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1
Q

big 4 that contribute to atherosclerosis

A 
HTN (primary)
hyperlipidemia (primary)
DM (T2)
smoking
(obesity as well)
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2
Q

CV #1 killer in US primarily due to

A

ischemic heart disease and stroke

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3
Q

“athero” “sclerosis”

A

porridge - hardening

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4
Q

location of atherosclerosis

A

arterial intima, beneath inner endo. cell lining of large and medium-sized arteries–>narrowing of art. lumen

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5
Q

conditions that result from atherosclerosis

A

angina pectoris and MI
TIA and ischemic forms of stroke
cardiac arrhythmias and CHF

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6
Q

antiHTN drugs: diuretics

A 
*hydrochlorothiazide (microzide)
chlorthalidone (thalitone)
indapamide
*furosemide (lasix)
triamterene (dyrenium)
*spironolactone (aldactone)
eplerenone (inspra)
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7
Q

primary vs secondary HTN

A

prim: don’t know cause, genetic, salt sensitivity
sec: i.e. pheochromocytoma triggers HTN

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8
Q

in HTN

A

elevation in vascular resistance +/- preceded by ^CO

we refer to SYSTEMIC pulmonary HTN rarely

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9
Q

non-drug tx

A

dietary (lower Na)

exercise

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10
Q

antiHTN drugs: adrenergic neuron blockers

A
  • reserpine
  • methyldopa
  • clonidine (catapres)
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11
Q

antiHTN drugs: adrenergic receptor blockers

A
  • Prazosin (Minipress)
  • Doxazosin (Cardura)
  • Terazosin (Hytrin)
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12
Q

loop diuretics

A

inhib. reabsorption of Na and Cl (water follows out in urine)
* more powerful than thiazides*

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13
Q

thiazide diuretics

A

inhib. reab of NaCl at distal tubule

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14
Q

antiK+ sparing diuretics

A

inhib. reab. of Na at collecting duct, K+ spared

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15
Q

antiHTN drugs: B-adrenergic rec blockers

A

Propranolol (Inderal‐LA)

  • Nadolol (Corgard)
  • Timolol
  • Pindolol
  • Atenolol (Tenormin)
  • Metoprolol (Toprol‐XL)
  • Acebutolol (Sectral
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16
Q

antiHTN drugs: a1/B Blocker and NO‐releasing β1 Blocker

A
  • Labetalol (Trandate) (not NO-releasing)

* Nebivolol (Bystolic) (NO releasing)

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17
Q

antiHTN drugs: Direct Arteriolar Dilators

A

Hydralazine

Minoxidil

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18
Q

antiHTN drugs: Calcium Channel Blockers (CCB) (in cell mem.,–>less Ca2+ influx)

A

*Verapamil (Calan) Diltiazem (Cardizem) (dec cardiac contractions)
*Nifedipine (Procardia ‐ XL) (dec. sm. musc. contr in arterioles)
Felodipine
Amlodipine (Norvasc)

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19
Q

antiHTN drugs: Angiotensin Converting Enzyme (ACE) Inhibitors

A 
*Captopril (Capoten)
Enalapril (Vasotec)
Lisinopril (Prinivil, Zestril)
Quinapril (Accupril)
Ramipril (Altace)
**all "PRILS"**
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20
Q

antiHTN drugs: Angiotensin II Receptor Blockers (ARBs)

A

*Losartan (Cozaar)
Valsartan (Diovan)
Candesartan (Atacand)
“SARTANS”

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21
Q

antiHTN drugs: Renin Inhibitors

A

Aliskiren (Tekturna)

-inhibits AFTER released, dec. renin activity

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22
Q

ACE inhibitors

A

inhib. conversion of AngI to ACTIVE AngII
AngII causes: vasoconstriction and aldosterone secretion
if inhib: dec. resistance, dec.

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23
Q

AngII causes

A

vasoconstriction and aldosterone secretion

if inhib: dec. resistance, dec. MORE

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24
Q

Ezetimibe (Zetia)

A

cholesterol absorption inhibitor

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25
Cholestyramine (Questran) Colestipol (Colestid) Colesevlam (WelChol)
bile acid binding resins
26
STATINS***
``` HMG-CoA Reductase Inhibitors *Lovastatin (Mevacor) Pravastatin (Pravachol) Simvastatin (Zocor) Atorvastatin (Lipitor) Rosuvastatin (Crestor) ```
27
importance of statins
HMG-CoA reductase** is rate limiting enzyme of cholesterol production in LIVER triggers endogenic prod. pathway: VLDL-->IDL-->LDL-->tissue
28
antidiabetic agents
insulin preps insulin secretory drugs (need more-directly stimulate) insulin sensitizing drugs (help insulin along- Metformin) a-glucosidase inhibitors (dec. gluc absorp) incretin mimetics (stim. insulin release) dipeptidyl peptidase IV inhibs (inhib. incretin brkdwn) amylin analogs
29
insulin main action
stim. glucose uptake to tissue inhib. glucose rel. from liver * all to lower blood glucose* (hyperglycemia)
30
consequences of atherosclerosis
angina
31
antianginal agents: nitrates
*Nitroglycerin (Minitran, Nitrostat) Isosorbide Dinitrate (Isordil) Isosorbide Mononitrate (Ismo) Amyl Nitrite
32
antianginal agents: Ca-channel blockers
*Nifedipine (Procardia XL) (vasculature) (misnomer!) Amlodipine (Norvasc) *Verapamil (Isoptin SR, Calan) (heart) Diltiazem (Cardizem) *"DIPINES"* dihydropyridines Ca2+ channel blockers in vasculature
33
antianginal agents: B-adrenergic blockers
``` [B1 and B2] *Propranolol (Inderal‐LA) *Nadolol (Corgard) *Timolol [B1 only] *Atenolol (Tenormin) *Metoprolol (Toprol‐XL) ```
34
3 types of angina: 1. atherosclerotic obstruction
plaque in large coronary arteries-->classic angina pectoris (effort or stable angina) *most common!* triggered by exercise, not enough O2 reaching heart, switch over to other pathway creating toxic metabolites -does not dilate very well, vasodilators will NOT help, make worse
35
3 types of angina: 2. vasospastic angina
reversible vasospastic reduction of flow in large coronary arteries (variant angina, Prinzmetal's angina)
36
3 types of angina: 3. unstable or crescendo angina
combo of 1st 2: or sudden marked platelet aggreg. with clot form. at site of ruptured plaque (rest or exertion) *may be immediate precursor to MI!!*
37
other ways to help atherosclerotic obstruction
reduce O2 DEMAND in tissue blocked by obstructed vessel
38
preload dep. on
venous smooth muscle tone, venous fluid volume
39
how to dec. preload to to red. O2 demand
* dec. VENOUS smooth muscle tone-->*nitrates*: becomes NO (rarely: dec. arteriole tone) dec. venous fluid volume (takes long time for diuretic to do that)
40
to dec. contractility/rate to red. O2 demand
B-blockers | Ca2+ chan. blockers (verapamil)
41
dec. afterload to red. O2
nifenampine, etc??
42
CHF drugs: digitalis glycosides and rel. agents
*Digoxin (Lanoxin) Digitoxin Digoxin Immune Fab (DigiFab)
43
CHF drugs: non-glycoside inotropic agents (+/- inotropic agents)
*Dobutamine *Dopamine | Inamrinone Milrinone
44
CHF drugs: ACE inhib.
*Captopril (Capoten) Enalapril (Vasotec) Fosinopril (Monopril) Quinapril (Accupril)
45
CHF drugs: AngII rec-I blocker
*Losartan (Cozaar) Valsartan (Diovan) Candesartan (Atacand)
46
CHF drugs: diuretics
*Hydrochlorothiazide (Microzide) *Furosemide (Lasix) *Spironolactone (Aldactone) Epleronone (Inspra)
47
CHF drugs: direct vasodilators
*Nitroglycerin (Minitran) Hydralazine Nitroprusside (Nitropress) Isosorbide Dinitrate (Isosordil) Nesiritide (Natrecor)
48
CHF
chronic impaired ability of ventricles to adequately fill AND/OR eject blood volume (diastolic or systolic failure)-->low ventr. output
49
causes of CHF
acute MI, pulmonary hypertension
50
CHF s/s
fesp, renal, musc, cardiac
51
preload is high/low in CHF?
it is HIGH, consequence of CHF
52
B receptors
stimulate Ca2+, inc. contractions in systole and diastole?
53
independent CHF mechanisms
1. impaired contractile proteins 2. inadequate reuptake and release of Ca2+ by SR 3. dec. B-rec cAMP function (downreg.)
54
inc. PRELOAD
inc. Stroke Volume
55
in CHF, inc. PRELOAD
does not appropriately inc. Stroke Volume | have high venous pressure
56
inc. PRELOAD
dec. Stroke Volume *even more so in CHF* vasodilators will help this (nitro, need high does to dilate arteries)
57
inc. HR
inc. CO until LIMIT-->then dec. (fluttering, inadequate filling time) tx with B blockers** (counter intuitive, but this is why it works!)
58
body attempts to compensate for CHF
hypertrophy-->exacerbates! SNS and RAAS go into high gear-->also exacerbate (SNS: tachycardiac, inc. HR, inc. afterload (constr) inc. preload)
59
why B rec. downreg.
chronic elevated SNS activity | *B blockers prevent down regulation @ B rec!*
60
the RAAS system may be detrimental to
structural changes of myocardium
61
digitalis glycoside mech
inhib of Na/K exchange-->increase Na-->dec. Na/Ca exchange (disrupted gradient due to inc. IC [Ca2+]-->inc. Ca2+-->inc. contraction
62
dec. automaticity in potential cardiac pacemaker cells
prevent ???
63
anti-CHF drugs: B-blockers
*Metoprolol (Toprol‐XL) Bisoprolol (Zebeta) Carvedilol (Coreg)
64
Class I antiarrhythmias
``` Class 1A Quinidine Procainamide Class 1B *Lidocaine (Xylocaine) Class 1C Flecainide (Tambocor) ```
65
Class II antiarrhythmias
``` *Propranolol (Inderal‐LA) *Acebutolol (Sectral) *Esmolol (Brevibloc) ```
66
Class III antiarrhythmias
*Amiodarone | Cordarone
67
Class IV antiarrhythmias
*Verapamil (Calan)
68
if slope not flat during phase 4
automaticity (slope suppressed with Ca rec. blocking drugs)

Pharm (45 decks)

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