Pharm: Exam1 (wk 4)

"silent killer"
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Terms in this set (111)
"silent killer"
HTN
What is HTN defined as
140/90 or above; or being of HTN meds
who are more at risk for HTN
African americans
an increase of 20 for SBP and 10 DBP _______ risk for CVD
doubles
which (SBP/DBP) is a greater risk for CVD
SBP
If the pt is older what is the greater risk for CVD
DBP
BP=
CO x systemic vascular resistance; primary HTN
chronotopic def
rate
ionotropic def
force of contraction
with peripheral receptor activation what will beta 1/2 do
1 stimulation will increase HR and contractility increasing CO
2 will increase a vasodilation (renin release)
what are baroreceptorsnerve endings in large a (aorta, carotid)What cause angina pectorisheart not getting enough blood bc narrowed arteries, result from lactice acid build upstable angina occur fromthe heart having to work harder and needs more o24 types of anginastable, unstable, microvascular, prinzmetals(variant)what type of angina has increased risk for MIunstablestable angina result ofphysical exertion and heart ischemiawhat is the cause of ischemiaeither incrase in o2 demand or decrease in the supplywhat are acute attacks of angina treated withorganic nitrated or nitriteswhat are the 2 purposes of treating anginaprevent MI/death and reduce sx (improve life quality)what is class 1 drugevidence and general agreement that a given treatment is usefulwhat is class 2 drugther is conflicting evidence and/or divergence of opinion about the usefulness of a treatmentwhat is class 2a drugweight of evidence/opinion is in afavor of usefulnesswhat is class 2b drugusefulnes is less well well est by evidence/opinionwhat is class 3 drugconditions for which there is evidence/opinion that the tx is ineffectiveNO mediated guanylyl cyclase activation inhibits whatplatelet aggregationASA what class and for whatantiplatelet class 1Clopidogrel class and what forantiplatelet for when ASA contraindicated, class 2acombo therapy ASA and clopidogrel for post ____ or ___ for how longACS, PSI, 12monthsbeta blockers are what classclass 1beta 1 blockade results indecrease HR, contractility, and CObeta 2 blockade results invasoconstriction bonchoconstrictionbeta receptors lead to productions of ___ and increased release of ____cAMP, NEbeta receptorscause vasodilationspositive chronoctropesincrease HRnegative chronotropesdecrease HRpositive ionotropesincrease force of contractioninhibiting beta 1 leads todecrease in BPCO=HR x SVreducing central release of _____ resutls in lower BPadrenergic substancesdecreasing ______ release = lower BPreninbeta blockers are contraindicated for which kind of anginavasospastic______ are less influenced by hepatic metabolism and excreted to a greater extent renallyless lipophilic drugsISA is whatintrinsic sympathomimetic activitybeta specific iscardioselectivitycardioselectve beta blockers bind tobeta 1 receptors, and beta 2 at higher dosesbeta blockers w/ ISA actas both agonist and antagonists at beta receptorsadverse effects of beta blockersfatigue, hypotension, bronchospasm, worsenig PVD, depression, rebound HTN w/ cessation, high LDLswhen at high doses ______ can stim b2 receptor which can exacerbate asthma and COPDselective beta blockersstatin does ____ and is what classLDL lowering class 1ace inhibitors are what for MI and what class are theyrampril, perindopril, trandolapril, class 1ca channel blockers bind to ______ to decrease.....ca++ channels, influx of Ca++ into extracellular fluid which relaxes smooth mus and vasodilates aCCB includePhenylalkylamines, benzothiazepine, dihydropyridines______ cause vasodilation and may cause fluid retention and tachycardiaDihydropyridines,decrease AV nodal conduction and cause vasodilationnon-dihydropyridinesorder of strongest vasodilators for CCBDHP, Diltiasem, and least Verapamilorder of strongest rate/force effectors for CCBverapamil, dilitiazem, DHPs(least)who benefits from non-dihydropyridinesCAD, Chronic unstable angina, prinzmetal (vasospastic)adverse effects of non-dihhydropyridinesbradycardia, constipation (verapamil), headache, dizzziness, flushingdihydropyridines adverse effects(pines) peripheral edema, dizziness, headache, flushing, tachycardiawhat does non-dihydropyridines includephenyalkylamines, benzothiazepineavoid using CCB in ___ and ___ ptlow renin HTN, systolic heart failure (CHF)ONitrates cause vaso_____dilation_____ decrease the perload and afterload of the heartO nitratesbenefits in nitrates due to decreasein O2 consumptionnitrates may cause an initial in fall in ____ till the system normalizesBPcommon side effect of nitrates and whyheadache bc vasodilation of meaningeal vesselsNitrates will cause a ____ in HR or not change itincrease_______pt usually appear flushed bc of vilation of arteries of the face and necknitratesnitrates higher doses may cause BP to ______ bc of venous -___drop, pooling and decrease arteriolar resistancecGMP inhibits platelet aggregation in with ______ usenitratewhat is the preferred method of admin for nitrates and whysublingual bc 2min to act3 types of nitrateisosorbide Dinitrates, Isosorbide mononitrate (oral), and amyl nitrate (IV)when using nitrates must try to avoid____tolerancewhat can not be taken with nitratesphophodiesterase-5 enzyme inhibitors (hypotension), ergot alkaloids (negate drug effects), pt that are hypytensive, tachycardia, or hypertrophic cardiomyopathyranolazineis used for _____ and ______ for pt that need nitrates but cant have the side effectsangina, ischemiaranolazine works by decreasing Na intracellularly and therefore reducing Ca- influxranolazinewhat is your first defense against anginabeta blockersif the first line of defense against angina is inadequate what is step 2add a Ca channel blockerif the first line of defense works for angina but the pt is intolerant then what is the next stepthen take them off Beta blocker and give them nitrates, ranolazine, or rate limiting Ca blockerswhat does ARB stand forangiotensin receptor blockwhat is the typical treatment for stage 1 HTNthiazide diureticwhat is the typical treatment for stage 2 HTNcombo therapy w/ thiazide and either ACEI, ARB, BB, CCbwhat 3 treatments are BB used forpost MI, DM, high risk coronary diseasew/ diuretics when is equilibrium reachedwhen water intake matches urinary output______inhibit active transport of ____in the distal tubule increasing Na and Cl excretionThiazide diuretics, Nathiazide diuretics also minorly inhibit ______ ______carbonic anhydraseex of thiazide diureticschlorothiazide, hydrochlorothiazide (BP),how long does it take for to see full effect of thiazides1 monthwhat is the first step to treating HTNdiuretics (thiazides)ex of thiazide like diureticschlorthalidone, indapamide, metolazone(heart failure)______ dont work well if pt has low functioning kidneys except metolazone drugthiazidesadverse effects of thiazide diureticshypotension, electrolyte imbalance, increase total cholesterol, altered glucose tolerance, EDloop diuretics inhibit___ and ____ absorption where?Na, Cl, all segments of uriniferous tubulesa pt w/ kidney dysfunction ______ _____ from loop diureticswill benefitloop diuretics inhibit ______ pump in _______ limb of the loop of henleNa, K, Cl; ascendingwhat are ex of loop diureticsfurosemide, bumetanide, torsemidemake sure avoid ______ w/ pt who have sulfonamide allergydiureticswho responds well to diuretic pearlsafrican americansthe renin angiotensin system ______ BPincreasescontraindications to ACEIhypersensitivity, hx of angioedema, renal artery stenosis, preg; possible: hyperkalemia, renal dysfunctionACEI adverse effectscough, hypotension, rash, pruritis, proteinuria, neutropenia (low WBC)Beta blockers ______ renin releasedecreaseantiHTN in DM pt must watch for glucose intolerance w/diureticswhat is the target BP for pt w/ DM130/80 or 125/75 is have proteinuria and renal insufficientcyin a HTN emergency DBP should not be lowered below ____-____ over _______ to ______100-110, several mins to hourswhat meds are used in HTN emergencynitroprusside, nitroglycerin,Labetalol, hydralazine, esmolol, fenoldopam, Nicardipine, Diazoxide, Clonidine, Captoprilmonitor ____ (4) when on nitroprussidehypotension, mental status, metabolic status, acidosisside effects of labetalol (3)othrostatic hypotension, dizziness, ab painuse hydrlazine in pt with _____ and watch for (3)eclampsia, angina, tachycardia, headacheside effects of esmololhypotension, thrombophlebitis, nauseadiazoxide is given in conjunction with_____ and _____diuretics, low pressors