Slides for Exam 1 Flashcards
(27 cards)
Alpha Blockers- block the alpha 1 adrenergic receptor on vascular smooth muscle and this leads to decrease in vascular resistance and decreased in total peripheral resistance.
Adverse effects- reflex tachycardia
Beta Blockers- mainstay of hypertension; adjunctive in heart failure
. primarily decrease heart rate and force of myocardial contraction
. negative ionotropic effect together with negative chronotropic effect lead to lower blood pressure.
.Adverse Effects: produce bronchoconstriction if have asthma; excessive depression of heart rate; myocardial contractility; orthostatic hypotension; can impair glucose and lipid metabolism.
Angiotensin Type I receptor blockers (ARBs)- use if the patient can not tolerate ACE inhibitors
Candesartan, losartan, telmisartan, valsartan
Angiotensin II blockers
= Block angiotensin II receptors on various tissues
Adverse effects of ACEI and ARBS
. postural hypotension-ACEI
. renal insufficiency-ACEI
. persistent dry cough (when angI converts to angII in the lungs- ACEI
. Avoid in pregnant women- ACEI and ARBs
. ARBs do not lead to dry cough.
Angiotensin Inhibitors- ACE inhibitors
These decreased vasoconstriction and increase NE; take on an empty stomach so it can absorb (catopril, enalapril, lisinopril, quinapril, fosinopril, ramipril).
MOA- Inhibits the enzyme that converts angiotensin I to angiotensin II
Calcium Channel Blockers
Diuretics
. Relieve pulmonary congestion and peripheral edema
. Increase the formation and excretion of urine.
. Increase renal excretion of water and sodium
. leads to decrease volume of fluid in the vascular system.
. Adverse effects- fluid depletion, electrolyte imbalance, decreased extracellular fluid volume which can lead to hyponatremia (decreased sodium) and/or hypokalemia (decreased potassium).
Thiazide diuretics-most common is hydrochorathiazide
. inhibits sodium reabsorption.
. Use with caution with lithium because lithium gets pulled back in and does not excrete and can lead to lithium toxicity.
Potassium Sparing diruetics- try to hold onto potassium
. prevents secretion of potassium into distal tubule (because normally the potassium would be excreted).
. potassium is spared from secretion and sodium is excreted.
. since these drugs reduce potassium loss they prevent hypokalemia.
. ** Important to note that potassium has a narrow range and this is important in maintaining muscle contraction.
Loop Diuretics-acts on the ascending limb of the loop of Henle (in the kidney).
. inhibits the reabsorption of sodium and chloride from the nephron
. prevents reabsorption of the water that follows these elecrolytes.
. Use a loop diuretic if there is poor renal function.
Renin-Angiotensin System
. Renin (formed in the kidney) is formed in the renal juxtagloberular cells in response to: salt depletion; B2 stimulation; and decrease in renal perfusion that might be found in hyopotension or hypovolemia.
. Angiotensin-is a protein
. Renin mediates the formation of angiotensin in the liver
. When angiotensin I reaches the lungs it is converted into angiotensin-II via an enzyme.
. Angiotensin-II causes: vasoconstriction, promotes release of NE, and stimulates aldosterone production resulting in sodium and water retention.
. If there is low aldosterone this will decrease sodium and water retention.
Additional effects of angiotensin II: increased systemic vascular resistance, arterial blood pressure, and intravascular volume
. If the renin angiotensin system is inhibited this will prevent systemic vasoconstriction, decrease NE levels, decreased blood pressure, and aldosterone production is no longer stimulated by Angiotensin II which results in decreased intravascular volume.
Vasodilators-directly vasodilate the peripheral vasculature by decreasing peripheral vascular resistance and also inhibits smooth muscle.
Adverse effects- reflex tachycardia, dizziness, postural hypotension, weakness, nausea, fluid retention, headache.
Inotropic drugs- increase in myocardial contraction; used in CHF-
. Increase calcium and therefore increase contraction.
. Digoxin (digitalis) is the most widely used Inotropic. It has a rapid onset but has a very narrow therapeutic window. It has a short half life so can leave the system quickly.
. Adverse effects- GI distress, N/V, diarrhea, drowsiness, fatigue, confusion, visual issues, arrhythmias, paroxysmal arial tachycardia, ventricular tachycardia, and atrioventricular block.
Antiarrhythmia drugs (pacemaker cells maintain a slow but spontaneous depolarization).
. Na+ channel blockers (Lidocaine is the most common and is a Class I drug)
. Beta adrenoreceptor blockers. Block sympathetic actions. (Class II antiarrhythmic drugs- propranolol [performance anxiety], metoprolol, esmolol
. K + channel blockers- (Class II; amiodarone, sotalol, dofetilide).
. CA+ channel blockers (Class IV; used in bipolar- Verapamil is the most common). Can cause excessive vasodilation and/or orthostatic hypotension. Dont use with TCA (Haldol)
Antianginal Drugs- insufficient oxygen flow in the arteries around the heart can lead to ischemia.
. Organic nitrates- decreased vasoconstriction and increase perfusion to myocardium [heart muscle]. Nitroglycerine is the most common; sublingual or transdermal; takes effect in one minute; can cause a headache.
Antihypertensive Drugs
. Diuretics are the first line of treatment for hypertension; used to prevent stroke, MI, CHF; hydrochlorathiazide is the most common.
Antithrombotic Drugs
. affect the synthesis and function of clotting factors.
. inhibits the function of platelets.
. prevents formation of arterial clots that cause coronary artery occlusion or cerebral infarction.
. aspirin- suppresses platelet aggregation by inhibiting the synthesis of prostaglandins and thromboxanes.
. a very low dose of aspirin has a meaningful antithrombotic effect. Aspirin is critical in the acute phase of an infarction.
. Heparin- blood thinner; contraindicated in brain surgery, etc.
. Warfarin-teratogenic (can cause abortion).
. Adverse effects of antithrombotics- increase risk of bleeding; GI irritation high doses can be toxic to the liver
Hyperlipidemia
. can be induced by some antipsychotics but sedentary lifestyle and poor diet are the main causes.
. high cholesterol medications are used when plasma lipid levels are not controlled by diet and exercise. These meds can cause GI distress.
. Statins- are the mainstay
. Fibrates
. Niacin.
. Bile acid sequestrants.
. cholesterol absorption inhibitors.
Asthma-
. 1st line of choice is beta 2 adrenergic agonists
. short acting- onset in 15 minutes with 4-6 hour relief (albuterol, trubuteroline)-bronchodilators
. long acting- not used for asthma episodes; lasts up to 12 hours
. corticosteroids.
. Use alternative drugs for poorly controlled astham
. antileukotriene
. cromolyn and nedocromil
. cholinergic antagonisits.
. theophylline: HAS A NARROW THERAPEUTIC WINDOW- therefore worried about overdose, seizures, and fatal arrythmias. There are A LOT OF drug/drug interactions with theophylline.
COPD
. primarily used are bronchodilators
. 2nd line- combination of anticholinergic agent and beta 2 agonist.
. longer acting drugs such as salmetrol and tiotropium require less frequent dosing.
Pulmonary medications
. Largely inhalants.
. treat asthma, allergic rhinitis, COPD, and cough
Pharmacodynamics
. synaptic transmission alteration is the most common MOA
. agonists- facilitate transmission
. antagonists- inhibit or block transmission
. direct- drug binds directly to sites on receptors that neurotransmitter binds to (competitive).
. indirect-drug binds to adjacent sites (non-competitive).
. Other- drug alters production, storage, or recycling.
Presynaptic receptors
. autoreceptors- located on the axon terminal or cell body; regulate neurotransmitter release (directly or indirectly) when the SAME neurotransmitter is present.
. heteroreceptors- DIFFERENT neurotransmitter binds to adjacent receptor and inhibits release of neurotransmitter (e.g., NE inhibits 5HT).
