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112 Cards in this Set

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  • Back
Renin is an enzyme that is made everywhere, but mainly where? and release is increased by?
in the kidney
Increased by low salt concentration
Low blood pressure
SNS activation B1 receptors.
Renin from the kidney goes where and does what?
goes into the blood and converts Angeotenisogen to Angeotensin I.
Birth control pills and pregnancy both increase what in the Renin cycle?
Increase Angiotensinogen.
What converts Angiotensin I to A II?
Angiotnesis II has what chemical effects?
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
What receptors does A II stimulate?
AT1 causing high ald, High preload (venoconstriction) High TPR (high afterload)
Angiotensis II has what normally helpful effects?
-Stimulates Angiogenesis (needed to grow blood vessels in fetus)
- contracts Efferent arteries increasing GFR.
ARB stands for what?
Angiotensin receptor Blockers
Captopril, Lisinoprel, enalapril, rampiril are all what type of Hypertension drugs?
ACE inhibitors more on Page 30
Losartan, valsartan, candesartan, telmisartan are all what?
ARB's Angiotensin receptor blockers.
True or false ARB's and ACE inhibitors have the same effect.
True same effect, blocking of A-II effects.
Which of the following drugs decreases A-II.
... Sartan
... prazosin
enalopril. Only the ACE inhibitors decrease A-II levels.
What are differences between ACE-I and ARBs?
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
What are similartites between ACE-Is and ARBs?
Lower Blood pressure
blocks A-II action
What ACE inhibitors have short half life (BID, TID)
Enalapril and Captopril
What is the effect of RACE, for ACE-I, and ARB?
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.
Why does a Diuretic and ACE-I or ARB work well together?
Diuretic increases Renin, lowers NaCl, Blood Volume, and increases SNS, ACE decreases action of Renin.
AA male 60 years BP 170/110 otherwise healthy. What do you do?
Diuretic and ACE-I. Diuretic alone would only lower the BP to 160 because of Increased Renin.
AA male 60 years on HCTZ 25mg QD BP is 150/95. what do you do?
keep the HCTC and add a low dose of ACE-I or ARB. Then after finding the right dose then give a combination pill
AA male 60 years on Lisinopril 20 mg bp is still 155/100 what do you do?
Add a Diuretic low dose and check for effect.
Which is better ACE-I or ARB?
They are equal ACE inhibitors are cheaper.
**On TEST**
Hypertensive A.A.s are less responsive to BP lowering by ACE and ARBs
**ACE-I and ARBs Are Renoprotective for patients with Diabetes Mellitus.
A patient with Diabetes put on an ACE-I or ARB does what?
Lowers the renal disease lengthening the life of kidneys. Hypertensive or not!!
A patient with proteinuria (proteins in the urine means kidney disease) is put on large doses of ACE-I for what?
Renoprotection. Decreases progression of kidney disease and decreases proteinuria.
**Any normal tensive or hypertensive with Diabetes (any age, race, gender) must be put on a(n) ______?
**ACE-I or ARB for renoprotection.
Diabetes with evidence of kidney disease automatically calls for what?
renoprotection ACE-I or ARB.
When diabetes and hypertensive exist together what should you get the blood pressure to what?
120/80 because of the increased cardiac disease from diabetes.
Angioedema is a side effect that is reported with what class of drug?
ACE-I It is a swelling of the breathing air way.
If a patient is taking an ACE-I and has swelling what is the next step?
Immediatly stop taking ACE-I to prevent the possiblity of
What are contrainhibited drugs due to pregnancy?
ACE-I's, ARBs, and Alaskinin (renin inhibitor) all of these cause less ____, and _____effects.
Aldosterone, and Angiotensin II effects.
Aldosterone gets rid of what and retains what ions?
Excrete Potassium and retain Sodium.
Ace inhibitors cause increased ___ Retention.
potassium. it can work as a potassium sparing diuretic (not as good, but still helps)
A patient on ACE-I, ARB, or Aliskiren must be watched for what?
Renal dysfunction, or more potassium will be lost.
Why won't you see enalapril and Amiloride together?
risk of Hyperkalamia. Both retain K+
Serum Creatinine is used to estimate GFR. A patient has 0.8 mg/dL before ACE-I. after ACE-I 1.0mg/dL. Why?
The angiotensen II constricts Efferent side and increases GFR. With the ACE-I less A-II causes less EFferent constriction and decreases GFR.
Why are ACE-Is good at protecting the kidneys?
Because the decreased in A-II causes decreased GFR, making the kidneys work less hard decreasing proteinuria.
what are activators of potassium channels?
Hydralazine, minoxidil, diazoxide, (direct acting vasodilators lowering TPR)
The direct acting vasodiloators are primarily used in... and as....?
in African americans and pregnant women, as a last resort.
Know page 37 second paragraph.
Hydralazine is metabolized by acetylation. Hydralazine may produce a clinical picture simulating systemic lupus erythematosus. Sympt....
For pregnant women, what is the order to use for hypertension therapy?
Calcium channel blockers
Alpha Methyl Dopa.
Calcium is important for the ______ and _______ muscles.
heart, smooth (Mainly the arteriols)
Calcium is important in what actions of the heart?
Cardiac contractility
Pacemaker conduction.
True or False? Calcium channels blockers decrease serum calcium.
False they decrease intracellular calcium by blocking the Voltage dependant calclium channels.
What are the effects of Calcium channel blockers?
Decrease in contractility of heart.
Decrease in Heart Rate.
Calcium is important in the SA node for what?
the action of the SA node. In skeletal muscle Sodium is the main depolorizer but in the SA node Calcium is.
What other pacemaker cell is Calcium dependant?
The AV node but the AV node is much slower, SV node is 60ish polorizations per min. AV node is 40ish Polorizations per min.
Calcium channel blockers slow the signal going through the AV node, if the slow down is too much it can cause _________
An AV block. caused by a high dose overdose of CaC blockers.
Calcium channel blockers produce what 3 effects.
Slow heart rate
Decrease Contractility
Slow AV conduction
The major blood vessels that depend on calclium channels to get Calcium into the cells?
Arteriols - Calcium channel blockers dilate arteriols
decrease TPR.
CaC Blockers have what effect on Veins?
No effect.
Calcium channel blockers are very good at dilating what ___
Coronary arteries small and large.
Verapamil and Dietizam are what kinds of drugs?
Non DHP Calcium channel blockers.
DHP Calcium channel blockers are what?
calcium channel blockers with Dihydropyridines.
nifedinipe, isradipine, nicardipine, amlodipine, nimodipine.... are all what kind of drugs?
DHP calcium channel blockers.
What calcium channel blocker is given IV and S.R.?
What is the most used Calcium Channel blocker?
Amlodipine (procardia) because it has a long half life (24hours)
Which DHT Calcium channel blocker is not used for Hypertension, but is cerebral blood vessel specific?
Nimodipine IV (Nimotop)
DHPs differ in effect from NON DHPs (diltiazem verapamil)
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.
Why are the DHPs increasing HR, and Contractility?
Because they are such good vasodilators they cause reflex tachycardia and contractility.
Side effects of DHP Calcium channel blockers.
Edema (diuretic insensitive)
Verapamil can have what side effects?
Constipation(don't give with codine, opiates etc.)
Death in someone with a weak heart.
Calcium channel blockers have what effect on Glomerulous?
no effect, they dilate afferent and efferent arterols evenly. they are somewhat renoprotective.
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?
Calcium channel blockers (can be first choice to help dilate the coronary arteries.) can be used with a diuretic.
What is the best aspect of Calcium channel blockers that other anti-hypertensives don't have?
They are salt-independant. all others are effected by salt intake.
What are your choices for anti-hypertnesives for African americans?
Diuretics, Angiotenson drugs, and Calcium channel blockers.
What are the drugs that are not first or second line for lowering BP?
Alpha blockers, Hydrolazine, minoxide, sympatholitics.
What is not a choice for patients with high blood pressure with Asthma?
Beta Blockers
What is not a choice for HBP and renal disease?
What is not a choice in a Patient with HBP and gout?
no diuretics
What is not used in a patient with HBP and Poor contractility?
Beta blockers, and Calcium channel blockers.
What is not used in a patient who has HBP and is an athlete?
Beta Blockers.
Congestive Heart Failure (CHF) is what 3 problems?
Low Stroke volume
Low cardiac output
Low tissue perfusion.
What are causes (etiology) of CHF?
50% Ischimic heart disease (lack of blood to heart)
35% Hypertension
Remainder viral, Aids, ethanol.
How do you prevent CHF?
By treating Ischimic heart disease and hypertension early on.
What is the cause of death for CHF?
Arrhythmias, Sudden death.
Pump Failure,
What are the signs and symptoms of CHF?
Dyspnea (shortness of breath)
Edemia (congestion of the veins) often starting in the ankles.
What is Acitis?
abdominal edema
What is systolic dysfunction?
Weak muscle, decreased S.V
What is diastolic dysfunction?
Stiff muscle, decreased filling.
Which is more common Diastolic or systolic dysfunction?
Most patients have both.
What are the compensitory mechanisms of CHF?
Increased SNS activity (increase contractility, HR, afterload and preload)and
Increased RAA system (Increases afterload, preload, water and sodium).
What do the high levels of NE, Aldosterone, and Angiotensin-II cause?
Abnormal caardiac growth and remodeling.
Cell Death and Fibrosis
Cell dysfunction
Spherical/elliptical shape heart.
What is the original therapy for this?
Digoxin which increased Contractility for increased Stroke volume. Caused death at the same rate because of overworking heart.
What is the better way to treat CHF (technically not drug name)?
by decreasing afterload and preload (ACEI decreases AII which lowers After, and Prelaod)
ACEIs treating CHF act how?
They act like a diuretic and increase Stroke volume Increase cardiac output and inturn decreases SNS and RAA compensation.
Mild Heart failure is a decrease in stroke volume but no edema, and only effort induced SOB what drug to you use?
First like ACEI or ARB
Moderate Heart Failure is Decreased Stroke volume more severe SOB, and Pedal Edema what medication?
ACE Higher dose (sometimes ARB also) and
Loop diuretic for Pedal edema.
Furosamide, Torsemide, Bumetanide, Etocrinic acid.
What do you do to monitor a patient with Moderate heart disease?
Weigh them to see if edema progresses.
What is Digoxin used for?
symptomatic treatment of more severe Heart failure.
What is Remodeling?
The changing of the elliptical shape of a heart to a round or oval shape.
What is the effect of ACEI on remodeling?
ACEIs reverse remodeling.
What are the only 2 beta blockers FDA approved for CHF? and why do they work
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%
What is the effect of a Beta blocker on the heart?
They decrease contractility which is bad but decrease NE effects on the heart which is good.
What are the drugs used to treat CHF?
1. ACEI/ARB (decreases AII action, Afterload, preload Only one that improves mortality rate)
2. Loop Diuretic (for edema)
3. Digoxin (Increase Contractility)
Hydralazine (dec Afterload) and Organic Nitrates (dec Preload) are used to treat CHF when?
When the effect of the above aren't enough, or there is a reaction to taking the others.
What is the mechanism of Digoxin?
Inhibits the Na/K ATPase, causing Increased intercellular Na, Depolarization. Pump usually sends out 3+ and brings in 2+
Increased Sodium in a cell will have what effect in a patient on Digoxin?
The Na will exit through the Na/Ca pump causing high levels of intracellular Calcium = Increased contractility.
Digoxin binds where?
to the K+ side of the Na/Kase pump. (outside the cell)
What are the effects of Digoxin?
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.
What are the drugs that affect the A-V node filtration? (slow A-V conduction)
beta blockers
whenever Serum Potassium goes down, what happens to Digoxin?
Toxicity goes up.
What drugs decrease mortality in CHF patients?
Beta Blockers
Spironolactone/Eplerenone (aldosterone antagonists)
Anti-Arrhythmic drugs are divided into what classes?
I. Na+ blockers
II. Beta Blockers
III. K+ channel blockers
IV. Ca++ channel blockers
(aditional non classified Digoxin, Aderosin)
Class I Anti-Arrhythmic drugs work where?
They decrease excitability and conduction velocity.
Class IV Anti-arrhythmic drugs act on what?
Act on the SA node and AV node. Slows (bradycardia) and decreases AV conduction.
Class III Anti-arrhythmic drugs do what?
Work by slowing the repolarization phase. Longer refractory period
Class II Anti-arrhythmic drugs do what?
Block N.E. in the heart decreases SA and AV node, sow conduction, decrease contractility.
Beta blocker names used for Arrhythmia?
Metoprolol, propranolol, atenolol
and Sotalol (both a Beta blocker and K+ blocker)
Calcium Channel Blockers for Arrhythmia?
Verapamil, Diltiazem, and Bepridil (Ca++ blocker and K+ blocker)
Potassium Channel Blockers for Arrhythmia?
Amiodarone (Most common anti-arrhythmic is a K+, Na+, Ca++, and Beta blocker, EFFECTS THYROID)
Ibutilide, Dibutilide. (sotolol, and Bepridil)
Sodium Channel Blockers for Arrhythmias?
Quinidine, Procainrmide, Disopyramide (these 3 are also K+ blockers)
Lidocaine only Sodium channel blocker.