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Flashcards in CV Deck (68):
1

big 4 that contribute to atherosclerosis

HTN (primary)
hyperlipidemia (primary)
DM (T2)
smoking
(obesity as well)

2

CV #1 killer in US primarily due to

ischemic heart disease and stroke

3

"athero" "sclerosis"

porridge - hardening

4

location of atherosclerosis

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

5

conditions that result from atherosclerosis

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

6

antiHTN drugs: diuretics

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

7

primary vs secondary HTN

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

8

in HTN

elevation in vascular resistance +/- preceded by ^CO
*we refer to SYSTEMIC* pulmonary HTN rarely

9

non-drug tx

dietary (lower Na)
exercise

10

antiHTN drugs: adrenergic neuron blockers

*reserpine
*methyldopa
*clonidine (catapres)

11

antiHTN drugs: adrenergic receptor blockers

*Prazosin (Minipress)
*Doxazosin (Cardura)
*Terazosin (Hytrin)

12

loop diuretics

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

13

thiazide diuretics

inhib. reab of NaCl at distal tubule

14

antiK+ sparing diuretics

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

15

antiHTN drugs: B-adrenergic rec blockers

Propranolol (Inderal‐LA)
*Nadolol (Corgard)
*Timolol
*Pindolol
*Atenolol (Tenormin)
*Metoprolol (Toprol‐XL)
*Acebutolol (Sectral

16

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

*Labetalol (Trandate) (not NO-releasing)
*Nebivolol (Bystolic) (NO releasing)

17

antiHTN drugs: Direct Arteriolar Dilators

Hydralazine
Minoxidil

18

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

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

19

antiHTN drugs: Angiotensin Converting Enzyme (ACE) Inhibitors

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

20

antiHTN drugs: Angiotensin II Receptor Blockers (ARBs)

*Losartan (Cozaar)
Valsartan (Diovan)
Candesartan (Atacand)
**"SARTANS"**

21

antiHTN drugs: Renin Inhibitors

Aliskiren (Tekturna)
-inhibits AFTER released, dec. renin activity

22

ACE inhibitors

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

23

AngII causes

vasoconstriction and aldosterone secretion
if inhib: dec. resistance, dec. MORE

24

Ezetimibe (Zetia)

cholesterol absorption inhibitor

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)