WOLFF Crossword Hypertension & Heart Failure Drugs Flashcards by Bridget Tesher

abbr. for enzyme that generates biologically active angiotensin II from the inactive angiotensin I generated by renin

ACE

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abbr. for class of drugs known to attenuate/partially correct the adverse consequence of chronic hypertension on blood vessels and proven to preserve/improve failing heart function and prolong life

ACEI

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group at greatest risk for hypertension development in US

African Americans

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increases prevalence of hypertension

age

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mineralocorticoid secreted by blood vessels adjacent to myocardial infracts, promotes myocardial fibrosis, effects blocked by spironolactone

aldosterone

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newest RAS drug, directly blocks renin, has no obvious clinical advantages over ACEI or ARB

aliskiren

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adrenergic receptors located on blood vessels (and prostate) to cause constriction

alpha1

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classically the presynaptic autoinhibitory populations of adrenergic receptors that decrease NE neuronal release, but also located postsynaptically in both CNS and periphery

alpha2

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potentially deadly adverse effect associated with the use of ACEI

angioedema

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potent vasoconstrictor, causes renal retention of salt and water via direct effects and by promoting aldosterone secretion, also a very important mitogen for the cardiovascular remodeling that causes a progressive deterioration of cardiovascular function in heart failure patients

angiotensin II

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renin substrate supplied by the liver

angiotensinogen

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abbrev. for class of drugs with similar beneficial effects on heart and vasculature as ACEI, but theoretically better since >1 way to generate Ang II, potentially allows for beneficial effects of AT2 stimulation, and has much lower incidence of cough and angioedema

ARB

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develop a thicker media during hypertensive remodeling and an increase in collagen in larger ones makes them stiff

arteries

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group for whom non-selective beta blockers are contraindicated for hypertension

asthmatics

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typical characteristic of hypertension

asymptomatic

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sense blood pressure, modulate firing of sympathetic nerves on blood vessels to maintain venous return during changes in body posture

baroreceptors

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drug combination that emerged as antihypertensive combination of choice in recent ACCOMPLISH clinical trial, among reasons many physicians are now choosing either of these agents as initial therapy since other can be added as necessary

benazepril amlodipine

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population of adrenergic receptors that increases heart rate and contractility, and renin secretion by the kidneys

beta1

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adrenergic receptor population responsible for dilation of skeletal muscle vasculature and bronchodilation

beta2

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class of drugs used for decades to lower blood pressure, but indications in the absence of angina or prior MI were decreased by the finding that other drug classes provide better protection against cardiovascular morbidity and mortality (especially stroke); once contraindicated in heart failure, now some (but definitely not all) can be used routinely/judiciously in clinically stable patients to protect against arrhythmias and keep the heart from becoming desensitized to sympathetic stimulation

beta blockers

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a vasodilator combination containing organic nitrate vasodilator isosorbide dinitrate to dilate veins and hydralazine to dilate arteries; especially useful in African Americans and others whom my not be able to use ACEI or ARB

BiDil

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ectopic beat alternating with normal beat, seen in digoxin toxicity

bigeminy

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increase in this increases blood pressure, it is decreased by diuretics

blood volume

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alpha-1 blockers are now seldom used to lower blood pressure but would also help treat this as a result of an adverse effect that manifests in healthy males as “reverse ejaculation” (abbr)

BPH

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normally broken down by ACE, its accumulation with use of ACEI is thought to contribute to the adverse effects of this drug class

bradykinin

inward current that makes a major contribution to the plateau phase of fast cardiac action potentials, drugs blocking this decrease myocardial contractility

calcium

ARB noteworth for relatively irreversible binding to the AT1 receptors

candesartan

prototypical ACE inhibitor (and supposedly first drug developed via rational drug design technology)

captopril

aka digitalis, widely used to treat heart failure until epidemiologists showed they may have reduced office visits but did not prolong life (e.g., felt better until moment of death due to fatal arrhythmia)

cardiac glycosides

refers to the vicious cycle that progressively worsens cardiac function once triggered by an index event

cardiac remodeling

while metoprolol and bisoprolol can be used, this is the beta blocker that appears to work best in heart failure, perhaps because it actually functions as an inverse agonist at these receptors; shown to reduce mortality in patients with systolic dysfunction due to MI, should be given to all CLINICALLY STABLE patients with symptomatic CHF and ejection fraction < 40%

carvedilol

class of drugs with utility in angina therapy, also widely used for treatment of primary hypertension; some evidence for improvement in vascular structure and function similar to ACEI and ARB

CCB

group more likely to have secondary hypertension

children

more potent and longer-acting than hydrochlorothiazide with benefits actually proven in ALLHAT clinical trial, this is now the preferred thiazide diuretic of hypertension specialists

chlorthalidone

prototypical alpha2 agonist, acts in the brainstem to decrease sympathetic outflow, which lowers blood pressure; little orthostatic hypotension, but dry mouth and sedation limit its utility

clonidine

microdeposits here are a near universal finding in patients receiving amiodarone

cornea

the primary reason patients stop taking ACEI to control their blood pressure, a sign of congestive heart failure

cough

action potential triggered by calcium oscillations in sarcoplasmic reticulum

delayed after-depolarization

unavoidable risk for hypertension development, reason to avoid non-selective beta blockers due to risk of hypoglycemia, reason for trying to keep blood pressure < 130/80 mm Hg

diabetes

heart failure in which ejection fraction is preserved, problem is that heart doesn't fill enough; usually has concentric remodeling/hypertrophy; increasingly common diagnosis, especially in elderly women

diastolic

should contain < 3 g of salt per day in heart failure patients

diet

aka cardiac glycosides such as digoxin, once first-line therapy in heart failure, now generally only used in systolic heart failure with very low ejection fraction

digitalis

a critical component of heart failure therapy; eliminate the fluid causing congestion in acute decompensated heart failure, prevent the accumulation of this fluid in stable heart failure, and, by decreasing blood volume, keep the heart from becoming overfilled and therefore unable to perform at its now optimal level

diuretics

synthetic catecholamine that selectively activates beta1 receptors; preferred drug to administer if symptomatic hypotension/hypoperfusion despite optimization of cardiac filling pressure due to low cardiac output

dobutamine

catecholamine that activates beta receptors at low dose and alpha receptors at higher doses, used to increase cardiac output in patients with acute heart failure; notion that it had a beneficial "renal sparing" effect has been discredited

dopamine

left-sided heart failure leads to this in lungs, right-sided heart failure leads to this in legs and ankles/periphery (aka "dropsy" in history); reason loop diuretics are used in heart failure

edema

renal arterioles preferentially constricted by Ang II, reason ARB and ACEI can attenuate the detrimental glomerular hypertension seen in diabetes

efferent

term now used for 120 < SAP < 129 mmHg and DAP < 80 mmHg

elevated

old term for primary hypertension when high blood pressure was deemed necessary to get adequate flow through blood vessels with smaller lumens

essential

loop/high ceiling diuretic that works when GFR is low (unlike thiazides), especially important for mobilizing the large volumes of fluid that accumulate in patients with heart failure and are responsible for the "congestion"

furosemide

early antihypertensive drug intended to improve upon reserpine, works by displacing NE from synaptic vesicle and blocking receptors; now seldom used because a "sledgehammer" with adverse effects including severe orthostatic hypotension

guanethidine

increasing this is why later generation antihypertensive drugs such as benazepril, amlodipine and telmisartan can be administered orally once per day

half-life

anorexia, nausea, vomiting and salivation may be the more common signs of digoxin toxicity, but the yellowish/greenish tinge of these make for a better test question

halos

potential adverse effect of beta blockers

heart-block

common consequence of coronary artery disease, chronic hypertension and diabetes, stage A evidence for it is reason to initiate treatment with ACEI or ARB

heart failure

should be greater than 60 before digoxin is administered

heartrate

classic ganglionic blocker among the first agents employed as antihypertensive therapy, raised resting HR and BP and had numerous intolerable side effects (google ____ man for classic description)

hexamethonium

heart failure with causes including hyperthyroidism, pregnancy, anemia, arteriovenous fistula, wet beriberi (thiamine deficiency), Paget’s disease

high-output

extrinsic modulators of renal function that shift the intrinsic relationship in kidneys between urinary output of salt and water sideways along the arterial pressure (x) axis in such a way that increases or decreases in Na+ intake normally have minimal effect on blood pressure

hormones

a direct acting vasodilator that preferentially acts on arterioles; the principal use for this drug is to control blood pressure in pregnant women with pre-ecclampsia

hydralazine

predominant thiazide diuretic, widely used as monotherapy and in drug combinations

hydrochlorothiazide

currently defined as SAP >180 mmHg or DAP > 120 mmHg

hypertensive crisis

because of the abundance of this in amiodarone, it can cause either hypo- or hyperthyroid disturbances

iodine

e.g., blood pressure of 170/80, type of hypertension common in elderly due to loss of elasticity in aorta and large distribution vessels

isolated systolic

"funny" current blocker used in heart failure if sinus rhythm but ejection fraction <35% and HR >70 bpm when beta blockers are either contraindicated or on board at maximally tolerated doses

ivabradine

theoretically the ultimate regulators of blood pressure because of their "infinite gain"

kidneys

a combination alpha/beta blockers useful in hypertensive emergencies

labetalol

changes from a V-shape to a U-shape during cardiac remodeling of systolic heart failure

left ventricle

digoxin and amiodarone are among the drugs for which this is required due to their long half-life

loading dose

prototype of angiotensin receptor blocker (ARB) drug class, now available as a generic

losartan

characteristic of ~25% of hypertension cases, more common in blacks & elderly, reason ARBs, ACEI and beta-blockers are less effective as monotherapy in these people

low-renin

syndrome associated with prolonged use of, among other drugs, hydralazine and procainamide (w/o hyphen)

lupus-like

early drug now known to be converted to a centrally acting alpha2 agonist that decreases sympathetic outflow, remains a drug of choice for pregnancy-induced hypertension

methyldopa

a phosphodiesterase inhibitor that increases cAMP levels in heart and blood vessels to cause increases in contractility and vasodilatation, respectively; can be used together with sympathomimetic drugs, but drug has been shown to decrease survival in some studies

milrinone

direct-acting vasodilator also applied directly to scalp to promote hair growth, must use with a diuretic since it can cause profound vasodilation with fluid retention sufficient to cause congestive heart failure and cardiac tamponade

minoxidil

digoxin binds/competes for the K+ binding site on this membrane transporter

Na-K-ATPase

hyped "3rd generation beta blocker" was widely expected to be better than existing beta-blockers due to vasodilatory effects, but has failed at least one major clinical trial attempting to prove this

nebivolol

synthetic B-natriuretic peptide; expensive drug once widely used for its ability to treat dyspnea in acute heart failure until other studies suggested it caused kidney failure; clinical trials later showed the drug to be safe with no additional benefit for dyspnea...

nesiritide

venous vasodilator often administered as initial therapy for treatment of acute decompensated heart failure; heart is being overfilled and venous pooling of blood helps alleviate that problem until diuretics can coax the kidneys to excrete that excess volume

nitroglycerin

mixed arterial and venous dilator with short half-life infused during hypertensive emergencies

nitroprusside

blood pressure with SAP < 120 mmHg and DAP < 80 mmHg

normal

can be the cause of hypertension in women

oral contraceptives

may need to administered this to patients presenting with acute decompensated heart failure

oxygen

early non-selective alpha blocker used for hypertension treatment with poorly tolerated adverse effects, a drug you should know as a classic non-competitive/irreversible receptor blocker

phenoxybenzamine

non-selective alpha-blocker and classic drug you should know; short half-life coupled with profound hypotension and reflex tachycardia made it poor antihypertensive therapy

phentolamine

contraindication for aliskiren, ACEI and ARB

pregnancy

occurs in heart due to conditions such as aortic stenosis or chronic hypertension; tends to cause concentric hypertrophy due to the parallel addition of new myofibrils

pressure overload

ending in generic drug name that tells you it is an ACE inhibitor

pril

prolonged in ECG by digoxin, manifests as heart block during digoxin toxicity, can be useful in atrial fibrillation to prevent ventricular tachycardia

PR interval

developed to treat angina by slowing heart rate, found to cause a slow onset but sustained decrease in blood pressure that elevated its drug class to the ranks of first-choice antihypertensive therapy for decades

propranolol

major side effect of amiodarone

pulmonary fibrosis

refers to the large and potentially lethal increases in blood pressure seen when patients taking beta blockers or alpha2 agonists as antihypertensive therapy abruptly stop taking their medication

rebound hypertension

among the earliest effective antihypertensive agents, blocks incorporation of NE into synaptic vesicles; modest effect --> increased dose --> severe depression/suicide --> realization that doing opposite might treat depression

reserpine

refers to people with hypertension in whom increases in sodium intake cause large increases in blood pressure

salt-sensitive

neutral endopeptidase inhibitor (prolongs half-life of endogenous natriuretic peptide) marketed in combination with valsartan for the treatment of heart failure

sacubitril

ending in generic drug name that tells you it is a blocker of AT1 receptors

sartan

body position utilized for patients presenting with acute decompensated heart failure

seated

refers to hypertension with an identifiable cause such as renal artery stenosis or chronic kidney disease

secondary

a bluish discoloration of this is among the adverse effects of amiodarone

skin

even though many have salt-resistant hypertension, all will see some benefit by decreasing this, and antihypertensive medications will work better

sodium intake

aldosterone antagonist and K+-sparing diuretic, can be added to K+-losing diuretics to increase Na+ elimination while minimizing concurrent K+ changes; has proven antifibrotic effects in post-MI heart leading to reductions in morbidity and mortality in clinical trials, but remains underutilized in heart failure due to a risk of hyperkalemia

spironolactone

current hypertension category with 130 < SAP < 139 mmHg or 80 < DAP < 89 mmHg

stage 1

current hypertension category for SAP > 140 mmHg or DAP > 90 mmHg, typically requires > 1 drug for therapy

stage 2

depressed in ECG by therapeutic levels of digoxin (--> "Salvadore Dali mustache")

ST segment

decreases with digoxin use since cardiac output is increased

sympathetic tone

another term for heart failure with reduced ejection fraction (i.e.< 50%); typically manifests as progressive chamber dilation with eccentric remodeling

systolic

class of diuretics discovered in 1958, and among drugs of first choice for hypertension treatment ever since

thiazides

a major concern with digoxin; KCl, lidocaine and antidigitalis antibodies are among the treatments

toxicity

abbr. for something that is always increase in chronic hypertension, either as an initiating feature or secondary to excessive blood flow through tissues because of excessive blood volume

TPR

increases with digoxin use since cardiac output is increased

urine production

ARB noteworthy for not being a prodrug requiring activation

valsartan

occurs in heart due to conditions such as valvular regurgitation, tends to cause eccentric hypertrophy due to the addition of sarcomeres in series

volume overload

law of Laplace dictates that this must increase much for smaller increases in lumen radius to generate and/or contain the same pressure

wall tension

ending of generic names for drugs selectively blocking alpha-1 adrenergic receptors; use discontinued dramatically in hypertension therapy when ALLHAT clinical trial linked these drugs to an increased risk for developing heart failure

zosin