• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/173

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

173 Cards in this Set

  • Front
  • Back
What is the formula for blood pressure?
BP = CO X SVR
what is another name for SVR?
total peripheral resistance.
When epinephrine and norepinephrine act as pressors, what are they binding to?
alpha 1 receptors
what effect does bradykinin have on the vasculature?
Vasodilatory
what effect does angiotensin II have on the vasculature?
it is the most potent vasoconstrictor or in the body
what effect does nitrous oxide have on the vasculature?
it's vasodilators. It acts locally.
What effect does prostacyclin have on the vasculature?
it is a vasodilator.
What effects does thromboxane have on the vasculature?
it is a vasoconstrictor.
What are the four areas of target for antihypertensive drugs?
area I: sympathetic nervous system,

area II: renin angiotensin aldosterone system,

area III: plasma volume, area

IV ( “other”)
where is B 1 receptor located?
in the heart.
Where is A 1 receptor located?
in the periphery (constriction.)
How important is volume in managing blood pressure?
it is huge. Diuretics decrease volume.
How are normal blood pressure parameters affected with diabetics and patients with chronic kidney disease?
less than 130 systolic is considered low in this population
why is blood pressure so hard to control in the United States?
concordance, kidney disease, diabetes, and clinicians not treating hypertension aggressively enough
how many Americans have hypertension?
one fourth the population (75 million.).
Of the 75 million Americans with hypertension, what percentage of them are controlled?
only 30%.
Of the 75 million Americans with hypertension, what fraction will need two or more drugs to control their blood pressure?
2/3
which is better, using multiple drugs at low doses, or one drug at high doses?
multiple drugs at low doses. You avoid the plateau effect that occurs with only one drug.
Which groups of drugs work on area I (sympathetic nervous system?)
sympatholytics:A-2 agonists, A-1 blockers, beta-blockers, other metabolic inhibitors.
Which groups of drugs work on area II (renin angiotensin aldosterone system?)
Ace inhibitors, angiotensin blockers, renin inhibitors.
Which groups of drugs work on area III (plasma volume?)
diuretics.
Which groups of drugs work on area IV (other?)
direct acting vasodilators, calcium channel blockers.
Where are alpha 2 receptors located?
in central nervous system.
What drug classes are considered sympatholytics?
alpha 1 antagonists, alpha-2 agonists, Beta 1 and Beta 2 blockers, and metabolic inhibitors (methyldopa,resperine and guanadrel.).
For high blood pressure, which drugs could be used in pregnancy?
methyldopa. It is a metabolic inhibitor. Beta-blockers are also safe.
How does resperine work?
it's depletes of the central nervous system of neurotransmitters. It is not well tolerated.
For blood pressure, what are the most important targets pharmacologically?
alpha receptors, beta receptors.
What is essential hypertension?
hypertension in which no specific medical cause can be found to explain it.
What is secondary hypertension?
hypertension that was caused by another condition, like kidney disease or adrenal tumors.
What percentage of high blood pressure sufferers have essential hypertension?
90%. It is inevitable with the aging process.
If hypertension is left untreated, what will happen?
stroke, MI, CHF
what will an alpha blocker do to the prostate and urine flow?
it's will relax smooth muscle and improve flow.
Do we have blood pressure drugs for Beta 2?
no.
From where does the hypothalamic autonomic center received information from in the body?
carotid sinus, arterial Baroreceptors in the aorta, cardiac baroreceptors.
Describe the route of the Vegas nerve:
from hypothalamus to the sinus node of the heart.
Describe the route of sympathetic outflow:
from the hypothalamus, and down the brainstem, to alpha-2 receptors in the central nervous system, to either beta-1 receptors in the heart, or to alpha-1 receptors in the arterioles. See picture one.
What 3 things happen when an alpha-1 receptor is stimulated?
vasoconstriction with reflex bradycardia,

bladder sphincter contraction,

reduced lipolysis (reduced breakdown of cholesterol,

(note, an alpha-1 blocker could help by increased lipolysis.)
What happens (synaptically and effect-wise) when you stimulate an alpha-2 receptor?
decreased presynaptic norepinephrine release (reduced sympathetic outflow.)

lower blood pressure
What's does an alpha agonist do to the prostate?
constricts it.
What does an alpha blocker do to the prostate?
loosens its up, relaxes smooth muscle sphincter
which receptor is Flomax specific for?
alpha 1 a. It is an alpha-1a blocker
Will Flomax decrease blood pressure?
no. It is specific for alpha-1a. There is no systemic alpha blocking.
How does Cardura differ from Flomax?
it is nonspecific. Its blocks alpha receptors throughout the body, not just alpha 1-a.
Which has more efficacy for bladder relief, Flomax or Cardura?
they both have the same. All alpha blockers have the same efficacy for bladder relief.
Which alpha blockers do we need to know?
Flomax, Hytrin, uroxatrol. They are considered sympatholytics
what is Hytrin?
it is an alpha one blocker. Generic name is Terazosin.
Describe orthostatic hypotension with alpha one blockers:
usually occurs with first dose. If you decrease SVR, you will have orthostasis. Patients need to know to be careful when first starting.
What is clonidine?
it is an alpha--2 agonist. Trade name is Catapres.
Name 5 adverse effects of clonidine:
sedation, dry mouth (25 to 50%), sexual dysfunction, dizziness, rebound hypertension and withdrawal syndrome with abrupt discontinuation.
What 2 kinds of beta-blockers are there?
selective and nonselective.
What do nonselective beta-blockers do?
they block both Beta-1 and Beta-2 receptors.
Give two examples of nonselective beta-blockers, one systemic and one topical:
propanolol (Inderal) and timolol
which beta-blockers are newer, selective or nonselective?
selective.
How do selective beta-blockers work?
they preferentially block beta-1 receptors.
Regarding selectivity with beta-blockers, what happens when you give really high doses?
you overcome selectivity, just like with any selective inhibition. Any time there is selective inhibition there is potential to overcome selectivity.
name 4 things that happen when you stimulate beta-1:
increased heart rate,

increased contractility,

increased renin secretion,

increased lipolysis.
name 5 things that happen when beta-2 is stimulated:
smooth muscle relaxation (bronchioles).

Peripheral vasoconstriction,

skeletal muscle stimulation (tremors),

glycogenolysis

gluconeogenesis.
What 3 selective beta-blockers do we need to know?
metoprolol tartrate, metoprolol succinate (X. L.) and atenolol
name 6 potential adverse effects of beta-blockers:
bronchospasm

hypoglycemia

bradycardia

increased triglycerides, decreased HDL,

fatigue/depression, sexual dysfunction.
Re: bronchospasm and beta-blockers, which receptor was blocked?
beta-2, propanolol.
Re: hypoglycemia and beta-blockers, which receptor was blocked?
beta-2, propanolol.
Re: triglycerides affects, which receptor was blocked?
either beta-1 or beta-2.
Re: fatigue/depression, which beta receptor was blocked?
either beta-1 or beta-2
Re: sexual dysfunction, which beta receptor was blocked?
either beta-1 or beta-2.
Of the sympatholytics, what safety mechcanism do mixed alpha and beta blockers?
they have a built-in mechanism to combat reflex tachycardia. They are safe to use in pregnancy.
Name 2 mixed alpha/beta-blockers:
labetalol and carvedalol.
What are the trade names for labetalol?
Normodyne, trandate
what are the trade names for carvedalol?
coreg, coreg cr
what does labetalol block?
alpha-1 plus Beta 1 and Beta 2
what drug does carvedalol resemble?
labetalol. It is a mixed alpha 1/Beta 1 and Beta 2 blocker. Only it is in pill form.
What type of patient would we give carvedilol to?
heart failure, once a stable.
Does to digoxin improve mortality in cardiac patients?
no. The dig trial showed it does not hurt or help.
give one example of “other” sympatholytics that can be used in pregnancy:
methyldopa (aldomet.).
How does methyldopa work?
it works like clonidine. It is converted to alpha methylnorepinephrine and stored in adrenergic neuron vesicles. It replaces norepinephrine. But it is still a vasoconstrictor. It's probably acts as an alpha-2 receptor agonist.
What is the net effect of secretion of renin?
vasoconstriction (direct and indirect), and increased plasma volume (indirect.).
What types of things stimulate renin?
upright position, hypotension, low salt diet, hemorrhage, dehydration.
What drugs modify renin?
beta-blockers (suppress renin production), Ace inhibitors, angiotensin receptor blockers (ARBs) and renin blockers.
What do you want to do with renin in hypertension?
you want to inhibit it
What happens to angiotensin I in the lungs?
the majority of it gets converted to type II (see picture 2).
Where does angiotensin converting enzyme hangout?
in the lungs (see picture two.).
What effect does angiotensin II have on the vasculature?
it is a potent vasoconstrictor.
What is the most important product of renin?
angiotensin II, with its powerful vasoconstrictor properties.
What will happen to potassium level of renally insufficient patients on Ace inhibitors?
it's will go up.
What stimulates renin in the body?
decreased volume status, among other things.
What effect does an Ace inhibitor have on patients with renal stenosis?
normally, angiotensin II constricts the efferent tubule. If it is blocked by an ace inhibitor, you will have acute renal failure.
What effect does angiotensin II have on the adrenal gland?
it promotes aldosterone, promotes sodium, water retention (via reabsorption in the distal tubule).
What two lab tests, should we monitor for patients on Ace inhibitors?
K, serum creatinine.
What lab test is a marker for how well the kidneys are doing?
serum creatinine.
What is an example of an angiotensin receptor blocker:
Cozaar or diovan (sound like sartan.).
What do Ace inhibitors due to bradykinin?
they cause it to build up (See picture two.)
What are 2 effects of giving an ace inhibitor?
vasoconstriction decreased

less aldosterone released.
How are Ace inhibitors rated for treating high blood pressure?
they are among the best.
Wname 8 adverse affects of Ace inhibitors?
headache, dizziness, acute renal failure with renal artery stenosis, hyperkalemia (more likely if risk factors present), cough, rash, angioedema, bone marrow suppression (rare).
Which ace inhibitor is more likely to cause angioedema?
captopril. It can occur early or years later.
What's pregnancy category are Ace inhibitors?
X..
What's two types of CHF problems are there?
filling problems and pumping problems
Briefly describe systolic dysfunction:
enlarged ventricles fill with blood, the ventricles pump out less than 40 to 50% of the blood.
Describe diastolic dysfunction:
stiff ventricles fill with less blood than normal. Volume is so low. The ventricles pump out about 60% of the blood, but the amount may be lower than normal
talk about Ace inhibitors and remodeling.

Which type of CHF are we talking about?
there is a question of whether or not they slow remodeling in systolic dysfunction.
What percentage of patients suffer cough from Ace inhibitors?
five to 10%.
Why do patients develop cough with Ace inhibitors?
angiotensin converting enzyme normally stimulates the breakdown of bradykinin's. With Ace inhibitors, bradykinin's accumulate locally in the lungs. This causes the cough. Time to switch the patient to an ARB.
How do Ace inhibitors affect heart failure?
there are proven benefits with the left ventricular systolic dysfunction.
How can Ace inhibitors affect patients with diabetes?
they reduce proteinuria and delay/prevent diabetic neuropathy.
What did the medical community think about beta-blockers years ago?
Beta-blockers were contraindicated. But then studies showed increased survival with beta-blockers. If you decrease with the workload of the heart, you help its to be more efficiently.
How do angiotensin receptor blockers work?
they specifically block receptors for angiotensin II
what are the net effects of using an angiotensin receptor blocker?
vasoconstriction is decreased, less aldosterone is released.
What is the question about angiotensin receptor blockers?
are they really different from Ace inhibitors?
What's to angiotensin receptor blockers do we need to know?
Cozaar (Losartan) and Diovan (Valsartan.).
What are some adverse effects of angiotensin receptor blockers?
similar to Ace inhibitors, but no cough. Headache, dizziness, hypotension, hyperkalemia, acute renal failure in renal artery stenosis or volume depletion, rash, angioedema (less than with Ace) and bone marrow suppression (rare).
What's pregnancy category are angiotensin receptor blockers?
X..
How do renin inhibitors work?
they suppress release of renin. They were just approved this year. It has been known that we can block a renin, but it took 20 years to develop a drug that can be absorbed. Its goal is unclear.
What are the adverse effects of renin inhibitors?
same as with angiotensin receptor blockers.
What's three types of diuretics do we need to know about?
loop diuretics, thiazide diuretics and potassium sparing diuretics. These are the ones that are used for high blood pressure.
What is the mechanism of loop diuretics?
they mostly inhibit sodium and chloride reabsorption, mostly in the loop of Henle
name two loop diuretics:
Lasix and bumex
what do all loop diuretics have in common?
they are all sulfonamides. If you have an allergy to sulfa, you may have an allergy to all loop diuretics.
What are some adverse effects of loop diuretics?
hypotension,

dehydration,

low potassium,

ototoxicity,

hyperuricemia (high uric acid levels),

hyperglycemia (will worsen for glucose control), and

hypochloremic (contraction) alkalosis secondary to loss of chloride ions.
What is the mechanism of thiazide diuretics?
they inhibit sodium and chloride reabsorption, mostly in the distal tubule.
Give one example of a thiazide diuretics:
hydrochlorothiazide.
What is the typical dose for hydrochlorothiazide?
12.5 to 50 mg once daily. This is to treat uncomplicated hypertension.
What is the effect of hydrochlorothiazide, as you go up in doses?
the effect is almost linear, but after 25 mg it plateaus. At that point, you need to add another.
What's to thiazide diuretics have in common with loop diuretics, in terms of composition?
they are both sulfonamide containing drugs.
What are some side effects of thiazide diuretics?
like loop diuretics, hypotension, hyperuricemia and hypokalemia. Hyperglycemia, hypercalcemia
how to thiazide diuretics help elderly people with osteoporosis?
they help promote calcium reabsorption
what is the mechanism of potassium sparing diuretics?
they block reabsorption of sodium in the distal tubule and collecting duct.
How potent is the diuresis with potassium sparing diuretics?
only mild
which potassium sparing diuretics do we need to know?
spironolactone (Aldactone). Aldactone has additional benefits for CHF.
What is the additional mechanism of Aldactone?
it's also involves antagonism of aldosterone activity in the collecting duct.
What is a typical dose for Aldactone?
25 to 100 mg once daily.
What are 3 adverse effects of Aldactone?
Acne, hirsutism, ,gynecomastia
what is the mechanism of direct vasodilators?
they work directly on the vasculature. They relaxes smooth muscle cells that surround blood vessels.
Name some direct vasodilators:
hydralazine, minoxidil, nitroprusside.
Which direct vasodilators are pure, arterial dialators?
hydralazine and minoxidil. A common side effect with these is a reflex tachycardia.
What is the effect of nitroprusside in the vasculature?
widespread violation of both arteries and veins.
What is the toxic caution with nitroprusside?
caution in use greater than 24 hours. There is a cyanide metabolite.
In what type of patients would we use hydralazine or minoxidil?
refractory hypertension.
What are some adverse affects of hydralazine and minoxidil?
headache, dizziness, hypotension, reflex tachycardia, fluid retention, lupus like syndrome with hydralazine, and hirsutism/hypertrichosis with minoxidil.
Do hydralazine and minoxidil cause postural hypotension?
less so than non-specific vasodilators.
Describe coronary steel would use of arterial vasodilators like hydralazine and minoxidil:
coronary blood flow shunts it away from the stenosed area, for example, from the right heart to the left heart.
With nitroprusside, what can happen if we ignored the accumulation of cyanide?
toxicity leading to lactic acidosis. This is often related to dose/rate of infusion
what three types of calcium channel blockers are there?
dihydropyridine, benzothiapine and phenylalkylamine.
name 3 drugs that fall into the dihydropyridine category?
nifedipine, Norvasc, felodipine (plendil).
Which drug falls into the benzothiapine category?
diltiazem.
Which drug falls into the phenylalkylamine?
verapamil.
What is the mechanism of calcium channel blockers?
blockade of calcium entry into myocytes and other vascular cells. They alter cardiac and smooth muscle contraction.
What are the net effects of giving a calcium channel blocker?
arterial smooth muscle relaxation and reduced heart rate and contractility
in regard to vasodilation, suppression of contractility and suppression of SA/AV node, where do dihydropyridines fall?
extremely strong vasodilation, minimal suppression of contractility, no suppression of SA/AV nodes. An example would be Norvasc
In regard to vasodilation, suppression of contractility and suppression of SA/AV node, we are do benzothiapines fall?
some vasodilation, some suppression of contractility, more suppression of SA/AV node. An example would be diltiazem.
In regard to vasodilation, suppression of contractility and suppression of SA/AV node, where do phenlalkylamines fall?
some vasodilation, moderate suppression of contractility, large suppression of SA/AV node.
Is Norvasc, D., B., or P.?
dihydropyridine.
Is diltiazem, D., B., or P.?
B
It's verapamil D., B., or P.?
phenylalkylamine
which two types of calcium channel blockers are best for controlling heart rate?
b , andphenylalkylamines (diltiazem, verapamil). They also cause the most constipation and bradycardia.
name 5 adverse affects of calcium channel blockers:
dizziness

headache

hypotension,

bradycardia heart block,

Drug interactions
Explain the benefit of calcium channel blocker hyperplasia?
they can be used to help skin wounds heal.
Recap: which types of drugs fall under area I?
sympatholytics. Alpha-2 agonists, alpha-1 blockers, beta-blockers, other metabolic inhibitors.
Recap: which types of drugs fall under area II?
Ace inhibitors, angiotensin blockers, renin inhibitors
recap: which types of drugs fall under area III?
diuretics.
Recap: which types of drugs fall under area "other?"
direct acting vasodilators, calcium channel blockers.
True or false: a drug that lowers blood pressure will reduce overall cardiac related morbidity and/or mortality
false.
Before an antihypertensive medication can be approved by the FDA is typically needs to: 1. show that it significantly reduces blood pressure when compared to a placebo, 2. Show that it reduces morbidity and mortality, 3. Both one and two
1: the company only needs to show that it significantly reduces blood pressure when compared to a placebo.
What is ALLHAT?
antihypertensive and lipid lowering therapy to prevent heart attack trial. Patients were randomized to one up for medications: a thiazide, an alpha blocker, a calcium channel blocker (Norvasc type), and an ace inhibitor. Patients were greater than 55 years old, had hypertension, and at least one cardiac risk factor. It was a longitudinal study carried out over eight years.
What did the ALLHAT study show?
they recommended stopping doxazosin six years into the study. Doxazosin group had significantly higher risk of heart failure and combined risk of cardiovascular events. This means that Doxazosin was not as protective
according to JNC 7 blood pressure classification, what is considered normal for systolic and diastolic?
systolic less than 120, diastolic less than 80
according to JNC 7 blood pressure classification, what is considered pre-hypertension?
systolic 120 to 139, diastolic 80 to 89.
According to JNC 7 blood pressure classification what is stage I hypertension?
systolic 140 to 159,

diastolic 90 to 99.
What are the JNC 7 blood pressure goals?
keep blood pressure less than 140/90 for most adults. Keep diabetic or chronic kidney patients less than 130/80.
name 9 JNC 7 cardiovascular risk factors?
hypertension,
smoking,
obesity (BMI 30 or higher), physical inactivity, diabetes,
dyslipidemia, microalbuminemia or estimated GFR less than 60, men older than 55, women older than 65,

family history <55 years old. In men, and <65 years old in women.
Case study: 35-year-old male with history of type 1 diabetes complicated by renal insufficiency (SCR 2.1) and proteinurea. Blood pressure is normal. Should he be on a blood pressure lowering medication?
yes. He should have an ace inhibitor or an angiotensin receptor blocker. Due to the fact that he has protein urea. These patients should get an ace, whether their blood pressure is normal or not, and to protect the kidneys. An ace will slow down the progression of his kidney disease.
Case study: 58-year-old man with history of hypertension, mi 6 months ago, hyperlipidemia, and asthma. He does not smoke. He drinks an occasional glass of wine. His father died of an M. I., in his 40s. Mother is 89 years old, alive and well. Blood pressure is currently controlled with Norvasc 10 mg once daily. What can we say about this man?
he is very high risk. He should be on a beta-blocker. Lopressor would be best because it is selective. Coreg would not be best in this case because it is mixed alpha/beta.
Where, in the nephron, do osmotic diuretics work? (See picture three)
they work in the first part of the tubule right after the glomerulus. They are most potent.
Where, in the nephron, do loop diuretics work? (See picture three)
at the loop of Henley. Not common for blood pressure control.
Where, in the nephron, does hydrochlorothiazide work (see picture three)?
and in the distal tubule. Most common for blood pressure control. They only need to inhibit 10% of sodium reabsorption. If you block sodium reabsorption, you block water reabsorption.