Session 3 Flashcards Preview

CPT > Session 3 > Flashcards

Flashcards in Session 3 Deck (26)
Loading flashcards...
1
Q

Map equation?

Impact of angiotensin 2?

A

Co x TPR

Vasoconstriction
ADH release so water absorption in collecting duct
Aldosterone from adrenal cortex causing tubular NA CL absorption thus h20 retention in kidney. And k excretion
Increase sympathetic

2
Q

Where is ACE found?

Through what receptors does angiotensin 1/2 have its effect?

A

Luminal surface of capillary endothelium predominantly in lungs

AT1 and AT2

3
Q

Effects of ACEi?

Relevance of bradykinin?

Complications of ACEi’s

A

Inhibits circulating and tissue ACE

Ace breaks down this vasodilator so inhibitor furthers vasodilation

Hypotension,dry cough, hyperkalaemia as low alsodsterone reduces k excretion. Renal failure especially if renal artery stenosis as efferent constriction is vital.

4
Q

When should ACEi not be used?

A

Renal artery stenosis,AKI, pregnancy, breastfeeding

5
Q

Why might you use angiotensin receptor antagonists/AT1 receptor blockers instead of ACEi?

Names of angiotensin blockers?

A

No effect on bradykinin therefore no dry cough/angioedema

Candesartan
Losartan

6
Q

What do CCB’s target?

Where do they act?

Where are these VOCC/LTCC’s located?

When are CCB’s the primary option?

A

Calcium initiated Sm contraction in hypertension

On alpha subunit of VOCC

Cardiac myocytes and vascular smooth muscle cells

Antihypertensive in low renin patients

7
Q

Three calcium channel blockers?

A

Dihydropyradines-peripheral vasculature, first line hypertension

Non dihydropyradines-phenylalkamines-negative inotropy as depresses as node and slows AV node conduction

Non dihydropyradines-benzothiazapines-do middle of both

8
Q

2 main of dihydropyradine class and role?

Complications?

A

Amlopidine

Nimodipine-cerebral vasculature-sub arachnoid

Ankle swelling,flushing,palpitations

9
Q

Example and use of phenylalkamines?

Why elderly black African treated with CCB not ACEi to start with?

How are type 2 diabetic patients with hypertension first treated?

If first line treatment don’t work what you do?

A

Verapamil, anti arythramtic prolonging ap, negative chronograph and inotropic effects.

Naturally have low renin levels so no point targeting that system is system ain’t working

ACEi/ARB,s

Series of steps eventually using all ACEi, arb’s, CCB, thiazides

10
Q

Benefits of ACEi on diabetic hypertension?

A

Not only aids hypertension by reducing peripheral vascular difference but also prevents glomerular nephropathy as dilates efferent arteriole reducing intraglomerular pressure.

11
Q

Options in resistant hypertension?

What do b blockers do?

Side effects of b blockers?

A

Spironolactone-aldosterone receptor antagonists but do not use in hyperkalaemia. If too high k then a/b blockers.

In pregnancy labetalol reduces sympathetic outflow (b)

Block NA thus lower sympathetic tone and reduce myocardial contraction thus lower CO

Bronchospaam, heart block, impotence

12
Q

What do a adrenoreceptor antagonists do?

Complications?

Average CO?

Symptoms of heart failure?

A

Decrease sympathetic tone lowering PVR

Dizzy,syncope,headache

5L/min

Dysponea, exercise intolerance and fatigue

13
Q

Ejection fraction?

Normal?

If low?

If not but still HF?

A

Blood pumped out/blood total in ventricle

> 50

Contractility/systolic problem

Diastolic/filling problem

14
Q

Treatment of heart failure with reduced ejection fraction?

Causes of this heart failure?

Why BB’s treat heart failure?

A

Furosemide as diuretic, bisprolol as BB, lisinopril as ACEi,

Narrowed artery or valve issue.

Slow heart rate and allow ventricle to fill with blood

15
Q

Why NSAIDS increase k?

A

Prostaglandins dilate afferent arteriole, NSAIDs inhibit this, so lower GFR, so less k excretion

16
Q

Define diuretic?

Naturetic?

Aquaretic?

A

Increased urine loss

Sodium loss

Water loss with no electrolytes

17
Q

What do carbonic anhydraze inhibitors do?

Use?

A

Stop the absorption of nahco3 in the proximal convoluted tubule. So higher sodium delivery down tubule increasing k loss due to unregulated enac along with less hco3 absorption causes hypokalaemia metabolic acidosis.

Glaucoma/mountain sickness/small diuretic function

18
Q

Example of osmotic agents and how they work?

Risk?

Where are SGLT2 transporters located? What they do?

A

Mannitol, acts as a solute and draws water into the lumen so its a diuretic.

Hypernatraemia

Proximal convoluted tubule, 1 glucose and one sodium into cells

19
Q

Use of SGLT2 inhibitors?

Example of loop diuretic?

A

Naturetic thus diuretic, more sodium to macula densa so also vasodilator afferent arteriole reducing hyperfiltration and lowers plasma glucose.

Furosemide

20
Q

What happens in loop diuretics?

Action of thiazides diuretics?

A

NA k 2Cl not reabsorbed so calcium and mg also not reabsorbed so calcium loss and loss of NA and water. Moreover hypokalaemia due to unregulated ENAC.
Example of hypokalaemia metabolic alkaliosis. Alkalosis as more NA unregulated NHE transporter so more h+ lost.

In distal convoluted tubule NaCl stopped reabsorption so normal loss of NA causing hypokalaemia, but lower NA increases ca absorption.
Also metabolic acidosis

21
Q

How does aldosterone increase BP?

Use of aquaretics/ADH antagonists?

Example?

What is an unwanted aquaretic? And when present?

A

Increases expression of ENAC and nakatpase in principal cells of collecting duct.

Cure hyponatraemia, NA is unaffected,

Tolvaptan

Lithium in poly cystic kidney disease

22
Q

How is alcohol a diuretic?

Coffee?

Complications of diuretics?

A

Inhibits ADH release

Increase GFR and lowers tubular NA reabsorption

Hypovalaemia, hypotension, which can activate RAAS leading to acute kidney injury, electrolyte disturbance

23
Q

ADR of

Thiazides

Furosemide

Spironolactone

A

Gout,hyperglycaemia

Ototoxicity,alkalosis

Hyperkalaemia, impotence

24
Q

Potential problem with ACEi/k mix?

BB’s/thiazides diuretics?

Digoxin/loop?

How to treat heart failure?

A

Hyperkalaemia

Hyperglycaemia,hyperlipidaemia

Hypokalaemia

Loop diuretics,spironolactone,ACEI, BB’s

25
Q

To treat decompensated liver disease?

Nephrotic syndrome? CKD (low GFR thus NA and water retention)?

A

Spironolactone and loop diuretics

Loop diuretics

26
Q

Problem with aminoglycosides and loop diuretic mix?

Steroids and thiazides?

Carbamazepine and thiazides?

A

Ototoxicity

Hypokalaemia

Hyponatraemia