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