Exam I Flashcards
The management of cardiovascular disease according to the prevention guidelines for hypertension are:
● 40 minutes of exercise 3-4 days a week
● Eat lots of fruit, veggies
● Reduce Sodium intake
The management of cardiovascular disease according to the prevention guidelines for obesity are:
● Team-based treatment
● Weight loss strategies based on BMI
● diet, exercise still best bets
The management of cardiovascular disease according to the prevention guidelines for cholesterol are:
● Overall health status and risks guide treatment
● “Bad cholesterol number” no longer main factor guiding treatment
● Decisions for drug treatment based on discussions with healthcare provider
The management of cardiovascular disease according to the prevention guidelines for risk assessment are:
● Calculators used to assess your personal risk set stage for discussions with healthcare provider
● Risks for African-Americans specified for the first time
● Stroke risks included for the first time
______________, are the firs line of defense for treatment of hypertension.
Diuretics
Regarding Diuretics,
the need for intervention for patients with DM/kidney disease or under and over 60 are:
■ 140/90 60 y.o
■ DM or kidney disease and
What are the AHA/ACC BP guidelines?
- Systolic?
- Diastolic?
■ Systolic 140-159
■ Diastolic 90-99
■ If higher, lifestyle changes + medications
Diuretics:
will ___________ urine formation.
Most _________the kidney tubular _________of Na+ which is __________ with an accompanying volume of water
- Increase
- block
- reabsorption
- excreted
Diuretics: \_\_\_\_\_\_\_\_\_\_ BP \_\_\_\_\_\_\_\_\_\_peripheral resistance \_\_\_\_\_\_\_\_\_\_ cardiac output \_\_\_\_\_\_\_\_\_\_ blood volume
- decrease
- reduce
- reduce
- decrease
Pharmacokinetics:
MOST diuretics are ___________ by kidney ________ secretion.
Drugs are secreted into _____________ then _______ from the body
- excreted
- tubular
- tubule
- excreted
What are the 8 kinds of classes of diuretics?
1) Mercurials
2) Thiazides
3) Loop (high ceiling)
4) Carbonic anhydrase inhibitors
5) Potassium-sparing diuretics
6) Osmotics
7) Acidifying agents
8) Xanthines
First class of diuretics are_____________
Mercurials (NOT ON THE MARKET ANYMORE)
What is the MOA (mechanism of action) for Mercurials?
Block Na reabsorption by releasing Hg ions to interact w/ sulfhydryl group of Na transport receptors in tubules
Blocking Na+ reabsorpation causes a ____________ of CL- transport, resulting in…?
Decreased Cl transport in ascending loop of Henle → risk of hypochloremic alkalosis
_________First choice agents for hypertension and congestive heart failure
Thiazide
Most commonly prescribed diuretic __________
Thiazide
What is the MOA for Thiazide?
○ inhibition of active Na reabsorption in proximal and distal tubule
○ inhibition of carbonic anhydrase = decrease H for exchange with Na
What are the desired effects of Thiazide on
-BP, plasma volume, EC fluid, CO, starling’s law, and peripheral resistance ?
1) Lowers BP
2) decreases plasma volume
3) decreases extracellular fluid
4) Decreased cardiac output that eventually normalized
5) Starling’s law= if decrease amount of blood returning to the heart (preload), heart doesn’t have to work as hard to eject blood back into the systemic circulation
6) Decreased peripheral resistance
7) Normalization of cardiac output after several days
What are the Preparations for Thiazide?
○ hydrochlorothiazide (HCTZ)
■ Use: hypertension, edema from congestive heart failure & nephrotic syndrome
What are the complications for Thiazide?
Complications= xerostomia, lichenoid drug reaction, photosensitivity
○ chlorothiazide (Diuril)
What are the Loop diuretics MOA?
1) Inhibition of active Na reabsorption in ascending Loop of Henle by blocking Cl reabsorption
(inhibits Na-K-Cl symporter)
2) major loss of volume
Drugs are toxic due to such rapid loss of ____________.
electrolytes
All loop diuretics are ototoxic to _______ degree (causes ____________, ________/_________)
-some
-hearing loss
deafness
What are the preparations for Loop diuretics?
-Use?
○ fureosemide (Lasix)
■ Use: hypertension, edema from congestive heart failure & renal/hepatic disease)
○ ethacrynic acid (Edecrin)
○ bumetanide (Bumex)
○ torsemide (Demadex)
What are the Potassium-sparing (retaining) diuretics MOA? 1)Receptor sites are where? 2) Increase excretion of what? 3) blocks effect of? 4) Prevents loss of ?
1) Competes with aldosterone for receptor sites in DISTAL renal tubules
2) INCREASE Na, Cl and water excretion while conserving K and H
3) blocks effect of aldosterone
4) prevents usual loss of K+
What is the Potassium-sparing (retaining) diuretics preparation?
○ spironolactone (Aldoactone)
○ triamterene (Dyrenium)
○ eplerenone (Inspra)
What is the MOA of Carbonic anhydrase inhibitors?
1) Inhibits carbonic anhydrase
2) exchange of H+ decreased
3) Na+/water excretion increased
Carbonic anhydrase inhibitors are __________ diuretics that work on ___________ and _________
- mild
- PCT
- DCT
Carbonic anhydrase inhibitors are used primarily for what?
Glaucoma & adjunctive therapy for congestive heart failure
Carbonic anhydrase inhibitors:
_______________ aqueous humor production(eye)
Retard _________ and __________ discharge from the CNS neurons (anticonvulsant properties)
- Decrease
- abnormal
- excessive
What are the preparations for Carbonic anhydrase inhibitors?
1) acetazolamide (Diamox)
2) methazolamide (Neptazane)
(not used very much)
Osmotic diuretics (urea):
Are used in _____________ situations when need to __________ blood volume.
Used when patients kidney ____________.
- emergency
- decrease
- shuts down
Osmotic diuretics MOA?
1) Cause major diuresis at Bowman’s capsule in proximal convoluted tubule
2) These drugs are filtered but NOT reabsorbed (water follows solute)
Preparations for Osmotic diuretics?
urea (Ureaphil)
Acidifying Agents (ammonium):
- Rare, but if used for treatment of ____________ states or metabolic ____________.
- Used in _____________ to produce a large amount of chloride
- _________ acidity by _________ free H+ [ ]
- hyperchloremic
- alkalosis
- emergency room
- increases
- increasing
Acidifying Agents (ammonium): MOA? Preparation?
MOA = Increases amount of Cl in urine and Na stays with it= diuresis
Preparation = Ammonium chloride
Xanthines:
_________ drugs for __________ and _________.
Xanthines are also ____________ (think caffeine)
- Respiratory
- asthma
- COPD
- stimulants (Makes you pee)
What is the MOA for Xanthines?
1) Stimulates cardiac function to increase renal blood flow and GFR
2) INCREASES cardiac output and vasodilation/blood flow to afferent arteriole Bowman’s capsule
3) INCREASE blood filtration
4) Inhibit ADH = INCREASE blood flow, decrease reabsorption of water in collecting duct
What is the Potency of diuretics (MOST to LEAST)?
Potency: loop > thiazide > carbonic anhydrase > K+ sparing
First drug of choice for HTN and congestive heart failure ?
Thiazide
Thiazide is the MOST commonly prescribed ____________.
HCTZ (microzide) can also be used for tx of _________ syndrome.
- diuretic
- nephrotic
Loop diuretics: Ethacrynic acid (Edecrin), furosemide (Lasix) cause what ?
1) serious edema
2) acute HTN
3) pulmonary edema
4) congestive heart failure
5) hepatic/renal disease
Common side effects associated with Thiazide diuretics:
-Hypokalemia: The more _______ that accumulates in distal proximal tubule the more ____________ to counteract this effect.
-Contraindicated for patients with __________, __________ and ___________.
-Fibric acid derivates drugs used to lower ____________ block _________ of these drugs.
Causes _______ drug reaction.
Loss of ____________, __________ and _______
-Inhibits _________ secretion.
-Elevated ____________ and __________.
-Lowered ________ because ______ not firing as quickly (leading to weakness/fatigue)
- ____________ dysfunction.
- Na+
- K+ salts
- diabetes
- high cholesterol
- lipids
- triglycerides
- absorption
- Lichenoid
- Carbonate
- Mg + (Hypomagnesaemia)
- Na+ (Hypoattremia)
- Uric acid ( Hyperuricemia)
- Cholesterol and triglycerides
- BP
- AP
- Sexual
What are the Loop diuretic side effects? (10)
1) Cause a major loss of volume
2) Drugs of choice for serious edema
3) Major loss of Na+ and K+ = serious electrolyte imbalances may result
4) ototoxic
5) hypocalcemia
6) nephrotoxicity (increased with Keflex)
7) Gi distress
8) CNS effects
9) causes major fluid loss and possible serious electrolyte imbalance
10) Lichenoid drug reaction
What are the Potassium-sparing specific side effects?
1) hyperkalemia
2) gynecomastia (mimic female sex hormones)
3) breast tenderness
4) menstrual irregularities
5) decreased libido in males
What are the K salt specific side effects?
1) Patients take potassium supplements to counteract K loss from diuretics.
2) Major adverse side effect: GI distress
3) ALL potassium supplements have K in the name (K-tab, Klor-Con)
What are the K salt specific contraindicated for:
1) severe renal impairment
2) taking K+ sparing
3) taking ACEIs (hyperkalemia)
What are the oral side effects associated with diuretics?
1) Xerostomia (b/c water loss)
2) aphthous stomatitis (mouth ulcers)
3) Lichenoid drug reaction: “fake” lichen planus → associated with Thiazides and Loops
4) delayed hypersensitivity reaction
- Use of NSAIDS for 3+ weeks can decrease effectiveness of diuretics
Beta blockers are _____________ and __________.
Desired effects include:
-____________ CO (even tho constrict vessels via β2)
-_______________ the work of the ________
-________________ renin secretion
-_____________ plasma volume and __________ return.
-_______________ sympathetic outflow from __________.
-_______________ peripheral resistance.
Chronotropic = + or -?
Ionotropic = + or - ?
-Cardioselective and Non-Cardioselective- (end in “olol”)
-decrease
-decrease
-heart
-decrease
-reduce
-venous
-decrease
- CNS
-reduce
+ chronotropic
+ inotropic: force of contraction INCREASES
Describe Cardioselective drugs?
1) Cardioselective (Start with A-M)
2) block β1
3) selective more commonly used
Describe Non-cardioselective ?
1) Non-cardioselective (Start with N-Z)
2) block both β1 and β2
3) Some exceptions for the A-M/N-Z rule (mostly ophthalmic preparations for glaucoma)
Alpha 1 blockers (at postsynaptic tissues)
- ***-end in “azosin”
- Peripheral __________ in arterioles and venules
- ___________ peripheral vascular resistance
- ______ effect on cardiac _________ and _____blood flow.
- vasodilation
- decrease
- little effect on cardiac
- output
- renal
Alpha 1 blockers are more effective when used with _____________ or ___________
- diuretic
- β-blocker
Alpha antagonists can block _________ that mediate contraction of ___________ such as the trigone and sphincter muscles of the bladder, leading to _________ resistance to urinary outflow.
This can be used to Tx ______
- Alpha 1 receptors
- nonvascular smooth muscle
- decreased
- BPH (enlarged prostate)