Reading...
Play button
Play button
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;
107 Cards in this Set
- Front
- Back
|
BP =
CO = |
CO x TPR
HR x SV |
|
|
What factors increase both SV and HR
|
Exercise and stimulation of SNS.
|
|
|
TPR is determined by _______ _____ of the _____.
|
Muscle tone, arterioles
|
|
|
Myocardial contractility and end diastolic volume determines ______.
|
Stroke volume (systolic volume)
|
|
|
Venous return is determined by
|
circulating volume & venous tone
|
|
|
Reduction in venous return to the heart , decrease in end diastolic pressures and volumes, SV & CO are all caused by _______ _____
|
venodilation.
|
|
|
Preload:
|
Preload: end diastolic volumes and pressures. which are strongly affected by venous tone. Venoconstriction inc. preload, while venodilation dec. preload
|
|
|
Circulating volume is regulated by...
|
water intake (thirst). fluid destribution (starling's law) and fluid elimination.
|
|
|
The _____ reflex rapidly modulates the activity of the sns and psns vervous system in response to changes in BP.
|
BARORECEPTORS.
|
|
|
Endogenous vasoconstrictors include
|
NE, EPI, AII, and endothelins.
|
|
|
NE act on alpha 1 receptors present on the _____ _____ of arterioles and venules to induce _____ and ____ constriction.
|
smooth muscle, arteriolar, veno.
|
|
|
alpha-1 rec. are coupled to _ proteins. that act. PLC, with the consequent inc. in the formation of IP3 AND ____.
|
G, DAG.
which will increase free calcium levels in the cytoplasm of muscle cells. Inc. in calcium binds to calmodulin which act. myosin light chain kinase. which phosphorylates myosin light chain leading to the coupling of actin and myosin. and consequent inc. in muscle contraction. |
|
|
AII is ___% more potent the NE as a vasoconstrictor.
|
40%
|
|
|
AII stimulation of AT1 arteriolar/venoconstriction increasing TPR and venous return; thus AII inc. both ____ and _____.
|
preload and afterload.
|
|
|
AT1 & AT2 are both __ ______ coupled receptor family.
|
G-protein.
|
|
|
L-arginine is used in the presence of endothelial NO synthase (eNOS) to make
|
NO
|
|
|
_______ is stimulated by the increases in intracellular calcium when it complexes with calmodulin inside the endothelial cells.
|
eNOS
|
|
|
Once __ is formed within endothelial cells, it it diffuses to the smooth muscles cells, where it activates the cytoplasmic guanylate (soluble) guanylate cyclase. Act. of this enzyme increases the intracellular levels of cyclic cGMP, which induces muscle relaxation and vasodilation, possibly be dec. free-cytoplasmic calcium.
|
NO
|
|
|
NO also acts as two other things..
|
NO inc. levels of cGMP w/in platels red. platelet adhesion and aggregation.
NO also present in peripheral and cns where it is syn by "nitridergic nerves" which play major role in penile erection. |
|
|
_________ destroys cGMP which red. the duration and magnitude of NO on it's effector organs.
|
phosphodiesterases.
|
|
|
Inhibition of type _ phosphodiesterase activiety with _____, potentiates the effect of NO by producing higher and more sustained levels of cGMP.
|
V(five), sildenafil
|
|
|
_____ improves endotoxic shock by inhibiting NO synthase by smooth muscle cells and macrophages.
|
Dexamethasone
|
|
|
_____ ________ can only be given IV, and acts to incr. intracellular cGMP in vascular smooth muscle cells and relaxes the smooth muscle.
|
sodium nitroprusside
when metabolized, turns into thiocyanate. |
|
|
endothelium indp. vasodilators that are NO donors del. NO to the tissues are..
|
organic nitrates (nitroglycerine, isosorbide dinitrate.
|
|
|
Prostalglandins not mediated by inc. prod. of NO are _____-______ mechanisms
|
endothelium independent ;
these agent act on adenylate cyclase and inc. intracell. conc. of cAMP. in the arteriolar smooth muscle. |
|
|
Left ventricular hypertrophy is an important risk factor for the development of ____ _______ and of sudden death.
|
fatal arrhythmia
|
|
|
classification for normal BP:
|
<120/<80 mmHg
|
|
|
classification for prehypertension:
|
120-139/80-89 mmHg
|
|
|
classification for hypertension:
|
stage 1: 140-159/90-99 mm HG
Stage 2: >160/100 mmHg |
|
|
T or F: does birth control cause drug induced hypertension?
|
True
|
|
|
Drug induced hypertension in men due to:
|
steroids, nicotine, and alcohol.
|
|
|
Drug induced hypertension
|
birth control pills: once stopped bp will dec.
steroids phenylephrine (alpha 1 agonist) nasal decongestand at high doses. psuedophed licorices alcohol, nicotine, salt |
|
|
renal disease, renovascular disease, drug-induced hypertension, pheochromocytoma and other endocrine trumors are the most common cause of ______ ________.
|
secondary hypertension
|
|
|
These 2 type of drugs should be the first line drugs for the treatment of uncomplicated essential hypertension.
|
Beta adrenergic and diuretics.
|
|
|
ACEI are the first line agents for..
|
type 1 diabetes and proteinuria, heart failure or MI with systolic dysfunction.
|
|
|
alpha-1 receptor antagonists,
beta receptor antagonists alpha-2 and imidazoline receptor agonists (centrally acting drugs) acting at sympathetic nerve terminals |
are drugs interfering with the SNS.
|
|
|
Drugs that inh. the RAAS.
|
beta rec. antag. and centrally acting SNS inh.
ACEI: enalapril Angiotensin rec. antagon. (ARB, AII-AT1); losartin aldosterone antagonist neutral endopeptidase inhibitors. |
|
|
K-channel activators
|
direct acting vasodilators
|
|
|
calcium channel blocker
|
one of the classification of antihypertensive drugs.
|
|
|
young caucasions respond better to these blockers for essential hypertension.
|
Beta blockers.
|
|
|
A high Na diet inh. the RAAS making the subject less sensitive to ACEI, ARB and beta-blockers and more sensitive to the K loosing effects of _____ diuretics.
|
thiazide
|
|
|
Antihypertensive drug regimen depends on the drug action which include..
|
dose, frequency of administration, class of drugs. the pathophysiology of the hypertension, but also onthe magn. of the compensatory adj.
|
|
|
T or F, elderly patient on antihypertensive drugs show smaller intensity of compensatory mechanisms.
|
true
|
|
|
T or F, patients who are volume depleted experience excessive BP drops with antihypertensives.
|
True
|
|
|
Prazosin, Doxazosin, and Terazosin are
|
selective alpha 1 antagonists.
|
|
|
Non-selective alpha antagonists include..
|
phentolamine and phenoxybenzamine.
|
|
|
yohimbine is a ...
|
selective alpha 2 antagonist
|
|
|
By reducing the effects of NE on arterioles and veins, the _____-1-_____ antagonists dilate both resistance and capacitance vessels, decreasing TPR, venous return and thus bp.
|
alpha-1-receptor
|
|
|
Most side effects of alpha-1 blockers are due to the act. of _____ ______ mechanisms triggered by drug-induced BP lowering. eg..palpitations, inc. in myocardial contractility and in CO.
|
reflex compensatory mechanisms
|
|
|
T/F
Fluid retention and weight gain may also be seen as side effects of alpha-1-blockers, due to reflex compensatory mech. |
True
|
|
|
T/F
Alpha-1-antagonists side effects also include nasal obstruction and difficulties in ejaculation. |
true
|
|
|
T/F
orthostatic hypertension due to alpha-1-blockers are more frequent in volume-depleted patients and in patients with poor compensatory mechanisms. |
true
|
|
|
T/F
because of their high incidence of side effects, alpha -1 antagonist are not first line agent to treat hypertension. |
true
|
|
|
a common indication for alpha -1 antagonist is hypertension associated with ....
|
benign prostatic hypertrophy.
|
|
|
The American College of Cardiology has recently recommended the disconinuing the use of this alpha-1 antagon for the treatment of hypertension.
|
doxazosin.
|
|
|
half life of:
Prazosin (alpha -1 antagonist) doxazosin terazosin: |
prazosin: 2-3 hr
doxazosin: 9-12 hr terazosin: 22hr |
|
|
T/F
Alpha-1-antag. causes arteriole vasodilation which increases blood flow of skeletal muscle, thus causing decrease in serum lipids including total, ldl, triglycerides and inc. insulin sensitivity. |
true
|
|
|
t/f
difference between hydralazine (vasodilator)and alpha1 blockers is that both dec. bp and aferload, but only alpha1 blocker dec. preload. |
true
|
|
|
alpha1 blockers are used for treatment of benign prostatic hyperptrophy.
|
improve hesitancy, intermittence, increase the strength and size of the stream, reduce terminal dribbling and daytime frequency and nocturia.
|
|
|
what alpha1 blocker is most uroselective?
|
tamsulosin;
tamsulosin and terazosin both have similar efficacy on trigone muscle bladder, but terazosin produces greater bp lowering than tamsulosin. |
|
|
t/f
prazosin, doxazosin and terazosin red. bp by dec. tpr (afterload) and by reducing preload (venous return). |
true
|
|
|
t/f
10-40% of cardiac beta-rec. are of beta-2 subtype. |
true
|
|
|
Beta blockers inh. renin release because they block beta1 rec. on the ....
|
juxtaglomerular apparatus.
|
|
|
Why aren't beta blockers used in the management of hypertensive crisis, emergencies and/ or urgencies?
|
beta blockers do not lower bp acutely.
|
|
|
celiprolol(isa), atenolol, bisoprolol, betaxolol, acebutolol(isa) and metoprolol
are ______ |
beta1 selective antagonists. but receptor sensitivity may be lost at high doses.
|
|
|
t/f
selective beta 2 antagonists have no appr. therapeutic appl. |
true
|
|
|
non-selective beta blockers:
would inhibit the chronotropic, inotropic, vasodilator, bronchodilator and uterine-relaxing responses to beta adrenergic stim. |
propranolol, naldolol, penbutolol, levobundolol, timolol, carteolol, carvedilol and labetalol.
|
|
|
name some non-selective beta blockers with isa
|
pindolol and penbutolol
|
|
|
name some beta1 selective blockers with isa.
|
acebutolol and celiprolol
|
|
|
beta blockers with isa such as pindolo, penbutolol, acebutolol, celiprolol reduce tpr due to..
|
mild stimulation of the heart (under resting conditions)and vasodilating actions. and produce a lesser red. in CO than the non-isa beta blockers.
|
|
|
Drug such as labetalol and carvedilol have
|
combined beta and alpha blocking act. that reduces both CO and tpr.
|
|
|
beta blockers are less effective in these populations. Because they have lower levels of renin.
|
elderlies and african americans.
|
|
|
t/f?
beta blockers combined with diuretics increases the antihypertensive effects because they act through different mechanisms. |
true:
beta blockers enhance the effects of the diuretic by opposing to the reflex mechanisms triggered by the diuretic. |
|
|
The reduction in cardiac work and in myocardial o2 req. prod. by the beta blockers account for their use as first-line drugs in the treatment of ..
|
effort-induced angina pectors, and for the secondary prevention of MI. beta blockers reduce exercise tolerance and performance.
|
|
|
t/f?
beta blockers should be avoided in patients with poor peripheral circulation. |
true:
mechanism is inhibition of vasodilatory beta-receptors and unopposed alpha receptors. Cold extremities and numbness often develop during treatment. |
|
|
t/f?
drugs with vasodilating action on peripheral vessels like calcium channel blockers are the drugs of choice for patients with peripheral vascular disease. |
true
|
|
|
Acebutolol ISA, is preffered for COPD if beta blockers are to be used because.
|
has beta-1 antagonist with beta -2 agonistic act.
|
|
|
Beta blockers may obscure premonitory signs and symptoms of acute hypoglycemia, which are
|
tachycardia, palpitations, tremor, hunger, but not sweating.
|
|
|
beta blockers may potentiate ____ induced hypoglycemia.
|
insulin
|
|
|
t/f?
drugs with vasodilatory activity dont change or improve insulin resistance. |
true
|
|
|
non-selctive beta blocker agents inhibit _____ induced hypokalemia. thus are effective in preventing arrhythmia associated with epi surges due to stress, hypoglycemia, and hypoxia.
|
epinephrine
|
|
|
abrupt withdrawal of beta blockers may induce
|
angina, mi, or even sudden death in patient with ischemic heart disease.
|
|
|
ISA beta blockers may produce ____ in some pateints due to stimulation of bet-2 receptors in the skeletal muscle, increaseing the discharge rate of the muscle spindles.
|
tremors.
|
|
|
lipid soluble beta blockers..
vivid dreams.. |
propranolol >metoprolol = timolol > acebutolol =pindolol >> nadolol > atenolol
|
|
|
t/f?
fat soluble beta blockers like propranolol, penbutolol, metoprolol and acebutolol suffer extensive first pass metabolism. |
true
|
|
|
t/f?
only non-isa beta-blockers have a labeled indication in MI |
true
|
|
|
prophylaxis use of propranolol bas been used for ...
|
common migraine headache.
|
|
|
t/f?
propranolol is effective in familial or essential tremor. it red. the amplitude, but not he tremor freq. |
true
|
|
|
Propranol also reduces the tachycardia, the tremor, the inc. myocardial O2 consumption and peripheral conversion of
|
T4 to t3, in hyperthyrodiism.
|
|
|
To avoid withdrawal syndrome of rebound hypertension, it is recommened that
|
gradual therapy discontinuation of centrally acting antihypertensive is implemented.
|
|
|
TCA may block the BP lowering effects of this drug
|
clonidine
|
|
|
In addition to its centrally acting characteristics, what else is clonidine used for?
|
management of opiate detoxification, alcohol and cigarette withdrawal, for menopausal hot flashes, ulcerative colitis and for spasticity of the skeletal muscle present in multiple sclerosis and following spinal cord trauma.
|
|
|
Tizanidine, an alpha-2 agonist is used for:
|
intermittent management of inc. muscle tone associated with spasticity. reduces muscle tone w/out affect muscle strength.
through inh. of ach release... |
|
|
this alpha-2 adr. agonist is approved for the chronic treatment of open angle glaucoma and ocular hypertension. It reduces production and inc. outflow of the aqueous humor. Outflow is inc. through the tubulo-scleral pathway.
|
brimonidine
|
|
|
hemolytic anemia, liver (cholestatic hepatitis) and hematological disorders may occur with this drug including it's cns side effects.
|
alpha-methyldopa.
|
|
|
Dopamine al low doses will ...
|
lower diastolic bp and inc. renal perfusion. by act. of dopamine 1 receptors.
|
|
|
Fenoldopam is used as a ____ 1-receptor agonist approved for clinical use with similar affects as dopamine.
|
dopamine-1 receptor agonist.
given parenterally, it dilates arterioles lower tpr, and act as a diuretic due to it's effects on increasing renal blood flow. |
|
|
thiazides act on what portion of the loop of henle?
|
thick ascending limb to inh. reab. of NaCl.
|
|
|
What are the duration of action for the 2 commonly most used thiazides?
|
HCTZ: 16hrs.
chlorthalidone: 24hrs. both taken orally. |
|
|
loop diuretics like furosemide, bumetanide, torsemide, piritanide and ethacrinic acid reduce NaCl reab. in the thick ascending limb by inh. the __-__-__ symport.
|
na-K-2Cl symport.
|
|
|
When is loop diuretics preferred over the common thiazides.
|
when there is edematous condition involved or when renal dysfunction is present.
|
|
|
t/f?
thiazides and loop diuretics given together may induce synergistic effect inducing a large diuresis. |
true
|
|
|
Triamterene and amiloride are K sparing diuretics that work through what mechanism?
|
inhibitors of the renal epithelial Na channels present in the luminal mem. of principal cells in the late distal tubule and collecting ducts.
|
|
|
Spironolactone a K-sparing diuretic act through what mechanism?
|
aldosterone antagonists. by red. aldosterone-mediated inc. synthesis, distribution and activation of na channels and of memb. bound na-k atpase.
|
|
|
K-sparing diuretic are weak in general, but when given the correct dose, will spironolactone have similar effects as thiazides?
|
yes.
|
|
|
t/f?
spironolactone use may casue gynecomastia. |
true
|
|
|
A new selctive aldosterone rec. antag. similar to spironolactone but not the endocrine sede effects ass. with spironolactone treatment.
|
eplerenone.
|
