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Term 4 > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

What % is reabsorbed through the proximal tubule? What ions?

A

65% Na, K, H20 reabsorbed

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2
Q

What is reabsorbed in the descending loop of henle?

A

H20

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3
Q

what % is reabsorbed and what ions in the ascending loop of henle?

A

25% Na, Cl, K

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4
Q

What percent and ions are reabsorbed in the distal convoluted tubule?

A

4-8% Cl, Na

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5
Q

What % and ions are reabsorbed in the cortical collecting duct?

A

2-5% Na, H20

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6
Q

what are edematous states you would use a diuretic for?

A

Heart failure, Hepatic Ascites, nephrotic syndrome, premenstrual edema

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7
Q

what are nonedematous states you would use a diuretic for?

A

hypertension, hypercalcemia, Diabetes insipidus

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8
Q

What are the two main clinical uses for diuretics?

A

Abnormal fluid retention
hypertension

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9
Q

What are the loop diuretic drugs?

A

Furosemide
Torsemide
Bumetanide

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10
Q

Furosemide
Torsemide
Bumetanide

A
  • act on ascending loop of henle
  • ## highest efficacy for removing Na and Cl
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11
Q

When would you use loop diuretics?

A
  • Edema associated with heart failure, hepatic and renal disease.
  • mod to severe hypertension
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12
Q

What channel do loop diuretics block?

A

NKCC2

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13
Q

What are the important actions of loop diuretics?

A

increase urine output
increase prostaglandin synthesis

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14
Q

Adverse effects of loop diuretics?

A

ototoxicity
hyperuricemia
acute hypovolemia
hypokalemia
hypomagnesemia
allergic reactions

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15
Q

What are the thiazide drugs?

A

Hydrochlorothiazide
Chlorthalidone
Metolazone

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16
Q

Hydrochlorothiazide
Chlorthalidone
Metolazone

A

act on the distal tubule
Block NCCT channels
acts similarly to loop diuretics

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17
Q

what are clinical applications for Thiazides?

A

Hypertension
Heart Failure
Hypercalciuria (inhibits Ca excretion)
Diabetes insipidus
Premenstrual edema

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18
Q

Thiazide actions

A

decrease in Ca excretion
decrease in PVR

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19
Q

What is half life of Chlorthalidone

A

40-60 hours

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20
Q

Metalozone

A

most potent
Na excretion in advance of kidney failure

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21
Q

Adverse effects of Thiazides

A

Hypokalemia
hyponatremia
metabolic alkalosis
hyperuricemia
hyperglycemia
hyperlipidemia
hypersensitivity
sexual dysfunction

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22
Q

K-sparing drugs (aldosterone antagonists)

A

Spironolactone and Eplerenone

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23
Q

Spironolactone
Eplerenone

A

used when there is excess aldosterone
monitor potassium, can be fatal
acts in collecting tubule

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24
Q

What are the clinical applications of K-sparing drugs?

A

Heart failure (spironolactone)
Hypertension
Primary Hyperaldosterone
Edema

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25
What is MOA of Ksparing drugs
antagonizes aldosterone receptors preventing the nuclear complex , thus decrease in Na reabsorption and decrease in K excretion (two way street)
26
Adverse effects of Ksparing drugs
Peptic ulcers Endocrine effects hyperkalemia Nausea, lethargy, mental confusion
27
Ksparing (na inhibitors)
Amiloride Triamterene
28
Amiloride Triamterene
blocks Na transporter not relient on aldosterone can prevent K loss associated with thiazides and furosemide
29
Ksparing (na inhibitor) MOA
blocks the ENaC decrease in Na reabsorption decrease in K excretion
30
Adverse affects of Ksparing (na inhibitors)
Hyperkalemia Hyponatremia leg cramps GI upset Dizziness, pruritus, headache, minor visual changes
31
What is the Carbonic Anhydrase Inhibitor drug?
Acetazolamide
32
Acetazolamide
CA inhibitor acts on epithelial cells in proximal tubule not as efficacious than other diuretics
33
Clinical applications of CA inhibitor
Glaucoma Epilepsy Mountain sickness prophylaxis metabolic alkalosis
34
MOA of CA inhibitor
inhibits CA decreases ability to exchange Na for H decrease ATPase activity HC03 retained in lumen increasing pH of urine
35
Adverse effects of CA inhibitors
Metabolic Acidosis hyponatremia hypokalemia crystalluria malaise, fatigue, depression
36
What are the osmotic diuretics?
Mannitol
37
Mannitol
raises osmotic pressure of plasma, drawing water out of the tissues. Directly increases urine volume. Given IV
38
Clinical applications of Osmotic Diuretics
increase urine flow pts with acute renal failure reduce intracranial pressure & tx of cerebral edema excretion of toxic substances
39
Osmotic diuretics contradictions
Congestive Heart Failure Pulmonary Edema
40
Adverse effects of Osmotic Diuretics
Extracellular water expansion tissue dehydration
41
ADH Antagonists
Conivaptan
42
Conivaptan
ADH controls permeability Conivaptan is a ADH antagonist, so there will be a decrease in water permeability, making dilute urine V1 and V2 receptors
43
What are the functions of V1 and V2 receptors?
V1 -> increases smooth muscle contraction V2 -> increases h20 permeability and reabsoprtion via aquaporins
44
Clinical applications of ADH antagonists
Euvolemic and hypervolemic hyponatremia syndrome of inappropriate ADH secretion (SIADH)
45
ADH Adverse affects
Infusion site reactions (only given IV) Thirst Atrial Fibrillation GI and Electrolyte disturbance Nephrogenic Diabetes insipidous
46
ADH contradictions
Hypovolemic Hyponatremia Renal Failure
47
What is hypertension?
SBP over 130 sustained DBP over 80 sustained
48
What are antihypertensives supposed to control?
Decrease CO Decrease PR
49
What are the 4 ways in which an antihypertensive can act?
Resistance Arterioles Capacitance venules Pump output of heart Volume of kidneys
50
What are the compensatory mechanisms for decreased blood pressure using drugs?
Baroreceptor reflex will engage and increase it again
51
How is stage 1 hypertension patients treated?
single drug lifestyle recommendations
52
How are stage 2 hypertension patients treated?
multiple drugs lifestyle recommendations
53
What are first line treatments for hypertension?
Ace inhibitors ARBs Calcium channel blockers Thiazides
54
Second line treatment for HTN?
B-blockers Aldesterone Antagonists
55
Captopril Enalapril Lisinopril
- ace inhibitors - first line for diabetics or pts with Chronic kidney disease - inhibit ACE -> cleaves angiotensin 1 to for angiotensin 2 - decreases PVR by decreasing sodium retention (aldost.) - increase bradykinin - NO reflex involved in ACE inhibitors
56
Clinical Applications of ACE inhibitors
- hypertension - Preserve renal function in pts with diabetic or non diabetic nephropathy - effective in tx of heart failure - Standard care for pts with MI
57
ACE and ARBS Preserves renal function how?
causing dilation to decrease GFR
58
Adverse effects of Ace Inhibitors
Dry hacking cough hyperkalemia hypotension angioedema Acute renal failure Rash, fever, alter taste
59
When are Ace inhibitors contradicted?
Pregnancy -> 1st bc congenital malformation and 2/3 due to fetal hypotension, anuria, and renal failure Pts with bilateral renal artery stenosis Pts with history of angioedema with hx of ACE inhibitors
60
Losartan Valsartan
Angiotensin Receptor blockers first line agents -> if pt is intolerable to ACEI Blocks angiotension 2 type 1 recp. -> decrease BP -> blocks Aldosterone release -> decreases Na and H20 retention decrease diabetic nephropathy NO INCREASE IN BRADYKININ
61
ARBS adverse side effects
NO dry cough angioedema risk is lower Losartan reduces uric acid by inhibiting URAT1 similar side effects to ACEI
62
Contradictions for ARB
Pregnancy pts with bilateral renal artery stenosis
63
Aliskiren
- renal inhibitor - Not first line MOA - inhibits enzyme activity of renin, prevents conversion of angiotensinogen to angiotensin 1, resulting in inhibition of angiotensin 2 and aldosterone release
64
Adverse effects of Aliskiren
similiar to ACEI Dry cough no not occur-> due to no increase in bradykinin Angioedema but low rist
65
Verapamil Diltiazem Nifedipine Amlodipine
First line agents for black or elderly people Two classes: 1) Non- dihydropyridines -> verapamil, Diltiazem 2) Dihydropyridines -> Nifedipine, Amlodipine
66
Verapamil
Non-dihydropyridine works mainly on heart and smooth muscle tx angina, supraventricular tachyarrhythmias, HTN, migraines, and cerebral vasospasm
67
Diltiazem
non-dihydropyridine for heart and smooth muscle has better side effect profiles tx same as Verapamil
68
Amlodipine nifedipine
Dihydropyridines high affinity for vascular calcium channels vs cardiac txs HTN ( not great for cardiac arrhythmias) reduces Ca into smooth muscles to cause vasodilation and lower BP
69
Clinical applications for Ca channel blockers
Hypertension for black/ elderly pts
70
what can increase risk of MI when referring to Ca Channel blockers?
High doses short acting dihydropyridine can incrase MI sustained release is preffered
71
Adverse side effects of channel blockers
Verapamil -> constipation, gingival hyperplasia, inotropic effects Diltiazem-> negative inotropic effects Dihydropyridines -> reflex tachycardia, headache, fatigue hypotension, edema

Term 4 (5 decks)

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