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Cardio VIII and IX Flashcards

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1
Q

What happens when there is increased baroreceptor firing?

A

Decreased sympathetic drive and increased parasympathetic tone, resulting in decreases in peripheral resistance, HR, BP

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2
Q

What is the basis for electrically stimulating the baroreceptor?

A

Will decrease sympathetic tone, and increase parsympathetic

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3
Q

What is the MOA of alpha-methyldopa? Is this safe to use in pregnancy? What are the disadvantages to this?

A

Alpha 2 agonist
yes
Short acting

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4
Q

What are 5 drugs that are safe to use to treat HTN in pregnancy?

A 
Alpha-methyldopa
labetalol
Nifedipine
Hydralazine
Metoprolol
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5
Q

What is the MOA of labetalol? is it safe to use in pregnancy?

A

third generation beta blocker (b1=b2>a1>a2)

yes, but short acting

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6
Q

Why is labetalol preferred to use in pregnancy, over other beta blockers?

A

Theoretical beneficial effect of alpha blockage on uteroplacental blood flow

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7
Q

What is the MOA of nifedipine safe to use in pregnancy?

A

CCB

Yes

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8
Q

What is the major drawback/ potential side effect of using hydralazine in pregnancy to treat HTN?

A

Increased risk of maternal hypotension

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9
Q

What is the MOA of metoprolol? Is it safe to use in pregnancy?

A

beta blocker

Yes

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10
Q

What are the three drugs that are generally avoided in treating HTN during pregnancy?

A

Diuretics
Atenolol
Nitroprusside

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11
Q

Why are diuretics avoided when treating HTN in pregnant individuals?

A

May impair pregnancy-associated expansion in plasma volume

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12
Q

Why is atenolol not used to treat HTN in pregnant patients?

A

May impair fetal growth

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13
Q

Why is nitroprusside not used to treat HTN in pregnancy?

A

Risk of fetal CN poisoning

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14
Q

What are the two drugs to treat HTN that are contraindicated in pregnancy?

A

ACE inhibitors

Angiotensin receptor antagonist

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15
Q

Why are ACE inhibitors contraindicated in pregnancy?

A

Multiple fetal abnormalities

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16
Q

Why are angiotensin receptor antagonists contraindicated in pregnancy?

A

Multiple fetal abnormalities

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17
Q

Which ethnicity does not respond well to ACEI?

A

African Americans

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18
Q

What is the first line treatment for HTN with DM? Additional?

A

ACEI or ARB

Thiazide and Beta blockers

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19
Q

Anginal pain is due to the release of what chemicals?

A

Bradykinin

Adenosine

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20
Q

Angina, unstable angina, or acute MI: retrosternal chest pressure/burning, or heaviness that radiates to the jaw/left arm

A

Angina

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21
Q

Angina, unstable angina, or acute MI: precipitated by exercise, cold weather, or emotional stress

A

Angina

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22
Q

Angina, unstable angina, or acute MI: typically

A

unstable angina

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23
Q

Angina, unstable angina, or acute MI: sudden onset, usually lasting >30 minutes, usually associated with SOB, n/v weakness

A

Acute MI

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24
Q

What is the effect of beta blockers on O2 demand of cardiac tissues? How?

Study These Flashcards
A

Decreases via decreased HR, contractility

25
What is the effect of organic nitrates on myocardial O2 demand? How?
Decreases via preload and afterload
26
What is the effect of vasodilators on myocardial O2 supply?
Increase supply via increased coronary blood flow
27
What is the effect of statins and antithrombotics on oxygen supply of the heart?
Increase via increase regional blood flow
28
What is the MOA of NTG?
Organic nitrate
29
What is the MOA of isosorbide dinitrate (ISDN)?
Organic nitrate
30
What is the MOA of isosorbide mononitrate (ISMN)?
Organic nitrate
31
What is the general MOA of nitrates?
Prodrugs that must undergo denitrification by mitochondrial aldehyde reductase to yield NO
32
What is the effect of NO on tissues?
Activates soluble GC, which increases cGMP, increasing mitochondrial Ca uptake, and decreases Ca influx
33
What is the effect of soluble GC on Ca in cells (2)?
Decreases uptake | Increases uptake by mitochondria
34
CP that changes with inspiration is probably what?
Not caused by MI
35
CP that is TTP is probably what?
Not MI--think costochondritis
36
What is the enzyme in the mitochondria that converts the prodrug of nitrates to NO?
Mitochondrial aldehyde reductase
37
What enzyme is phosphorylated when NO is added to cells?
MLCK (which inactivates it, and causes vasorelaxation)
38
How long does it take for nitrate tolerance to develop?
24 hr period
39
How can you maintain the effect of nitrates, and prevent the tolerance that develops?
Using dosing regimens that allow for a nitrate-free time for several hours
40
What are the tissues that metabolize NTG?
hepatic | Intravascular
41
What are the two routes by which NTG is given?
SL or TD
42
True or false: there is no evidence for NTG's efficacy when given orally
True
43
How is isosorbide dinitrate given? What is the usual dose?
PO or SL | QD dosing
44
Which of the nitrates does not undergo a first pass hepatic metabolism?
Isosorbide mononitrate
45
Which of the nitrates can be given QD?
Isosorbide di and mononitrates
46
What is the major effect of nitrates?
Potent vasodilation to decrease ventricular volume and preload
47
What is the effect of nitrates on peripheral vascular resistance?
None
48
What is the effect of nitrates on the coronary resistance? What is the importance of this?
None | No coronary steal
49
What is coronary steal?
Vasodilation in one area of the heart leads to decreased blood flow to another area.
50
What is the therapeutic use of SL nitrates?
Acute attacks of angina | Prophylactically before doing something that would cause angina
51
What is the therapeutic use of long-acting nitrates?
Aginal pain and to increase exercise tolerance
52
What should you do if giving a pt NTG for the first time?
Have them lie supine
53
What diseases, besides angina, are nitrates used?
acute HF and active ischemia
54
ISDN and what other drug is useful for treating CHF in african americans?
Hydralazine
55
Why are nitrates useful in treating CHF?
Decreases preload
56
What is the MOA of using nitrates for an MI?
Dilation and prevention of constriction of epicardial coronary constriction
57
What are the two side effects of NTG?
HA | Hypotension
58
How should you begin ISDN treatment?
Titrated up over several days
59
Q waves greater than 1 mm^2 indicates what?
Previous MI

Pharm (73 decks)

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