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42 Cards in this Set
- Front
- Back
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beta blocker effects on body
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decrease HR and inotropy
decrease renin decrease PVR via CNS All lead to decrease PVR |
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ISA
what is it? when used? when NOT used? |
intrinsic sympathomimetic activity
some BBs at high concentrations will activate B1 receptos while blocking them also. useful in ppl exhibiting excessive bradycardia with sustained BB treatment NOT used in Post MI |
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What drug used acute and post MI
what does it do? |
BBs, recommended in all patients if tolerated, continue indefinitely
reduces chance to go into arrythmia, reduces M&M |
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major side effects of BBs
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bradycardia, during exercise no rise in HR
av conduction abnormatities - AV blocks bronchospasms nightmares, depression sexual dysfunction increase TGs and decrease HDL GLUCOSE intoelrance Unopposed vasoconstriction in ppl w/ peripheral vascular disease |
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what other conditions to watch for when giving BBs
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asthma, copd, diabetes, peripheral vasc. disease, bradycardia, AB block
hyperlipidemic stable angina |
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CCBs, how do we know them
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non dhps - verapamil, diltiezem
dhps - -idipines |
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how do CCBs work
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block calcium channels on vacular smooth muscle, relax, decrease PVR
Non DHPs on heart, show down and make less contractile |
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which CCB is selective for cerebral arteries, good for what condition
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nimodipine
subarachnoid hemorrhage |
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side effects of CCBs
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sinus bradycardia
av block !!!!exacerbation of heart failure or pulmonary edema!!!! **CONSTIPATION** and those related to vasodilation |
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what to give to treat peripheral edema caused by CCBs
WHY? |
ace inhibitors
CCBs preferentially dilate arterioles and veins stay constricted |
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what does ang II affect
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constrict arterioles > venules , but both
facilitate SNS activity constrict efferent renal arteriole releases aldosterone _> Na H20 retention Stimulate thirst |
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other effects of Ang II
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Stime thirst
stimulates vasopressin release hypertrophy/hyperplasia of vasc SMC, mesengial cells, cardiac myocytes myocyte apoptosis inflamm mediator help regulate GFR |
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Uses for Ace Inh
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acute and post MI, give within 24 hrs of MI
Diabetic and non diabetic nephropathy - to decrease pressure on glomerulus |
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major S.E. of Ace Inh.
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Possible renal insufficiency
hypotension hyperkalemia Heme effects - neutropenia, agranulocytosis CAPTOPRIL - loss of taste, metal taste skin rash ANGIOEDEMA/COUGH - swith to arbs |
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MOA for ace inhibitors, what do they also block
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blocks formation of ANG II and also blocks the degradation of bradykinin so we get its vasodilitory effects
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ABSOLUTE CONTRAINDICATIONS FOR ACE INHIBITORS
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stenosis of renal arteries, or one side
PREGNANCY |
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what to be careful of when iving Ace Ings to a person with diabetic kidney disease
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hyperkalemia - from the decrease in aldosterone
increase in serum creatinine - B/c we are decreaseing hydrostatic pressure in glom. |
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Why use arbs
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if ppl cannot tolerate the effects of ace inhibitos, angio edema
because we still allow bradykinin to break down |
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why use aliskiren
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to inhibit renin, same as arbs.
can be monotherapy |
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where do alpha blockers work
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on veins and arteries!!
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acute effects of Alpha blockers
2 reflexes! then what? |
decrease PVR
but reflex tachycardia reflex renin release chronic use - CO and plasma renin return to normal and vasodilation stays |
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what line drug is alpha blocker
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2nd
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side effects from alpha blockers
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orthostatic hypotension - FIRST DOSE EFFECT
reflex tach edema b/c of reflex renin release |
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what do we use to counter act one of the major side effects of alpha blockers
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edema - use diuretics, from reflex renin
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how does labetalol work
what is it used for |
alpha and beta blocker
blocks A1 on vessels blocks B1 on heart ++ B2 on vessels (less effect) But little effect on Heart also USED FOR HYPERTENSIVE URGENCIES |
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what are the centrally acting Alpha 2 agonists
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clonidine
methyldopa |
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side effects: dry mouth
what other side effects what can we use for one of these side effects |
clonidine
depression, sedation, impotence, NA/H20 retention (compensetory use diuretic with clonidine) |
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problem with clonidine
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Rebound HTN !!!!!
nervousness, tachycardia, headache |
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Side effects:
positive coombs test |
methyldopa
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side effect of HTN drug:
hepatotoxicity |
methyldopa
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name all the direct vasodilators that we should use for HTN
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hydralazine
minoxidil fenoldapam nitroprusside |
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MOA of minoxidil
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activates the K+ channels on areriolar vascular SMCells
hyperpolarize relaxation decrease PVR |
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problem with minoxidil
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REFLEXES
decrease in PVR causes increase renin, Na/H2O retention leads to increase CO also causes a reflex SNS response --> tachy --> up CO and SNS and ANGII constrict vessels --> up BP |
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what do we use with minoxidil
why? |
BB to block HR, SNS effects and maybe even Ang II
and use diuretic to treat the water retention |
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side effect of a HTN drug: lupus like rash
what drug and what other SE |
hydralazine
execessive vasodilation tachycardia can lead to angina |
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side effect: hypertrichosis
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minoxidil
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MOA: activate D1 receptors
where does it work? when used? |
fenoldapam
vasodilates arteries and renal arteries used in HTN emergency - only IV |
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MOA of nitroprusside
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increase NO --> increase cGMP --> vasodilate arteries and veins
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what drugs dilate veins and arteries
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ace inhibitors, nitroprusside, alpha blockers
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side effect of nitroprusside
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cyanide toxicity
hypotension |
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Drugs to use for HTn urgency
ACEI? alpha2 agonist? Alpha and beta blocker? CCB? why possible baD? |
captopril?
clonidine labetalol nifedipine |
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drugs for HTN emergency
CCB? ACEI? Alpha blocker? BB? alpha and beta blocker? direct Vasodilators? |
CCB - nicardipine and clevidipine
ACEI - enalaprilat ABlock - phentolamine BB- esmolol, propanolol A&B block - labetaolo DVD - hydralazine, minoxidil, sodium nitroprusside |
