CV127 &128 Flashcards
What type of drug is enalapril?
angiotensin converting enzyme inhibitor (ACEI)
What type of drug is losortan?
angiotensin receptor blocker
What type of drug is amlodipine ?
CCB (calcium channel blocker) dihydropyridine
What type of drug is verapamil ?
CCC non-dihydropyridine
What type of drug is diltiazem ?
CCB non-dihydropyridine
What type of drug is hydralazine?
arteriolar dilator - may involve NO
What type of drug is minoxidil ?
arteriolar dilator
What type of drug is sodium nitroprusside?
venous/arterial dilator - NO from parent compound
What type of drug is thiosulfate?
sulfur donor
What type of drug is nitroglycerin?
venous dilator - NO from parent compound
What type of drug is sildenafil
type 5 (not 4) phosphodiesterase inhibitor
under what conditions does the renin angiotensin aldosterone system (RAAS) system become activated?
when there is a need to increase the blood pressure and/or blood volume (sodium retention)
what is the juxtaglomerular apparatus?
cells in the kidney that synthesize, store, and secrete the enzyme renin
when is renin released?
when the body senses a decrease in blood pressure or a need for sodium
what happens to vasoconstriction and after load and preload when the RAAS system is blocked?
vasoconstriction is decreased. Afterload and preload are also decreased significantly.
what effect does blocking the RAAS system have on K ions?
decreases potassium loss
Where does chymase come from and what action does it have?
chymase comes from the heart and it converts angiotensin I to angiotensin II. Therefore it acts as an ACE (angiotensin converting enzyme)
blocking chymase and the resting action is analogous to what kind of drugs?
ACEIs
what does ARB stand for?
angiotensin receptor blocker
what does ACEI stand for?
angiotensin converting enzyme inhibitor
how do ACEIs and ARBs decrease blood pressure?
1) decrease TPR by decrease angiotensin II
2) decrease Na reabsorption
3) increasing bradykinin (which vasodilator by increasing NO and prostaglandins)
at what levels of renin are ACEIs and ARBs used with caution and why?
at very high renin levels because ACEIs and ARBs may produce a dangerous fall in BP since it removes all Angiotensin II
1) during hypervolemia when angiotensin II is already increased because of the existing condition
2) during renal artery stenosis in which Angiotensin II is produced to correct renal perfusion pressure due to stenosis.
what does blocking the RAAS system do to sodium retention?
It decreases sodium retention
when the angiotension receptor is activated, what are the resulting effects?
1) vasoconstriction
2) increase in aldosterone and increase in Na retention
3) increase in sympathetic activity
4) increased tropic effect (ventricular remodelling)
how are ARBs excreted?
Through the hepatic pathway (i.e the liver). Therefore decrease the dose in patients with liver disease
How are ACEIs excreted?
through the kidney. Therefore, decrease does in those with renal failure.
in which cardiovascular conditions are ARBs and ACEIs the first line treatment ?
1) hypertension
2) heart failure
What is the first line treatment for congestive heart failure?
ACEIs and ARBs
What are the benefits of using ACEIs and ARBs in Post Myocardial Infarction?
1) decreases post infarction myocardial remodelling
2) may decrease mortality following an MI
What are the benefits of using ACEis and ARBs in diabetic nephropathy?
1) prevent/delay diabetic nephropathy
2) decreases protein excretion and decreases renal deterioration
3) effective at doses that do not decrease blood pressure
How does aldosterone work?
increases reabsorption of ions and water in the kidney, to cause the conservation of sodium, secretion of potassium,
What is the first line treatment for preventing or delaying diabetic nephropathy?
ACEIs and ARBs
What is proteinuria?
the presence of abnormal quantities of protein in the urine, which may indicate damage to the kidneys.
When should ACEIs and ARBs be used with caution?
1) in pregnancy b/c harmful to the fetus
2) when combining with K sparing drugs
3) in renal artery stenosis because renin levels are high
4) diabetes type 4 renal tubular acidosis
What class of calcium channel blockers are vascular?
dihydropyridines
What class of calcium channel blockers are cardiac and vascular?
non-dihydrophyridines
What type of channels do CCB block? What does this result in?
L-type voltage gated calcium channels; decreases calcium available for contraction
what conditions are nifedipine and amlodipine used for ?
angina, raynaud’s phenomenon, hypertension, hypertensive crisis
describe diltiazem (type and uses)
non-dihydropyridine CCB with both cardiac and vascular effects. used to treat angina and hypertension
describe verapamil (type and uses)
non-dihydropyridine CCB that blocks mainly in the heart (limited vascular tissue)
TRUE OR FALSE: Verapamil should not be used in combination with a beta receptor blocker
TRUE; this has the potential to cause severe or total AV nodal block.
Which CCB of those discussed would be most preferentially used to decrease the contractility of the heart?
verapamil
Which CCB of those discussed would be most preferentially used for vasodilation of the vessels?
amlodipine
Which CCB would you use to treat supra ventricular tachycardia?
verapamil/diltiazem - this decreases condition velocity, and increases AV node refractory period
which vasodilator is the one which may cause lupus like syndrome?
hydralazine
which vasodilator is effective even if one has renal failure?
minoxidil
What kind of drug is sodium nitroprusside?
venous and arteriolar dilator
What drug would you administer in hypertensive emergencies and why?
sodium nitroprusside because it is potent and very fast acting.
How does sildenafil work ?
it is a type 5 phosphodiesterase inhibitor. Since phosphodiesterase breaks down cGMP, inhibiting it allows for cGMP to be preserved and to continue vasodilation/relaxation of the vessels
Why can chronic use of sodium nitroprusside lead to toxicity?
when nitroprusside is broken down, it is broken down into nitric oxide (vasodilator) and cyanide which is converted to thiocyanate in the liver and excreted in the kidneys. Chronic use can lead to cyanide accumulating
