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Antianginal Drugs Fr

FARM TEST 4

QuestionAnswer
What is the principle symptom of ischemic heart disease? Angina pectoris
Where is angina pectoris pain felt? Middle of the chest behind the sternum.
What are the 3 major categories of angina pectoris? Stable, unstable, vasospastic
Describe Stable angina pectoris. Predictable in response to exertion, stress.
Describe Unstabla angina pectoris. Increase risk of MI/death, need to use antiplatelet therapy
Describe Vasospastic angina. Caused by coronary artery spasm, can produce pain at anytime even while asleep, little evidence of coronary flow impairment
Name factors that affect myocardial oxygen demand. Contractility, heart rate, ventricular wall tension, preload, afterload
Name three classes of ANTIANGINAL DRUGS. Organic nitrates, B-Adrenergic receptor antagonists, Calcium channel blocking drugs
How do Oragnic nitrates work? They decrease preload and afterload resulting in decreased myocardial work and decreased oxygen demand, increase heart rate/contractility, decrease wall tension
Do organic nitrates DIRECTLY alter INOTROPIC or CHRONOTROPIC state of the hear? No
What effects do Organic Nitrates have on Coronary blood flow? They dilate large coronary arteries and collateral vessels to increase oxygen delivery.
What is the mechanism of pain relief in angina? Organic nitrate drugs decrease myocardial work and decrease oxygen demand, some improvement of heart perfusion.
Name an Organic Nitrate. Nitroglycerin
What is the oral bioavailability of organic nitrates? Low due to the first-pass metabolism in the liver.
How much of Oral Isosorbide is absorbed? It is completely absorbed.
What route of organic nitrates are used to provide prophylaxis against angina? Oral and transdermal
Name Adverse Effects related to Organic Nitrates. Vasodilation, hypotension, orthostatic hypotension, reflex tachycardia
What type of angina are Organic Nitrates used for? Stable and Vasospastic Angina
How do B-Adrenergic receptor antagonists work? Decrease Afterload, heart rate, contractility, wall tension
What do B-adrenergic receptors do to the heart muscle? They increase its contractility, heart rate, and secret renin in kidney.
What are the 3 major determinants of myocardial oxygen demand? Heart rate, contractility, systolic wall tension when reduced.
Name two B-Adrenergic receptor antagonists. Propranolol, metoprolol
Which B-Adrenergic receptor antagonist will you use for B1 B2 receptors? Propranolol
What type of receptors does Metoprolol work on? Only B1
What are adverse effects of B-Adrenergic receptor antagonists? Wheezing, bronchoconstriction, bradycardia.
What can occur with an abrupt withdrawal of B blockers? They can worsen angina.
Are B-Adrenergic receptor antagonists useful for VASOSPASTIC angina? No, they are most useful in pts w/ frequent and unpredictable angina attacks.
Name two CCB drugs. Verapamil, Nifedipine
Out of Verapamil and Nifedipine, which one has a direct effect on the heart? Verapamil
What is the major use of CCB? Angina Pectoris, Hypertension, Cardiac Arrhythmias
What are the effects of Verapamil on the heart? Decrease afterload, heart rate, contractility, wall tension
What are the effects of Nifedipine on the heart? Decreased afterload, wall tension, Increased heart rate
Which CCB affects the SA node and AV conduction slowing down the heart rate? Verapamil
Which CCB causes reflex tachycardia? Nifedipine
Describe the Chronic Angina Pectoris treatment algorithm. Sublingual Nitro, Beta Blocker, CCB, Long acting nitrate, Revascularization
Name five diuretics. Furosemide, Hydrochlorothiazide, Spironolactone, Triamterene, Mannitol
What are some used of Diuretics? Treat Hypertension, Mobilize Edema Fluid, Prevent Renal Fluid
How do most Diuretics work? By increasing Na excretion and diuresis
Where does filtration occur in the kidney? The glomerulus
Where does resorption occur in the kidney? Tubular epithelium
Where does Tubular Secretion occur in the body? Distal Nephron
What part of the Kidney does Mannitol work on? Proximal Convoluted Tubule
What part of the Kidney does Furosemide work on? Ascending limb of Loop of Henle
What part of the Kidney do Thiazides work on? Early Distal Convoluted Tubule
What part of the Kidney do Spironolactone & Triamterene work on? Late Distal Convolute Tubule and Collecting Duct (distal nephron)
What is the fxn of the Proximal Convoluted tubule? Resorption of Na, Cl, K, Bicarbonate, glucose and amino acids.
What is the fxn of the Loop of Henle? Decrease urine volume, concentrate urine
What are the Main Classes of Diuretics? Loop (high ceiling) Diuretics, Thiazide diuretics, K Sparing diuretics, Na Channel blockers, Osmotic Diuretics
What is blocked by Loop Diuretics? Na-K-2Cl co transporter
What are the therapeutic uses of Loop diuretics like Furosemide? When rapid and massive fluid removal is needed
What are the PO and IV action times for Furosemide? PO 60 minutes and lasts 8 hrs, IV w/in 5 minutes and last for 2 hours
What are the adverse affects of Furosemide? Hyponatremia, hypochloremia, dehydration, hypotension, HYPOKALEMIA, ototoxicity, hyperuricemia.
Name some drug-drug interactions for Furosemide. Digoxin, Otoxoic drugs, increase lithium toxicity.
Name a Thiazide Diuretic. Hydrochlorothiazide
Where do Thiazdie Diuretics work at? Distal Convoluted Tubule
What is the MOA of Hydrochlorothiazide? Blocks the resportion of Na and Cl cotransporter
When doe Thiazides not work well? When renal blood flow and glomerular filtration rates are low.
What are the pharmacokinetics of Hydrochlorothiazide? PO peak at 4-6 hrs and lasts 12 hrs DONT TAKE AT BEDTIME.
What are the Therapeutic uses of Hydrochlorothiazide? Primary Hypertension, Diabetes Insipidus, Decrease kidney stones
What are adverse affects of Hydrochlorothiazide? K losing diuretic, Increase plasma glucose, lipid levels, SHOULD NOT BE USED DURING PREGNANCY, NO OTOTOXICITY.
Name DRUG-DRUG for Hydrochlorothiazide. Increase digoxin/lithium toxicity, COMBINED W/ ANTIHYPERTENSIVES
What class of Diuretics decrease K excretion but only produce a modest increase in urine volume? Potassium Sparing Diuretics
Name a Potassium Sparing diuretic. Spironolactone
Where do Potassium Sparing diuretics work? At the collecting duct.
What is the MOA of Potassium Sparing Diuretics? Blocks the ability of Aldosterone, leading to increase Na excretion and decrease K excretion.
What are the adverse effects of Potassium Sparing Diuretics? Hyperkalemia, Gynecomastia, irregular Menses, Impotence, Hirsutism, Deepening voice
What type of drugs should not be combined with Potassium Sparing Diuretics? ACE inhibitors
Name a Na channel blocker? Triamterene
What is the MOA of Na Channel blockers? Blocks Na channel.
What are the pharmacokinetics of Triamterene? More rapid effects than Spironolactone
What are the therapeutic uses of Triamterene? Treat hypertension/edema.
What are the Adverse Effects of Triamterene? Hyperkalemia, N,V, leg cramps, dizziness, blood dyscrasias.
Name an Osmotic Diuretic. Mannitol
What is the MOA of Mannitol? It gets rid of Intracellular water as it pulls water out of cells.
What are the pharmacokinetics of Mannitol? IV effects in 30-60 minutes
What are the adverse effects of Mannitol? HA, N, V, fluid/electrolytes imbalances occur, ECV is acutely increased = HF
What are the therapeutic uses of Mannitol? Prophylaxis of Renal Failure, reduce intracranial pressure/intraocular pressure
What are the two types of hypertension? Primary and Secondary
What is another name for Primary hypertension? Essential Hypertension
Which hypertension has an identified primary cause and some people can be cured by treating the cause? Secondary Hypertension
What are the systems that help regulate blood pressures? Baroreceptor reflex, Renin-Angiotensis System (RAS), Renal Regulation of blood pressure
What is the purpose of Alpha 1 adrenergic receptors? To cause vasoconstriction
What is the purpose of Alpha 2 adrenergic receptors? Decrease sympathetic tone in brain/periphery
What is the purpose of Beta 1 adrenergic receptors? Increase heart rate/contractility, stimulate renin
What is the purpose of Beta 2 adrenergic receptors? Dilate skeletal musculature during flight or fight.
What does a decrease in arterial pressure do? Decreases GFR which promotes retention of Na, Cl, and H2O increasing blood volume.
What does Angiotensin II control? Blood pressure
What type of drugs are used to treat hypertension? Diuretics
What is the most commonly used diuretic for hypertension used in monotherapy or combination? Thiazides
How doe Thiazides work? ↓ blood volume & arterial resistance
What are the adverse affects of Thiazides? ↓K, dehydrations, hyperglycemia, hyperuricemia
Which diuretic drugs is reserved for pts requiring maximum diuresis and pts with low GFR? Loop Diuretics (High Ceiling)
What are the adverse effects of Loop Diuretics? ↓ K, dehydration, hyperglycemia, hyperuricemia, OTOTOXICITY
Which diuretics are the least effective but balance the K loss by thiazides or loop diuretics? Potassium Sparing diuretics
What is the most significant adverse effect of Potassium Sparing Diuretics? HyperKalemia
Can you use Potassium Sparing Diuretics with ACE inhibitors? Why or Why not? No, because ACE inhibitors can cause hyperkalemia.
How do Sympatholytics fxn? They suppress the influence of the sympathetic nervous system on the heart and BV.
Name some Sympatholytics. B-Adrenergic blockers, Alpha 2 agonists, Alpha 1 adrenergic Antagonists, Alpha 1/Beta blocker combos
Name some B-Adrenergic Blockers. Propranolol, metoprolol
What are the adverse effects of B-adrenergic blockers? Bizarre dreams, Sexual dysfxn, bradycardia, heart block, depression, insomnia
Name an Alpha 2 agonist. Clonidine
How doe Alpha 2 agonists work? Act in brain to ↓ SNS tone
What are adverse effects of Alpha 2 agonists? Dry mouth, Sedation
Name an Alpha 1 adrenergic antagonist. Prazosin
How doe Alpha 1 adrenergic antagonists work? Block Vasoconstriction
What are the adverse effects of Alpha 1 Adrenergic antagonists? Orthostatic hypotension
What is Hydralazine? It is a direct acting vasodilator used to ↓ Blood pressure by dilating arterioles.
What are the adverse effects of Hydralazine? Lupus-like syndrome
How do CCB work? ↓BP by dilating arterioles.
Name a CCB in the Dihydropyridine class. Nifedipine
Since Nifedpine is a CCB, what are its adverse effects? Ankle edema, reflex tachycardia
What are the adverse effects of ACE inhibitors? Persistent "tickle" cough, first does hypotension, HYPERKALEMIA
Can ACE inhibitors be taken during pregnancy? They cause fetal harm during the 2nd and 3rd trimesters of pregnancy.
What is an ARB? an Angiotensin Receptor Antagonist
Can ARB's be taken during pregnancy? They are harmful during the 2nd and 3rd trimester fetus.
Name an Angiotensin II Receptor Antagonist (ARB). Losartan
Name a Directe Renin Inhibitor. Aliskiren, cause fetal harm
Where do THIAZIDEs work at? Vascular Smooth Muscle
Where does FUROSEMIDE, K Sparing Diuretics, and Thiazide Diuretics work at? Renal Tubules
Where do Beta Blockers such as Propranolol and Metoprolol work at? Cardiac Beta 1 receptors
Since Prazosin is a Alpha 1 blocker, where does Prazosin work at? Vascular Receptors to cause vasodilation
Where do Clonidine and Methyldopa work at? Brainstem
Created by: jesusrvillarreal
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