Test 1: Wk2: Vasodialators - Salisbury Flashcards
1
Q
BP =
A
TPR x CO
2
Q
Arteriodilation ➡⬇TPR
Venodialation ➡⬇CO
A
both lead to ⬇BP
3
Q
Vasodilators compensatory mechanisms
A
⬆HR and ⬆fluid retention
4
Q
Ca channel blockers (2)
A
Dihydropyridines and non
5
Q
Dihydropyridines (1)
A
amlodipine
6
Q
non-Dihydropyridines (2)
A
verapamil and Diltiazem
7
Q
K channel opener (1)
A
Minoxidil
8
Q
Dopamine D1 Receptor Antagonist (1)
A
Fenoldopam
9
Q
Guanylate Cyclase Activators (5)
A
Nitroprusside Nitroglycerine Isosorbide Dinitrate Isosorbide Mononitrate Nitric Oxide
10
Q
Phosphodiesterase inhibitors (2)
A
Sildenafil and Tadalafil
11
Q
Ca Channel Blocker suffix
A
-dipine
12
Q
All Ca channel blockers share what mechanisms
A
⬇Ca influx through voltage gated L type Ca Channels
13
Q
Ca Channel Blockers targets (2)
A
blood vessels ion arterial system
heart
14
Q
Vascular effects of Ca Channel Blockers
A
arteriodilation
⬇TPR➡⬇BP
15
Q
are dihydropyridines stronger than non
A
yes, much stronger
16
Q
Ca Channel Blockers Cardiac Effects
A
inhibit L-type Ca channels
17
Q
Ca Channel Blockers inhibit what at the SA and AV nodes
A
phase 0 depol
18
Q
Ca Channel Blockers inhibit what in cardiomyocytes
A
phase 2 action potential
19
Q
Inhibition of L-type Ca channels leads to what 3 cardiac effects
A
⬇firing rate of SA node ➡⬇HR
⬇conduction velocity in AV node➡ block
⬇contractility of A and V muscles
20
Q
Verapamil Diltiazem and Dihydropyridines cardiac effects
A
see chart
21
Q
Ca Channel Blockers metabolized by
A
liver - hepatic metabolism
22
Q
Ca Channel Blockers are effective through what administration
A
orally
23
Q
Ca Channel Blockers uses
A
angina
24
Q
Tx of angina
A
⬆ Coronary blood flow
⬇ MVO2 demand
25
how do Ca Channel Blockers ⬇ MVO2 demand
| 2 ways
⬇ afterload (all)
| ⬇ CO (verapamil and diltiazam)
26
what drug treats Supraventricular Tachyarrhythmias
verapmil - Ca Channel Blockers
27
how does verapamil treat Supraventricular Tachyarrhythmias (3 ways)
⬇ AV nodal conduction
control V and A flutter and A fib
⬇ PSVT
28
Ca Channel Blockers are used for --- by --- and ---
hypertension
⬇ TPR
⬇ CO
29
which Ca Channel Blockers decrease CO
verapamil and diltiazem
30
Ca Channel Blockers adverse effects
see chart
31
Ca Channel Blockers contraindications (3)
avoid short term acting agents (Nifefipine)
Severe hepatic dysfunction
LV Dysfuntion
32
Short acting agents given with Ca Channel Blockers and increase
mortality and risk if MI
33
Ca Channel Blockers precautions (3)
Hypotension (all)
AV block (verapamil and diltiazem)
Sick sinus syndrome (verapamil and diltiazem)
34
Ca Channel Blockers drug interactions (4)
CYP3A4 inhibitors/ inducers
B blockers (verapamil diltiazem)
Digoxin (verapamil)
Antiarrhythmic drugs
35
Minoxidil is a
K channel opener
36
Minoxidil increases --- efflux from vascular SM cells ➡ ---➡ --- ⬇ --- ➡ ⬇---
Minoxidil increases K+ efflux from vascular SM cells ➡ hyperpol ➡ relaxation ⬇ TPR ➡ ⬇ BP
37
Minoxidil compensatory mechanism
increase HR CO and fluid accumulation
38
Minoxidil is a potent ---
vasodilatior
39
Minoxidil therapeutic uses (2)
refractory/malignant hypertension
alopecia
40
Minoxidil adverse effects (4)
fluid retention
tachycardia
pericardial effusion/ cardiac tamponade
hypertrichosis
41
Guanylyl Cyclase Activators mechanisms
activate GC
⬆ cGMP formation
⬆cGMP ➡ vasodilation
42
Nitroprusside effects on arteriodilation and venodilation
they are balanced
43
Nitroprusside Arteridilation ➡
⬇TPR➡⬇BP
44
Nitroprusside venodilation ➡
⬇Preload➡ ⬇CO ➡⬇BP
45
⬇BP ➡ Reflex ➡
⬆HR
46
Nitroprusside overall effects
⬇TPR
⬇BP
⬇CO
⬆HR
47
Nitroprusside t1/2 and onset
2min
| immediate
48
Nitroprusside administration
IV only
49
--- sensitivity with Nitroprusside
light
50
Nitroprusside therapeutic uses (3)
hypertensive emergencies
CHF
MI
51
Nitroprusside acute adverse effects
hypotension
52
Nitroprusside chronic effects
CN- toxicity
53
what can be given with Nitroprusside to reduce CN- toxicity
Thiosulfate
54
Organic Nitrates (3)
Nitroglycerin
Longer acting
ISDN
ISMN
55
Effects of Organic Nitrates are
dose related
56
Organic Nitrates Low Dose
venodilation
| see slide for more info
57
Organic Nitrates High Dose
Venodilation
Arteriodilation
Reflex ⬆HR
58
what Organic Nitrates have extensive first pass HM
nitroglycerin and ISDN
59
what enzyme denitrations Organic Nitratesin HM
Glutathione-organic nitrate reductase
60
what Organic Nitrates experience Vascular Metabolism
nitroglycerin
61
how is nitroglycerin metabolized in vasulature
nitroglycerine ➡ ALDH2 ➡ NO
62
Organic Nitrates tolerance
tx for >24 hrs
nitrate free period of 8-12 hrs
63
nitroglycerin ointment dosing interval
3-4x day remove for 12 hr
64
nitroglycerin patch dosing
1x daily remove for 12 hr
65
ISDN oral sustained relase dosing
1-2x daily, 14hr tablet free interval
66
ISMN
1x daily
67
Organic Nitrates therapeutic uses (3)
angina
CHF
Acute MI
68
Organic Nitrates adverse effects (2)
excessive hypotension
tolerance
69
excessive hypotension effects
headache
tachycardia
orthostatic hypotension
angina
70
Organic Nitrates with PDE5 inhibitors will result in
extreme hypotension
71
Nitric oxide administration and t1/2
inhalation
| very short
72
nitrate and nitrite excreted in
urine
73
Nitric oxide therapeutic uses
reverse hypoxic respiratory failure in neonates with pulmonary hypertension
74
Nitric oxide adverse effects (2)
pulmonary edema
hypoxemia
75
Hydralazine is a strong
arterial dialator
76
Hydralazine therapeutic uses
CHF
Hypertension
77
Hydralazine metabolism
hepatic and renal
78
Hydralazine adverse effects (5)
```
fluid retention
tachycardia
headache
hypotension
drug induced lupus-like syndrome
```
79
antinuclear antibody positve is caused by what drug
hydralazine
80
drug induced lupus-like syndrome risk factors
slow acetylates and female
81
Fenoldopam is a
peripheral dopamine D1 receptor agonist
82
Fenoldopam induces
systemic and renal arterial vasodilation
83
Fenoldopam adminstration
IV - rapid acting 15-20 min
lasts 1-4 hrs
84
Fenoldopam uses
hypertensive emergency
85
Fenoldopam adverse effects (3)
hypersensitivity to sodium metabisulfate
tachycardia
hypotension
86
PDE inhibitors (3)
sildenafil, tadalafil, verdenafil
87
PDE Inhibitors inhibit --- resulting in ---
PDE type 5 resulting in ⬆ NO cGMP
88
PDE Inhibitors relax SM in --- and --- resulting in --- and ----
corpus cavernosum and lower urinary tract
erection and urination
89
sildenafil, verdenafil, tadalafil time to peak conc.
1
1
1.5 hrs
90
sildenafil, verdenafil, tadalafil t1/2
3-4
4-5
18
91
sildenafil, verdenafil, tadalafil uses
erectile dysfunction
| BPG - tadalafil
92
sildenafil, verdenafil, tadalafil kinetics
orally
HM metabolized
93
sildenafil, verdenafil, tadalafil adverse effects
hypotension
94
sildenafil, verdenafil, tadalafil contraindications (4)
organic nitrates
a-blockers
CYP3A4 drugs
hepatic dysfunction
