Chapter 21: Vascular Tone Flashcards Preview

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Flashcards in Chapter 21: Vascular Tone Deck (33)
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1

How do nitrates work?

NO activates guanylyl cyclase and increases DEphosphorylation of myosin light chain in vascular smooth muscle. This case vasodilation.

2

What drug selectively dilates pulmonary vasculature?

Inhaled nitric oxide gas

(makes sense - INHALE/GAS/LUNGS!

3

Which drugs dilate veins moreso than arteries?

Isosorbide dinitrate
Isosorbide 5 mononitrate
NTG

4

Which drug targets arteries and veins equally by a non-enzymatic process? It is used for hypertensive emergencies.

Sodium nitroprusside.

5

Which drug comes in a transdermal patch that you should remove at night to prevent tolerance and "Monday Morning headaches"?

NTG

6

Why isosorbide 5 mononitrate preferred over dinitrate?

It has a longer half life, is absorbed better from the GI tract, less reboudn angina....

7

Which nitrate is used for newborns with hypertension?

Inhaled nitric oxide gas

8

How does NTG prevent coronary steal?

Preferentially dilates larger epicardial arteries than the smaller coronary arteries

9

With what nitrate do you have a risk for cyanide toxicity?

Sodium nitroprusside (sounds like an evil little bitch...like the king of PRUSSia)

10

What are nitrates typically used for? Short acting vs. long acting?

Acute angina attacks
Chronic heart disease

11

When does cyanate toxicity become life threatening? concentration?

200mg/L

12

SildenaFIL
VardenaFIL
TadalaFIL

MOA: Phosphodiesterase inhibitors (PDE5) leads to cGMP accumulation = smooth muscle relaxation

TX: ED

13

Phosphodiesterase inhibitors are contraindicated when?

patients also taking organic nitrates NO NO NO DON'T DO ITTT

Also pts with a history of vision loss

14

Sildenafil can be used to treat ED and what else?

pulmonary hypertension

15

How do calcium channel blockers work?

They block voltage gated Ca channels so you prevent actin myosin cross bridge formation.

16

Nifendipine

Ca channel blocker
Serious reflex tachycardia

17

Amlodipine

Ca channel blocker
Higher bioavailability

18

Felodipine

Ca channel blocker

19

Clevidipine

Ca channel blocker
IV infusion for hypertension emergencies

20

Which Ca channel blockers favor arterial vasodilation?

dyhydropyridines

21

Diltiazem & verapamil

Ca channel blockers with less vascular to cardiac selectivity....

Use for Prinzmetal angina, hypertension, tachycardia

Verapamil w/alcohol makes alcohol more potent

22

What Ca channel blocker has the most cardiac effect?

Verapamil (suppresses cardiac conductivity most)

23

MOA potassium channel openers

open ATP modulated K channels and hyperpolarize the membrane --> inhibit influx of Ca --> decrease arterial BP

24

Minoxidil
Pinacidil
Nicordandil

"Dil Pickle Potassium"

MOA: K channel opener
TX: severe hypertension or hair loss (ROGAINE!!!)
Use with beta blocker and diuretic to prevent reflect tachycardia

25

How do you prevent reflex tachycardia when administering a K channel opener?

Give a Beta blocker also

26

Rogaine is a ---?

K channel opener! Dil

27

Bosentan
Ambrisentan

"Sentan" --> Sun Tan --> endothelin gets TAN
MOA: endothelin receptor antagonist
TX: severe pulmonary hypertension
DO NOT use in preggo ladies

28

Which endothelin antagonist has greater selectivity for ETa?

Ambrisentan

29

Hydralazine

Dilates arteries
Mechanism unclear
TX: Moderate hypertension/severe heart failure
Hypertension: use with B blocker
Heart failure: use with nitro dinitrate

30

Prazosin
Doxazosin
Terazosin

a-1 antagonists in venules and arterioles
but more in arterioles
= vasodilation
reduces arterial pressure - use to tx hypertension

31

B blockers - what are they

b2 antagonists (propanolol, atenolol, LOLs)
relaxes smooth mm.
tx: hypertension, angina, cardiac craps
net effect = lower BP

32

Captopril
Enalapril
Lisinopril

ACE inhibitors
inhibit cleavage of AT1 to AT2
Reduces BP

33

Losartan
Valsartan

Block activatiion of AT1 receptors
"AT still is the sultan"