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Pharm > CV > Flashcards

CV Flashcards

1
Q

Aliskiren

A
  • Direct renin inhibitor
  • contraindicated w/ use w/ ARBs or ACEIs in patients with renal impairment (i.e. GFR < 60 mL/min)
  • Black Box warning w/ pregnancy
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2
Q

Angiotensin Receptor-Blockers (ARBs)

A
  • as effecacious as ACEIs
  • Lower incidence of kinin-mediated side-effects
  • less cough and angioedema
  • risk of hyperkalemia
  • Black box warning for pregnant women (AngII required for normal fetal development)
  • Selectively block AT1 receptor
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3
Q

ACE inhibitors

A
  • end in ( - pril) [ex. Captopril]
  • Side effects
  • ACE breaks down bradykinin in the lungs
  • dry cough
  • angioedema (greater risk in African-Americans)
  • Hyperkalemia
  • Increased creatinine (< 30% is normal)
  • Black box warning for pregnant women (AngII required for normal fetal development)
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4
Q

Diuretics

A

Effects

  • increased Na+ excretion, venodilation, decrease intravascular volume
  • eventually decrease peripheral resistance
  • Subclasses: Thiazides, Loop, and Potassium-sparing

Side Effects

  • Hypotension, orthostasis
  • Hypokalemia (hyperkalemia w/ K+-sparing)
  • Hyponatremia and hypercalcemia (thiazide)
  • Ototoxicity (Loop)
  • Hyperglycemia, hypercholesterolemia, hyperuricemia
  • Erectile dysfunction
  • Sulfa-allergy (thiazide)
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5
Q

Aldosterone Antagonists

A
  • Beneficial in resistant HTN when combined w/ other diuretics
  • Increased risk of hyperkalemia when combined with ACE-I or ARB
  • Spironolactone (non-selective)
  • Side effects:
  • Men: ED and gynecomastia
  • Women: menstrual abnormalities
  • Eplerenone (selective but costs more)
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6
Q

Calcium Channel Blockers

A
  • block influx of Ca2+ and smooth muscle contraction
  • Effects
  • vasodilate arteriolar smooth muscle
  • decreae peripheral vascular resistance

Side Effects

  • gingival hyperplasia
  • aggravate GERB
  • Non-dihydropyridines
  • also decrease Ca2+ influx to myocardium causing bradycardia, AV block and constipation
  • Dihydropyridines
  • edema, headache, flushing, dizziness, palpitations
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7
Q

ß-Adrenoceptor Blockers

A
  • Decreased CO, inhibit renin secretion inhibit norepinephrine release
  • reductions of HR (negative chronotropic effects)
  • reduces ventricular hypertrophy, stroke, heart failure, coronary events and mortality
  • ß1 (selective): targets myocardium, less effect on airways
  • ß2 (non-selective): myocardium, vascular, bronchial cells
  • vasodilatory properties (carvedilol or labetalol) antagonize a-adrenergic receptor and increase NO release
  • Not first line HTN treatment

Side Effects

  • bradycardia, heart block, dizziness
  • bronchospasm, cold extremities (ß2 effect)
  • CNS: fatigue, depression, dry mouth
  • ED and hyperglycemia
  • Lipid abnormalities (TG elevation and HDL reduction)
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8
Q

Hydralazine

A
  • Direct vasodilator
  • relax smooth muscle and decrease peripheral resistance
  • given w/ diuretic and ß-blocker to prevent “pseudotolerance”
  • tachycardia and volume retention
  • metabolized by N-acetyltransferase (genetic component)
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9
Q

Minoxidil

A
  • Opens K+ channels in vascular smooth muscle
  • most useful in pts w/ severe hypertension and renal failure
  • Given w/ diuretic and ß-blocker to prevent “pseudotolerance”
  • Side effects: pericardial effusion (3%), facial hirsutism
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10
Q

a-Adrenergic Receptor Blockers

A
  • Selective a1-antagonists (blocks NE site)
  • decrease arteriolar resistance
  • beneficial for pts w/ prostate symptoms (ex. doxazosin)
  • Side effects:
  • Postural hypotension
  • dizziness, syncope
  • reflex tachycardia
  • nasal congestion
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11
Q

a2 agonists (clonidine, methyldopa)

A
  • reduce sympathetic outflow to the heart and blood vessels
  • Side-effects: sedation, severe dry mouth, ED
  • Clonidine: rebound HTN, skin hypersensitivity
  • Methyldopa: Coombs’ positive hemolytic anemia, elevated LFTs
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12
Q

M1 Receptors

A
  • tissue
    • autonomic ganglia
  • response
    • depolarizes postsynaptic neurons (slow EPSP)
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13
Q

M2 Receptors

A
  • Heart
    • decrease heart rate, conduction velocity, contractility
      • bradycardia (SA node)
      • decrease AV node conductivity
      • decrease atrial contractility
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14
Q

M3 Receptors

A
  • Smooth muscle (eye, bronchioles, GI tract, urogenital system)
    • contraction
      • iris circular muscle –> miosis
      • ciliary smooth muscle –> accommodation
      • bronchoconstriction
      • circular and longitudinal muscles in intestinal walls –> increase motility (relaxation of GI sphincters)
      • gall bladder
      • bladder detrusor muscle (relaxation of trigone and sphincter)
      • contracts uterus
  • Secretory glands
    • increase secretion
      • lacrimation
      • mucous bronchial gland secretion
      • acid secretion from parietal cells
      • gastric and intestinal glands
      • watery secretions from salivary, nasopharyngeal, pulmonary, GI and eccrine sweat glands
  • Vascular endothelium (w/o innervation)
    • dilates blood vessels
      • relaxation of endothelial cells
      • decrease BP
      • penile erection
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15
Q

NM Receptors

A
  • Neuromuscular junction
    • skeletal muscle contraction
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16
Q

NN Receptors

A
  • Autonomic ganglia
    • depolarizes postsynaptic neurons
  • Adrenal medulla
    • depolarizes medullary cells –> secretion of catecholamines
17
Q

a1 Receptors

A
  • smooth muscle (eye, vascular, urogenital, hair follicles)
    • contracts smooth muscle
      • iris radial muscle –> mydriasis
      • erector pili
      • vasocontriction –> increase BP
      • GI sphincters
      • trigone and sphincter –> urinary retention
      • seminal vesicles, prostatic capsule, vas deferens –> ejaculation
      • uterus
      • secretion from aprocine sweat glands
      • viscous salivary secretions
  • liver
    • increase glycogenolysis and gluconeogenesis
18
Q

a2 Receptors

A
  • axon terminals (autoreceptors)
    • decrease NE release
  • pancreatic B cells
    • decrease insulin release
  • vascular smooth muscle
    • contracts smooth muscle (less than a1)
      • vasocontriction –> increase BP
  • platelets
    • aggregation
19
Q

B1 Receptors

A
  • Heart
    • increase HR, conduction velocity, contractility (opposite of M2)
      • tachycardia (SA node)
      • increase AV node automaticity and conductivity
      • increase His-Purkinje automaticity and conductivity
      • increase ventricular automaticity and contractility
  • Kidney (juxtaglomerular cells)
    • increase renin release
20
Q

B2 Receptors

A
  • Smooth muscle (eye, bronchioles, GI, urogenital, vascular)
    • relaxes smooth muscle
      • iris circular muscle –> mydriasis
      • bronchodilation
      • watery secretion via CFTR activation in bronchial glands
      • decrease TPR and increase blood flow to liver and skeletal muscles
      • intestinal muscle –> decreased motility
      • decreased gastric acid secretion, relaxes gall bladder, increases amylase secretion
      • relaxes detrusor –> urinary retention
      • relaxes uterus
  • Heart
    • increase HR, contractility (B1 dominates)
      • tachycardia (SA node)
      • increase AV node automaticity and conductivity
      • increase His-Purkinje automaticity and conductivity
      • increase ventricular automaticity and contractility
  • Liver and skeletal muscle
    • increased glycogenolysis, gluconeogenesis (liver)
    • slight increase in insulin release
21
Q

B3 Receptors

A
  • Lipocytes
    • activates lipolysis
22
Q

D1 Receptors

A
  • Vascular smooth muscle, especially renal vasculature
    • dilates blood vessesls (increased renal perfusion)
      • increase GFR
23
Q

D2 Receptors

A
  • Axon terminals (autoreceptors)
    • decrease DA release
  • Cholinergic neurons in the gut
    • decrease GI motility

Pharm (6 decks)

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