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38 Cards in this Set

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  • Back
Vasodilators are useful in treating what (2) conditions?
What is the role of Vasodilators in CHF?
The body's normal physiologic response in CHF is vasoconstriction. Excessive vasoconstriction can lead to pulmonary congestion (venous) and/or decreased Cardiac Output(arteriolar). This can be modulated by VD's.
What is the role of Vasodilators in HTN?
Decrease arteriolar resistance with subsequent drop in Blood Pressure.
Give examples of different Vasodilators based on location of action (i.e. Venous, Arteriolar or both).
Venous = nitrates;
Arteriolar = Hydralazine, minoxidil;
Both = ACE In.,alpha-blockers, Na nitropruside
TRUE/FALSE - Angiotensin Converting Enzyme leads to increase AII, which binds to AT1 causing increased natriuresis.
False - ACE does lead to increased AII, which binds to AT1, but causes decreased natriuresis.
What are the 2 physiologic effects of Angiotensin II binding to AT1?
1. Vasoconstriction;
2. release of aldosterone;
What are the 3 net effects of ACE inhibitors?
1. decreased Arteriolar Pressure (vasodilation Bradykinin accumulation); 2.Facilitate natriuresis;
3. Reduce Ventricular Remodeling
TRUE/FALSE - ACE inhibitors are only effective in hypertensive patients with "high renin"
False - ACE Inhibitors are effective regardless of Serum Renin levels.
TRUE/FALSE - Diuretics are the perferred treatment in diabetics with HTN to slow diabetic nephropathy.
False - ACE Inhibitors
BP = (?) x (?)
In CHF, What effect does ACE inhibitors have on PVR, AL, PL, & CO?
PVR, AL, PL decrease;
CO increases
TRUE/FALSE - Side Effects of ACE inhibitors are more common in patients with intravascular volume depletion.
What are the side effects of ACE Inhibitors?
Rare: Hypotension, Hyperkalemia, Renal Insuffiency, Cough
What is the mechanism of action of AT1R antagonists (ARBs)?
Competitive inhibitors of AII by binding to AT1 R, thereby inhibit vasoconstriction and aldosterone release.
TRUE/FALSE - ARBs are more effective than ACE inhibitors at blocking the renin-Angitotensin system, and equally effective as an anti-hypertensive.
What are the side effects of ARBs?
Hypotension, Hyperkalemia, NOT cough
Give 4 examples of Direct Acting Vasodilators?
Hydralazine, minoxidil, Na nitroprusside, diazoxide.
ACE inhibitors can precipate renal failure in ?
bilateral renal stenosis
Hydralazine and Minoxidil can cause reflex Tachycarida, causing precipitation of what? This is prevented by what concomitant treatment?
Myocardial Infarction with underlying CAD.
Addition of a Beta Blocker.
TRUE/FALSE - Hydralazine, an arteriolar dilator,has low bioavailability due to limited absorption.
FALSE - Bioavailabilty is determined by rate (slow/fast) acetylation of drug, through 1st pass through the liver.
What are the side effects of Hydralazine?
HA, palpitations, flushing, nausea, anorexia, SLE like syndrome
What is the mechanism of action of Minoxidil?
Increased K channel permeability leading to hyperpolarization, smooth muscle relaxation and decreased renal perfusion.
What are the side effects of minoxidil?
reflex Tachycardia, fluid retention, hypertrichosis, occasional pericardial effusion
TRUE/FALSE - Minoxidil's primary clinical indication is in severe, intractable HTN.
Na Nitroprusside is used in HTN/CHF emergencies. Why?
IV continous infusion with 30 second response.
What precautions (2) must be taken with Na Nitroprusside?
Beta blocker to prevent reflex tachycardia and Cyanide toxicity.
What is the mechanism of action of Na Nitroprusside?
RBC's metabolism of the drug results in NO release(vasodilator) and cyanide byproduct.
TRUE/FALSE - Fenoldopam causes arteriolar dilation, but unlike other Direct acting VD's it enhances renal perfusion.
In what condition is Fenoldopam, an DA1 Receptor agonist, contraindicated?
Glaucoma patients
What is the mechanism of Calcium Channel Blockers (CCBs)?
Calcium Channel Blockers (CCBs) prevent Ca influx via voltage gated Channels L & T.
What is the effect of CCBs on VSM & CSM?
VSM can't contract leading to vasodilation. CSM interferes with excitation-contraction coupling (can slow depolarizatoin also).
What are the physiologic effects of CCBs?
Negative inotropic effect and Vasodilation.
What are the indications for CCBS?
Angina pectoris, Coronary Artery spasm (Variant Angina), HTN, Supraventricular Arrhythmias
What are the side effects of CCBs? Why are short acting CCBs not used?
Side effects are hypotension, edema & brady arrhythmias. Short acting CCBs have higher incidence of MI in HTN/CAD patients.
TRUE/FALSE - Nitrates, such as nitroglycerin, cause vasodilation via NO production, resulting in vasular smooth muscle relaxation.
What is the major condition in which Nitrates are used?
Angina Pectoris
At which dosage (high/low), do nitrates preferentially vasodilate systemic veins leading to venous pooling?
Low doses
What are the side effects of nitrates?
flushing, HA, Hypotension, reflex Tachycardia