Pharm- Cardio Renal ?s

Question 1

Blood Pressure is?

Answer 1

Force exerted againt artery walls determined by:
HEART RATE
STROKE VOLUME
TOTAL PERIPHERAL RESISTANCE

Question 2

HTN Regulatory Systems

Answer 2

Autonomic Nervous System
Kidneys
RAAS

Question 3

How does the Autonomic Nervous System regulate bp?

Answer 3

Baroreceptors found in carotid sinus and aortic arch.
Made up of alpha and beta receptors. When stimulated => Sympathetic N.S. response
(a and b receptors found throughout the body, just diff concentrations of each in diff body parts)

Question 4

How do the kidneys regulate bp?

Answer 4

Release Renin when hypotensive

Long term regulation of bp through fluid/electrolyte balance

Question 5

How does the RAAS regulate bp?

Answer 5

End products cause vasoconstriction of arteries and vol expansion by inc Na

Question 6

Primary HTN

Answer 6

aka Essential HTN or Idiopathic HTN

No known cause

Question 7

Secondary HTN

Answer 7

Has a known cause

Caused by some other disease process (ie Kidney disease)

Question 8

bp ranges (Normal, PreHTN, Stage 1 HTN, Stage 2 HTN)

Answer 8

Normal: S <120 and D <80
PreHTN: S 120-139 or D 80-89
Stage 1 HTN: S 140-159 or D90-99
Stage 2 HTN: S >=160 or D >=100

Question 9

Conditions related to untreated HTN

Answer 9

CAD, MI, Stroke, Renal Failure, Loss of Vision, Death

Question 10

Non-med Tx options for HTN

Answer 10

Lifestyle Mods (wt loss, stress reduction, reg. aerobic exercise, smoking cessation, mod alcohol consumption, DASH diet)

Question 11

DASH

Answer 11

Dietary Approaches to Stop HTN

Question 12

Stepped Approach to Tx HTN

Answer 12

Step 1: Lifestyle Mods
Step 2: if step 1 does not work, drug Tx added
Step 3: if the patient’s response is low, drug doses or class may be changed
Step 4: includes all of the above with the addition of more anti-HTN agents until bp is controlled (eg multiple drugs)

Question 13

Drugs used to Tx HTN

Answer 13

Diuretics: Thiazide diuretics are usually 1st line drugs
ACE Inhibitors: Captopril and Enalapril
ARBs: Irbesartan and Losartan
Vasodilators: Hydralazine

Question 14

RAAS

Answer 14

Liver releases Angiotensinogen + Kidney releases Renin in response to hypotension = Angiotensin I (A1)

A1 + Lungs release ACE = Angiotensin II (A2)

A2 works on adrenal glands = Aldosterone: inc Na = inc bp & dec K
A2 works on kidneys = vasoconstriction in the arteries = inc bp

Question 15

How many bpm produced by each of the following:
SA node
AV node
Ventricular cell

Answer 15

SA node: 60-100 bpm
VA node: 40-50 bpm
Ventricular cell: 10-20 bpm

Question 16

ECG: P, Q, R, S, T

Answer 16

P: atrial depolarization
Q: beginning of vent depolarization
R: vent depolarization
S: end of vent depolarization
T: vent repolarization

Question 17

ECG: PR Interval

Answer 17

time between atrial and ventricular contraction;

lag here indicated a heart block

Question 18

ECG: QRS Complex

Answer 18

ventricle depolarization;

atrial repolarization

Question 19

ECG: ST Interval

Answer 19

time between ventricle depolarization and repolarization;

lag here indicated MI (the heart is taking a long time to get ready to repolarize indicating damage to the myocardium)

Question 20

Ectopic Focus

Answer 20

heart beat originatin from anywhere NOT the SA node

Question 21

Pulse Pressure

Answer 21

Difference between systole and diastole

the heart relies on diastole for perfusion; the rest of the body relies on systole for perfusion

Question 22

3 Types of Angina

Answer 22

Stable-resolves with rest; not associated with tissue damage.
Unstable-more severe narrowing of artery; maybe associated with a clot formation; pain at rest; inc rick of MI.
Variant (Prinzemetal)-caused by muscle spasm.

Question 23

Blood Coagulation Homeostasis

Answer 23

the balance between clot formation and breakdown.

Question 24

Platelet Aggregation

Answer 24

Platelets react to a change in chemicals in the blood stream to cause them to adhere to each other and to the site of damage.

Question 25

Coagulation

Answer 25

aka Clot Formation; the process of blood changing from a fluid state to a solid state to plug injuries to the vascular system; involves cascade of events and clotting factors.

Question 26

Antiplatelet Agents

Answer 26

Dec the formation of the platelet plug;
Block platelet receptor sites thus preventing the physiological changes that lead to adhesion and aggregation;
Used prophylactically to prevent vascular accidents (ie. TIA)

Question 27

TIA

Answer 27

Trans Ischemic Attack aka Mini Stroke

Question 28

Congestive Heart Failure (CHF) Causes and Tx goals

Answer 28

Condition in which the heart fails to effectively pump blood through the body;
Causes: Damage to cardiac muscle (Atherosclerosis and Cardiomyopathy), CAD, HTN (inc workload), Valvular heart disease, Congenital heart defects;
Tx goals: allow the heart muscle to contract more efficiently in an effort to bring the system back into balance.

Question 29

CHF Pharmacological Tx Options

Answer 29

Cardiotonic (Inotropic) drugs
-Cardiac glycosides (Digoxin)
-Phosphdiesterase Inhibitors
-HCN Blocker;
Nitrates;
B-blockers;
Diuretics;
ACE Inhibitors