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renal II > Vasodilators and sympathoplegics > Flashcards

Vasodilators and sympathoplegics Flashcards

1
Q

CCBs- DHPs

A

CaCh blockers- dihydropyridines
Amlodipine
Nifedipine
-dipine

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2
Q

CCBs- non-dihydropyridines

A

Diltiazem

Verapamil

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3
Q

KCh openers

A

diazoxide

minoxidil

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4
Q

Dopamine agonist

A

fenoldopam

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5
Q

NO modulators

A

Hydralazine
Nitroprusside
Organic Nitrates: Isoorbide dinitrate, nitroglycerin

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6
Q

vasodilators

A

CCBs
KCh openers
Dopamine agonist
NO modulators

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7
Q

Sympathoplegics

A

beta-blockers

alpha-blockers

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8
Q

beta blockers

A 
Atenolol
carvediol 
labetalol
metoprolol
propanolol 
-olol
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9
Q

alpha 1 blockers

A

prazosin

-osin

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10
Q

alpha 2 blockrs

A

clonidine
methyldopa
guanbenz
guanfacine

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11
Q

DHP prototypes

A

nifedipine

amlodipine

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12
Q

DHP MOA

A

blocks vascular L-type CaCh > cardiac Chs

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13
Q

Non DHP prototypes

A

Verapamil

diltiazem

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14
Q

Non DHP MOA

A

nonselective block of vascular and cardiac L-type CaCh

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15
Q

CCBs effects on SM

A

vasodilate -> decrease peripheral resistance
aa more sensitive then vv so orthostatic hypotension not usually an issue
decreases O2 demand and work of heart

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16
Q

CCBs effects on cardiac mm

A

reduced contractility throughout the heart and decreases in SA node pacemaker rate and AV node conduction velocity

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17
Q

CCB pharmacodynamics

A

PO, but high first pass metabolism
high degree of plasma protein binding
Nifedipine, clevidipine, verapamil, and diltiazem are also IV

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18
Q

DHPs adverse effects

A

generally well tolerated

excessive hypotension, dizziness, HA, peripheral edema, flushing, tachycardia, rash, gingival hyperplasia

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19
Q

Non-DHPs adverse effects

A

dizziness, HA, peripheral edema, constipation, AV block ,bardycardia, heart failure, lupus-like rash (diltiazem), pulmonary edema, cough, wheezing

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20
Q

short-acting DHPs

A

nifedipine
increased risk of MI, stoke, death
should NOT be used for management of chronic HTN

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21
Q

Non-DHP contraindications

A

couse w/beta blocker

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22
Q

CCB general contraindications

A

overt heart failure

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23
Q

CCB drug interactions

A

verapamil may increase digoxin in blood levels
DHPS additive w/other vasodilators
Non-DHPs additive w/other cardiac depressants and hypotensive drugs

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24
Q

CCB indications

A

long-term outpatient therapy of HTN
HTN emergencies
angina

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25
Q

Diazoxide MOA

A

K Ch opener in SM

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26
Q

Diazoxide pharmacodynamics

A

reduced contraction -> arteriolar dilator -> reduced peripheral resistance -> reduced mean arterial pressue

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27
Q

Dizaoxide pharmacokinetics

A

relatively long acting 4-14hrs
exhibits high protein binding
typically administered in 3-4 injections 5-15min apart, sometimes IV

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28
Q

diaoxide adverse effects/contraindications

A

excessive hypotension resulting in stroke and MI
hypotensive effects are greater in renal failure or when on beta-blockers
hyperglycemia
avoided in patients w/ischemic heart disease
causes Na and H20 retention

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29
Q

dizoxide clinical uses

A

HTN emergencies

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30
Q

minoxidil MOA

A

opens KCh in SM

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31
Q

minoxidil Pharmacodynamics

A

increased K permeability -> decrease contraction

dilation of aa, but not vv

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32
Q

minoxidil adverse effects/contrainidcations

A

common- HA, sweating, hypertrichosis
reflex sympathetic stimulation and Na and fluid retention resulting in tachycardia, palpitations, angina, and edema
minoxidil must be used in combo w/beta blocker and loop diuretic

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33
Q

minoxidil clinical uses

A

long-term outpatient therapy of severe HTN

topical formulations for hair growth

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34
Q

Fendolopam MOA

A

agonist at D1R

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35
Q

Fenoldopam pharmacodynamics

A

peripheral arteriol dilator, natriuretic

36
Q

Fenoldopam pharmacokinetics

A

administered by continuous IV due to rapid meta and short half life

37
Q

Fenoldopam adverse effects/contraindications

A

tachycardia, HA, flushing

should be avoided in patients w/glaucoma

38
Q

fenoldopam clinical uses

A

HTN emergencies

postoperative HTN

39
Q

Hydralizaine MOA

A

stimulates release of NO from endo

40
Q

Hydralazine pharmacodynamics

A

dilation of aa, but not vv, reflex tachycardia

41
Q

hydralazine pharmacokinetics

A

well absorbed, but high first pass

metabolism occurs in part bia actylation, so varied

42
Q

hydralazine adverse effects/contraindications

A

common: HA, nausea, anorexia, palpitations, sweating, flushing
in patients w/ischemic heart disease, reflex tachycardia and sympathetic stimulation may provoke angina or ischemic arrhythmias
rarely can cause peripheral neuropathy and drug fever

43
Q

hydralazine indications

A

long term outpatient HTN
combo w/nitrates is effective in heart failure and should be considered in patients (especially african americans) w/both HTN and heart failure
first line therapy for HTN in pregnancy
parenteral formulation is useful in HTN emergencies

44
Q

Na nitroprusside MOA

A

drug metabolism releases NO resulting in increased cGMP

45
Q

Na nitroprusside pharmacodynamics

A

powerful dilation of aa and vv, reduced peripheral vascular resistance and venous return
in absence of heart failure blood pressure drops and CO does not chance
when CO is already low due to heart failure, CO often increases due to afterload reduction

46
Q

Na nitroprusside pharmacokinetics

A

rapid meta results in rapid onset and short duration effect

should be administered by IV infusion w/continuous monitoring of arterial blood pressure

47
Q

Na nitroprusside adverse effects

A

excessive hypotension
cyanide poisoning ->metabolic acidoisis, arrythmias, excessive hypotension and death
thiocyanate toxicity

48
Q

Na nitroprusside indications

A

HTN emergencies

severe heart failure

49
Q

organic nitrates protype

A

nitroglycersin

50
Q

Nitroglycerin MOA

A

release of NO via enzymatic reaction

51
Q

Nitroglycerin pharmacodynamics

A

relaxes all types of SM (vv>aa)
virtually no direct effect on cardiac or skeletal mm
increases venous cpacitance, decreases ventricular preload, pulmonary vascular pressures and heart size are reduced
in absence of heart failure CO is reduced
decreases platelet aggregation

52
Q

Nitroglycerin pharmacokinetics

A

high first pass therefore sublingual usually used
therapeutic blood levels are reached w/in minutes and last 15-30
PO, transdermal and buccal available for longer duration
tolerance may occur

53
Q

nitroglycerin adverse effects/contraindications

A

common: orthostatic hypotension, syncope, throbbing HA
compensatory responses contributing to tolerance: tachycardia, increased cardiac contractility, rentention of Na and H20
contraindicated if intracranial pressure is elevated
transdermal patches should be removed before use of external defibrillators

54
Q

nitroglycerin drug-drug interaction

A

synergistic hypotension w/phosphodiesterase type 5 inhibitos

55
Q

nitroglycerin indications

A

HTN emergencies, angina, heart failure

56
Q

Non-ISA non-selective beta blockers

A

propanolol
carvediol
nadolol
timolol

57
Q

ISA Non-selective beta blockers

A

labetalol (also blocks alpha 1)
cartelol
penbutolol
pindolol

58
Q

non ISA cardioselective beta blockers

A 
metopropol
atenolol
esmolol
bisoprolol
betazolol
59
Q

ISA cardioslective beta blockers

A

acebutolol

nebibolol (also beta 3 agonist)

60
Q

propanolol MOA

A

non selective beta blocker

61
Q

beta blocker pharmacodynamics

A

non-selective agents primarily decrease BP by decreasing CO
cadioselective decrease TPR
do not usually cause hypotension in healthy people
blockade of beta 1 in kidney inhibits renin release
several beta-blockers exhibit local anesthetic actions

62
Q

beta blocker oral

A

except esmolol, all are available as oral preparations

63
Q

beta blockers extended release tablets

A

carvedilol, metoprolol, and propranolol

64
Q

beta blockers parenteral

A 
atenolol
esmolol
labetalol
metoprolol
propranolol
65
Q

beta blocers adverse/effects contraindicatios

A

asthma/COPD
diabetes
cardiac arrhythmias
most common side affect is fatigue, bradycardia, sexual dynsfunction, depression
chronic used associated w/high VLDL and low HDL
sudden withdrawl may cause rebound HTN, angina, possibly MI

66
Q

beta blockers drug-drug interactions

A

can cause heart block when combined w/CCBs verapamil or dltiazem

67
Q

beta blocker clinical uses

A

HTN: metoprolol and atenolol
heart failure: carvediol, bisoprolol, metoprolol
ischemic heart disease
cardiac arrythmias
glaucoma
bradyarrythmias or peripheral vascular disease

68
Q

alpha blockers prototype

A

prazosin

69
Q

prazosin MOA

A

reversible antagonist at alpha 1

70
Q

alpha blockers pharmacodynamics

A

prevent vasoconstriction of both aa and vv, decrease TPR
relaxes SM in prostate
retention of Na and H2O when used w/o diuretic
associated w/either no change or increased HDL levels

71
Q

alpha blockers adverse effects/contraindications

A

generally well tolerated
orthostatic hypotension, dizziness, palpitations, HA, lassitude
less incidence of reflex tachycardia than non-selective alpha blockers

72
Q

alpha blockers drug-drug interactions

A

most effective when used in combo w/other agents

73
Q

alpha blocker indications

A

men w/HTN and BPH

74
Q

alpha 2 blockers protoypes

A

clonidine

methydopa

75
Q

alpha 2 agonists MOA

A

reduce sympathetic outflow from vasomotor centers in brainstem, but allow centers to retain or even increase their sensitivity to baroreceptor reflex

76
Q

alpha agonists indications

A

with the exception of clonidine these agents are rarely used, methyldopa for HTN in pregnancy

77
Q

clonidine pharmacodynamics

A

lowers BP by reducing CO and TPR

78
Q

clonidine adverse effects

A

sedation, dry mouth, depression, sexual dysfunction
transdermal prep associated w/less sedation, but may cause skin rxn
abrupt withdrawl can lead to life-threatening HTN crisis

79
Q

Methyldopa pharmocodynamics

A

lowers BP by reducing TPR

varialbe reduction in HR and CO

80
Q

methyldopa adverse effects

A

sedation, dry mouth, lack of concentration, sexual dysfunction

81
Q

HTN in pregnancy

A

should be treated at systolic > or equal to 160 and/or diastolic > or equal o 110

82
Q

acute management of HTN in pregnancy

A

labetalol (IV)
hydralazine (IV)
CCBs
Nitroglycerin (IV)

83
Q

long term treatment of HTN in pregnancy

A

methyldopa
labetalol
nifesdipine
hydralazine

84
Q

contraindication in pregnancy

A

ACEIs, ARBs, direct renin inhibitors (fetal renal and cardiac abnormalities)
nitroprusside (fetal cyanide poisoning)

85
Q

vasodilators for HTN emergencies

A 
Na nitroprusside
nitroglycerin
nicardipine
clevidipine
fenoldopam
hydralazine (pregnancy HTN emergencies)
86
Q

adrenergic antagonists for HTN emergencies

A

phentolamine (cocain intoxication, phenochromocytoma)
esmolol (aortic dissection, postoperative HTN)
labetolol (active coronary aa disease)

87
Q

common drug combos

A 
ACEIs and CCBs
ACEIs and diuretics
ARBS and diurectis
beta blockers and diuretics
centrally acting agent and diuretic
diuretic and diuretic

renal II (4 decks)

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