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Flashcards in Cardio VII Deck (105)
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1
Q

What are the three broad groups of ACEIs?

A

Sulfhydryl
Dicarboxyl
Phosphorus

2
Q

The sulfhydryl group of ACEI are structurally related to what drug?

A

Captopril

3
Q

The dicarboxyl group of ACEI are structurally related to what drug?

A

Enalapril

4
Q

The phosphorus group of ACEI are structurally related to what drug?

A

Fosinopril

5
Q

What is the MOA of ACEIs?

A

Decreased production of angiotensin II, causing decreased vasoconstriction, decreased aldosterone, and decreased Na reuptake

6
Q

What is the special advantage that ACEIs confer to DM pts?

A

slowing the development of diabetic retinopathy

7
Q

How do ACEIs slow chronic renal disease formation?

A

slow glomerulosclerosis, which causes HTN

8
Q

What is the relationship between ACEIs and CAD, LV dysfunction, and ischemic stroke?

A

Improves ventricular dysfunction, and reduce morbidity/mortality

9
Q

What is the effect of ACEIs on bradykinin?

A

Inhibits its breakdown, causing vasodilation

10
Q

Drug that has an -opril or -april suffix is what kind of drug?

A

ACEI

11
Q

True or false: you should never combine ACEIs with diuretics

A

False–very commonly used together

12
Q

What organ is responsible for most of the clearance of ACEIs? What disease, then, do you have to reduce the dose for?

A

Kidneys

Renal disease

13
Q

What should you do in pts with high plasma renin levels?

A

Reduce doses

14
Q

What are the absolute contraindications for ACEIs?

A

Pregnancy
Bilateral artery stenosis
h/o angioedema

15
Q

What disease is there a potentially favorable effect of using ACEIs?

A

Prediabetes

16
Q

What are the two situations in which there may be a potentially unfavorable effect of ACEIs?

A

Hyperkalemia

Volume depletion

17
Q

Why should you not give ACEIs to a pt with bilateral renal artery stenosis?

A

GFR is maintained by angII’s effects to increase resistance in the post-glomerular arteriole

18
Q

Why are ACEIs contraindicated with hyperkalemia?

A

Stopping aldosterone decreases K loss

19
Q

What is the most common adverse effects of ACEIs?

A

Dry coughing

20
Q

Angioedema is an adverse effect of what drugs?

A

ACEIs

21
Q

What is the MOA of losartan?

A

Block angiotensin type I receptor

22
Q

What is the MOA of valsartan?

A

Block angiotensin type I receptor

23
Q

What is the MOA of candesartan?

A

Block angiotensin type I receptor

24
Q

What is the MOA of irbesartan?

A

Block angiotensin type I receptor

25
Q

What is the MOA of telmisartan?

A

Block angiotensin type I receptor

26
Q

What is the MOA of olmesartan?

A

Block angiotensin type I receptor

27
Q

What is the MOA of eprosartan?

A

Block angiotensin type I receptor

28
Q

What is the effect of blocking the angiotensin type I receptor?

A

Decreased angiotensin II effects (vasoconstriction, aldosterone secretion, Na/water retention)

29
Q

What is the effect of angiotensin II on smooth muscle contraction?

A

increased

30
Q

What is the effect of angiotensin II on thirst?

A

Increased

31
Q

What is the effect of angiotensin II on vasopressin release?

A

Increased

32
Q

What is the effect of angiotensin II on aldosterone secretion?

A

Increased

33
Q

What is the effect of angiotensin II on release of adrenal catecholamines?

A

Increased

34
Q

What is the effect of angiotensin II on noradrenergic neurotransmission?

A

Increased

35
Q

What is the effect of angiotensin II on sympathetic tone?

A

Increased

36
Q

Drugs with -artan suffix = ?

A

angiotensin antagonist

37
Q

What is the drug of choice for treating HTN in pts with intolerance to ACE inhibitors?

A

Angiotensin receptor antagonists

38
Q

ARBs are not used in the treatment of HTN in pts with what previous condition?

A

Stroke

39
Q

What are the absolute contraindications for ARBs?

A

Pregnancy

Bilateral artery stenosis

40
Q

What are the diseases that have benefits with ARBs?

A

pre DM

41
Q

What are the two situations that have unfavorable effects with ARBs?

A

Hyperkalemia

Volume depletion

42
Q

What types of drug is nifedipine?

A

dihydropyridine Ca channel blocker

43
Q

What type of drug is amlodipine?

A

dihydropyridine Ca channel blocker

44
Q

What type of drug is felodipine?

A

dihydropyridine Ca channel blocker

45
Q

What are the two conditions where DHP Ca channel blockers may be an add on therapy for treating HTN?

A

DM

CAD

46
Q

DHP Ca channel blockers are an alternative to what in CAD?

A

Beta blockers

47
Q

What condition absolutely contraindicates DHP Ca channel blockers?

A

left ventricular dysfunction

48
Q

What diseases do DHP Ca channel blockers have a potentially beneficial effect?

A

Reynaud syndrome

elderly pts with isolated systolic HTN

49
Q

What are the situations in which DHP Ca channel blockers have a potentially unfavorable effect?

A

Tachycardia

50
Q

NDHP drugs are used as an alternative to beta blockers in which disease?

A

CAD

51
Q

What disease should you avoid using NDHP to treat HTN?

A

Left ventricular dysfunction

52
Q

What are the three situations in which NDHP for HTN are favorable?

A

Migraine HA
Arrhythmias
tachycardia

53
Q

What is the situation in which NDHPs have a potentially unfavoarble effect?

A

Low normal HR

54
Q

What is the MOA of verapamil?

A

NDHP

55
Q

What is the MOA of diltiazem?

A

NDHP

56
Q

Thiazide diuretics are first line therapy for what conditions?

A

Left ventricular dysfunction

Previous ischemic stroke

57
Q

Why is there a favorable effect of treating HTN with thiazide diuretics in pts at risk of osteoporosis?

A

Increases Ca absorption

58
Q

Why are thiazide diuretics contraindicated in pts with pre-DM?

A

Causes hyperglycemia

59
Q

Is Propranolol a selective, nonselective, beta blocker?

A

Selective (for beta 1)

60
Q

What are the first generation beta blockers? Are these selective or nonselective?

A

Propanolol
Nadolol
timolol
Pindolol

Nonselective

61
Q

What are the second generation beta blockers? What is the receptor affinity for these?

A
Atenolol
Metoprolol
Esmolol
Beliprolol
Acebutolol

B1&raquo_space;»> B2

62
Q

What are the third generation beta blockers? What is the receptor affinity?

A

Labetalol
Carvedilol

B1 = B2 > a1 > a2

63
Q

Beta blockers are first line therapy for HTN what?

A

CAD

LVD

64
Q

What is the MOA of spironolactone?

A

Aldosterone antagonist

65
Q

What is the MOA of eplerenone?

A

Aldosterone antagonist

66
Q

What are the three characteristics of “other” drugs used to treat HTN?

A
  1. Effective in lowering BP
  2. Are approved for HTN
  3. Have not been shown to reduce CV events
67
Q

What is the MOA of prazosin?

A

Alpha 1 receptor antagonist

68
Q

What is the MOA of doxazosin?

A

Alpha 1 receptor antagonist

69
Q

What is the MOA of terazosin?

A

alpha 1 receptor antagonist

70
Q

What is the basis for using alpha 1 receptor antagonists in treating BP?

A

Block vasoconstrictive effects of alpha 1 on vessels

71
Q

What are the adverse effects of alpha 1 antagonists (e.g. prazosin) in treating BP?

A

reflex tachycardia

Sexual dysfunction

72
Q

What is the MOA of clonidine?

A

Alpha 2 agonists

73
Q

What is the basis for using alpha 2 agonists (e.g. clonidine) in treating HTN?

A

Decrease sympathetic outflow

74
Q

What is the MOA of alpha methyldopa?

A

Alpha 2 agonist

75
Q

What is the MOA of apraclonidine?

A

Alpha 2 agonist

76
Q

What is the MOA of brimonidine?

A

alpha 2 agonist

77
Q

What are the adverse effects of alpha 2 agonists?

A

Anticholinergic effects

78
Q

What is the potential issue of stopping an alpha 2 receptor agonist abruptly?

A

Rebound HTN

79
Q

What other drug is used in combination with alpha 2 receptor agonist?

A

Diuretic

80
Q

What specific condition is alpha-methyldopa used to treat HTN in?

A

Gestational HTN

Chronic HTN in pregnancy

81
Q

What is the MOA of hydralazine?

A

Decreases IP3 / Ca in arteries, causing vasodilation

82
Q

What is hydralazine used for? (3)

A
  1. Add on for resistant HTN
  2. Severe chronic kidney disease
  3. Gestational HTN
83
Q

What are the adverse effects of hydralazine?

A

induces SLE with long term use

Tachycardia d/t Na retention

84
Q

What are the two drugs that should be added when using hydralazine?

A

beta blocker and diuretic

85
Q

What is the MOA of minoxidil?

A

Opens K channels, causing vasorelaxation

86
Q

What is the role of minoxidil in antiHTN therapy?

A

Only for severe, refractory HTN

87
Q

What drugs should be combined with minoxidil?

A

beta blockers and diuretics

88
Q

What is the major adverse effect with minoxidil?

A

Reflex increase in myocardial contractility

89
Q

What is the MOA of sodium nitroprusside?

A

donates NO, cGMP mediated Ca sequestration

90
Q

What is the effect of sodium nitroprusside on the heart?

A

Decreases afterload and preload

91
Q

How is sodium nitroprusside administered?

A

IV

92
Q

What are the adverse effects of sodium nitroprusside?

A

CN poisoning

Methemoglobin

93
Q

What is the MOA of aliskiren?

A

Direct renin inhibitor

= prevents it from cleaving angiotensinogen

94
Q

What should you use aliskiren for?

A

monotherapy in HTN

95
Q

What are the drugs that should be used in combination with aliskiren?

A

ACEIs, thiazide or ARB

96
Q

What is the MOA of reserpine?

A

Blocks VMAT in catecholamine synapses

97
Q

The most effective use of reserpine is in combination with what other type of drug?

A

Thiazide diuretic

98
Q

What are the side effects of reserpine?

A

Strong sympatholytic effect

increased parasympathetic activity

99
Q

Rauwolfia alkaloid = what drug?

A

Reserpine

100
Q

Why are diuretics a good choice for second line therapy in RHTN?

A

Most pts are fluid overloaded

101
Q

What is the major diuretic to treat RHTN?

A

Chlorthalidone

102
Q

Which aldosterone receptor antagonist is used in the treatment of RHTN?

A

Spironolactone

103
Q

Which alpha 2 blocker is used in the treatment of RHTN?

A

Doxazosin

104
Q

Which epithelial Na channel blocker is used in the treatment of RHTN?

A

Amiloride

105
Q

To lower BP, do you want to cut the sympathetic or parasympathetic tone from the kidneys?

A

lower sympathetic tone