Lecture 15-Drugs to treat hypertension, CVD, CHF, and Hyperlipidemia

Question 1

What are 4 factors that affect BP?

Answer 1

1. Cardiac output
2. stroke volume
3. peripheral resistance
4. blood volume

Question 2

What is normal BP?

Answer 2

120/80

Question 3

What are the 7 antihypertensive agents?

Answer 3

1. Calcium channel blockers
2. beta-blockers
3. ACE inhibitors
4. Angiotensin-receptor blockers
5. Diuretics
6. Vasodilators
7. Central and peripherally acting blockers

Question 4

What do calcium channel blockers do?

Answer 4

slow heart rate
reduce conduction irritability
dilate vessels

Question 5

What is one calcium channel blocker used as an antihypertensive (hint: trade name starts with Ca)?

Answer 5

verapamil - Calan (covered in lecture 14)

Question 6

What do beta blockers do?

Answer 6

primarly block B1 and B2 receptors

block effect of norepinephrine and epinephrine –> reduce heart rate, reduce BP, constrict air passages

Question 7

What is a “NON-SELECTIVE” beta blocker and what does it do?

Answer 7

propranolol

block B1 and B2 receptors

Question 8

What is a “SELECTIVE” beta blocker and what does it do?

Answer 8

metoprolol

Primarily block B1 –> affects heart NOT air passages

Question 9

What is an alpha blocker used to treat hypertension?

Answer 9

labetalol –> Trandate

Question 10

Are Alpha blockers selective or non-selective?

Answer 10

selective –> A1 primarily

Question 11

What are the adverse effects of alpha and beta blockers?

Answer 11

CNS related (dizzy, headache)

Question 12

What do ACE (angiotensin converting enzyme) inhibitors do as antihypertensives?

Answer 12

decrease formation of Angiotension II
- overall decreases blood volume
- overall decreases BP

treats SEVERE hypertension

Question 13

What are the adverse effects of ACE inhibitors?

Answer 13

hypotension

CNS related

renal problems

Question 14

What are two ACE inhibitors used to treat hypertension?

Answer 14

1. enalapril
2. ramipril

Question 15

What are ARBs?

Answer 15

block receptors of angiotensin II in vascular smooth muscle
overall:
- block vasoconstriction
- block aldosterone secretion

treats:
- hypertension
- CHF

Question 16

What ARB medication should we know for hypertension?

Answer 16

1. candesartan –> Atacand

Question 17

What are the 4 classes of Diuretics used for hypertension?

Answer 17

1. Thiazide-type
2. Loop
3. Potassium-sparing
4. Acetazolamide and mannitol

Question 18

How is each class distinguished for diuretics?

Answer 18

site at which they impair sodium reabsorption

Question 19

Where is thizaide-type diruetics impairing sodium reabsorption?

Answer 19

distal tubule

connecting segment

Question 20

What do thizaide-type diuretics do?

Answer 20

increase urinary excretion of sodium and water
increase excretion of chloride, potassium and bicarbonate ions
inhibit sodium-chloride transporter in distal tubule of kidneys

Question 21

What are two thiazide direutic medications for hypertension?

Answer 21

1. chlorothiazide
2. chlorothalidone

Question 22

Where is loop diruetics impairing sodium reabsorption?

Answer 22

thick ascending limb of loop of Henle

Question 23

Are loop diruetics very powerful?

Answer 23

YES!!!

Question 24

What is a loop diuretic med for hypertension?

Answer 24

furosemide –> Lasix

Question 25

Where is potassium Sparing diruetics impairing sodium reabsorption?

Answer 25

collecting tubule or distal convoluted tubule

Question 26

What does potassium sparing diuretics do?

Answer 26

compete with aldosterone for receptor sites OR block sodium channels

Question 27

What is a potassium sparing diuretic medication?

Answer 27

spironolactone --> Aldactone

Question 28

What do vasodilators do for hypertension?

Answer 28

- relax vascular smooth muscle - used with beta-blockers and diuretics

Question 29

What are the adverse effects of vasodilators?

Answer 29

Headache dizzy nausea CV related

Question 30

What are two vasodilators used to treat hypertension?

Answer 30

1. fenoldopam ---> Corlopam 2. minoxidil ---> Loniten

Question 31

What do "centrally acting Adrenergic Blockers" do for hypertension?

Answer 31

reduce hyperactivity in medulla oblongata in brain overall reduce vascular resistance and cardiac output

Question 32

What are the adverse effects of "centrally acting Adrenergic Blockers" meds?

Answer 32

- CV related (hypotension) - CNS related (headache, dizzy)

Question 33

What is the name of a "centrally acting Adrenergic Blockers" used to treat hypertension?

Answer 33

Clonidine --> Catapres

Question 34

What are "peripherally acting adrenergic blockers" used for ?

Answer 34

- inhibit norepinephrine release - severe hypertension - adverse effects are CNS and CV related

Question 35

What is the name of a "peripherally acting Adrenergic blocker" to treat hypertension?

Answer 35

doxazosin --> Cardura

Question 36

What is Congestive Heart Failure (CHF)?

Answer 36

heart cannot pump enough blood to the body's other organs --> insufficent rate --> kidneys retain sodium and water --> fluid accumulates in interstitial space

Question 37

What are the 7 types of drugs used to treat CHF?

Answer 37

1. ACE inhibitors --> blood flows more easily 2. vasodilators --> blood flows more easily 3. Beta blockers --> improve pumping of lower left chamber 4. Digitalis --> increase pumping action of heart 5. Beta-agonists --> improve cardiac performance 6. Phosphodiesterase inhibitors --> increase force of heart contraction result in vasodilation 7. diuretics --> decreases plasma volume to eliminate excess salt and water

Question 38

What is the one medication to know for treatment of CHF?

Answer 38

1. cardioglycosides - digoxin

Question 39

What do Cardiac Glycosides do?

Answer 39

increasing cell calcium concentration to enhance contractility of cardiac muscle DOES NOT REVERSE CHF

Question 40

What is Digoxin?

Answer 40

- derived from foxglove (purple plant) - induces an increase in intracellular sodium --> influxes calcium in heart --> increases contractility

Question 41

What is Hyperlipidemia?

Answer 41

when there is elevated lipids in the blood

Question 42

What are the 4 types of meds used to treat hyperlipidemia?

Answer 42

1. Bile Acid Sequestrants 2. Statins 3. Nicotinic Acid 4. Fibric Acid Derivatives

Question 43

What is the name of a drug for "Bile Acid Sequestrants" to treat hyperlipidemia?

Answer 43

colestipol

Question 44

What do "Bile Acid Sequestrants" do?

Answer 44

increases binding of cholesterol to bile acids --> lowers LDLs , increases HDLs

Question 45

What is the name of two drugs for "statins" to treat hyperlipidemia?

Answer 45

1. atorvastatin 2. rosuvastatin

Question 46

What do "statins" do?

Answer 46

inhibit HMG CoA reductase --> lowers cholesterol Reduces LDL Increases HDL

Question 47

should you take grapefruit/ grapefruit juice when taking simavastatin?

Answer 47

NO!!!!

Question 48

What does Nicotinic acid do?

Answer 48

reduces LDL increases HDL reduces cholesterol

Question 49

What is the name of drug in "fibric acid derivatives" used to treat hyperlipidemia?

Answer 49

1. clofibrate

Question 50

What does "fibric acid derivatives" do?

Answer 50

stimulate cellular fatty acid uptake , conversion to acyl-CoA derivatives, and catabolims by the beta-oxidation pathways overall --> lower LDL, increase HDL, lower triglycerides

Question 51

what is common adverse effects with medications for hyperlipidemia?

Answer 51

GI probs (constipation, nausea, farting)