Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/71

Click to flip

71 Cards in this Set

  • Front
  • Back
What is the concept behind using a diuretic to treat HTN? What happens initially after use? What happens later?
Initially, plasma volume decreases, which decreases EDV and increases TPR, but after several weeks, there is an increase in plasma volume and a decrease in TPR
What happens to plasma renin levels with chronic diuretic use?
they are elevated
When are diuretics most effective?
When there is a low rening dependent HTN
Adverse effects of diuretics?
Volume depletion
Hypokalemia
hypercuricemia(gout)
hypercalcemia
Hypercholesterolemia
Hyperkalemia (in K sparing)
Other than HTN, what can diuretics be used to treat?
CHF/edema
CNS edema
Nephrolithiasis
Electrolyte d/o
MOA of thiazides?
Block NaCl resorption from DCT
MOA Furosemide?
LOH drug, blocks NKCC transporter
Use of furosemide?
HTN and resistant edema
MOA of K sparing diuretics?
Antagonize aldosterone
Which durg can be esp useful in chronic cardiac failure?
Spironolactone
Adverse effects of Spironolactone?
Gynecomastia
Sexual dysfxn
What hemodynamic effect do vasodiltors have?
Decrease TPR and increase HR
Decrese in renal perfusion pressure and increase in SNS --> renin release
Adverse effects of vasodilators?
Can precipitate angina
Causes vascular HA
Which vasodilator is safe in pregnancy?
Hydralazine
Adverse effects of hydralazine?
Potential for lupus syndrome (pericarditis)
MOA of minoxidil?
K channel opener, very potent
Vasodilation
ADverse effects of minoxidil?
Hypertricosis
Na-volume retention/weight gain prominent
Pericardial effusions
What must be co-administered with minoxadil?
LOH diuretic and B-blocker
MOA of Na-Nitroprusside (SNP)
NO activates guanylate cyclase --> formation of cyclic GMP and vasodilation
Dilates arterioles and venules, lowering preload and afterload
Main fxn of SNP?
Treats HTN emergencies and pulmonary edema
Has a very rapid onset and offset
What receptors does NE have strong affinity for?
A1=A2 >>>> B
Phentolamine administration? MOA?
IV
non-selective a-antagonist
Phenoxybenzamine administration? MOA?
Oral
non-selective a-antagonist
Examples of alpha1 antagonists?
Prazosin
Erazosin
Doxazosin
Hemodynamic effecs of a-1 antagonists?
Vasodilation --> increased VR/CO, decreased TPR, decreased HR
No reflex SNS b/c a2 receptors are not blocked
Which drug class can treat HTN and BPH?
a1 antagonists
Which drug in addition to treating HTN also increases HDL and deceases LDL?
a1 antagonists
Why are a2 antagonists effective?
suppresses SNS sympathetic outflow
No serious adverse effects
Alpha methyldopa?
a prodrug
inhibits CNS NE release
Adverse effects of alpha-methyldopa?
Postural HTN
Hepatic toxicity
hemolytic anemia
Clonidine
Lowers BP by agonizing a2 receptors
Where are B1 receptors located?
SA node, ventricles, JG cells (mediate renin release)
Where are B2 receptors?
vascular smooth muscle, mediates vasodilation and decreses TPR
What are the immediate hemodynamic effects of beta blockers?
decrease in CO and increase in TPR, raising BP slightly
Several days/weeks later TPR declines b/c there is a beta-adrenergic inhibition of renin release
Propranolol
nonselective beta blocker
high lipid solubility (can enter CNS)
Metrolprolol
beta1 blocker
Less lipid soluble
Atenolol
beta1 blocker
less lipid soluble
Pindolol
ISA (intrinsic sympathetic agonist)
has less bradycardia at rest
Acebutolol
ISA (intrinsic sympathetic agonist)
less bradycardia at rest
Labetolol
alpha-beta receptor antagonist
alpha antagonism speeds onset, but ultimately is b-blocker
Carvedilol
alpha-beta receptor antagonist
alpha antagonism speeds onset, but ultimately is b-blocker
Use of alpha-beta receptor antagonists?
(labetolol and carvedilol)
tx of HTN emergency
random roles of ACE
degrades bradykinin, substance P, and other neuropeptides
what is the primary sie effect seen in ACE-I? What causes it?
Cough and edema
increases levels of bradykinin, substance P
Net hemodynamic change in ACE-I?
Decrease in TPR and CO, w/o increase in HR
Which drug class is useful in decreasing the amt of LV remodeling?
ACE-I
Adverse effects of ACE-I?
Hypotension in high renin or v-depleted states
hyperkalemi a
renal fialure in bilateral renovascular dz
cough
edema
In addition to HTN, what else can ACE-I treat?
CHF
Nephropathy from DM-I
Types of ca channel blockers?
DHP
Phenylalkylamine CCB
Benzothiazapine CCB
How do the -dipines work?
they are DHP CCBs
Inhibit L channels in peripheral arteriole sm and cardiac muscle (cardiac to lesser extent)
Adverse effects of DHP?
can precipitate angina or MI
Verapamil?
Phenylalkylamin CCB
Inhibits L channel in myocardium, SA and AV node, NON-vascular sm muscle
Net hemodynamic effect of verapamil?
Decreased CO d/t negative inotropic and chronotropic effects
Adverse effects of verapamil?
Constipation
Can systolic cardiac dysfunction and worsen CHF
Can produce/worsen heart block
Diltiazem
Benzothiazapine CCB
Inhibits Ca influx through L channels in cardiac and peripheral vascular sm muscle
Which CCB has the most benefits?
Diltiazem
SAFE in CAD, less risk in CHF
MOA of sartans
AT1 receptor antagonist
Secondary rise in plasma renin
Metabolism of candesartan cilexetil
gets coverted to cadesartan in intestinal wall
which HTN med is used to also slow progression of nephropathy in DMII
irbesartan
losartan
Aliskiren
direct renin inhibitor (still in clinical trials)
[renin] increased, but diminished renin activity
AI, AII, aldosterone levels decreased
what drugs can be used to treat HTN with low renin levels
diuretic
CCB
a-blocker
what drugs can be used to treat HTN with high renin
ACI-I
ARB
b-blocker
what class of drugs do AA respond best to? worst to?
Diuretics, CCB, a-blockers

less response to ACE-I and b-blockers when used alone
What are the renin levels in elderly??
low
what drug combo used to treat LVH
b-blocker and ACE-I
Drug combo to treat cardiac failure
diuretics + ACE-I
What should not be used in PVD?
non-selective B-blocker- can worsen sx
B2 causes vasodilation!!!
Which HTN drugs worsen hyperlipemia
diuretics
b-blockesr
which drugs can exacerbate asthma
b-blockers and a-b-blockers
(b2 receptors dilate bronchiles)
what do OTC cold medication interact with? what can result?
ACE-I --> accel HTN
what drugs are contra-indicated in pregnancy?
ACE-I
ARBs
(both are teratogenic)