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Pharmacology > CVS disorder > Flashcards

CVS disorder Flashcards

1
Q

CVS disorder

A

Hypertension
Ischemic Heart Disease
Cognitive Heart Failure

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2
Q

Hypertension

A

Any sustained BP systolic/diastolic above 140/90
At least 3 measurement
Asymptomatic

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3
Q

Hypertension Stage

A

Prehypertensive 120/80 40-60 years
Stage 1 140/90
Stage 2 160/100

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4
Q

Hypertension Complication

A 
Heart attack
Coronary heart disease
Stroke
Renal failure
Blindness
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5
Q

Mean Arterial Pressure(MAP)= CO x Total Peripheral Resistance(TPR)

A 
CO= Heart rate,
Stroke volume(Contractility, Filling pressure(Venous tone, Blood volume))
TPR= Blood volume
Arteriolar diameter
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6
Q

Major mechanism control BP

A

Neural = Ans(PSNS,SymNS)
Hormonal
Local Factor = Alter blood vessel

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7
Q

Catecholamine

A

Adrenal Hormonal control BP mechanism
Phaeochromacytoma(tumor)
Increase sec

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8
Q

Aldosterone

A

Adrenal Hormonal control BP mechanism
Na, H20 retention
Inc BP

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9
Q

Angiotensin II

A

Renal renin(SymNS) Hormonal control
Stimulate sympa NS
Affect aldosterone release
Inc BV, hypertension

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10
Q

Antihypertension Drug Target

A 
CNS, ANS - Decrease sympatetic tone
Heart- Decrease cardiac output
Veins - Dilate - Decrease preload
Arterioles - Dilate- Decrease afterload
Kidney- Increase diuresis- Inhibit RAA system
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11
Q

Type of hypertension

A

White Coat
Essential
Secondary

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12
Q

White Coat

A

Stress associated with office/environment

Need 3-6 independent measurement

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13
Q

Essential

A

No known cause(95%)

Pharmacological theraphy

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14
Q

Secondary

A

Increase BP secondary to pathology

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15
Q

Renal Artery Stenosis

A

Secondary Hypertension

Isocheimal result increase AR(Angiotensinogen Renin)

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16
Q

Phaeochromocytoma

A

Secondary Hypertension
Tumor in chromafin cell of adrenal gland
Hypersecretion of adrenal catecholamine

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17
Q

Aortic Coarctation

A 
Secondary Hypertension
Severe congestion at arch & 
increase upper body pressure to
maintain lower body perfusion
Back BV are very dilated
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18
Q

Adrenal Tumor

A

Secondary Hypertension

Hypersecretion of glycocorticoid(aldosterone)

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19
Q

Hyperthyroidism

A

Secondary Hypertension

Increase CO with palpitation

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20
Q

General Hypertension treatment strategy

A

Diagnosis- At least 3 independent measurement
Determination of primary vs secondary hypertension
If secondary treat underlying pathology
If primary initiate lifestyle change
next Pharmacological treatment essential hypertension

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21
Q

lifestyle change include

A 
Weight reduction
Salt reduction
Withdrawal of drug
Tobacco
Alcohol
Stress reduction
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22
Q

Class of Anti-Hypertensive Drug

A 
Diuretic(de BV)
Peripheral a1 adrenergic antagonist
Central Sympatholytic a2 agonist
B-adrenergic antagonist
Anti-angiotensin II 
Ca++ channel blocker
Vasodilator
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23
Q

Type of Diuretics

A

Thiazides
Loop Diuretic
K+ Sparing
Osmotic(HTN emergency)

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24
Q

Hydrochlorothiazide

A 
Thiazides
Mild to moderate HTN
Direct vasodilator action
Start with low potency diuretic
Used with low na, high k
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25
Q

Furosemide

A

Loop Diuretic

Severe HTN, with CHF

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26
Q

Spironolactone

A

K+ Sparing
Combination with other drug
Week, prevent K loss

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27
Q

Diuretic Site of Action

A

Renal nephron

Different segment of nephron

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28
Q

Diuretic MOA

A

Inc urinary Na & H2O excretion,
dec extracellular fluid, plasma vol
All decrease Na reabsorption
Act on renal system, transporter, hormones, ion channel

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29
Q

Diuretic Effect on cardiovascular

A

Acute decrease in CO
Chronic decrease TPR, CO return normal
Compensate Na+ retaining reflex

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30
Q

Diuretic ADR

A 
Hypokalemia
Hyperglycemia(Thiazides)
Hyperuricemia(gout)
Dizziness
Electrolyte imbalance
Hyperlipidemia
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31
Q

Diuretic Contraindication

A 
Hypersensitivity
Compromised kidney function
Cardiac glycosides
Hypovolemia
Hyponatremia
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32
Q

MOA antagonist a1

A

Competitive antagonist a1 receptor on sm

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33
Q

Site of action a1 antagonist

A

Peripheral arterioles, sm
Block a1= vasodilator
Major mech sym con of BP

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34
Q

Adr a1 antagonist

A

Postural Hypotension
Tachycardia
Nausea, drowsiness

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35
Q

Postural Hypotension

A

Adr a1 antagonist
1st dose syncope
Take smaller dose
Take when sitting

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36
Q

Type a1 antagonist

A

Prazosin(Miniores)

Terazosin(Hytrin)

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37
Q

a1 antagonist Fx to CVS

A

Vasodilation, reduce peripheral resistance

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38
Q

a1 antagonist Contraindication

A

Hypersensitivity

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39
Q

a1 antagonist Uses

A

Diabetes, asthma, hypercholesterolemia
Mild to moderate HTN
Often used with diuretic, B-antagonist

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40
Q

Clonidine

A

Central Sympatholytic a2 agonist
Direct agonist
Rebound increase in BP
Prolong used Salt, water retension Add diuretic

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41
Q

Methyldopa

A 
Central Sympatholytic a2 agonist
Converted to methylnorepinephrin
False neurotrans
DOC in pregnancy
Prolong used Salt, water retension Add diuretic
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42
Q

Site of action a2 agonist

A

CNS Medullary Cardiovascular Center

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43
Q

MOA a2 agonist

A

activate CENTRAL a2 receptor
Peripheral sym inhibition
Decrease norepinephrine release
Decreased vasoconstriction Decrease TPR

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44
Q

Type of B antagonist

A 
Propanolol(Inderal)
Atenolol(Tenormin)
Metoprolol(Lopressor)
Nadolol(Corgard)
Pindolol(Visken)
45
Q

Site of action B antagonist

A

Selective b1 heart

Non selective b1&2 heart kidney

46
Q

MOA B antagonist

A

Competitive antagonist with b adrenergic receptor

47
Q

B antagonist Fx on CVS

A

Heart- Dec contractility, reduce BP

Kidney - Antagonize catecholamine

48
Q

Antagonize catecholamine

A

Dec renin release
Dec angiotensin 2, Dec TPR
Dec aldosterone release, No na retention CO reduce, BP reduce

49
Q

Adr B antagonist

A

Bradycardia

Exercise intolerance

50
Q

B antagonist Contraindication

A

Asthma
Diabetes
Bradycardia
Hypersensitivity

51
Q

B antagonist Uses

A 
Selectively 
Nadolol nonselective 20h t1/2
Metoprolol selective b1 3-4h t1/2
Risky in pulmonary disease
Mixed a/b blocker- Labetalol
Post MI- protective
With diuretic- Prevent reflex tachycardia
52
Q

Anti-angiotensin II drug type

A

ACE inhibitor(-pril)
Angiotensin 2 receptor antagonist
Direct renin inhibition (Aliskiren)

53
Q

ACE inhibitor example

A 
Enalopril (Commonly used
IV hypertensive emergency)
Captopril(prototype)
Quinapril(Accupril)
Fosinopril(Monopril)
Moexipril(Univasc)
Lisinopril(Zestril,Prinivil)
Benazepril(Lotensin)
54
Q

ACE inhibitor function

A

Angiotensinogen&raquo_space;renin&raquo_space;angiotensin
1»ACE»angiotensin 2
In present of ACE Inhibitor, no angiotensin 2 act on sympathetic system, no aldosterone
Associated with persistent cough due to accumulation of
bradykinin(breakdown)

55
Q

Angiotensin 2 receptor antagonist

A

Block receptor where angiotensin supposed to bind

Act on type 1 receptor

56
Q

Angiotensin 2 antagonist example

A

Valsartan(Diovan)
Losartan(Cozaar)
Candesartan(Atacand)

57
Q

Adr antiangiotensin 2

A

Hyperkalemia
Angiogenic edema, cough (ACE Inhibitor)
Rash
Itching

58
Q

CVS fx antiangiotensin 2

A

Dec CO

Dec constriction, Dec TPR

59
Q

antiangiotensin 2 Contraindication

A

Pregnancy
Bilateral renal stenosis
Hypersensitiviy

60
Q

antiangiotensin 2 Uses

A

Diabetes, renal insufficient
Adjunctive theraphy with heart failure
Often used with diuretic

61
Q

Verapamil(Calan)

A

Ca++ channel blocker

Cardiac muscle, rec in force of contraction

62
Q

Nifedipine(Procardia)

A 
Ca++ channel blocker
Inc SymNS
Tachycardia
Mainly arterioles of vascular sm
CI - CAD or Heart failure
63
Q

Diltiazem(Cardizem)

A

Ca++ channel blocker

Between cardiac & vascular

64
Q

MOA of Ca++ blocker

A

Block Ca++, Decrease contraction, Rec TPR

65
Q

Ca++ blocker adr

A

Headache
Dizziness
Peripheral edema

66
Q

Ca++ blocker Contraindication

A

Congestive heart failure
Pregnancy & Lactation
Post-myocardial infection

67
Q

Vasodilator

A 
Rarely used unless emergency
Dilate BV, BP fall, reflex tachycardia occur
Accompony with
B-blocker - Reduce heart rate
Diuretic - Prevent Na, H2O retention
68
Q

Hydralazine(Apresoline)

A

Vasodilator
Act on NO, Ca++
Lupus
Safe for pregnancy

69
Q

Nitroprusside(Nipride)

A 
Vasodilator
Used in emergency hypertension
Act on NO
Cyanide toxicity
Iv only
70
Q

Diazoxide(Hyperstat IV)

A

Vasodilator

Severe hypertension

71
Q

Minoxidil(loniten)

A

Vasodilator
Act on blood vessel
Hypertrichosis

72
Q

Fenoldopam(Corlopam)

A

Vasodilator

Act in dopamine receptor

73
Q

Vasodilator Site of action

A

Vascular sm

74
Q

Vasodilator CVS fx

A

Vasodilation

Decrease TPR

75
Q

Vasodilator Adr

A

Reflex tachycardia

Inc SymNS Hydralazine, Minoxidil, Diazoxide

76
Q

Summary MOA site HTN

A 
Brain a2 agonist
Heart b blocker
Receptor angiotensin: a1 anta, Ang 2 anta
Vasodilator, Ca++ anta
Kidney : Diuretic, B- bocker
Lung, VSM, Kidney, CNS ACE inhibitor
77
Q

HTN TT common condition

A 
Heart failure- ACE inhibitor, Diuretic
MI - B-blocker, ACE inhibitor
Diabetes- ACE inhibitor, Avoid B-blocker
Isolated systolic hypertension -Diuretic, Ca++ anta
Renal insufficiency- ACE inhibitor
Angina- B-blocker, Ca++ anta
Asthma- Ca++ blocker, Avoid B-blocker
78
Q

ischemic heart disease

A

Angina pectoris

79
Q

Angina pectoris

A

Sudden, severe subternal pain , pressure

Imbalance between oxygen demand & supply

80
Q

Angina pectoris Type

A

Stable
Unstable
Vasospastic

81
Q

Stable(exertional, typical, classic, angina of effort,atherosclerotic angina)

A

Atherosclerosis
Can percipitate by Exercise, Cold, Stress
Emotion, Eating
Therapeutic goal
Dilate c.artery- Increase o2 delivery
Decrease cardiac load-Preload & afterload

82
Q

Unstable(Preinfarction, Crescendo, Angina at rest)

A

Change in character, frequency, duration of stable angina & episode of angina at rest
Caused by recurrent episode of small platelet clot site of ruptured atherosclerotic plaque, can precipitate local vasospasm

83
Q

Unstable Therapeutic rationale

A

Inhibit platelet agg & thrombus formation
Decrease cardiac load
Vasodilate coronary arteries

84
Q

Vasospastic(Variant, Prinzmetal)

A

Caused by transient vasospasm of coronary vessel
Associated with atheromas
Chest pain may develop at rest
Therapeutic rationale- Decrease vasospasm of c.vessel, Ca++ blocker effective >70%, Increase o2 delivery

85
Q

Type AP drug

A 
Organic nitrate (DOC)(nitrovasodilator)
Calcium channel blocker
Beta adrenergic blocker
86
Q

Production of nitric oxide

A

Taken sublingual
Short lived
SM relaxant

87
Q

Organic nitrate fx

A

Vasodilate coronary artery
Reduce preload & afterload
Increase blood flow

88
Q

Isosorbidemononitrate(5-ISMN)

A

oral Organic nitrate

Not affected by first pass

89
Q

Isosorbidedinitrate(ISDN) (first pass)(oral ON)

Glyceralnitrate(GNT)(sublingual)

A

Hepatic blood flow & disease can affect pharmacokinetic

Rapid onset given sublingually(1-3min) last for (20-30 min), not suitable for maintainance theraphy

90
Q

Nitroglycerine

A

Tolerance problem, Use transdermal patches, Avoid first pass
Apply when doing work, remove before sleeping
IV- treat severe recurrent unstable angina

91
Q

Slowly absorbed preparation AP

A

Oral, buccal, transdermal
prolong prophylaxis against angina(3-10hour)
Can lead to tolerance(tachyphylaxis)

92
Q

Amyl Nitrate

A

Inhalation ON AP

Rapid onset, short duration(3-5min)

93
Q

Adr excessive ON

A 
Orthostatic hypotension
Tachycardia
Severe throbbing headache
Dizziness
Flushing
Syncope
94
Q

Contraindicated ON

A

Elevated intracranial pressure

95
Q

Drug interaction ON

A

Sildenafil(Viagra) other PDE-5 inhibitor
Erectile dysfunction
Can potentiate action of nitrovasodilator
Inhibit breakdown of cGMP
Should not be taken within 6 hour taking nitrovasodilator

96
Q

Calcium channel blocker AP

A

Vasodilate coronary artery
Reduce after load
Nondihydropyridines also decrease heart rate & contractility
Verapamil, Diltiazem

97
Q

Beta adrenergic blocker AP

A

Dec h.rate & contractility
Dec afterload , dec in CO
Improve myocardial perfusion due to decrease in heart rate
For post MI

98
Q

Congestive Heart Failure

A

Progressive inability of heart to supply adequate blood flow
to vital organs
Accomponiedby significant fluid retention (Leg edema, Pulmonary congestion, Ascites)
Leading cause of mortality & morbidity

99
Q

CHF Symptom

A

Shortness of breath
Edema
Fatigue

100
Q

CHF cause

A 
Hypertension
Coronary artery disease(CAD)
Diabetes
Mitral Valve Disease
Chronic Alcohol Intake
101
Q

CHF drug

A

Increase contraction force(c.inotropes)
Reduce venous return(Diuretic, Vasodilator)
Reduce renin & angiotensin(ACE Inhibitor, B-blocker, Ang 2 blocker)

102
Q

Dobutamine

A

Beta 1 agonist, inc contractility & CO
Acute heart failure Taken IV
Cardiac inotropes

103
Q

Digoxin

A

Cardiac inotropes
Inhibit Na/K ATPase Pump, More ca, more contraction
Restore vagal tone, Counteract sym stimulation
Increase refractoriness of AV node, dec ventricular response to atrial rate
First line or patient with atrial fibrilation
T1/2 30-36 hour

104
Q

Digoxin ADR

A

Narrow TI
Nausea, vomiting, gynecomastia, visual disturbance, psychosis
Ventricular bigeminy, AV block, Bradycardia
Not combined with Amiodarone, Verapamil, beta blocker,
Increase plasma con of digoxin by inhibit its excretion

105
Q

Digoxin Toxicity(Hypokalemia)

A 
Tt with higher dose of Potassium
Heart Failure need diuretic, Potassium sparing diuretic
Digitoxin antibody(digibind) used in life-treatening digoxin overdose(antidote)
106
Q

Milrinone

A

Inodilator

Phosphodiesterase 3 inhibitor

107
Q

CHF Condition

A

CO dec, Less renal perfusion pressure, Neurohormonal activation, Sym stimulation, Tachycardia, aldosterone(na n h20 retention), Lung congestion, Shortness of breath

108
Q

CHF Stage

A

Class 1- Mild, no symptom
Class 2- Mild, gradually
Class 3- same
Class 4- Unable to do any physical activities, Heart symptom appearing

Pharmacology (5 decks)

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