PHARMACOLOGY 2
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PHARMACOLOGY 2 - Marcador
PHARMACOLOGY 2 - Detalles
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| Maintain homeostasis depending on the continuous & controlled movement of blood thru capillaries Consists: Heart & Blood vessels (AVC) | CVS – aka blood-vascular, circulatory system |
| Where the blood performs its ultimate transport function | Microscopic capillaries |
| Blood Circulation IN ORDER | 1 S / I vena cava 2 Right atrium 3 Tricuspid valve 4 Right ventricle 5 Pulmonary artery 6 Lungs 7 Left atrium 8 Mitral valve 9 Left ventricle 10 Aorta 11 Distribute to tissues |
| Which has thicker walls? 1 Left or Right ventricles ? 2 Left or Right atrium ? | 1 Left ventricles 2 Left atrium |
| 1 The only part that carry deoxygenated blood 2 The only part that carry oxygenated blood | 1 Pulmonary artery 2 Pulmonary vein |
| Rhythmic beat of the heart is __ | Myogenic |
| Heart is influenced by the Autonomic Nervous System. 1 Increases the heart rate 2 Decreases the heart rate | . 1 Norepinephrine 2 Acetylcholine |
| Impulse of the Heart (In order) | 1 Sinoatrial Node 2 Atrio-ventricular Node 3 Atrio-ventricular Bundle 4 Ventricles |
| 1 Chronotrophic effect 2 Volume of blood ejected by the heart per beat 3 Inotropic Effect | 1 Tachycardia (fast heart rate) 2 Stroke volume 3 Increased force of contraction |
| Volume of blood pumped in one minute; depends on the heart rate and stroke volume | Cardiac Output HR x SV |
| 1 thick-walled chambers that forcefully pump blood out of the heart 2 thin-walled chambers that receive blood from the veins. | 1 ventricles 2 atria |
| 1 receives oxygenated blood from the pulmonary veins 2 receives deoxygenated blood from systemic veins | 1 left atrium 2 right atrium |
| 1 carry blood toward the heart 2 After blood passes through the capillaries, it enters the smallest veins, called __ | 1 Veins 2 venules |
| 1 transport blood that has a low oxygen content from the right ventricle to the lungs. 2 transport oxygenated blood from the left ventricle to the body tissues | 1 Pulmonary arteries 2 Systemic arteries |
| 1 transport blood that has a low oxygen content from the right ventricle to the lungs. 2 transport oxygenated blood from the left ventricle to the body tissues | 1 Pulmonary arteries 2 Systemic arteries |
| Normal | Less than 120/80 mmHg |
| Elevated | 120-129/80 and below |
| Stage I | 130-139/80-89 mmHg |
| Stage II | Above 140 /90mmHg |
| A fall in BP causes __ to send fewer impulses to CV centers in the spinal cord. This prompts a reflex response of increased sympathetic and decreased parasympathetic output to the heart and vasculature, resulting in vasoconstriction and increased cardiac output. These changes result in a compensatory rise in BP | Pressure-sensitive neurons (baroreceptors in the aortic arch and carotid sinuses) |
| Decrease in Blood Pressure Responses (Decrease or Increase) 1 Sympathetic Activity 2 Renal Blood Flow 3 Renin 4 B1 adrenoceptors | . 1 Increase 2 Decreased 3 Increase 4 Increase |
| Primary Prevention (Hypertension) First Line: | Thiazide diuretic, ACE Inhibitors or ARB or combo |
| Diabetes Mellitus First Line: Sequential Therapy: | First Line: ACE Inhibitors (Angiotensin-converting enzyme inhibitors) Sequential Therapy: Thiazide, CCB or Beta blocker |
| Chronic Kidney Disease First Line: | ACE Inhibitors (Angiotensin-converting enzyme inhibitors) |
| Coronary Artery Disease First Line: Sequential Therapy: | First Line: ACE Inhibitors (Angiotensin-converting enzyme inhibitors) or ARB or B-blockers Sequential Therapy: Thiazide (BP CONTROL) CCB or Beta blocker (ISCHEMIA CONTROL) |
| Prior Ischemic Stroke First Line: | ACE Inhibitors (Angiotensin-converting enzyme inhibitors) and Thiazide |
| Left Ventricular Dysfunction First Line: Sequential Therapy: | First Line: ACE Inhibitors (Angiotensin-converting enzyme inhibitors), Thiazide and B-blockers Sequential Therapy: 1 Aldosterone Antagonist (SEVERE HEART FAILURE) 2 Hydralazine & Isosorbide |
| Traditionally, the first choice for the initial treatment of chronic hypertension. | Thiazide-type diuretic or a ß-adrenergic receptor blocker |
| __ is indicated in hypertensive emergencies, usually with nitroprusside or diazoxide; IV labetalol or SL nifedipine are also suitable. | Parenteral therapy |
| Most frequently used diuretics | Thiazides |
| Produce greater diuresis than the thiazides, but have a weaker antihypertensive effect and can cause SEVERE ELECTROLYTE BALANCE | Furosemide, ethacrynic acid, bumetanide- loop diuretics |
| Useful in combination with a thiazide diuretic, whose effects they potentiate and they minimize K+ loss; K+-sparing diuretics | Spironolactone, triamterene, amiloride |
| Principal function of Loop of Henle | The recovery of water and sodium chloride from urine. |
| Selective β1 blockers , the most commonly prescribed βB | Metoprolol, atenolol |
| Nonselective BB causes bronchoconstriction thus not to be used in __ patients due to their blockade of β2-mediated bronchodilation. | Asthmatic can precipitate bronchospasm in patients with bronchial asthma |
| Adverse effects of BB | 1 Common effects: bradycardia, hypotension, and CNS side effects such as fatigue, lethargy, and insomnia βB may decrease libido and cause erectile dysfunction, which can severely reduce patient compliance. 2 Alterations in serum lipid patterns 3 Drug withdrawal: Abrupt withdrawal may induce ANGINA, MI, and even sudden death in patients with ischemic heart disease. |
| Lower blood pressure by reducing peripheral vascular resistance without reflexively increasing cardiac output, heart rate, or contractility. | ACE INHIBITORS (ACEIn) |
| Ace inhibitors block the enzyme __ the ACE which cleaves angiotensin I to form the potent vasoconstrictor angiotensin II. | Peptidyl dipeptidase |
| Recommended as first-line treatment of hypertension in patients with high coronary disease risk | Enalapril and lisinopril |
| While on ACE Inhibitors, we should monitor __ | 1 Potassium Levels K supplements and K-sparing diuretics should be used with caution due to the risk of hyperkalemia. 2 Serum Creatinine Levels particularly in patients with underlying renal disease. |
| ACE inhibitors can induce __ and should not be used by pregnant women | Fetal malformations |
| Are alternatives to the ACE inhibitors. | Losartan and irbesartan (ANGIOTENSIN II RECEPTOR BLOCKERS(ARBs)) |
| Adverse effects of ARBs | 1 Do no increase BRADYKININ Levels 2 May be used as first-line agents for HTN, esp in patients with a compelling indication of DM,HF, or CKD. 3 Similar effects as ACEIn, although the risks of cough and angioedema are significantly decreased. |
| Renin Inhibitor Side Effects | Diarrhea, cough, angioedema, Not for Pregnant (Fetal Toxicity) |
| Classes of CCB | 1 Diphenylalkylamines: Verapamil 2 Benzothiazepines: Diltiazem 3 Dihydropyridines : Nifedipine (prototype), Amlo,felo,isra,nicar,nisol |
| Are used in the treatment of atrial fibrillation. | Diltiazem and verapamil |
| Competitively block of α1-adrenoceptors decrease peripheral vascular resistance and lower arterial BP by causing relaxation of both arterial and venous smooth muscle. | Α-ADRENOCEPTOR–BLOCKING AGENTS Drugs: Prazosin, doxazosin , and terazosin |
| Have been shown to reduce morbidity and mortality associated with heart failure. | Α-/β-ADRENOCEPTOR–BLOCKING AGENTS Drugs: Labetalol and carvedilol block α1, β1, and β2 receptors. |
| Have been shown to reduce morbidity and mortality associated with heart failure. | Carvedilol, & metoprolol succinate, bisoprolol |
| Hydralazine A/E | Include headache, tachycardia, nausea, sweating, arrhythmia, and precipitation of angina.A lupus-like syndrome can occur with high dosages, but it is reversible upon discontinuation of the drug. |
| HYPERTENSIVE EMERGENCY medications | CCB (nicardipine and clevidipine) nitric oxide vasodilators (nitroprusside and nitroglycerin), adrenergic receptor antagonists (phentolamine, esmolol, and labetalol), vasodilator hydralazine dopamine agonist fenoldopam. |
| __ therapy may lower BP more quickly with minimal adverse effects. | Combination therapy with separate agents or a fixed-dose combination pill |
| Initiating therapy with two antihypertensive drugs should be considered in patients with blood pressures that are more than __ | 20/10 mm Hg above the goal |
| Is the inability of the heart to meet the metabolic requirements of the peripheral system. Symptoms: Major symptoms include weakness, fatigue, and dyspnea | Congestive heart failure (CHF) |
| 1 an increase and growth of muscle cells. 2 restricted blood flow 3 relates heart performance to the size of the individual | 1 Hypertrophy 2 Ischemia 3 Stroke volume index (SVI) |
| Pathophysiology 1 Myocardial cell loss due to regional __ results in deterioration of systolic and diastolic performance. 2 When confronted by an increased load, the remaining normal heart __ to maintain adequate cardiac performance. 3 __ develop to maintain cerebral and coronary perfusion. | . 1 ischemia or myopathy 2 hypertrophies 3 Vasoconstrictor compensatory mechanisms |
| Vasoconstrictor compensatory mechanisms includes: | 1) Stimulation of the sympathetic nervous system 2) Stimulation of the renin-angiotensin system |
| Cardiac Muscle Contraction (in order) | 1 Rapid depolarization occurs when fast‐opening Na + channels in the sarcolemma open and allow an influx of Na + ions into the cardiac muscle cell. The Na + channels rapidly close. 2 A plateau phase occurs during which Ca 2+ enters the cytosol of the muscle cell. Ca 2+ enters from the sarcoplasmic reticulum (endoplasmic reticulum) within the cell and also from outside the cell through slow‐opening Ca 2+channels in the sarcolemma. the Ca 2+ channels open, K + channels, which normally leak small amounts of K + out of the cell, become more impermeable to K + leakage. 3 Repolarization occurs as K + channels open and K + diffuses out of the cell. At the same time, Ca 2+ channels close. These events restore the membrane to its original polarization, except that the positions of K + and Na + on each side of the sarcolemma are reversed. 4 A refractory period follows, during which concentration of K + and Na + are actively restored to their appropriate sides of the sarcolemma by Na +/K + pumps. The muscle cell cannot contract again until Na + and K + are restored to their resting potential states. |
| Are the combination of an aglycone, or genin, and one to four sugars. | Cardiac glycosides |