Vasodilators

Question 1

Primary Mechanisms of Action of Vasodilators

Answer 1

Increasing intracellular cGMP
Preventing the depolarization
Decreasing intracellular Ca2+
Increasing intracellular cAMP

Question 2

Nitric Oxide Donors: Mechanisms of Action and Pharmacology

Answer 2

Release NO when metabolized 
Relax smooth muscle
Vascular
Corpora cavernosa
Short-lived in others (e.g. bronchial, GI)
Inhibit platelet aggregation

Question 3

NO mech of action

Answer 3

increases cGMP, which causes the breakdown of myosin and actin, causing relaxation in vascular smooth muscle

Question 4

Organic Nitrites and Nitrates

Answer 4

Isosorbide dinitrate

Nitroglycerin

Question 5

Inorganic NO Donors

Answer 5

Nitroprusside

Question 6

Organic NO Donors: Pharmacodynamics (site of action)

Answer 6

NO broken down in veins (relax coronary arteries)

-effect on preload (decreases O2 demand in heart)

Question 7

Inorganic NO Donors: Pharmacodynamics (site of action)

Answer 7

dialate veins and arteries (good antihypertensive)

Question 8

adverse effect of inorganic NO donors

Answer 8

cyanide toxicity

Question 9

Isosorbide

Answer 9

Angina

Heart failure

Question 10

Nitroglycerin clinical use

Answer 10

Acute myocardial infarction†
Anal fissure
Angina (stable and unstable)
Hypertensive emergency* (*=IV)
Hypotension induction*
Perioperative hypertension*
Pulmonary edema†

Question 11

Nitroprusside

Answer 11

Hypertensive emergency (only IV)

Question 12

angina

Answer 12

short-lived ischemia

Question 13

short acting

Answer 13

nitroglycerin, nitroprusside (good for acute events)

Question 14

long acting

Answer 14

isosorbide dinitrate, nitroglycerin (long term use)

Question 15

NO donor tolerance

Answer 15

nitrate-free period of greater than 10 hours are necessary to prevent or attenuate tolerance
-want coverage during the day only (during activity that will lead to angina)

Question 16

nitric oxide donor side effects

Answer 16

Hypotension
Dizziness
Headache
Flushing
Syncope

Question 17

Nitroglycerin and nitroprusside are both pregnancy category

Answer 17

C

Question 18

Isosorbide dinitrate and Nitroglycerin interaction

Answer 18

Sildenafil

Question 19

PDE V

Answer 19

breaks down cGMP

Question 20

Sildenafil mech of action

Answer 20

blocks action of PDE V (build up of cGMP–> relaxation)

Question 21

Sildenafil clinical use

Answer 21

pulmonary hypertension, erectile disfunction

Question 22

Sildenafil side effects/ adverse reactions

Answer 22

Severe hypotension and death if combined with nitrates, dyspepsia, priapism

Question 23

Hydralazine clinical use

Answer 23

Hypertension; CHF

Question 24

Hydralazine Side effects/Adverse Reactions

Answer 24

Dizziness, headache, angina, tachycardia, peripheral edema; Pregnancy category C

Question 25

Nitroglycerine + Hydralazine

Answer 25

decreases tolerance of NO donor

Question 26

Hydralazine is not used for

Answer 26

angina; healthy artery will dialate more than injured

Question 27

Hydralaine half life is

Answer 27

relatively short; making it a non ideal hypertensive

Question 28

Calcium-Channel Blockers: Mechanisms of Action and Pharmacology

Answer 28

Block calcium channels Decrease calcium influx into cells Decrease ER/SR calcium loading Effects depend on selectivity

Question 29

DHPs act on

Answer 29

blood vessels (L type receptors)

Question 30

non DHPs act on

Answer 30

heart and blood vessels (L and T type receptors)

Question 31

DHP action

Answer 31

promotes diuresis; main effect on resistance arterioles, some effect on capacitance venules; some effect on kidneys

Question 32

non DHP

Answer 32

decreases heart rate and force of contraction

Question 33

DHP drugs

Answer 33

Amlodipine and nifedipine

Question 34

non DHP drugs

Answer 34

Diltiazem and Verapamil

Question 35

Amlodipine half life

Answer 35

good for hypertension treatment

Question 36

Long-acting CCB

Answer 36

1st line antihypertensive; great for treating low renin producers (esp africans and elderly)

Question 37

Dihydropyridine CCBs have less effect on exercise performance than ________ and will not affect

Answer 37

b-blockers; electrolytes like diuretics do

Question 38

Long duration of CCB action provides

Answer 38

superior long-term outcomes (also applicable to other anti-HTN meds).

Question 39

Typically antihypertensives will be compensated for in the body unless

Answer 39

more than 1 drug is used

Question 40

Treatment of Isolated Systolic Hypertension without Other Compelling Indications

Answer 40

Long-acting DHP CCB (good for isolated systolic bc won't drop diastolic that much bc doesn't have direct effect on heart)

Question 41

nonDHPs and DHPs are both useful for ______, but

Answer 41

angina, but non DHPs have a stonger effect (bc they have an effect on the heart)

Question 42

non DHPs treat these types of angina

Answer 42

stable angina-exertion, unstable angina-plaque, variant angina-spasm

Question 43

DHPs treat these types of angina

Answer 43

stable (exertion) and variant (spasm)

Question 44

DHP interactions

Answer 44

beta blocker withdrawal-increased rate of contraction in heart, then CCB will increase blood flow->bad! (not as severe for non DHPs)

Question 45

non DHPs main use

Answer 45

arrhythmias, also angina

Question 46

DHP main use

Answer 46

hypertension, also angina