Crr Week 4: Drugs Affecting Vascular Smooth Muscle (Blair)

Front 1

The compensatory responses can be divided into 2 major regulatory systems. What are they?

Back 1

1. Short term: baroreceptor reflex
2. Long term: salt and water retention

Front 2

List the 4 dihydropyridines.

Back 2

1. Nifedipine
2. Nicardipine
3. Amlodipine
4. Felodipine

Front 3

At therapeutic doses, what sort of effects do dihyrdropyridines have?

Back 3

Relax ARTERIAL smooth muscle, but have little to no effect on the heart or venous smooth muscle.

Front 4

What is the effect of dihydropyridines on afterload and preload?

Back 4

Reduce afterload but have no direct effect on preload or cardiac function.

Front 5

Which drug is a phenylalkylamine?

Back 5

Verapamil

Front 6

Which drug is a benzothiazepine?

Back 6

Diltiazem

Front 7

How do Verapamil and Diltiazem differ from the dihydropyridines?

Back 7

At therapeutic doses, they DO affect cardiac function

Front 8

Which produces more cardiac depression-- Verapamil or Diltiazem?

Back 8

Verapamil

Front 9

What are the actions of Verapamil and Diltiazem?

Back 9

1. Reduce heart rate of phase 4 depolarization in SA nodal cells --> Slows down heart rate
2. Reduce intracellular Ca2+ in cardiac muscle cells --> Decreases contractility
3. Slow conduction through the AV node.

Front 10

What are the most common adverse effects of the dihydropyridines?

Back 10

1. Hypotension
2. Headache
3. Peripheral or pulmonary edema

Front 11

When are Verapamil and Diltiazem contraindicated?

Back 11

When the patient is taking beta blockers

Front 12

What is the mechanism of action of the ACE inhibitors?

Back 12

Antagonize angiotensin converting enzyme, blocking the conversion of angiotensin I to angiotensin II

Front 13

List 4 actions of the ACE inhibitors.

What may be the primary beneficial effect of these drugs on the peripheral vasculature?

Back 13

1. Reduce vasoconstriction
2. Reduce secretion of aldosterone (retards Na+ and water retension)
3. Block the enhancement of sympathetic outflow (catecholamines)
4. Block the degradation of bradykinin <---- Primary beneficial effect on the peripheral vasculature

Front 14

List 3 ACE inhibitors.

Back 14

1. Captopril
2. Enalapril
3. Benazepril

Front 15

List 4 major adverse effects of the ACE inhibitors.

Back 15

1. Hypotension
2. Hyperkalemia
3. Dry cough
4. Angioedema

Front 16

Which drug is a benzothiazepine?

Back 16

Diltiazem

Front 17

How do Verapamil and Diltiazem differ from the dihydropyridines?

Back 17

At therapeutic doses, they DO affect cardiac function

Front 18

Which produces more cardiac depression-- Verapamil or Diltiazem?

Back 18

Verapamil

Front 19

What are the actions of Verapamil and Diltiazem?

Back 19

1. Reduce heart rate of phase 4 depolarization in SA nodal cells --> Slows down heart rate
2. Reduce intracellular Ca2+ in cardiac muscle cells --> Decreases contractility
3. Slow conduction through the AV node.

Front 20

What are the most common adverse effects of the dihydropyridines?

Back 20

1. Hypotension
2. Headache
3. Peripheral or pulmonary edema

Front 21

When are Verapamil and Diltiazem contraindicated?

Back 21

When the patient is taking beta blockers

Front 22

What is the mechanism of action of the ACE inhibitors?

Back 22

Antagonize angiotensin converting enzyme, blocking the conversion of angiotensin I to angiotensin II

Front 23

List 4 actions of the ACE inhibitors.

What may be the primary beneficial effect of these drugs on the peripheral vasculature?

Back 23

1. Reduce vasoconstriction
2. Reduce secretion of aldosterone (retards Na+ and water retension)
3. Block the enhancement of sympathetic outflow (catecholamines)
4. Block the degradation of bradykinin <---- Primary beneficial effect on the peripheral vasculature

Front 24

List 3 ACE inhibitors.

Back 24

1. Captopril
2. Enalapril
3. Benazepril

Front 25

List 4 major adverse effects of the ACE inhibitors.

Back 25

1. Hypotension
2. Hyperkalemia
3. Dry cough
4. Angioedema

Front 26

Hyperkalemia may be an adverse side effect of ACE inhibitors in which patients?

Back 26

Those who are taking a K+ sparing diuretic or K+ supplements, or who have diabetes

Front 27

One adverse effect of ACE inhibitors is a dry cough, why is this the case?

Back 27

Probably due to the enhanced levels of bradykinin.

Front 28

Which AT receptor do Angiotensin receptor blockers act on?

Back 28

AT1

Front 29

Why is a dry cough a less likely side effect of Angiotensin Receptor blockers?

Back 29

There is no effect on the metabolism of bradykinin

Front 30

List 3 Angiotensin Receptor blockers.

Back 30

1. Losartan
2. Candesartan
3. Valsartan

Front 31

List 3 adverse effects of the Angiotensin Receptor blockers.

Back 31

1. Hypotension
2. Hyperkalemia
3. Angioedema

Front 32

Give one example of a renin inhibitor.

Back 32

Aliskiren

Front 33

List 3 side effects of renin inhibitors.

Back 33

(Aliskiren)

1. Hypotension
2. Hyperkalemia
3. Angioedema

Front 34

List 4 nitrates.

Back 34

1. Nitroglycerin
2. Isosorbide dinitrate
3. Isosorbide mononitrate
4. Sodium nitroprusside

Front 35

Which nitrates are administered sublingually?

How long do they take to start working and how long is their duration of action?

Back 35

1. Nitroglycerin
2. Isosorbide dinitrate

Start working within 1-3 minutes
Duration of action is short-- only up to an hour

Front 36

Which nitrate is administered orally?

How long is its duration of action?

Back 36

Isosorbide mononitrate
(not susceptible to the first pass effect)

*Duration of action = 6-10 hours

Front 37

Which nitrate can be administered by a patch?

What is the duration of action?

Back 37

Nitroglycerin

*Duration of action = 10 hours

Front 38

Which nitrate is given by intravenous infusion?

When do its effects stop after an infusion has ended?

Back 38

Sodium nitroprusside

*Effects only last 1-10 minutes after infusion has stopped

Front 39

What is the major adverse effect of nitrates?

Back 39

Hypotension/ orthostatic hypotension

Front 40

Which drug can have the adverse effect of cyanide poisoning?

Which 2 drugs can be administered to treat CN- poisoning?

Back 40

Sodium nitroprusside
(structure contains CN- groups)

Treat CN- poisoning:
1. Sodium thiosulfate
2. Hydroxocobalamin

Front 41

When are nitrates contraindicated?

Back 41

When a patient is taking phosphodiesterase 5 inhibitors such as Sildenafil (Viagra)
(due to the risk of large decrease in arterial pressure)

Front 42

Tolerance quickly develops with which group of drugs?

Back 42

Nitrates

Front 43

What is the MOA of Hydralazine?

Back 43

Releases nitric oxide from endothelium.
*It dilates ARTERIOLES but not veins

Front 44

How is Hydralazine administered?

Back 44

Orally

Front 45

List 3 adverse side effects of Hydralazine.

Back 45

1. Compensaotry salt and water retention
2. Angina or arrhythmias (due to increase in sympathetic outflow)
3. Rapid development of tachyphylaxis

Front 46

What is the MOA of Minoxidil?

Back 46

Opens K+ channels in vsm membranes, which maintains the cells in a more hyperpolarized state, reducing the ability to contract.

*Just dilates ARTERIOLES

Front 47

List 4 adverse effects of Minoxidil.

Back 47

1. Salt and water retention
2. Increase in sympathetic flow
3. Tachycardia, angina, palpitations, and edema
4. Hypertrichosis

Front 48

Why must a beta blocker and a loop diuretic be administered with Minoxidil?

Back 48

To curb compensatory responses
(otherwise tachycardia, angina, palpitations, and edema will result)

Front 49

Which drug results in hypertrichosis?

Back 49

Minoxidil

Front 50

What is the MOA of Diazoxide?

Back 50

Opens K+ channels in vsm membranes

Front 51

How is Diazoxide administered?

Back 51

1. Parentally for treating hypertension
2. Orally for treating hyperinsulinism

Front 52

What are 2 major side effects of diazoxide?

Back 52

1. Excessive hyptoension resulting in stroke or MI.
2. Angina, cardiac ischemia, or cardiac failure in people with ischemic heart disease

Front 53

What is the MOA of Fenoldopam?

Back 53

Stimulates Dopamine (D1) receptors which produces arteriolar dilation and also produces natriuresis.

Front 54

How is Fenoldopam administered and what is its half life?

Back 54

IV infusion

*Half life is SHORT -- 10 minutes

Front 55

List 2 adverse side effects of Fenoldopam.

Back 55

1. Reflex tachycardia
2. Increased intraocular pressure

Front 56

Fenoldapam is contraindicated in what kind of patients?

Back 56

Those with glaucoma
(causes increased intraocular pressure)

Front 57

What are the Ca2+ channel antagonists used to treat?

Back 57

1. Hypertension
2. Angina

Front 58

What are the ACE inhibitors and angiotensin receptor blockers used to treat?

Back 58

1. Hypertension
2. Congestive heart failure
3. Slow the advancement of diabetic nephropathy

Front 59

What are renin inhibitors used to treat?

Back 59

Hypertension

Front 60

What are nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate used to treat?

Back 60

Angina

Front 61

Which drugs are used to treat hypertensive emergencies?

Back 61

1. Sodium nitroprusside
2. Diazoxide
3. Fenoldapam

Front 62

Which drug is used to treat refractory hypertension?

Back 62

Hydralazine

Front 63

Which drug may be used to treat hypertension in people who do not respond well to hydralazine or in people with renal failure?

Back 63

Minoxidil

Front 64

Which drug, in a topical cream form, can be used to treat baldness?

Back 64

Minoxidil

Front 65

Which drug is used to treat hypertensive emergencies AND hyperinsulinism?

Back 65

Diazoxide

Front 66

Which drug is used in hypertensive emergencies and for postoperative hypertension?

Back 66

Fenoldapam

Front 67

What is Nifedipine?

Back 67

Dihydropyridine
(Ca2+ channel blocker)

Front 68

What is Nicardipine?

Back 68

Didropyridine
(Ca2+ channel blocker)

Front 69

What is Amlodipine?

Back 69

Didropyridine
(Ca2+ channel blocker)

Front 70

What is Felodipine?

Back 70

Didropyridine
(Ca2+ channel blocker)

Front 71

What is Verapamil?

Back 71

Phenylalkylamine
(Ca2+ channel blocker)

Front 72

What is Diltiazem?

Back 72

Benzothiazepine
(Ca2+ channel blocker)

Front 73

What is Captopril?

Back 73

ACE inhibitor

Front 74

What is Enalapril?

Back 74

ACE inhibitor

Front 75

What is Benazepril?

Back 75

ACE inhibitor

Front 76

What is Losartan?

Back 76

AT receptor blocker

Front 77

What is Candesartan?

Back 77

AT receptor blocker

Front 78

What is Valsartan?

Back 78

AT receptor blocker

Front 79

What is Aliskiren?

Back 79

Renin inhibitor

Front 80

What is Hydralazine?

Back 80

Direct vasodilator

Front 81

What is Minoxidil?

Back 81

Direct vasodilator

Front 82

What is Diazoxide?

Back 82

Direct vasodilator

Front 83

What is Fenoldopam?

Back 83

Direct vasodilator