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82 Cards in this Set
- Front
- Back
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direct --- dilation leads to --- in tpr
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arteriolar
decrease |
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a decrease in tpr leads to ---- activation and ---- sympathetic activation
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baroreflex
reflex |
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reflex sympathetic activation can lead to
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tachycardia
increased co fluid retention increased renin |
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due to reflex mechanisms what can occur
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tacyphylaxis
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why do some direct acting agents lose effectiveness
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counteract relaxation
so use meds in combo ex: beta blockers and diuretics |
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which meds have the most action on arterioles
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minoxidl
diazoxide |
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which meds have the most reflex tacycardia
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minoxidil
diazoxide |
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why use thiazide w/ minoxidil and diazoxide
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cuz they cause the most na retention
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t/f
nitroprusside cause na retention |
f
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meds that don't act on the veins
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hydralazine
minoxidil |
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what meds will you use for severe or refractory htn
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minoxidil
diuretic bb |
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for chornic htn what will you use
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hydralazine and minoxidil
in combo w/ bb and diuretic |
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meds for htn crisis
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nitroprusside
diazoxide fenoldopam |
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route for nitroprusside
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iv infusion
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route for diazoxide
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iv 8-10 hrs
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fenoldopam route
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iv
less than 48 hrs |
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hydralazine causes an increase in ----- which increase ---
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cGMP
NO |
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hydralazine work on the renal ----
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prostaglandins
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hydralazine work on -- movements
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Ca++
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hydralazine working on Ca movement interfere w/ the --- process
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contractile
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when hydralazine increase cGMP this will activate --- and inhibit ------
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phosphatase
inhibit Ca |
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hydralazine is --- ---- in the liver
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N-acetylated
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eskimo's will metabolize hydralizine faster/slower
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faster
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hydralazine will have a reflex increase in ---- and --- vol
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CO
fluid |
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se of hydralazine
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ha
dizziness flushing (skin) |
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who will have lupus syndrome w/ hydralazine
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high dose
long term women slow acetylators caucasians |
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ci w/ hydralazine
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CAD
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why is hyralazine ci in CAD
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vasodilator arterioles, so more blood on ateriole side and less bl to heart
leading to ischemia also stimulate CO, HR, increasing O2 demand and increase risk of MI, ischemia, etc |
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t/f
w/ hyralazine stools may turn black |
t
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why is hydralazine ci in ischemia
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stimulate co, hr leading to an increase in O2 deman and MI, ischemia
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t/f
hydralazine ok to use in the elderly |
f
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what does minoxidil activate
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ATP-modulated K channels
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minoxidil increase --- efflux
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K
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when K efflux increase what occurs
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hyperpolarization
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after hyperpolarization what occurs
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muscle relaxation
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w/ the k efflux what's more difficult
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L and T type voltage channels
inside the cell becomes more neg so harder to reach threshold |
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what metabolizes minoxidil
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liver suflotransferase
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minoxidil---- acitvates channels
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SO4
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how does minoxidil have more severe hemodynamic actions
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increases CO 2-3 x
stimulates renin release |
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an increase in renin release will lead to -- and --- retention
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Na
H2O |
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myocardial ischemia due to --- and ----
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reflexes and sympathetics
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---- in minoxidil due to action on K channel
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arrhythmias
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which med used in hypertrichosis (hair growth)
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minoxidil
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t/f
rogaine can have cv effects |
t
if enough absorbed |
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w/ minoxidil always use -- and ---
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bb
diuretics |
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nitroprusside has - NO and 5 ---- bound to Fe
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1 NO
5 Cyanide |
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NO activates ----
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cGMP
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cGMp decreases intracellular ---
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Ca
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t/f
nitroprusside effects veins only |
veins and arteries
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se of nitropursside:
---- metabolites |
toxic
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cyanide toxicity can lead to
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trembling
vomiting convulsions death |
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what do you give to limit cyanide toxicity
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sodium thiosulfate
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two toxicities of nitroprusside
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cyanide
thiocyante |
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thiocyanate toxicity can lead to
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weakness
anoxia tinnitus muscle spasms toxic psychosis |
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thiocyanate toxicity more prone w/ --- ---- and --- ---- ---
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renal failure
long term infusions |
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thocyanate is boutn to Na ----
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thiosulfate
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diazoxide mechanism r/t ------ structurally
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thiazide
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diazoxide works at the ATP sensitive --- channel
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K
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diazoxide prolongs the --- time of the K channel
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open
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diazoxide ---- the smooth muscle
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hyperpolarizes
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hyperpolarizing the smooth muscle makes it difficult to open the --- channels
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Ca
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diazoxide given via the -- route
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IV
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t/f
diazoxide is --- acting |
long
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diazoxide is used in ---- emergecies
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hypertensive
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which is longer acting diazoxide or nitroprusside
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diazoxide
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indications for nitroprusside
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htn emergencies
less bleeding |
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w/ diazoxide reflex what's increased
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CO
HR Renin Na retention Edema Coronary blood flow |
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due to the reflexes what can occure w/ diazoxide
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cardiac and cerebral ischemia
due to decreased pressure |
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--- and --- ischemia for all direct acting vasodilators
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cardiac
cerebral |
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diazoxide inhibits ----- leading to increase in glucose
mainly in type -- dm |
insulin
2 |
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how is there less insulin due to diazoxide
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due to action on K channels. . . decrease in insulin release
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other uses of diazoxide
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orally or injection to tx hypoglycemic conditions
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fenoldopam is a ---- agonist
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Dopamine: D1
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d1 agonist will stimulate ---
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cAMP
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fenolopam will also hae ---- agonist activity
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a2
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fenoldopam will also have direct renal --- and ----
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natriuretic
diuretic |
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t/f
give diuretic w/ fenoldopam |
no
maybe |
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route of fenoldopam
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IV
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length of administration of fenoldopam
why |
< 48 hrs
due to toxicity |
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ae of fenoldopam
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ha
flushing excessive vasodilation dysrhythmias |
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indication for fenoldopam
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htn emergencies
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which ones cause flushing and ha
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fenoldopam
hyrdralazine |
