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Pharmacology > L3: Direct Acting Vasodilators > Flashcards

L3: Direct Acting Vasodilators Flashcards

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1
Q

Arterial Blood pressure is directly proportional to what?

A

CO and TPR

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2
Q

What mechanisms control CO and TPR?

A

Baroreceptor reflex and renin-angiotensiin-aldosterone system (RAAS)

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3
Q

What do most antihypertensive drugs reduce?

A

CO and TPR

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4
Q

What is the short term effect of decrease ion BP?

A
  1. Increased symp activity via baroreceptors
  2. Increased alpha-1 to contract the smooth muscle
  3. Increased Beta-1 to increase cardiac contractility and increase renin release
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5
Q

What is the long-term effect of a decrease in BP?

A
  1. Decrease in renal blood flow causes decreased renin
  2. Increased angiotensin 2 increases aldosterone which increases water retention
  3. Increased blood volume increases CO and increases BP
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6
Q

Where is angiotensin produced?
Where is Renin produced?
Where is ACE produced?

A

Liver
Kidney
Lungs

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7
Q

What is the path to get angiotensin to angiotensin 2?

A
  1. Angiotensin reacts with renin to become angiotensin I
  2. Angiotensin I reacts with ACE to become angiotensin II
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8
Q

What are the physiological effects of angiotensin II?

A
  1. Increased sympathetic activity
  2. Water retention
  3. Aldosterone secretion from adrenal medulla to increase water retention
  4. Arteriolar vasoconstriction
  5. Increased ADH secretion from the pituitary
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9
Q

What are the three ways VSM contraction can be initiated?

A
  1. Myogenic response from stretching
  2. Electrical depol from increased intercellular Ca
  3. Chemical stimuli like NE, Angiotensin, vasopressin, endothelin and TXA2
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10
Q

Does MLCK initiate contraction or relaxation? What stimulates MLCK?

A

contraction, Ca

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11
Q

Does MLCP initiate contraction or relaxation? What stimulates MLCP?

A

Relaxation, cGMP

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12
Q

What drug class is Isosorbide dinitrate?

A

Nitrate

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13
Q

What drug class is nitroglycerine?

A

Nitrate

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14
Q

What drug class is Nitroprusside?

A

Nitrate

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15
Q

What drug class is hydralazine?

A

Hydralazine

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16
Q

What drug class is sildenafil?

A

Phosphodiesterase v inhibitor

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17
Q

What drug class is Dilitiazem?

A

non-DHP CCB

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18
Q

What drug class is Verapamil?

A

Non-DHP CCB

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19
Q

what drug class is Amlodipine?

A

DHP CCB

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20
Q

What drug class is Nifedipine?

A

DHP CCB

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21
Q

What is the MOA of nitric oxide donors?

A

Release NO when metabolized
Relax smooth muscle
Inhibit platelet aggregation

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22
Q

What is the difference between the natural pathway for nitric oxide and the nitric oxide donor pathway?

A

In the donor pathway, it skips the need for endothelial cells.

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23
Q

What drugs do you not give with sildenafil?

A

Nitrates

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24
Q

What are the organic nitrates and nitrites?

A

Amyl Nitrate
Isosorbide dinitrate
Nitroglycerin

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25
What are the inorganic NO donors?
nitroprusside
26
How many NO groups do each have to donate? Amyl Nitrate Isosorbide dinirate Nitroglycerin Nitropursside
1 2 3 1
27
What are the pharmacokinetics of organic nitrates and nitrites?
Metabolized in the vein, short 1/2 life and only target veins
28
What are the pharmacokinetics of inorganic NO donors?
Metabolized in blood cells, cyanide toxicity and target veins and arteries
29
What are the pharmacodynamics of organic NO donors?
1. Increase vein capacitance which decreased preload so the heart doesn't have to work as hard. 2. Increases blood flow to coronary arteries **doesn't decrease afterload bc it doesn't work on arteries
30
What are the pharmacodynamics of inorganic NO donors?
Decrease preload and afterload
31
What happens when: 1. oxygen supply is equal to or greater than oxygen demand? 2. Oxygen demand is greater than oxygen supply 3. Oxygen demand in greater than oxygen supply but we have an NO donor?
1. This is good and normal 2. Ischemia and if it continues more than 20 min, heart attack 3. Decreased oxygen demand from NO and increased o2 from coronary blood flow prevents heart attack.
32
What is stable angina?
Working very hard and getting heart pain from exertion.
33
What is unstable angina?
Plaque that causes chest pain
34
What is variant angina?
Artery spasms that reduce blood flow
35
What type of angina is helped by organic NO donorS?
Stable angina
36
What are the clinincal uses of Isosorbide dinitrate/mononitrate?
Stable angina
37
What are the clinical uses of nitroglycerin?
HTN emergency Hypotension inductionn perioperative hypertension Angina
38
What are the clinical uses of nitroprusside?
HTN emergency
39
What is organic nitrate/nitrite tolerance?
If you use them over and over again, you develop tolerance. You need a nitrate-free period of at least 10 hours or else you can have a fast decline in BP. *No tolerance to nitroprusside
40
Which nitrate has no tolerance?
Nitroprusside
41
Which nitrate is inorganic?
nitroprusside
42
Which nitrate is used for stable angina?
Isosorbide
43
Do we use nitrate for systemic HTN?
No
44
Which nitrate can be used with viagra?
Nitroprusside
45
Which nitrate has cyanide toxicity?
Nitroprusside
46
What is the clinical use for phosphodiesterase inhibitors?
ED and pulmonary arterial hypertension
47
Why dont we use sidenafil and nitrates together?
Bc they both increase cGMP and this would lead to severe hypotension and vasodialtion.
48
What does hydralazine require to work?
NO from the endothelium
49
When do you not use hydralazine? why?
If pt has angina bc hydralazine only dilates healthy veins to even less o2 will go through the constricted vein which causes even more angina.
50
What drug can lower organic nitrate tolerance?
Hydralazine
51
What type of vessel does each drug dilate: Nitrates? Nitroprusside? Hydralazine?
veins BOTH Artery
52
What is the MOA of calcium channel blockers?
Decreased calcium influx into cells which decreases SR calcium release
53
Where do Non-DHP drugs work?
Vaculataure and heart
54
Where do DHP drugs work?
Just vasculature
55
What are the pharmacodynamics of CCBs?
Decrease HR Decreased heart force Decreased resisatnce Increased GFR Increased peeing
56
What blood vessel do CCBs work on?
Mainly arteries
57
Which works faster, Amlodipine or Nifedipine?
Amlodipine takes longer but lasts longer. Nifedipine works faster but doesn't last
58
What is done for adults with systolic/diastolic HTN 20mmHg above the target?
You may have to treat with multiple drugs
59
What populations are low rening producers and wha drugs are more useful for them?
African americans and elderly- CCBs
60
Which drugs have less effect on excercise performace compared to beta-blockers?
DHP CCBs
61
What are the preferred antihypertensive combos? What are the acceptable antihypertensive combos? What are the not preferred antihypertensive combos?
1. ACE I or ARB + thiazide 2. CCB+ thiazide (nonblack) BB + DHP CCB or thiazide 3. BB +nonDHP CCB (decrease HR too much)
62
Which drugs are used for tx of systolic HTN?
CCB
63
Non DHPs can affect which of the following? a. Coronary Blood flow B. Afterload C. Contractility and HR
A, B, C
64
DHPs can affect which of the following? a. Coronary Blood flow B. Afterload C. Contractility and HR
A, B
65
What drug would you use for unstable angina?
Non-DHP CCBs
66
What drug can you use for both Variant angina and stable angina?
All CCBs
67
Which type of CCB can you still use while on BBs?
DHP
68
Which type of CCB can cause AV block or Bradycardia?
Non DHP
69
What type of CCB is used forA-fib and PSVT?
Non-DHP
70
Which CCBs are non-DHP?
diltiazem and verapamil
71
Which CCBs are DHP?
Amlodipine, Nifedipine and nimodipine

Pharmacology (8 decks)

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