Unit 4 &10--CV AND ENDOCRINE

Question 1

How does the central nervous system affect BP?

Answer 1

beta receptors stimulate release of norepinephrine producing vasodilation and decreased bp

Question 2

How does the peripheral nervous system affect BP?

Answer 2

Receptors located on effector cells-Alpha 1 and Beta 1 and Beta 2

Question 3

what do Alpha 1 receptors on venues and arterioles cause?

Answer 3

vasoconstriction

Question 4

Where are beta 1 receptors and what do they do?

Answer 4

heart and kidneys-regulate heart rate and contractility, as well as renin release thus affecting cardiac output.

Question 5

where are beta 2 receptors and what do they do?

Answer 5

Located in lungs, liver, pancreas and arteriolar smooth muscle.. Regulate bronchodilation and vasodilation.

Question 6

Where are baroreceptors located?

Answer 6

large arteries such as aorta and carotids

Question 7

Describe the RAAS.

Answer 7

Renin is released in response to change in BP. Renin catalyzes conversion of angiotensinogin to angiotensin I which is converted to potent vasoconstrictor angiotensin II by ACE. Angiotensin II stimulates release of aldosterone from adrenals resulting in Na and H2O retention.

Question 8

what is considered normal blood pressure?

Answer 8

<120/80-encourage pt

Question 9

what is considered prehypertension? is this treated?

Answer 9

120-139/80-89-no treatment unless compelling indications

Question 10

what is considered Stage I hypertension? What are first line choices?

Answer 10

140-159/90-99. Thiazide diuretics, may consider aces, arbs, bb, ccb or combo

Question 11

What is considered stage II hypertension? What is first line treatment?

Answer 11

> 160/100. Two drug combo or thiazide and either ace, arb, bb, or ccb

Question 12

What is the goal of therapy for htn?

Answer 12

decreasing CV and renal morbidity and mortality.

Question 13

In which patients are thiazide diuretics contraindicated?

Answer 13

anuric patients or those with known sensitivity to thiazides and/or sulfonamides

Question 14

What are side effects of spironolactone?

Answer 14

gynecomastia, hirsutism, menstrual irregularities

Question 15

which beta blockers are cardioselective (i.e. Beta 1 receptor blockers) and are better choices for patients with asthma or copd?

Answer 15

atenolol, metoprolol, bisoprolol

Question 16

What class of antihypertensives is first line therapy in hypertensive diabetic patients w/ proteinuria?

Answer 16

ACE inhibitors

Question 17

what are nondihydropyridine CCBs? In whom should they be avoided?

Answer 17

verapamil and diltiazem. Patients with cardiac dysfunction-can accelerate HF.

Question 18

What can occur with hydrazine? What meds should be given with it to prevent this?

Answer 18

May cause fluid retention and reflex tachy. Given w/ diuretics and beta blocker or other heart-slowing agent

Question 19

What is the first choice for hypertension in patients with stable angina?

Answer 19

beta blockers and long acting CCBs

Question 20

What is first line therapy for patients w/ hypertension and HF?

Answer 20

BB and ACE inhibitors.

Question 21

What makes up metabolic syndrome

Answer 21

abdominal obesity, glucose intolerance, bp of at least 130/85, trigs of over 150, HDL <40 or 50 for men and women respectively

Question 22

What is the best choice of antihypertensives for african americans?

Answer 22

chlorthalidone and amlodipine

Question 23

what constitutes malignant hypertension?

Answer 23

DBP over 120

Question 24

how do antioxidants improve cholesterol?

Answer 24

They block conversion of LDL to modified LDL in the vascular endothelium. Modified LDL may be more atherogenic so slowing its production could decrease atherogenic process.

Question 25

How is LDL calculated?

Answer 25

Total Chol-HDL-VLDL (VLDL=trigs/5)

Question 26

what is first line treatment for newly diagnosed hyperlipidemia (most patients)

Answer 26

lifestyle modification for 6-12 weeks

Question 27

what is main goal of drug therapy in hyperlipidemia?

Answer 27

reduce CV risk without affecting quality of life

Question 28

what meds can affect metabolism of statins?

Answer 28

CYP450-cyclosporine, emycin, azole antifungals

Question 29

when should hepatic function labs be drawn on patients after starting statin therapy?

Answer 29

baseline, 6-12 weeks, and periodically thereafter.

Question 30

what meds interact with bile acid resins?

Answer 30

abx and thyroid

Question 31

what are major side effects of bile acid resins?

Answer 31

GI symptoms

Question 32

what is niacin useful for treating?

Answer 32

low hdl, high trigs, ldl to some extent

Question 33

what are cholesterol absorption inhibitors?

Answer 33

zetia, fibrin acid derivatives, gemfibrizol

Question 34

After statins, what is the next line of treatment in hlp?

Answer 34

niacin, bile acid resins

Question 35

how do CCBs treat angina?

Answer 35

act as vasodilators

Question 36

what are some dihydropyridines?

Answer 36

nifedipine, felodipine, amlodipine

Question 37

What antianginal medication can interfere with CYP3A4 inhibitors?

Answer 37

Ranexa

Question 38

what is thought to be first line therapy for acute anginal episodes?

Answer 38

beta blockers

Question 39

What is second line therapy for acute anginal episodes?

Answer 39

Combo with beta blocker and CCB or long-acting nitrate

Question 40

what are symptoms of right sided heart failure?

Answer 40

pitting edema, abdominal pain, anorexia, N/V, JVD, ascites

Question 41

what are symptoms of left sided heart failure?

Answer 41

cough, dyspnea, orthopnea, PND, cardiomegaly, S3 heart sound, rales, pulmonary edema

Question 42

what is class I heart failure?

Answer 42

symptoms of HF only at levels of activity that would produce symptoms in normal people

Question 43

what is class II heart failure?

Answer 43

symptoms with ordinary exertion

Question 44

what is class III heart failure?

Answer 44

patients have symptoms of HF on less than ordinary exertion

Question 45

what is class IV heart failure?

Answer 45

symptoms of HF at rest

Question 46

what is first line and should always be started on patients with EF <35-40%

Answer 46

ACE inhibitors

Question 47

What are class Ia Ib and Ic antiarrhythmics?

Answer 47

Sodium channel blockers. Ia: Quinidine Ib: lidocaine Ic: flecainide, propafenone

Question 48

what are class II antiarrhythmic?

Answer 48

beta blockers: atenolol, lopressor, inderal

Question 49

what are class III antiarrhythmics?

Answer 49

Potassium channel blockers: amio, tikosyn, multaq, sotalol

Question 50

what are class IV antiarrhythmics?

Answer 50

calcium channel blockers: diltiazem, verapamil.

Question 51

in whom should flecainide and propafenone (Class Ia) be avoided?

Answer 51

patients with structural heart disease including cad, LV dysfunction, valvular disease, LVH

Question 52

How does DM II affect different body shapes differently?

Answer 52

In lean people, the problem is usually with beta cells. In overweight people, problem is in target cells

Question 53

What results in Hgb A1c, FBG, and OGTT need repeat testing?

Answer 53

Hgb A1c >6.5%, FBG > 126, OGTT PG> 200

Question 54

What blood results yield diagnosis of pre-diabetes?

Answer 54

FBG 100-125 or OGTT PG 140-199

Question 55

Any random glucose over ______ indicates DM.

Answer 55

200

Question 56

What meds cause hyperglycemia?

Answer 56

glucocorticoids, furosemide, thiazides, estrogen, beta blockers, nicotinic acid

Question 57

How does the onset of DM I and DM II differ?

Answer 57

DM I is often sudden and preceded by ketoacidosis. | DM II is often gradual insidious and undiagnosed for years.

Question 58

What are the goals of drug therapy in terms of glycemic control?

Answer 58

Hbg A1c <180.

Question 59

What are common sulfonylureas? What is their mechanism of action? How is it taken?

Answer 59

glyburide, glipizide. They stimulate insulin release due to action on beta cells. once daily

Question 60

In what DM meds do patients need to be concerned with hypoglycemia?

Answer 60

sulfonylureas (glipizide, glyburide), meglitinide analogs (prandin, starlix) and pramlintide acetate as well as others IF GIVEN IN COMBINATION WITH ONE OF THE ABOVE OR INSULIN

Question 61

what are common thiazolidinediones? What is their mechanism of action? How is it taken?

Answer 61

actos and avandia They reduce insulin resistance at sites of insulin action. Taken once daily.

Question 62

what are common alpha glucosidase inhibitors? What is their mechanism of action? How is it taken?

Answer 62

glyset and precose They slow absorption of carbs from intestines, minimizing postprandial increase in blood sugar Taken tid with first bit of meal.

Question 63

what are common meglitinide analogs? What is their mechanism of action? How is it taken?

Answer 63

prandin and starlix They stimulate release of insulin from pancreas in response to a meal. with 2-4 meals daily.

Question 64

what are common dipeptidyl peptidase-4 inhibitors? What is their mechanism of action? How is it taken?

Answer 64

januvia and onglyza They block effect of against GLP1 and increase amount of circulating incretins. Taken once daily.

Question 65

What are common incretins and what is their mechanism of action?

Answer 65

Byetta. They slow gastric emptying and stimulate glucose-dependent secretion of insulin from pancreatic beta cells while suppressing release of glucagon from alpha cells Injectable only. Given 2x daily over 60 minutes or prior to largest 2 meals, at least 6 hours apart.

Question 66

How does pramlintide acetate work and how is it taken?

Answer 66

It is an injectable synthetic of pancreatic amylin which is consecrated with insulin. Delays gastric emptying, alters release of additional inappropriate glucose and increases satiety. given prior to large meals.

Question 67

What insulins are given as boluses?

Answer 67

very rapid acting-humalog | short acting-regular or "r"

Question 68

What insulins are given as basals?

Answer 68

Intermediate-NPH, lente, "n" or "l" | Long-acting-"u", lantus

Question 69

How is daily insulin dosing divided? What is the ratio?

Answer 69

2/3 of daily dose is in the AM, 1/3 is in the PM. 2:1 ratio of intermediate to short acting before breakfast, 1:1 ratio of before dinner

Question 70

how much insulin do adults and children need daily (approximately)

Answer 70

0.5-0.6 units/kg/d

Question 71

how much insulin do adults and adolescents need during illness?

Answer 71

0.5-0.75 units/kg/d

Question 72

how much insulin do adolescents need during a growth spurt per day?

Answer 72

1.25-1.5 units/kg/day

Question 73

How much insulin to pregnant women need daily?

Answer 73

0.7 units/kg/day

Question 74

What is the "1500 rule?"

Answer 74

Divide 1500 by total daily dose of insulin. The result is how much a single unit of insulin lowers blood glucose.

Question 75

what is the Somogyi effect?

Answer 75

Rebound of hyperglycemia that occurs after early morning episode of insulin induced hypoglycemia.

Question 76

What is first line treatment for DM I? DM II?

Answer 76

DM I: Insulin DM II: mono therapy w/ oral agent-sulfonylureas if glucose >250 et thin, biguanides et TZDs are best in metabolic syndrome.