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
2
Q
high blood pressure:
> _____ mm Hg
> _____ mm Hg
-the term _____ is not used anymore
A
140
90
prehypertension
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
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
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
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
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
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
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
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
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
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
13
Q
blood pressure = _____ x _____
A
cardiac output
peripheral vascular resistance
14
Q
antihypertensive drugs
- _____
- _____ (_____) inhibitors
- _____ receptor blockers
- _____ blockers
- _____ blockers
- _____ blockers
- _____ acting antihypertensives_
- _____
A
diuretics angiotensin converting enzyme ACE angiotensin CCB beta alpha centrally vasodilators
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
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
