CV Module 2

Question 1

How does angiotensin II increase blood pressure?

Answer 1

It causes systemic vasoconstriction
Stimulates thirst which will increase blood volume
Increase sodium and fluid retention both through direct action on the kidney and indirectly through stimulating the adrenal cortex to release aldosterone

Question 2

What is the PD of ACE-I?

Answer 2

Interfere with the conversion of angiotensin I to angiotensin II

Question 3

How does bradykinin work in lower doses?

Answer 3

A vasodilator

Question 4

What are increased level of bradykinin though to contribute to?

Answer 4

cough with ACE-I

Question 5

What are the advantage of ACE-I?

Answer 5

No change in plasma volume or HR
No reflex sympathetic activation (safe in angina and cardiac ischema)

Question 6

Which ACE-I has a sulfur group?

Answer 6

Captopril

Question 7

Which ACE-I can be used in diabetic neuropathy?

Answer 7

Captopril

Question 8

When does the max effect of ACE-I happen?

Answer 8

2-4 weeks after starting therapy

Question 9

What is the effect of ARBs on bradykinin metabolism?

Answer 9

No effect, little chance of cough

Question 10

What is the effect of food with ACE-I, specifically captopril?

Answer 10

Food can decrease absorption from 30-40%

Question 11

What is the effect of ACE-I that african american patients experience?

Answer 11

Angioedema. Can be subtle and often attributed to a food allergy

Question 12

What are the two classes of calcium channel blockers?

Answer 12

Dihydropyridines
Non-dihydropyridines

Question 13

What are the cardiac effects of CCB?

Answer 13

Decrease contractility
Decrease HR
Decrease conduction velocity

Question 14

What are the vascular effects of CCBs?

Answer 14

Smooth muscle relaxation

Question 15

What are Dihydropyridines used for?

Answer 15

Used more in HTN
Not for the treatment of SVT, can increase HR d/t reflex tachycardia

Question 16

Where do dihydropyridines have better affinity?

Answer 16

Vascular not cardiac

Question 17

What is the mechanism of action of non-dihydropyridines?

Answer 17

Depress SA node automaticity
Slow AV node conduction

Question 18

What are the two classes of non-dihydropyridines?

Answer 18

Phenylkalmine (verapamil)
Benzothiazepin (Diltiazem)

Question 19

How does the mechanism of action of aliskiren work?

Answer 19

Vasodilation by decrease in blood volume by promoting renal excretion of sodium and water

Question 20

When should renal function be monitored when taking ACE-I?

Answer 20

during the first 3 months of therapy and when dose is changed

Question 21

What patients should have their wbc monitored when taking ACE-I?

Answer 21

Patients with collagen vascular disease

Question 22

Which ARB has the highest bioavailability?

Answer 22

Irbesartan

Question 23

Which ARB has the longest half-life?

Answer 23

Telmisartan

Question 24

How should dosing be education to patients?

Answer 24

Take at the same time every day, missed doses need to be taken as soon as remembered unless next dose is soon

Question 25

Which drug class is associated with reflex sympathetic stimulation that may cause tachycardia?

Answer 25

Dihydropyridines

Question 26

Which drug class is associated with a dry couhg, and how could this problem be ameliorated?

Answer 26

ACE-I

Question 27

Would a prescriber recommend any of the drugs in this PPT for use during pregnancy?

Answer 27

CCBs during the second half

Question 28

What are the 1st generation BB?

Answer 28

Non-selective, block all beta receptors

Question 29

What are the 2nd generation BB?

Answer 29

Relative Beta 1 selectivity at low doses

Question 30

What are the 3rd generation BB?

Answer 30

Relative beta 1 selectivity and have vasodilatory properties

Question 31

Which generation of BB cause little to no increase in blood glucose or lipids?

Answer 31

3rd generation

Question 32

What alpha adrenoceptor has the longest half life?

Answer 32

Doxazosin

Question 33

What alpha adrenoceptor is the most bioavailable?

Answer 33

Terazosin

Question 34

Which central acting alpha 2 adrenergic agonist is most commonly used in pregnancy?

Answer 34

Methyldopa

Question 35

How should you stop taking clonidine?

Answer 35

Wean to prevent rebound HTN

Question 36

Why does Clonidine cause fatigue?

Answer 36

Rapidly crosses the blood brain barrier

Question 37

What alpha adrenergic antagonist is useful in treating HTN and BPH?

Answer 37

Apha 1

Question 38

What cautions need to be taken when prescribing BB?

Answer 38

BB can mask hypoglycemia symptoms

Question 39

What is the contraindication for alpha 1 adrenergic antagonists?

Answer 39

Do not give if recent cataract surgery d/t floppy iris syndrome

Question 40

What patients should not be prescribed clonidine?

Answer 40

Demenia, CVD, d/t crossing the blood brain barrier

Question 41

How should the first dose of alpha 1 adrenergic antagonist be given?

Answer 41

Lower dose to higher; first dose needs to be given at bedtime

Question 42

What serious adverse effects to methyldopa cause?

Answer 42

Hepatic necrosis, pancreatitis, anemia, thrombocytopenia

Question 43

What patient education needs to be given with methyldopa?

Answer 43

Do not stop abruptly, take at bedtime, postural hypotension