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P&T Block 1 > L16 > Flashcards

L16 Flashcards

1
Q

What does the P wave represent?

A

Atrial depol

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2
Q

What does the QRS represent?

A

Ventricular depol

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3
Q

What does the T wave represent?

A

Ventricular repol

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4
Q

What does the QT interval represent?

A

Length of ventricular cycle

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5
Q

How does the sympathetic NS respond to heart failure (↓CO)?

A

Sympathetic

  • Vasoconstriction = ↑afterload
  • Na/H2O retention = ↑BV
  • LV remodeling
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6
Q

Which substances naturally oppose vasoconstriction and Na retention to counter regulate maladaptive processes?

A

Natriuretic peptides

PGs

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7
Q

What is the difference between short and long term adaptations/compensation for ↓CO?

A 
Short = adaptive changes
Long = maladaptive
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8
Q

Which vasoactive peptides are released due to heart failure?

A

RAAS
Natiuretic peptides
ADH
Endothelins

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9
Q

What inflammatory mediators are released due to heart failure?

A

PGs

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10
Q

What type of HF are RAS inhibitors and BB really beneficial for?

A

HR w/ ↓EF

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11
Q

What are the 3 triggers that ↑renin release during HF?

A

↓Pre-glomerular BP
↓NaCl @ macula densa
↑NE from sympa at B1 receptors

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12
Q

What is ACE2? Same as ACE?

A

ACE = Angiotensin converting enzyme, AGT1 –> AGT2
ACE2 = counters adverse cardiac effects of excess AGT2
- Vasodilation
- Antiproliferative

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13
Q

3 ACE inhibitors

A

Captopril
Enalapril
Linospril

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14
Q

2 angiotensin receptor blockers

A

Losartan

Valsartan

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15
Q

Renin inhibitor

A

Aliskiren

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16
Q

How does AGT 2 change TPR when binding AT1 receptors? Net response?

A

↑vasoconstriction
↑Sympa
Net = rapid ↑BP

17
Q

How does AGT2 change renal fxn when binding AT1 receptors? Net response?

A

↑Na reabsorption
- Directly
- Indirectly via ↑aldosterone
Net = slow ↑BP (volume expansion)

18
Q

How does AGT2 change CV structure when binding AGT1 receptors? Net response?

A 
↑proto-oncogenes
↑GF
↑Afterload 
↑Wall tension
Net = LV hypertrophy/remodeling
19
Q

What explains part of ↓BP of ACE inhibitors?

A

↑Bradykinin & PGs

Turning off ACE also turns off the enzymes that inactivates bradykinin

20
Q

Bradykinin fxn

A

Vasodilator

↑PG synthesis

21
Q

Adverse effects of ↑bradykinin/PGs due to ACE inhibitors

A

Dry cough

Angioedema

22
Q

Captopril

  • Excretion
  • Dosing
A

Renal excretion - impt for pts w/ HF

Low doses to avoid SEs

23
Q

Captopril SE (usually seen at high doses)

A

Disrupt taste
Skin rashes
Nephropathy
Neutropenia

24
Q

Enalapril & fosinopril

- Excretion

A 
Both = longer t1/2 than captopril 
Enalapril = renal excretion
Fosinopril = renal and bile excretion
25
Q

Changes in plasma levels due to ACE inhibitors

  • Renin
  • AGT1
  • AGT2
  • Aldosterone
A

↓AGT2 & aldosterone
- Both downstream of ACE action
↑renin –> ↑AGT1 b/c no - FB
- Doesn’t matter b/c ↑AGT1 can’t be converted

26
Q

Aldosterone fxn

A

↑Na & H2O reabsorption in collecting duct

K wasting

27
Q

2 mineralcorticoid receptor antagonists

A

X aldosterone binding
Spironolactone
Eplerenone

28
Q

Effects of binding AT2 receptors (not AT1)

A 
Counter reg to AT1:
Vasodilation
Antiprolif
Differentiation
Plaque rupture
29
Q

When do you see AT2 receptors ↑regulated?

A

Failing heart!

Natural counter reg against AGT1

30
Q

Which drug is AT1 selective?

A

Angiotensin receptor blockers

Big deal b/c the AGT2 produced by feedback acts selectively on AT2 receptors = beneficial!

31
Q

Which drug changes AT1 & AT2 receptor activity?

A

ACE inhibitors

↓total AGT2 so can’t work on either receptor

32
Q

Plasma levels of these on ARBs

  • Renin
  • AGT1
  • AGT2
  • Aldosterone
A

↓Aldosterone

↑renin, AGT 1 & 2

33
Q 
Plasma level on renin inhibitors of 
Renin
AGT1 
AGT2
Aldosterone
A

↓all

34
Q

What is one of the biggest shared benefits of ACE, renin inhibitors, and ARBs?

A

INHIBIT vascular hyperplasia
Regress existing LVH!!!
Preserve renal fxn

35
Q

Shared adverse effects of ACE inhib, renin inhib, ARBs?

A

Hyperkalemia –> arrhythmia
Renal failure if you have renal artery stenosis
Teratogenic - don’t give to women of childbearing age

36
Q

What change is significant to pts with renal artery stenosis?

A

Any ↓AGT2

That is what is constricting the efferent arteriole of the glomerulus to maintain GFR

37
Q

What is measure to determine natriuretic peptide levels?

A

Cleavage product in plasma that has longer t1/2
= BNP
↑BNP = ↑HF level

38
Q

Effects of natiuretic peptide

  • Renal
  • Vasc
  • Cardiac
  • SNS
A

Renal: ↓Na resorption
Vasc: vasodilation
Cardiac: ↑rate relaxation, antiproliferative
SNS: ↓SNS & renin release

P&T Block 1 (43 decks)

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