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PMCOL 343 > 6-cardio > Flashcards

6-cardio Flashcards

(66 cards)

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1
Q

why can diuretics be good for heart failure (3)

A

relieve oedema, reduce work load, may have vasodilatory action

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2
Q

name two diuretics used in heart failure

A

thiazides, furosemide

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3
Q

what do thiazides do

A

diuretic, cause K+ loss

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4
Q

how does furosemide work

A

diuretic, causes K+ loss

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5
Q

what type of diuretic is furosemide

A

“high ceiling”, aka loop diuretics

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6
Q

what is spironolactone

A

K+ sparing diuretic

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7
Q

how does spironolactone work

A

aldosterone antagonist

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8
Q

where is aldosterone released from

A

adrenal cortex

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9
Q

what are the net effects of aldosterone

A

renal K+ loss, Na+ retention, water retention

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10
Q

what are the net effects of spironolactone

A

renal K+ retention, renal Na+ loss, renal water loss

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11
Q

what are the 3 major effects of a vasodilator on a NORMAL patient

A

dilate veins, dilate arterioles, increased heart rate

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12
Q

why does heart rate increase when vasodilators are given to normal patients (mechansim)

A

veinous dilation causes decreased preload which leads to decreased CO. dilation of arterioles leads to decreased arterial presure and decreased afterload. net effect: decreased CO and arterial pressure decreases BP, activating baroreceptors and increased HR

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13
Q

what is amyl nitrate (poppers)?

A

a recreational drug that is a fast acting NO donor, resulting in vasodilation

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14
Q

what is the net effect on BP and HR with vasodilators (in healthy subject)

A

hypotension and tachycardia

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15
Q

why does afterload increase during heart failure

A

compensatory sympathetic reflexes + increased angiotension = arteriolar constriction

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16
Q

what does high afterload do to output of a failing heart

A

it may limit output

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17
Q

why does CO increase when heart failure patients are given vasodilators?

A

less afterload so the heart will have an easier time pumping out blood

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18
Q

what happens to BP and HR when heart failure patients are given vasodilators? why?

A

BP doesn’t fall, no reflex tachycardia since the decreased peripheral resistance is balanced out by increased CO

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19
Q

where is angiotensinogen released

A

liver

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20
Q

where is renin released

A

kidneys

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21
Q

where does angiotensin converting enzyme come from

A

lungs

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22
Q

what does ACE do

A

convers angiotensin 1 into angiotensin2

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23
Q

what does renin do

A

converts angiotensinogen into andgiotension 1

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24
Q

what are the two major effects of angiotensin II

A

increase aldosterone release, vasocontriction

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25
what are 4 main effects of ACE inhibitors
vasodilation decreased aldosterone production K+ retention H2O and Na+ loss
26
what do ACE inhibitors do to bradykinin
prevents its catabolism
27
what is the role of bradykinin
potent activator of NO release from endothelium, resulting in vasodilation
28
list 3 side effects of ACE inhibitors
dry cough, angioedema and tase disturbances
29
what causes side effects of ACE inhibitors
they prevent breakdown of bradykinin which causes dry cough when acting in lungs
30
name 2 ACE inhibitors
enalapril and captopril
31
what is the mechanism of enalapril and captopril
ACE inhibitor, stop AG2 synthesis, increased Na+ and water loss
32
what are the physiological effects of ACE inhibitors
lower afterload, lower preload, incrased CO. also relieve edema by encouraging NA+/H2O loss
33
what receptor does SARS-CoV-2 use to gain entry to cells
ACE2 receptor
34
why are ACE inhibitors and ARBs speculated to worsen COVID-19 disease progression?
ACE inhibitors and ARBs tend to upregulate ACE2 expression
35
what are 2 drugs classes that are often combined to treat heart failure
ACE inhibitor and diuretic
36
why is it good to use low doses of both ACE inhibitor and diuretic instead of a high dose of one drug?
you get additive therapeutic effects and less side effects (sometimes side effects cancel out)
37
which side effects cancel out with ACE inhibitor and diuretics?
thiazide diuretics promore K+ loss and ACE inhibitors promote K+ retention, resulting in normal K+
38
name 3 angiotensin 1 receptor blockers (ARBs)
losartan, candesartan, telmisartan
39
which have more side effects: ACE inhibitors or ARBs?
ACE inhibitors
40
why do ARBs have less side effects than ACE inhibitors?
ARBs do not result in increased bradykinin levels
41
what class of drugs are amrinone and milrinone
phosphoriesterase inhibitors
42
what are the physiological effects of amrinone and milrinone
increase contraction of the heart, reduce contraction of smooth muscle
43
how do beta agonists work on cardiac muscle
cAMP, PKA, increase Ca++ through L type
44
is myocin light chain kinase in heart
no
45
how do B2 agonists cause vascular smooth muscle relaxation
elevated cAMP inactivates MLCK by phosphorylating it so then it cant contract
46
what is hypertension
elevated peripheral resistance resulting in a resting BP of 140/90
47
what can hypertension lead to
heart failure, strok, kidney damage
48
what are 4 therapeutic approaches to high BP
- diuretics - sympatholytic agents - direct vasodilators - ACE inhibitors/ARBs (drugs that block angiotensin)
49
how can diuretics be used to treat hypertension
promote hypertension depleting Na+ reduces blood vessel stiffness vasodilatory action
50
thiazides inhibit reabsorption of which ions? where?
NaCl in the distal convoluted tubule
51
what is propanolol
beta 1 and 2 receptor antagonist
52
what is metoprolol
b1 selective antagonist
53
why can metoprolol be better than propranolol
acute vasodilatory action from b2 receptors may reduce effectiveness ( you dont wanna block those )
54
what are 4 main things that beta blockers do
- inhibit renin release by NA - inhibit presynaptic beta receptors that increase NA release - reduce sympathetic outflow (possible actions in CNS) - slows HR during exercise and stress
55
name 4 vasodilators used to treat hypertension
hydralazine nitroprusside verapamil nifedipine (DHPs)
56
what does hydralazine do (3)
arteriolar vasodilation, lowers BP and reflex tachycardia
57
what do you usually combine with hydralazine and why
beta blocker to help prevent the reflex tachycardia
58
what is nitroprusside? when is it used?
powerful arteriolar and venous vasodilator used in hypertension emergencies
59
name two Ca2+ channel blockers used to treat hypertension
verapamil nifedipine (and other DHPs)
60
what are 3 agents that block the production or action of angiotensin
captopril enalapril losartan
61
what is captopril
ACE inhibitor
62
what is enalapril
ACE inhibitor
63
what is losartan
angiontensin receptor blocker
64
does captopril make the dry cough
yes
65
does enalapril make the dry cough
yes
66
does losartan make the dry cough
no

PMCOL 343 (31 decks)

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