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DPT710A: Pharmacology > Quiz 2 - Cardivascular Pharmaology and Lipid Pharmacology > Flashcards

Quiz 2 - Cardivascular Pharmaology and Lipid Pharmacology Flashcards

1
Q

What is Hypertension and three things that can cause it?

A

Too much pressure with blood pressing against blood vessel.

  1. Excessive Vascular Volume
  2. Low Compliance (not flexible) of Vasculature
  3. Increase activity of RAAS system
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2
Q

What is Hypertension and three things that can cause it?

A

Too much pressure with blood pressing against blood vessel.

  1. Excessive Vascular Volume
  2. Low Compliance (not flexible) of Vasculature
  3. Increase activity of RAAS system
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3
Q

What is Renin and what releases it?

A

a proteolytic enzyme that is released into circulation primarily by the kidneys

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4
Q

What is the release of Renin stimulated by? (3)

A
  1. Sympathetic nerve activation (action via beta1-adrenoceptors)
  2. Renal artery hypotension (caused by systemic hypotension or renal artery stenosis)
  3. Decreased sodium delivered to the distal tubules of kidney
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5
Q

What is Essential vs. Secondary Hypertension?

A

Essential or Primary HTN: no clear cause

Secondary HTN: increase in BP due to a specific known cause (head trauma, cancer, renal, endocrine disorders)

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6
Q

T/F: frequently more than one drug will be required to adepquately control BP

A

True

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7
Q

What is the sequence of events with additional medications?

A

Start with one or more agents depending on the inital BP readings.
Add additional agents or optimize doses if current regimen is not successful.

Use agents with different mechanisms.

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8
Q

What are first line medication classes for hypertension (4)?

A
  1. Thiazide Diuretics
  2. Ace inhibitors
  3. Angiotensin receptor blocks (ARBs)
  4. Calcium channel blockers (CCBs)
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9
Q

What are first line medication classes for hypertension (4)?

A
  1. Thiazide Diuretics
  2. Ace inhibitors
  3. Angiotensin receptor blocks (ARBs)
  4. Calcium channel blockers (CCBs)
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10
Q

What is Renin and what releases it?

A

a proteolytic enzyme that is released into circulation primarily by the kidneys

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11
Q

What is the release of Renin stimulated by? (3)

A
  1. Sympathetic nerve activation (action via beta1-adrenoceptors)
  2. Renal artery hypotension (caused by systemic hypotension or renal artery stenosis)
  3. Decreased sodium delivered to the distal tubules of kidney
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12
Q

What is Essential vs. Secondary Hypertension?

A

Essential or Primary HTN: no clear cause

Secondary HTN: increase in BP due to a specific known cause (head trauma, cancer, renal, endocrine disorders)

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13
Q

T/F: frequently more than one drug will be required to adepquately control BP

A

True

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14
Q

What is the sequence of events with additional medications?

A

Start with one or more agents depending on the inital BP readings.
Add additional agents or optimize doses if current regimen is not successful.

Use agents with different mechanisms.

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15
Q

What is target blood pressure for most patients?

A
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16
Q

What are first line medication classes for hypertension (4)?

A
  1. Thiazide Diuretics
  2. Ace inhibitors
  3. Angiotensin receptor blocks (ARBs)
  4. Calcium channel blockers (CCBs)
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17
Q

What are Second Line and Third Line medication classes for hypertension?

A
  1. Beta-blockers
  2. Aldosterone antagonists
  3. Loop diuretics
  4. Direct vasodialators, alpha-1 blockers, alpha-2 agonists (will not be discusses)
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18
Q

What are the 3 basic targets for treating hypertension?

A
  1. Direct Cardiac Agents
  2. Peripheral Vascular Agents
  3. Renal Agents
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19
Q

Why is it important as a PT to know if someone is on Diuretics?

A
  1. Orthostatic Hypotension (lowered blood pressure in general - similar with all these drugs though)
  2. Dehydration
  3. Hyponeutrima
  4. Hyperkalemia
  5. Having to get up a lot to pee, so if at fall risk makes them even in more of a fall risk.
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20
Q

What is impacted with Peripheral Vascular Agents? What drugs are included?

A

Impact peripheral resistance, pre-load, vascular health, vasodialation (Hydralazine, Alpha 1 Antagonists, Alpha 2 Agonists)

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21
Q

What is impacted with Renal Agents? What drugs are included?

A

Impact fluid volume, metabolites (ACE Inhibitors, Angiotensin 2 Inhibitors, Diuretics: Carbonic Anhydrase Inhibitors, Loop, Thiazide Diuretics, Aldosterone Antagonists, Potassium Sparing Diuretics)

22
Q

Diuretics

Primary Action:
Anti-HTN Effects:

A

Diuretics

Primary Action: Kidneys
Anti-HTN Effects: Decrease plasma fluid volume (pee out)

23
Q

Sympatholytics

Primary Action:
Anti-HTN Effects:

A

Sympatholytics

Primary Action: Various sites within sympathetic nervous system
Anti-HTN Effects: Decreased sympathetic influence on heart (don’t let your flight or fight system get your heart riled up)

24
Q

Vasodilators

Primary Action:
Anti-HTN Effects:

A

Vasodilators

Primary Action: Peripheral Vasculature
Anti-HTN Effects: Lower Vascular Resistance

25
Q

Inhibition of Renin-Angiotensin (ACE-inhibitors)

Primary Action:
Anti-HTN Effects:

A

Inhibition of Renin-Angiotensin (ACE-inhibitors)

Primary Action: Peripheral vasculature and certain involved organs
Anti-HTN Effects: Various

26
Q

What are common thiazides used with Route - Onset - Duration? (5)

A
  1. Hydrochlorothiazide (HCTZ): PO - 102hrs - 6-12hrs
  2. Chlorthalidone - PO - 2hr - 48-72hr
  3. Metolazone (Zaroxolyn): PO - .5-1hr - 24hrs
  4. Chlorthiazide (Diuril): IV -
27
Q

Why is it important as a PT to know if someone is on Diuretics?

A
  1. Orthostatic Hypotension (lowered blood pressure in general - similar with all these drugs though)
  2. Dehydration
  3. Hyponeutrima
  4. Hyperkalemia
  5. Having to get up a lot to pee, so if at fall risk makes them even in more of a fall risk.
28
Q

Diuretics-

Therapeutic Uses:

A 
Diuretics-
Therapeutic Uses:
-Hypertension (thiazides are first line)
-Heart Failure
-Edema (peripheral/pulmonary)
29
Q

What are common Loop Diuretics used with Route - Onset - Duration? (4)

A
  1. Furosemide (Lasix): PO/IV -
30
Q

Diuretics-

Side Effects:

A 
Diuretics-
Side Effects:
-Hypotension
-Renal Dysfunction
-Volume Depletion
-Electrolyte Disturbances
31
Q

Diuretics-

Cautions/Contraindications:

A 
Diuretics-
Cautions/Contraindications:
-Sulfa allergy (loops)
-Anuric patients
-Concamitant use of other nephrotoxic agens
32
Q

What do Thiazide Diuretic Agents target and what is the effect?

A

Inhibition of Sodium/Cl reuptake

  • Excretes Sodium
  • Loosely coupled with Potassium excretion
  • Moderate diuresis and afterload reduction

(therapeutic value appears to be beyond diuresis)

33
Q

Which Dieuretic Agent is known as being a first line option?

A

Thiazide

34
Q

What are common thiazides used with Route - Onset - Duration? (5)

A
  1. Hydrochlorothiazide (HCTZ): PO - 102hrs - 6-12hrs
  2. Chlorthalidone - PO - 2hr - 48-72hr
  3. Metolazone: PO - .5-1hr - 24hrs
  4. Chlorthiazide: IV -
35
Q

What do Loop Diuretic Target and what is the effect?

A

Inhibit Na, K, CA, Mg reabsorption in the loop of Henle

  • Powerful diuresis and volume reduction
  • Decreased afterload
36
Q

Who are Loop Diuretics used for and what is the most common?

A
  • Not used much for BP reduction
  • Useful in patients with edema and heart failure
  • Most common is furosemide (Lasix)
37
Q

What are common Loop Diuretics used with Route - Onset - Duration? (4)

A
  1. Furosemide (Lasix): PO/IV -
38
Q

What do Potassium Sparing Diuretics - Aldosterone Antagonists target and effect?

A

Inhibits aldosterone by inhibiting sodium-potassium exchange site in the distal tubule

  • Excretes sodium
  • Excretes water
  • Retains potassium
39
Q

Who are Potassium Sparing Diuretics - Aldosterone Antagonists used for?

A

Used for resistant hypertension

Also used to treat heart failure

40
Q

What are common ACE Inhibitors with Route - Onset - Duration - CHF Indication? (9)

A
  1. Benazepril (Lotensin): PO - 1hr - 24hrs - No
  2. Captopril (Capoten): PO - .5hr - varies w/ dose - Yes
  3. Enalapril and Enalaprilat (Vasotec) - PO/IV - 1hr/2-4hrs - 24hr/6hr - Yes
  4. Fosinopril (Monopril): PO - 1hr - 24hrs - Yes
  5. Lisinopril (Prinivil, Zestril): PO - 1hr - 24hrs - Yes
  6. Moexipril (Univasc): PO - .5hr - 24hrs - No
  7. Quinapril (Accupril): PO - 1hr - 24hrs - Yes
  8. Ramipril (Altace): PO - 1-2hrs - 24hrs - Yes
  9. Trandolopril (Mavik): PO - 4hr - 24hrs - No
41
Q

What do ACE Inhibitors target and effect?

A

Inhibition of Angiotension Converting Enzyme (ACE) (Inhibition of conversion of Angiotensin I to Angiontension II)

  • Peripheral Vasodilation (ATII causes peripheral vasoconstriction
  • Reduced Antidiuretic Hormone (ADH) Production (reduced fluid volume)
  • Reduced Aldosterone Production (reduced fluid volume)
42
Q

T/F: Ace Inhibitors are a first line option.

A

True

43
Q

Affecting Bradykinin in the mechanism of the renin-angiotensin system has what side-effect?

A

Dry Cough

44
Q

ACE Inhibitors-

Therapeutic Uses:

A 
ACE Inhibitors-
Therapeutic Uses:
-Hypertension
-Post MI (with LVSD) - remodeling
-Heart Failure
-Diabetic patients
45
Q

ACE Inhibitors-

Monitoring:

A 
ACE Inhibitors-
Monitoring:
-BP
-K+
-Renal function (BUN/SCr)
46
Q

ACE Inhibitors-

Side Effects:

A 
ACE Inhibitors-
Side Effects:
-Angioedema (very swollen lips and throat/tongue)
-Cough
-Orthostsis/hypotension
-Hyperkalemia
47
Q

ACE Inhibitors

Cautions/Contraindications:

A 
ACE Inhibitors
Cautions/Contraindications:
-Acute kidney injury
-bilateral renal artery stenosis
-hypotension
-history of angioedema
48
Q

What are common ACE Inhibitors with Route - Onset - Duration - CHF Indication? (9)

A
  1. Benazepril (Lotensin): PO - 1hr - 24hrs - No

2. Captopril (Capoten): PO - .5hr - varies w/ dose - Yes

49
Q

What do Angiotension Receptor Blockers target and effect?

A

Inhibition of Angiotensin II receptor (action of angiotensin is blocked despite its production)

  • Peripheral Vasodilation (ATII causes peripheral vasoconstriction)
  • Reduced Antidiuretic Hormone (ADH) Production (reduced fluid volume)
  • Reduced Aldosterone Production (reduced fluid volume)
50
Q

T/F: Angiotensin Receptor Blocker are a first line option?

A

True (should not be combined with ACE inhibitors)

DPT710A: Pharmacology (8 decks)

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