Part 2 CVS drugs Flashcards
1
Q
angiotensin converting enzyme inhibitors
- popular antihypertensive agents today
- _____ is released from its storage in _____ and _____ vessels with _____ stimulation
- renin combines with angiotensininogen = _____
- angiotensin 1 goes to the _____ and is acted upon by _____ (_____) to convert to _____
- angiotensin II is a potent _____
- it also stimulates release of _____ from _____
- aldosterone results in _____ reabsorption
- used in _____, _____, and post _____ (_____)
A
renin afferent efferent adrenergic angiotensin I lungs angiotensin converting enzyme (ACE) angiotensin II vasoconstrictor aldosterone adrenal cortex sodium hypertension heart failure myocardial infarction (MI)
2
Q
ACE- inhibitors
- widely used, important class of antihypertensive drugs
- all generic names of this drug class end in _____
- _____ (vasotec)
- _____ (altace)
- _____ (prinivil)
- used alone or in combination with other antihypertensives
A
‘-pril’
enalapril
ramipril
lisinopril
3
Q
renin angiotensin system
- regulates:
- -_____
- -blood _____ and _____
- -_____ balance
- pathology:
- -_____
- -_____ failure
- -
A
blood pressure volume fluid electrolyte hypertension heart myocardial infarction
4
Q
renin angiotensin system
renin secretion:
-1. _____ activation (_____-adrenergic receptors)
-2. reduction in _____ tension in _____ arterioles
-3. reduction in _____ reabsorption by renal ______
angiotensin I; II and III:
- angiotensin I:
- -precursor of II, little or no _____ activity
- angiotensin II:
- -potent _____ degraded to angiotensin III
- angiotensin III:
- -has some biological activity but significantly less than angiotensin II
A
sympathetic B1 wall renal afferent NaCl renal macula densa biological vasoconstrictor
5
Q
angiotensin II receptors
- two types: _____ and _____
- -AT: activation results in the
- -increase in _____ (_____) leading to an increase in _____
- -increase in _____ metabolites
- decrease in _____
- -_____ (activation)
- –synthesis and release of _____
- pharmacological actions
- -_____ (arterioles)
- -release of _____
- -alteration of _____ and _____ structure
A
AT1 AT2 inositol phosphate (IP3) intracellular calcium arachidonic acid metabolites cAMP adrenal cortex aldosterone vasoconstriction aldosterone cardiac vascular
6
Q
ACE-inhibitors
- _____, _____, _____, _____, _____
- clinical uses:
- -_____; cardiac _____, diabetic _____, _____
- -mechanism: inhibition of _____, inhibits the production of _____
- pharmacological effects
- -vasodilation:
- –blocks _____
- –mainly arterioles, less on _____
- –decrease _____ - decrease in _____
- -both arterial and venous pressure _____
- –what happens to preload and afterload? _____
A
catopril enalapril fosinopril lisinopril ramipril hypertension failure nephropathy MI ACE angiotensin II vasoconstriction veins PR BP DECREASES BOTH DECREASE
7
Q
drug interactions of ACE inhibitors
_____ & ______ diuretics:
-augmented _____ and _____ insufficiency
-caution when used in combinations
_________
–combined hypotension
- drugs that increases _____ levels
- -_____ supplements
- -_____-sparing _____
-_____: increase levels of Li+
A
loop & thiazide hypotension renal antihypertensives potassium K potassium diuretics lithium
8
Q
side effects of ACE inhibitors
- rash 5-10%
- _____ 5% with _____ (from bradykinin)
- contraindicated in _____, causes severe fetal injury
- -_____ failure
- –in patients with _____
- –patient is dependent on _____ to maintain renal blood flow and glomerular filtration
A
dry cough lisinipril pregnancy renal bilateral renal artery stenosis angiotensin II
9
Q
angiotensin II receptor blockers
- angiotensin II has a strong _____ effect due to activation of _____ receptors present on _____
- ARBs compete for these receptors and _____ them
- _____ (cozaar) is the first ARB
- _____ + _____ (Hyzaar) is a combination available
A
vasoconstrictor angiotensin II blood vessels block losartan losartan hydrochlorothiazide
10
Q
angiotensin II receptors blockers (ARBs) MOA -blocks activation of \_\_\_\_\_ receptors --vascular smooth muscle: \_\_\_\_\_ of \_\_\_\_\_ --adrenal glands: ---\_\_\_\_\_ and decrease \_\_\_\_\_ secretion ----increase \_\_\_\_\_ and \_\_\_\_\_ excretion ----no significant effect on \_\_\_ levels and do not cause dyspnea, \_\_\_\_\_ or angioedema --the net effect is similar to \_\_\_\_\_\_
A
angiotensin dilation arterioles vasodilation aldosterone Na+ water K+ cough ACE inhibitors
11
Q
angiotensin II receptors blockers (ARBs)
- ARBs: Losartan
- -adverse effects:
- –no major adverse effects
- –low incidence of _____
- –DO NOT increase serum _____; _____, or alter _____ levels
- -contraindicated in:
- –_____ - 2nd and 3rd trimester
- –_____ diseases: renal artery stenosis
A
dizziness glucose uric acid serum lipid pregnancy renal
12
Q
beta blockers
- sympathetic antagonists at the beta receptors in _____ and _____
- inexpensive agents used with _____ for hypertension
- decrease _____ rate and _____ demand of heart muscle
- block beta 1 receptors and beta 2 or only beta 1
- block the _____ and _____ effect
- decrease rate of spontaneous _____, slow _____ conduction
- end in “_____”: _____, _____, _____
A
heart blood vessels diuretics pulse oxygen positive inotropic chronotropic depolarization AV lol propranolol metoprolol atenolol
13
Q
beta blockers
- non-selective beta blockers may block the beta 2 receptors in _____ airways
- results in _____ / life threatening!
- beta blockers may also blunt the _____ that occurs with _____
- recovery from_______ may be delayed
- may block the sympathetic symptoms of _____
A
bronchial bronchoconstriction glycogenolysis catecholamines hypoglycemia hypoglycemia
14
Q
uses of beta blockers
- management of _____: acute and chronic
- _____ is cardio-selective: Mx of angina pectoris
- _____: blocks beta receptors on ciliary blood vessels
- decreases production of _____ (IOP)
- _____: Mx of hypertension, angina, SVTs migraine prophylaxis, tremors, social phobia, GAD
- _____ (ultra short acting): critically ill patients
- _____ has intrinsic beta agonist activity, used for chronic hypertension
- _____ is a non selective beta blocker. airway stimulation in a patient may cause bronchoconstriction
A
hypertension atenolol timolol aqueous humor propranolol esmolol pindolol nadolol bronchoconstriction
15
Q
propranolol
- _____ to _____ hypertension
- severe hypertension: combine with _____
- blocks _____ and _____ adrenoceptors (non-selective)
- -decreases BP by decreasing _____
- inhibit the stimulation of _____ production
- -(which is via B1 stimulation by _____)
- –depress (partly) the _____ system
- –propranolol is contraindicated in first degree _____, _____, cardiogenic shock COPD and bronchial asthma
- –given _____ for hypertension/ _____ for arrhythmias
A
mild moderate vasodilators B1 B2 cardiac output renin catecholamines renin-angiotensin-aldosterone heart block CHF orally IV
