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23 Cards in this Set
- Front
- Back
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SMC and cardiomyocyte contraction varies based on Ca. how is intracellular Ca regulated?
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increase Ca: voltage-gated channel, IP3/Ryanodine receptors on SR
decrease Ca: Ca ATPase exporter, Ca/Na exchanger, SERCA |
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in normal cells, how does Ca lead to contraction? how does NO lead to relaxation? how do beta2 agonists affect this?
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Ca -> leads to Calmodulin which activates MLCK to phosphorylate Myosin Light Chain (MLC) = contraction.
NO -> turns on guanylyl cyclase, cGMP dephosphorylates MLC -b2 agonist: upregulates cAMP to inactivate MLCK |
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list the 5 classes of anti-HTN drugs from class
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1. diuretic
2. ACE inhibitor / ARB 3. ANS Blockers/agonists 4. Ca channel Blockers 5. Direct Vasodilators |
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list the diuretics
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thiazides: hydrochlorothiazide, chlorthalidone (long 1/2 life)
loop diuretics: furosemide, bumetanide |
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what is the MOA of hydrochlorothiazide? what is the physio reflex?
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Diuretics increase Na excretion to decrease BV and decrease TPR.
phys reflex: Renin is upregulated by 1. beta R's on JGC, 2. low BP in kidney, 3. blocking Na reabsorption in loop (for furosenide and bumetanide) |
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what are the side effects of diuretics? extra one with loop diuretics?
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HYPOKALEMIA. also hyperglycemia, gout, impotence
loop - adds Ototoxicity |
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what is the effect of ACE inhibitors?
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limit Ang2 production and bradykinin breakdown. thus less vasoconstrict by Ang2, more vasodilate by BK, and less aldosterone thus less Na retention
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what is the angiotensin II receptor called? what type of receptor is it?
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AT1. it is a Gq receptor, thus PLC-> ip3 and dag, ca and PKC, etc.
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list the ACE-i's and ARBs
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ACE-i: captopril, enalapril, lisinopril
ARB: losartan, valsartan also Aliskiren is renin inhibitor |
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discuss GFR in patients with renal insufficiency, how ACE-i affects this, and specifically regarding bilateral renal artery stenosis
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GFR is usually maintained by Ang2 in efferent artery, also leading to increased GFR, proteinuria, collagen in glomerulus.
ACE-i can relax efferent artery to reduce the pressure thus limit GFR, proteinuria, and collagen production. contraindicated in bilateral renal artery stenosis |
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effect of beta blockers on HTN?
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block beta 1, reduce CO; also reduce renin release by JGC
propranolol, metoprolol |
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for HTN, don't give beta blocker to
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pt w/ asthma, hyperlipidemia, a-v conductance problem
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what is prazosin?
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alpha1 blocker, thus blocks vaoconstriction, has reflexive tachycardia
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beta blockers and alpha1 blockers lead to undesired reflexes. what single drug can have same effect w/out reflex?
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carvedilol. alpha and beta blocker
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what drugs can block NE secretion from the nerve terminal? side effects?
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alpha2 agonist - clonidine, alpha methyldopa
storage blocker - reserpine -can cause depression |
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what is the ER drug for HTN, a direct vasodilator
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Sodium Nitroprusside
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what are the non-ER drugs that are direct vasodilators? when are they contraindicated?
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hydralazine, minoxidil, (isosorbide dinitrate)
-not for use in SLE |
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list the calcium channel blockers, and describe their main differences
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dihydropyridines (nifedipine and amlodipine) act on VSM only
verapamil and diltiazem act on heart and VSM |
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HTN drugs for blacks:
HTN drugs for asians: |
blacks: diuretics and Ca blockers are good. ACE-i are ok if given with diuretic
elderly: diuretic and Ca blocker and ACE-i |
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HTN drugs contraindicated in diabetes pts:
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Beta blockers (blocks insulin release)
high dose diuretics |
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HTN drugs contraindicated in pregnancy
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ACE-i, ARB
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HTN drugs contraindicated in bilateral renovascular disease
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ACE-i, ARB
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when might potassium-sparing diuretics be contraindicated?
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renal insufficiency, or w/ use of ACE-i as these can retain K also
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