Cardio VII Flashcards by tcarlso 3

Q

What are the three broad groups of ACEIs?

A

Sulfhydryl
Dicarboxyl
Phosphorus

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Q

The sulfhydryl group of ACEI are structurally related to what drug?

A

Captopril

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Q

The dicarboxyl group of ACEI are structurally related to what drug?

A

Enalapril

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Q

The phosphorus group of ACEI are structurally related to what drug?

A

Fosinopril

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Q

What is the MOA of ACEIs?

A

Decreased production of angiotensin II, causing decreased vasoconstriction, decreased aldosterone, and decreased Na reuptake

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Q

What is the special advantage that ACEIs confer to DM pts?

A

slowing the development of diabetic retinopathy

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Q

How do ACEIs slow chronic renal disease formation?

A

slow glomerulosclerosis, which causes HTN

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Q

What is the relationship between ACEIs and CAD, LV dysfunction, and ischemic stroke?

A

Improves ventricular dysfunction, and reduce morbidity/mortality

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Q

What is the effect of ACEIs on bradykinin?

A

Inhibits its breakdown, causing vasodilation

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Q

Drug that has an -opril or -april suffix is what kind of drug?

A

ACEI

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Q

True or false: you should never combine ACEIs with diuretics

A

False–very commonly used together

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Q

What organ is responsible for most of the clearance of ACEIs? What disease, then, do you have to reduce the dose for?

A

Kidneys

Renal disease

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Q

What should you do in pts with high plasma renin levels?

A

Reduce doses

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Q

What are the absolute contraindications for ACEIs?

A

Pregnancy
Bilateral artery stenosis
h/o angioedema

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Q

What disease is there a potentially favorable effect of using ACEIs?

A

Prediabetes

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Q

What are the two situations in which there may be a potentially unfavorable effect of ACEIs?

A

Hyperkalemia

Volume depletion

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Q

Why should you not give ACEIs to a pt with bilateral renal artery stenosis?

A

GFR is maintained by angII’s effects to increase resistance in the post-glomerular arteriole

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Q

Why are ACEIs contraindicated with hyperkalemia?

A

Stopping aldosterone decreases K loss

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Q

What is the most common adverse effects of ACEIs?

A

Dry coughing

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Q

Angioedema is an adverse effect of what drugs?

A

ACEIs

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Q

What is the MOA of losartan?

A

Block angiotensin type I receptor

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Q

What is the MOA of valsartan?

A

Block angiotensin type I receptor

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Q

What is the MOA of candesartan?

A

Block angiotensin type I receptor

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Q

What is the MOA of irbesartan?

A

Block angiotensin type I receptor

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What is the MOA of telmisartan?

Block angiotensin type I receptor

What is the MOA of olmesartan?

Block angiotensin type I receptor

What is the MOA of eprosartan?

Block angiotensin type I receptor

What is the effect of blocking the angiotensin type I receptor?

Decreased angiotensin II effects (vasoconstriction, aldosterone secretion, Na/water retention)

What is the effect of angiotensin II on smooth muscle contraction?

increased

What is the effect of angiotensin II on thirst?

Increased

What is the effect of angiotensin II on vasopressin release?

Increased

What is the effect of angiotensin II on aldosterone secretion?

Increased

What is the effect of angiotensin II on release of adrenal catecholamines?

Increased

What is the effect of angiotensin II on noradrenergic neurotransmission?

Increased

What is the effect of angiotensin II on sympathetic tone?

Increased

Drugs with -artan suffix = ?

angiotensin antagonist

What is the drug of choice for treating HTN in pts with intolerance to ACE inhibitors?

Angiotensin receptor antagonists

ARBs are not used in the treatment of HTN in pts with what previous condition?

Stroke

What are the absolute contraindications for ARBs?

Pregnancy | Bilateral artery stenosis

What are the diseases that have benefits with ARBs?

pre DM

What are the two situations that have unfavorable effects with ARBs?

Hyperkalemia | Volume depletion

What types of drug is nifedipine?

dihydropyridine Ca channel blocker

What type of drug is amlodipine?

dihydropyridine Ca channel blocker

What type of drug is felodipine?

dihydropyridine Ca channel blocker

What are the two conditions where DHP Ca channel blockers may be an add on therapy for treating HTN?

DM | CAD

DHP Ca channel blockers are an alternative to what in CAD?

Beta blockers

What condition absolutely contraindicates DHP Ca channel blockers?

left ventricular dysfunction

What diseases do DHP Ca channel blockers have a potentially beneficial effect?

Reynaud syndrome elderly pts with isolated systolic HTN

What are the situations in which DHP Ca channel blockers have a potentially unfavorable effect?

Tachycardia

NDHP drugs are used as an alternative to beta blockers in which disease?

CAD

What disease should you avoid using NDHP to treat HTN?

Left ventricular dysfunction

What are the three situations in which NDHP for HTN are favorable?

Migraine HA Arrhythmias tachycardia

What is the situation in which NDHPs have a potentially unfavoarble effect?

Low normal HR

What is the MOA of verapamil?

NDHP

What is the MOA of diltiazem?

NDHP

Thiazide diuretics are first line therapy for what conditions?

Left ventricular dysfunction | Previous ischemic stroke

Why is there a favorable effect of treating HTN with thiazide diuretics in pts at risk of osteoporosis?

Increases Ca absorption

Why are thiazide diuretics contraindicated in pts with pre-DM?

Causes hyperglycemia

Is Propranolol a selective, nonselective, beta blocker?

Selective (for beta 1)

What are the first generation beta blockers? Are these selective or nonselective?

Propanolol Nadolol timolol Pindolol Nonselective

What are the second generation beta blockers? What is the receptor affinity for these?

``` Atenolol Metoprolol Esmolol Beliprolol Acebutolol ``` B1 >>>>> B2

What are the third generation beta blockers? What is the receptor affinity?

Labetalol Carvedilol B1 = B2 > a1 > a2

Beta blockers are first line therapy for HTN what?

CAD | LVD

What is the MOA of spironolactone?

Aldosterone antagonist

What is the MOA of eplerenone?

Aldosterone antagonist

What are the three characteristics of "other" drugs used to treat HTN?

1. Effective in lowering BP 2. Are approved for HTN 3. Have not been shown to reduce CV events

What is the MOA of prazosin?

Alpha 1 receptor antagonist

What is the MOA of doxazosin?

Alpha 1 receptor antagonist

What is the MOA of terazosin?

alpha 1 receptor antagonist

What is the basis for using alpha 1 receptor antagonists in treating BP?

Block vasoconstrictive effects of alpha 1 on vessels

What are the adverse effects of alpha 1 antagonists (e.g. prazosin) in treating BP?

reflex tachycardia | Sexual dysfunction

What is the MOA of clonidine?

Alpha 2 agonists

What is the basis for using alpha 2 agonists (e.g. clonidine) in treating HTN?

Decrease sympathetic outflow

What is the MOA of alpha methyldopa?

Alpha 2 agonist

What is the MOA of apraclonidine?

Alpha 2 agonist

What is the MOA of brimonidine?

alpha 2 agonist

What are the adverse effects of alpha 2 agonists?

Anticholinergic effects

What is the potential issue of stopping an alpha 2 receptor agonist abruptly?

Rebound HTN

What other drug is used in combination with alpha 2 receptor agonist?

Diuretic

What specific condition is alpha-methyldopa used to treat HTN in?

Gestational HTN | Chronic HTN in pregnancy

What is the MOA of hydralazine?

Decreases IP3 / Ca in arteries, causing vasodilation

What is hydralazine used for? (3)

1. Add on for resistant HTN 2. Severe chronic kidney disease 3. Gestational HTN

What are the adverse effects of hydralazine?

induces SLE with long term use Tachycardia d/t Na retention

What are the two drugs that should be added when using hydralazine?

beta blocker and diuretic

What is the MOA of minoxidil?

Opens K channels, causing vasorelaxation

What is the role of minoxidil in antiHTN therapy?

Only for severe, refractory HTN

What drugs should be combined with minoxidil?

beta blockers and diuretics

What is the major adverse effect with minoxidil?

Reflex increase in myocardial contractility

What is the MOA of sodium nitroprusside?

donates NO, cGMP mediated Ca sequestration

What is the effect of sodium nitroprusside on the heart?

Decreases afterload and preload

How is sodium nitroprusside administered?

IV

What are the adverse effects of sodium nitroprusside?

CN poisoning | Methemoglobin

What is the MOA of aliskiren?

Direct renin inhibitor | = prevents it from cleaving angiotensinogen

What should you use aliskiren for?

monotherapy in HTN

What are the drugs that should be used in combination with aliskiren?

ACEIs, thiazide or ARB

What is the MOA of reserpine?

Blocks VMAT in catecholamine synapses

The most effective use of reserpine is in combination with what other type of drug?

Thiazide diuretic

What are the side effects of reserpine?

Strong sympatholytic effect | increased parasympathetic activity

Rauwolfia alkaloid = what drug?

Reserpine

Why are diuretics a good choice for second line therapy in RHTN?

Most pts are fluid overloaded

What is the major diuretic to treat RHTN?

Chlorthalidone

Which aldosterone receptor antagonist is used in the treatment of RHTN?

Spironolactone

Which alpha 2 blocker is used in the treatment of RHTN?

Doxazosin

Which epithelial Na channel blocker is used in the treatment of RHTN?

Amiloride

To lower BP, do you want to cut the sympathetic or parasympathetic tone from the kidneys?

lower sympathetic tone