Cubeddu Cardiovascular Part 2

Front 1

Renin is an enzyme that is made everywhere, but mainly where? and release is increased by?

Back 1

in the kidney
Increased by low salt concentration
Low blood pressure
SNS activation B1 receptors.

Front 2

Renin from the kidney goes where and does what?

Back 2

goes into the blood and converts Angeotenisogen to Angeotensin I.

Front 3

Birth control pills and pregnancy both increase what in the Renin cycle?

Back 3

Increase Angiotensinogen.

Front 4

What converts Angiotensin I to A II?

Back 4

A.C.E.

Front 5

Angiotnesis II has what chemical effects?

Back 5

increase Aldosterone - (reabsorbs Salt) looses H+, K+, Hg++
(High Ald causes low urine volume, and diarrhea)
Increases after-load and pre-load
Increases Thirst and ADH

Front 6

What receptors does A II stimulate?

Back 6

AT1 causing high ald, High preload (venoconstriction) High TPR (high afterload)

Front 7

Angiotensis II has what normally helpful effects?

Back 7

-Stimulates Angiogenesis (needed to grow blood vessels in fetus)
- contracts Efferent arteries increasing GFR.

Front 8

ARB stands for what?

Back 8

Angiotensin receptor Blockers

Front 9

Captopril, Lisinoprel, enalapril, rampiril are all what type of Hypertension drugs?

Back 9

ACE inhibitors more on Page 30

Front 10

Losartan, valsartan, candesartan, telmisartan are all what?

Back 10

ARB's Angiotensin receptor blockers.

Front 11

True or false ARB's and ACE inhibitors have the same effect.

Back 11

True same effect, blocking of A-II effects.

Front 12

Which of the following drugs decreases A-II.
...Sartan
... Sartan
... prazosin
...Enalapril

Back 12

enalopril. Only the ACE inhibitors decrease A-II levels.

Front 13

What are differences between ACE-I and ARBs?

Back 13

ACE VS. ARB
prils vs. sartins
Low A-II High A-II
Bk higher No effect on Bk
dry cough
skin itch
Activated in body already active
(except losartan)
some BID most QD

Front 14

What are similartites between ACE-Is and ARBs?

Back 14

Lower Blood pressure
blocks A-II action

Front 15

What ACE inhibitors have short half life (BID, TID)

Back 15

Enalapril and Captopril

Front 16

What is the effect of RACE, for ACE-I, and ARB?

Back 16

both work better in Caucasians than African Americans. Drugs work well with high levels of Renin. African Americans have lower levels of Renin. Add a diuretic.

Front 17

Why does a Diuretic and ACE-I or ARB work well together?

Back 17

Diuretic increases Renin, lowers NaCl, Blood Volume, and increases SNS, ACE decreases action of Renin.

Front 18

AA male 60 years BP 170/110 otherwise healthy. What do you do?

Back 18

Diuretic and ACE-I. Diuretic alone would only lower the BP to 160 because of Increased Renin.

Front 19

AA male 60 years on HCTZ 25mg QD BP is 150/95. what do you do?

Back 19

keep the HCTC and add a low dose of ACE-I or ARB. Then after finding the right dose then give a combination pill

Front 20

AA male 60 years on Lisinopril 20 mg bp is still 155/100 what do you do?

Back 20

Add a Diuretic low dose and check for effect.

Front 21

Which is better ACE-I or ARB?

Back 21

They are equal ACE inhibitors are cheaper.

Front 22

**On TEST**
Hypertensive A.A.s are less responsive to BP lowering by ACE and ARBs

Back 22

**ACE-I and ARBs Are Renoprotective for patients with Diabetes Mellitus.

Front 23

A patient with Diabetes put on an ACE-I or ARB does what?

Back 23

Lowers the renal disease lengthening the life of kidneys. Hypertensive or not!!

Front 24

A patient with proteinuria (proteins in the urine means kidney disease) is put on large doses of ACE-I for what?

Back 24

Renoprotection. Decreases progression of kidney disease and decreases proteinuria.

Front 25

**Any normal tensive or hypertensive with Diabetes (any age, race, gender) must be put on a(n) ______?

Back 25

**ACE-I or ARB for renoprotection.

Front 26

Diabetes with evidence of kidney disease automatically calls for what?

Back 26

renoprotection ACE-I or ARB.

Front 27

When diabetes and hypertensive exist together what should you get the blood pressure to what?

Back 27

120/80 because of the increased cardiac disease from diabetes.

Front 28

Angioedema is a side effect that is reported with what class of drug?

Back 28

ACE-I It is a swelling of the breathing air way.

Front 29

If a patient is taking an ACE-I and has swelling what is the next step?

Back 29

Immediatly stop taking ACE-I to prevent the possiblity of

Front 30

What are contrainhibited drugs due to pregnancy?

Back 30

ACE-I, ARBs

Front 31

ACE-I's, ARBs, and Alaskinin (renin inhibitor) all of these cause less ____, and _____effects.

Back 31

Aldosterone, and Angiotensin II effects.

Front 32

Aldosterone gets rid of what and retains what ions?

Back 32

Excrete Potassium and retain Sodium.

Front 33

Ace inhibitors cause increased ___ Retention.

Back 33

potassium. it can work as a potassium sparing diuretic (not as good, but still helps)

Front 34

A patient on ACE-I, ARB, or Aliskiren must be watched for what?

Back 34

Renal dysfunction, or more potassium will be lost.

Front 35

Why won't you see enalapril and Amiloride together?

Back 35

risk of Hyperkalamia. Both retain K+

Front 36

Serum Creatinine is used to estimate GFR. A patient has 0.8 mg/dL before ACE-I. after ACE-I 1.0mg/dL. Why?

Back 36

The angiotensen II constricts Efferent side and increases GFR. With the ACE-I less A-II causes less EFferent constriction and decreases GFR.

Front 37

Why are ACE-Is good at protecting the kidneys?

Back 37

Because the decreased in A-II causes decreased GFR, making the kidneys work less hard decreasing proteinuria.

Front 38

what are activators of potassium channels?

Back 38

Hydralazine, minoxidil, diazoxide, (direct acting vasodilators lowering TPR)

Front 39

The direct acting vasodiloators are primarily used in... and as....?

Back 39

in African americans and pregnant women, as a last resort.

Front 40

Know page 37 second paragraph.

Back 40

Hydralazine is metabolized by acetylation. Hydralazine may produce a clinical picture simulating systemic lupus erythematosus. Sympt....

Front 41

For pregnant women, what is the order to use for hypertension therapy?

Back 41

Calcium channel blockers
Hydrolazine
Alpha Methyl Dopa.

Front 42

Calcium is important for the ______ and _______ muscles.

Back 42

heart, smooth (Mainly the arteriols)

Front 43

Calcium is important in what actions of the heart?

Back 43

Cardiac contractility
and
Pacemaker conduction.

Front 44

True or False? Calcium channels blockers decrease serum calcium.

Back 44

False they decrease intracellular calcium by blocking the Voltage dependant calclium channels.

Front 45

What are the effects of Calcium channel blockers?

Back 45

Decrease in contractility of heart.
Decrease in Heart Rate.

Front 46

Calcium is important in the SA node for what?

Back 46

the action of the SA node. In skeletal muscle Sodium is the main depolorizer but in the SA node Calcium is.

Front 47

What other pacemaker cell is Calcium dependant?

Back 47

The AV node but the AV node is much slower, SV node is 60ish polorizations per min. AV node is 40ish Polorizations per min.

Front 48

Calcium channel blockers slow the signal going through the AV node, if the slow down is too much it can cause _________

Back 48

An AV block. caused by a high dose overdose of CaC blockers.

Front 49

Calcium channel blockers produce what 3 effects.

Back 49

Slow heart rate
Decrease Contractility
Slow AV conduction

Front 50

The major blood vessels that depend on calclium channels to get Calcium into the cells?

Back 50

Arteriols - Calcium channel blockers dilate arteriols
decrease TPR.

Front 51

CaC Blockers have what effect on Veins?

Back 51

No effect.

Front 52

Calcium channel blockers are very good at dilating what ___

Back 52

Coronary arteries small and large.

Front 53

Verapamil and Dietizam are what kinds of drugs?

Back 53

Non DHP Calcium channel blockers.

Front 54

DHP Calcium channel blockers are what?

Back 54

calcium channel blockers with Dihydropyridines.

Front 55

nifedinipe, isradipine, nicardipine, amlodipine, nimodipine.... are all what kind of drugs?

Back 55

DHP calcium channel blockers.

Front 56

What calcium channel blocker is given IV and S.R.?

Back 56

nifedinipe

Front 57

What is the most used Calcium Channel blocker?

Back 57

Amlodipine (procardia) because it has a long half life (24hours)

Front 58

Which DHT Calcium channel blocker is not used for Hypertension, but is cerebral blood vessel specific?

Back 58

Nimodipine IV (Nimotop)

Front 59

DHPs differ in effect from NON DHPs (diltiazem verapamil)

Back 59

DHP is better at lowering BP, TPR, Corinary Arteries,

Non-DHP is better at lowering Heart rate and contractility (DHP generally increases HR and contractility), Slowing AV conduction.

Front 60

Why are the DHPs increasing HR, and Contractility?

Back 60

Because they are such good vasodilators they cause reflex tachycardia and contractility.

Front 61

Side effects of DHP Calcium channel blockers.

Back 61

Headaches
Palpitations
Flushing
Edema (diuretic insensitive)

Front 62

Verapamil can have what side effects?

Back 62

Constipation(don't give with codine, opiates etc.)
Death in someone with a weak heart.

Front 63

Calcium channel blockers have what effect on Glomerulous?

Back 63

no effect, they dilate afferent and efferent arterols evenly. they are somewhat renoprotective.

Front 64

60 year old African American Hypertensive bp 160/100. First visit is given HCTZ or chlorthaledone. has lots of side effects what is the next choice for Hypertensive treatment?

Back 64

Calcium channel blockers (can be first choice to help dilate the coronary arteries.) can be used with a diuretic.

Front 65

What is the best aspect of Calcium channel blockers that other anti-hypertensives don't have?

Back 65

They are salt-independant. all others are effected by salt intake.

Front 66

What are your choices for anti-hypertnesives for African americans?

Back 66

Diuretics, Angiotenson drugs, and Calcium channel blockers.

Front 67

What are the drugs that are not first or second line for lowering BP?

Back 67

Alpha blockers, Hydrolazine, minoxide, sympatholitics.

Front 68

What is not a choice for patients with high blood pressure with Asthma?

Back 68

Beta Blockers

Front 69

What is not a choice for HBP and renal disease?

Back 69

Angeotensins.

Front 70

What is not a choice in a Patient with HBP and gout?

Back 70

no diuretics

Front 71

What is not used in a patient with HBP and Poor contractility?

Back 71

Beta blockers, and Calcium channel blockers.

Front 72

What is not used in a patient who has HBP and is an athlete?

Back 72

Beta Blockers.

Front 73

Congestive Heart Failure (CHF) is what 3 problems?

Back 73

Low Stroke volume
Low cardiac output
Low tissue perfusion.

Front 74

What are causes (etiology) of CHF?

Back 74

50% Ischimic heart disease (lack of blood to heart)
35% Hypertension
Remainder viral, Aids, ethanol.

Front 75

How do you prevent CHF?

Back 75

By treating Ischimic heart disease and hypertension early on.

Front 76

What is the cause of death for CHF?

Back 76

Arrhythmias, Sudden death.
Pump Failure,

Front 77

What are the signs and symptoms of CHF?

Back 77

Dyspnea (shortness of breath)
Edemia (congestion of the veins) often starting in the ankles.

Front 78

What is Acitis?

Back 78

abdominal edema

Front 79

What is systolic dysfunction?

Back 79

Weak muscle, decreased S.V

Front 80

What is diastolic dysfunction?

Back 80

Stiff muscle, decreased filling.

Front 81

Which is more common Diastolic or systolic dysfunction?

Back 81

Most patients have both.

Front 82

What are the compensitory mechanisms of CHF?

Back 82

Increased SNS activity (increase contractility, HR, afterload and preload)and
Increased RAA system (Increases afterload, preload, water and sodium).

Front 83

What do the high levels of NE, Aldosterone, and Angiotensin-II cause?

Back 83

Abnormal caardiac growth and remodeling.
Cell Death and Fibrosis
Cell dysfunction
Spherical/elliptical shape heart.

Front 84

What is the original therapy for this?

Back 84

Digoxin which increased Contractility for increased Stroke volume. Caused death at the same rate because of overworking heart.

Front 85

What is the better way to treat CHF (technically not drug name)?

Back 85

by decreasing afterload and preload (ACEI decreases AII which lowers After, and Prelaod)

Front 86

ACEIs treating CHF act how?

Back 86

They act like a diuretic and increase Stroke volume Increase cardiac output and inturn decreases SNS and RAA compensation.

Front 87

Mild Heart failure is a decrease in stroke volume but no edema, and only effort induced SOB what drug to you use?

Back 87

First like ACEI or ARB

Front 88

Moderate Heart Failure is Decreased Stroke volume more severe SOB, and Pedal Edema what medication?

Back 88

ACE Higher dose (sometimes ARB also) and
Loop diuretic for Pedal edema.
Furosamide, Torsemide, Bumetanide, Etocrinic acid.

Front 89

What do you do to monitor a patient with Moderate heart disease?

Back 89

Weigh them to see if edema progresses.

Front 90

What is Digoxin used for?

Back 90

symptomatic treatment of more severe Heart failure.

Front 91

What is Remodeling?

Back 91

The changing of the elliptical shape of a heart to a round or oval shape.

Front 92

What is the effect of ACEI on remodeling?

Back 92

ACEIs reverse remodeling.

Front 93

What are the only 2 beta blockers FDA approved for CHF? and why do they work

Back 93

Metoprolol and Carvedilol. They start at Very low levels and increase very slowly work in patients who are already on ACEI or ARB and a diuretic. Drops mortality by 40%

Front 94

What is the effect of a Beta blocker on the heart?

Back 94

They decrease contractility which is bad but decrease NE effects on the heart which is good.

Front 95

What are the drugs used to treat CHF?

Back 95

1. ACEI/ARB (decreases AII action, Afterload, preload Only one that improves mortality rate)
2. Loop Diuretic (for edema)
3. Digoxin (Increase Contractility)

Front 96

Hydralazine (dec Afterload) and Organic Nitrates (dec Preload) are used to treat CHF when?

Back 96

When the effect of the above aren't enough, or there is a reaction to taking the others.

Front 97

What is the mechanism of Digoxin?

Back 97

Inhibits the Na/K ATPase, causing Increased intercellular Na, Depolarization. Pump usually sends out 3+ and brings in 2+

Front 98

Increased Sodium in a cell will have what effect in a patient on Digoxin?

Back 98

The Na will exit through the Na/Ca pump causing high levels of intracellular Calcium = Increased contractility.

Front 99

Digoxin binds where?

Back 99

to the K+ side of the Na/Kase pump. (outside the cell)

Front 100

What are the effects of Digoxin?

Back 100

1. Increased myocardial contractility (increased intercellular Ca++)
2. Increased blood flow, increased urine/tissue perfusion decreased SNS.
3. A-V conduction "Block" Vegal like action.

Front 101

What are the drugs that affect the A-V node filtration? (slow A-V conduction)

Back 101

digoxin
verapamil
diltizam
beta blockers

Front 102

whenever Serum Potassium goes down, what happens to Digoxin?

Back 102

Toxicity goes up.

Front 103

What drugs decrease mortality in CHF patients?

Back 103

AceI/ARBs
Beta Blockers
Spironolactone/Eplerenone (aldosterone antagonists)

Front 104

Anti-Arrhythmic drugs are divided into what classes?

Back 104

I. Na+ blockers
II. Beta Blockers
III. K+ channel blockers
IV. Ca++ channel blockers
(aditional non classified Digoxin, Aderosin)

Front 105

Class I Anti-Arrhythmic drugs work where?

Back 105

They decrease excitability and conduction velocity.

Front 106

Class IV Anti-arrhythmic drugs act on what?

Back 106

Act on the SA node and AV node. Slows (bradycardia) and decreases AV conduction.

Front 107

Class III Anti-arrhythmic drugs do what?

Back 107

Work by slowing the repolarization phase. Longer refractory period

Front 108

Class II Anti-arrhythmic drugs do what?

Back 108

Block N.E. in the heart decreases SA and AV node, sow conduction, decrease contractility.

Front 109

Beta blocker names used for Arrhythmia?

Back 109

Metoprolol, propranolol, atenolol
and Sotalol (both a Beta blocker and K+ blocker)

Front 110

Calcium Channel Blockers for Arrhythmia?

Back 110

Verapamil, Diltiazem, and Bepridil (Ca++ blocker and K+ blocker)

Front 111

Potassium Channel Blockers for Arrhythmia?

Back 111

Amiodarone (Most common anti-arrhythmic is a K+, Na+, Ca++, and Beta blocker, EFFECTS THYROID)
Ibutilide, Dibutilide. (sotolol, and Bepridil)

Front 112

Sodium Channel Blockers for Arrhythmias?

Back 112

Quinidine, Procainrmide, Disopyramide (these 3 are also K+ blockers)
Lidocaine only Sodium channel blocker.