CV Pharm Flashcards
contrast hypertensive urgency & hypertensive emergency
hypertensive urgency has NO associated acute end organ damage, vs. hypertensive emergency which does
what is the term for both hypertensive urgencies & emergencies?
hypertensive crisis
term for: when bp is uncontrolled depite the use of 3+ antihypertensive drugs, one of which is a diuretic
resistant HTN
risk factors for resistance HTN?
older age, obesity, chronic kidney disease, diabetes, obstructive sleep apnea, high salt diet, Af Am race, females (post menopause)
common causes of secondary HTN?
renal parenchymal disease, obstructive sleep apnea, renal artery stenosis, primary aldosteronism
ppl with resistance HTN are expected to have high or low fluid levels?
expect to be fluid overloaded
inadequate diuretic use is top cause of tx resistance
what is the preferred diuretic for Resistant HTN?
chlorthalidone
which drugs can be used to tx HTN in pregnancy?
Methyl dopa, labetalol, nifedipine, hydralazine, metoprolol
what is the safest antihypertensive drug for pregnant women?
methyldopa
what antihypertensives need to be avoided in pregnant women?
diuretics, atenolol, nitroprusside,
ACE inhibitors, angiotensin receptor antagonists
what is anginal pain caused by?
release of bradykinin & adenosine onto nociceptive afferents
downside of using organic nitrates?
can only be used in acute setting–>tolerance develops early
how to combat nitrate tolerance
use dosing regimens that allow for nitrate free of low nitrate concentration for several hrs/day
during window without nitrate, can cover with other drugs (beta blockers, vasodilators, etc)
the ability for a cell to initiate an AP
automaticity
the ability of a cell to receive and transmit an AP
conductivity
the ability of a cell to receive and transmit an AO
dromotropism
what maintains the plateau of the AP?
the late INa channels
the ERP/APD ratio is important for what?
propagation of abnormal impulses
lower ERP/APD ratio indicates what?
it will be easier for tissue to be depolarized by abnormal imppulses
what are some things that could create marked prolongatino of the cardiac AP?
slow HR, hypokalemia
what cell type are early after depolarizatios most readily induced?
purkinje cells
what do early after repolaizations result in?
torsade de pointe
delayed after-depolarization occurs under what sort of conditions?
Ca overload
ie. MI, adrenergic stress, digitalis intox, HF
what happens in delayed after depolarization?
if DAD reaches threshold, a secondary triggered beat or beats may occur
normal upstroke followed by abnormal depolarization * secondary upstroke
what is teh most common cause of paroxysmal regular narrow complex tachy?
AV nodal reentrant tachycardia (AVNRT)
what class of antiarrhytmics is good for use in digitalis & MI induced arryhtmia?
class 1b
why is there an early reoccurence of arryhtmias after amiodarone is discontinued?
all tissues are saturated, there is a rapid redistribution out of the myocardium–>responsible for early reoccurrence
is binding to L-type Ca channel alpha subunit by Ca-channel blockers a complete blockage?
no, it is an incomplete blockage
what is the most metabolically active section of the nephron?
- proximal convoluted tubule
2. thick ascending limb (2nd most)
why is cirrhosis a contraindication for use of acetazolamide?
induced alkalinizatino of urine will decr urinary excretion of NH4–>may contribute to hyperammonemia, hepatic encephalopathy
role of thizaides in tx of nephrogenic diabetes insipidis?
- incr renal Na reabsorption
- recovery of Aquaporin 2 abundance
- recovery of NCC, ENaC
how does spironolactone prevent LV remodeling & cardiac fibrosis?
inhibits MMP, inhibits protein kinase C
how does spirinolactone prevent sudden cardiac death?
improve HR variability, reduce QT dispersion, reduce early morning risk in HR in HF patients, prevents hypokalemia
what are the hemodynamic effects of spirinolactone?
bp reduction
modest diuresis, natriuresis
what are the vascular effects of spirinolactone?
decr vascular NADPH oxidase activity reduce the generation of reactive oxygen species reverse endothelial dysfunction increase nitric oxide bioactivity retard the thrombotic response to injury
what are the best agents to use in ppl with previous MI (to prevent risk of sudden cardiac death?
beta blockers
what is anginal pain mostly due to?
release of bradykinind + adenosine onto nocioceptive afferents
anginal pain
rest or unstable angina
anginal pain >30 min, shortness of breath, weakness, N/V
acute MI
GTN & ISDN are prescribed as what sort of tx for angina?
prophylactic tx
which of the organic nitrates has a phasic release formulation?
ISMN
how to calculate CO?
SV x HR
frank starling mechanism
greater preload = greater contractility
describe anrep
if you incr the afterload acutely, can trigger incr in contractilty
describe bowditch
relationship b/w hr & contractility
how to calculate corrected QT interval?
QT/sq root of R to R interval
