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Pharm > CV > Flashcards

CV Flashcards

1
Q

big 4 that contribute to atherosclerosis

A 
HTN (primary)
hyperlipidemia (primary)
DM (T2)
smoking
(obesity as well)
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2
Q

CV #1 killer in US primarily due to

A

ischemic heart disease and stroke

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3
Q

“athero” “sclerosis”

A

porridge - hardening

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4
Q

location of atherosclerosis

A

arterial intima, beneath inner endo. cell lining of large and medium-sized arteries–>narrowing of art. lumen

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5
Q

conditions that result from atherosclerosis

A

angina pectoris and MI
TIA and ischemic forms of stroke
cardiac arrhythmias and CHF

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6
Q

antiHTN drugs: diuretics

A 
*hydrochlorothiazide (microzide)
chlorthalidone (thalitone)
indapamide
*furosemide (lasix)
triamterene (dyrenium)
*spironolactone (aldactone)
eplerenone (inspra)
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7
Q

primary vs secondary HTN

A

prim: don’t know cause, genetic, salt sensitivity
sec: i.e. pheochromocytoma triggers HTN

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8
Q

in HTN

A

elevation in vascular resistance +/- preceded by ^CO

we refer to SYSTEMIC pulmonary HTN rarely

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9
Q

non-drug tx

A

dietary (lower Na)

exercise

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10
Q

antiHTN drugs: adrenergic neuron blockers

A
  • reserpine
  • methyldopa
  • clonidine (catapres)
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11
Q

antiHTN drugs: adrenergic receptor blockers

A
  • Prazosin (Minipress)
  • Doxazosin (Cardura)
  • Terazosin (Hytrin)
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12
Q

loop diuretics

A

inhib. reabsorption of Na and Cl (water follows out in urine)
* more powerful than thiazides*

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13
Q

thiazide diuretics

A

inhib. reab of NaCl at distal tubule

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14
Q

antiK+ sparing diuretics

A

inhib. reab. of Na at collecting duct, K+ spared

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15
Q

antiHTN drugs: B-adrenergic rec blockers

A

Propranolol (Inderal‐LA)

  • Nadolol (Corgard)
  • Timolol
  • Pindolol
  • Atenolol (Tenormin)
  • Metoprolol (Toprol‐XL)
  • Acebutolol (Sectral
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16
Q

antiHTN drugs: a1/B Blocker and NO‐releasing β1 Blocker

A
  • Labetalol (Trandate) (not NO-releasing)

* Nebivolol (Bystolic) (NO releasing)

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17
Q

antiHTN drugs: Direct Arteriolar Dilators

A

Hydralazine

Minoxidil

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18
Q

antiHTN drugs: Calcium Channel Blockers (CCB) (in cell mem.,–>less Ca2+ influx)

A

*Verapamil (Calan) Diltiazem (Cardizem) (dec cardiac contractions)
*Nifedipine (Procardia ‐ XL) (dec. sm. musc. contr in arterioles)
Felodipine
Amlodipine (Norvasc)

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19
Q

antiHTN drugs: Angiotensin Converting Enzyme (ACE) Inhibitors

A 
*Captopril (Capoten)
Enalapril (Vasotec)
Lisinopril (Prinivil, Zestril)
Quinapril (Accupril)
Ramipril (Altace)
**all "PRILS"**
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20
Q

antiHTN drugs: Angiotensin II Receptor Blockers (ARBs)

A

*Losartan (Cozaar)
Valsartan (Diovan)
Candesartan (Atacand)
“SARTANS”

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21
Q

antiHTN drugs: Renin Inhibitors

A

Aliskiren (Tekturna)

-inhibits AFTER released, dec. renin activity

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22
Q

ACE inhibitors

A

inhib. conversion of AngI to ACTIVE AngII
AngII causes: vasoconstriction and aldosterone secretion
if inhib: dec. resistance, dec.

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23
Q

AngII causes

A

vasoconstriction and aldosterone secretion

if inhib: dec. resistance, dec. MORE

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24
Q

Ezetimibe (Zetia)

A

cholesterol absorption inhibitor

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25
Q

Cholestyramine (Questran)
Colestipol (Colestid)
Colesevlam (WelChol)

A

bile acid binding resins

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26
Q

STATINS***

A 
HMG-CoA Reductase Inhibitors
*Lovastatin (Mevacor)
Pravastatin (Pravachol) 
Simvastatin (Zocor) 
Atorvastatin (Lipitor) 
Rosuvastatin (Crestor)
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27
Q

importance of statins

A

HMG-CoA reductase** is rate limiting enzyme of cholesterol production in LIVER
triggers endogenic prod. pathway: VLDL–>IDL–>LDL–>tissue

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28
Q

antidiabetic agents

A

insulin preps
insulin secretory drugs (need more-directly stimulate)
insulin sensitizing drugs (help insulin along- Metformin)
a-glucosidase inhibitors (dec. gluc absorp)
incretin mimetics (stim. insulin release)
dipeptidyl peptidase IV inhibs (inhib. incretin brkdwn)
amylin analogs

29
Q

insulin main action

A

stim. glucose uptake to tissue
inhib. glucose rel. from liver
* all to lower blood glucose* (hyperglycemia)

30
Q

consequences of atherosclerosis

A

angina

31
Q

antianginal agents: nitrates

A

*Nitroglycerin (Minitran, Nitrostat)
Isosorbide Dinitrate (Isordil)
Isosorbide Mononitrate (Ismo)
Amyl Nitrite

32
Q

antianginal agents: Ca-channel blockers

A

*Nifedipine (Procardia XL) (vasculature) (misnomer!)
Amlodipine (Norvasc)
*Verapamil (Isoptin SR, Calan) (heart)
Diltiazem (Cardizem)
“DIPINES” dihydropyridines Ca2+ channel blockers in vasculature

33
Q

antianginal agents: B-adrenergic blockers

A 
[B1 and B2]
*Propranolol (Inderal‐LA) 
*Nadolol (Corgard) 
*Timolol
[B1 only]
*Atenolol (Tenormin)
*Metoprolol (Toprol‐XL)
34
Q

3 types of angina: 1. atherosclerotic obstruction

A

plaque in large coronary arteries–>classic angina pectoris (effort or stable angina) most common!
triggered by exercise, not enough O2 reaching heart, switch over to other pathway creating toxic metabolites
-does not dilate very well, vasodilators will NOT help, make worse

35
Q

3 types of angina: 2. vasospastic angina

A

reversible vasospastic reduction of flow in large coronary arteries (variant angina, Prinzmetal’s angina)

36
Q

3 types of angina: 3. unstable or crescendo angina

A

combo of 1st 2:
or sudden marked platelet aggreg. with clot form. at site of ruptured plaque (rest or exertion)
may be immediate precursor to MI!!

37
Q

other ways to help atherosclerotic obstruction

A

reduce O2 DEMAND in tissue blocked by obstructed vessel

38
Q

preload dep. on

A

venous smooth muscle tone, venous fluid volume

39
Q

how to dec. preload to to red. O2 demand

A
  • dec. VENOUS smooth muscle tone–>nitrates: becomes NO (rarely: dec. arteriole tone)
    dec. venous fluid volume (takes long time for diuretic to do that)
40
Q

to dec. contractility/rate to red. O2 demand

A

B-blockers

Ca2+ chan. blockers (verapamil)

41
Q

dec. afterload to red. O2

A

nifenampine, etc??

42
Q

CHF drugs: digitalis glycosides and rel. agents

A

*Digoxin (Lanoxin)
Digitoxin
Digoxin Immune Fab (DigiFab)

43
Q

CHF drugs: non-glycoside inotropic agents (+/- inotropic agents)

A

*Dobutamine *Dopamine

Inamrinone Milrinone

44
Q

CHF drugs: ACE inhib.

A

*Captopril (Capoten)
Enalapril (Vasotec)
Fosinopril (Monopril)
Quinapril (Accupril)

45
Q

CHF drugs: AngII rec-I blocker

A

*Losartan (Cozaar)
Valsartan (Diovan)
Candesartan (Atacand)

46
Q

CHF drugs: diuretics

A

*Hydrochlorothiazide (Microzide)
*Furosemide (Lasix)
*Spironolactone (Aldactone)
Epleronone (Inspra)

47
Q

CHF drugs: direct vasodilators

A

*Nitroglycerin (Minitran)
Hydralazine
Nitroprusside (Nitropress)
Isosorbide Dinitrate (Isosordil) Nesiritide (Natrecor)

48
Q

CHF

A

chronic
impaired ability of ventricles to adequately fill AND/OR eject blood volume (diastolic or systolic failure)–>low ventr. output

49
Q

causes of CHF

A

acute MI, pulmonary hypertension

50
Q

CHF s/s

A

fesp, renal, musc, cardiac

51
Q

preload is high/low in CHF?

A

it is HIGH, consequence of CHF

52
Q

B receptors

A

stimulate Ca2+, inc. contractions in systole and diastole?

53
Q

independent CHF mechanisms

A
  1. impaired contractile proteins
  2. inadequate reuptake and release of Ca2+ by SR
  3. dec. B-rec cAMP function (downreg.)
54
Q

inc. PRELOAD

A

inc. Stroke Volume

55
Q

in CHF, inc. PRELOAD

A

does not appropriately inc. Stroke Volume

have high venous pressure

56
Q

inc. PRELOAD

A

dec. Stroke Volume
even more so in CHF
vasodilators will help this (nitro, need high does to dilate arteries)

57
Q

inc. HR

A

inc. CO until LIMIT–>then dec. (fluttering, inadequate filling time)
tx with B blockers** (counter intuitive, but this is why it works!)

58
Q

body attempts to compensate for CHF

A

hypertrophy–>exacerbates!
SNS and RAAS go into high gear–>also exacerbate
(SNS: tachycardiac, inc. HR, inc. afterload (constr) inc. preload)

59
Q

why B rec. downreg.

A

chronic elevated SNS activity

B blockers prevent down regulation @ B rec!

60
Q

the RAAS system may be detrimental to

A

structural changes of myocardium

61
Q

digitalis glycoside mech

A

inhib of Na/K exchange–>increase Na–>dec. Na/Ca exchange (disrupted gradient due to inc. IC [Ca2+]–>inc. Ca2+–>inc. contraction

62
Q

dec. automaticity in potential cardiac pacemaker cells

A

prevent ???

63
Q

anti-CHF drugs: B-blockers

A

*Metoprolol (Toprol‐XL)
Bisoprolol (Zebeta)
Carvedilol (Coreg)

64
Q

Class I antiarrhythmias

A 
Class 1A
Quinidine Procainamide
Class 1B 
*Lidocaine
(Xylocaine)
Class 1C Flecainide
(Tambocor)
65
Q

Class II antiarrhythmias

A 
*Propranolol
(Inderal‐LA)
*Acebutolol
(Sectral)
*Esmolol (Brevibloc)
66
Q

Class III antiarrhythmias

A

*Amiodarone

Cordarone

67
Q

Class IV antiarrhythmias

A

*Verapamil (Calan)

68
Q

if slope not flat during phase 4

A

automaticity (slope suppressed with Ca rec. blocking drugs)

Pharm (45 decks)

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