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Pharmacology > CV review study guide > Flashcards

CV review study guide Flashcards

1
Q

How does the body regulate blood pressure?

A

With two different systems, immediate and gradual/long-term control

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2
Q

What regulates short-term control of BP?

A

Primarily, the autonomic nervous system

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3
Q

What regulates long-term/gradual control

A

Primarily, the kidney

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4
Q

What factors control blood pressure?

A
  • Heart rate
  • Force of contractility
  • Vascular tone
  • Blood volume
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5
Q

What is the most common cause of HTN?

A

Mostly genetic and environmental (diet and exercise)

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6
Q

What are the stages of HTN?

A
  • Normal
  • Pre-hypertension
  • Stage 1 HTN
  • Stage 2 HTN
  • Hypertensive Crisis
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7
Q

Normal BP range

A

<120 systolic AND <80 diastolic

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8
Q

Pre-Hypertension range

A

120-139 systolic OR 80-89 diastolic

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9
Q

Stage 1 HTN range

A

140-159 systolic OR 90-99 diastolic

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10
Q

Stage 2 HTN range

A

> 160 systolic OR >100 diastolic

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11
Q

Hypertensive crisis range

A

> 180 systolic OR >110 diastolic

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12
Q

What is considered an emergency?

A

When there is organ damage

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13
Q

What drug is used for HTN emergency? How do you keep this drug from becoming inactivated?

A
  • nitroprusside

- Protect the drug from light

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14
Q

Orthostatic hypotension AKA?

A

Postural hypotension (occurs when someone is lying down)

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15
Q

What should a patient do to avoid syncope?

A
  • Take time getting up
  • Dangle their feet before getting up
  • Hold on to something, get up slowly
  • Sit for a few seconds before getting up
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16
Q

What drugs or combination of drugs can cause orthostatic hypotension?

A
  • anti-hypertensive drugs

- drugs that block HR, vasodilators

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17
Q

What drugs cause hyperkalemia?

A

Spironolactone, Lisinopril, Losartan

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18
Q

What drugs cause hypokalemia?

A

Hydrochlorothiazide, Furosemide, Mannitol

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19
Q

Potency of the different diuretics depends on?

A

The location of action in the renal nephron

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20
Q

List the diuretics from strongest to weakest

A
  • Loop diuretics (Loop of Henle)
  • Thiazide diuretics (Distal tubule)
  • K+ sparing diuretics (Collecting duct)
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21
Q

What are the differences between ACE-I and ARBs?

A

ACE-I: Blocks the formation of angiotensin I to angiotensin II
ARBs: Directly blocks it at the receptor site
(less incidents of coughing)

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22
Q

Which drugs should be used with caution in asthma patients and patients with diabetes?

A

Beta blockers

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23
Q

What is first dose phenomenon and which drug can cause it?

A

prazosin (minipress)

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24
Q

What is first dose phenomenon and which drug can cause it?

A
  • Can faint on the first dose

- prazosin (minipress)

25
Q

ACE-I end with?

A

(-pril)s

26
Q

ARBs end with?

A

(-sartan)s

27
Q

Which drugs should not be abruptly discontinued because of rebound HTN?

A
  • clonidine

- beta blockers

28
Q

Why might a diuretic be useful in a patient on hydralazine?

A

hydralazine causes Na+ and water retention which increases aldosterone secretion. So patient’s BP won’t go down and they are increasing their volume. We don’t want that so we need to block aldosterone with spironolactone (diuretic)

29
Q

Why is renal function important to monitor with Mannitol?

A

Mannitol increases urine output, if patient can’t pee, still administer the drug to push the kidneys

30
Q

Why is renal function important to monitor with Lisinopril?

A

Risk of acute renal failure (if kidney don’t work, K+ goes up)

31
Q

Why is renal function important to monitor with nitroprusside?

A

Risk of thiocyanate toxicity in patients with renal impairment

32
Q

What are the signs and symptoms of HF?

A
  • Shortness of breath
  • Edema
  • Rales
  • Fatigue
  • Rapid or irregular heart rate
  • Sudden weight gain (from water they retain)
  • Persistent wheezing or coughing
33
Q

What are the drug therapy goals for HF?

A
  • Reduce preload
  • Reduce after-load (SVR)
  • Inhibit RAAS and vasoconstrictor mechanisms (morbidity and mortality reduction)
34
Q

What are the drugs that have been shown to reduce morbidity and mortality?

A
  • Beta blockers

- ACE Inhibitors

35
Q

What are the drugs that have been shown to reduce morbidity and mortality?

A
  • Beta blockers

- ACE Inhibitors

36
Q

Why are isosorbide dinitrate and hydralazine given together for heart failure?

A

-isosorbide dinitrate reduces preload
-hydralazine reduces after-load
Using them together will work on both sides of the heart

37
Q

With Acute Decompensated Heart Failure (ADHF) how do treat someone who is cold & dry?

A
  • IV fluid (if patient is hypovolemic)

- Inotrope (for perfusion)

38
Q

With Acute Decompensated Heart Failure (ADHF) how do treat someone who is cold & wet?

A
  • Vasopressor (if patient is hypotensive)
  • IV diuretics and/or vasodilators (if patient is NOT hypotensive)
  • Inotrope (if patient has low output)
39
Q

With Acute Decompensated Heart Failure (ADHF) how do treat someone who is warm & dry?

A

IV fluid (to treat hypovolemia)

40
Q

With Acute Decompensated Heart Failure (ADHF) how do treat someone who is warm & wet?

A

IV diuretic and/or vasodilators (to treat fluid overload)

41
Q

How do low dose, moderate dose, and high dose dopamine differ in its effects?

A

low dose: Vasodilators (improve cardiac output, opens up kidneys)
moderate dose: B1 takes over, becomes more of a pressor
high dose: Pressor (similar to using NE & EPI)

42
Q

Which drugs are considered positive inotropes? How do they work?

A
  • Milrinone, Dobutamine, and Isoproterenol
  • Milrinone is a phosphodiesterase inhibitor, not affected by BB therapy. Decreases degradation of cAMP, improves contractility.
  • Dobutamine is a beta 1 agonist
  • Isoproterenol is a beta 1 and 2 agonist
43
Q

What are the indications for nitrates?

A
  • Acute or chronic angina
  • Myocardial infarction
  • Hypertension
  • Heart Failure
44
Q

How do nitrates work and on what vessels?

A
  • Nitrates release nitric oxide (NO) and induces smooth muscle relaxation, causes vasodilation, and reduces oxygen demand
  • Works on both venous and arterial vessels, but MAINLY venous
  • Coronary artery vasodilation
45
Q

What drug should the patient avoid taking with nitrates and why?

A
  • Avoid combination with Phosphodiesterase inhibitors (e.g Viagra) for 24-72 hours
  • Can cause severe hypotension
46
Q

What would you tell a patient receiving nitrates?, especially with SL tabs?

A
  • When they have chest pain, put drug under tongue. We want to try to reduce the oxygen demand so you need to lie down and rest
  • Repeat every 5 minutes x 3 prn, if after 3x they still have chest pain, call 911/go to the ER
47
Q

Which drugs are indicated for angina?

A
  • Nitrates
  • BBs
  • CCBs
48
Q

Which drugs are best for Prinzmetal’s angina?

A

-CCBs preferred first line

49
Q

Which drugs are best for chronic stable angina?

A
  • BBs

- CCBs

50
Q

Which drugs are best for acute coronary syndrome?

A 
"MONA" 
-Morphine 
-Oxygen 
-Nitroglycerin SL, topical, or IV 
-Aspirin 160-325mg
(beta blockers as appropriate to reduce O2 demand)
51
Q

What would you tell a patient who is started on amiodarone?

A
  • This drug has a long half life ~54-58 + days
  • Excreted in breast milk
  • Numerous drug interactions
52
Q

What has to be monitored while the patient is on amiodarone?

A
  • Liver
  • Heart
  • Lungs
  • Thyroid
  • Vision
53
Q

What is adenosine used for?

A
  • Drug of choice for converting PSVT to normal sinus rhythm
  • Used diagnostically to block or slow the AV node from conducting impulses to the ventricles for better rhythm interpretation
  • Used for exercise stress tests
54
Q

How is adenosine administered?

A
  • Place patient in supine position
  • Rapid IV push (1-3 seconds) administration through IV access closest to the heart followed by large IV flush (20 mins)
  • Use half dose if line is near the heart
55
Q

How does adenosine affect the EKG?

A

Causes a flat line because of temporary heart block

56
Q

What common stimulant (not necessarily a drug) can interact with adenosine?

A

Caffeine

57
Q

What drug is used to treat bradycardia?

A

Atropine

58
Q

Which drugs cause tachycardia?

A
  • Prazosin(Minipress)
  • nifedipine
  • hydralazine
  • Dobutamine
59
Q

Which drugs have a narrow therapeutic range requiring drug level monitoring and what factors affect drug levels?

A
  • Digoxin
  • Procainamide
  • Lidocaine
  • Fecainide
  • Amiodarone and BB may increase lidocaine levels

Pharmacology (6 decks)

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