Last lecture for Exam 2 Flashcards
Does nitroprusside (SNP) only work on arteries or veins or both
BOth
Differentiate structure of hydralazine from Organic nitrates
Does hydralazine dilate arteries or veins or both
Artery
MOA of hydralazine
Interferes with Ca release from ER and orevents oxidation of NO
Why is hydralazine and ISDN used together? WHat os the drug called?
Hydralazine stops the oxidation of NO, this potentiates the vasodilatory effect of ISDN
BilDil is drugs name (useful in african american)
T/F organic nitrates stimulate guanylyl cyclase
True
What are the two drugs that have MOA related to Type B natriuretic peptide (BNP
Natrecor
Sacubitril
differentiate between Natrecor and Sacubitril
Natrecor is the synthetic version of BNP.
It binds to and activates membrane bound guanylyl cyclase
Sacubitril prevents the breakdown of BNP and enhances its action by inhibiting the protease that breaks down BNP (bneprilysin)
Can sacubitril be used with ACE? ARB? WHY?
ARB yes, not ACE
Not ACE because both elevated bradykinin
Know name and structure of PDE inhibitors
Is PDE3 more selective to cAMP or cGMP
cAMP
Name PDE3 drugs
Amrinone
Milrinone (has an extra carbon)
Is PDE5 cAMP or CGMP
CGMP
Name CGMP (PDE5) drugs
Sildenafil
Dipyridamole
Where are PDE3 most commonly found in
Vascular Smooth muscle
PDE 3 drug names and MOA
Amrinone and Milrinone
-They inhibit PDE 3s breakdown of cAMP to AMP
-lead to cAMP elevation
-Elevation of cAMP causes vasodilation
How does elevation of cAMP cause vasodilation
It inhibits myosin LC K, inducing relaxation
What is sildenafil selective for
PDE5
Why does sildenafil cause a little blueish vision
Some PDE6 activity
What are PDE5 drugs usually used for? Why?
Erectile dysfunction. This is due to the fact that PDE4 is predominant is corpus cavernosum
3 major PDE 5 inhibitors
Sildenafil (ciagra)
Vardenafil (levitra)
Tadalafil(cialis
Structural difference between Sildenafil and Vardenafil
Sildenafil has jude bellingham O=S=O with 1 carbon on para N
C=Vardenafil has jude ellingham O=S=O with 2 carbons on para N
longest duration of action for PDE5 inhibitors
Cialis
What is contraindicated with PDE5
any organic nitrates
Which adrenoreceptor regulates vasoconstriction
A-1 adrenergic receptor
what drugs are used chronic orthostatic hypotension
Droxidopa
Midodrine
use of epinephrine with local anesthetic
-elongates the duration of anesthetic due to reduction of bloodflow to area
-reduced toxicity
reduced dose required
What are some direct and indirect vasoconstrictors used for nasal and opthalmic decongestion
direct- phenylephrine
indirect- sudafed
name 4 things that can increase HTN
NSAIDS, steroids, caffeine, nicotine
for HTN below 120/80 tx, follow up?
normal. Reassess in 1 year
tx For htn 120-129 /<80
follow uo
elevated, non pcol
follow up in 3-6 months
Tx for 130-139/80-89
Follow up
If ASCVD risk>or=10 nonpcol, pcol and reassess in 1 month
if ASCVD risk<10, non pcol, reassess in 3-6 months
even if ASCVD risk is <10, but patient has DM, CKD, HF or ischemic heart disease, use pcol
If 140/90 tx
follow up
Pcol + 2 meds—> reassess in 1 month
non pcol recommendations for HTN
Weight loss
DASH diet
reduced salt (<1500mg)
Increased K intake
physical resistance
Moderate alc
DASH diet
Dietary approach to reduce HTN
