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28 Cards in this Set

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Pheochromocytoma
adrenal medulla tumor
Cushing's disease
increased adrenal cortex secretion

increased Na+ retention
Renal disease
increases retention of fluid: also renin - angiotension -aldosterone release
Autonomic modifiers
Non-autonomic inhibitors of smooth muscle of vessels
Modifiers of circulatory volume
What are the 3 broad classes of antihypertensive drugs?
Autonomic modifiers
broad class name

affect heart and blood vessel diameter

block sympathetic only - either alpha or beta or both

Parasympathetic stimulators not used
Non-autonomic inhibitors of smooth muscle of vessels
Dilate blood vessels diameter directly or indirectly, not using neural receptors

(broad class name)
Modifiers of circulatory volume
(broad class name)

direutics

brings blood volume down
Alpha blockers
Beta blockers
Ganglionic blockers
Central or central and peripherial sympathetic blockers
What are the 4 autonomic modifiers?
Alpha blockers
mechanism of action

block action of E and NE on receptors - inhibits vasoconstriction
Alpha blockers
Side or toxic effects

postural hypotension (dizziness upon standing including weakness and fainting), reflex tachycardia
Beta blockers
mechanism of action

decreases HR and heart force of contraction, therefore decreases Cardiac output; also inhibits renin release
Beta blockers
Side effects or toxic effects

GI - nausea, vomiting, diarrhea

heart - uncommon, but may cause serious cardiac depression; can cause AV block

bronchioles - constrict airway
asthma

AV block
What are the contraindications for B-blockers?
Ganglionic blocker
This drug is no longer recommended.

(mechanism of action)

antinicotinic drug

inhibits sympathetic ganglia decreases BP (decrease CO and vasoconstriction)

inhibition of parasympathetic ganglia, may increase HR.
Ganglionic blocker
Therapeutically, __________ blockers are as good as many other antihypertensives, BUT too many annoying side effects.
Beta

Calcium channel
______ blockers most useful in patients under 40, but patients over 60 do poorly, and respond well to ________ _________ blockers.
Central blockers
Rauwolfia Alkaloids (resperpine)

Monoamine Oxidase inbititors
What are the different central and peripheral sympathetic blockers called?
Central blockers
withdrawl can cause rebound hypertension

do not miss a dose; withdraw slowly - these agents should not be used for initial treatment. Sedation, dry mouth, dizziness occur frequently.
Rauwolfia Alkaloids (resperpine)
What drug was originally used to treat psychoses?
Rauwolfia Alkaloids (resperpine)
mechanism of action

depletes Norepi

decreases sympathetic effect by decreasing Norepi released in sympathetic centers in the brain as well as in the heart.
Rauwolfia Alkaloids (resperpine)
side effects or toxic effects

(mostly due to CNS and GI tract)

CNS - sedative effect, psychic depression

GI - (decreases symp. so parasymp. effect seen) increases tone and motility - abdominal cramps and diarrhea, increased gastric secretion.

other - nasal congestion
cancerous
seminal
cancer
Rauwolfia Alkaloids (resperpine)

Note: Is a correlation btwn use and __________ tumors of adrenal medulla gland, mammary gland and _______ vesicles in rats and mice. However, risks of hypertension are much worse than risks of _______.
Rauwolfia Alkaloids (resperpine)
Contraindications or cautions

patients with depressive episodes

gastric ulcers

pregnant women (babies born with respiratory problems)
Monoamine Oxidase inbititors
What does MAO stand for?
increases
NE

decreases
false transmitter
tyrosine
Monoamine Oxidase inbititors

Mechanism of action

In CNS, ________ NE (good antidepressant) MAO is prevented from destroying ____________.

In SNS, first increases then _________ NE.

The increase is expected with MAO inhibition

The decrease is thought to be because of the "______ _________" idea GI enzyme also inhibited which floods peripheral vesicles and receptors with ________ which is much less effective as a transmitter. This is why it works as an antihypertensive.
Monoamine Oxidase inbititors
Side effects or toxic effects

possibly more than any other any hypertensive agent.

Acute: 1. CNS stimulation - hallucination, agitation, convulsions
2. hypo or hypertension

Chronic: 1. CNS stimulation - tremors, insomnia, nightmares, mood elevation rarelly confusion and hallucinations

2. Inhibition of sympathetic nervous sytem

-GI - nausea, constipation (common, but cause unknown)
- postural hypotension
- decreased sexual function

3. hypertensive crisis may occur
Monoamine Oxidase inbititors
Contraindication or cautions

1. Interactions with food
2. Interactions with drugs
3. Watch for renal and accumulation of the drug
increase
cheeses
hypertensive
suicidal
antihistamines
2
failure
Contraindication or cautions

1. Interactions with food - som foods ________ NE release (aged _______, beer, chianti wine, canned figs)

- may bring on _________ crisis (headache, fever, chest pain, death from intracranial bleeding)

- depressed patients may use foods as ________ agents

2. Interactions with drugs - caffiene, alcohol, __________ , barbituates, chloralhydrates, other hypnotics, sedatives, tranquilizers and narcotics; i.e. use caution with all drugs - wait up to ____ weeks before switching treatment to a contraindicated drug.

3. Watch for renal _______ and accumulation of the drug