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Pharmacotherapy 2 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Pulmonary circulation

A

R ventricle to pulmonary artery (no O2) to lungs to pulmonary vein (O2) to L ventricle

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2
Q

Systemic circulation

A

L ventricle to aorta to organs/tissues to R atrium

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3
Q

Arteries

A

move away from the heart and are oxygenated

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4
Q

Veins

A

move toward the heart

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5
Q

Tricuspid valve

A

R atrium to R ventricule

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6
Q

Mitral valve

A

L atrium to L ventricle

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7
Q

Pulmonary valve

A

R ventricle to pulmonary artery

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8
Q

Aortic valve

A

L ventricle to aorta

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9
Q

Tunica externa

A

outermost layer, loose connective tissue

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10
Q

Tunica media

A

middle layer, smooth muscle

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11
Q

Tunica intima

A

inner most layer, simple squamous epithelium and elastic fibers

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12
Q

SA node

A

R atrium near superior vena cava
discharge rate determines the heart rate
action potential spreads from R atrium to L atrium

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13
Q

AV node

A

base of R atrium

links atrial and ventricular depolarization

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14
Q

Bundle of His

A

AV bundle
interventricular septum
impulse from AV node goes to bundle of His

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15
Q

Purkinje Fibers

A

RBB and LBB make contact

large conducting cells distribute impulse

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16
Q

Diastole

A

at rest

filling of ventricles

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17
Q

Systole

A

Contraction

pump blood out of L ventricle

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18
Q

Renin Angiotensin Aldosterone System

RAAS

A

Liver produces angiotensinogen
Renin converts angiotensinogen into angiotensin 1
ACE converts angiotensin 1 into angiotensin 2

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19
Q

RAAS by products

A

Bradykininogen converted to bradykinin by Kallikrenin

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20
Q

Preload

A

Pressure stretching the ventricle of the heart after atrial contraction and subsequent passive filling of the ventricle
End diastolic volume

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21
Q

Afterload

A

Tension or pressure used by the chamber of the heart in order to contract and eject blood out of the chamber
End systolic volume

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22
Q

Stroke Volume

A

= End diastolic volume (amount pumped) - End systolic volume (amount left)

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23
Q

Cardiac output

A

Amount of blood pumped per unit of time

CO = HR x SV

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24
Q

Cardiac index

A

CO adjusted for BSA

CI = CO/BSA

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25
Q

Ejection Fraction

A

Fraction of blood ejected by the L ventricle during contraction or ejection phase of cardiac cycle (a percentage)

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26
Q

Mean Arterial Pressure

A

= CO x systemic vascular resistance + central venous pressure

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27
Q

Pulmonary capillary wedge pressure

A

Under most circumstances provides an accurate estimate of the diastolic filling (preload) of the L ventricle

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28
Q

Preload Symptoms

A 
Hepatomegaly
Jugular venous distension
Peripheral edema
Pulmonary crackles
S3 heart sound
Mucous membranes and skin turgor
Daily weight
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29
Q

Afterload Symptoms

A

Vascular diastolic pressure
Increased pulse pressure
Pulses change

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30
Q

Arteriosclerosis

A

Hardening of the arteries

31
Q

Atherosclerosis

A

Subset of ateriosclerosis

Formation of atheroma in arterial walls (fibrous fatty intimal plaques)

32
Q

Ischemic Heart Disease (IHD)

A

Ischemia is a lack of oxygen tension at the cellular level and results in loss of high energy phosphates due to disruption of aerobic metabolism (imbalance in oxygen supply and demand)

33
Q

Pathology of Atherosclerosis

A
  1. Endothelial dysfunction
  2. Fatty streak formation
  3. Fibrous plaque formation
  4. Thrombus formation
34
Q

Endothelial Dysfunction Definition

A

Diminished ability of the endothelium to regulate vascular tone, clotting, and inflammation

35
Q

Endothelial Dysfunction Causes

A 
Age, 
Sex, 
Smoking, 
Family history of CHD, 
Dyslipidemia, 
Obesity, 
Diabetes, 
Hypertension, 
Increased homocystein
36
Q

Fatty Streak Formation

A

Yellow streak of lipid-filled macrophage foam cells (initial lesion of atherosclerosis)
Protrudes and affects blood flow

37
Q

Fibrous Plaque Formation

A

Whitish yellow lump occluding lumen of coronary arteries, aorta, and carotids
Stable vs. Unstable plaque
Asymptomatic (Angina)

38
Q

Thrombus Formation

A

Either complete or partial vessel occlusion resulting in a mismatch of oxygen supply and demand
Plaque ruptures causing thrombus or clot

39
Q

Modifiable risks

A 
Cigarette smoking
Hypertension
Total cholesterol
HDL
Diabetes
40
Q

Non-modifiable risks

A

Gender
Race
Family history of CHD
Age

41
Q

Non-invasive testing

A 
Electrocardiogram
Echocardiography
Exercise Stress Testing
Pharmacologic Testing
Coronary Artery Calcium Score
Carotid artery intima-media thickness
42
Q

Invasive Testing

A

Coronary Angiography
Coronary CT Angiography
Coronary angioplasty/percutaneous coronary intervention
Coronary Artery Bypass Surgery

43
Q

Essential Hypertension

A

No identifiable cause and the most common form of hypertenstion

44
Q

Office or “White Coat Hypertension”

A

Situation where a patient has elevated BP values when measured in a clinical environment, but not at home

45
Q

Secondary Hypertension

A

Either related to a drug or a disease and though potentially reversible often will require drug therapy

46
Q

Normal

A

120/80

47
Q

Prehypertension

A

120-139/80-89

48
Q

Stage 1 Hypertension

A

140-159/90-99

Start with one drug

49
Q

Stage 2 Hypertension

A

> /= 160/100

Start with 2 durgs

50
Q

Secondary causes of Hypertension: diseases

A

Chronic Kidney Disease
Obstructive sleep apnea
Thyroid disease

51
Q

Secondary Causes of Hypertension: Drugs

A 
Amphetamines
Corticosteroids
Decongestants
Estrogen containing oral contraceptives
NSAIDs
52
Q

AHS-ISH Guidelines

A

Under 80 140/90

Over 80 150/90

53
Q

KDIGO

A

With CKD and persistent albumineria

130/80

54
Q

HTN Lifestyle Modifications

A 
Weight loss
DASH type dietary patterns
Reduced salt intake
Physical activity
Moderation of alcohol intake
55
Q

Stage 1 Hypertension Therapy

A

Monotherapy - ACEi, ARB, CCB, Thiazide

Black or > 60 - CCB or Thiazide

56
Q

Stage 2 Hypertension Therapy

A

Two drug combination
Thiazide or CCB and
ACEi or ARB

57
Q

Compelling Indications

A 
Heart Failure with Reduced Ejection Fraction
Post MI
Coronary Artery Disease
Diabetes
Chronic Kidney Disease
Recurrent Stroke Prevention
58
Q

Compelling Indication: Heart Failure

A
  1. Diuretic
  2. ACEi or ARB
  3. Beta-blocker
  4. Add on: Aldosterone Antagonist
59
Q

Beta-Blockers for HF

A

Bisoprolol
Carvedilol
Metoprolol XL

60
Q

Compelling Indication: Coronary Artery Disease

A
  1. Beta-Blocker
  2. ACEi or ARB
  3. Add on: CCB then Thiazide
61
Q

Compelling Indication: Diabetes

A
  1. ACEi or ARB

2. Add on: CCB, then Diuretic and/or Beta-blocker

62
Q

Compelling Indication: Chronic Kidney Disease

A
  1. ACEi or ARB
63
Q

Compelling Indication: Recurrent Stroke Prevention

A
  1. Thiazide or ACEi with a thiazide
64
Q

Compelling Indication: Post MI

A
  1. Beta-blocker

2. ACEi/ARB

65
Q

Orthostatic Hypotension

A

When there is a supine-to-standing SBP decrease of > 20 mm Hg or DBP decrease >10 mm Hg

66
Q

Re-evaluate BP

A

In 2-4 weeks for clinically stable patients
In 1-7 days for unstable patients or for very high BP

When BP goal not attained, increase dose and/or add another agent

67
Q

ACCOMPLISH trial

A

ACEi and amlodipine did better then ACEi and a thiazide

68
Q

ON-TARGET trial

A

Never use and ACEi with an ARB

69
Q

Resistant HTN

A

Patients not at their goal BP on 3 or more agents OR

Patient requiring 4 or more agents even if they are at goal BP

70
Q

Hypertensive Urgency

A

BP >/= 180/110

No end organ damage

71
Q

Hypertensive Emergency

A

BP >/= 180110

End organ damage

72
Q

Mean Arterial Pressure (crisis)

A

= 2/3 DBP + 1/3 SBP

73
Q

Definition of CKD

A

Abnormalities in kidney structure or function, present for 3 months or longer with implications for health.

ACR > 30, kidney transplant
eGFR less than 60

Pharmacotherapy 2 (3 decks)

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