Pharmacology 512

Front 1

What are the two primary function of circulatory system?

Back 1

1.- Delivery of oxygen, nutrients, hormones, electrolytes, and other essentials to cells.
2.- Removal of carbon dioxide, metabolic wastes, and other detrius from cells

Front 2

what are the components of the circulatory system?

Back 2

Heart and Blood vessels

Front 3

what is the function of the heart?

Back 3

pump that moves blood through the arterial tree

Front 4

what are the components of blood vessels?

Back 4

1. Arteries-muscular,less,elastic
2.-Arterioles
3.-Capillaries
4.-Venules
5.-Veins-less muscular, more distensible

Front 5

where is located the majority of the blood flow?

Back 5

84 % in Systemic circulation( veins)

Front 6

where does blood flow?

Back 6

blood flows from point where pressure is higher towards the point where pressure is lower

Front 7

How is resistance determined?

Back 7

by blood viscosity, vessel legth, vessel diameter

Front 8

True or False
the larger the diameter, the smaller the resistance, and vice versa

Back 8

True

Front 9

How heart rate is controlled?

Back 9

by the autonomic nervous system

Front 10

how heart rate increases?

Back 10

rate increase with sympathetic branch on ß 1 receptor in SA node

Front 11

how rate decrease

Back 11

rate decrease with parasympathetic on muscrarinic receptors in
SA node

Front 12

What are the factors that determined stroke volume?

Back 12

myocardial contractility, cardiac afterload, cardiac preload

Front 13

what is arterial pressure?

Back 13

Arterial pressure is the driving force that moves blood through arterial side of systemi circulation

Front 14

How autonomic nervous system regulate arterial pressure ?

Back 14

by adjusting CO and PVR

Front 15

what organ sense arterial pressure?

Back 15

Baroreceptors in aortic arch and carotid sinus

Front 16

what happens to the heart when arterial pressure change?

Back 16

when AP changes: 1.-vasoconstrictor center compensates by sending appropriate instructions to the arterioles, veins, and heart
2.- Reflex acts within seconds to restore the preset pressure( e.g. reflex tachycardia if AP falls)

Front 17

True or False
If AP remains elevated or lowered, the system resets to new pressure within 1-2 days.

Back 17

True

Front 18

What are the regulation of arterial pressure?

Back 18

Autonomic Nervous System, the Renin-Angiotensin-Aldosterone system (RAAS), the kidneys

Front 19

How renin-Angiotensin-Aldosterone sytem support AP?

Back 19

by causing
1.- Constriction of arterioles and veins
a) vasoconstriction is mediated by angiotensin II
b) response develops in hours
2.- Retention of water by the kidney
a) water retention mediated by aldosterone
b) fluid retention increases blood volume
c)response develps in days
3.- Natriuretics peptides

Front 20

what is the function of natriuretic peptides?

Back 20

reduce blood volume and promote dilation of arterioles and veins

Front 21

How RAAS exerts its effects?

Back 21

through angiotensin II and aldosterone

Front 22

What are the types of angiotensins?

Back 22

angiotensin I- weak biologic activity
angiotensin II- strong biologic activity
angiotensin III- moderate biologic activity

Front 23

what is the function pf angiotensin II?

Back 23

1. promote actiona to raise blood pressure
a) vasoconstriction and stimulation of aldosterone release via the adrenal cortex.
release also stimulated by decreased sodium and increased potassium
2. Act on heart and blood vessels to cause pathophysiologic changes and function
a) hypertrophy and remodeling of the heart

Front 24

what are the mechanism of action for Angiotensin-converting enzyme inhibitors (ACE-I)?

Back 24

1.- Reduces levels of angiotensins II and
2.- Inhibits kinase II, increasing levels of bradykinin.

Front 25

what are the therapeutic use for ACE-I?

Back 25

HTN, HF, diabetic, nephropathy, acute MI, left ventricular dysfunction, prevention of MI.

Front 26

what are the drugs that associated with angiotensin-converting enzyme inhibitors (ACE-I)?

Back 26

Captopril, enalapril,lisinopril,ramipril

Front 27

what are the adverse effects of ACE-I?

Back 27

cough, first dose hypotension, hyperkalemia, angioedema, renal failure, fetal harm, renal insufficiency

Front 28

what is the name of the only drug that can be used for stroke in high CAD risk patients?

Back 28

Ramipril

Front 29

what is the effect of ACE I?

Back 29

dilation of blood vessels (primarily arterioles), reduce blood volume, and prevent or reverse pathologic changes in the heart and blood vessels.

Front 30

what are the ACE-I drug interactions?

Back 30

diuretics-exacerbate first dose hypotension, antihypertensives,drugs that raise potassium levels, lithium-accumulation, NSAID-decrease effects of ACE inhibitors

Front 31

what is the mechanism of action for angiotrnsin II receptor blockers?

Back 31

blocks action of angiotensin II in blood vessels, adrenals, and other tissues

Front 32

what are angiotensin II receptor blockers drugs?

Back 32

Valsartan, candesartan,irbesartan,losartan

Front 33

what are the therapeutic uses for angiotensin II receptor blockers?

Back 33

HTN, heart failure, Diabetic,

Front 34

what are the drugs that can be used to treat nephropathy?

Back 34

Irbesartan and losartan

Front 35

what are the adverse effects of using angiotensin II receptor blockers?

Back 35

Angioedema, renal failure, fetal harm

Front 36

True or false

Valsartan approved for reducing risk of stroke in patients with HTN,LV hypertrophy

Back 36

False

Front 37

True or false

Losartan approved for decreasing CV mortality post MI in patients with HF?

Back 37

Fasle

Front 38

what are the aldosterone antagonists drugs?

Back 38

Spironolactone and eplerenone

Front 39

what are the mechanism of action for aldosterone antagonists?

Back 39

blocks action of aldosterone on its receptor

Front 40

what are the therapeutic uses for aldosterone antagonists?

Back 40

hypertension and heart failure

Front 41

what are the adverse effect of aldosterone antagonists?

Back 41

hyperkalemia, also binds with receptors for other steroid hormone

Front 42

what are the effect of aldosterone antagonists?

Back 42

reduction in blood volume and blood pressure, blockade at nonrenal sites may prevent or reverse pathologic effects of aldosterone on cardiovascular structure and function

Front 43

what are the direct renin inhibitor?

Back 43

Aliskiren (tekturna)

Front 44

what is the mechanism of action of direct renin inhibor?

Back 44

inhibits renin, preventing the conversion of angiotensin to angiotensin I

Front 45

what are the therapeutic uses for direct renin inhibitor?

Back 45

hypertension, under investigation for treatment of heart failure and diabetes associated renal failure

Front 46

what are the adverse effects of direct renin inhibitor?

Back 46

diarrhea, fetal harm, angioedema, cough and hyperkalemia.

Front 47

true or false
direct renin inhibitor can suppress the entire RAAS

Back 47

True

Front 48

what are calcium channels blockers?

Back 48

calcium channels are gated pores in the cytoplasmic membrane that regulate entry of calcium ions in cells

Front 49

what is the function of calcium entry?

Back 49

plays a critical role in the function of vascular smooth muscel(VSM) and the heart

Front 50

what are the critical role of calcium in the vascular smooth muscle?

Back 50

1. Action potential→calcium channels open→calcium ions flow inward→contraction
2. Calcium channels blocked→
prevent contration→vasodilation

Front 51

what are the critical role of calcium in the heart?

Back 51

myocardium: decrease contratile force
SA node: pacemaker activity declines, reduces heart rate
AV node: decrease velocity of conduction
* Calcium channels at all 3 of theses sites are coupled with ß1 adrenergic receptors; both have identical effects on the heart

Front 52

what are the calcium channels blockers?

Back 52

Dihydropyridines and nondihydropyridines

Front 53

what are the function of dihydropyridines?

Back 53

act on the arterioles

Front 54

what are the nondihydropyridines?

Back 54

verapamil and diltiazem

Front 55

what are the dunction of nondihydropyridines?

Back 55

act on arterioles and on the heart

Front 56

what are the mechanism of action of nondihydropyrines?

Back 56

blocks calcium channels in the blood vessels and the heart

Front 57

what are the hemodynamic effects of nondihydropyrines?

Back 57

direct effect on the heart and blood vessels

Front 58

what are the therapeutic uses of nondihydropyridines?

Back 58

Angina pectoris, hypertension, cardiac dysrhytmias

Front 59

what are the adverse effects of nondihydropyridines?

Back 59

constipation, dizziness, facial flushing, headache, peripheral edema

Front 60

what are the effect of nondihydropyridines?

Back 60

1.- blockade at peripheral arterioles→dilation→reduces arterial pressure
2.-blockade at arteries and arterioles→ increase in coronary perfusion
3. blockade at SA/AV node→decrease in nodal conduction→ decrease in HR
4. Blockade in the myocardium → decrease in the force of contraction

Front 61

what are the agent that act mainly on vascular smooth muscle?

Back 61

nifedipine, nicardipine, amlodipine,isradipine, nimodipine, felodipine, nisoldipine

Front 62

what are the mechanism of action of agents that act mainly on vascular smooth musce?

Back 62

blocks calcium channels in the VSM

Front 63

what are the hemodynamics effects of agents that act mainly on VSM?

Back 63

direct effects on blood vessels (vasodilation), thereby lowering arterial pressure and increasing coronary perfusion

Front 64

what are the therapeutic uses of agents that act on VSM?

Back 64

flushing, dizziness, headache, peripheral edema, reflex tachycardia (baroreceptor reflex with fast acting fromulations)

Front 65

what is the name of calcium channels blockers that increase heart rate?

Back 65

amlodipine

Front 66

what are the cacium channels blockers dru that can be used to decrease heart rate, myocardial contractility and AV nodal conduction?

Back 66

Verapamil and diltiazem

Front 67

How drugs that dilate the arterioles work?

Back 67

decrease cardiac output afteload (decrease cardiac work while increasing CO and tissue perfusion)

Front 68

How drugs that dilate the veins work?

Back 68

decrease cardiac output preload (decrease cardiac work while decreasing CO and tissue perfusion

Front 69

what are the therapeutic uses for vasodilators?

Back 69

essential hypertension, hypertensive crises, angina pectoris, heart failure, myocardial infarction

Front 70

what are the adverse effect related to vasodilation?

Back 70

postural (orthostatic) hypotension, reflex tachycardia, expansion of blood volume.

Front 71

what are the vasodilator drugs for the artery?

Back 71

hydralazine,minoxidil,nesiritide,sodium nitroprusside

Front 72

what are the vasodilator drugs for vein?

Back 72

nesiritide and sodium nitroprusside

Front 73

what are the types of hypertension?

Back 73

primary(essential) hypertension (frequency-92%)
and secondary hypertension

Front 74

what are the major cardiovascular risk factots?

Back 74

cigarette smoking, obesity, inadequate exercise, dyslipidemia, diabetes, microalbuminuria, advancing age (above 55 for men, above 65 years for women), family history of premature cardiovacular disease

Front 75

what are the target end-organ damage?

Back 75

heart disease (LVH, angina, MI, HF), chronic kidney disease, stroke or transient ischemic attack, peripheral arterial disease, retinopathy

Front 76

what are the drugs that can be used for stage 1 hypertension without compelling indications?

Back 76

Thiazide-type diuretics for most patients. My consider: ACE-I, Angiotensin II receptor blockers ,Direct Renin Inhibitor,beta blocker, calcium channels blockers or combination

Front 77

what are the initial drug selection for stage 2 hypertension?

Back 77

two drugs combination for most patients (usuaaly a thiazide-type plus an : ACE-I,ARB, BB, CCB?

Front 78

what are the ways to promote adherence?

Back 78

patient self-monitoring, teach self-monitoring, minimize side effects, establish a collaborative relationship, simplify the regimen

Front 79

what are the hypertensive urgency?

Back 79

no immediate threat of end organ damage, reduce blood pressure over 24-48 hours

Front 80

what are the hypertensive emergency?

Back 80

involves end organ damage, blood pressure reduction within 30-60 minutes

Front 81

what are the IV medications?

Back 81

1.- Nitroprusside- direct acting vasodilator
2.-fenoldopam- D1 receptors on arterioles→ vasodilator
3.- labetolol- blocks α and ß adrenergic receptors
4.- diazoxide- selective dilation of arterioles
5.- clevidipine- dihydropyridine CCP

Front 82

what is preeclamsia?

Back 82

characterized by combination of elevated blood pressure (>140/90) and proteinuria (>300 mg /24 hr) that develop after the 20th week of gestation

Front 83

what are the preeclamsia risks for the fetus?

Back 83

intrauterine growth restriction, premature birth, death

Front 84

what are the preeclamsia risks for the mother?

Back 84

seizures (eclampsia), renal failure, pulmonary edema, stroke, and death

Front 85

what are the congestive heart failure physiologic adaptation to reduce CO?

Back 85

increased sympathetic tone, water retention & increased blood volume, natriuretics peptides

Front 86

what are the cardiac remodeling in congestive heart failure?

Back 86

reduced cardiac output, cardiac dilation, increased (SNS, RAAS, water retention, blood volume), increased heart rate and venous and arterial pressure

Front 87

what are the signs and symptoms of heart failure?

Back 87

Exercise intolerance, fatigue, shortness of breath, tachycardia, pulmonary edema, peripheral edema, hepatomegaly, distention of the jugular veins, weight gain

Front 88

what are the treatment goals for congestive heart failure?

Back 88

decrease intravascular volume(diuretics), increase cardiac contractility (positive inotrope), and decrease afterload (ACE I, vasodilators)

Front 89

what are the causes of arrhytmias?

Back 89

Disturbances of automaticity( hypoxia, electrolyte imbalance, myocardial infarction, antidysrhythmic drugs2.- disturbance of conduction (AV block and reentry)