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Therapeutics P2 > Exam 2 lecture 6 > Flashcards

Exam 2 lecture 6 Flashcards

1
Q

BP formula

A

CO X PR

cardiac output x peripheral resistance

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2
Q

what are two direct effects of NE

A

On heart- Increase HR
on kidney- Renin release (RAAS)

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3
Q

How does renin release affect BP

A

Rennin release can affect BP

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4
Q

what receptors does NE act on in the heart.

A

B-1 receptors

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5
Q

Renin inhibitor stops what step

A

Angiotensinogen to angiotensin I

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6
Q

ACE inhibitor stops what step

A

Angiotensin I to angiotensin II

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7
Q

How does B1 activation affect CO

A

increases it

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8
Q

do RAAS blockers affect BV and SV?

A

yes

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9
Q

why do alpha blockers matter for SV

A

they reduce peripheral resistance

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10
Q

How is renin release activated in the kidney

A

When we have low Na or low BP

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11
Q

Where is ACE released from

A

Lungs

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12
Q

Where is angiotensinogen released from

A

Liver

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13
Q

What does aldosterone secretion do

A

Increase Na retention

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14
Q

How does angiotensinogen affect BP

A

increases it

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15
Q

What is renins substrate

A

angiotensinogen

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16
Q

What is the product for Renin and angiotensinogen

A

angiotensin I

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17
Q

What kind of molecule is Angiotensin I? What is it a substrate for?

A

Angiotensin I is a peptide.
Angiotensin I is a substrate for ACE

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18
Q

What does ACE do to Angiotensin I

A

Converts it to Angiotensin II

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19
Q

What are the two targets for Angiotensin II

A

1) Producing vasoconstriction, increasing BP
2) aldosterone secretion, increasing NA and H20 retention, increasing BP

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20
Q

What do ACE inhibitors target? WHat do ARBs target?

A

ACE inhibitor targets ACE
ARBs target Angiotensin II

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21
Q

ARB acronym. WHat does it block

A

Angiotensin receptor blcoker. Blocks Angiotensin II

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22
Q

Additional action of ACE

A

Works on bradykinin

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23
Q

Is bradykinin active? Is Angiotensin I active

A

ANgiotensin I is inactive and Angiotensin II is actove. ACE inhibitors stop the activation of angiotensin I

Bradykinin is active. ACE cleavs it and makes it inactive. ACE makes it inctive. ACE inhibitors keep t active

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24
Q

Bradykinin use

A

Goes through prostaglandin to cause vasodilation

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25
How does ACE affect bradykinin
When ACE deactivates bradykinin, it blocks vasodilation. Causing vasocinstriction and increasing BP. ACE inhibitors stop this inactivation of bradykinin
26
What causes and stops angiotensinogen to angiotensin
Renin causes it Renin inhibitors stop it
27
What causes and stops angiotensin I to angiotensin II
ACE causes ACE inhibitors stop
28
ACE inhibitor drug names end in
-pril
29
Name some ACE inhibitor drugs
Benzapril Captopril Enalapril Lisinopril Ramipril
30
What blocks angiotensin II to aldosterone
ARB
31
Name ARB drugs
-sartans Losartan candesartan Valsartan irbesartan
32
What blocks aldosterone reaching target cell
aldosterone antagonist (spironolactone)
33
What cells release renin
Juxtaglomerular cells in kidney
34
How is angiotensinogen degraded
angiotensinogen->angiotensin I->angiotensinII->angiotensin III. Angiotensin III is the inactive product
35
name a renin inhibitor drug
Aliskiren
36
Aliskiren MOA
It is a renin inhibitor that stops formation of ANG I from angiotensinogen
37
What is a contraindication for all RAAS drugs (renin inhibitors, ACE inhibitors, ARBs)
Pregnant and nursing
38
Ace inhibitor drugs all end in
-Pril
39
What is the most potent ACE inhibitor
Enalapril
40
What is something all ACE inhibitors share in common with each other
They are prodrugs (except lisinopril)
41
What are the 3 ACE inhibitor classes
Sulfhydryl containing Dicarboxyl containing Phosphorous containing
42
Sulfhydryl containing ACE inhibitor prototype
Captoptril
43
Dicarboxyl containing ACE inhibitor prototype
enalapril
44
Phosphorous containing ACE prototype
Fosinopril
45
Most commonly used ACE inhibitor
Lisinopril
46
Which ACE inhibitor is not a prodrug
Lisinopril
47
What is enalaprils name when active? ROA? Prodrug or not?
Enalaprilat Oral and IV Prodrug
48
Captoptril pro drug or no? side effects?
Not pro drug may cause rashes
49
How can we tell if an ACE inhibitor is active or a prodrug from a structure
If the structure has two carboxylate groups, it is ACTIVE
50
How is enalapril activated? How can we tell the structure apart
Esterase cleaves it and activates it. has ester group and carboxylic acid group
51
How can we differentiate captopril structurally
sulfohydryl (HS group)
52
How can we tell fosinopril apart from the other ACe inhibitors
Has phosphate group
53
What do ACE inhibitors do
Reduce vasoconstriction and reduce myocardial mitogenic actovity
54
1st line tx for HTN
ACE and ARB
55
Demographics of who ACE inhibitors and ARBs could benefit most
Works least on african american
56
ACE inhibitors side effects
Dry cough, Angioedema, hyperkalemia
57
NSAID and ACE inhibitor inhibitor worry
NSAIDs may lower effectiveness
58
Why is cough and angioedema a side effect for ACE inhibitors but not ARBS (AT1)
Cough and angioedema caused by bradykinin pathway. ARBs do not affect this pathway.
59
how do NSAIDs affect ACE inhibitors
NSAIDs block the production of prostaglandins. This lowers the hypotensive effect of ACE
60
ARBs all end with? also known as
-SARTANS AT1 receptor blockers
61
MOA of ARBs
Block angiotensin I receptors with a much higher affinity for AT1 versus AT2
62
Are ARBs more selective for AT1 or AT2
AT1
63
least potent ARB? most potent ARB?
least- losartan most- candesartan and omesartan
64
Main ARBs
Losartan and Valsartan
65
Recognize the ARB scaffold
phenyl ring attatched to imidazoline
66
How to differentiate Valsartan and Losartan structurally
Valsartan has an Isopropyl group (looks like a V) Losartan has an OH group (LOHsartan)
67
T/F Even though losartan is the least potent ARB, Losartans metabolite is as potent as valsartan
True
68
in what order do we try ACE and ARBs
ACE 1st, then ARB
69
Clinical use of ARBs
HTN 1st line, use if ACE do not work or are not tolerated
70
Adverse effects of ARBs? COntraindicated in
Hyperkalemia pregnant and nursing women (just like the other RAAS drugs)
71
ARBs and ACEs do not work well in african americans yes or no
True
72
Aldosterone MOA and drug bnames
Spironolactone and eplerone MOA -potassium sparring diuretic
73
adverse effects of spironolactone
Hyperkalemia Gynecomastia
74
1st line drugs for HTN
Diuretics (thiazides) ACE inhibitors ARBs CCBs In no particular order
75
2nd line drugs for HTN
Loop diuretics sympatholytics (B and A blockers) Direct renin inhibitor
76
Two thiazide drugs
Chlorthalidone Hydrochlorothiazide
77
Where do thiazides work? what transorter does it use?
DCT Uses Na-CL transporter
78
Do thiazides work well in african americans?
Good for AFrican americans Not good for diabetes patients
79
Side effects of Thiazides
Hyperkalemia, Hyperuremia, Hypercalcemiia
80
Why are loop diuretics not 1st line?
Single doses are potent but very short acting
81
Drugs to avoid in pregnancy
ACE inhibitors ARBs Direct renin inhibitors Aldosterone antagonists
82
B blocker end with Alpha blockers end with ACE inhibitors end with Angiotensin II receptors end with
B blockers- LOL Alpha blockers-AZOSIN ACE inhibitors- PRIL ARBs- SARTAN
83
renin inhibitor drug name
Aliskiren
84
Aldosterone drugs
Spironolactone Epelrone
85
Thiazide drug name
Chlorothalidone Hydrochlorothiazide
86
Alpha 2 agonist drug names
Clonidine Methyldopa
87
Dopamine receptor agonist drug name
Fenoldopam
88

Therapeutics P2 (41 decks)

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