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Therapeutics P2 > Exam 2 lecture 4 > Flashcards

Exam 2 lecture 4 Flashcards

1
Q

What is resting pulse pressure

A

SBP-DDBP

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2
Q

Resting pulse pressure markers

A

> 40 is unhealthy
60 is a risk factor for heart disease

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3
Q

Are age and genders a factor for HTN

A

yes

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4
Q

Who has lower SBP when younger

A

women

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5
Q

who has higher SBP when older

A

women

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6
Q

What happens to BP as we age

A

Increases

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7
Q

Age and sex affect on BP

A

Women have lower SBP at a younger age, higher when older, Old people have higher BP

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8
Q

parameters for HTN

A

Cardiac output (CO) lowers as we age
Peripheral resistance- increases as we age

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9
Q

Two classifications of HTN

A

primary and secondary

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10
Q

difference between primary and secondary HTN

A

primary is more common (90 percent)

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11
Q

risk factors for HTN

A

FH
age
diabetes
obesity
diet
lack of exercise
alcohol

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12
Q

biggest cause of secondary HTN

A

CKD

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13
Q

what are some causes of secondary HTN

A

ABCDE

aldosterone
Bad kidney
cushings
drugs
endocrine disorders

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14
Q

How interrelated are HTN and DM

A

Lifestyles that lead to HTN also lead to diabetes

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15
Q

strategies for lowering of risk of HTN for elevated BP (120-129/<80)

A

Non-pcol, reassess in 3-6 months

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16
Q

strategies for lowering of risk of HTN for stage 1 (130-139/80-89)

A

If ASCVD<10 non pcol, reassess in 3-6 months
If ASCVD > or = 10 pcol and non col, reassess in 1 month

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17
Q

strategies for lowering of risk of HTN for stage 2 (140-149/90+)

A

pcol and nonpcol, reassess in 3-6 months if goals are met

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18
Q

LSM to reduce BP

A

-Lose 10 kg (will reduce 5-20 mm hg)
-adopt DASH (dietary approach to stop HTN) (8-14 mm hg)
-Increased physical activity (4-9 mm hg)
Na decrease (2-8 mm hg)
moderate alc consumption (2-3 mm hg)

effect of single drug therapy 8-14

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19
Q

in HTN, weightloss and DASH is considered comparable to pills

A

Yes

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20
Q

Race with most HTN

A

non hispanic blacks

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21
Q

How do we calculate BP

A

BP= CO x TPR

cardiac output
toral peripheral resistance

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22
Q

how to calculate CO

A

SV x HR
stroke volume x heart rate

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23
Q

what is SV determined by (Stroke volume)

A

-Cardiac contractility
-venous return to heart
-resistance the left ventricle must overcome to eject blood into aorta

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24
Q

how is contractility affected by catecholamines?

A

Increased catecholamines lead to increased contractility (so increased stroke volume)

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25
Q

neurotransmitter types in ANS

A

Parasympathetic, sympathetic

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26
Q

parasympathetic neurotransmitter

A

Ach

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27
Q

Sympathetic neurotransmitter

A

Norepinephrine, epinephrine

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28
Q

What are the two adrenoceptors for norepinephrine and epinephrine

A

Alpha (a1 and a2)
Beta (b1, b2, b3)

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29
Q

for a1, B and a2, name what GPCR they are coupled with

A

a1- Gq
B- Gs
a2- Gi

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30
Q

A1 functions (innervated or no)

A

-vasoconstriction (INNERVATED)
-pupilary dilation
-ejaculation
-Gi inhibition

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31
Q

A2 functions (innervated or no)

A

-Vasoconstriction (uninnervated)
-Prejunctional NE inhibition
-lower CV SNS input in CNS

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32
Q

B1 functions (innervated or no)

A

-Cardiac stimulation (innervated)
-renin secretion

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33
Q

B2 functions (innervated or no)

A

-Cardiac stimuation (uninnervated)
-bronchodilation
-Uterine relaxation
Vasodilation (uninnervated)

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34
Q

which adrenoceptors does Epinephrine bind more? Which ones does norepinephrine bind more?

A

Epinephrine- B» A
Norepinephrine- A1, A2, B1

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35
Q

What is the only structural difference between epinephrine and norepinephrine

A

epinephrine has an extra methyl group

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36
Q

In general which adrenoceptor is on cardiac and which one is on BV

A

B is cardiac (cardiac stimulation), A is on BV (vasoconstriction)

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37
Q

For AV node name the receptor, SNS and PSNS response

A

B1 receptor

SNS- increase conduction
PSNS- decrease conduction

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38
Q

For myocardium, name the receptor, SNS, and PSNS response

A

B1 receptor
SNS- increase contraction force
PSNS- decrease contraction force

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39
Q

for veins, name receptor and SNS and PSNS function

A

Receptors- A1, B2
sympathetic constriction/dilation
no PSNS

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40
Q

For arteries, name receptor, SNS and PSNS function

A

Receptor- A1
sympathetic- constriction
no PSNS

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41
Q

Which one does SNS and PSNS control?? Which one does only SNS control?
a) vessels
b) HR

A

Vessels controlled by SNS
HR controlled by both

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42
Q

What is the tissue distribution of adrenoceptors for
a)cardiac
b)skeletal muscle
c)Vascular smooth muscle
d)Liver

A

cardiac- B1 and B2, mostly B1
skeletal muscle- B1 and B2, mostly B2
vascular smooth muscle- A1 and B2- most;y A1
Liver- B2

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43
Q

what are the two types of baroreceptors

A

Carotid and aortic

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44
Q

What does the baroreceptor do?

A

Detects BP

45
Q

How does Baroreceptor react when BP lowers

A

-Decrease in BP activates SNS that feedback and innervate the heart (B1)
-Causes rise in HR (reflex tachycardia)
-innervated BV (a1 receptors) result in vasoconstriction
-inhibits vagus (PSNS)
- net increase in BP

46
Q

How does Baroreceptor react when there is a rise in BP

A

-inhibits SNS
-activates vagus (PSNS)
-leads to reflex brady cardia (lowering of HR)

47
Q

Which adrenoceptors do epinephrine, norepinephrine and isoproterenol act on more? where do they usually function?

A

Norepinephrine- A1>B1 (mainly BV)
Epinephrine- B1 and B2> A1 (mainly heart function)
Isoproterenol- B1 and B2

48
Q

How to easily recognize B blocker drugs by name?
B agonist drugs?

A

B agonist- nol
B blocket- lol

49
Q

How do Norepinephrine, epinephrine and isoproterenol affect BP regulation?

A

Norepinephrine- Has direct A1 effect, has a strong vasoconstriction effect

epinephrine- affects B1, B2 and A effects, net increase in HR. no effect on BP

isoproterenol- leads to net dilation due to action on B, leads to lower BP

50
Q

Strongest B1 agonist

A

isoproterenol

51
Q

How does epinepherine affect BP? why?

A

No BP change, this is due to B1 and B2 canceling each other out

52
Q

Isoproterenol effect on BP

A

B2 effect is stronger than B1 effect, reduced BP is seen

53
Q

What are the 4 classes of antihypertensives

A

Diuretics
Sympatholytics
vasodilators
Renin angiotensin-aldosterone system antagonist

54
Q

What are the 3 types of diuretics used as antihypertensives

A

Thiazide
K sparring
Loop diuretics

55
Q

How do diuretics lower BP for HTN

A

decrease circulating volume

56
Q

What are the sympatholytic drug classes for antihypertension

A

B-blockers
Combined a and b blockers
central a2- agonist
peripheral a-1 agonist

57
Q

How does each sympatholytic act as an antihypertension medication

A
  • B blockers- lower HR, contractility and renin secretion
  • Combined a and B blockers- same as B blockers, plus vascular SM relaxation
    -central a2 agonist- decrease sympathetic tone
    -peripheral a1 agonist- vascular SM relaxation
58
Q

Name the vasodilator drugs used to lower BP

A

Ca channel blockers
Direct vasodilators

59
Q

How do Vasodilator drugs lower BP

A

Ca channel blockers and direct vasodilators Lower vascular resistance

60
Q

how do renin angiotensin-aldosterone system antagonists lower BP

A

lower vascular resistance
lower Na retention

61
Q

Which antihypertensive meds can be used in HF

A

diuretics, B blockers ACE inhibitors, angiotension II receptor blocker, aldosterone antagonist

62
Q

Which antihypertensive drugs can be used post MI

A

B blockers, ACE inhibitors, ANG II blockers, aldosterone antagonists

63
Q

Which antihypertensive is indicated in diabetes

A

ACE inhibitor
ANG II blocker
Ca 2+ blocker

64
Q

tissue distribution of a receptor? function in BV

A

vascular smooth muscle.
mediates vsoconstriction

65
Q

Name a-antagonist drugs. Hlaf life arrange

A

-osins

Perazosin, Terazosin, Doxazosin

(shortest- perazosin 3h, longest doxazosin, 20hrs)

66
Q

structure of A- antagonist

A

know for exam

has piperazine and quinazoline

67
Q

indication for a-antagonist drugs, how are they named

A

-osins
indicated for HTN and BPH

68
Q

MOA of a-agonist?

A

stop A- receptor binding and acts as a vasodilator

69
Q

Compare a-antagonsits and non-selective antagonsits (phentolamine)

A

alpha antagonists Produce vasodilation without causing a lot of reflex tachycardia

70
Q

What is an issue seen when taking a-selective blockers? what other condition can a-selective blockers be used for?

A

1st dose phenomenon- orthostatic HTN, with 1st dose
also used for reynauds phenomenon

71
Q

Which drug has less tachycardia, prazosin or phentolamine

A

prazosin

72
Q

Name A-2 agonist drugs

A

clonidine
methykdopa
guanabenz
guanfacine
Brimonidine

73
Q

How does A2 affect sympathetic output from brain? can A1 do this? why? how does it affect BP

A

A2 lowers sympathetic output from brain and lowers BP. A1 can not do this because it does not cross BB.

74
Q

how does A2 agonist lower SNS

A

inhibition of NE release

75
Q

how does a-agonists inhibition of NE release affect specific parts of SNS?

A

Lower HR
lower contractility
lower renin
lower vasoconstriction

76
Q

how to recognize clonidine structurally?

A

is an imidazoline drug with two Cls.

77
Q

Clonidine MOA

A

The two Cls withdraw electrons and reduce PKA from 13 to 8.

it goes into brain and activates A2 receptor

78
Q

indications ofnclonidine

A

HTN, ADHD, glaucome

79
Q

which a2 agonist drug has the shortest and longest half life

A

Guanabenz has shortest
clonidine and guanfacine are the longest

80
Q

how to recognize guabenz and guanfacine

A

open ring imidazoline

81
Q

Which a2 agonist is a prodrug

A

methyldopa

82
Q

what is the active form of methyldopa

A

methylnorepineohrine

83
Q

MOA of methyldopa to methylepinephrine

A

Methyldopate

(catalyzed by esterase)

methyldopa

(catalyzed by aromatic amino decarbpxylase)

methyldopamine

(catalyzed by dopamine)

methylnorepinephrine

84
Q

Which A2 agonist is safe for pregnant women

A

Methyldopa

85
Q

how do B blockers reduce BP

A

reduce CO, inhibit renin secretion

86
Q

B blocker structure

A

know (aryloxypropanolamines

87
Q

How to recognize B blocker drugs

A

all en in -olol

RECOGNIZE STRUCTURE

88
Q

Name the non-selective B blockers

A

Propanolol
Nadolol
timolol
pindolol
carteolol

89
Q

which teo non selective B blockers have intrinsic sympathomimetic activity(ISA) (partial agonists)

A

Pindolol
carteolol

90
Q

what use do ISA B blocker drugs have?

A

less likely to cause bradycardia

91
Q

Name selective B blockers

A

Metorpolol
Atenolol
Esmolol

92
Q

main difference in structure between selective and non selective B blocker

A

Selective have para substituent on aromatic group

93
Q

shortest acting B blocker? why is it the shortest acting? when is it used?

A

Esmolol.
It is easily hydrolized by esterase
only used for surgery

94
Q

Which non selective B blocker has more hydrophilicity

A

Atenolol

95
Q

name the 3rd gen B1 blocker

A

Nebivolol

96
Q

How is the 3rd gen drug nebivolol mechanistically different in how it acts

A

vasodilation function is due to nitric oxide production

It is B1 selective

97
Q

side effects of B blockers

A

Bradycardia, AV blocks, sedation

98
Q

contraindications of B blockers

A

Asthma, COPD, Type IV HF

99
Q

difference in action between propanolol, and Metoprolol, atenolol, esmolol

A

propanolol- 1st gen- non selective B1 and B2,
metoprolol, atenolol, esmolol- 2nd gen, selective B1

100
Q

mixed action adrenergic blocker drugs

A

Labetalol
Carvedilol

101
Q

Important info when DX b blockers

A

Always taper doses down.

102
Q

which receptor does Labetalol work on

A

A1 antagonism and non selective B1 and B2 antagonism

103
Q

Which receptor does carvedilol work on?

A

A1 antagonism and non selective B1 and B2 antagonism

104
Q

Name a dopamine receptor agonist

A

fenoldopam.

105
Q

MOA of fenoldopam

A

Does not activate alpha or Beta receptors, it is an agonist for dopamine 1 receptor

106
Q

when is fenoldopam useful? when should we not use it?

A

Useful in pts with renal impairments
Do not use in pts with glaucoma

107
Q

fenoldopam is used for

A

SEVERE htn

108
Q
A

Therapeutics P2 (41 decks)

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