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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
Q

Adverse effects of Beta blockers

A

bradycardia, hypotension, fatigue, insomnia, sexual dysfunction, hypoglycemia (DM!!), hypokalemia (monitor diuretic use)

26
Q

In what instances would you not want to use a beta blocker?

A

Low HR, respiratory disease, hypersensitivity, 1st degree heart block, acute HF

27
Q

MOA of CCBs

A

dilation of arterioles
block movement of calcium into smooth muscle -> no contraction-> relaxation/dilation

-does not dilate veins

28
Q

2 main types of CCBs & their specific drugs

A

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
Q

Adverse effects of CCBs

A 
Bradycardia
Heart block - (Non)
Constipation -(non)
peripheral edema - (especially dihydro.)
Headache
Flushing
gingival hyperplasia (dihydro)
reflex tachycardia (dihydro)
30
Q

When would you not want to use a CCB

A 
HR <60
With a B-blocker
If patient is hypersensitive or reduced EF
severe sinus bradycardia
A fib or flutter w/ bypass tract
31
Q

Things to remember when dosing CCBs

A

Most have very short half lives (except Amlodipine) so extended release is preferred for 1-2 times daily dosing

32
Q

MOA of ACE inhibitors

A

Inhibit conversion of angiotensin I to angiotensin II so cannot increase output of SNS

33
Q

What are the ACE inhibitors? -pril

A 
Benazepril
Captopril
Enalapril
Fosinopril
Lisinopril
Moexipril
Perindopril
Quinapril
Ramipril
34
Q

Adverse effects of ACEI

A

Common:

  • hyperkalemia
  • dry cough
  • reduced GFR, serum Cr increase

Serious:

  • acute renal failure
  • blood dycrasias
  • angioedema
35
Q

Contraindications of ACEI or ARB

A

Pregnancy
hypersensitivity
Bilateral renal artery stenosis (or only 1 kidney is functioning)

36
Q

When treating with ACEI or ARB, what is important to remember?

A
  • Must monitor K+ and renal function

- Make dose adjustments for renal impairment, elderly, volume depleted or w/ diuretic therapy

37
Q

MOA for ARBs (angiotensin receptor blocker)

A

Block angiotensin II from binding to angiotensin receptor

38
Q

What is the difference between ACEI and ARB

A

Not much! ARBs may be better tolerated: no cough

39
Q

What are the types of ARBs? -sartan

A 
Azilsartan
Candesartan
Eprosartan
Irbesartan
Losartan
Omesartan
Telmisartan
Valsartan
40
Q

Adverse effects of ARBs

A

Hyperkalemia
Renal function deterioration
angioedema
hypotension/syncope

41
Q

MOA for Direct Renin Inhibitor (Aliskren)

A

Directly inhibits renin

42
Q

Contraindications for Direct Renin Inhibitor use

A
  • Pregnancy
  • In combo with ACEI or ARB, potassium sparing diuretics, other meds
  • Caution with severe renal impairment
43
Q

Types of Alpha 1 Blockers (antagonists)

-azosin

A

Doxazosin
Prazosin
Terazosin

44
Q

Indications for use of Alpha 1 Blockers

A

Indications: use with other meds, not for mono therapy (4th or 5th line)

45
Q

Adverse effects of Alpha 1 Blockers

A

Syncope
Dizziness
Palpitations
orthostatic hypotension

46
Q

MOA of Alpha 2 Agonists

A

reduce sympathetic outflow & enhance parasympathetic
reduce HR, CO and total PR

Occasionally used for resistant HTN

47
Q

Types of Alpha 2 Agonists

A

Clonidine (must taper when discontinuing!)
Methyldopa
Guanfacine
Guanabenz

48
Q

Adverse effects of Alpha 2 Agonists

A
  • sedation
  • vision disturbances
  • Methyldopa causes: hepatotoxicity, hemolytic anemia, peripheral edema and orthostatic hypotension
  • Clonidine causes: Dry mouth, muscle weakness, orthostatic hypotension
49
Q

Main reason to use Alpha 2 Agonists?

When not to use?

A

Methyldopa is 1st line HTN in pregnancy

  • hypersensitivity
  • w/MAO inhibitor
  • hepatic disease
  • pheochromocytoma
50
Q

MOA of Peripheral Sympathetic Inhibitor (Reserpine)

A

reduces sympathetic tone and PR

depletes NE from sympathetic nerve endings

51
Q

Things to remember about Peripheral Sympathetic Inhibitors

A
  • Slow to act
  • Poorly tolerated
  • Interacts with OTC cough and cold meds
52
Q

Adverse Reactions to Peripheral Sympathetic Inhibitors

A
  • 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
Q

MOA of Direct Vasodilators

A

relaxes smooth muscle in arterioles and they activate baroreceptors

54
Q

When would you want to use a Direct vasodilator?

A

For resistant HTN

*need to use B-blocker and diuretic too

55
Q

Types of Direct Vasodilators

A

Isosorbide denigrate/hydralazine
Hydralazine
Minoxidil

56
Q

What are the adverse effects of Direct Vasodilators, and when would you not want to use them?

A

Edema, hypertrichosis, Tachycardia (why you use B-Blocker), Lupus-like syndrome

Don’t use with pheochromocytoma or with increased cranial pressure

57
Q

Important points when choosing which anti-hypertensive in Pregnancy

A
  • 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
Q

Tips to improve antihypertensive adhearance

A

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
Q

What changes to antihypertensives do we make for elderly patients?

A

Lower starting dose
Higher BP goal may be appropriate
Watch for postural hypotension (syncope)

60
Q

What to remember when choosing what class to use…

A

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
Q

What is a Hypertensive crisis and what do you do?

A
  • 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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