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73 Cards in this Set
- Front
- Back
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What is the treatment for decreased Cardiac Output?
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Positive inotropics
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What are 2 results that Decreased CO leads to?
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-Decreased carotid sinus firing
-Decreased renal bloodflow |
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What is the responder to decreased renal bloodflow?
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RENIN!
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What inhibits that RENIN release?
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Beta blockers
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What does Renin release achieve if uninhibited?
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Activates ACE and Ang II
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What inhibits Ang II activation?
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ACE inhibitors
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What are 3 effects of Ang II if not inhibited?
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-Increased Preload
-Increased Afterload -Cardiovascular remodeling |
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What 2 types of drugs can reduce afterload and/or preload?
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-Diuretics
-Vasodilators |
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What is the responder to decreased Carotid sinus firing?
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Increased SNS outflow!
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What are 5 effects of Increased SNS outflow?
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-Increased heartrate
-Increased contractility -Increased Preload -Increased afterload -Cardiovasc remodeling |
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What are 2 diuretics that are given as anti-hypertensives?
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-Thiazides
-Loop diuretics |
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What are 6 major side effects of Thiazide diuretics like HCTZ?
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-Lassitude
-HypoKALEMIA -Hyperlipidemia, glycemia, calcemia, uricemia |
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What are 4 major side effects of LOOP diuretics like Ethacrynic acid, Bumetanide, and Furosemide?
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-HYPOkalemia
-Metabolic ALKALOSIS -HYPOtension -Ototoxicity!! |
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What are 2 alpha2 blockers that are given for hypertension?
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-Clonidine
-Methyldopa |
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What are 3 major side effects of Clonidine?
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-Drymouth
-Sedation -Severe rebound HTN |
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What are 2 major side effects of Methyldopa?
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Sedation
Pos coombs test |
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What are 3 atypical sympathoplegics for HTN?
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-Hexamethonium
-Reserpine -Guanethidine |
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4 side effects of Hexamethonium:
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-Severe ortho-hypotension
-Blurred vision -Constipation -Sexual dysfunction |
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4 major side effects of RESERPINE:
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-Nasal stuffiness
-Sedation -Depression -DIARRHEA |
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4 side effects of Guanethidine:
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-Ortho/exercise hypotension
-Diarrhea -Sexual dysfunction |
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What is the a1-blocker that is used for HTN treatment?
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Prazosin
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What side effects can Prazosin cause?
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First dose phenomenon
-Severe ortho hypotension -Headache -Dizziness |
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What are the major side effects of Beta blockers?
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-Asthma exacerbations
-Impotence -CV effects - CHF, AV block -CNS effects - sedation, altered sleep |
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What are 4 vasodilators for treating hypertension?
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-Hydralazine
-Minoxidil -Nifedipine/Verapamil -Nitroglycerine |
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What should always be given with Hydralazine or Minoxidil? Why?
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-Beta blockers to prevent reflex TACHYcardia and ANGINA
-Diuretics - they cause SALT retention |
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What are 3 side effects of HYDRALAZINE in addition to Tachycardia/Angina and Salt retention?
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-Nausea
-Headache -LUPUS LIKE SYNDROME (it's not Hipp) |
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What are 2 major side effects of Minoxidil in addition to Tachycardia/Angina and Salt retention?
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-Hypertrichosis (it's rogaine!)
-Pericardial EFFUSIONS |
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What are 4 side effects of Nifedipine and Verapamil?
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-Constipation
-Nausea -Flushing -Dizziness |
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What is a major side effect of Nitroprusside? Why?
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Cyanide toxicity - it releases CN
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What are 3 ACE inhibitors for HTN treatment?
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-Enalapril
-Captopril -Fosinopril |
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What is an acronym for remembering the side effects of ACE inhibitors?
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Hyperkalemia
CAPTOPRIL |
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What does Hyperkalemia CAPTOPRIL stand for?
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HYPERKALEMIA
Cough Angioedema Pregnancy - renal dmg to fetus Taste changes hypOtension Proteinuria Rash Increased Renin (compens) Lower Ang II |
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What is the ARB?
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Losartan
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What are 2 side effects of Losartan?
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-Fetal renal toxicity
-Hyperkalemia |
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So what are 2 side effects that BOTH ACE inhibitors and ARBs cause?
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-Teratogen - kidney dmg
-Hyperkalemia |
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What drugs cause Potasium LOSS?
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Thiazides and Loop diuretics
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What is the mechanism of HYDRALAZINE?
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Increases cGMP which causes smooth muscle relaxation - vasodilation
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What vessels does Hydralazine preferentially dilate? What effect does this have?
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Arterioles>veins - decreases AFTERLOAD
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What are the 2 main clinical uses of Hydralazine?
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-Severe hypertension
-Cong heart failure |
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What 2 drugs are FIRST LINES for hypertension in Pregnancy?
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-Hydralazine
-Methyldopa |
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And what are the 2 major side effects of Hydralazine?
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-Reflex Tachycardia (give a b-blocker
-Fluid retention (diuretic) -Lupus like syndrome |
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What is the mechanism of Calcium channel blockers?
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Block L-type calcium channels in BOTH Cardiac muscle AND smooth muscle; decrease contractility
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Which CCBs work best on SMOOTH muscle in vessels?
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Nifedipine/Amlodipine
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Which CCBs work best on CARDIAC muscle in the heart?
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-Verapamil
-Diltiazem |
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What are 5 clinical uses for the CCB's?
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-Hyperension
-Angina -Arrythmias (except Nifedipine) -Prinzmetal's angina -Raynaud's phenomenon |
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What are the major side effects of Verapamil?
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Constipation/nausea
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What are side effects of all the CCBs?
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Flushing/Dizziness
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What is the mechanism of Nitrites like Nitroglycerin and Isosorbide dinitrate?
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Increase cGMP and NO and thus cause vasodilation
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What vessels do the nitrites preferentially vasodilate and what is the effect?
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Veins>arteries -> reduce PRELoad
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What are 4 clinical uses of nitrites?
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-Angina
-Pulmonary edema -Aphrodisiac -Enhance erections |
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What is "Monday disease"?
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The development of tolerance to nitrates ability to decrease angina as the work week goes on
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What are the 4 main side effects seen in Nitrate use?
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-Hypotension
-Flushing -Dizziness -Tachycardia |
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What is the major goal in Antianginal therapy?
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Reduce MVO2 of the heart!
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What are 5 ways to reduce MVO2?
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-Lower EDV (preload)
-Lower MAP (afterload) -Lower heartrate/contractility -Ejection time |
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What drugs primarily affect preload?
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Nitrates
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What drugs primarily affect afterload?
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B-blockers
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Which CCB is similar to Nitrates and lower preload?
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Nifedipine
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Which CCB is similar to B-blockers and lowers Afterload?
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Verapamil
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How do the STATINS affect levels of LDL, HDL, and Triglycerides?
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-Greatly decrease LDL
-Increase HDl -Decrease Tri |
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3 side effects of STATINS:
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-Expensive
-Reversible increase in LFT's -MYOSITIS |
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Effect of NIACIN on LDL, HDL, and Triglycerides:
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LDL - greatly lowered
HDL - greatly higher Triglyc - lower |
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What are the 2 major side effects of Niacin?
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Red face and Flushing
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What makes Niacin induced face flushing go away?
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Aspirin or longterm use
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Effect of Bile acid resins on LDL, HDL, and Triglycerides:
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LDL - greatly lowered
HDL - no effect Triglyc - sl HIGHER!! YIKES |
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What are the 2 major side effects of Bile acid resins?
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Patients hate the taste
Causes GI discomfort |
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What is Ezetimibe?
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A cholesterol absorption blocker!
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What is the only effect Ezetimibe has?
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Decreases LDL because you don't absorb it
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What is the main effect Fibrates have?
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Majorly reduce TRIGLYCERIDES
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2 side effects of Fibrates (gemfibrozel)?
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-Increased LFTs
-MYOSITIS |
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What is the mechanism of the STATINS?
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Inhibit HMG-CoA reductase so inhibit Cholesterol synthesis
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What is the mechanism of NIACIN?
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Inhibits VLDL synthesis in the liver
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What is the mechanism of the Bile acid binding resins?
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Increase Bile acid excretion, which is the only way to excrete cholesterol
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What is the mechanism of Gemfibrozil and the fibrates?
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Activation of LPL in the peripheral endothelial cells
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