cardiovascular disease and drugs Flashcards
1
Q
hypertension
- _____ cause of cardiovascular disease
- blood pressure: _____ = normal
- _____ or _____ hypertension - unknown >95%
- _____ hypertension - result of other diseases
- _____
- renovascular disease (_____)
- _____
- contraction of the _____
A
#1 120/80 primary essential secondary pheochromocytoma renal artery stenosis aldosteronism aorta
2
Q
2017 new guidelines for hypertension
-high blood pressure should be treated earlier with _____ changes and in some patients with _____ - at _____ mm Hg rather than _____ mm Hg - based on new ACC and American Heart Association (AHA) guidelines
blood pressure categories in the new guidelines are:
- normal: less than _____ mm Hg
- elevated: systolic between _____ and diastolic less than _____
- stage 1: systolic between _____ or diastolic between _____
- stage 2: systolic at least _____ or diastolic at least _____
- hypertensive crisis: systolic over _____ and/or diastolic over _____
A
lifestyle medication 130/80 140/90 120/80 120-129 80 130-139 80-89 140 90 180 120
3
Q
2017 new guidelines for hypertension
- only prescribing medication for stage 1 hypertension if a patient has had a _____ event (_____ or _____)
- patient at high risk of _____ or _____ based on _____
- presence of _____, _____ or _____ risk (high cholesterol)
- patients may need _____ or more types of medications
- _____: multiple medications combined into single pill
- identifying _____ status and psychosocial _____ as risk factors for high blood pressure
A
cardiovascular MI CVA MI stroke age diabetes mellitus chronic kidney disease atherosclerotic two compliance socioeconomic stress
4
Q
isolated systolic hypertension
- not distinguished as a separate entity for BP management
- _____ should be primarily considered during treatment and not just _____ BP
- _____ is a cardiovascular risk factor after age 50
- _____ is more important before age 50
A
SBP
diastolic
systolic BP
diastolic BP
5
Q
secondary HTN- clues on Exam
- _____, _____, other signs of _____ disease
- _____ especially with a diastolic component (_____)
- _____, purple _____, buffalo hump (_____)
laboratory tests: -increased \_\_\_\_\_, abnormal \_\_\_\_\_ (renovascular and renal parenchymal disease) -unexplained \_\_\_\_\_ (hyperaldosteronism) -impaired blood glucose (\_\_\_\_\_) impaired \_\_\_\_\_ (hypo-/hyperthyroidism)
A
pallor edema renal abdominal bruit renovascular truncal obesity striae hypercortisolism creatinine urinalysis hypokalemia hypercortisolism TFT
6
Q
target organ damage
- heart
- _____
- MI
- prior coronary revascularization _____
- heart failure
- brain: _____ or _____ attacks
- chronic _____ disease
- peripheral _____ disease
- _____
A
left ventricular CABG stroke transient ischemic kidney arterial retinopathy
7
Q
hypertensive crisis
- acute elevation of BP associated with end _____ damage
- potentially _____!
- hypertensive crisis/ hypertensive emergency/ malignant hypertension
- BP = _____ mm Hg x _____ consecutive readings
- damage to _____ tissue, _____ end arteries, and _____ arteries as well as ischemia to the _____
- hypertensive _____
- acute _____
- acute _____
- acute _____ (_____)
A
organ fatal 180/120 2 nervous renal retinal mural cardiac musculature encephalopathy aortic dissection MI CVA cerebrovascular accident
8
Q
common causes:
- antihypertensive drug withdrawal (_____)
- autonomic hyperactivity (_____)
- collagen vascular disease (such as _____)
- renal disease (name one _____)
- trauma to the _____
- neoplasia (example _____)
- pre-eclampsia (leading to _____)
- recreational drugs (such as _____)
A
clonidine Adrenergic SLE systemic lupus renal stenosis, acute tubular necrosis head pheochromocytoma convulsions during pregnancy heroin, LSD, cocaine, cannabis
9
Q
evaluation of a patient
- _____ history of the patient
- _____ history past and present
- _____ history of patient
- _____ of all peripheral pulses/ _____
- _____/ _____/ BUN/ creat/ _____
- chest Xray/ _____/ _____ head
drugs commonly used:
- _____/ nifedipine
- _____/ _____
- _____/ _____
A
BP cardiovascular medication palpation fundoscopy CBC electrolytes urinalysis EKG CT sodium nitroprusside labetalol esmolol diazoxide minoxidil
10
Q
major cardiovascular risk factors
- _____
- _____
- _____ (BMI >30 kg/m2)
- physical _____
- _____
- _____
- _____ or estimated GFR <60 mL/min
- age (older than _____ for men, _____ for women)
- family history of premature cardiovascular disease
A
hypertension cigarette smoking obesity inactivity dyslipidemia diabetes mellitus microalbuminuria 55 65
11
Q
identifiable causes of hypertension
- sleep apnea
- _____-induced or related causes
- chronic _____ disease
- primary _____
- _____ disease
- chronic _____ therapy and _____ syndrome
- _____
- contraction of the _____
- _____ or _____ disease
A
drug kidney aldosteronism renovascular steroid cushings pheochromocytoma aorta thyroid parathyroid
12
Q
blood pressure = _____ x _____
A
cardiac output
peripheral vascular resistance
13
Q
antihypertensive drugs
- _____
- _____ (_____) inhibitors
- _____ receptor blockers
- _____ blockers
- _____ (_____) blockers
- _____ (_____) blockers
- centrally acting _____
- _____
A
diuretics angiotensin converting enzyme ACE angiotensin beta B alpha a antihypertensives vasodilators
14
Q
control of blood pressure
- _____ reflexes modulate the sympathetic stimulation of _____ and _____ and adjust BP in response to _____ changes and altered physical activity
- -provide short term regulation of BP via the _____ nervous system
- kidney: regulation of _____, and the _____ axis
- -provide _____-term control of BP
- both mechanisms ensure BP remains in a narrow range
A
baroreceptor CO PR postural sympathetic plasma volume renin-angiotensin-aldosterone long
15
Q
diuretics
- diuretics act at various sites in the _____ to increase _____ production
- inhibit _____ from the _____ into circulation
- -causing an increase in _____ of _____ in _____
A
nephron urine sodium nephron excretion sodium urine
16
Q
clinical uses of diuretics
- _____ diseases
- treatment of _____
- _____ diseases
- _____ abnormalities
- treatment of _____
- increased _____ pressure
- others
A
cardiovascular hypertension renal endocrine glaucoma intracranial
17
Q
classification: diuretic drugs
- _____ (loop) diuretics (_____)
- _____ diuretics (_____)
- _____-sparing diuretics
- -_____: spironolactone
- -_____: triamterene
- others: _____ inhibitors, _____ diuretics
A
high ceiling furosemide thiazide hydrochlorothiaz potassium aldosterone non-aldosterone carbonic anhydrase osmotic
18
Q
loop diuretics
- _____ (Lasix)
- _____
- _____
- _____
high ceiling or high threshold
- act on the _____ of _____
- inhibit _____, _____ and _____ reabsorption
- these drugs are the _____ effective of the diuretics
A
furosemide bumetanide torsemide ethacrynic acid ascending limb henle sodium potassium chloride most
19
Q
furosemide (Lasix)
- MOA:
- -acts on the _____ of _____
- -results in the _____ of _____, _____ and _____ in the tubule
- the drugs are the _____ efficacious of the diuretics
- -potent _____ effect, highly efficient
- produce _____ by increasing _____ - _____ exchange in the _____ and _____
- increase _____ and _____ excretion
A
ascending loop henle retention Na+ Cl- water most natriuretic kaliuresis sodium potassium late distal tubule collecting ducts magnesium calcium
20
Q
adverse effects of loop (high ceiling) diuretics
- _____: loss of potassium via increased secretion in the _____ (_____)
- _____ (reversible) tinnitus, ear pain, vertigo and hearing impairment
- _____: dry mouth; unusual thirst and scanty urine output
- _____: dizziness, lightheadedness
A
hypokalemia distal nephron dysrhythmias ototoxicity dehydration hypotension
21
Q
loop (high ceiling) diuretics
- furosemide (lasix): drug interactions
- -_____ induced ventricular dysrhythmias
- –only when serum _____ level is low
- -_____ causes _____
- ototoxic drugs
- -_____ (increased ototoxicity)
- _____ excretion reduced
- -increase serum _____ levels
-potassium sparing diuretics (_____, _____)
A
digoxin potassium furosemide hypokalemia aminoglycosides lithium lithium spironolactone triamterene
22
Q
thiazide and related diuretics
- very commonly used diuretics
- _____ (effective), have moderate _____ effect
- block reabsorption of _____ and _____ in the _____
- increased renal excretion of _____, _____, _____ and _____
- _____ ceiling diuretics
- not effective when _____ diuresis required
- use cautiously in _____-drug allergy
A
orally natriuretic sodium chloride distal convoluted tubule sodium chloride potassium water low immediate sulfa
23
Q
thiazides
- hydrochlorothiazide: clinical uses
- essential hypertension
- –reduce _____: decrease load, immediate _____ effect
- –reduce _____: this effect develops over time, mechanism unknown
- _____:
- -patients with heart failure (mild to moderate) or with renal or hepatic disease
- _____- excessive _____ production
- -a paradoxical effect; mechanism unknown
A
blood volume anti-hypertensive arterial resistance edema diabetes insipidus urine
24
Q
thiazides
- hydrochlorothiazide (HCTZ)
- -HCTZ alone
- -HCTZ in combination with other drugs
- –HCTZ and _____ (Inderil)
- chlorothiazide (diuril)
- -chlorothiazide alone
- -chlorothiazide and _____ (Diupres 20)
- _____ (Lozide)
- used in _____ term management of _____
- long term management of _____
- do not use during _____
A
propranolol reserpine indapamide long heart failure hypertension pregnancy
25
thiazides
hydrochlorothiazide: adverse effects
- _____ (excessive loss of K+)
- elevated uric acid (_____)
- -inhibit uric acid secretion from the _____
- elevated _____ levels (_____)
- -altered serum lipids: _____, _____
- elevated blood glucose (_____)
- -in part due to _____, which reduces _____ secretion by pancreatic beta cells
- _____ allergies
```
hypokalemia
hyperuricemia
proximal tubule
lipid levels
hyperlipidemia
HDL
LDL
hyperglycemia
hypokalemia
insulin
sulfa
```
26
potassium-sparing diuretics
- act in the _____ where _____ is normally reabsorbed in exchange for _____
- they decrease _____ reabsorption and thus decrease _____ excretion
- useful to counteract _____ loss induced by _____ and _____ diuretics
- they produce a modest increase in urine production. not potent as a stand alone drug to promote diuresis
```
distal tubule
sodium
potassium
sodium
potassium
potassium
thiazide
loop
```
27
potassium sparing diuretics
two types:
-_____ blockers (_____; _____)
-_____ receptor antagonists (spironolactone): _____ action of aldosterone (_____ hormone)
--aldosterone promotes _____ retention and _____ excretion
--decrease _____ reuptake (more in lumen)
--increase retention of _____
```
epithelial sodium channel
amiloride
triamterene
aldosterone receptor
blocks
adrenal cortex
sodium
potassium
Na+
K+
```
28
```
potassium-sparing diuretics
adverse effects:
-_____
-_____ effects
--male: _____, _____
--female: _____ irregularities, _____ tenderness and enlargement
```
- spironolactone (aldactone)
- -blocks action of _____
- --decreased _____ reuptake (more in lumen)
- --increased retention of _____ (more recovered)
```
hyperkalemia
endocrine
gynecomastia
impotence
menstrual
breast
aldosterone
Na+
K+
```
29
```
potassium sparing diuretics
clinical uses:
-prevention and treatment of _____
-_____
-_____ disease (antiandrogen effect)
-_____
```
adverse effects:
- _____
- -_____, vomiting, dizziness
- -blood _____ (RARE)
```
hypokalemia
primary hyperaldosteronism
polycystic ovary
hirsutism
hyperkalemia
nausea
dyscrasias
```
30
osmotic diuretics
- they are freely filtered at the _____ and undergo minimal reabsorption
- they do not have a _____ (no _____)
- they act via their physiochemical properties
- -increase _____ pressure of tubular fluid, reducing _____ reabsorption
- _____, _____, _____, _____
```
glomerulus
molecular target
receptors
osmotic
water
mannitol
isosorbide
urea
glycerol
```
31
carbonic anhydrase inhibitors
- carbonic anydrase: enzyme
- -present in many _____ sites - _____, _____ membranes and cytoplasm of the _____ cells and _____
- -luminal membranes of _____
- -critical step in _____ reabsorption
carbonic anhydrase inhibitors
-block _____ reabsorption, causing _____ diuresis and a reduction in body _____ stores
```
nephron
luminal
basolateral
epithelial
RBCs
proximal tubule
bicarbonate
sodium bicarbonate
sodium
bicarbonate
```
32
carbonic anhydrase
clinical uses:
-_____: topical application of - _____ or _____
--reduces _____
- _____: acetazolamide
- -increased urinary pH enhances excretion of _____ and _____
-_____: acetazolamide
```
glaucoma
dorzolamide
brizolamide
IOP
urinary alkalinization
uric acid
ASA
metabolic alkalosis
```
