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2013-02-21 17:17:58
Midterm exam

Hypertension and cardiac arrhythmias
Show Answers:

  1. Stage 1 hypertension
  2. Stage 2 Hypertension
  3. Stage 3 hypertension
  4. What are the 4 pharmacologic hypertension treatments?
    • Diuretics—deplete
    • body of sodium, decrease plasma volume

    • Vasodilators—relax
    • vascular smooth muscle

    Angiotensin antagonists—reduce PVR

    • Sympathoplegics—inhibit
    • cardiac function, reduce PVR
  5. How do Loop Diuretics work?
    selectively inhibit NaCl reabsorption in the thick ascending limb of the loop of Henle
  6. Loop diuretic indications are...
    hyperkalemia, ARF, Anion overdose
  7. ADR:hypokalemia, hyperuricemia, ototoxicity (damage to ear), hypomagnesemia 
    loop diuretics
  8. torsemide, furosemide,
    bumetanide are
    loop diuretics.
  9. torsemide
    loop diuretic
  10. furosemide
    loop diuretic
  11. bumetanide
    loop diuretic
  12. how do thiazides work?
    Inhibit NaCl reabsorption from the luminal side of epithelial cells in the distal convoluted tubule
  13. indications for Thiazides are..
    • hypertension
    • CHF
    • nephrolithiasis due to idiopathic hypercalciuria
    • nephrogenic diabetes insipidus
  14. ADR of Thiazides include...
    • hypokalemia
    • impaired carbohydrate tolerance
    • hyperlipidemia
    • hyponatremia
    • weakness
    • allergic reactions
  15. How do Potassium Sparing diuretics work?
    Reduce Na+ absorption in the collecting tubules and ducts
  16. spironolactone, triamterene, and amiloride are...
    Potassium sparing diuretics
  17. spironolactone
    potassium sparing diuretic
  18. triamterene
    potassium sparing diuretic
  19. amiloride
    potassium sparing diuretic
  20. Indications of potassium sparing diuretics.
    • mineralocorticoid excess
    • CHF
    • nephrotic syndrome
    • hepatic cirrhosis
  21. ADR of potassium sparing diuretics...
    • hyperkalemia
    • hyperchloremic metabolic acidosis
    • gynecomastia (enlarged breast)
    • ARF
    • renal stones
  22. Patient has mild to moderate hypertension, whats a good drug to start with?
  23. A patient has severe hypertension, existing renal insufficiency, cardiac failure, sodium retention or cirrhosis. What's a good drug?
    loop diuretic (torsemide, furosemide, bumetanide)
  24. I want to enhance the effects of other diuretics.. how do I do this?
    Potassium sparing diuretics (Spironolactone, triamterene, amiloride)
  25. How do vasodilators work?
    relax smooth muscle of arterioles, decreasing systemic vascular resistance
  26. Hydralazine and Minoxidil are...
    Oral Vasodilators
  27. Hydralazine
    Oral vasodilator
  28. Minoxidil
    Oral vasodilator
  29. Nitoprusside
    Parenteral vasodilator (relaxes both arterioles and veins)
  30. Diazoxide
    Parenteral Vasodilator (arteriolar dilator)
  31. headache, nausea, anorexia,
    palpitations, sweating, flushing, peripheral neuropathy, drug fever. ADR of...
    Hydralazine (oral vasodilator)
  32. tachycardia, palpitations, angina,
    edema, headache, sweating, hypertrichosis. ADR of...
    Minoxidil (oral vasodilator)
  33. This drug has most serious toxicity due to accumulation of cyanide—metabolic acidosis, arrhythmias, excessive hypotension, death. ADR of
    Sodium Nitroprusside (parenteral vasodilator)
  34. Thiocyanate is a metabolite of...
    nitroprusside (parenteral vasodilator)
  35. weakness, disorientation,psychosis, muscle spasms convulsions, methemoglobinemia. ADR of..
    Thiocyanate (metabolite of nitroprusside)
  36. excessive hypotension, angina, cardiac failure in patients with ischemic heart disease. Inhibits insulin release from the pancreas. Causes renal salt and water retention (limited by short term use) ADR of?
    Diazoxide (parenteral vasodilator)
  37. How do calcium channel blockers work? 
    Dilate peripheral arterioles and reduce blood pressure due to blockade of calcium influx into arterial smooth muscle cells
  38. Verapamil, diltiazem, amlodipine, felodipine, isradipine, nicardipine, nifedipine
    Calcium channel blockers. all equally effective in lowering BP.
  39. Verapamil
    Calcium channel blocker
  40. diltiazem
    calcium channel blocker
  41. amlodipine
    Calcium channel blocker
  42. felodipine
    Calcium channel blocker
  43. isradipine
    Calcium channel blocker
  44. nicardipine
    Calcium channel blocker
  45. nifedipine
    Calcium channel blocker
  46. This calcium channel blocker will immediately decreases heart rate
  47. This calcium channel blocker has the greatest effect on the heart, causing decrease in heart rate and cardiac output
  48. this class has greater vasodilator activity with less cardiac suppressant activity
  49. How do ACE inhibitors work?
    Angiotensin Converting Enzyme Inhibitors (ACE) inhibit the enzyme peptidyl dipeptidase that hydrolyzes angiotensin I to angiotensin II.  Angiotensin II causes vasoconstriction. Blockade of angiotensin II will result in decreasing PVR
  50. Captopril, enalapril, lisinopril, benazepril, fosinopril, quinapril, ramipril are
    ACE inhibitors  (-prils)
  51. Severe hypotension, ARF, hyperkalemia, angioedema, dry cough (sometimes accompanied by wheezing) ADR of
    ACE inhibitors
  52. Minor ADR of ACE inhibitors:
    altered sense of smell, rash, fever
  53. Whom should you NOT give ACE inhibitors to...
    Women in 2nd and 3rd trimester of pregnancy (contraindicated)
  54. Drug interactions with ACE inhibitors
    • Potassium supplements, potassium sparing diuretics– may result in hyperkalemia
    • NSAIDs–impair the hypotensive effects of ACE inhibitors through blockade of bradykinin mediated vasodilation, which is prostaglandin mediated
  55. How do angeiotensin receptor blockers work?
    block the angiotensin II receptor, causing a decrease in PVR
  56. Valsartan, losartan, irbesartan, candesartan, telmisartan are...
    Angiotensin II receptor blockers (-Strans)
  57. Who gets Angiotensin II receptor blockers?
    • NOT pregnant women!!
    • patients who cannot tolerate ADR profile of the ACE inhibitors
  58. How do sympathoplegics work?
    reduce sympathetic outflow from vasopressor centers in the brain stem – central alpha adrenergic stimulants
  59. Methyldopa, clonidine, Guanabenz, guanfacine are..
  60. ADR: sedation, nightmares, depression,
    lactation, positive Coombs test, impaired mental concentration, vertigo
    Methlydopa (sypathoplegic)
  61. ADR: dry mouth, sedation, mental
    depression, rebound hypertension (patients taking more than 1mg/day)
    Clonidine (sympathoplegic)
  62. How do Alpha Adrenoceptor Blocking Agents work?
    • Blockade of alpha-1 receptors in arterioles and venules, allowing norepinephrine to exert unopposed negative feedback on its own release; reduce arterial pressure by dilating resistance and capacitance vessels
    • More effective when administered with other agents, than when used alone
  63. Prazosin, terazosin, doxazosin are...
    Alpha Adrenoceptor Blocking Agents
  64. ADR:1st dose syncope, dizziness,palpitations,
    headache, lassitude
    Alpha-1 Blocker ADR
  65. How do Adrenergic Neuron Blocking Agents work?
    Lower blood pressure by preventing normal physiologic release of norepinephrine from postganglionic sympathetic neurons
  66. Guanethidine and Reserpine are...
    • Adrenergic neuron blocking agents.
    • Guanethidine—posturalhypotension, diarrhea, impaired ejaculation
    • Reserpine—sedation, lassitude,nightmares, severe mental depression, extrapyramidal symptoms
  67. How do Beta Adrenergic Antagonists work?
    Antagonizes catecholamines at the beta receptors, decreases cardiac output initially, and with continued therapy decreases PVR

    Also inhibits stimulation of renin production by catecholamines through depression of renin angiotensin-aldosterone system
  68. Propranolol, Nadolol, Carteolol
    Non-selective beta adrenergic antagonist.
  69. Metoprolol, Betaxolol, Atenolol
    Selective beta adrenergic antagonist
  70. Pindolol, Acebutolol, Penbutolol
    Beta adrenergic antagonist with Intrinsic sympathomimetic activity
  71. Labetalol
    Alpha & Beta Blocker
  72. ADR: Bradycardia, nausea, vomiting, mental depression, nightmares, insomnia, increase plasma triglycerides, and decrease HDL
    Beta adrenergic antagonist
  73. Mild Hypertension—monotherapy
    • Thiazide diuretics
    • Beta-blockers
    • ACE inibitors
    • Calcium channel blockers
  74. Patient admitted to ICU for hypertensive emergency– parenteral medications for rapid decrease in blood pressure include (5)
    • sodium nitroprusside
    • diazoxide
    • nitroglycerin
    • hydralazine
    • reserpine
  75. A 45 year old man recently diagnosed with hypertension is started on monotherapy. He has developed a persistent cough. Which of the following is most likely the culprit?
  76. Which of the following can cause a precipitous fall in blood pressure and fainting on initial administration?
  77. Which of the following can produce a hypertensive crisis following abrupt cessation
    of therapy?
  78. Class I anti-arrhythmic drugs...
    inhibit fast sodium channels
  79. Class II anti-arrhythmics
    Beta-adrenergic antagonist
  80. Class III anti-arrhythmics
    Primarily block potassium channels
  81. Class IV anti-arrhythmics
    Calcium channel antagonist
  82. How many subclasses of Class I anti arrhythmic drugs are there and how do they do?
    3. IA, IB, IC.

    IA- prolong ventricular refractoriness and QT interval 

    IB- Less potent sodium channel blockers, at high tissue concentrations, shorten action potential duration and refractoriness 

    IC- Very powerful agents, markedly slow  conduction with little effect on repolarization
  83. Quinidine
    Class IA anti arrhythmic. (prolong QT and ventricular refractoriness)
  84. disopyramide
    Class IA anti-arryhthmic (prolong QT and ventricular refractoriness)
  85. procainamide
    Class IA anti-arryhthmic (prolong QT and ventricular refractoriness)
  86. lidocain
    Class IB anti-arryhthmic (less potent sodium channel blockers, at high tissue concentration, shorten AP duration and refractoriness)
  87. mexiletine
    Class IB anti-arryhthmic (less potent sodium channel blocker, at high tissue concentration, shorten AP duration and refractoriness)
  88. tocainide
    Class IB anti-arryhthmic (less potent sodium channel blocker, at high tissue concentration, shorten AP duration and refractoriness)
  89. flecainide, propafenone
    Class IC anti-arrhthmic (very powerful agents, markedly slow conduction with little effect on repolarization)
  90. GI: NVD, abdominal pain, anorexia
    CNS toxicity
    Proarrhythmia (1-3%)
    Other ADR: rash, fever, immune-mediated
    thrombocytopenia, hemolytic anemia
    Increase digoxin levels, avoid agents
    that prolong QT interval
    ADR of Quinidine
  91. ADR: lupus-like syndrome (fever, pleuropericarditis, hepatomegaly, arthralgias)
    33% of patients on chronic therapy
    Other ADR: agranulocytosis, proarrhythmias similar to quinidine
    ADR of procainamide
  92. Precipitation or worsening of CHF (negative inotropy)
    Anticholinergic effects
    Hypoglycemia and masking of hypoglycemic
    symptoms may occur
    Proarrhythmia risk similar to that of quinidine
    ADR of disopyramide
  93. CNS: convulsions, confusion, stupor,
    rarely respiratory arrest
    CV: negative inotropic effects at high
    doses, arrhythmias (sinus arrest, AV block, asystole)
    ADR of lidocain
  94. CNS: tremor, dizziness, blurred
    vision.  Higher levels: nystagmus,
    diplopia, dysarthria, impaired level of consciousness
    GI: nausea, vomiting (common)
    CV: proarrhythmic effects (TDP)—less common than with IA & IC agents
    Increases theophylline plasma levels
    ADR of mexiletine
  95. Neurologic symptoms and gastrointestinal
    side effects similar to mexiletine
    Pulmonary fibrosis, interstitial
    pneumonitis, fibrosing alveolitis
    Agranulocytosis, leukopenia, hypoplastic
    anemia, thrombocytopenia (0.1-0.2% of patients—monitor CBC)
    ADR Tocainide
  96. Conduction abnormalities (up PR and QRS intervals)
    Negative inotropic effects (exacerbate or
    precipitate CHF)
    Other ADR: confusion, irritability, blurred vision, dizziness, nausea & headache
    Reduce dose by 1/3 in patients on amiodarone
    Increases plasma digoxin levels
    ADR Flecainide
  97. Propranolol, Esmolol, Pindolol
    • Class II ani arrhythmic beta adrenergic blockade
    • Diminish phase 4 depolarization, depressing automaticity, prolonging AV conduction, and decreasing heart rate and contractility
  98. ADR: AV block, insomnia, depression, impotence, nasal congestion, decreased HDL (mainly with non-selective agents), bronchospasm (non-selective)
    ADR of beta adrenergic antagonists
  99. Abrupt withdrawal of these agents may
    cause angina pectoris & increase in blood pressure
    Beta adrenergic antagonist
  100. Amiodarone
    Class III anti arrhythmic- prolonging repolarization
  101. Bretylium
    Class III anti arrhythmic- prolonging repolarization
  102. Sotalol
    Class III anti arrhythmic- prolonging repolarization
  103. Ibutilide
    Class III anti arrhythmic- prolonging repolarization
  104. dofetilide
    Class III anti arrhythmic- prolonging repolarization
  105. Pulmonary toxicity (1-15% of patients)–
    dry cough, dyspnea, pulmonary infiltrates, rales
    Photosensitivity (blue gray skin discoloration)
    Thyroid dysfunction—hypo/hyperthyroidism
    Corneal microdeposits
    Sinus bradycardia, prolonged AV node conduction
    Nausea, anorexia, increased LFTs,
    Reduce dosages of warfarin and digoxin
    Amiodarone Class III ant Arr
  106. Verapamil and Diltiazem
    Class IV anti arrhythmic drugs Ca+
  107. Verapamil
    Class IV anti arrhythmic Ca+
  108. Dilate peripheral arterioles and reduce blood pressure due to blockade of calcium influx into arterial smooth muscle cells
    Calcium channel blockers
  109. Cause arteriolar vasodilation by blockade of inward calcium channels in vascular smooth muscle cells
    Calcium channel antagonists
  110. ADR: lower-extremity edema, flushing, headache, rash
    calcium channel antagonist
  111. Digoxin is a
    positive inotrope
  112. Amrinone and Milrinone are
    positive inotropes
  113. Digoxin & Digitoxin have narrow..
    therapeutic margin
  114. Erythromycin and tetracycline intertact with
    Digoxin (up its effect)
  115. Which of the following categories of agents is a class II antiarrhythmic agent
    Propranolol (beta blocker)
  116. Which is untrue: 
    Quinidine: blocks sodium channels
    Bretylium: blocks potassium channels
    Verapamil: blocks calcium channels
    Propranolol: blocks beta adrenoceptors
    Mexiletine: blocks potassium channels
    Mexiletine: blocks potassium channels 

    Is Sodium blocker Class IB
  117. Which of the following is the mechanism of action of Class IV antiarrhythmic agents?Blockade of sodium channels
    Blockade of beta adrenoceptors
    Blockade of potassium channels
    Blockade of calcium channels
    Blockade of acetylcholine receptors
    Blockade of calcium channels