Vasodilator

Question 1

What controls BP

Answer 1

Directly related to cardiac output and peripheral vascular resistance

Question 2

What are CO and peripheral resistance controlled by

Answer 2

1. Baroreceptors/flexors

2. Renin-angiotensin-aldosterone system

Question 3

How do most antihypertensive drugs work

Answer 3

By reducing CO or decreasing peripheral vascular resistance

Question 4

How does the baroreceptor system work

Answer 4

Controls BP and CO by changing the sympathetic/parasympathetic response mechanisms of the heart. Sympathetics cause vasoconstriction, which increases CO and BP

Question 5

How does the renin system work

Answer 5

The kidneys control BP by altering blood volume in the body

Question 6

What does angiotensin II do

Answer 6

Potent vasoconstrictor that causes increase in BP. Activated by ACE in the kidney

Question 7

Name 3 classes of calcium channel blockers

Answer 7

1. Dihydropyridines
2. (di)Phenylalkylamines
3. Benzothiazepines

Question 8

What is the only phenylalkylamine that is approved in the US

Answer 8

Verapamil

Question 9

What is the only benzothiazepine used in the US

Answer 9

Diltiazem

Question 10

What are 2 dihydropyridines that are used

Answer 10

1. Nifedipine (adalat)

2. Amlodipine

Question 11

What is the MOA for calcium channel blockers

Answer 11

Inhibits or blocks the calcium ion channels which prevents ca+ from entering the muscle cells. This causes a decrease in smooth muscle contraction and increases vasodilation. (DO NOT DILATE VEINS)

Question 12

Uses of CCB

Answer 12

Hypertension in pts who also have asthma, diabetes, angina.

Really effective in black people

Question 13

Uses of diphenylalkylamines

Answer 13

Cardiac and smooth muscle cells. Good for treating angina!

Question 14

Uses of benzothiazepines

Answer 14

Cardiac and smooth muscle cells. Can be used to treat angina and hypertension.

Question 15

Uses of dihdropyridines

Answer 15

Much greater affinity for vascular ca+ channels. Great for treating hypertension

Question 16

Adverse effects of CCB

Answer 16

1. Constipation
2. Dizziness
3. fatigue
4. no verapamil in CHF pts

Question 17

Name 2 ACE inhibitors

Answer 17

1. Lisinopril (zestril)

2. Captopril (Capoten)

Question 18

When are ACE inhibitors used

Answer 18

When 1st line drugs are contraindicated or ineffective or in diabetic patients

Question 19

MOA of ACE inhibitors

Answer 19

Lower BP by reducing peripheral vascular resistance without increasing CO,rate or contractility. Blocks the ACE which is responsible for inducing Angiotensin II which is a potent vasoconstrictor. WORK ON BOTH ARTERIES AND VEINS

Question 20

What is the effect of ACE inhibitors on cardiac output

Answer 20

Reduces preload and after load, which decreases cardiac work

Question 21

What are ACE inhibitors used for

Answer 21

1. Gold standard for treating heart failure
2. MI
3. hypertension in young white pts, can be used with diuretics
4. Coronary artery disease

Question 22

Adverse effects of ACE inhibitors

Answer 22

1. Dry cough (due to increased bradykinin)
2. Hyperkalemia
3. Skin rash
4. Hypotension
5. fever

Question 23

What is the major contraindication of CCB

Answer 23

Never use short acting version of dihydropyridines for angina!!

Question 24

What are some contraindications for ACE inhibitors

Answer 24

1. HX of angioedema
2. Bilateral renal stenosis
3. Pregnant

Question 25

Name 2 angiotensin receptor blockers (ARBs)

Answer 25

Valsartan (diovan) and Losartan (cozaar)

Question 26

What is the MOA of ARBs

Answer 26

Block directly at the angiotensin I receptors, which does not allow for angiotensin II to be created which decrease vasoconstriction. WORK ON BOTH ARTERIES AND VEINS

Question 27

What are the uses of ARBs

Answer 27

1. CHF patients that are intolerant to ACEI 2. Hypertension 3. MI 4. Diabetic nephropathy

Question 28

Contraindications of ARB

Answer 28

1. hypersensitivity 2. Bilateral renal artery stenosis 3. Pregnancy

Question 29

Name a renin inhibitor

Answer 29

Aliskiren (tekturna)

Question 30

MOA for renin inhibitors

Answer 30

Directly inhibits renin which means it as earlier in the renin-angiotensin system than ACEI or ARBs do.

Question 31

What are the uses of renin inhibitors

Answer 31

1. Hypertension | 2. Heart failure pts (not nearly as often used as ACEI or ARBs for this)

Question 32

Adverse effects of renin inhibitors

Answer 32

1. Diarrhea 2. Cough 3. angioedema

Question 33

Contraindications of renin inhibitors

Answer 33

1. pregnant women 2. hypersensitivity 3. Hyperkalemia

Question 34

Name 2 centrally acting adrenergic drugs (sympatholytics)

Answer 34

Clonidine (catapres) and methyldopa (aldomet)

Question 35

What is the MOA of centrally acting sympatholytics

Answer 35

Blocks sympathetic activity by binding to and activating alpha 2 adrenoreceptors in the brain. Blocks sympathetic effects and epinephrine release

Question 36

What is the use of centrally acting sympatholytics

Answer 36

1. Hypertension that does not respond to treatment with 2 or more drugs (clonidine specifically) 2. Hypertension in pregnant women (methyldopa)

Question 37

Adverse effects of centrally acting sympatholytics

Answer 37

1. Dry mouth 2. Constipation 3. Rebound hypertension 4. Sedation and drowsiness

Question 38

Name some direct vasodilators

Answer 38

(hydralazine) Nitroglycerin and isosorbide dinitrate (Isordil)

Question 39

MOA of the direct vasodilators

Answer 39

Direct relaxation of peripheral smooth muscles. Accumulation of cGMP which decreases Ca+ used in muscle contraction

Question 40

Name 2 phosphodiesterase inhibitors

Answer 40

Sildenafil (viagra) and Tadalafil (cialis)

Question 41

What is the MOA of phosphodiesterase inhibitors

Answer 41

Selective inhibition of an enzyme in the corpus cavernosa that results in increase concentrations of cGMP which causes a decrease in vasoconstriction. This allows for more blood flow to the penis

Question 42

Adverse effects of direct vasodilators

Answer 42

1. Headache 2. Hypotension 3. Reflex tachycardia

Question 43

What are the direct vasodilatros used for

Answer 43

1. Hypertension | 2. CHF in combo with nitrates

Question 44

What are phosphodiesterase inhibitors used for

Answer 44

Erectile dysfunction

Question 45

Adverse effects of phosphodiesterase inhibitors

Answer 45

1. Flushing 2. rash 3. GI symptoms 3. dizziness 4. MI 5. Optic neuropathy