Resp 283 - Week 6

Front 1

Antihypertensives

Back 1

Drug used to lower high blood pressure

Front 2

Antianginals

Back 2

Any drug used in the treatment of angina pectoris, a symptom of ischemic heart disease

Front 3

Antithrombotics

Back 3

Drugs that prevent or break up blood clots in conditions such as thrombosis or embolism, including anticoagulants, antiplatelets, and thrombolytics

Front 4

Please categorize the stages of normal to high blood pressure

Back 4

?

Front 5

Hypertensive crisis

Back 5

Defined as systolic BP 180mmHg or greater and diastolic BP of 120mmHg or greater representing either hypertensive urgency or a hypertensive emergency

Front 6

Hypertensive emergency

Back 6

Blood pressure greater than 180/120mmHg, with the elevation of blood pressure accompanied by acute, progressing target organ injury

Front 7

Hypertensive urgency

Back 7

Blood pressure greater than 180/120mmHg without signs or symptoms of acute target organ complications

Front 8

Angiotensin-converting enzyme inhibitors mechanism

Back 8

Act primarily through suppression of the renin-angiotensin-aldosterone system (RAAS), blocking the conversion of angiotensin I to angiotensin II

Front 9

Calcium channel blockers mechanism

Back 9

Cause coronary and peripheral vasodilation via L channel blockaded

Front 10

β blockers mechanism

Back 10

-Blockade of the β-receptors on the renal receptors on the renal juxtaglomerular cells,

-Blockade of myocardial β-receptors,

-Blockade of central nervous system β-receptors

Front 11

Please describe the formation and elimination of an acute coronary thrombus.

Back 11

-Formation initiated by injury to the endothelium

-Platelets adhere to the site of injury, release chemicals that cause further aggregation, forming an unstable thrombus

-Eventually forms an unstable fibrin clot

-Must be removed by fibrinolytic system for homeostasis to be maintained

Front 12

Please describe the pathophysiology of angina

Back 12

Chest pain

Symptom of myocardial ischemia

Imbalance of myocardial O2 supply and demand

Front 13

Drugs used to treat angina

Back 13

-Nitrates (nitroglycerin)

-Beta blockers

-CCBs

-Ranolazine (Ranexa)

Front 14

Anticoagulants

Back 14

Work by preventing the formation of the fibrin clot and preventing further clot formation in already existing thrombi

Front 15

Antiplatelet

Back 15

Inhibits the action of platelets in the initial stage of the clotting process

Front 16

Thrombolytic

Back 16

Break up thrombi by degrading fibrin

Front 17

Please describe the mechanism of action of heparin

Back 17

?

Front 18

What is the difference between heparin and low molecular weight heparin?

Back 18

?

Front 19

What are the laboratory parameters that may be used to monitor for the effect of heparin, LMWH, and direct thrombin inhibitors?

Back 19

?

Front 20

Please describe the mechanism of heparin-induced and warfarin-induced paradoxical thrombosis.

Back 20

?

Front 21

Please list the indications for thrombolytic agents.

Back 21

Management of PE

Ischemic stroke

Acute ST elevation MI

Front 22

List the contraindications for thrombolytic agents

Back 22

Hemorrhages

Arteriovenous malformations

SBP>185 or DBP<110

Platelets<100,000/mm3

Prothrombin>15seconds

INR>1.7

Internal bleeding

Head trauma

Rapidly improving stroke symptoms

MI

Recent major surgery

Pregnancy

Front 23

Why do most patients require two or more drugs to reach target blood pressure?

Back 23

Because most patients reach the maximum recommended dose of the first medication without reaching their target BP and must supplement it with a second drug

Front 24

When would hypertension be termed primary or essential hypertension?

Back 24

When the etiology of hypertension is unknown

Front 25

Angiotensin II receptor blockers are indicated for hypertension, and what other disease process?

Back 25

Reduce target organ damage in hypertension

Reduce cardiovascular events in systolic heart failure

Reduce progression of nephropathy in type II diabetes

Front 26

The half-life of unfractionated heparin is approximately 30 to 60 minutes, whereas the half-life of low molecular weight heparin is?

Back 26

4-5 hours

Front 27

Damage to vital body organs resulting from hypertension is called:

Back 27

Cardiovascular disease (CVD)

Front 28

Uncontrolled hypertension increases the risk for what disease processes?

Back 28

-Left ventricular hypertrophy

-Angina

-Myocardial infarction

-Heart failure

-Stroke

-Peripheral artery disease

-Retinopathy

-Kidney disease

Front 29

What agents act to lower blood pressure by stopping the conversion of angiotensin I to angiotensin II?

Back 29

Angiotensin-converting enzyme inhibitors (ACEIs)

Front 30

The product of cardiac output and total peripheral resistance defines:

Back 30

Arterial blood pressure

Front 31

Hypertension in adults is defined as a blood pressure greater than

Back 31

>140/90mmHg

Front 32

What are the first-line agents for treatment of uncomplicated hypertension?

Back 32

-Angiotensin-converting enzyme inhibitors (ACEIs)

-Angiotensin II receptor blockers (ARBs)

-Calcium channel blockers (CCBs)

-Thiazide-type diuretics

Front 33

Angiotensin-converting enzyme inhibitors produce what effects?

Back 33

Produce hemodynamic effect

Reduce peripheral arterial resistance (PAR)

Increase CO

Increase renal blood flow

Front 34

Angiotensin-converting enzyme inhibitors are indicated for what disease processes?

Back 34

Hypertension (HTN),

Heart failure,

Systolic dysfunction,

MI prevention,

LV dysfunction, and

Diabetic neuropathy

Front 35

What is the most common side effect of angiotensin-converting enzyme inhibitors?

Back 35

Persistent nonproductive dry cough (20-30%)

Front 36

A significant drug interaction occurs between angiotensin-converting enzyme inhibitors and:

Back 36

NSAIDs

Front 37

What are the classes of diuretics?

Back 37

-Thiazides

-Loop diuretics

-Potassium sparing agents

-Carbonic anhydrase inhibitors (CIA's)

-Osmotics

Front 38

Thiazide diuretics increase excretion of:

Back 38

Increase sodium and chloride excretion by interfering with their reabsorption in the distal tubule

Front 39

Lasix and Bumex are:

Back 39

Loop diuretics

-Lasix = furosemide

-Bumex = bumetanide

Front 40

Which agent’s reduce total peripheral resistance by a direct action on vascular smooth muscle?

Back 40

Vasodilators

-Hydralazine (Apresoline)

-Minoxidil (Rogaine, Loniten)

Front 41

What is the most common symptom of myocardial ischemia?

Back 41

Angina pectoris

Front 42

How does nitroglycerin relieve chest pain?

Back 42

By reducing myocardial O2 demand by causing venodilation of coronary arteries and collaterals resulting in decreased end diastolic pressures

Front 43

What are the routes of administration for nitrates?

Back 43

-Oral

-Intravenous

-Ointment

-Transdermal

-Translingual

-Sublingual tablets

Front 44

All patients with angina should receive what drug for prophylaxis of a myocardial infarction?

Back 44

Nitrates

Front 45

How do anticoagulants work?

Back 45

By preventing the formation of the fibrin clot and preventing further clot formation in already existing thrombi

Front 46

What is the most commonly used anticoagulant?

Back 46

?

Front 47

How does aspirin work as an anticoagulant?

Back 47

?

Front 48

Thrombolytic agents should be given _____________ in relation to the onset of symptoms.

Back 48

12 hours of symptom onset (benefit can be realized for 24 hours)

Front 49

How do thrombolytics restore coronary blood flow?

Back 49

Thrombolytics restore coronary blood flow by dissolving the thrombus limiting the extent of ischemia and necrosis

Front 50

Your 37 year old patient has an initial blood pressure reading of 160/98 mm Hg. No other readings have been taken since this last reading. Should he be diagnosed as having hypertension?

Back 50

No, because according to the lecture slides hypertension is diagnosed by 2 or more seated BP readings taken on different days

Front 51

Your 74 year old patient has a recorded blood pressure of 185/125 mm Hg. He is not currently showing any signs or symptoms of acute organ complications. You would label his condition as:

Back 51

Hypertensive urgency

Front 52

Antihypertensive effects of β blockers include:

Back 52

-Blockade of β receptors on the renal juxtaglomerular cells, leading to renin blockade and decreased angiotensin II concentrations

-Blockade of myocardial β receptors leading to decreased cardiac contractility and HR, diminishing CO

-Blockade of CNS β receptors leading to decreased sympathetic output from the CNS and plausible blockade of peripheral β receptors decreasing norepinephrine concentrations

Front 53

Centrally acting adrenergic agents lower blood pressure by:

Back 53

-α2 agonists decrease BP by affecting cardiac output and peripheral resistance

-They are negative inotropes and chronotropes

-Stimulate brainstem α2 receptors resulting in a decrease in sympathetic outflow from the CNS

Front 54

Anticholinergic side effects centrally acting adrenergic agents?

Back 54

-Sedation

-Blurred vision

-Dry mouth

-Constipation

-Urinary retention

Front 55

CNS side effects centrally acting adrenergic agents?

Back 55

-Drowsiness

-Fatigue

-Headaches

-Depression

-Psychosis

-Nightmares

Front 56

Long term use side effects centrally acting adrenergic agents?

Back 56

Sodium and fluid retention

Front 57

The unmonitored dosing for unfractionated heparin for deep vein thrombosis and pulmonary embolism is?

Back 57

?

Front 58

What is the dose of aspirin for prevention of myocardial infarction?

Back 58

81-325mg daily

Front 59

Delayed onset heparin induced thrombocytopenia type 2 is due to:

Back 59

Due to the formation of antiplatelet antibodies between days 6-12

Front 60

What is the standard for monitoring warfarin therapy?

Back 60

International Normalized Ratio

Front 61

Glycoprotein inhibitors are indicated for the treatment of?

Back 61

Patients with ACS – unstable angina or non-ST elevation acute MI – and patients who are medically managed and patients undergoing PCI

Front 62

What is the most common adverse effect associated with thrombolytic agents?

Back 62

Major and minor bleeding

Front 63

Which of the β blockers possess selective β1 blocker activity?

Back 63

-Acebutolol

-Atenolol

-Betaxolol

-Bisoprolol

-Metoprolol

Front 64

What are the most common side effects of nitrates?

Back 64

-Tachycardia

-Palpitations

-Headaches

-Dizziness

-Flushing

Front 65

What is the best available parameter to monitor the effects of warfarin?

Back 65

INR

Front 66

What is the antidote to heparin?

Back 66

Protamine sulfate

Front 67

What is the mechanism of action of warfarin?

Back 67

By interfering with the hepatic synthesis of vitamin K dependent clotting factors II, VII, IX, and X

Front 68

What thrombolytic is recommended for patients older than 75 years who present with ST segment elevation myocardial infarction?

Back 68

Streptokinase

Front 69

What is the best available parameter to monitor the effects of heparin?

Back 69

Activated partial thromboplastin time (aPTT)