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Ch 20
Respiratory Pharmacology (Rau's)
61
Pharmacology
Undergraduate 1
12/15/2009

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Term
Cardiovascular disease
Definition
damage to the heart and the blood vessels or circulation, including the brain, kidney, and the eye
Term
Definition
a maximal dose of a drug beyond which it no longer exerts a therapeutic effect; however, it toxilogical effect does increase
Term
Antithrombotic
Definition
a drug that prevents or breaks up blood clots in such conditions as thrombosis ot embolism, includes anticoagulants, antiplatelets, and thrombolytics
Term
Arterial blood pressure
Definition
defined hemodynamically as the product of cardiac output and total peripheral resistance
Term
Chronotropic
Definition
Influencing the rate of rhythmic movement
Term
Circadian Rhythm
Definition
human biological variations of rhythm within a 24-hour cycle
Term
Creatinine clearance
Definition
Measurement of the renal clearance if endogenous creatinine per unit time
Term
D-Dimers
Definition
Covalently cross-linked degradation fragments of cross-linked fibrin polymer during plasmin-mediated fibrinolysis
Term
Dose-Ceiling effect
Definition
a max dose of a drug, beyond which it not longer exerts a therapeutic effect; however its toxic effect does increase
Term
Fibrin split or fibrinogen degredation products (FDPs)
Definition
Small peptides that result following the action of plasmin on fibrinogen and fibrin in the fibrinolytic process.
Term
Glomerular filtration rate
Definition
The volume of water filtered from the plasma by the kidney via glomerular capillary walls into bowmans capsule per unit time; considered to be 90% of creatinine clearance and equivalent to insulin clearance
Term
Hypertensive emergency
Definition
Blood pressure above 180/120 mmHG when te elevation of blood pressure is accompanied by acute, chronic, or progressing target organ injury
Term
Hypertensive emergency
Definition
Blood pressure above 180/120 without signs or symptoms of acute target organ complications
Term
Inotrope
Definition
a drug influencing the contractility of a muscle (heart)
Term
intrinsic sympathomimetic activity
Definition
Having the ability to activate and block adrenergic receptors, producing a net stimulatory effect on the sympathetic ns
Term
pharmacotherapy
Definition
treatment of disease by drug therapy
Term
Renin
Definition
an enzyme also known as angioteninogenase, released by the kidney in response to a lack of renal blood flow, and responsible for converting angiotensin to angiotensin I
Term
Subtitute neurotransmitter
Definition
neurotransmitter or hormone replacements that may be weak or inert
Term
hypertension
Definition
blood pressurre of 140/90 mmHG or greater
Term
first line agents to treat hypertension
Definition
thiazide diuretics, B blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptors blockers (ARBs), a-B blockers, and calcium antagonists
Term
Second line antihypertensives
Definition
a2 agonists, vasodilators, and antiadrenergics
Term
what are ACEIs and how do they work
Definition
Angiotensin-converting enzyme inhibitors. Primarily act through suppression of renin-angiotensin-aldosterone system
Term
are ACEIs effective alone?
Definition
Yes but they can be combined with other hypertensive agents, especially thiazide-type diuretics
Term
what is the most common ACEI-induced adverse effect?
Definition
Persistent nonproductive dry cough (20-30%)
Term
what other drugs do ACEIs have a significant drug reaction with?
Definition
NSAIDs. These increase renin release by inhibiting renal vasodilating prostaglandins and thereby blunting or negating the antihypertensive effects of ACEIs.
Term
describe nonrenin pathways to generate angiotensin II from angiotensinogen
Definition
this is done via tissue plasminogen activator, cathepsin G, and tonin.
Term
how do ARBS work?
Definition
They are angiotensin II type 1 receptor antagonists. Helpful since there are nonrenin ways of making angiotenin II
Term
ARBs have been shown to
Definition
Term
ARBs have been shown to reduce what?
Definition
morbidity such as target organ damage, cardiovascular events in systolic heart failure pts, and progression of nephropathy in pts with type 2 diabetes
Term
what do L type calcium channel blockers do?
Definition
They mediate coronary and peripheral vasodilation and may also cause reflex sympathetic activation or a negative inotropic effect
Term
what do conventional calcium channel blockers (CCBs) do?
Definition
CCBs inhibit only L-channels
Term
what are 2 negative chronotropic effects?
Definition
lowers SA node automaticity and decreases AV node conduction
Term
Name 2 negative inotropes and their effects
Definition
Verapamil and diltiazem. they may exacerbate heart failure especially in pts with left ventricular dysfunction
Term
what kind of drugs lower the efficacy of calcium antagonist
Definition
cytochrome P450 enzyme inducers since calcium antagonist are significantly metabolized by cytochrome P450
Term
what are the 3 antihypertensive effects of B blcokers?
Definition
-Blockade of the B receptors on the renal juxtaglomerular cells
-blockade of myocardial B receptors
-blockade of central ns B receptors
Term
what is labetalol
Definition
an a-B blocker with B2ISA
Term
when is treatment with labetalol contraindicated?
Definition
Contraindication: pts with asthma and COPD
Term
side effect of beta blockers include..
Definition
hyperglycemia and glucose intolerance
Term
how are beta blockers metabolized and why is it important?
Definition
by cytochrome P450. important because P450 inducers may decrease serum levels of B blockers
Term
what are 5 types of diuretics?
Definition
Thiazides and thiazide like agents, loop diuretics, potassium sparing agents, carbonic anhydrase inhibitors, and osmotics
Term
2 diuretics that are primarily used for the management of hypertension are?
Definition
thiazides and potassium sparing agents
Term
what kind effect will you have when combining diuretics with NSAIDs?
Definition
effect of diuretic will be decreased
Term
what should potassium sparing agents be paired with and why?
Definition
Thiazide diuretics since alone they are weak hypotensive agents. it can offset the potassium excretion effects of other diuretics
Term
how do potassium sparing agents work?
Definition
they block sodium channels in the lumenal membrane of cells in the distal tubule and collecting duct, thereby attenuating the excretion of potassium, calcium, and magnesium.
Term
how do thiazide like diuretics work?
Definition
their antihypertensive activity is caused primarily by direct vasodilation.
Term
what are indications for thiazide?
Definition
hypertension, chronic edema, CHF, and ascites
Term
when do thiazides lose their antihypertensive potency?
Definition
In pts with a creatinine clearance less than 30 ml/min
Term
Loop diuretics are also referred to as..
Definition
high ceiling diuretics
Term
how do loop diuretics work?
Definition
they act on the thick ascending limb of loop of henle where they decrease sodium reabsorption by competing for the chloride site on the Na+-K+-2Cl- symporter
Term
what kind of diuretic potency do thiazides have?
Definition
they have a limited diuretic potency
Term
where do aldosterone antagonists act?
Definition
late distal tube and collecting duct
Term
what affect to centrally acting adrenergic agents have?
Definition
they affect CO and peripheral resistance. They have negative chronotropic and inotropic effects
Term
how to a2 agonists work?
Definition
they stimulate the brainstem a2 receptors resulting in a decrease in sympathetic outflow from the central NS
Term
why are a2 agonist not considered 1st line therapy for antihypertensive?
Definition
side effects like high incidence of anticholinergic-like side effects such as sedation, blurred vision, dry mouth, constipation, and urinary retention. also CNS side effects
Term
what line of therapy are antiadrenergic agents considered to be?
Definition
second line therapy
Term
why are vasodilators considered second line therapy for management of hypertension?
Definition
because of their adverse effects
Term
what are treatment for angina pectoris?
Definition
nitrates, B blockers, calcium antagonists, and ranolazine.
Term
why are vasodilators considered second line therapy for management of hypertension?
Definition
because of their adverse effects
Term
what are treatments for angina pectoris?
Definition
nitrates, B-blockers, calcium antagonists, ranolazine
Term
what does nitroglycerine do?
Definition
reduces myocardial oxygen demand by causing venodilation or coronary arteries and collaterals, resulting in decrease end diastolic pressures
Term
dont forget to look at the questions at the end of the chpt
Definition
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