating Raynaud's Phenomenon
CCBs
128
Ranolazine
adjunct to other angina meds
prolongs QT interval
torsades
129
HMG Co-A Reductase Inhibitors
block rate limiting step in synthesis of cholesterol
| clears LDL, lowers TG, raises HDLs
130
Examples of HMG Co-A Reductase Inhibitors
Statins
131
Adverse Effects of Statins
muscle pain
| caution with grapefruit juice
132
Fenofibrate
activates PPAR-a that increases lipoprotein lipase
| clears TG
133
Fenofibrate is often paired with....
statin
134
Niacin
reduces VDL synthesis- lowers LDLs
decrease free fatty acid and TG
decrease metabolism of HDL
135
Adverse Effects of Niacin
cutaneous flushing
itching
pretreat with NSAIDs
136
Cholestyramine
binds to bile salts to decrease their recycling, forcing the liver to make more via LDLs
137
Ezetemibe
decreases GI uptake of cholesterol
138
Alirocumab
prevents enzyme from degrading LDL receptors- lowers LDLs
| EXPENSIVE
