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38 Cards in this Set
- Front
- Back
MOA of Diuretics
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ACUTE EFFECT:
Diuretics ↑ Na+ and Water Excretion by the kidney --> ↓BV & ↓CO --> ↓BP CHRONIC: CO returns to pretreament value, ↓PVR --> ↓BP** |
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Which diuretics ↓ serum K+ levels?
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Loop Diuretics and Thiazide Diuretics
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Spironolactone and Eplerenone are what types of drugs?
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Aldosterone Receptor Blockers (K+ Sparing Diuretics)
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Targets of: Thiazide, Loop and K+ Sparing Diuretics?
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Thiazide: DCT
Loop: Loop of Henle K+ Sparing: Collecting Duct |
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What is the first line tx for hypertension?
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Thiazide Diuretics
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MOA: NA+ Channel Blockers
(K+ Sparing Diuretics) |
Blocking Na+ Channels in Collecting Tubule stops the efflux of K+ into the lumen (Sparing K+)
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Which type of diuretic is Used for hypertension in patients who have reduced renal function, or for those with severe hypertension when drugs that retain Na+ are being used?
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Loop Diuretics
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"-olol" & NO BEAM
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Non-Selective, Competitve β Antagonists - Reversible
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"-olol" + BEAM
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Selective, Competitive
β1 Antagonists - Reversible |
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ACUTE AND POST MI (2 drugs)
Administer __ within the first 24 hours of an acute MI and continue indefinitely unless contraindicated. Reduces mortality post-MI. |
β Blocker or ACE INHIBITOR
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Rebound hypertension upon withdrawal of tx.?
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β Blockers and Clonidine
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MOA: β BLOCKERS
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Block β1's on the heart:
↓ heart rate ↓ contractility Block β1's in the CNS: ↓ sympathetic discharge =↓ blood pressure Block β1's on the kidney: ↓ renin ↓ ang II ↓ aldosterone = ↓ blood pressure |
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Which drug is bystolic? β1 selective at 10 mg or less
At >10 mg, or in those who are poor metabolizers, it becomes a non-selective β antagonist. Works by stimulating endothelial NO activity. |
Nebivolol
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MOA of Ca++ Channel Blockers ? **Non-DHP**
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BLOCK L-TYPE, VOLTAGE GATED CA2+ CHANNELS - important for contraction of both vascular smooth muscle and cardiac myocytes.
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MOA of Ca++ Channel Blockers? **DHP**
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Block L-type Ca2+ channels - important for contraction of just vascular smooth muscle.
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Does not cause reflex tachycardia - the affect on the heart BLUNTS the reflex tachycardia generated by the changes in the PVR.
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Verapimil (Ca++ Channel Blocker- Non-DHP)
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What are the two Non-DHP Ca++ Channel Blockers covered in class?
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Verapimil and Diltiazem
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Side effect: Constipation
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Particularly Verapimil
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Absolutely contraindicated in pt's with Heart Failure
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Ca++ Channel Blockers- Non-DHP
(Verapimil and Diltiazem) |
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These Ca++ Blockers particularly affect the heart and peripheral vasculature
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Ca++ Blockers- Non-DHP
(Verapimil and Diltiazem) |
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"-dipine"
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DHP Ca++ Channel Blockers
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What drug is somewhat selective for cerebral arterioles, making it useful for the treatment of SUBARACHNOID HEMORRHAGES?
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Nimodipine
(Ca++ Channel Blocker-DHP) |
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Which type of Ca++ Channel Blocker vasodilates ONLY peripheral vasculature?
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Ca++ Channel Blocker-DHP
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"-pril"
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ACE INHIBITORS
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MOA: ACE INHIBITORS?
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**Inhibits the production of Ang II**
**Inhibits the breakdown of bradykinin* Ang II vasocontricts and Bradykinin Vasodilates ↓ vasoconstrictor & ↑ vasodilator → dilation of arterioles → ↓ PVR |
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What drug class would you use for diabetic and non-diabetic nephropathy?
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ACE INHIBITORS --> Prevent renal damage
They decrease extracellular matrix accumulation, the generation of reactive oxidation species, TGF-β production, and the hypertrophy of mesangial cells |
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Contraindicated in those with previous history of angioedema.
Absolutely contra-indicated in those with bilateral renal artery stenosis or renal artery stenosis in a sole kidney. Absolutely contra-indicated in those who are pregnant or could become pregnant |
ACE INHIBITORS
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Explain why you should avoid ACE INHIBITORS in pt's with renal insufficiency
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ACE INHIBITORS ↓↓↓ GFR
Pt's with renal insufficiency already have ↓ GFR ---> need Ang II to balance GFR |
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Name an adverse effect of an ACE INHIBITOR causing ↑ bradykinin levels
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Angioedema/Cough
(Especially in Blacks) |
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Explain hyperkalemia with use of ACE INHIBITORS
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Patients w/ renal insufficiency taking K+ Sparing diuretics can have a large volume of serum K+ because:
ACE I's ↓ Aldosterone levels (Aldosterone ↓K+) |
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"-artan"
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Angiotensin II Receptor Blockers
(ARBs) |
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MOA: ARBs
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AT1 receptor antagonists
Blocks the effects of Ang II: -Smooth muscle contraction -Increased sympathetic activity -Aldosterone release DOES NOT AFFECT BRADYKININ |
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You are considering putting a pt. with hypertension on an ACE INHIBITOR until you realize they have ANGIOEDEMA. What should you use instead?
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Use an ARB
ARBs do not effect bradykinin (VD) levels so there will be no exacerbation of angioedema/cough |
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"-ren"
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Renin INHIBITOR
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Aliskren is what class of drug?
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Renin INHIBITOR
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MOA: Renin INHIBITOR
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Inhibits the production of Ang I from renin
Similar effects to ACE I's and ARBs NO EFFECT ON BRADYKININ |
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Would you use an ARB or Renin INHIBITOR on a pt. with bilateral renal artery stenosis and is pregnant?
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NO!
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MOA: Diuretics
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Diuretics Increase Na+ and Water Excretion which lowers BV, PVR and eventually BP
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