Drugs Used for Heart Failure and Hypertension

Question 1

The functioning unit of the kidney is the

Answer 1

nephron

Question 2

the door into the kidney is

Answer 2

afferent arteriole

Question 3

The rotary—

Answer 3

the glomerulus (a capillary plexus) where filtration takes place

Question 4

the door out of the kidney

Answer 4

the efferent arteriole

Question 5

MI can lead to

Answer 5

heart failure

Question 6

heart failure does not mean

Answer 6

coronary heart disease

Question 7

At any given moment, the kidney is

Answer 7

“sensing” the pressure and volume of blood flow throughout the body

Question 8

efferent arteriole

Answer 8

will increase pressure in capillary so stuff can be pushed out of tubules

Question 9

toxins in kidneys go out vessels through

Answer 9

the loop of Henle out through urine , along this pathway things get absorbed or pushed out

Question 10

if excess fluid then makes the heart

Answer 10

work harder so increasing preload, so overwhelming heart pumps by excessive fluid

Question 11

With low volume or low BP, the kidney will release

Answer 11

Renin** from a small area (juxtaglomerulus apparatus) just inside the afferent arteriole

Question 12

Renin (the messenger)→

Answer 12

(liver) angiotensin 1→angiotensin 2→ via Angiotensin Counting Enzyme (ACE)

Question 13

Angiotensin 2 triggers the release of

Answer 13

“AL” (Aldoesterone) from the adrenal cortex causing sodium and water retention

Question 14

Angiotensin 2 tells every vessel to

Answer 14

vasoconstrict so increases bp to the kidney

Question 15

What does angiotensin 2 “tense”

Answer 15

“Tenses” your “angios”— vasocontricts

Question 16

What does angiotensin 2 trigger the release of

Answer 16

“AL”—aldosterone (from the adrenal cortex to save Na+ & H2O

Question 17

Wheredoes angiotensin 2 increase inflammation

Answer 17

in the arteries

Question 18

What does angiotensin 2 increase with tissues

Answer 18

Increases tissue resistance to insulin; so doesn’t let it do what it needs to do w/ blood glucose

Question 19

What factors do angiotensin 2 have

Answer 19

Prothrombotic - clot producing factor; Potent growth factor

Question 20

Drugs that influence the RAA (Renin Angiotensin Aldosterone) system

Answer 20

1.Direct renin inhibitor (DRI) 2.ACE inhibitor 3. Angiotensin Receptor Blockers (ARBs) 4. Drugs that block aldosterone

Question 21

Direct renin inhibitor (DRI)

Answer 21

aliskiren (Tekturna); tells JGA to shut off renin production

Question 22

ACE inhibitors

Answer 22

captopril (Capoten); typically end with prill

Question 23

Angiotensin Receptor Blockers (ARBs)

Answer 23

block angiotensin at the tissue receptor: losartan (Cozaar), valsartan (Diovan); similar to ACE inhibitors

Question 24

Drugs that block aldosterone

Answer 24

spironolactone (Aldactone)

Question 25

"Prils"

Answer 25

ACE inhibitors (Derived from venom of Brazilian pit viper); Captopril (Capoten), Enalapril (Vasotec), Benazepril (Lotensin)

Question 26

ACE Inhibitors Function:

Answer 26

anti-hypertensive, to treat CHF, anti-inflammatory, anti-thrombotic, hypoglycemic, decrease growth of tissue "remodeling"

Question 27

ACE Inhibitors as Anti-hypertensive agents via

Answer 27

vasodilation and inhibition of aldosterone (Na+ and H20 diuresis)

Question 28

ACE Inhibitors treat CHF why?

Answer 28

CHF is a hyperreninemic state (low volume/low pressure as the heart is not pumping effectively)—increased renin—angiotensin—aldosterone—the PRILS stop the vicious cycle

Question 29

ACE Inhibitors provide a ________ effect

Answer 29

a Hypoglycemic effect (be careful when starting ACE inhibitors in diabetics on anti-glycemic drugs) - diabetes have poor circulation and swinging blood glucose levels so over time have damage to vessels

Question 30

ACE Inhibitors Decrease growth of tissues or “remodeling”

Answer 30

not good when talking about heart; angie 2 remodels heart and disrupts conduction, it reshapes left ventricle and increases growth of tissues, leads to dysrythmia

Question 31

if pt on ACE then pt will

Answer 31

go to the bathroom more

Question 32

if the ACE inhibitor is blocking the absorption of Na and H2O

Answer 32

then will excrete them

Question 33

In your heart after a myocardial infarction–

Answer 33

angiotensin 2 remodels and enlarges the myocardium and disrupts the conduction system…

Question 34

In your heart with chronic heart failure--

Answer 34

remodeling increases the risk of ventricular dysrhythmias

Question 35

Angiotensin increases

Answer 35

vascular fibrosis resulting in hypertension

Question 36

Angiotensin vasoconstricts & increases

Answer 36

inflammation in arteries

Question 37

Angiotensin increases intraglomerular blood pressure resulting in

Answer 37

intraglomerular hypertension leading to CKD (chronic kidney disease)

Question 38

"Angie” is a _____________ girl…

Answer 38

bad

Question 39

ACE inhibitors are used: To decrease the risk of

Answer 39

of 1st and 2nd myocardial infarctions in high-risk patients due to anti-inflammatory effects

Question 40

ACE inhibitors are used:for prevention of

Answer 40

strokes, diabetic nephropathy, and diabetic retinopathy

Question 41

ACE inhibitors are used: to decrease

Answer 41

insulin resistance and reduce the risk of progression to type 2 diabetes

Question 42

ACE inhibitors are used for Prevention of diabetic nephropathy by

Answer 42

destroying vessels in the nephron

Question 43

ACE inhibitors are used for Prevention of diabetic retinopathy by

Answer 43

destroying vessels in the retina

Question 44

side effects of ACE inhibitors

Answer 44

hypotension, hyperkalemia, hypoglycemia, cough, angiodema

Question 45

hyperkalemia and ACE inhibitors

Answer 45

excreting sodium and water and retaining potassium; the higher the K the less the heart contracts, so k can stop the heart

Question 46

never give _____ through an IV push

Answer 46

Potassium

Question 47

hypoglycemia and ACE inhibitors

Answer 47

especially when the patient is already on hypoglycemic drugs

Question 48

cough with ACE inhibitors

Answer 48

dry, hacking cough

Question 49

angioedema

Answer 49

lip and tongue swelling most common- almost like an allergic reaction

Question 50

What is the mechanism of the ACE inhibitor-induced angioedema?

Answer 50

Angiotensin Converting Enzyme normally breaks down bradykinin, a potent vasodilator

Question 51

ACE inhibitors inhibit the breakdown of bradykinin resulting in

Answer 51

The accumulation of bradykinin with 2 effects: 1) vasodilation 2) increased permeability