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Pharmacology -AM > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

The nervous system has 2 major divisions, what are they?

A

Central (CNS)- brain and spinal cord

Peripheral (PNS) -neuronal tissues outside CNS

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2
Q
  • Fight or flight nervous system.
  • Increase in heart rate, increases blood flow to muscles & heart, dilation of pupils & bronchioles. Restricts GI motility, bladder function, sexual organs.
  • Discharges as complete system
A

Sympathetic nervous system

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3
Q
  • Rest and digest nervous system
  • maintains homeostasis & essential body functions
  • never discharges as complete system (organs affected individually)
A

Parasympathetic nervous system

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4
Q

How does a nerve cell communicate with a target effector cell (smooth muscle, cardiac muscle, glands)?

A

Neurotransmitters - chemical transmission of information

*Drugs can mimic transmitter substances

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5
Q 
NE (norepinephrine)
Epinephrine
ACh (acetylcholine)
Dopamine
Serotonin
Histimine
Glutamate
And many more, are examples of ....
A

Neurotransmitters

NE & ACh are primary chemical signals in ANS

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6
Q

Muscarinic/Cholinergic Agonists encourage ____________ response

A

parasympathetic

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7
Q

Muscarinic/Cholinergic Antagonists allow ____________ response

A

sympathetic

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8
Q

NE or epinephrine is an (agonist or antagonist) of alpha/beta receptors

A

Agonist

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9
Q

NE or epinephrine in low doses allows (alpha or beta) effects to predominate

A

Beta

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10
Q

NE or epinephrine in high doses allows (alpha or beta) effects to predominate

A

Alpha

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11
Q

What risk factors predispose someone to HTN?

A 
African American
Men
Smoking
Metabolic syndrome (obesity, dyslipidemia, diabetes)
Family history of CVD
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12
Q

What type of HTN is called the “silent killer” because it is asymptomatic, idiopathic, and accounts for 90% of cases?

A

Essential HTN

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13
Q

What type of HTN due to physiologic causes, such as renal disease, coarctation of the aorta, endocrine diseases, and accounts for 10-15% of cases?

A

Secondary

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14
Q

The body controls BP rapidly and with moment-to-moment regulation with the _________ system

A

Baroreceptors and sympathetic nervous system

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15
Q

The body controls BP with long term regulation with the _________ system

A

Renin-Angiotensin-Aldosterone system (Renal response)

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16
Q

Four general categories of Antihypertensives

A

Diuretics -work by reducing blood volume

Sympathoplegic agents- reduce peripheral vascular resistance, inhibit cardiac function and encourage venous pooling in capacitance vessels

Direct vasodilators- relax vascular smooth muscle (dilates vessels)

Agents that block angiotensin- reduce peripheral vascular resistance, potentially reduce blood volume

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17
Q

3 classes of diuretics

A

Thiazide
Loop
Potassium sparing

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18
Q

MOA of Diuretics

A

Decrease blood volume (decrease BP)

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19
Q

Things to remember about Diuretics

A

Need to monitor electrolytes
Rarely used alone in Tx of HTN
Can cause hyperkalemia (except potassium sparing)
Work by reducing Na & water retention, which reduces blood volume, which reduces cardiac output

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20
Q

What are the Thiazide diuretics

-one + -ide

A

Hydrochlorothiazide*
Chlorthalidone*
Metalozone
Indapamide

Not effective when GFR <30

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21
Q

What are the Loop diuretics

-ide + acid

A

Furosemide
Toresemide
Bumetianide
Ethacrynic acid

Works with poor renal function
Acts quickly

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22
Q

What are the Potassium Sparing diuretics

-one, -ene, -ide

A

Amiloride
Triamterene
Spironolactone
Eplerenone

Sometimes used with other diuretics to reduce K+ loss

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23
Q

MOA of Beta Blockers

A

Decrease cardiac output
-may also decrease sympathetic outflow & inhibit release of renin

Non-selective: beta 1&2
Cardioselective: beta 1
Mixed alpha 1, non-selective beta (beta 1&2)

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24
Q

When are you likely to choose a cardioselective beta blocker

A

For patients with asthma, COPD, peripheral vascular disease (avoid nonselective)

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25
Adverse effects of Beta blockers
bradycardia, hypotension, fatigue, insomnia, sexual dysfunction, hypoglycemia (DM!!), hypokalemia (monitor diuretic use)
26
In what instances would you not want to use a beta blocker?
Low HR, respiratory disease, hypersensitivity, 1st degree heart block, acute HF
27
MOA of CCBs
dilation of arterioles block movement of calcium into smooth muscle -> no contraction-> relaxation/dilation -does not dilate veins
28
2 main types of CCBs & their specific drugs
Dihydropyridines (Think Legs) better for vascular calcium channels- periphery - Nifedipine - Amlodipine Non-dihydropyridines (Think Not Just the Legs)- both vascular & cardiac channels - Verapamil - Diltiazem
29
Adverse effects of CCBs
``` Bradycardia Heart block - (Non) Constipation -(non) peripheral edema - (especially dihydro.) Headache Flushing gingival hyperplasia (dihydro) reflex tachycardia (dihydro) ```
30
When would you not want to use a CCB
``` HR <60 With a B-blocker If patient is hypersensitive or reduced EF severe sinus bradycardia A fib or flutter w/ bypass tract ```
31
Things to remember when dosing CCBs
Most have very short half lives (except Amlodipine) so extended release is preferred for 1-2 times daily dosing
32
MOA of ACE inhibitors
Inhibit conversion of angiotensin I to angiotensin II so cannot increase output of SNS
33
What are the ACE inhibitors? -pril
``` Benazepril Captopril Enalapril Fosinopril Lisinopril Moexipril Perindopril Quinapril Ramipril ```
34
Adverse effects of ACEI
Common: - hyperkalemia - dry cough - reduced GFR, serum Cr increase Serious: - acute renal failure - blood dycrasias - angioedema
35
Contraindications of ACEI or ARB
Pregnancy hypersensitivity Bilateral renal artery stenosis (or only 1 kidney is functioning)
36
When treating with ACEI or ARB, what is important to remember?
- Must monitor K+ and renal function | - Make dose adjustments for renal impairment, elderly, volume depleted or w/ diuretic therapy
37
MOA for ARBs (angiotensin receptor blocker)
Block angiotensin II from binding to angiotensin receptor
38
What is the difference between ACEI and ARB
Not much! ARBs may be better tolerated: no cough
39
What are the types of ARBs? -sartan
``` Azilsartan Candesartan Eprosartan Irbesartan Losartan Omesartan Telmisartan Valsartan ```
40
Adverse effects of ARBs
Hyperkalemia Renal function deterioration angioedema hypotension/syncope
41
MOA for Direct Renin Inhibitor (Aliskren)
Directly inhibits renin
42
Contraindications for Direct Renin Inhibitor use
- Pregnancy - In combo with ACEI or ARB, potassium sparing diuretics, other meds - Caution with severe renal impairment
43
Types of Alpha 1 Blockers (antagonists) | -azosin
Doxazosin Prazosin Terazosin
44
Indications for use of Alpha 1 Blockers
Indications: use with other meds, not for mono therapy (4th or 5th line)
45
Adverse effects of Alpha 1 Blockers
Syncope Dizziness Palpitations orthostatic hypotension
46
MOA of Alpha 2 Agonists
reduce sympathetic outflow & enhance parasympathetic reduce HR, CO and total PR Occasionally used for resistant HTN
47
Types of Alpha 2 Agonists
Clonidine (must taper when discontinuing!) Methyldopa Guanfacine Guanabenz
48
Adverse effects of Alpha 2 Agonists
- sedation - vision disturbances - Methyldopa causes: hepatotoxicity, hemolytic anemia, peripheral edema and orthostatic hypotension - Clonidine causes: Dry mouth, muscle weakness, orthostatic hypotension
49
Main reason to use Alpha 2 Agonists? | When not to use?
Methyldopa is 1st line HTN in pregnancy - hypersensitivity - w/MAO inhibitor - hepatic disease - pheochromocytoma
50
MOA of Peripheral Sympathetic Inhibitor (Reserpine)
reduces sympathetic tone and PR | depletes NE from sympathetic nerve endings
51
Things to remember about Peripheral Sympathetic Inhibitors
- Slow to act - Poorly tolerated - Interacts with OTC cough and cold meds
52
Adverse Reactions to Peripheral Sympathetic Inhibitors
- gastric ulceration - depression - sexual side effects - orthostatic hypotension - nasal congestion - fluid retention - peripheral edema - diarrhea - increased gastric secretion Don't use with: peptic ulcers or ulcerative colitis, Hx of depression, Hx of ECT
53
MOA of Direct Vasodilators
relaxes smooth muscle in arterioles and they activate baroreceptors
54
When would you want to use a Direct vasodilator?
For resistant HTN | *need to use B-blocker and diuretic too
55
Types of Direct Vasodilators
Isosorbide denigrate/hydralazine Hydralazine Minoxidil
56
What are the adverse effects of Direct Vasodilators, and when would you not want to use them?
Edema, hypertrichosis, Tachycardia (why you use B-Blocker), Lupus-like syndrome Don't use with pheochromocytoma or with increased cranial pressure
57
Important points when choosing which anti-hypertensive in Pregnancy
- Methyldopa 1st line in pregnancy, although Labetalol is becoming increasingly preferred (less data) - B-blockers generally acceptable - Clonidine & CCBs have limited data - Diuretics are probably safe but have limited data - angiotensin-converting enzyme inhibitors and angiotensin II antagonists are contraindicated! Fetal toxicity and death
58
Tips to improve antihypertensive adhearance
Fewer drugs = better adherence Explain to patient: - HTN is asymptomatic -> goal is to prevent end organ damage - Adverse effects may be more noticeable than benefits - Takes 2-3 weeks to see full effects (wait to add on or increase meds)
59
What changes to antihypertensives do we make for elderly patients?
Lower starting dose Higher BP goal may be appropriate Watch for postural hypotension (syncope)
60
What to remember when choosing what class to use...
ACEI & ARBS are first choice overall (don't use together) CCBs & Thiazides are best for African Americans B-blockers not great for HTN, but help with CAD, HF, etc If combo of 3 drugs isn't working- consult specialist Patients with CKD = ACEI or ARB (including African Americans
61
What is a Hypertensive crisis and what do you do?
- BP very high >220/100 - Emergency! although it is rare, risk of target organ damage - Goal is to decrease BP quickly without going too low - Use short acting IV antihypertensives: labetalol, enalaprilat, hydrazine, nitroprusside

Pharmacology -AM (4 decks)

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