Term
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Definition
Nicotine agonist, (blocker) metabolized and excreted rapidly
insecticide, cigarettes |
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Term
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Definition
Nicotine antagonist not orally active hypertensive emergencies controled hypotension during surgery short duration of action S: PHT, mydriasis |
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Term
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Definition
Nicotine antagonist active orally longer acting than trimethapan S: PHT, mydriasis |
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Term
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Definition
depolarizing agonist Fasiculations Non reversible rapid onset, 1-2 min brief duration 5-10 min due to breakdown by pseudocholinesterase
SE: atypical AchE, malignant hyperthermia, hyperkalemia (in burn/trauma patients 2-3 days later) |
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Term
What are the two types of neuromuscular blocking agents |
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Definition
1. Non depolarizing (competitive) -Tubocurarine (curare) -Rocuronium, Pancuronium, cisAtracurium
2. depolarizing (non competitive) |
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Term
These compete with Ach for binding to the receptor. The muscle can still be stimulated directly by increasing the concentration of Ach. They cause flaccid , relaxed paralysis |
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Definition
Competitive (non depolarizing ) neuromuscular blocking agents |
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Term
How are competitive, non depolarizing neuromuscular blocking agents reversed |
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Definition
cholinesterase inhibitors such as neostigmine |
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Term
What are the 3 side effects of succinylcholine |
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Definition
1. Malignant hyperthermia 2. Hyperkalemia (trauma/burn patients due to upregulation of N-receptors) 3. prolonged paralysis due to atypical pseudocholinesterase |
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Term
Can succinylcholine be reversed? |
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Definition
No, can only give mechanical breathing support |
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Term
What breaks down succinylcholine |
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Definition
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Term
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Definition
Not orally transmitted long onset 4-6 mins, long acting 80-120 min histamine release (cause bronchospasm) |
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Term
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Definition
longer lasting and cleaner than tubocurarine more potent than tubocurarine (x5) less histamine release! |
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Term
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Definition
fast onset 1-2 min short intermediate durationof 30-40 min good substitute for succinylcholine |
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Term
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Definition
Hoffman degradation organindependent and has less risk in patients with liver or renal disease |
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Term
What drug is give to those who have atypical pseudocholinesterase or cannot have succinylcholine |
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Definition
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Term
what neuromuscular blocking agent is given to someone who has liver or renal disease |
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Definition
rocuronium, due to Hoffman degradation |
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Term
This is the DOC given to prevent malignant hyperthermia due to succinylcholine |
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Definition
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Term
The ganglionic nicotinic receptor is a ______. ___ goes inward while ____ goes outward |
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Definition
pentamer ion channel Na+ K+ |
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Term
What happens when nicotine reaches a toxic level |
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Definition
NMJ paralysis due to depolarizing blockade hypertension initially followed by hypotension due to depolarizing block, cardiac arrhythmias convulsions, vomiting, CV |
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Term
What is the treatment for nictotine toxicity |
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Definition
treatment is symptom directed 1. muscarinic excess- anticholinergic (atropine) 2. NMJ blockade- mechanical respiration 3. CNS stimulation: anticonvulsant (diazepam) |
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Term
Toxicity by ganglionic blocking agetns causes |
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Definition
hypotension, posteral hypotension give presser agent to counter hypotension actions |
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Term
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Definition
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Term
Can the effects of succinylcholine be overcome? |
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Definition
No, trying to over come the effects will only make it worst. Mechanical respiration is the only treatment |
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Term
True or false: succinylcholine has a shorter duration than Ach |
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Definition
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Term
What is the most important factor in regulating BP |
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Definition
|
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Term
What are reasons for secondary HT and treatment |
|
Definition
-cortisol overproduction -aldosterone overproduction -renal artery stenosis -pheochromocytoma
**treat the disease, and HT will be treated |
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Term
What are reasons for primary HT and treatment |
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Definition
genetics, stress, obesity, smoking, salt intake, age, caffeine, and alcohol.
**Can lower HT with medication and lifestyle changes but HT will not be "cured" |
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Term
What are the treatment indications for pre hypertension |
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Definition
|
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Term
what are the treatment indications for stage 1 hypertenison |
|
Definition
use a single drug and lifestyle change |
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Term
what are the treatment indications for stage 2 hypertension |
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Definition
use a drug combination and lifestyle change |
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Term
What are the four front line drugs for treating HT |
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Definition
1. Diuretics 2. Renin/A-II system (ACE1, ARBs) 3. Calcium antagonists 4. Beta receptor antagonists |
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Term
Which hypertension drug is recommended for an uncomplicated case |
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Definition
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Term
patients with diabetes who have HT should use which front line hypertension drug |
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Definition
Renin/ A-II system/ ACE1 ARBs |
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Term
patients with a history of myocardial infarct should use which front line hypertension drug |
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Definition
beta receptor antagonists |
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Term
Where do thiazides take action and how |
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Definition
early distal tubule, inhibit Na-CL symporter to inhibit water/Na reabsorption. This decreased BP by depleting the body of Na |
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Term
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Definition
thiazide treats hypertension, HF decrease Na reabsorbtion in early distal tuble and decreases blood volume
SE: hypokalemia, decreased glucose tolerance, photosensitivity, hearing loss |
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Term
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Definition
thiazide treats hypertension, HF decrease Na reabsorbtion in early distal tuble and decreases blood volume
SE: hypokalemia, decreased glucose tolerance, photosensitivity, hearing loss |
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Term
|
Definition
thiazide treats hypertension, HF decrease Na reabsorbtion in early distal tuble and decreases blood volume
SE: hypokalemia, decreased glucose tolerance, photosensitivity, hearing loss |
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Term
|
Definition
thiazide treats hypertension, HF decrease Na reabsorbtion in early distal tuble and decreases blood volume
SE: hypokalemia, decreased glucose tolerance, photosensitivity, hearing loss |
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Term
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Definition
Acts on collecting tube, no K+ loss, blocks aldosterone |
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Term
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Definition
Acts on collecting tube, no K+ loss, blocks aldosterone |
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Term
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Definition
Acts on collecting tube, no K+ loss, blocks Na channels |
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Term
Angiotensin converting enzyme inhibitors end in |
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Definition
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Term
This is a potent vasocontrictor peptide which increases the production of aldosterone |
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Definition
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Term
What are the steps in the making of Angiotensin II |
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Definition
Angiotensinogen converted to angiotensin I by renin. angiotensin I converted to angiotensin II by ACE |
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Term
What drug blocks the conversion of angitensinogen to angiotensin I |
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Definition
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Term
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Definition
Treatment of hypertension
direct renin inhibitor decreases angiotensin I NO DRY COUGH hyperkalemia, altered taste (Zn), glossitis, angioedema, dry mouth |
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Term
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Definition
treats hyptertension, heart failure ACE inhibitor decreasess angiotensin II and aldosterone, which decreases TPR
SE: increases bradykinin which causes a dry cough other side effects: hyperkalemia, altered taste (Zn), glossitis, angioedema, dry mouth |
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Term
|
Definition
treats hyptertension, heart failure ACE inhibitor decreasess angiotensin II and aldosterone, which decreases TPR
SE: increases bradykinin which causes a dry cough other side effects: hyperkalemia, altered taste (Zn), glossitis, angioedema, dry mouth |
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Term
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Definition
treats emergency hyptertension, heart failure prodrug with a half life of 6 hours ACE inhibitor decreasess angiotensin II and aldosterone, which decreases TPR
SE: increases bradykinin which causes a dry cough other side effects: hyperkalemia, altered taste (Zn), glossitis, angioedema, dry mouth |
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Term
All Angiotensin II Type 1 Receptor Blockers (ARBs) end in |
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Definition
|
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Term
What are the two receptors that angiotensin II affect. Which ones do ARBs affect? |
|
Definition
angiotensin II type I receptor angiotensin II type II receptor
angiotensin II type I receptor |
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Term
Angiotensin II type I receptors mediate |
|
Definition
production of aldosterone, anti diuretic hormone, increased TPR, increased sympathetic NS |
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Term
Angiotensin II type II receptors mediate |
|
Definition
vasodilation, decreased TPR, increase NO |
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Term
|
Definition
Treats Hypertension and heart failure angiotensin II type I receptor blocker
treats hyptertension, heart failure ACE inhibitor decreasess angiotensin II and aldosterone, which decreases TPR
NO DRY COUGH side effects: hyperkalemia, altered taste (Zn), glossitis, angioedema, dry mouth |
|
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Term
|
Definition
Treats Hypertension and heart failure angiotensin II type I receptor blocker
treats hyptertension, heart failure ACE inhibitor decreasess angiotensin II and aldosterone, which decreases TPR
NO DRY COUGH side effects: hyperkalemia, altered taste (Zn), glossitis, angioedema, dry |
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|
Term
What are the two classes of calcium channel blockers |
|
Definition
Non dihydropyridines Dihydropyridines (end in dipine) |
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|
Term
What is the effect of calcium channel blockers |
|
Definition
bind to L type calcium channels in cardiace and vascular smooth muscle and causes dilation of vessels |
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Term
Nifidipine is a _____ and mainly causes ____ vasodilation and has little effect on ____. |
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Definition
dihydropyridine calcium channel blocker arteriole cardiace tissue commonly causes reflex tachycardia |
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Term
Verapamil is a ______ and has effect on _______ |
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Definition
non dihydropyridine calcium channel blocker cardiac tissues causes brady cardia |
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Term
Dilitazem is a _____ and has actions on ____ and _____.
Is it more similar to nifidipine or verapamil? |
|
Definition
non dihydropyridine calcium channel blocker cardiac and vascular beds
verapamil action |
|
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Term
|
Definition
treats hypertension and mainly acts on arterioles.
causes reflex tachycardia |
|
|
Term
what are side effects of calcium channel blockers |
|
Definition
constipation (more so w/ non-DHPs) cardiac depression, brady cardia (non DHPs) hypotension (DHP) gingival hyperplasia (esp with nifedipine) |
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Term
Beta blockers have a ____ hypotensive action. |
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Definition
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Term
What are the possible mechanisms of action for beta blockers |
|
Definition
CNS effect to decrease sympathetic NS tone inhibition of renin secretion: beta 1 receptors mediate renin release
block cardiac beta 1 receptors which causes a decrease in HR and cardiac output decreasing the BP |
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Term
Selective beta blockers have names beginning with ___ |
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Definition
|
|
Term
All beta blockers end in ___ |
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Definition
|
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Term
|
Definition
selective B1 blocker No local anestetic action |
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Term
|
Definition
Non selective B blocker with partial alpha blocker activity
local anesthetic action |
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Term
|
Definition
selective B1 blocker local anesthetic action |
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Term
|
Definition
non selective B blocker with local anesthetic action and partial agonist |
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Term
|
Definition
non selective B blocker with local anesthetic action |
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Term
|
Definition
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|
Term
What are the 2 mixed alpha and beta recepter blockers that are used for acute and chronice hypertension |
|
Definition
|
|
Term
What are the 2 mixed alpha and beta recepter blockers that are used for Heart Failure |
|
Definition
carvedilol and metoprolol |
|
|
Term
What antihypertensive agents cause hypokalemia |
|
Definition
|
|
Term
what antihypertensive agents cause hyperkalemia |
|
Definition
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|
Term
What antihypertensive agents/CHF drugs are contraindicated for pregnant women? |
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Definition
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|
Term
Define compensated heart failure |
|
Definition
resting cardiac function is ok excessive stress or exercise is not ok |
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Term
Define congestive heart failure (CHF, decompensated) |
|
Definition
resting cardiac function is inadequate for body's oxygen demand |
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Term
What are some symptoms of CHF |
|
Definition
venous pooling which causes edema especially in the lungs dyspnea neurohormonal storm |
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Term
Describe the neurohumoral storm |
|
Definition
Decreased cardiace function leads to neuro-humoral activation which increases sympathetic NS activity and Renin angiotensin aldosterone system activity. This also leads to tissue remodeling (hypertrophy, decreased CO) |
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Term
are calcium channel blockers used for CHF? |
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Definition
|
|
Term
What is the site of action for cardiac glycosides |
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Definition
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|
Term
What is the cardiac glycoside that we need to know for this test? |
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Definition
|
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Term
|
Definition
cardiac glycoside has very narrow therapeutic range contraindicated for women |
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Term
An increase in potassium concentration causes ________ of the alpha subunit of the Na/K ATPase pump causing cardiac glycosides to bind _______ |
|
Definition
dephosphorylation less effectively |
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Term
An decrease in potassium concentration causes ________ of the alpha subunit of the Na/K ATPase pump causing cardiac glycosides to bind _______ |
|
Definition
phosphorylation more effectively |
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|
Term
Do ACE inhibitors enhance or weaken the effects of cardiac glycosides |
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Definition
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|
Term
Do thiazide diuretics enhance or weaken the effects of cardiac glycosides |
|
Definition
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|
Term
Describe the steps of how digoxin works |
|
Definition
It inhibts the Na/K/ATPase which decreases the exchange of Na/K. the concentrat the Na/Ca exchanger to reverse or to become depolarized and the intracellular concentration of Ca increases, thus increasing the SR stores of Ca and increasing contractile force |
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Term
cardio glycosides have an ionotropic effect which means |
|
Definition
it increases the influx of Ca stores which increases contraction |
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|
Term
How does digoxin affect the frank-starling graph |
|
Definition
it will shift the line up and to the left (increase steepness of the curve) |
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Term
What effects are seen with cardiac glycoside toxicity |
|
Definition
ventricular tachycardia, delirium, fatigue, weakness, dizziness, nausea, vomiting, vision/light disturbances (halo effect, mainly yellow and green ) |
|
|
Term
what is the treatment for toxicity by cardiac glycoside |
|
Definition
discontinue cardiac glycoside or alter dose administer K or discontinue K depleting diuretics |
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Term
What type of drug is used in IV form in acute emergency CHF NOT CHRONIC |
|
Definition
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|
Term
What 3 drugs are catecholamines used for acute emergency CHF |
|
Definition
dobutamine, milrinone, Inamrinone |
|
|
Term
These catecholamine inhibit phosphodiesterase III. Which increases cAMP levels and causes phosphorylation of Ca channel |
|
Definition
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|
Term
what vasodilator is a combination of isosorbide dinitrate and hydralazine and is good for treating African Americans with CHF |
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Definition
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|
Term
Is propranolol recommended for CHF? |
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Definition
|
|
Term
Beta-type natriuretic peptide is also known as ____ |
|
Definition
|
|
Term
Beta-type natriuretic peptide |
|
Definition
Uses NO to Increase cGMP, leading to smooth muscle relaxation and vasodilation. works on both arteries and veins. |
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