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88 Cards in this Set
- Front
- Back
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WHAT EFFECT DO ACE INHIBITORS HAVE ON HTN?
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LOWER BLOOD PRESSURE BY REDUCING PERIPHERAL VASCULAR RESISTANCE (WITHOUT INCREASING CARDIAC OUTPUT, RATE, OR CONTRACTILITY
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THESE DRUGS INHIBIT THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM AT THE ANGIOTENSIN I TO ANGIOTENSIN II STEP
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ACE INHIBITORS
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WHAT ENZYME CONVERTS ANGIOTENSIN I TO ANGIOTENSIN II?
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RENIN
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HOW IS RENIN RELEASED?
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RENIN IS RELEASED FROM THE KIDNEY WHEN RENAL BLOOD FLOW DECREASES
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THIS IS A POTENT VASOCONSTRICTOR IN THE RAAS SYSTEM
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ANGIOTENSION II
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WHAT DOES ACE STAND FOR?
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ANGIOTENSION CONVERTING ENZYME
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WHAT DOES ANGIOTENSIN II STIMULATE THE SECRETION OF?
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STIMULATES THE SECRETION OF ALDOSTERONE WHICH CAUSES SODIUM AND WATER RETENTION
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WHAT IS THE EFFECT OF ALDOSTERONE ON FLUID AND ELECTROLYTE BALANCE
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CAUSES US TO SAVE WATER AND SODIUM, AND TO DUMP POTASSIUM
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WHAT ELEMENT OF THE RAAS BREAKS DOWN BRADYKININ?
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ANGIOTENSIN II
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WHAT HAPPENS AS A RESULT OF THE ACTIVITIES OF ALDOSTERONE (IN REGARDS TO BLOOD PRESSURE)?
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THE BLOOD PRESSURE INCREASES BECAUSE THERE IS MORE BLOOD VOLUME
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IS BRADYKININ A VASODILATOR OR A VASOCONSTRICTOR?
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A VASODILATOR
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WHAT DO ANGIOTENSIN II RECEPTOR ANTAGONISTS DO TO THE LEVEL OF BRADYKININ?
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THERE IS NO EFFECT SO THERE IS NO COUGH AS A SIDE EFFECT
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WHAT ARE THE THREE GENERAL ACTIONS OF ACE INHIBITORS?
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VASODILATION OF VASCULAR SMOOTH MUSCLES, REDUCE RETENTION OF SODIUM AND WATER, REDUCE THE OUTPUT OF THE SYMPATHETIC NERVOUS SYSTEM
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HOW DO ACE INHIBITORS REDUCE RETENTION OF SODIUM AND WATER?
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THEY BLOCK THE CONVERSION OF ANGIOTENSIN I TO ANGIOTENSIN II, AND THUS BLOCK THE SECRETION OF ALDOSTERONE BY ANGIOTENSIN II. NORMALLY ALDOSTERONE SECRETION WOULD CAUSE WATER AND SODIUM RETENTION.
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WHAT IS THE SUFFIX FOR ACE INHIBITORS?
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THEY END IN PRIL
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WE WOULD CONSIDER ACE INHIBITORS IN PATIENTS WITH WHAT DISEASES?
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HEART FAILURE, POST MI WITH SYSTOLIC DYSFUNCTION, DM WITH PROTEINURIA, RENAL INSUFFICIENCY
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WHY DO WE USE CAUTION IN USING ACE INHIBITORS IN PATIENTS WITH RENAL ARTERY STENOSIS?
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A HIGH ANGIOTENSIN II CONCENTRATION IS NEEDED TO MAINTAIN RENAL BLOOD FLOW (ACE INHIBITORS BLOCK THE CONVERSION OF ANGIOTENSIN I TO ANGIOTENSIN II)
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MOST COMMON ADVERSE REACTION TO ACE INHIBITORS
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COUGH (SECONDARY TO INCREASE IN BRADYKININ)
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ADVERSE SIDE EFFECTS OF ACE INHIBITORS
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COUGH; TASTE DISTURBANCES; HYPOTENSION, ANGIOEDEMA, INCREASED SERUM POTASSIUM, ELEVATION IN SERUM CREATININE
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WHAT DRUG CAN REDUCE THE HYPOTENSIVE EFFECTS OF ACE INHIBITORS?
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NSAID's
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ANGIOTENSIN II RECEPTOR BLOCKERS END IN WHAT SUFFIX?
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END IN ARTAN
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WHERE DO ARBs BLOCK THE RENIN-ANGIOTENSIN-ALDOSTERONE PATHWAY?
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IT DOESN'T BLOCK CREATION OF ANGIOTENSIN II, IT JUST BLOCKS IT AT THE RECEPTOR
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WHEN DO WE USE ARBs CLINICALLY?
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WHEN THE PATIENT HAS A COUGH DUE TO THE USE OF ACE INHBITORS
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NAMES OF THE TWO NON-DIHYDROPYRIDINES CCB
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VERAPAMIL (CALAN AND ISOPTIN) AND DILTIAZEM (CARDIZEM AND TIAZAC)
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VERAPAMIL IS WHAT KIND OF DRUG
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NON-DIHYDROPYRIDINE (NON-DHP CCB0
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DILTIAZEM IS WHAT KIND OF DRUG
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NON-DHP CCB
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THREE TYPES OF DRUGS USED FOR ATRIAL TACHYCARDIA
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B BLOCKERS, CCB, DIGOXIN
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WHAT IS THE EFFECT OF DHPs ON ARTERIOLAR VASODILATION IN COMPARISON TO VERAPAMIL AND DILTIAZEM?
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EFFECT OF DHP >>>VERAPAMIL >> DILTIAZEM
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WHAT IS THE EFFECT OF VERAPAMIL (NON-DHP CCB) ON HR?
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IT HAS VARIABLE EFFECTS; INITIALLY MAY CAUSE A DECREASE BUT WILL EVENTUALLY CAUSE REFLEX TACHYCARDIA
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WHY DO WE AVOID SHORT ACTING NIFEDIPINE (A DHP TYPE CCB) FOR THE TREATMENT OF HYPERTENSION?
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ASSOCIATED WITH SEVERE HYPOTENSION, CEREBRAL ISCHEMIA, MI, AND DEATH
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WHY DO YOU AVOID THE USE OF VERAPAMIL (A NON DHP CCB) IN PATIENTS WITH AV NODE DYSFUNCTION OR LEFT VENTRICULAR DYSFUNCTION WHEN THE EF IS BELOW 45%?
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BECAUSE THEY FURTHER SLOW CONDUCTION THROUGH THE AV NODE
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WHAT DRUG IS CONSIDERED SAFE FOR PATIENTS WITH HTN AND ADVANCED HEART FAILURE FOR THE TREATMENT OF HTN WHEN A CCB IS REQUIRED?
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AMIODIPINE (NORVASC) ALTHOUGH ONE STUDY DID SHOW THAT THERE WAS AN INCREASED RISK OF HF USING THIS DRUG RATHER THAN A DIURETIC
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WHEN USING CCB DRUGS, BRADYCARDIA IS A CONCERN. WHAT CCB'S ARE MOST LIKELY TO CAUSE BRADYCARDIA?
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NON DHP CALCIUM CHANNEL BLOCKERS- VERAPAMIL AND DILTIAZEM
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WHY IS ANKLE EDEMA, FLUSHING, AND DIZZINESS MORE OF A CONCERN WITH DHP CCB THAN NON-DHP CCB?
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BECAUSE DHP CCB'S CAUSE A GREATER ARTERIOLAR VASODILATION THAN NON-DHP DRUGS
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WHAT DOES ISH STAND FOR?
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ISOLATED SYSTOLIC HYPERTENSION
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WHAT HAPPENS WHEN DIGOXIN IS TAKEN WITH THE NON DHP CCB'S?
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THE COMBINATION MAY INCREASE DIGOXIN LEVEL BY 20-70%
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WHAT IS THE POSSIBLE DRUG INTERACTION WHEN YOU COMBINE BETA BLOCKERS WITH VERAPAMIL OR DILTIAZEM?
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PRODUCE A NEGATIVE INOTROPIC EFFECT SO THERE IS A GREATER LIKELIHOOD FOR BRADYCARDIA
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WHAT IS THE MOA FOR ALPHA 1 ADRENERGIC BLOCKING AGENTS?
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THEY DECREASE PVR AND RELAX SMOOTH MUSCLE ON BOTH ARTERIES AND VEINS
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WHAT IS THE PURPOSE OF ALPHA 1 ADRENERGIC BLOCKING AGENTS IN HTN?
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THEY ARE USED IN PATIENTS THAT HAVE BOTH BPH AND HTN, OR IN HTN NOT CONTROLLED BY OTHER DRUGS
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WHAT ARE THE ADVERSE EFFECTS OF ALPHA 1 ADRENERGIC BLOCKERS?
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REFLEX TACHYCARDIA, FIRST DOSE EFFECT (FIRST DOSE SYNCOPE)
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TERAZOSIN (HYTRIN), DOXAZOSIN (CARDURA), PRAZOSIN (MINIPRESS) ARE WHAT TYPES OF DRUGS?
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ALPHA 1 BLOCKERS USED FOR HTN
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TERAZOSIN (HYTRIN) AND DOXAZOSIN (CARDURA) ARE GIVEN HOW MANY TIMES A DAY/
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ONLY ONCE A DAY
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PRAZOSIN (MINIPRESS) REQUIRES BEING TAKEN HOW MANY TIMES A DAY?
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TWO TO THREE
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THIS CLASS OF DRUGS MAY CAUSE FLUID RETENTION AND MAY REQUIRE A DIURETIC
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ALPHA 1 BLOCKERS ESPECIALLY PRAZOSIN
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THESE AGENTS IMPROVE CHOLESTEROL LEVELS (LOWER LDL AND RAISE HDL), ALTHOUGH THIS IS NOT CLINICALLY SIGNIFICANT
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ALPHA 1 BLOCKERS
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POSSIBLE ADVERSE EFFECTS OF USING TERAZOSIN, DOXAZOSIN, AND PRAZOSIN FOR HTN
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REFLEX TACHYCARDIA AND FIRST DOSE EFFECT
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THESE DRUGS (3 SPECIFIC) ARE USED IN TREATMENT OF HTN AND BPH TOGETHER
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TERAZOSIN, DOXAZOSIN, AND PRAZOSIN
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THIS IS A DRUG AVAILABLE AS A TABLET THAT IS USED IN BOTH HTN AND HF
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CARVEDILOL (COREG)
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CARVEDILOL (COREG) IS IN THIS CLASS OF DRUGS
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COMBINATION ALPHA1 AND BETA BLOCKERS
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WHY SHOULD WE NOT USE COMBINATION ALPHA1 AND BETA BLOCKERS WITH ASTHMATICS?
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BECAUSE THE BETA COMPONENT IS NON SELECTIVE
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THIS DRUG IS USED IN HYPERTENSIVE EMERGENCY AND AS A SECOND LINE AGENT IN PREGNANCY
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LABETALOL (TRANDATE AND NORMODYNE)
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LABETALOL AND CARVEDILOL ARE WHAT CLASS OF DRUGS?
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COMBINATION ALPHA1 AND BETA BLOCKERS
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WHAT ARE THE SIDE EFFECTS OF COMBO ALPHA1 AND BETA BLOCKERS?
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FIRST DOSE EFFECT, DIZZINESS, FATIGUE
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WHAT IS THE MOA OF ALPHA2 AGONISTS IN THE CNS?
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STIMULATION OF A2 RECEPTORS IN THE CNS INHIBITS SYMPATHETIC OUTFLOW TO THE HEART, KIDNEYS, AND PERIPHERAL VASCULATURE CAUSING PERIPHERAL VASODILATION
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THIS CLASS OF DRUGS GENERALLY CAUSES FLUID RETENTION AND THEY ARE USED IN CONJUNCTION WITH DIURETICS
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ALPHA 2 AGONISTS
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ALPHA2 AGONISTS ARE BEST USED WITH WHAT DRUGS?
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THEY ARE BEST USED WITH AGENTS THAT HAVE A DIFFERENT MOA SUCH AS DIURETICS OR ACE INHIBITORS AND NOT WITH ADRENERGIC BLOCKERS
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WHERE DO ALPHA 2 AGONISTS WORK?
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AT THE PRESYNAPTIC CLEFT VIA NEGATIVE FEEDBACK SYSTEM
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WHAT TYPE OF SIDE EFFECTS WILL YOU SEE WITH ALPHA2 AGONISTS?
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ANTI CHOLINERGIC TYPE SIDE EFFECTS-- DRY MOUTH, SEDATION, CONSTIPATION, URINARY RETENTION, AND SOME POSTURAL HYPERTENSION
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YOU WILL SEE DRY MOUTH, SEDATION, CONSTIPATION, URINARY RETENTION, AND POSTURAL HYPERTENSION WITH THE USE OF WHAT CLASS OF DRUGS?
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ALPHA2 AGONISTS
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WHY SHOULD YOU AVOID RAPID DISCONTINUATION OF ALPHA2 AGONISTS?
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TO AVOID REBOUND HYPERTENSION
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WHAT CLASS OF DRUGS IS CLONIDINE (CATAPRESS)?
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ALPHA2 AGONISTS (CENTRALLY ACTING ADRENERGIC)
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WHAT FORM DOES CLONIDINE (CATAPRESS) COME IN?
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PATCH OR TABLET
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WHAT PATIENTS USE THE CLONIDINE PATCH?
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THOSE THAT CANNOT FOLLOW THE DAILY DOSING SCHEDULES (THE PATCH IS APPLIED ONCE WEEKLY)
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WHEN CLINICALLY WOULD YOU MOST OFTEN USE CLONIDINE (CATAPRES)?
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USED WITH OTHER AGENTS IN HARD TO CONTROL HYPERTENSION
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NAME SOME OF THE CONDITIONS OTHER THAN HYPERTENSION THAT CLONIDINE (CATAPRES) HAS BEEN TRIED ON.
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ALCOHOL WITHDRAWAL, ADHD, TOURETTE'S, MANIA, RESTLESS LEG SYNDROME, SMOKING CESSATION
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WHAT IS THE FIRST LINE AGENT FOR CHRONIC HYPERTENSION IN PREGNANCY?
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METHYLDOPA (ALDOMET)
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WHAT CLASS OF DRUGS WOULD YOU USE FOR ECLAMPSIA?
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ALPHA2 AGONISTS
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HOW MANY TIMES A DAY MUST METHYLDOPA (ALDOMET) BE TAKEN?
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TID OR QID
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WHAT ARE THE SIDE EFFECTS OF METHYLDOPA (ALDOMET)?
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SEDATION, DRY MOUTH, POSTURAL HYPERTENSION
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THIS CLASS OF DRUGS DIRECTLY RELAXES ARTERIOLAR SMOOTH MUSCLE AND DECREASES PERIPHERAL VASCULAR RESISTANCE AND ARTERIAL BLOOD PRESSURE?
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ARTERIAL VASODILATOR AGENTS
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WHAT CLASS OF DRUGS INCREASES PLASMA RENIN CONCENTRATIONS?
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ARTERIAL VASODILATORS
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WHEN SHOULD YOU USE HYDRALAZINE (APRESOLINE)?
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WHEN PATIENTS FAIL TRIPLE THERAPY ON OTHER AGENTS OR WHEN SIDE EFFECTS PRECLUDE THE USE OF OTHER AGENTS
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MINOXIDIL (LONITEN) AND HYDRALAZINE (APRESOLINE) ARE WHAT CLASS OF DRUGS?
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ARTERIAL VASODILATOR AGENTS
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THIS DRUG IS A COMBINATION ALPHA AND BETA BLOCKER USED TO REAT HYPERTENSIVE EMERGENCIES
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LABETALOL (NORMODYNE, TRANDATE)
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WHY IS LABETALOL A GOOD DRUG FOR CORONARY ARTERY DISEASE OR MI?
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BECAUSE IT DOES NOT CAUSE BRADYCARDIA
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WHAT IS THE FIRST LINE AGENT FOR HYPERTENSIVE EMERGENCY?
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CLONIDINE
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IF A PATIENT IS IN HYPERTENSIVE URGENCY AND HAS HEART FAILURE, WHAT DRUG WOULD BE FIRST LINE?
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CAPTOPRIL
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WHY DO WE NO LONGER USE NIFEDIPINE IN HYPERTENSIVE URGENCY?
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IT HAS BEEN ASSOCIATED WITH INCREASED RISK OF ISCHEMIA, MI, AND STROKE DUE TO REFLEX TACHYCARDIA AND INCREASED MYOCARDIAL OXYGEN DEMAND
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WHAT EFFECT DOES NITROPRUSSIDE (NITROPRESS) HAVE IN A HYPERTENSIVE EMERGENCY WHEN GIVEN VIA IV INJECTION?
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IT IS AN ARTERIAL AND VENOUS DILATOR
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WHY MUST NITROPRESS (NITROPRUSSIDE) BE GIVEN IV?
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DUE TO ITS SHORT HALF LIFE
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WHAT IS A GOOD CHOICE FOR PATIENTS IN HYPERTNSIVE EMERGENCY THAT ALSO HAVE ISCHEMIC HEART DISEASE, MI, OR HTN FOLLOWING A BYPASS?
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NITROGLYCERIN
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WHAT IS THE DIFFERENCE BETWEEN NITROPRUSSIDE (NITROPRESS) AND NITROGLYCERIN (NITRO BID IV)?
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THEY ARE VERY SIMILAR EXCEPT THAT NITROGLYCERIN HAS A GREATER EFFECT ON THE VENOUS CIRCULATION
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A CARDIOSELECTIVE BETA BLOCKER THAT IS USED FOR HYPERTENSIVE EMERGENCY
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ESMOLOL (BREVIBLOC)
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WHAT IS ESMOLOL/BREVIBLOC USED FOR?
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IT IS A CARDIOSELECTIVE BETA BLOCKER USED FOR HTN EMERGENCY
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WHAT ARE COMMON CAUSES OF INADEQUATE RESPONSE TO TREATMENT FOR HYPERTENSION?
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PSEUDORESISTANCE, NONADHERANCE TO THERAPY, VOLUME/SODIUM OVERLOAD, DRUG RELATED CAUSES, ASSOCIATED CONDITIONS, AND INDENTIFIABLE CAUSES OF HTN
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WHAT DOES PSEUDORESISTANCE MEAN?
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THE APPEARANCE OF LACK OF BP CONTROL CAUSED BY INACCURATE MEASUREMENT, INAPPROPRIATE CHOICES OF DRUGS OR DOSES, NONADHERANCE, OR WHITE COAT EFFECT
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USE OF POTASSIUM PREPARATIONS AND ACE INHIBITORS TOGETHER COULD CAUSE WHAT?
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INCREASED SERUM POTASSIUM LEVELS
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IF NSAIDS ARE BEING USED AND THEY INHIBIT PROSTAGLANDINS CAUSING VASOCONSTRICTION ON THE AFFERENT END OF KIDNEY, WHAT WOULD BE THE OUTCOME OF USING THEM WITH AN ACE INHIBITOR?
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THE ACE INHIBITOR WOULD CAUSE VASODILATION OF THE EFFERENT END, SO THE HYPTOTENSIVE EFFECTS WOULD BE COUNTERACTED BY THE NSAID
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