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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
Ejection Fraction
Fraction of blood ejected by the L ventricle during contraction or ejection phase of cardiac cycle (a percentage)
26
Mean Arterial Pressure
= CO x systemic vascular resistance + central venous pressure
27
Pulmonary capillary wedge pressure
Under most circumstances provides an accurate estimate of the diastolic filling (preload) of the L ventricle
28
Preload Symptoms
``` Hepatomegaly Jugular venous distension Peripheral edema Pulmonary crackles S3 heart sound Mucous membranes and skin turgor Daily weight ```
29
Afterload Symptoms
Vascular diastolic pressure Increased pulse pressure Pulses change
30
Arteriosclerosis
Hardening of the arteries
31
Atherosclerosis
Subset of ateriosclerosis | Formation of atheroma in arterial walls (fibrous fatty intimal plaques)
32
Ischemic Heart Disease (IHD)
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
Pathology of Atherosclerosis
1. Endothelial dysfunction 2. Fatty streak formation 3. Fibrous plaque formation 4. Thrombus formation
34
Endothelial Dysfunction Definition
Diminished ability of the endothelium to regulate vascular tone, clotting, and inflammation
35
Endothelial Dysfunction Causes
``` Age, Sex, Smoking, Family history of CHD, Dyslipidemia, Obesity, Diabetes, Hypertension, Increased homocystein ```
36
Fatty Streak Formation
Yellow streak of lipid-filled macrophage foam cells (initial lesion of atherosclerosis) Protrudes and affects blood flow
37
Fibrous Plaque Formation
Whitish yellow lump occluding lumen of coronary arteries, aorta, and carotids Stable vs. Unstable plaque Asymptomatic (Angina)
38
Thrombus Formation
Either complete or partial vessel occlusion resulting in a mismatch of oxygen supply and demand Plaque ruptures causing thrombus or clot
39
Modifiable risks
``` Cigarette smoking Hypertension Total cholesterol HDL Diabetes ```
40
Non-modifiable risks
Gender Race Family history of CHD Age
41
Non-invasive testing
``` Electrocardiogram Echocardiography Exercise Stress Testing Pharmacologic Testing Coronary Artery Calcium Score Carotid artery intima-media thickness ```
42
Invasive Testing
Coronary Angiography Coronary CT Angiography Coronary angioplasty/percutaneous coronary intervention Coronary Artery Bypass Surgery
43
Essential Hypertension
No identifiable cause and the most common form of hypertenstion
44
Office or "White Coat Hypertension"
Situation where a patient has elevated BP values when measured in a clinical environment, but not at home
45
Secondary Hypertension
Either related to a drug or a disease and though potentially reversible often will require drug therapy
46
Normal
120/80
47
Prehypertension
120-139/80-89
48
Stage 1 Hypertension
140-159/90-99 Start with one drug
49
Stage 2 Hypertension
>/= 160/100 Start with 2 durgs
50
Secondary causes of Hypertension: diseases
Chronic Kidney Disease Obstructive sleep apnea Thyroid disease
51
Secondary Causes of Hypertension: Drugs
``` Amphetamines Corticosteroids Decongestants Estrogen containing oral contraceptives NSAIDs ```
52
AHS-ISH Guidelines
Under 80 140/90 | Over 80 150/90
53
KDIGO
With CKD and persistent albumineria | 130/80
54
HTN Lifestyle Modifications
``` Weight loss DASH type dietary patterns Reduced salt intake Physical activity Moderation of alcohol intake ```
55
Stage 1 Hypertension Therapy
Monotherapy - ACEi, ARB, CCB, Thiazide Black or > 60 - CCB or Thiazide
56
Stage 2 Hypertension Therapy
Two drug combination Thiazide or CCB and ACEi or ARB
57
Compelling Indications
``` Heart Failure with Reduced Ejection Fraction Post MI Coronary Artery Disease Diabetes Chronic Kidney Disease Recurrent Stroke Prevention ```
58
Compelling Indication: Heart Failure
1. Diuretic 2. ACEi or ARB 3. Beta-blocker 4. Add on: Aldosterone Antagonist
59
Beta-Blockers for HF
Bisoprolol Carvedilol Metoprolol XL
60
Compelling Indication: Coronary Artery Disease
1. Beta-Blocker 2. ACEi or ARB 3. Add on: CCB then Thiazide
61
Compelling Indication: Diabetes
1. ACEi or ARB | 2. Add on: CCB, then Diuretic and/or Beta-blocker
62
Compelling Indication: Chronic Kidney Disease
1. ACEi or ARB
63
Compelling Indication: Recurrent Stroke Prevention
1. Thiazide or ACEi with a thiazide
64
Compelling Indication: Post MI
1. Beta-blocker | 2. ACEi/ARB
65
Orthostatic Hypotension
When there is a supine-to-standing SBP decrease of > 20 mm Hg or DBP decrease >10 mm Hg
66
Re-evaluate BP
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
ACCOMPLISH trial
ACEi and amlodipine did better then ACEi and a thiazide
68
ON-TARGET trial
Never use and ACEi with an ARB
69
Resistant HTN
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
Hypertensive Urgency
BP >/= 180/110 | No end organ damage
71
Hypertensive Emergency
BP >/= 180110 | End organ damage
72
Mean Arterial Pressure (crisis)
= 2/3 DBP + 1/3 SBP
73
Definition of CKD
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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