Cardiovascular System and Drugs Flashcards

1
Q

hypertension

  • # 1 cause of ____ disease
  • blood pressure: _____ = normal
  • _____ or _____ hypertension - unknown >95%
  • _____ hypertension - result of other diseases
  • _____
  • renovascular disease (_____)
  • _____
  • coarctation of the _____
A
CVD
120/80
primary
essential
secondary
pheochromocytoma
renal artery stenosis
aldosteronism
aorta
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2
Q

high blood pressure:
> _____ mm Hg
> _____ mm Hg

-the term _____ is not used anymore

A

140
90
prehypertension

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3
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
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4
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 MI or stroke 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
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5
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

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6
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
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7
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
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8
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 _____ musculature
  • hypertensive _____
  • acute _____
  • acute _____
  • acute _____ (_____)
A
organ
fatal
180/120
2
nervous
renal
retinal
mural cardiac 
encephalopathy
aortic dissection
MI
CVA
cerebrovascular accident
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9
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
eclampsia convulsions during pregnancy
heroin, LSD, cocaine, cannabis
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10
Q

evaluation of a patient

  • _____ history of the patient
  • _____ history past and present
  • _____ history of patient
  • _____ of all peripheral pulses/ _____
  • _____/ _____/ BUN/ creat/ _____
  • chest Xray/EKG/ CT head

drugs commonly used:

  • _____/ nifedipine
  • _____/ _____
  • _____/ _____
A
BP
cardiovascular
medication
palpation
fundoscopy
CBC
electrolytes
urinalysis
sodium nitroprusside
labetalol
esmolol
diazoxide
minoxidil
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11
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
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12
Q

identifiable causes of hypertension

  • ______
  • _____-induced or related causes
  • chronic _____ disease
  • primary _____
  • _____ disease
  • chronic _____ therapy and _____ syndrome
  • _____
  • coarctation of the _____
  • _____ or _____ disease
A
sleep apnea
drug
kidney
aldosteronism
renovascular
steroid
cushings
pheochromocytoma
aorta
thyroid
parathyroid
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13
Q

blood pressure = _____ x _____

A

cardiac output

peripheral vascular resistance

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14
Q

antihypertensive drugs

  • _____
  • _____ (_____) inhibitors
  • _____ receptor blockers
  • _____ blockers
  • _____ blockers
  • _____ blockers
  • _____ acting antihypertensives_
  • _____
A
diuretics
angiotensin converting enzyme ACE
angiotensin
CCB
beta 
alpha 
centrally 
vasodilators
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15
Q

control of blood pressure

  • _____ reflexes modulate the sympathetic stimulation of _____ and _____ and adjust BP in response to _____ changes and altered physical activity
  • -provide ____ 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
short
sympathetic
plasma volume
renin-angiotensin-aldosterone
long
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16
Q

diuretics

  • diuretics act at various sites in the _____ to increase _____ production
  • inhibit _____ reabsorption from the _____ into circulation
  • -causing an increase in excretion of _____ in _____
A
nephron
urine
sodium
nephron
sodium
urine
17
Q

clinical uses of diuretics

  • _____ diseases
  • treatment of _____
  • _____ diseases
  • _____ abnormalities
  • treatment of _____
  • increased _____ pressure
  • others
A
cardiovascular
hypertension
renal
endocrine
glaucoma
intracranial
18
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
19
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
20
Q

furosemide (Lasix)

  • MOA:
  • -acts on the _____ of _____
  • -results in the retention 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
21
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
22
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
23
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
24
Q

thiazides

  • hydrochlorothiazide: clinical uses
  • _____ hypertension
  • –reduce _____: decrease load, immediate antihypertensive effect
  • –reduce _____: this effect develops over time, mechanism unknown
  • _____:
  • -patients with _______ (mild to moderate) or with renal or hepatic disease
  • _____- excessive _____ production
  • -a paradoxical effect; mechanism unknown
A
essential
blood volume
arterial resistance
edema
heart failure
diabetes insipidus
urine
25
Q

thiazides

  • hydrochlorothiazide (HCTZ)
  • -HCTZ alone
  • -HCTZ in combination with other drugs
  • –HCTZ and _____ (Inderil)
  • chlorothiazide (diuril)
  • -chlorothiazide alone
  • -chlorothiazide and _____ (Diupres 20)
  • Indapamide (Lozide)
  • used in _____ term management of _____
  • long term management of _____
  • do not use during _____
A
propranolol
reserpine
indapamide
long
heart failure
hypertension
pregnancy
26
Q

thiazides

hydrochlorothiazide: adverse effects
- _____ (excessive loss of K+)
- elevated uric acid (_____)
- -inhibit uric acid secretion from the proximal tubule
- elevated _____ levels (_____)
- -altered serum lipids: _____, _____
- elevated blood glucose (_____)
- -in part due to _____, which reduces _____ secretion by pancreatic beta cells
- _____ allergies

A
hypokalemia
hyperuricemia
lipid levels
hyperlipidemia
HDL
LDL
hyperglycemia
hypokalemia
insulin
sulfa
27
Q

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 _____ production. not potent as a stand alone drug to promote diuresis
A
distal tubule
sodium
potassium
sodium
potassium
potassium
thiazide
loop
urine
28
Q

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 _____

A
epithelial sodium channel
amiloride
triamterene
aldosterone receptor
blocks
adrenal cortex
sodium
potassium
Na+
K+
29
Q
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)
A
hyperkalemia
endocrine
gynecomastia
impotence
menstrual
breast
aldosterone
Na+
K+
30
Q
potassium sparing diuretics
clinical uses:
-prevention and treatment of \_\_\_\_\_
- primary \_\_\_\_\_
-\_\_\_\_\_ disease (antiandrogen effect)
-\_\_\_\_\_

adverse effects:

  • _____
  • -_____, vomiting, dizziness
  • -blood _____ (RARE)
A
hypokalemia
hyperaldosteronism
polycystic ovary
hirsutism
hyperkalemia
nausea
dyscrasias
31
Q

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
  • _____, _____, _____, _____
A
glomerulus
molecular target
receptors
osmotic
water
mannitol
isosorbide
urea
glycerol
32
Q

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 _____ and a reduction in body _____ stores

A
nephron
luminal
basolateral
epithelial
RBCs
proximal tubule
bicarbonate
sodium bicarbonate
dieuresis
bicarbonate
33
Q

carbonic anhydrase
clinical uses:
-_____: topical application of - _____ or _____
–reduces _____

  • _____: acetazolamide
  • -increased urinary pH enhances excretion of _____ and _____

-_____: acetazolamide

A
glaucoma
dorzolamide
brizolamide
IOP
urinary alkalinization
uric acid
ASA
metabolic alkalosis
34
Q

menopause increases the risk of heart disease in women due to decreased ______ level in patient

A

estrogen