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Hypertension and CVS 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 NadololPropranolol 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 ejectionSE 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 blockadeBlock sympathetic autonomic effects on the heartProlong refractory timeCa channel blockade

Hypertension and CVS Therapeutics (1 decks)

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