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human disease and therapeutics > Hypertension and CVS Therapeutics > Flashcards

Hypertension and CVS Therapeutics Flashcards

1
Q

Where and how does mannitol work?

A

In the proximal convoluted tubule and the descending loop, it works by increasing the osmolarity of the lumen fluid. It is filtered and not reabsorbed.

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2
Q

Acetazolamide

A

Carbonic anhydrase inhibitor, decreases NaCO3 resorption, makes urine alkaline, not used for hypertension but for epilepsy.

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3
Q

Furosemide

A

Loop diuretic, inhibits NKCC pump in the ascending loop, more Na in the lumen so water follows

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4
Q

Bumetanide

A

Loop diuretic, inhibits NKCC pump in the ascending loop, more Na in the lumen so water follows

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5
Q

What are some problems you see with loop diuretics?

A

Hypokalemia, aldosterone sensitive Na/K exchanger, pulls Na back into the body at the expense of K. Hypokalemia can cause heart arrhythmias

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6
Q

Hydrochlorothiazide

A

Thiazide, works in the distal convoluted tubule, inhibits the Na/Cl co transporter, more Na and H2O in the lumen. SE hypokalemia

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7
Q

Chlorthialindone

A

Thiazide, works in the distal convoluted tubule, inhibits the Na/Cl co transporter, more Na and H2O in the lumen. SE hypokalemia

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8
Q

What are some issues resulting from hypokalemia?

A

Arrhythmias and decreased insulin secretion leading to hyperglycemia

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9
Q

What are the 2 K sparing diuretics?

A

Spironolactone and amiloride, weak diuretics so used in combination with other diuretics. Don’t give with ACE inhibitors because it increases hyperkalemia

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10
Q

How does amiloride work?

A

It blocks the aldosterone sensitive Na/K exchanger

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11
Q

How does spironolactone work?

A

It blocks aldosterone itself so it has the same effect as amiloride

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12
Q

Clonidine

A

Alpha 2 agonist, receptors in the medulla (autoreceptor), reduces sympathetic tone resulting in decreased BP (more parasympathetic). SE xerostomia and sedation

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13
Q

Mecamylamine

A

Nicontinic Neuronal antagonist, shuts down both sympathetic and parasympathetic, rarely used.

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14
Q

Guanethidine

A

Used for resistant hypertension, depletes NE in sympathetic nerve terminals so when nerve gets stimulated there is no effect. SE orthostatic hypotension and diarrhea

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15
Q

What are the cardioselective beta blockers?

A

Atenolol and Metoprolol

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16
Q

What are the non cardioselective beta blockers?

A

Propranolol and Nadolol
Propranolol also inhibits the stimulation of renin production by catecholamines (beta 1) so it also effects the renin-angiotensin-aldosterone pathway

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17
Q

What are the beta and alpha 1 blockers?

A

Labetalol and carvedilol

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18
Q

What are the cardioselective alpha blockers? (alpha 1 antagonists)

A

Prozosin and Terazosin

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19
Q

What are the non cardioselective alpha blocker? (mixed alpha antagonists)

A

Phentolamine and Phenoxybenzamine

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20
Q

What is the direct vasodilator that caused NO release for endothelium or from the drug itself?

A

Hydralazine

21
Q

What direct vasodilator drug (3) cause reduction of Ca influx?

A

Verapamil, Diltiazem, and Nifedipine (smooth muscle relaxation)

22
Q

What direct vasodilator drug causes hyper polarization of smooth muscle membranes?

A

Minoxidil (opens K channels causing the hyperpolarization)

23
Q

T/F Direct vasodilators cause hypotension?

A

F. They do not effect they baroreceptors or the sympathetic reflexes

24
Q

Captopril

A

ACE inhibitor, aldosterone sensitive Na/K exchanger doesn’t get activated causing a hyperkalemia

25
Q

What are the 2 ways ACE inhibitors cause decrease in BP?

A

They stop the conversion of angiotensin I to angiotensin II, which stops aldosterone secretion therefore more water is secreted. They also cause an increase in bradykinin concentration which cause vasodilation themselves and through increased prostaglandin production.

26
Q

Losartan

A

Angiotensin II inhibitor, no bradykinin effects. SE hyperkalemia

27
Q

Nitroglycerine

A

Metabolized to NO, causes vasodilation and reduces O2 consumption of heart. SE orthostatic hypotension, tachycardia, throbbing headache

28
Q

Amyl nitrate

A

Metabolized to NO, causes vasodilation and reduces O2 consumption of heart. SE orthostatic hypotension, tachycardia, throbbing headache

29
Q

Ca channel blockers?

A

Verapamil, diltiazem, and nifedipine. Effect L-type Ca channels, blocks contraction of smooth and cardiac muscles. SE cardiac depression and bradycardia, flushing and dizziness (vasodilation)

30
Q

Non selective beta blocker?

A

Propranolol, used prophylactically. Toxicities, asthma and acute heart failure

31
Q

Cardioselective beta blocker?

A

Atemolol, less risk for bronchospasm (b1 selective)

32
Q

Statins

A

Lovastatin, Atorvastatin, and Simvastatin. Competitive inhibitors of HMG-COA reducatase. Reduce synthesis of cholesterol and have most effect of LDL (some effect of tryglicerides)
SE Liver toxicity, weakness in skeletal muscles that can become permanent (increase creatine kinase)

33
Q

Fenobrate

A

Increases oxidation of fats in liver and muscles, reduces VLDL modest effect on LDL, increases HDL, and reduces triglycerides
SE GI symptoms

34
Q

Niacin

A

Decreases triglycerides and LDL, tolerance develops. SE mild flushing

35
Q

Cholersteramine

A

Reduces reabsorption of bile acids and metabolites

SE constipation and bloating

36
Q

Ezetimibe

A

Inhibits intestinal absorption of cholesterol and reduces LDL

37
Q

Digitalis

A

Provides cardiac glycosides such as digoxin, orally effective, Increases intracellular Ca and cardiac contractility, increases blood ejection
SE premature depolarization, ectopic beats (arrhythmias), effects all excitable tissues

38
Q

Milrinone

A

Works similar to digitalis, increases contractility and Ca flux

39
Q

Dobutamine

A

Beta 1 adrenoreceptor agonist can cause arrhythmias

40
Q

Furosemide

A

No positive ionotropic effects, reduces NaCl and H2O retention, reduces venous pressure and ventricular preload

41
Q

Captopril

A

Reduce peripheral resistance by reducing salt and water retention

42
Q

Hydralazine

A

Vasodilator, smooth muscle relaxant

43
Q

Metoprolol

A

Beta blocker, reduces HR and blocks sympathetic N.S.

44
Q

Procainamide

A

Na channel blocker, slows action potential conduction, can cause new arrhythmias, works for both atrial and ventricular arrhythmias, not first choice

45
Q

Quinidine

A

Similar to procainamide

46
Q

Lidocaine

A

Low toxicity, effective against infarct-related arrhythmias, 1st choice for ventricular arrhythmias

47
Q

Amiodarone

A

Prolong refractory time, tx ventricular arrhythmias and atrial fibrillation. SE pulmonary fibrosis

48
Q

What are the 4 classes of drugs used to treat arrhythmias?

A

Na channel blockade
Block sympathetic autonomic effects on the heart
Prolong refractory time
Ca channel blockade

human disease and therapeutics (4 decks)

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