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N929: Advanced Pharmacology > Cardiovascular Week 2 > Flashcards

Cardiovascular Week 2 Flashcards

1
Q

What are 5 alpha antagonists?

A
  1. clonidine
  2. phenoxybenzamine
  3. phentolamine
  4. prazosin
  5. sildenafil
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2
Q

What are 6 beta antagonists?

A
  1. Atenolol
  2. Carvedilol
  3. Esmolol
  4. Labetalol
  5. Metoprolol
  6. Propanolol
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3
Q

What type of drug is used to treat

  • pheochromocytoma
  • hypertensive emergencies
  • chronic HTN
  • erectile dysfunction
A

alpha blockers

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4
Q

What type of drug is used to treat

  • HTN
  • ischemic heart disease
  • cardiac arrhythmias
  • heart failure
A

beta blockers

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5
Q

How do ACEi treat HTN?

A

decrease total body volume

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6
Q

How do ARBs treat HTN?

A

decrease total body water

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7
Q

What 6 drugs or class of drugs treat HTN by manipulating vascular tone?

A
  1. Ca channel blockers
  2. K channel openers
  3. Endothelin receptor antagonists
  4. Hydralazine
  5. Alpha 1 antagonists (clonidine)
  6. Beta antagonists
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8
Q

What does activation of a1 cause?

A
  • vasoconstriction

- relaxation of the GI tract

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9
Q

Where are a1 receptors found?

A

presynaptic

vasculature
heart
glands
gut

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10
Q

Where are a2 receptors found & what do they do?

A

presynaptic

  • peripheral vascular smooth muscle
  • coronaries
  • brain
  • *activation = inhibition of norepi release → inhibition of SNS = ↓BP/HR/↓CNS activity

postsynaptic

  • coronaries
  • CNS
    • activation causes constriction, sedation, analgesia
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11
Q

Where are B1 found?

A 
myocardium
SA node
vent-conduction system
coronaries
kidney
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12
Q

What does activation of B1 cause?

A
  • increase inotropy
  • increase chronotropy
  • ↑myocardial conduction - velocity
  • coronary relaxation
  • renin release
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13
Q

Where are B2 receptors found?

A

smooth muscle of vasculature, bronchial, uterus

  • smooth muscle of the skin
  • myocardium
  • coronaries
  • kidneys
  • GI tract
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14
Q

What do B2 receptors do when activated?

A

vasodilation

  • bronchodilation
  • uterine relaxation
  • gluconeogenesis
  • insulin release
  • k uptake by the cells
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15
Q

Is ephedrine a direct or indirect acting?

A

both

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16
Q

Is phenylephrine a direct or indirect acting agent?

A

direct

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17
Q

in the the treatment of HTN, what medications target HR?

2

A
  1. beta blockers

2. calcium channel blockers

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18
Q

in the treatment of HTN, what medications target contractility?
(2)

A
  1. beta-blockers

2. calcium channel blockers

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19
Q

in the treatment of HTN, what medications target venous tone?
(4)

A
  1. a1 antagonists
  2. ACEi
  3. ARB
  4. Nitroprusside
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20
Q

in the treatment of HTN, what medications target Na/H2O retention?

A
  1. diuretics
  2. ACEi
  3. ARB
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21
Q

in the treatment of HTN, what medications target the direct innervation of vascular smooth muscle cells to decrease SVR?

A
  1. a1 antagonists

2. a2 agonists

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22
Q

in the treatment of HTN, what medications target circulating regulators to decrease SVR?

A

a1 antagonists
a2 agonists
ACEi
ARB

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23
Q

in the treatment of HTN, what medications target local regulators to decrease SVR?

A
  1. endothelin antagonists
  2. nitroprusside
  3. ACEi
  4. ARB
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24
Q

in the treatment of HTN, what medications target local regulators to decrease SVR?

A
  1. endothelin antagonists
  2. nitroprusside
  3. ACEi
  4. ARB
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25
What are the 2 biggest cardiovascular effects of anesthetics?
1. decreased SVR = decreased BP | 2. depressed myocardial contractility
26
What are 4 types of receptors located in the peripheral nervous system?
1. alpha 2. beta 3. nicotinic 4. muscarinic
27
Stimulation of beta receptor results in activation of
adenyl cyclase → | ↑cAMP
28
Increased cAMP from beta receptor activation causes..
↑ kinase activation & phosphorylation
29
B1,2,3 receptors are what kind of GPCR?
Gs
30
In the physiological response of Beta receptors, increased cAMP results in...
relaxation of smooth muscle & stimulation of cardiac contractility
31
What are the second messengers of a1 activation?
PLC IP3 & DAG PKC & increased free Ca2+
32
What are the second messengers of a2 activation?
1. inhibition of adenylate cyclase 2. ↓cAMP 3. ↑K conduction
33
What does ↓cAMP from a2 activation cause?
smooth muscle contraction | - K hyperpolarization
34
What does PLC, IP3/DAG, & PKC/↑ free Ca2+ from a1 activation cause?
smooth muscle vasoconstriction
35
a2 is excitatory or inhibitory?
inhibitory
36
a1 is excitatory or inhibitory?
excitatory ↑Ca++ → calmodulin activation → ↑actin/myosin interaction → sm muscle contraction
37
a2 is excitatory or inhibitory?
inhibitory ↓cAMP → ↓norepinephrine release
38
In the treatment of HTN, what 4 classes of drugs targets the SNS?
1. B-antagonists 2. a1 antagonists 3. mixed a/B antagonists 4. centrally acting a2 agonists
39
In the treatment of HTN, what 3 classes of drugs target the RAAS
1. ACEi 2. ARB 3. Diuretics
40
In the treatment of HTN, what classes of drugs target endothelium derived mediator and/or ion channel modulators?
1. direct vasodilators (nitroprusside, hydralazine) 2. calcium channel antagonists 3. potassium channel opener
41
What is a normal BP?
120/80
42
What is the treatment threshold for those <60yr or >60yr with renal dz or diabetes?
140/90 or greater
43
What is the treatment threshold for those >60yr w/o DM or renal dz?
150/90 or greater
44
What is the first line therapy for HTN treament?
thiazide diuretic UNLESS there is a "compelling indication"
45
Why do most patients require at least 2 medications to reach their BP goal?
physiological compensations
46
What is the threshold for a hypertensive URGENCY?
DBP >120 with evidence of | progressive end organ DAMAGE
47
What is the goal when a patient has a hypertensive urgency? & what medication is used?
goal, decrease DBP to 100-105 w/n 24 hours Clonidine
48
What is the threshold for a hypertensive CRISIS?
DBP >120 with evidence of end organ FAILURE
49
What is the goal when a patient has a hypertensive CRISIS?
decrease DBP 100-105 ASAP
50
What 4 medications can be used to treat a hypertensive crisis?
1. Nitroprusside 2. Nitroglycerin 3. Labetalol 4. Fenoldapam
51
What are the three competitive alpha antagonists?
Phentolamine, Prazosin, Yohimibine
52
What is an alpha antagonist that covalently binds and is difficult to overcome?
phenoxybenzamine
53
When must you give an a antagonist?
BEFORE you B-block a | pheochromocytoma or local anesthetic toxicity
54
What are 2 non-selective alpha antagonists?
phenoxybenzamine | phentolamine
55
What are 5 a1 selective antagonists?
``` prazosin terazosin doxazosin aifuzosin tamsulosin ```
56
What is 1 a2 selective antagonist?
yohimbine
57
What are 5 non-selective FIRST generation beta antagonists?
``` Nadolol Penbutolol Pindolol Propranolol Timolol ```
58
What are 5 B1 selective beta antagonists?
``` acebutolol atenolol bisoprolol esmolol metoprolol ```
59
What are 4 non-selective THIRD generation beta antagonists?
Carteolol Carvedilol Bucindolol Labetolol
60
What are 3 B1 selective THIRD generation beta antagonists?
betaxolol caliprolol nebivolol
61
What are the mixed a and B antagonists?
labetalol | carvedilol

N929: Advanced Pharmacology (6 decks)

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