(2) Cardiovascular pharmacology

Question 1

What is the diagnostic blood pressure for Hypertension

Answer 1

130/80

Question 2

hypertension increases the risk of…

Answer 2

Stroke
Myocardial Infarction
Atherosclerosis

Question 3

What three things do antihypertensive drugs aim to do

Answer 3

1. reduce cardiac output
2. reduce plasma volume
3. reduce peripheral resistance

Question 4

What are the Major antihypertensive drug types

Answer 4

1. Diuretics
2. ACE inhibitors
3. Angiotensin II blockers
4. Direct renin inhibitors (aliskiren)
5. Beta blockers
6. Alpha 1-blockers
7. Ca channel blockers

Question 5

How do diuretics decrease blood pressure

Answer 5

1. decrease plasma volume (which also decreases cardiac output)

Question 6

What are the important players in the Renin-Angiotensin-Aldosterone System

Answer 6

1. Angiotensinogen in the blood
2. renin converts it to angiotensin 1
3. ACE enzyme converts angiotensin 1 to angiotensin 2
4. Angiotensin 2 acts in various ways that increase blood pressure

Question 7

what are the 4 ways in which angiotensin 2 causes blood pressure to increase

Answer 7

1. causes vasoconstriction of arterioles
2. stimulates cardiovascular control center in medulla
3. causes release of vasopressin (ADH)
4. causes release of aldosterone (increase Na reabsorption)

Question 8

What are the antihypertensive drugs that lower blood pressure by disrupting the RAAS

Answer 8

1. ACE inhibitors
2. Angiotensin II blockers
3. Direct renin inhibitors
4. Beta blockers

Question 9

how does the retention of Na affect blood pressure

Answer 9

increased Na in the plasma = increased fluid intake = increased blood volume = increased blood pressure

Question 10

How do ACE inhibitors work to treat hypertension

Answer 10

they inhibit the formation of angiotensin 2 from angiotensin 1. this prevents aldosterone release and Na reabsorption = less blood volume

Question 11

What are the common ACE inhibitors (and the suffix)

Answer 11

Lisinopril
Enalapril
Enalaprilat
Captopril

-pril

Question 12

what is a common side effect of ACE inhibitors

Answer 12

persistent cough
(ACE breaks down bradykinin, more bradykinin = cough)
hyperkalemia (if used with K+ sparing diuretics)
Angioneurotic edema

Question 13

how do angiotensin II receptor blockers decrease blood pressure

Answer 13

they are potent vasodilators (decrease peripheral resistance)

Question 14

What are common angiotensin II receptor blockers (and the suffix)

Answer 14

Losartan
Valsartan
Candesartan

Question 15

how do aldosterone antagonists decrease blood pressure

Answer 15

they are potent vasodilators (decrease peripheral resistance)

Question 16

What are common aldosterone antagonists

Answer 16

spironolactone

eplerenone

Question 17

Beta blockers and RAAS?

Answer 17

Inhibits renin release (don’t know how)

Question 18

How do diuretics decrease blood pressure

Answer 18

increase Na and fluid loss = decrease plasma volume

Question 19

How do beta blockers decrease blood pressure

Answer 19

block the effects of the sympathetic nervous system = slows heart rate, causes vasodilation

Question 20

What are common beta blockers (and whats the suffix)

Answer 20

propranolol
pindolol
nadolol
Timolol
Metoprolol

Question 21

How do alpha adrenergic receptor antagonists treat hypertension

Answer 21

A1 selective receptor agonists treat hypertension by blocking norepinephrine receptors on smooth muscle and thus cause vasodilation

Question 22

What are common alpha adrenergic receptors and what is the suffix

Answer 22

doxazosin
prazosin
terazosin

Question 23

What are the adverse affects of alpha adrenergic receptor antagonists

Answer 23

hypotension and syncope (first dose effect)
tachycardia
nasal congestion
dry mouth

Question 24

How do Calcium channel blockers decrease blood pressure

Answer 24

they block the contraction of smooth muscle which leads to vasodilation which lowers blood pressure

Question 25

What are common Ca channel blockers

Answer 25

Verapamil Diltiazem Nifedipine

Question 26

What are the adverse affects associated with Ca channel blockers

Answer 26

flushing headaches hypotension gingival hyperplasia

Question 27

What class of hypertension drugs can cause gingival hyperplasia

Answer 27

Ca channel blockers

Question 28

``` What are these following drugs taken for nitroprusside sildenafil Clonidine a-Methyldopa Guanabenz guanfacine ```

Answer 28

Hypertension

Question 29

What are the 5 mentioned hypertensive emergency drugs

Answer 29

``` nitroglycerine nitroprusside fenolodopam labetalol hydralazine ```

Question 30

What method of administration is used for nitroglycerine and why

Answer 30

oral administration | because you have to avoid hepatic metabolism

Question 31

how does nitroprusside affect hypertension

Answer 31

peripheral vasodilation

Question 32

``` What are these drugs taken for epoprostenol Bosentan Ambrienten sildenafil tadalafil ```

Answer 32

pulmonary hypertension

Question 33

What are drugs are taken for pulmonary hypertension

Answer 33

``` epoprosentol Bosentan Ambrienten sildenafil tadalfil ```

Question 34

What are diuretics used to treat

Answer 34

Hypertension Heart Failure Edema

Question 35

What is the affect of diuretics

Answer 35

decrease plasma and extracellular fluid volume = decreased preload, cardiac output, and total peripheral resistance = decreased workload on heart and decreased blood pressure

Question 36

Where do thiazide diuretics act

Answer 36

on the distal tubule of the kidney nephron

Question 37

where do loop diuretics act

Answer 37

on the ascending loop of the kidney nephron

Question 38

what transporters in the distal tubule are decreased by thiazide diuretics

Answer 38

Na+ and Cl-

Question 39

what transports in the ascending loop tubule are decreased by loop diuretics

Answer 39

Na+, Cl-, and K+

Question 40

What are amiloride and triamterene used for

Answer 40

they are diuretics that block na channels in the late distal tubule. used for hypertension, edema, heart failure

Question 41

What is spironolactone used for

Answer 41

diuretic that blocks aldosterone receptor in the late distal tubule used for hypertension, edema, heart failure

Question 42

What are common thiazide diuretics

Answer 42

benzothiazide hydrochlorothiazide chlorthalidone

Question 43

Are thiazide diuretics K sparing

Answer 43

nope

Question 44

What is the problem with thiazide diuretics not being K+ sparing

Answer 44

they can cause hypokalemia

Question 45

What are common loop diuretics

Answer 45

furosemide bumetanide Torsemide

Question 46

Do thiazide or loop diuretics have a higher ceiling

Answer 46

loop diuretics

Question 47

Do thiazide or loop diuretics cause hyponatremia

Answer 47

both can cause hyponatremia

Question 48

What is the effect of thiazide diuretics on Ca excretion

Answer 48

thiazide diuretics decrease Ca excretion

Question 49

What is the effect of loop diuretics on Ca excretion

Answer 49

loop diuretics increase Ca excretion

Question 50

What are the side effects of loop diuretics

Answer 50

``` hyponatremia Excessive fluid loss hyperuricemia tinnitus hearing loss ```

Question 51

Amiloride and Triamterene are diuretics, what are their qualities

Answer 51

They are K+ sparing | They are often used with other diuretics in order to prevent hypokalemia

Question 52

What is a risk associated with amiloride and triamterene

Answer 52

hyperkalemia

Question 53

Spironolactone and Eplerenone are diuretics that are similar to amiloride and triamterene, what is the difference?

Answer 53

they are true antagonists of the aldosterone receptor

Question 54

What are Drug interactions common to diuretics

Answer 54

``` antidiabetic drugs corticosteroids Digoxin Lithium NSAIDS ```

Question 55

What is the common complication when taking diuretics and antidiabetic drugs

Answer 55

increased glucose levels

Question 56

what is the common complication when taking diuretics and corticosteroids

Answer 56

hypokalemia

Question 57

what is the common complication when taking diuretics and Digoxin

Answer 57

digoxin toxicity secondary to hypokalemia

Question 58

what is the common complication when taking diuretics and lithium

Answer 58

lithium toxicity

Question 59

what is the common complication when taking diuretics and NSAIDS

Answer 59

decreased diuretic activity

Question 60

How does warfarin prevent coagulation (anticoagulant)

Answer 60

it inhibits the vitamin K dependent synthesis of factors 2, 7, 9, and 10

Question 61

How quickly does warfarin work

Answer 61

it takes several days to reach its full effect

Question 62

what is the antidote for warfarin

Answer 62

Vitamin K (phytonadione)

Question 63

how does heparin prevent coagulation

Answer 63

it simulates antithrombin 3 which blocks the action of factors 2a and 10a

Question 64

how quickly does heparin work

Answer 64

immediately

Question 65

what is the antidote for heparin

Answer 65

protamine

Question 66

What drugs are classified as Low molecular weight heparins

Answer 66

Enoxaparin Dalteparin Tinzaparin

Question 67

how do the low molecular weight heparins work

Answer 67

they stimulate antithrombin 3 which blocks the action of factors 2a and 10a (LMWH mostly blocks 10a, not 2a)

Question 68

how quickly do the low molecular weight heparins work as anticoagulants

Answer 68

immediately

Question 69

What is the antidote for low molecular weight heparins

Answer 69

protamine will partially antagonize

Question 70

What is the method of action for Fondaparinux as an anticoagulant

Answer 70

binds to antithrombin 3, which blocks the action of Xa

Question 71

does protamine antagonize the action of fondaparinux as an anticoagulant

Answer 71

nope

Question 72

``` What type of drugs are the following lepirudin bivalirudin argatroban dabigatran rivaroxaban ```

Answer 72

anticoagulants (direct thrombin inhibitors)

Question 73

What are the common antiplatelet drugs

Answer 73

aspirin (COX inhibitor) | Dipyramidole (phosphodiesterase inhibitor)

Question 74

What does INR stand for

Answer 74

international normalized ratio

Question 75

what does INR measure

Answer 75

the effect of warfarin (how "thin" or less likely to clot the blood is)

Question 76

What is the normal INR range

Answer 76

0.8 to 1.2

Question 77

What is the target INR for low intensity anticoagulant therapy

Answer 77

2 - 3

Question 78

what is the target INR for high intensity anticoagulant therapy

Answer 78

2.5 - 3.5

Question 79

Why is it important to know a patients INR as a dentist

Answer 79

the higher the INR the higher the risk of excessive bleeding

Question 80

how quickly after stopping taking warfarin does the INR return to normal levels and why

Answer 80

several days because the body has to synthesize new clotting factors

Question 81

What do plasminogen activators do

Answer 81

they stimulate fibrinolysis and break down clots

Question 82

What are the plasminogen activator drugs

Answer 82

``` alteplase (tissue plasminogen activator) TPA tenecteplase reteplase streptokinase Urokinase ```

Question 83

What does a plasminogen inhibitor do

Answer 83

inhibits clot breakdown (fibrinolysis)

Question 84

What is the plasminogen inhibitor we discussed

Answer 84

aminocaproic acid

Question 85

What does aminocaproic acid do

Answer 85

inhibits clot breakdown