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HTLH 2511 > Module C: CV, Renal, Hematologic > Flashcards

Module C: CV, Renal, Hematologic Flashcards

1
Q

Role of Intracellular Ca+ in CV system

A
  • essential to actin-myosin interaction (causing contraction)
  • higher the intracellular Ca+ = ^ force of contraction (inotropic effect), ^ conduction velocity (chronotropic effect-HR), and vasoconstriction
  • decreased intracellular Ca+ causes the opposite
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2
Q

4 factors affecting Cardiac Output

A
  1. Preload- ventricular filling pressure (pressure on ventricular walls at end of diastole)
  2. Afterload- force against which heart must pump blood- reflected by systemic vascular resistance (SVR)
  3. Contractility- how well cardiac muscle contracts
  4. Heart Rate
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3
Q

Primary action of diuretics

A

inhibit Na+ reabsorption in early portions of the nephron (PCT, Loop of Henle)

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4
Q

5 Types of Diuretics

A
  • loop
  • carbonic anhydrase inhibitors
  • thiazides
  • potassium-sparing
  • osmotic
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5
Q

Thiazides

A
  • most commonly used oral diuretics
  • moderate nature tic effect
  • aka low-ceiling diuretics (^ dose does not promote more diuresis- flat dose-response curve)
  • few side effects
  • inhibit NaCl reabsorption in early distal tubule
  • Tx for HTN, edema associated with CHF, nephrolithiasis and diabetes insipidus
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6
Q

Carbonic Anhydrase Inhibitors

A
  • rarely used as diuretic
  • used for glaucoma and acute mountain sickness
  • side effect:metabolic acidosis
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7
Q

Loop Diuretics

A
  • most potent diuretics
  • inhibit NaCl reabsorption by inhibiting Na/K/2Cl transport system in ascending limb of Loop of Henle
  • aka high-ceiling diuretics (diuresis increases with dose)
  • used for acute pulmonary edema
  • can cause K+ secretion, can also increase secretion of Ca and Mg into filtrate
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8
Q

Potassium-Sparing Diuretics

A
  • two types: Aldosterone receptor antagonists and epithelial sodium channel blockers
  • reduce Na+ absorption in late distal tubule and collecting duct (do not exchange Na for K)
  • used for excess aldosterone and to counteract hypokalemic diuresis
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9
Q

Osmotic Diuretics

A
  • increase blood osmolarity (water is drawn from interstitial and transcellular spaces into blood)
  • freely pass into filtrate but not easily reabsorbed resulting in increased filtrate osmolarity
  • used to decrease ICP, intraocular pressure, cerebral edema and to increase urine volume
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10
Q

Edema

A

accumulation of fluid in either interstitial spaces or body cavities due to increased hydrostatic pressure or decreased colloid osmotic pressure in the plasma

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11
Q

What causes increased hydrostatic pressure

A

heart and/or kidney failure

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12
Q

How is colloid osmotic pressure determined

A

by amount of Na+ and proteins in the plasma; decreased colloid osmotic pressure is due to low protein diet and/or hepatic disease

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13
Q

Lasix (Furosemide)

A
  • loop diuretic
  • strong natriuretic effect
  • aka high-ceiling diuretics
  • side effects: variety of electrolyte abnormalities
  • PO or IV
  • used for edema associated with CHF, liver failure or kidney disorder; also for HTN
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14
Q

Apo-Hydro (Hydrochlorothiazide)

A
  • thiazide diuretic
  • most frequently prescribed thiazide
  • HTN, edema
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15
Q

Diamox (Acetazolamide)

A
  • carbonic anhydrase inhibitor

- Tx of acute mountain sickness and glaucoma; rarely used as diuretic

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16
Q

Aldactone (Spironolactone)

A
  • aldosterone inhibitor (K+ sparing)
  • competitively blocks aldosterone binding reducing sodium reabsorption and accompanying secretion of K+
  • long duration of action
  • used to prevent hypokalemia and in Tx of primary hyperaldosteronism
17
Q

Mannitol

A
  • osmotic diuretic
  • increase osmotic pressure of plasma
  • Tx of cerebral edema and to reduce ICP, acute glaucoma (reduces intraocular pressure)
  • as diuretic, used to improve renal function in oliguric phase of acute renal failure
  • used to promote renal excretion of toxins in OD or poisoning
  • primary adverse effect: eccessive plasma volume expansion which can lead to CHF and edema
18
Q

Blood pressure equation

A

BP = CO x SVR(PVR)

antihypertensives work on reducing either or both factors

19
Q

4 categories of Antihypertensives

A
  1. diuretics
  2. sympatholytics - sympathetic nervous system
  3. angiotensin inhibitors - renin-angiotension-aldosterone system
  4. vasodilators - vascular smooth muscle
20
Q

Natriuresis

A

excretion of sodium in urine

21
Q

How do diuretics reduce BP

A

by increasing renal sodium excretion

22
Q

Thiazides in Tx of HTN

A
  • most frequently used diuretics for HTN
  • one example: Diuril (Chlorothiazide)
  • typically 2 or more antihypertensives needed for Tx
  • may cause hypokalemia by typically only in high doses
  • advantage is protection against osteoporosis (probably due to decreased urinary excretion of calcium)
23
Q

Loop Diuretics for Tx of HTN

A

-less effective at reducing BP if normal kidney function exists; therefore, more commonly used where abnormal kidney function exists

24
Q

Potassium Sparing Diuretics for Tx of HTN

A
  • ex. Aldactone (Spironolactone)
  • cause mild natriuresis and mild antihypertensive effect
  • primarily used in conjunction with thiazides to counteract K+ loss of thizades
25
Q

2 classifications of sympatholytic agents

A
  1. adrenergic blockers, or antagonists (a or b)

2. central-acting agents

26
Q

Adrenergic Blockers/Antagonists

a1 Antagonists

A

-ex. Minipress (Prazosin)
-cause vasodilation and reduce SVR
-disadvantages:
:reflex cardiac stimulation and increased circulating Norepi
:activation of renin-angio-aldo system = fluid retention (therefore must be given in conjunction with a diuretic)

27
Q

Adrenergic Blockers/Antagonists

B Antagonists or Blocks

A

-can be selective or non-selective
-reduce HTN by
: blocking B1 receptors on heart=reduce HR and force of contraction
:block B1 on juxtaglomerular cells=prevent stimulation of renin-angio-aldo system
:reduce sympathetic outflow from CNS

28
Q

Central Acting Agents

A

ex. Aldomet (Methyldopa)
- too many side effects
- used when other antihypertensives are ineffective or during HTN emergencies
- stimulate a2 receptors in CNS inhibiting sympathetic outflow from brain stem to heart, vessels, etc
- cause vasodilation without greatly reducing HR and SV
- cause immunologic effects ie. hemolytic anemia

HTLH 2511 (10 decks)

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