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Fall Pharm > Exam 3 review > Flashcards

Exam 3 review Flashcards

1
Q

Beta Blockers used in:

A
  • ***HTN
  • **CHF
  • **Arrhythmias
  • ***Angina
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2
Q

Ca++ channel blockers used in:

A
  • ***HTN
  • ***Arrhythmias
  • ***Angina
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3
Q

ACE-I/ARBs/Aliskiren used in:

A
  • ***HTN

* ***CHF

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4
Q

Diuretics/Thiazides used in:

A
  • ***HTN

* ***CHF

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5
Q

Cardiac glycosides/Digoxin used in:

A
  • *CHF

* Arrhythmias

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6
Q

Vasodilators used in:

A
  • **HTN
  • *CHF
  • ***Angina
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7
Q

Na+ channel blockers used in:

A

**Arrhythmias

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8
Q

Nitrates used in:

A
  • *CHF

* ***Angina

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9
Q

Blood volume for males and females:

A

Females: 4-5L
Males: 5-6L

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10
Q

Large proportion of blood volume is located..

A

..in the splanchnic bed.

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11
Q

Mean arterial pressure

A

pressure that propels blood into the tissues.

MAP = (SBP + 2DBP)/3

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12
Q

4 factors affecting BP:

A
  • Peripheral resistance
  • Vessel elasticity
  • Blood volume
  • Cardiac output
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13
Q

Cardiac output

A

SV x HR = CO

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14
Q

Preload

A

The amount of stretch due to the amount of blood in the heart at end diastole (EDV)

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15
Q

4 main anatomic sites that are targets for high BP:

A
  • Resistance arterioles
  • Capacitance venules
  • Pump output heart
  • Kidneys
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16
Q

Resistance arterioles

A

primarily targeted by alpha 1 agonism

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17
Q

Capacitance venules

A

Have a lot of volume

When contracted, will contribute considerably to preload/EDV

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18
Q

Kidneys role in BP:

A

Juxtaglomerular apparatus senses an increase in pressure and releases NO.
OR
Juxtaglomerular apparatus senses a decrease in volume and (or direct beta agonism) activates renin/angiotensin/aldosterone system.

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19
Q

Peripheral Resistance

A

Blood cells and plasma encounter resistance when they contact blood vessel walls.

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20
Q

3 main sources of peripheral resistance:

A
  • blood vessel diameter (most controllable via Alpha1)
  • blood viscosity
  • total vessel length
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21
Q

Primary HTN

A

Idiopathic

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22
Q

How is Renin stimulated?

A

Decreased pressure in renal arterioles
Reduced Na+ delivery
Increased Na+ concentration at distal renal tubule
Sympathetic stimulation

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23
Q

What does Angiotensin 2 do?

A
  • Constricts vessels
  • Stimulates aldosterone secretion in adrenal cortex
  • inhibits further renin release (negative feedback)
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24
Q

What does Aldosterone do?

A
  • increases renal Na+ absorption

- increases intravascular blood volume

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25
How do diuretics decrease BP?
Deplete Na+
26
How do Sympathoplegics decrease BP?
Decrease PVR Reduce CO (Alpha-blockers, Beta-blockers, and Alpha 2 agonist in CNS)
27
How do direct vasodilators decrease BP?
relax vascular smooth muscle
28
How do anti-angiotensin decrease BP?
block activity or production of angiotensin
29
Sympathoplegic categories:
- Central Acting - Ganglion Blocking - Adrenergic neuron blocking - Adrenoceptor antagonist
30
Central acting MOA:
Decrease sympathetic outflow from vasomotor center in brain. Binds to Alpha2 and Alpha 1 receptors in CNS.
31
Central acting drugs:
Clonidine and Methyldopa
32
Ganglion blocking MOA:
Block ACh of post-ganglionic autonomic neurons (sympathetic and parasympathetic)
33
Ganglion blocking drugs:
Hexamethonium
34
Adrenergic neuron blockers MOA:
Block NE release from post-ganglionic sympathetic neuron
35
Adrenergic neuron blocker drugs:
Guanethidine and Reserpine
36
Adrenoceptor antagonist MOA:
Antagonize catecholamines at alpha and beta receptors
37
Adrenoceptor antagonist drugs:
Prazosin (A1) and Propranolol (B)
38
Vasodilators
Relax smooth muscle of arterioles (all) and veins (nitroprusside and nitrates) Reduce PVR and MAP
39
When MAP is decreased..
..there is a compensatory response by the body to increase MAP.
40
Angiotensin inhibitors:
ACE-I and ARBs
41
Outpatient therapy considerations:
Na+ intake Weight Current home meds that increase BP
42
1st line HTN drugs:
B-blockers | Diuretics
43
Best HTN med for DM patients:
ACE-I | no Beta blockers due to B3
44
Best HTN med for Angina patients:
Beta blockers | Ca++ channel blockers
45
Best HTN med for CHF patients:
Diuretic | ACE-I
46
Best HTN med for African American patients:
Diuretic | Ca++ channel blockers
47
Chinese population tend to be more sensitive to what HTN med?
Beta blockers.
48
Types of vascular tone:
Arteriolar tone Capillary tone Venous tone
49
Capillary function
Exchange of gasses. | has no smooth muscle
50
Pre-capillary sphincters
Rings of smooth muscle around beginning of capillaries. | Respond to alpha 1 agonism.
51
What happens when pre-capillary sphincters dilate?
There is more fluid loss (edema) | Happens in shock.
52
What happens when pre-capillary sphincters constrict?
They shunt blood from arteries to veins
53
Angina
Accumulation of metabolites due to myocardial ischemia. | Heart switches to deoxygenated energy metabolism and byproducts build up.
54
2 Functions of venous system:
- Conduct blood back to heart (maintains filling of heart despite changes in blood volume) - Reservoir for blood volume
55
Compliance of veins VS arteries:
Veins have 30x more compliance
56
The venous system contains ____% of total blood volume.
70% | 20-30% is in splanchnic bed
57
Splanchnic bed
Veins in intestins, stomach, spleen, liver
58
Angina immediate relief:
Nitroglycerin (Artery and venous dilation)
59
Angina prophylaxis:
Ca++ channel blockers | Beta blockers
60
Stable Angina
"classic" or "Angina of effort" Cause: plaque Precipitating fx: Exercise, stress Brief, relieved by rest
61
Unstable Angina
"Acute Coronary Syndrome" Cause: plaque Precipitating fx: resting Emergency
62
Variant Angina
"Prinzmetal" or "Angina inversa" Cause: hyperreactive vessels Precipitating fx: resting Rare (2% of angina)
63
Microvascular Angina
"MVD" Cause: Coronary microvascular disease Precipitating fx: exercise, stress Long lasting (>30 minutes)
64
Tx for stable, unstable, MVD angina:
Reduce O2 demand | Easier to treat pharmacologically
65
Tx for variant angina:
Vasodilators | Nitrates or CCB
66
Factors effecting oxygen availability for the heart:
Arterial pO2 concentration Hgb concentration Coronary flow and distribution O2 extraction and coronary microcirculation
67
Factors effecting oxygen requirements of the heart:
HR contractile state wall tension
68
Coronary blood flow is related to:
Perfusion pressure Duration of diastole (no flow during systole) Inversely proportional to coronary vascular bed resistance
69
Targets to relax vascular tone:
Block Ca++ influx Open K+ channels Increase cAMP Increase cGMP
70
Increasing cAMP causes..
More phosphorylation of MLCK which inhibits phosphorylation of MLC preventing contraction
71
Increasing cGMP causes..
Un-phosphorylation of MLC preventing it from interacting with actin
72
Actions on vascular smooth muscle: | NO, Nitrates, Nitrites
Activates GC --> increases cGMP --> relaxation | best response is in large veins
73
Actions on vascular smooth muscle: | Beta-2 Agonists
GPCR--> cAMP --> Relaxation (mainly respiratory)
74
Actions on vascular smooth muscle: | Beta-blockers
Decrease demand of heart
75
Actions on vascular smooth muscle: | CCB
less total Ca++ --> relaxation
76
Actions on vascular smooth muscle: | Sildenafil
Blocks PDE5-->increases cGMP --> relaxation
77
Nitrates and Nitrites action:
``` (primary action: decrease venous return to heart) Increase venous capacitance Decrease ventricular preload Decrease heart size Decrease CO ```
78
Nitrates and Nitrites SE:
``` Orthostatic hypotension Syncope HA Reflex tachycardia hemoglobin interactions (meth-hgb) ```
79
Nitrates and Nitrites tolerance:
continuous dose long term exposure workplace exposure
80
Nitrates and Nitrites carcinogenicity:
nitrogen in foods | powerful carcinogen in animals
81
Nitrates and Nitrites on Angina of effort:
Decrease venous return to heart | Reduction in intra-cardiac volume
82
Nitrates and Nitrites on Variant angina:
Relax coronary arteries | Relieve coronary artery spasm
83
Nitrates and Nitrites on unstable angina:
Dilation of coronary arteries
84
Ca++ Channel Blockers (CCB) action: | Vessels
long lasting smooth muscle relaxation (mainly vascular) Reduce BP Decrease PVR Decrease coronary arterial tone
85
CCB action: | heart
Decrease contractility Decrease SA node rate Decrease AV node conduction velocity
86
CCB toxicity:
Serious cardiac suppression (rare) | More toxicity with immediate acting
87
CCB contraindicated in:
``` AV block arrhythmia low BP digoxin unstable angina CHF ```
88
CCB in variant angina:
Decreased myocardial contractile force Decreased myocardial oxygen demand Decreased arteriolar tone Decreased PVR Decreased atrial/ventricular pressure Decreased left ventricle wall stress Decreased HR Prevents coronary spasm
89
Beta blockers
``` Not vasodilators Decrease O2 demand Decrease HR Decrease contractility Decrease BP ```
90
Beta blockers use in angina:
Angina of effort | Silent (ambulatory) ischemia
91
Angina risk factors:
smoking HTN hyperlipidemia
92
Tx for stable angina in HTN patient:
CCB | Beta blocker
93
Tx for stable angina in normal BP patients:
longer-acting nitrates
94
Tx for vasospastic angina:
Nitrates | CCB
95
Systolic Heart failure
``` reduced cardiac function (thinned walls) decreased CO (bc of decreased force) decreased EF ```
96
Diastolic heart failure
reduced cardiac filling (heart or peripheral cause) thickened walls (chronic HTN) decreased CO (bc of decreased volume) normal EF (doesn't respond well to positive inotropic drugs)
97
Congestive heart failure
increased left ventricle pressure at end diastole. | results in increased pulmonary pressure and pulmonary edema
98
Classes of heart failure: Stage A
High risk of HF, without structural heart disease/symptoms
99
Classes of heart failure: stage B
Heart disease with asymptomatic left ventricular dysfunction
100
Classes of heart failure: stage C
Prior or current symptoms of HF
101
Classes of heart failure: stage D
Advanced heart disease and severely symptomatic or refractory HF
102
Long-term tx of HF
therapy directed at non-carediac targets maybe more useful: ACE-I, ARB, B-Blockers, Aldosterone receptor antagonist, Vasodilators
103
High output heart failure
not a heart issue, cause is in the periphery (Hyperthyroidism, beriberi, anemia, arteriovenous shunts)
104
Cardiac performance: 4 factors
preload afterload contractility heart rate
105
Decrease Preload tx:
salt restriction diuretics vasodilation

Fall Pharm (8 decks)

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