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Pharmacology 2240 - Orrock > Module 5 > Flashcards

Module 5 Flashcards

1
Q

HTN

A

Hypertension = High Blood Pressure
most forms of HTN are idiopathic or “essential” - meaning the cause is not identifiable.

less than 10% caused by renal endocrine, or other abn such as morbid obesity or sleep apnea.

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2
Q

CAD

A

Coronary artery disease = coronary heart disease (CHD)

is a narrowing of the small blood vessels that supply blood and oxygen to the heart

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3
Q

CHF risk factors:

A

Congestive heart failure - causes of CHF include alcohol, pregnancy, viral…but most common cause of CHF is high blood pressure in conjuction with clogging and hardening (atherosclerosis) of the arteries (often occurs post MI)

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4
Q

Myocardial infarction MI

A

Heart attack - Permanent loss of heart muscle cause by CAD. MI is irreversible (meaning it causes scarring of the myocardium)
*leading cause of death in the US for male and female

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5
Q

ANGINA

A

ANGINA PECTORIS - heart pain caused by CAD

Angina is heart pain that is reversible - it is due to lack of oxygen to the heart muscle.

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6
Q

HF

A

Heart Failure - is a condition in which the heart fails to pump adequate a mounts of blood. HF often occurs months or years after a heart attack.
Risk factors - CHF is high blood pressure in conjuction with clogging and hardening (atherosclerosis) of the arteries (often occurs post MI)

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7
Q

HF prognosis

A

is very poor, worse than most cancers. with FH pressure builds up within the heart and fluids accumulate in body tissues

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8
Q

One of a patient with HF and the other of a highly conditioned athlete during competition. Which of the two have the most heart exposure to the transmitter Norepinephrine? Grandma with HF or Michael Jordan?

A

The answer is Grandma with HF. HF pt will be exposed to more NE “24/7” than the heart of a trained competing athlete during the period of athletic performance. High NE loads improve the hearts performance in the short term, but they are toxic if exposure is 24/7.
* The body tries to “help” the pump (heart) by releasing more NE, but it eventually remodels and destroys the heart

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9
Q

arrhythmia

A

better said as dysrhythmia - is used to describe an abn heart rate or rhythm.

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10
Q

ECG

A

is the best way to diagnose the nature of the rhythm, but not the underlying disease.

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11
Q

ABN of heart rhythm

A
  • fast heart rates (tachycardia)
  • slow heart rates (bradycardia)
  • many weird conduction patterns and most bizarre configuration is no rhythm ast all
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12
Q

Dietary “Cholesterol” from

A

red meat, egg yolk and dairy products.

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13
Q

Dietary “triglyceride” from

A

oils, margarine, and sugar

* excess sugar is converted into triglycerides for storage

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14
Q

Lipid disorders

A

Fats are essential to good health; but eating too must fat, and of the wrong type, or having a disorder of lipids, can lead to atherosclerosis and other diseases.

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15
Q

Risk factors for Hyperlipidemia

A

are mostly genetics, poor diet both.

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16
Q

Initial drug therapy in treating hypertension involves prescribing an ACE-inhibitor, a calcium channel blocker, or?

A 
A. a loop diuretic
B. a cardiac glycoside
C. a thiazide diuretic
D. an antiarrhythmic drug
E. vitamins A and D
ans: C
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17
Q

Hypertension drugs

A

ACE-inhibitor/ARB, CCBs, vasodilators and diuretics.

ACE = Angiotensin Converting Inhibitor

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18
Q

Hypertension ladder - non drug therapy

A

The standard approach to treatment is a “stepped-care” or increasing complexity, starting with:

  • salt reduction
  • weight loss
  • exercise
  • smoking cessation
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19
Q

Diuretics

A

or “water pills”, through various mechanisms, promote excretion of Na+ and water by the kidneys

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20
Q

HCTZ

A

Hydrochlorothiazide is the prototype Thiazide diuretic, often used in combination with a potassium sparing diuretic.

21
Q

furosemide (Lasix)

A

drug work for Loop Diuretics (not used for HTN)

inhibits reabsorption of Na+/H2O in the ascending loop of Henle.

22
Q

Potassium Supplements

A

K+ as a drug is given to pt who are taking loop diuretics to avoid complications of hypokalemia.

  • Oral usually given
  • IV K+ usually given only in urgent situations or in the ICU
  • Banana - good source of K+
23
Q

Thiazides and Loop diuretics cause

A

loss of K+ (which we don’t have much) as well as Na+ (which we have a lot).

***loss too much of K+ can cause serious side efffects: Muscle weakness, dysrhythmias, and nerve conduction problems.

24
Q

Potassium Sparing Diuretics drug

A

are used to help maintain blood K+ levels - drug like triamterence (Dyrenium)

25
Q

The first-line drugs (combo) for treatment of uncomplicated “essential” HTN

A

Thiazides diuretic + K+ sparing

{HCTZ + triamterene (Dyrenium)}

26
Q

Diuretic drug used to treat CHF

A

Loop diuretics like Lasix are used to treat CHF but not HTN.

27
Q

Non-selective Beta-blockers

A

bind to and inactivate both the Beta 1 and B2 rc

* propranolol (Inderal) is the prototype

28
Q

Cardioselective Beta-blockers

A

block mainly B1 rc in the heart, sparing the B2 rc in the bronchi (less tendency to trigger asthma

29
Q

ACE Inhibitors

A
  • Renin coverts the plasma protein angiotensinogen (produced in the liver) into angiotension I
  • ACE converts angiotensin I to to angiotension II
  • Angiotension II - stimulate the adrenal cortex to secrete aldosterone, which increase salt and water resorption and indirectly increases BP.
30
Q

RAAS

A

Renin-angiotension-aldosterone system - is stimulates by a decrease in blood volume and /or blood pressure - as in cases of dyhydration or hemorrhage. Low BP stimulates juxtaglomerular cells in the kidney to secrete the enzyme renin

31
Q

ACE - I drug

A

Captopril (Capoten) and enalapril (Vasotec)

most frequently used antihypertensive because of their low side effect.

32
Q

ARB

A

Angiotensin II rc blockers - these drugs work very much like the ACE inhibitor I so often write ACEI/ARB

33
Q

CCB

A

Calcium Chanel Blokers relax the smooth muscle of the blood vessels causing them to dilate, low BP and increase the blood flow.

34
Q

Combo drugs for HTN

A

Capozide (captopril, ACEI + diuretic, HCTZ)

ACE-I/ARB, Beta blockers and CCBs can all be combined with a mild diuretic like HCTZ.

35
Q

drugs used to relieve chest pain or angina pectoris

A

drugs used to relieve chest pain by dilating coronary vessels, or lowering the O2 demands - include nitroglycerine, beta-blockers and CCBs

36
Q

Drugs class for CAD - Angina or MI

A
  • Nitroglycerin (Nitrostat- sub lingual) tablets, (nitroglycerin paste- topical cream) and Transderm-Nitro patch and long acting capsules, and I.V. infusions.
  • Nitrates - cause vasodilation throughout the circulatory system, enabling more blood and O2 to be available to the heart muscle.
  • isosorbide dinitrate (Isordil) is a longer acting oral NTG preparation
  • Isosorbide dinitrate / hydralazine (BiDil) is the first race based prescription drug in the US…approved for blacks in 2005
  • Beta blockers - lower the heart rate which dramatically decreases the heart muscle’s need for O2 - propranolol (Inderal) used in 1970
  • Calcium Channel Blockers - decrease blood pressure decrease heart rate, and increase coronary blood flow- improve myocardial O2 supply over O2 demand
37
Q

Drugs for CAD - Angina or MI

A
  1. Nitroglycerin (Nitrostat)
  2. Nitrates
  3. Isosorbide dinitrate (Isordill)
  4. Isosorbide dinitrate / hydralazine (BiDil) - only approved for use in heart failure
  5. Propranolol (Inderal) - Beta blockers (can worsen some forms of depression, so they must be used with caution in people who are prone to this problem.
  6. Verapamil (calan) - CCB treating angina, hypertension certain dysrhythmias and migraine headaches
38
Q

during an M.I

A

. TAKE 2 (325 mg) of aspirin tablets, chewed and swallowed - hopefully blood flow is quickly restored.

39
Q

Aspirin

A

Anticoagulants are used to inhibit clot formation, and thrombolytics to “bust” the clot in a clogged coronary artery.

40
Q

Post M.I drugs

A

captopril, Capoten and enalapril, Vasotec - when given within 24 hrs of and MI can increase survival rate

Post MI pts are often put on low-dose aspirin theyrapy, possibly combined with Beta blokers like atenolol(Tenormin) and metoprolol (Lopressor)

41
Q

Digitalis

A

is the original drug for treating CHF, but because of its propensity for toxicity, and failure to show improved survival for those taking the drug, it has been relegated to back-up therapy - “carvedilol”

42
Q

carvedilol

A

treating CHF. use for those NOT responding to a loop diuretic and ACE inhibitor, and a blocker.

43
Q

Drugs for dysrhythmias

A
  • Atropine - increases the heart rate
  • Inderal (propranolol) - Beta blockers have negative chronotropic effects that slow the heart rate and stabilize “twitchy” areas of the myocardium that give rise to abn rhythms
  • Verapamil (calan) - CCBs also slow the heart rate and suppress aberrant activity
  • Digoxin’s negative chronotropy slows the heart rate
44
Q

Statins

A

are currently the most widely used lipid lowering drugs because they have a good side effect profile.
* atorvastatin (Lipitor)
* simvastatin (Zocor)
these Statin drugs use to reverse the effects of plaque depositions. they block the production of cholesterol with lowers the LDL while increasing HDL.

45
Q

Niaspan

A

is a recently added time released prescription preparation of niacin (vitamin B3) that raises HDL while lowering LDL and triglycerides.
Niaspan is used to lower the risk of heart attack

46
Q

Name 6 diseases that Beta blockers are used to treat

A
  1. HTN but not drug of choice
  2. Tachycardia
  3. Angina
  4. CHF - only carvedilol
  5. Migraine headaches
  6. Anxiety disorders like test anxiety, and specifically PTSD (with imprinting of traumatic memories)
47
Q

positive inotrope

A

any drug that increases the “force (strength)” of the heartbeat. A negative inotrope does the opposite.

48
Q

positive chronotrope

A

any drug that increases the “rate” of the heartbeat

Pharmacology 2240 - Orrock (17 decks)

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