Unit 4 &10--CV AND ENDOCRINE Flashcards
How does the central nervous system affect BP?
beta receptors stimulate release of norepinephrine producing vasodilation and decreased bp
How does the peripheral nervous system affect BP?
Receptors located on effector cells-Alpha 1 and Beta 1 and Beta 2
what do Alpha 1 receptors on venues and arterioles cause?
vasoconstriction
Where are beta 1 receptors and what do they do?
heart and kidneys-regulate heart rate and contractility, as well as renin release thus affecting cardiac output.
where are beta 2 receptors and what do they do?
Located in lungs, liver, pancreas and arteriolar smooth muscle.. Regulate bronchodilation and vasodilation.
Where are baroreceptors located?
large arteries such as aorta and carotids
Describe the RAAS.
Renin is released in response to change in BP. Renin catalyzes conversion of angiotensinogin to angiotensin I which is converted to potent vasoconstrictor angiotensin II by ACE. Angiotensin II stimulates release of aldosterone from adrenals resulting in Na and H2O retention.
what is considered normal blood pressure?
<120/80-encourage pt
what is considered prehypertension? is this treated?
120-139/80-89-no treatment unless compelling indications
what is considered Stage I hypertension? What are first line choices?
140-159/90-99. Thiazide diuretics, may consider aces, arbs, bb, ccb or combo
What is considered stage II hypertension? What is first line treatment?
> 160/100. Two drug combo or thiazide and either ace, arb, bb, or ccb
What is the goal of therapy for htn?
decreasing CV and renal morbidity and mortality.
In which patients are thiazide diuretics contraindicated?
anuric patients or those with known sensitivity to thiazides and/or sulfonamides
What are side effects of spironolactone?
gynecomastia, hirsutism, menstrual irregularities
which beta blockers are cardioselective (i.e. Beta 1 receptor blockers) and are better choices for patients with asthma or copd?
atenolol, metoprolol, bisoprolol
What class of antihypertensives is first line therapy in hypertensive diabetic patients w/ proteinuria?
ACE inhibitors
what are nondihydropyridine CCBs? In whom should they be avoided?
verapamil and diltiazem. Patients with cardiac dysfunction-can accelerate HF.
What can occur with hydrazine? What meds should be given with it to prevent this?
May cause fluid retention and reflex tachy. Given w/ diuretics and beta blocker or other heart-slowing agent
What is the first choice for hypertension in patients with stable angina?
beta blockers and long acting CCBs
What is first line therapy for patients w/ hypertension and HF?
BB and ACE inhibitors.
What makes up metabolic syndrome
abdominal obesity, glucose intolerance, bp of at least 130/85, trigs of over 150, HDL <40 or 50 for men and women respectively
What is the best choice of antihypertensives for african americans?
chlorthalidone and amlodipine
what constitutes malignant hypertension?
DBP over 120
how do antioxidants improve cholesterol?
They block conversion of LDL to modified LDL in the vascular endothelium. Modified LDL may be more atherogenic so slowing its production could decrease atherogenic process.
How is LDL calculated?
Total Chol-HDL-VLDL (VLDL=trigs/5)
what is first line treatment for newly diagnosed hyperlipidemia (most patients)
lifestyle modification for 6-12 weeks
what is main goal of drug therapy in hyperlipidemia?
reduce CV risk without affecting quality of life
what meds can affect metabolism of statins?
CYP450-cyclosporine, emycin, azole antifungals
when should hepatic function labs be drawn on patients after starting statin therapy?
baseline, 6-12 weeks, and periodically thereafter.
what meds interact with bile acid resins?
abx and thyroid
what are major side effects of bile acid resins?
GI symptoms
what is niacin useful for treating?
low hdl, high trigs, ldl to some extent
what are cholesterol absorption inhibitors?
zetia, fibrin acid derivatives, gemfibrizol
After statins, what is the next line of treatment in hlp?
niacin, bile acid resins
how do CCBs treat angina?
act as vasodilators
what are some dihydropyridines?
nifedipine, felodipine, amlodipine
What antianginal medication can interfere with CYP3A4 inhibitors?
Ranexa
what is thought to be first line therapy for acute anginal episodes?
beta blockers
What is second line therapy for acute anginal episodes?
Combo with beta blocker and CCB or long-acting nitrate
what are symptoms of right sided heart failure?
pitting edema, abdominal pain, anorexia, N/V, JVD, ascites
what are symptoms of left sided heart failure?
cough, dyspnea, orthopnea, PND, cardiomegaly, S3 heart sound, rales, pulmonary edema
what is class I heart failure?
symptoms of HF only at levels of activity that would produce symptoms in normal people
what is class II heart failure?
symptoms with ordinary exertion
what is class III heart failure?
patients have symptoms of HF on less than ordinary exertion
what is class IV heart failure?
symptoms of HF at rest
what is first line and should always be started on patients with EF <35-40%
ACE inhibitors
What are class Ia Ib and Ic antiarrhythmics?
Sodium channel blockers. Ia: Quinidine Ib: lidocaine Ic: flecainide, propafenone
what are class II antiarrhythmic?
beta blockers: atenolol, lopressor, inderal
what are class III antiarrhythmics?
Potassium channel blockers: amio, tikosyn, multaq, sotalol
what are class IV antiarrhythmics?
calcium channel blockers: diltiazem, verapamil.
in whom should flecainide and propafenone (Class Ia) be avoided?
patients with structural heart disease including cad, LV dysfunction, valvular disease, LVH
How does DM II affect different body shapes differently?
In lean people, the problem is usually with beta cells. In overweight people, problem is in target cells
What results in Hgb A1c, FBG, and OGTT need repeat testing?
Hgb A1c >6.5%, FBG > 126, OGTT PG> 200
What blood results yield diagnosis of pre-diabetes?
FBG 100-125 or OGTT PG 140-199
Any random glucose over ______ indicates DM.
200
What meds cause hyperglycemia?
glucocorticoids, furosemide, thiazides, estrogen, beta blockers, nicotinic acid
How does the onset of DM I and DM II differ?
DM I is often sudden and preceded by ketoacidosis.
DM II is often gradual insidious and undiagnosed for years.
What are the goals of drug therapy in terms of glycemic control?
Hbg A1c <180.
What are common sulfonylureas? What is their mechanism of action? How is it taken?
glyburide, glipizide. They stimulate insulin release due to action on beta cells. once daily
In what DM meds do patients need to be concerned with hypoglycemia?
sulfonylureas (glipizide, glyburide), meglitinide analogs (prandin, starlix) and pramlintide acetate as well as others IF GIVEN IN COMBINATION WITH ONE OF THE ABOVE OR INSULIN
what are common thiazolidinediones? What is their mechanism of action? How is it taken?
actos and avandia They reduce insulin resistance at sites of insulin action. Taken once daily.
what are common alpha glucosidase inhibitors? What is their mechanism of action? How is it taken?
glyset and precose They slow absorption of carbs from intestines, minimizing postprandial increase in blood sugar Taken tid with first bit of meal.
what are common meglitinide analogs? What is their mechanism of action? How is it taken?
prandin and starlix They stimulate release of insulin from pancreas in response to a meal. with 2-4 meals daily.
what are common dipeptidyl peptidase-4 inhibitors? What is their mechanism of action? How is it taken?
januvia and onglyza They block effect of against GLP1 and increase amount of circulating incretins. Taken once daily.
What are common incretins and what is their mechanism of action?
Byetta. They slow gastric emptying and stimulate glucose-dependent secretion of insulin from pancreatic beta cells while suppressing release of glucagon from alpha cells Injectable only. Given 2x daily over 60 minutes or prior to largest 2 meals, at least 6 hours apart.
How does pramlintide acetate work and how is it taken?
It is an injectable synthetic of pancreatic amylin which is consecrated with insulin. Delays gastric emptying, alters release of additional inappropriate glucose and increases satiety. given prior to large meals.
What insulins are given as boluses?
very rapid acting-humalog
short acting-regular or “r”
What insulins are given as basals?
Intermediate-NPH, lente, “n” or “l”
Long-acting-“u”, lantus
How is daily insulin dosing divided? What is the ratio?
2/3 of daily dose is in the AM, 1/3 is in the PM. 2:1 ratio of intermediate to short acting before breakfast, 1:1 ratio of before dinner
how much insulin do adults and children need daily (approximately)
0.5-0.6 units/kg/d
how much insulin do adults and adolescents need during illness?
0.5-0.75 units/kg/d
how much insulin do adolescents need during a growth spurt per day?
1.25-1.5 units/kg/day
How much insulin to pregnant women need daily?
0.7 units/kg/day
What is the “1500 rule?”
Divide 1500 by total daily dose of insulin. The result is how much a single unit of insulin lowers blood glucose.
what is the Somogyi effect?
Rebound of hyperglycemia that occurs after early morning episode of insulin induced hypoglycemia.
What is first line treatment for DM I? DM II?
DM I: Insulin
DM II: mono therapy w/ oral agent-sulfonylureas if glucose >250 et thin, biguanides et TZDs are best in metabolic syndrome.
