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Pharm Exam 2 > Topic 7 > Flashcards

Topic 7 Flashcards

1
Q

Hypertension=

A

Sustained systolic BP > 140 (120) mm Hg or a sustained diastolic BP > 90 mm Hg.

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2
Q

Pre-HTN=

A

120-130/80-90 mm Hg

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3
Q

Stage 1 HTN

A

140-160/90-100 mm Hg

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4
Q

Stage 2 HTN

A

> 160/100 mm Hg

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5
Q

Primary (Essential) HTN

A

HTN is caused by a blend of nurture and nature, is generally idiopathic and is the most common form (~90%).

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6
Q

Secondary HTN

A

HTN is caused by a specific etiology and is less common (~10%).

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7
Q

BP control (7)

A 
#1!: Arterioles!
#2: Venules
#3: The Heart
#4: Renin/angiotensin
#5: The “Pump”
#6: Anesthetic Depth
#7: Drugs
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8
Q

most antihypertensives work to alter BP by

A

Decreasing cardiac output

Decreasing peripheral resistance

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9
Q

BP formula=

A

CO*SVR

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10
Q

CO and SVR are controlled by

A

1) The SNS
2) baroreceptotor feedback.
3) The Renin/Angiotensin System

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11
Q

Combination therapy

A

Frequently more than one category of drug therapy is used to treat HTN to minimize side-effects

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12
Q

having ___% of normal blood volume can cause profound HTN

A

110%

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13
Q

having __% of normal blood volume can mean the critter’s normotensive

A

95%

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14
Q

first-line Rx for HTN

A

Diuretics

-fairly safe (wide therapeutic margin) -inexpensive

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15
Q

diuretics are superior for treatment of HTN in the

A

Elderly

-because they have stiffer arteries

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16
Q

B-Blockers decrease:

A

C.O.
SNS “tone”
renal renin release

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17
Q

Beta blocker type commonly prescribed

A

B1

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18
Q

Beta blockers are good for…. and not good for…

A
  • Good for young & white patients.

- NOT well suited for patients with CHF, asthma, &/or COPD. Black patients respond relatively poorly.

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19
Q

Beta blocker drug names: (5)

A
  • Nadolol (Corgard) (Non-selective)
  • Propanolol (Inderal, Innopran) (Non-selective)
  • Metoprolol (Lopressor, Toprol-XL) (B1 selective)
  • Atenolol (Tenormin) (B1 selective)
  • Nebivolol (Bystolic) (B1 selective/potent vasodilator)
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20
Q

“ACE” = “Angiotensin Converting Enzyme”=

A

Prevents pulmonary and renal endothelium from converting Angiotensin I into Angiotensin II (the active form)

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21
Q

ACE Inhibitors work on multiple levels:

…without causing

A

reflex increase C.O.
cardiac contractility
increasing H.R.

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22
Q

ACE Inhibitors Commonly used as a first line drug

A

post-MI for HTN

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23
Q

ACE inhibitors can be used for

A

patients with systolic dysfunction

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24
Q

ACE inhibitors can be used in everyone except

A

pregnant patients

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25
ACE inhibitor limiting side effect
bad cough
26
ACE inhibitor drugs (9
``` Captopril (Capoten) Enalapril (Vasotec) Lisinopril (Prinivil, Zestril) Benzapril (Lotensin) Fosinopril (Monopril) Moexipril (Univasc) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) ```
27
Captopril
(Capoten)
28
Enalapril
(Vasotec)
29
Lisinopril (2)
(Prinivil, Zestril)
30
Benzapril
(Lotensin)
31
Fosinopril
(Monopril)
32
Moexipril
(Univasc)
33
Quinapril
(Accupril)
34
Ramipril
(Altace)
35
Trandolapril
(Mavik)
36
Angiotensin II-Receptor Blockers (“ARBs”)= Like ACE Inhibitors but DON’T cause
bradykinin release and fewer respiratory side-effects (particularly coughing).
37
Angiotensin II-Receptor Blockers (“ARBs”) drugs (7)
``` Losartin (Cozaar ) Valsartin (Diovan) Candesartan (Atacand) Eprosartan (Teveten) Irbesartan (Avapro) Telmisartan (Micardis) Olmesartan (Benicar) ```
38
Losartin
(Cozaar )
39
Valsartin
(Diovan)
40
Candesartan
(Atacand)
41
Eprosartan
(Teveten)
42
Irbesartan
(Avapro)
43
Telmisartan
(Micardis)
44
Olmesartan
(Benicar)
45
Renin Inhibitor=
These drugs inhibit the first and rate-limiting step of the renin-angiotensin-aldosterone system (RAAS), namely the conversion of angiotensinogen to angiotensin I. Very similar-acting to ACE-Inhibitors and ARBS.
46
Renin Inhibitor drug name
Aliskiren (Tekturna)
47
Aliskiren
(Tekturna)
48
Calcium Channel Blockers=
Prevent calcium from moving into cardiac cells
49
α₂-Agonists or “Centrally Acting Sympathoplegics" act by
- decreasing the outflow of sympathetic firing from the CNS. - Decreased peripheral vascular tone. - Used in combination therapies - All tend to cause sedation as a major side-effect
50
α₂-Agonists dilates peripheral vessels but not
- renal arteries. | - Useful in HTN complicated by renal disease
51
α₂-Agonists drugs
Clonidine (Catapres, Duraclon) | α-Methyldopa (Aldomet) [Like Clonidine but less trans-placental passage]
52
Clonidine (2)
(Catapres, Duraclon)
53
α-Methyldopa
(Aldomet)
54
α₁-Blockers causes
causes smooth muscles to relax…resulting in both venous and arterial dilation
55
α₁-Blockers drugs
Prazosin (Minipres) Doxazosin (Cardura) Terazosin (Hytrin)
56
Prazosin
(Minipres)
57
Doxazosin
(Cardura)
58
Terazosin
(Hytrin)
59
What we use on bypass to contol HTN
Flow, Anesthetic depth, Drugs - Hydralazine “Apresoline” - Nitoglycerin - Nitroprusside (Nipride, Nitropress)
60
Hydralazine “Apresoline” =
Causes endothelial cells to release nitric oxide—a potent vasodilator causing smooth muscle relaxation - Arterials/arterioles dilate. - SVR falls. - Arterial pressure drops
61
Nitroglycerin at low doses=
venous dilation>arterial
62
Nitroglycerin at high doses=
arterial dilation>venous
63
Nitroglycerin Converted to nitric oxide by
mitochondrial enzymes.
64
Nitroglycerin Commonly used as a
bolus or IV drop on CPB to treat “HTN”.
65
Nitroglycerin decreases what
``` B.P. PCWP SVR. myocardial O2 demand during ischemia -while leaving contractility unaffected ```
66
Nitroglycerin is preferred in patients with
- coronary spasms | - air down the coronaries
67
Nitroglycerin | •Typical adult dose:
50-100 μg bolus | 0.1-7.0 μg/kg/minute
68
Nitroglycerin | •Typical pediatric infusion:
0.1-0.5 μg/kg/minute
69
Nitroprusside- other drug names
Nipride or Nitropress
70
Nitroprusside is a
Potent arterial & capacitance dilator. | ...so it decreases both preload and afterload which helps increase C.O. in patients with heart failure.
71
Nitroprusside MUST be given
parenterally
72
Nitroprusside is very commonly used to control
BP on CPB (both bolus and IV drip)
73
Nitroprusside Breaks down in the blood stream into
nitric oxide | cyanide
74
Although nitroprusside has a half life of...
1-2 minutes... | •It’s toxic metabolite thiocyanate has a half life of many days.
75
Nitroprusside Normal adult dosage is
0.5-10.0 μg/kg/min (peds receive the low end of this dose)
76
DO NOT give nitroprusside at higher dosages for more than
ten minutes or toxicity can result
77
Nitroprusside: Cyanide “shuts down”
cellular metabolism
78
Nitroprusside & NTG are often used at
CPB termination
79
Nadolol
(Corgard)
80
Propanolol
(Inderal, Innopran)
81
Metoprolol
(Lopressor, Toprol-XL)
82
Atenolol
(Tenormin)
83
Nebivolol
(Bystolic)

Pharm Exam 2 (9 decks)

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