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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
Q

ACE inhibitor limiting side effect

A

bad cough

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26
Q

ACE inhibitor drugs (9

A 
Captopril (Capoten)
Enalapril (Vasotec)
Lisinopril (Prinivil, Zestril)
Benzapril (Lotensin)
Fosinopril (Monopril)
Moexipril (Univasc)
Quinapril (Accupril)
Ramipril (Altace)
Trandolapril (Mavik)
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27
Q

Captopril

A

(Capoten)

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28
Q

Enalapril

A

(Vasotec)

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29
Q

Lisinopril (2)

A

(Prinivil, Zestril)

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30
Q

Benzapril

A

(Lotensin)

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31
Q

Fosinopril

A

(Monopril)

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32
Q

Moexipril

A

(Univasc)

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33
Q

Quinapril

A

(Accupril)

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34
Q

Ramipril

A

(Altace)

35
Q

Trandolapril

A

(Mavik)

36
Q

Angiotensin II-Receptor Blockers (“ARBs”)= Like ACE Inhibitors but DON’T cause

A

bradykinin release and fewer respiratory side-effects (particularly coughing).

37
Q

Angiotensin II-Receptor Blockers (“ARBs”) drugs (7)

A 
Losartin (Cozaar )
Valsartin (Diovan)
Candesartan (Atacand)
Eprosartan (Teveten)
Irbesartan (Avapro)
Telmisartan (Micardis)
Olmesartan (Benicar)
38
Q

Losartin

A

(Cozaar )

39
Q

Valsartin

A

(Diovan)

40
Q

Candesartan

A

(Atacand)

41
Q

Eprosartan

A

(Teveten)

42
Q

Irbesartan

A

(Avapro)

43
Q

Telmisartan

A

(Micardis)

44
Q

Olmesartan

A

(Benicar)

45
Q

Renin Inhibitor=

A

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
Q

Renin Inhibitor drug name

A

Aliskiren (Tekturna)

47
Q

Aliskiren

A

(Tekturna)

48
Q

Calcium Channel Blockers=

A

Prevent calcium from moving into cardiac cells

49
Q

α₂-Agonists or “Centrally Acting Sympathoplegics” act by

A
  • 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
Q

α₂-Agonists dilates peripheral vessels but not

A
  • renal arteries.

- Useful in HTN complicated by renal disease

51
Q

α₂-Agonists drugs

A

Clonidine (Catapres, Duraclon)

α-Methyldopa (Aldomet) [Like Clonidine but less trans-placental passage]

52
Q

Clonidine (2)

A

(Catapres, Duraclon)

53
Q

α-Methyldopa

A

(Aldomet)

54
Q

α₁-Blockers causes

A

causes smooth muscles to relax…resulting in both venous and arterial dilation

55
Q

α₁-Blockers drugs

A

Prazosin (Minipres)
Doxazosin (Cardura)
Terazosin (Hytrin)

56
Q

Prazosin

A

(Minipres)

57
Q

Doxazosin

A

(Cardura)

58
Q

Terazosin

A

(Hytrin)

59
Q

What we use on bypass to contol HTN

A

Flow, Anesthetic depth, Drugs

  • Hydralazine “Apresoline”
  • Nitoglycerin
  • Nitroprusside (Nipride, Nitropress)
60
Q

Hydralazine “Apresoline” =

A

Causes endothelial cells to release nitric oxide—a potent vasodilator causing smooth muscle relaxation

  • Arterials/arterioles dilate.
  • SVR falls.
  • Arterial pressure drops
61
Q

Nitroglycerin at low doses=

A

venous dilation>arterial

62
Q

Nitroglycerin at high doses=

A

arterial dilation>venous

63
Q

Nitroglycerin Converted to nitric oxide by

A

mitochondrial enzymes.

64
Q

Nitroglycerin Commonly used as a

A

bolus or IV drop on CPB to treat “HTN”.

65
Q

Nitroglycerin decreases what

A 
B.P.
PCWP
SVR.
myocardial O2 demand during ischemia
-while leaving contractility unaffected
66
Q

Nitroglycerin is preferred in patients with

A
  • coronary spasms

- air down the coronaries

67
Q

Nitroglycerin

•Typical adult dose:

A

50-100 μg bolus

0.1-7.0 μg/kg/minute

68
Q

Nitroglycerin

•Typical pediatric infusion:

A

0.1-0.5 μg/kg/minute

69
Q

Nitroprusside- other drug names

A

Nipride or Nitropress

70
Q

Nitroprusside is a

A

Potent arterial & capacitance dilator.

…so it decreases both preload and afterload which helps increase C.O. in patients with heart failure.

71
Q

Nitroprusside MUST be given

A

parenterally

72
Q

Nitroprusside is very commonly used to control

A

BP on CPB (both bolus and IV drip)

73
Q

Nitroprusside Breaks down in the blood stream into

A

nitric oxide

cyanide

74
Q

Although nitroprusside has a half life of…

A

1-2 minutes…

•It’s toxic metabolite thiocyanate has a half life of many days.

75
Q

Nitroprusside Normal adult dosage is

A

0.5-10.0 μg/kg/min (peds receive the low end of this dose)

76
Q

DO NOT give nitroprusside at higher dosages for more than

A

ten minutes or toxicity can result

77
Q

Nitroprusside: Cyanide “shuts down”

A

cellular metabolism

78
Q

Nitroprusside & NTG are often used at

A

CPB termination

79
Q

Nadolol

A

(Corgard)

80
Q

Propanolol

A

(Inderal, Innopran)

81
Q

Metoprolol

A

(Lopressor, Toprol-XL)

82
Q

Atenolol

A

(Tenormin)

83
Q

Nebivolol

A

(Bystolic)

Pharm Exam 2 (9 decks)

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