Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

HLTH 2511 > Module C: 10-13 > Flashcards

Module C: 10-13 Flashcards

1
Q

The majority (~95%) of hypertension is classified as _______ (primary / secondary) hypertension

A

Primary

this is hypertension that can not be attributed to a specific cause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

normal ranges for SBP are _______ for normal, _________ for prehypertension, _________ for stage 1 hypertension, and _________ for stage 2 hypertension

A

Normal: <120

Prehypertension: 120-139

Stage 1 HT: 140-159

Stage 2 HT: 160+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The diuretics that are most frequently used in the treatment of hypertension are:

A

Thiazide diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The 5 common classes of diuretic and their site of action are:

A
  1. Thiazide and thiazide-related
    • NaCl Symporter in DCT
  2. Loop
    • NaK2Cl costransporter in thick ascending limb of loop of henle
  3. Potassium sparing
    • Aldosterone receptors or Na channels in CD
  4. Osmotic
    • Cause osmotic diuresis
  5. Carbonic anhydrase inhibitors
    • Carbonic anhydrase near PCT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the effects of thiazide diuretics on electrolyte balance

A

Increased excretion of sodium, potassium, and magnesium. Retention of Calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The hypokalemia caused by thiazide and loop diuretics may cause a secondary ___________ (blood pH imbalance)

A

Hypokalemic metabolic alkalosis

body cells exchange H+ ions for potassium in an attempt to preserve serum potassium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Explain why thiazide diuretics may be used in treatment of nephrolithiasis

A

thiazides reduce calcium excretion and thereby reduce calcium concentration of the filtrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Apo-Hydro (Hydrochlorothiazide)

A
  • thiazide diuretic
  • Acts on NaCl symporter in DCT, causing natriuresis, kaliuresis, and Calcium retention
  • First line diuretic for treatment of hypertension and edematous states.
  • Also used in treatment of nephrolithiasis, diabetes insipidus, and renal disorders
  • Common side effects: hypokalemia, hyperglycemia, hyperlipidemia, hyperuricemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

_______ diuretics are called “high-ceiling” diuretics because they produce a __________ (dose - dependent / flat) dose-response curve.

A

loop** diuretics are called “high-ceiling” diuretics because they produce a **dose-dependent dose-response curve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the effects of loop diuretics on electrolyte balance

A

Increased excretion of sodium, potassium, magnesium, and calcium

contrast this with the calcium-sparing effects of the thiazide diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Common non-electrolyte side effects of thiazide diuretics include:

A

Hyperuricemia, hyperglycemia, and hyperlipidemia. May also cause a hypokalemic metabolic alkalosis

result of inhibition of uric acid secretion from the PCT and decreased insulin sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The preferred diuretics for treatment of edematous states (CHF, pulmonary edema, cirrhosis, nephrotic syndrome, etc.) are:

A

loop diuretics

especially due to their dose-dependent response across the therapeutic range

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Lasix (Furosemide)

A
  • Loop diuretic
  • Inhibits the Na/K/2Cl cotransporter in thick ascending limb of loop of henle
  • high-ceiling dose-dependent diuretic
  • Preferred first line diuretic for edematous states
  • Adverse effects: hypokalemia, hypomagnesemia, hypocalcemia, hyperglycemia, hyperuricemia, ototoxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

_______ is a diuretic that has an anti-androgenic effect and is therefore used in treatment of PCOS

A

spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The two classes of potassium-sparing diuretics are:

A

sodium-channel blockers and aldosterone receptor antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment of edematous states that causes hypokalemia may be supplemented with:

A

a potassium-sparing diuretic like spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Aldactone (Spironolactone)

A
  • Potassium-sparing diuretic, aldosterone receptor antagonist
  • inhibits binding of aldosterone in the late DCT and collecting duct, which prevents expression of sodium channels.
  • Used in combination with other diuretics to prevent hyperkalemia, in treatment of primary hyperaldosteronism, and in PCOS as an anti-androgenic
  • Adverse effects; gynecomastia and infertility in men, hyperkalemia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Osmotic diuretics are primarily used to manage: (list 2)

A

glaucoma and cerebral edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Mannitol

A
  • osmotic diuretic
  • increases filtrate osmolarity, drawing additional fluid into urine and causing diuresis
  • Used in treatment of cerebral edema, increased intraocular pressure (glaucoma), and to icrease urine volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Diamox (Acetazolamide)

A
  • Carbonic anhydrase inhibitor, diuretic
  • Inhibits Carbonic anhydrase at the PCT, which causes increased bicarbonate excretion and a weak diuretic effect
  • may cause a secondary metabolic acidosis
  • used in treatment of glaucoma, acute mountain sickness, and epilepsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Common non-electrolyte side effects of loop diuretics include:

A

Hyperuricemia, hyperglycemia, and ototoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Name the preferred first-line class of diuretic for treatment of each of the following states:

  1. Edematous states (cirrhosis, CHF, etc.)
  2. Hypertension
  3. Hypokalemia
  4. Renal impairment
  5. Glaucoma
  6. Nephrolithiasis
  7. High altitude sickness
  8. Cerebral edema
A
  1. Edematous states (cirrhosis, CHF, etc.)
    • Loop diuretics
  2. Hypertension
    • Thiazides
  3. Hypokalemia
    • K+ - sparing
  4. Renal impairment
    • Loop
  5. Glaucoma
    • CAIs
  6. Nephrolithiasis
    • thiazides
  7. High altitude sickness
    • CAIs
  8. Cerebral edema
    • osmotic diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Carbonic anhydrase inhibitors cause increased excretion of _________ and may therefore cause a matabolic ________

A

Carbonic anhydrase inhibitors cause increased excretion of bicarbonate** and may therefore cause a metabolic **acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Suggest two ways in which thiazide diuretics provide a therapeutic effect in hypertension

A

in early treatment they lower BP through natriuretic diuresis. With prolonged treatment there is a decrease in sodium in arteriolar smooth muscle cells, causing vasodilation and decreased PVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Describe how potassium-sparing diuretics are used in the management of hypertension

A

Potassium-sparing diuretics are highly effective anti-hypertensives, but also have a relatively high rate of adverse events, so they are used in hypertension not already managed with 3 other drugs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

The four major classes of antihypertensive agents are:

A
  1. Diuretics
  2. Sympatholytics
  3. Angiotensin inhibitors (ACEIs or ARBs)
  4. Vasodilators (CCBs, minoxidil)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Blood Pressure = ______ X ______

A

Blood Pressure = Cardiac Output (CO) X Systemic Vascular Resistance (SVR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

An advantage of using thiazides in the management of hypertension is they protect against _______

A

osteoporosis

thiazide diuretics reduce the rate of calcium excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Loop diuretics are preferred for treating hypertension in individuals with _______ (normal / reduced) kidney function

A

reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

α1 - blockers used in management of hypertension may cause “first dose” _______

A

syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Minipress (Prazosin)

A
  • α1 - blocker, sympatholytic, anti-adrenergic
  • used to manage hypertension by decreasing SVR
  • Generally a second-line treatment, used in combination with a diuretic (diuretic required due to RAAS activation)
  • may cause reflex sympathetic activation (resulting in increased CO), orthostatic hypotension, or “first dose” syncope
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Aldomet (Methyldopa)

A
  • centrally-acting sympatholytic antihypertensive, selective α2 - agonist
  • inhibit sympathetic outflow from the CNS, causing vasodilation and some reduction in CO
  • too many side effects compared to other drugs, especially immunologic effects. Used only when other options are ineffective. Also used in pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Inderal (Propranolol)

A
  • Non-selective β-antagonist (beta-blocker)
  • Primarily given orally but may be given parenterally
  • One of the first developed and thus has the ridest range of approved clinical uses
    • hypertenion, angina, cardiac dysrhythmias, migraine, AMI, pheochromocytoma
  • Has more CNS side effects than other non-selective beta-blockers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Tenormin (Atenolol)

A
  • Selective β1-antagonist (beta-blocker)
  • oral or parenteral
  • good antihypertensive, antianginal, antiarrhythmic
  • Low rate of CNS side effects due to poor lipid solubility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Brevibloc (Esmolol)

A
  • Selective β1-antagonist (beta-blocker)
  • IV-only!
  • good antihypertensive, antianginal, antiarrhythmic
  • very short half-life compared to other beta-blockers, used in emergent settings (check out that trade name!)
36
Q

Lopressor (Metoprolol)

A
  • Selective β1-antagonist (beta-blocker)
  • oral or parenteral
  • good antihypertensive, antianginal, antiarrhythmic
  • relatively short half-life (3-4hr)
37
Q

Under what conditions are Beta-blockers (beta-antagonists) the preferred drugs in the management of hypertension

A

hypertension in the context of cardiovascular disease, otherwise CCBs or angiotensin inhibitors are preferred

38
Q

Calcium channel blockers are better ________ (arteriole / venous) vasodilators

A

arteriole

they therefore decrease SVR without decreasing preload as much

39
Q

Nipride (Nitroprusside)

A
  • Nitric Oxide donor, vasodilator, antihypertensive
  • Causes smooth muscle relaxation in arterioles and veins
  • short half-life and time of onset
  • Used in hypertensive emergencies
  • Prolonged use may lead to cyanide and thiocyanate toxicity
40
Q

Suggest a treatment strategy for a patient with stage 1 hypertension (SBP 140-159)

A
  • lifestyle modifications
  • Drug monotherapy (likely Angiotensin inhibitor or CCB due to low side-effect risk)
41
Q

Suggest a treatment strategy for a patient with stage 2 hypertension (SBP >160)

A
  • lifestyle modifications
  • Drug therapy with at least 2 medications, often starting with CCBs and angiotensin inhibitors, perhaps adding a thiazide diuretic or beta-blocker
  • Trial new drug combinations for several weeks before switching treatment
42
Q

Centrally-acting sympatholytics are rarely used to treat hypertension, but may be useful in: (list 2)

A
  • hypertensive emergencies in an outpatient setting (one dose provides lasting effect)
  • pregnancy (methyldopa does not harm the fetus)
43
Q

identify the differences between the various classifications of angina

A
  • Typical angina involves narrowing of coronary artery lumens by atherosclerotic plaques and is seperated into stable and unstable
  • Stable angina occurs with exertion/sympathetic activation
  • Unstable angina occurs at rest and varies in intensity, frequency, and duration. Caused by thrombotic occlusion and may lead to MI
  • Variant/Prinzmetal angina is due to coronary artery spasm and is prolonged and cyclic
44
Q

The cause of angina is ________

A

myocardial hypoxia

45
Q

Drugs to treat angina generally work by: (list 2)

A
  • decreasing myocardial oxygen demand
  • increasing myocardial oxygen supply
46
Q

Use the provided chart to organize the antianginal drugs

A
47
Q

Use the provided chart to organize the antihypertensive drugs

A
48
Q

Organic nitrites and nitrates are useful in which forms of angina?

A

All forms of angina

49
Q

CCBs are useful in which forms of angina?

A

Stable typical angina and variant angina. CCBs are not useful in MI or unstable angina

50
Q

β - blockers are useful in which forms of angina?

A

all forms of typical angina, especially in MI. Not useful in atypical/prinzmetal angina

51
Q

Nitrostat (Nitroglycerin)

A
  • Nitrate antianginal
  • Increases NO concentrations near vascular smooth muscle, which leads to increased cGMP production and venous vasodilation.
  • Causes a decrease in preload and myocardial oxygen demand. In higher doses has arteriolar effects, resulting in decreased afterload
  • May cause drop in SBP and reflex tachycardia
52
Q

Explain how nitrates reduce myocardial workload and oxygen demand

A

nitrates primarily cause venous vasodilation which reduces preload and myocardial wall tension

53
Q

A danger of prolonged administration of nitrates is _________

A

development of tolerance

54
Q

nitrates are primarily ________ (arteriolar / venous) vasodilators

A

venous

55
Q

which CCBs have the greatest vasodilatory effect relative to cardiac effect?

A

the dihydropyridine (those that end in -pine) CCBs. For example; amlodipine, felodipine, nifedipine

56
Q

How do CCBs help relieve angina?

A
  • All CCBs cause smooth muscle relaxation and therefor increase coronary blood flow, and also may decrease cardiac workload.
  • Diltiazem and verapamil also have a higher affinity for cardiac calcium channels and are negative inotropes and chronotropes, so they must be used with cuation in heart failure
57
Q

Which CCBs must be used with caution in heart failure and why?

A

Diltiazem and especially Verapamil, due to their negative inotropic and chronotropic effects.

58
Q

Adalat (Nifedipine)

A
  • Calcium channel blocker (CCB), antianginal, antihypertensive
  • dihydropyridine CCB, therefore has primarily vasodilatory effects
  • may cause reflex tachycardia
  • As an antianginal, increases coronary perfusion and reduces afterload
  • Short half-life, but may be given as a sustained-release formulation once daily
59
Q

Isoptin (Verapamil)

A
  • Calcium-channel blocker, antianginal, antiarrhythmic
  • Has the strongest cardiac effect of the CCBs
  • Useful in stable and variant angina
  • Must be used with caution in heart failure due to its negative inotropic and chronotropic effect
60
Q

Cardiazem (Diltiazem)

A
  • Calcium-channel blocker, antianginal, antiarrhythmic
  • Has an intermediate cardiac effect (more than nifedipine, less than verapamil)
  • Useful in stable and variant angina
  • Must be used with caution in heart failure due to its negative inotropic and chronotropic effect
61
Q

CCBs act on _________ (arterial / venous / both) smooth muscle

A

arterial only!!

62
Q

How do CCBs provide an antianginal effect? (list 3 ways)

A
  • they increase coronary blood flow (arteriolar vasodilation)
  • they decrease afterload (arteriolar vasodilation), thereby reducing cardiac wall tension and oxygen demand
  • The non-dihydropyridines (diltiazem, verapamil) have negative chronotropic and inotropic effects which reduce workload
63
Q

How do β1-blockers provide their anti-anginal effect?

A

They reduce cardiac ischemia by preventing exercise-induced tachycardia and may prevent reflex tachycardia caused by other antianginals (esp. nitrates and dihydropridine CCBs)

64
Q

Why should β1-blockers be used in caution in patients with heart failure? What drugs might potentiate this effect?

A

because they are negative inotropes. This could be potentiated by verapamil, and to a lesser degree, diltiazem.

65
Q

The hallmark of heart failure is _________

A

reduced stroke volume and cardiac output

66
Q

List common changes that occur as a result of cardiac/ventricular remodelling

A
  • Wall thickening (hypertrophic) or thinning (dilated)
  • Cardiac narrowing (hypertrophic) or dilatation (dilated)
  • Interstitial fibrosis
  • Cardiac wall stiffening
67
Q

Describe how neuroendocrine responses can exacerbate heart failure

A
  • SNS activation, RAAS, Inflammatory cytokines attempt to restore CO by Frank-Starling mechanism
  • Leads to an increase in cardiac remodelling (incr. wall stiffness, fibrosis, hypertrophy/thinning, dilation/narrowing)
  • RAAS activation leads to incr. PVR and blood volume, incr. workload on myocardium
68
Q

β1-blockers ________ (do / do not) improve mortality in unstable angina

A

DO

69
Q

Goals of treatment in heart failure are:

A
  1. improve symptoms
  2. slow or reverse deterioration
  3. prolong survival / reduce mortality
70
Q

The 3 major strategies to treat heart failure, and the classes of drugs used in each are:

A
  1. Increase cardiac output
    • positive inotropes
    • vasodilators
  2. Reduce pulmonary and systemic congestion
    • vasodilators
    • diuretics
  3. Slow or reverse cardiac remodelling
    • angiotensin inhibitors
    • sympatholytics
71
Q

The three classes of inotrope used in the management of HF are:

A
  1. cardiac glycosides
  2. adrenergic agonists
  3. PDE3 inhibitors
72
Q

Describe the MOA and role of digoxin in the management of HF

A
  • Digoxin inhibits the action of the Na/K pump, increasing intracellular sodium, which activates the sodium-calcium exchanger. This increases intracellular calcium. Also inihibits sympathetic activity
  • Decreases AV nodal conduction, positive inotrope
  • Generally used to treat heart failure associated with A Fib
73
Q

Digoxin has a _______ (low / high) therapeutic index

A

LOW!

adverse effects include arrhythmias, GI disorders, hallucinations, seizures. Antidote is digoxin-immune Fab.

74
Q

Lanoxin (Digoxin)

A
  • Cardiac Glycoside, antiarrhythmic
  • used in treatment of A Fib and HF
  • inhbits Na/K pump and increases intracellular Ca through Ca/Na exchanger
  • negative chronotrope and positive inotrope
  • LOW therapeutic index
75
Q

What is the advantage of using dobutamine in treating HF vs. other adrenergic agonists

A

it improves SV with little to no increase in HR

76
Q

Adrenergics and PDE3 inhibitors are used in __________ (acute / chronic) heart failure

A

Acute!

these drugs may cause angina, increased myocardial workload, tolerance, and other adverse effects.

77
Q

Primacor (Milrinone)

A
  • type 3 phosphodiesterase inhibitor (PDI), positive inotrope
  • increases cAMP and therefore Ca2+ concentration in cardiomyocytes
  • used in acute heart failure when other inotropes are ineffective.
78
Q

Describe the roles of Angiotensin inhibitors (ACEIs and ARBs) in the management of heart failure

A

they reduce both preload (reduces congestion) and afterload (improves SV) while slowing cardiac remodelling. ARBs are generally less effective in HF than ACE inhibitors

79
Q

Common drug types used in the management of acute heart failure are:

A
  • IV vasodilators (nitrates/hydralazine)
  • Diuretics
  • Inotropic agents, esp. Dobutamine and Milrinone
  • Oxygen
80
Q

Common management of chronic systolic heart failure generally includes 3 classes of drugs:

A

A diuretic (loop), an angiotensin inhibitor, and a β - Blocker. Aldosterone antagonists may be added as needed

81
Q

Use the table provided to organize drugs commonly used in managing heart failure

A
82
Q

Which Beta-blockers have been shown to reduce mortality in heart failure?

A

carvedilol, metoprolol, bisoprolol

83
Q

Describe the MOA of nitric oxide donors in management of angina and hypertension

A

NO donors increase local concentrations of NO, which triggers increased intracellular cGMP production. cGMP causes decreased intracellular Ca2+ concentration which brings about smooth muscle relaxation and vasodilation

84
Q

What determines the level of Ca2+ in cells? How does this differ between different cell types?

A
  • cAMP concentration determines Ca2+ level
  • In cardiomyocytes and pacemaker cells, cAMP levels correlate positively with Ca2+ concentration. The opposite is true in smooth muscle cells explaining how the same types of receptor (Gs GPCRs) can have opposite effects in different cells when stimulated.
  • Ex: both beta-1 and beta-2 receptors are Gs GPCRs but have opposite effects on calcium levels when stimulated
85
Q

Describe the locations and functions of V1 and V2 receptors for ADH

A
  • V1 receptors are found in vascular smooth muscle. Activation causes vasoconstriction
  • V2 receptors are found in the basolateral membrane of the kidney tubules. Stimulation leads to aquaporin insertion and increased water retention
  • The result of V1 and V2 activation is increased circulating volume and vasoconstriction leading to increased BP
86
Q

Which class of diuretics are referred to as “low-ceiling” diuretics?

A

thiazides

87
Q

Why are beta1-blockers better at reducing BP than alpha1-blockers?

A

Because alpha1 blockers cause reflex tachycardia, leading to increased CO and BP. Beta1-blockers inhibit reflex tachycardia directly, while alpha1-blockers have no direct cardiac effect.

HLTH 2511 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions