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Pharmacology > Hypertension and Heart Diseases (Chapter 12) > Flashcards

Hypertension and Heart Diseases (Chapter 12) Flashcards

1
Q

most tissues in the body are connected to the sympathetic and parasympathetic NS. what tissue in the body is predominantly sympathetic?

A

adrenal gland

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2
Q

how does signal transmission occur in a parasympathetic nerve ?

A

pre-ganglionic nerve releases ach, detected by nicotinic receptors on post-ganglionic nerve.

then, post-ganglionic nerve releases ach, detected by cholinergic receptors on target tissue

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3
Q

what are the three types of cholinergic receptors on target tissue ?

A

muscarinic, nicotinic ganglionic, nicotinic neuromuscular

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4
Q

how does signal transmission occur in a sympathetic nerve ?

A

pre-ganglionic nerve releases ach, detected by nicotinic receptors on post-ganglionic nerve.

then, post-ganglionic nerve releases NE, detected by adrenergic receptors on target tissue

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5
Q

what are the five types of adrenergic receptors on target tissue ?

A 
B1 
B2
B3
A1 
A2
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6
Q

what two NT’s do AR’s sense?

A

NE, and E released by adrenal medulla

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7
Q

which nerve signal transmission involve ach release- SNS or PNS?

A

both
PNS: released by pre and post- ganglionic nerve
SNS: released by pre-ganglionic nerve

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8
Q

explain what happens after NE binds to a B2 AR.

A

B2 AR acts as a G-Protein coupled receptor. Induces a second messenger pathway. It converts ATP to cAMP (second messenger)

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9
Q

what does cAMP do ?

A

causes vasodilation in blood vessel smooth muscle
bronchodilation in lungs
suppresses immune system

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10
Q

what is the difference between E and NE ?

A

NE comes from everywhere in the body and can specifically target tissues
E comes from adrenal medulla

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11
Q

which nerve decreases HR?

A

vagus nerve

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12
Q

which nerves increase HR and force of contraction ?

A

sympathetic cardiac nerves

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13
Q

which part of the ANS can control both HR and force of contraction ?

A

SNS

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14
Q

by how many bpm can the PNS decrease HR ?

A

10 bpm

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15
Q

by how many bpm can the SNS increase HR?

A

usually 10 bpm

in a strong SNS response, by more

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16
Q

what is the main adrenergic receptor that controls HR?

A

B1

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17
Q

what are the two main adrenergic receptors that control BP ?

A

A1

B2

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18
Q

what is the main role of A1 AR ?

A

causes vasoconstriction of blood vessel smooth muscle

therefore binding to it can cause BP increase

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19
Q

what is the main role of A2 AR ?

A

some vasoconstriction, also regulates NE by negative feedback

(not that important here)

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20
Q

what is the main role of B1 AR ?

A

increase HR and contractility

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21
Q

what is the main role of B2 AR?

A

increase BP, heart muscle contraction

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22
Q

what is the main role of B3 AR ?

A

thermogenesis

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23
Q

what NT is BP mostly controlled by ?

A

NE

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24
Q

termination of a neural signal can occur in two ways

A

1) promote reuptake of NT

2) promote destruction of NT by enzymes

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25
Q

which enzyme inactivates ach ?

A

cholinesterase

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26
Q

which enzyme inactivate NE ?

A

monoamine oxidase

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27
Q

what is the main mechanism of blood pressure increase ?

A

vasoconstriction via A1 AR on blood vessel walls.

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28
Q

what is the main mechanism of HR increase ?

A

B1 AR binding, increases rate and force of contraction

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29
Q

why don’t we use parasympathetic drugs to lower HR or to increase HR?

A

bc these drugs also modify the pre-ganglionic function in the SNS, leading to adverse effects.

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30
Q

what is the normal goal of the renin-angiotension-aldosterone system ?

A

to increase BP

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31
Q

what is renin ?

A

an enzyme which converts angiotensinogen to angiotensin I

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32
Q

what is angiotensin converting enzyme

A

ACE converts angiotensin I to angiotensin II

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33
Q

what does angiotensin II do ?

A

increase BP

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34
Q

what are the 2 ways in which angiotensin II increases BP ?

A

1) induce vasoconstriction by elevating epinephrine and inactivating bradykinin
2) increases sodium and water retention by causing release of aldosterone

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35
Q

what does bradykinin cause in the circulatory system ?

A

vasodilation

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36
Q

what is the role of aldosterone ?

A

it retains water and sodium, therefore increasing BP

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37
Q

what is renin release stimulated by (4) ?

A

decreased blood flow, drop in BP, diminished sodium and water retention, or increased SNS response on renal cells

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38
Q

what is renin released inhibited by ?

A

high blood pressure

indirect negative feedback

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39
Q

what is chronic high blood pressure called ?

A

hypertension

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40
Q

what is essential hypertension ?

A

if cause of high BP is unknown

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41
Q

what is secondary hypertension ?

A

high BP symptom that something else is wrong

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42
Q

what are the guidelines for high BP classification ?

A

normal: SBP <120 and DBP <80
prehypertension: SBP 120-139 OR DBP 80-89

stage 1 hypertension: SBP 140-159 OR DBP 90-99

stage 2 hypertension: SBP >160 OR DBP >100

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43
Q

what are the treatment options for prehypertension

A

lifestyle modifiction

drugs not typically given unless there is also kidney disease or diabetes

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44
Q

what are the treatment options for hypertension stage I

A

lifestyle modification

single drug prescribed

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45
Q

what are the treatment options for hypertension stage II

A

lifestyle modification

two drugs prescribed in combination

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46
Q

what are lifestyle modifications for hypertension that do not do much ? (3)

A

changing garlic, magnesium, caffeine intake

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47
Q

what are 5 lifestyle modification important in hypertension ?

A
  • lose weight
  • exercise aerobically
  • no smoking
  • less alcohol
  • more potassium
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48
Q

why is it good to have more potassium in diet ?

A

eating potassium forces salt into urine. as potassium is absorbed, salt and water will go to kidney

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49
Q

what are foods really high in potassium ?

A

avocado, beans, dates, peanuts, baked potatoes with skin, raisins, plain yogurt

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50
Q

what are foods with intermediate potassium ?

A

apricots, banana, carrots, hamburger, salmon

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51
Q

what are foods low with potassium ?

A

apples, asparagus, blueberries, corn, hot dog, peach, peas, pizza

foods high in Na+ basicallt

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52
Q

what is angina ?

A

a chronic heart diease, where coronary arteries cannot supply adequate blood to heart muscles

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53
Q

what is ischemic heart disease ?

A

another word for angina pectoris

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54
Q

what are the three kinds of angina ?

A

chronic stable angina
variant angina
unstable angina

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55
Q

what kind of pain is in angina ?

A

sudden pain behind sternum, radiates to left shoulder and arm, may be in neck and jaw

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56
Q

what is the most common form of angina ?

A

chronic stable angina

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57
Q

what is the cause of chronic stable angina ?

A

atherosclerosis of coronary arteries- partial occlusion and restricted blood flow

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58
Q

what is chronic stable angina pain brought on by ?

A

exercise, can’t meet demand of myocardial muscles

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59
Q

what do drugs for chronic stable angina do ?

A

increase O2 to heart muscles, or reduce demand for oxygen

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60
Q

what are two other names for variant angina

A

vasospastic angina

Prinzmetal’s angina

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61
Q

what is the main difference between MI and angina ?

A

in MI the pain doesn’t go away

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62
Q

what is the main difference between variant and chronic stable angina ?

A

in variant, coronary artery spasm can happen at any time, not just during exertion

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63
Q

what kind of drugs treat variant angina ?

A

those that increase O2 to heart muscles

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64
Q

what is unstable angina ?

A

angina symptoms come and go regularly or at rest

changes in severity of pain or pattern of angina compared to normal

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65
Q

what is the most life threatening type of angina ?

A

unstable angina

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66
Q

what kind of drugs treat unstable angina ?

A

lower oxygen demand, increase oxygen delivery to heart muscle

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67
Q

what kind of occlusion occurs in myocardial infarction ?

A

partial or full occlusion

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68
Q

what is MI usually due to ?

A

atherosclerosis

plaque breaks off and closes off vessels

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69
Q

how does exercise reduce risk of MI ?

A

more branching, more blood vessels therefore less probability that it will get blocked off

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70
Q

what symptoms in MI differ from angina ?

A

vomiting, chest pressure, numbness/tingling in arm, shortness of breath

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71
Q

what are 4 risk factors for MI ?

A

hyperlipidemia
hypertension
smoking
history of angina

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72
Q

what medication would be involved in emergency treating MI ?

A

aspirin to inhibit clotting

morphine to reduce pain and reduce oxygen demand in heart

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73
Q

are heart disease and heart failure the same ?

A

no

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74
Q

what subset of the population has heart failure more

A

old people

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75
Q

what is the mechanism in heart failure

A

ventricles fail to eject enough blood for body tissues, which means diastolic filling increases
heart gets 2-3 times larger

heart stretched, therefore enlarged. as a compensation, contractility is increased.

constriction of blood vessels to maintain blood pressure.

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76
Q

what is another name for heart failure ?

A

congestive heart failure

77
Q

what are the three primary symptoms of heart failure ?

A

fatigue
shortness of breath
tachycardia

78
Q

what is the main treatment for heart failure ?

A

lifestyle changes (less salt, more exercise)

79
Q

what classes of heart failure are allowed or not allowed exercise ?

A

allowed : I and II

not allowed : III and IV

80
Q

what exercise is allowed in heart failure ?

A

low moderate

81
Q

what do beta blockers do ?

A

competitive inhibitors of the beta adrenergic receptor (are antagonists)

82
Q

why are adverse reactions an issue with beta blockers ?

A

because the beta-adrenergic receptors are all over the body

83
Q

people suffering from what diseases should not take beta blockers ?

A

asthmatics

and diabetics: delays recovery from hypoglycemia, and dampen feeling you get when blood sugar is low

84
Q

how do beta-blockers influence HR and force of contraction ?

A

decrease it

85
Q

how do beta blockers influence on the heart ?

A

slow the rate of impulses initiated by SA node and the conduction velocity through the AV node

86
Q

how do beta blockers influence renin ?

A

decrease its release

87
Q

how do beta blockers act on lungs ?

A

bronchoconstriction

88
Q

how do beta blockers act on liver and muscle ?

A

inhibit glycogenolysis

89
Q

how do beta blockers act on fat ?

A

inhibit lipase activation

90
Q

how do beta blockers affect vascular resistance ?

A

decrease peripheral vascular resistance

91
Q

when is the beta blocker effect the most prominent ?

A

when adrenergic effect is high, like in exercise or stress

92
Q

what is one downside to using beta blockers in exercise ?

A

contribute to exercise induced fatigue

93
Q

what is dysrhythmia ?

A

when HR in a pathological state

94
Q

what diseases can be treated with beta blockers ?

A

chronic hypertension
some anginas
heart failure

95
Q

how are beta-blockers administered ?

96
Q

how come beta blockers are good for the angina patients ?

A

because they reduce heart contractions, therefore diminishing oxygen demand on the heart

97
Q

what is the main mechanism of diuretics ?

A

increase excretion of Na+ and Cl-

98
Q

What does too much Na+ lead to ?

A

fluid retention and edema

99
Q

why are diuretics good for the heart ?

A

decrease workload of heart by decreasing blood volume and peripheral vascular resistance

100
Q

what do thiazide diuretics act on ?

A

act on early distal convoluted tubule of kidney

increase excretion of Na+, Cl-, K+

101
Q

what do loop diuretics act on ?

A

act on loop of Henle

increase excretion of Na+, Cl-, K+

102
Q

what do potassium sparing diuretics act on ?

A

act on distal convoluted tubule and collecting duct

prevents K+ loss

103
Q

which diuretic prioritizes K+ preservation ?

A

potassium sparing diuretics

104
Q

what disease cannot be treated with an angiotensin converting enzyme inhibitor ?

105
Q

what do ACE-inhibitors do ?

A

decrease angiotensin II production, which decreases aldosterone, vasoconstriction
increases bradykinin, vasodilation

106
Q

what can ACE-inhibitors be combined with ?

A

beta-blockers and thiazide and loop diuretics

107
Q

what are adverse effects of ACE-inhibitors ?

A

cough, edema, rashes

108
Q

why cant pregnant people take ACE-inhibitors ?

A

fetus malformation

109
Q

what do ACE-inhibitors interact with ?

A

NSAIDs and antacids

110
Q

what do angiotensin II receptor blockers do ?

A

increase vasodilation

increase Na+ and water excretion by suppressing aldosterone

111
Q

what drug is often used instead of ACE-I if ACE-I have too many side effects ?

A

angiotensin II receptor blockers

112
Q

what do calcium channel blockers do ?

A

prevent calcium from flowing into heart muscle

prevent heart muscle contraction

113
Q

what are calcium channel blockers approved for ?

A

hypertension

chronic stable or vasospastic angina

114
Q

what kind of dosage do calcium channel blockers have to have ?

A

high dosage because subject to first pass effect

115
Q

what do organic nitrates do ?

A

dilate peripheral smooth muscle

116
Q

which blood vessels are mostly influenced by organic nitrates ?

A

veins mostly

117
Q

what is the most common way of administering organic nitrates ?

A

sublingual because first pass effect prevents oral dosing

118
Q

it can be fatal to combine organic nitrates with these three drugs

A

alcohol
viagra
calcium channel blockers `

119
Q

what is digoxin ?

A

group of drugs called cardiac glycosides

120
Q

what is digoxin used for ?

A

treat heart failure by increasing force of contraction

121
Q

what drug increases the effect of digoxin ?

A

tetracycline

122
Q

what kind of beta-blockers are better ?

A

B1- blockers because more specific to the heart, less side effects

123
Q

why are calcium channel blockers used with beta-blockers in angina?

A

if not, reflex tachycardia may occur

124
Q

what is nitroglycerine ?

A

organic nitrate

125
Q

what s the drug of choice for acute angina attacks ?

A

nitroglycerine

126
Q

which drug has a burning sensation under the tongue as a side effect ?

A

nitroglycerine (administered sublingually)

127
Q

what condition can encourage toxicity of digoxin ?

A

hypokalemia

128
Q

which drug recommended for stage 1 hypertension ? (first line)

A

thiazide diuretic

129
Q

which drug recommended for stage 2 hypertension ?

first line and second line

A

thiazide diuretic and ACE-inhibitor, ARB, or CCB and maybe third drug

130
Q

what is the dosage recommended for antihypertensive drugs?

A

initial doses low, gradually increase

131
Q

which drug recommended for angina with hypertension ?

A

b-blockers or CCB

132
Q

which drug recommended for hypertension with history of MI ?

A

b-blockers, ACE-inhibitors, maybe CCB

133
Q

which drug recommended for hypertension with heart failure ?

A

ACE-inhibitors, diuretics

134
Q

which drug recommended for hypertension with renal insufficiency ?

A

ACE-inhibitors, ARB

135
Q

which drug recommended for hypertension with diabetes ?

A

ACE inhibitor, ARB

136
Q

which drugs contraindicated while pregnant ?

A

ACE inhibitors, ARB, DRI

137
Q

what medication do black people respond to better ?

A

diuretics and CCB

138
Q

which drug recommended for chronic stable angina ?

A

beta-blockers to reduce oxygen demand

CCB/organic nitrates to increase oxygen supply

139
Q

which drug recommended for variant angina ?

A

CCB/organic nitrates to increase oxygen supply

140
Q

why are beta-blockers not useful for variant angina ?

A

oxygen demand isn’t increased in variant angina

141
Q

which drugs decrease mortality risk from MI ?

142
Q

which drug recommended for acute angina attack ?

A

nitroglycerin

143
Q

what is the best long term treatment to prevent MI ?

A

treatment of underlying conditions of hypertension, angina, hyperlipidemia

144
Q

what kind of therapy is recommended to prevent MI?

A

anti-platelet (low dose aspirin)

145
Q

following MI, what kind of long term therapy is recommended ?

A

beta-blockers

146
Q

which drug recommended to prevent recurrent MI and heart failure after MI?

A

ACE-inhibitors

147
Q

which drug recommended for improving survival and symptoms of heart failure ? (3)

A

ACE inhibitors, beta-blockers, and spironolactone

148
Q

what drug is the cornerstone in therapy for heart failure ?

A

ACE-inhibitors

149
Q

what kind of diuretics are preferred to be used with ACE inhibitors or beta-blockers to relieve edema in heart failure ?

150
Q

which drug recommended for long term use for class II or III heart failure

A

beta blockers

151
Q

what is spironolactone / Aldactone ?

A

potassium sparing diuretic, ued in lower doses as an aldosterone antagonist

152
Q

which drug recommended for long term use for class III or IV heart failure

A

spironolactone

153
Q

which drugs improve symptoms but not survival in heart failure ? (2)

A

digoxin, diuretics

154
Q

NSAIDs interact with which drugs?

A

diminish effects of diuretics, beta blockers, ACE-inhibitors

155
Q

exercise intolerance can happen with which drug ?

A

beta-blockers

156
Q

exercise intolerance can happen with which drug ?

A

beta-blockers

157
Q

which drug is effective for congested lungs ?

A

loop diuretic

158
Q

which drug is used to treat hypokalemia and enlarged heart remodelling ?

A

potassium sparing diuretic

159
Q

what is the antihypertensive drugs ?

160
Q

what is a second line antihypertensive drug ?

A

beta blockers

161
Q

what are 4 drugs of choice for hypertension ?

A

diuretics, ACE inhibitors, ARB, CCB

162
Q

what symptoms and diseases do thiazide diuretics treat

A

high BP - hypertension and

edema- heart failure

163
Q

what symptoms and diseases do loop diuretics treat

A

high BP- hypertension

edema and congested lungs- heart failure

164
Q

why are potassium sparing diuretics usually used with other diuretics ?

A

bc the others promote K+ excretion

165
Q

which drug acts as an aldosterone antagonist

A

potassium sparing diuretic

166
Q

what is the first line drugs for heart failure ? (3)

A

ACE inhibitors, beta blockers, diuretics

167
Q

if diabetes exists, what drugs are counter indicated for hypertension ?

A

beta blockers and calcium channel blocker

168
Q

if diabetic, what are the recommended drugs for hypertension?

A 
ACE-I and ARB first
then diuretics (preferably loop)
169
Q

which drugs will improve symptoms, but not survival in heart failure ? 2

A

digoxin and diuretics

170
Q

what are diuretics used for in heart failure ?

A

relieve edema

171
Q

What is the priority in treating variant angina as opposed to chronic stable? Why?

A

Chronic stable: increase oxygen supply AND decrease demand

Variant: priority is to increase oxygen supply
Can’t decrease demand since demand not that high (not like chronic stable where attacks happen on exertion)

172
Q

What are the three therapeutic goals of unstable angina?

A

Decrease demand of O2
Increase supply
Decrease persistent pain

173
Q

What are the three therapeutic goals of unstable angina?

A

Decrease demand of O2
Increase supply
Decrease persistent pain

174
Q

How is MI different from angina?

A

In MI, ischemia is PERSISTENT and leads to myocardial cell death

175
Q

Explain the stages of heart failure

A

1) ventricles fail to eject, increased diastolic filling
2) heart enlarges because of all the excess blood
3) heart muscle stretches
4) compensating mechanism- increase in contractility to increase CO
Increase in HR

176
Q

why is there edema in heart failure?

A

Water retention due to activated renin-angiotensin system!

177
Q

Which drug should be used to treat a dysrhytmia? Why?

A

Beta blockers bc they slow the rate of impulses in SA and AV node

178
Q

what do betablockers generic name end with

179
Q

Why is there a reduced release of renin with beta blockers ?

A

B1 receptor blockade

Reduces impact of renin-angiotensin system

180
Q

When are beta blockers useful in heart failure ?

A

They decrease the sympathetic response that is usually elevated in patients with heart failure

181
Q

Why would diuretics help treat edema in heart failure?

A

They encourage water excretion

182
Q

What are symptoms in hypokalemia?

A

Muscle fatigue, cramps, dysrhythmia

183
Q

Are potassium sparing diuretics used with ACE-I? Why or why not

A

No because hyperkalemia is a concern, and they both encourage that

184
Q

Why can ACE-I be better than beta blockers to treat hypertension?

A

They do not affect automatic cardio responses

Do not cause sexual dysfunction, hypokalemia, hyperglycemia

185
Q

What is the main adverse effect of ACE-I? Why

A

Persistent dry cough in 5-20% of patients from the accumulation of bradykinin (less bradykinin inactivation bc renin-angiotensin system inhibited)

186
Q

How do ARB work? how do they not have the same side effects as ACE I?

A

Prevent response of angiotensin II after it has been produced

Does not affect bradykinin metabolism, therefore no cough

187
Q

what can CCB treat? what are they mostly used for ?

A

can treat hypertension and angina

mostly for chronic and variant angina

188
Q

for hypertension, what drug do black people respond to better ? worse ?

A

worse to b-blockers

therefore use CCB or diuretics

Pharmacology (15 decks)

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