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Pharmacology - Midterms

front 1

It is a sustained, reproducible inc in BP that could lead to cardiovascular problem, renal dse; blindness

back 1

Hypertension

front 2

It is the most common dse

back 2

Hypertension

front 3

What are the combination of several abnormalities that causes HTN?

back 3

  • generic inheritance
  • psychological stress
  • environmental
  • dietary factors

front 4

What kind of HTN when Pt in whom no specific cause of HTN?

back 4

essential hypertension

front 5

What are the specific causes of HTN?

back 5

  • renal artery constriction
  • coarctation of the aorta
  • phenochromocytoma
  • cushing's disease
  • primary aldosteronism

front 6

normal control of BP - short term

back 6

baroreceptor reflex

front 7

normal control of BP - long term

back 7

kidneys

front 8

possible mechanism in essential hypertension

back 8

  • diet
  • stress
  • cigarrete smoking
  • alcohol

front 9

<12 mm systolic; <80 mmHg diastolic

back 9

Normal BP

front 10

120-129 systolic; <80 mmHg diastolic

back 10

Elevated BP

front 11

130 - 139 systolic or 80-89 mmHg

back 11

Stage 1 Hypertension

front 12

> 140 systolic; > 90 mmHg diastolic

back 12

Stage 2

front 13

6 Major Categories of Drugs for HTN

back 13

  • diuretics
  • sympatholytic drugs
  • vasodilator
  • ace inhibitor
  • calcium channel blocker
  • angiotensin receptor blocking agents

front 14

It decreases the plasma fluid volume @ kidneys

back 14

DIURETICS

front 15

It decreases sympathetic influence on: heart &/or peripheral vasculature @ various sites w/in sympathetic division of ANS?

back 15

SYMPATHOLYTIC DRUGS

front 16

It lower vasuclar resistance by directly vasodilating @ peripheral vessels?

back 16

VASODILATORS

front 17

These are ACE inhibitory - prevents conversion of nagiotensin I to angiotensin II receptor blockers.

back 17

inhibition of renin-angiotensin system

front 18

These dec vascular smooth-mm cxn, dec myocardial force; rate of cxn

back 18

calcium channel blockers

front 19

MOA: inc formation and excretion fo renal, and inc renal excretion of water; sodium; dec fluid volume lowers blood pressure

back 19

diuretics

front 20

what are the 3 classification of diuretics?

back 20

  • thiazide diuretics
  • loop diuretics
  • potassium string

front 21

It act primarily on early portion of DCT of nephron; inhibit sodium reabsorption

back 21

thiazide diuretics

front 22

it act primarily on ascending limb of loob of Henle, which inhibits reabsorption of sodium; chloride thus prevents reabsorption of water

back 22

loop diuretics

front 23

this prevents secretion into the distal tubule

back 23

potassium sparring

front 24

diuretic drugs used to treat HTN

back 24

  1. thiazide diuretics
  2. bendroflumethiazide
  3. chlorothiazide
  4. hydrochlorothiazide
  5. hydroflumethiazide
  6. methyclothiazide
  7. metolazone
  8. quinethazone
  9. trichlormethiazide

front 25

loop diuretics for HTN

back 25

  1. bumetanide
  2. ethacrynic acid
  3. furosemide
  4. torsemide

front 26

potassium-sparring diuretics

back 26

  • amiloride
  • spironolactone
  • triamterene

front 27

what are the adverse effect of diuretics?

back 27

  • fluid depletion
  • electrolyte imbalance
  • gi disturbances
  • weakness, fatigue
  • orthostatic hypotension

front 28

it is the increase in sympathetic activity may be an underlying factor in essential htn, can be classified according to where and how they interrupt sympathetic activity

back 28

sympatholytic drugs

front 29

it is the mainstay in treatment of HTN, well tolerated by most pt, incidence of side effects are low

back 29

beta blockers

front 30

this exerts primary effect on heart; dec HR; force of myocardia cxn; general dec sympathetic tone

often complement effects of other anti-HTN

back 30

beta blockers - sympatholytic drugs

front 31

what are the 4 theories of beta blocker - sympatholytic drugs?

back 31

  1. central inhibitory effect on sympathetic activity
  2. influence renin release from kidneys w/in CNS
  3. impair sympathetic activity in ganglia/ @ presynaptic adrenergic terminals
  4. act by a combination of these

front 32

specific agents of beta blockers - sympatholytic drugs

back 32

  • acebutolol
  • atenolol
  • betaxolol
  • bisoprolol
  • carvedilol
  • esmolol
  • labetalol
  • metoprolol
  • nebivolol
  • nadolol
  • penbutolol
  • pindolol
  • propanolol
  • sotalol
  • timolol

front 33

beta blockers - selective for beta 1 receptors (cardioselective)

back 33

  • pindolol
  • acebutolol
  • propranolol
  • labetalol

front 34

beta blocker - which are partial agonists, intrinsic sympathomimetic activity

back 34

pinodolol, acebutolol

front 35

beta blocker - which are membrane stabilizing activity

back 35

labetalol, propranolol

front 36

beta blocker - which are peripheral vasodilator and cardiac beta blockade

back 36

labetalol, newer beta blockers

front 37

what are the adverse effects of beta blocker - sympatholytic drugs

back 37

  • bronchoconstriction
  • excessive depression of HR; myocardial contractility
  • orthostatic HOTN
  • depression, fatigue, gi disturbance, allergic reaction

front 38

this blocks alpha 1 adrenergic receptor on vascular smooth mm, ability to improve blood lipid profiles and produce favorable effect on glucose metabolism; insulin resistance

back 38

alpha blockers - sympatholytic drugs

front 39

indication for mild to moderate HTN, which acts directly to tissues - mediate inc BP, peripheral vasculature

back 39

alpha blockers - sympatholytic drugs

front 40

can also be used to treat the symptoms of
benign prostatic hypertrophy as they
decrease sympathetic-mediated
contraction of smooth muscle located in
the prostate gland

back 40

alpha blockers - sympatholytic drugs

front 41

specific agents: alpha blockers - sympatholytic drugs

back 41

  • doxazosin
  • prazosin
  • terazosin

front 42

what are the adverse effects of alpha blocker - sympatholytic drugs

back 42

  • reflex tachycardia
  • orthostatic HOTN
  • gi disturbance
  • risk of cardiac dse

front 43

this is an adverse effect of alpha blocker when peripheral vascular resistance
falls d/t the effects of these drugs,
the baroreceptor reflex often responds
by generating a compensatory
inc in HR

back 43

reflex tachycardia

front 44

this is an adverse effect of alpha blocker wherein blockade of alpha-1 receptors in
peripheral arteries and veins often
promotes pooling of blood in the LE
when a patient stands up

back 44

orthostatic HOTN

front 45

this are drugs that inhibit release of norepinephrine from presynaptic
terminals of peripheral adrenergic neurons
may be used effectively in some individuals
with hypertension

back 45

presynaptic adrenergic inhibitors

front 46

MOA: : prevent normal physiologic release of
norepinephrine from postganglionic
sympathetic neurons

back 46

presynaptic adrenergic inhibitors

front 47

what are the specific agents of presynaptic adrenergic inhibitors?

back 47

  • guanadrel
  • guanethidine
  • reserpine

front 48

This only drug in presynaptic adrenergic inhibitors that is still
used commonly in the United States
to treat hypertensio

back 48

reserpine

front 49

adverse effects of presynaptic adrenergic inhibitors

back 49

  • Other arrhythmias
  • Drowsiness
  • Depression
  • GI Disturbances
  • Bradycardia

front 50

this drug inhibit sympathetic discharge from
brainstem which are similar to alpha 2 agonists; decrease sympathetic outflow

back 50

centrally acting agents

front 51

specific agents of centrally acting

back 51

  • clonidine
  • monoxidine
  • rilmenidine
  • guanabenz
  • guanfacine
  • methylodpa

front 52

adverse effect of centrally acting agents

back 52

  • dry mouth
  • dizziness
  • drowsiness

front 53

these are drugs that block synaptic transmission @autonomic ganglia will dramatically; effectively reduce BP by
dec systemic sympathetic activity

back 53

ganglionic blockers

front 54

essentially nicotinic cholinergic
antagonists, w/c block transmission @the
junction between presynaptic and
postsynaptic neurons in sympathetic and
parasympathetic pathways

back 54

ganglionic blockers

front 55

most of such drugs are no longer
available clinically because of intolerable
toxicities related to their primary action

back 55

ganglionic blockers

front 56

MOA:
1. block synaptic transmission at autonomic
ganglia
2. decrease sympathetic activity
3. nicotinic cholinergic antagonists - between
pre and postsynaptic neurons of both
divisions

back 56

ganglionic blockers

front 57

what is the indication of ganglionic blockers?

back 57

hypertensive crisis

front 58

what are the specific agents of ganglionic blockers?

back 58

  • trimethapan
  • mecamylamine

front 59

what are the adverse effect of ganglionic blockers?

back 59

  • Dry Mouth
  • GI Discomfort, Constipation
  • Urinary Retention
  • Visual Disturbances like Precipitation of Glaucoma, Blurred Vision
    Excessive Orthostatic Hypotension
    and Sexual Dysfunction
    (Sympathoplegia)
  • Neuromuscular Blockade

front 60

these are drugs that directly vasodilate the
peripheral vasculature will produce an
antihypertensive effect by decreasing
peripheral vascular resistance

back 60

vasodilators

front 61

these drugs exerts inhibitory effect: vascular smooth-mm cells, inhibit smooth mm cxn by inc intracellular production of 2nd messengers and also inc amounts of cGMP, inhibit fxn of contractile process in vascular smooth-mm cell - leading to vasodilation

back 61

vasodilators

front 62

MOA:
1. vasodilates peripheral vasculature
2. inhibits smooth muscle contraction due to
increased 2nd messengers (cyclic GMP)

back 62

vasodilators

front 63

specific agents of vasodilators

back 63

  • diazoxide
  • fenoldopam
  • hydralazine
  • minoxidil
  • nitroprusside

front 64

adverse effect of vasodilators

back 64

  • reflex tachycardia
  • dizziness
  • postural HOTN
  • weakness
  • nausea
  • fluid retention
  • headache

front 65

this is an adverse effect of vasodilators whi often occurs because the baroreceptor
reflex attempts to compensate for the
fall in vascular resistance that these
drugs produce

back 65

reflex tachycardia

front 66

involves several endogenous components
that help regulate vascular tone an
regulate sodium and water balance in the
body

back 66

angiotensin converting enzyme inhibitors

front 67

an enzyme produced primarily in the
kidneys; when blood pressure falls, renin
is released from the kidneys into the
systemic circulation

back 67

renin

front 68

a peptide that is produced by the liver and
circulates continually in the bloodstream

back 68

angiotensinogen

front 69

MOA: inhibits enzyme that converts
angiotensin 1 to angiotensin 2
(renin-angiotensin system)

back 69

angiotensin converting enzyme inhibitors

front 70

it is an indication of mild to moderate HTN; used alone of in combination

back 70

angiotensin converting enzyme inhibitors

front 71

what are the advantages of angiotensin converting enzyme inhibitors?

back 71

  1. lower incidence of cardiovascular side
    effect
  2. no reflex tachycardia and orthostatic
    hypotension
  3. prevents hypertrophy of heart and
    vasculature (animal)

front 72

specific agents of angiotensin converting enzyme inhibitors?

back 72

  • benazepril
  • cilazapril
  • captopril
  • delapril
  • enalapril
  • fosinopril
  • imidaprin
  • lisinopril
  • moexipril
  • perindopril
  • quinapril
  • ramipril
  • trandolapril

front 73

what are the adverse effect of angiotensin converting enzyme inhibitors

back 73

  • allergic reaction, rash
  • gi discomfort
  • dizziness
  • chest pain
  • persistent dry cough

front 74

these are drugs recognized as being beneficial in the treatment of essential HTN where calcium appears to play a role in activating the contractile element in
smooth muscle

back 74

calcium channel blockers

front 75

MOA:

1. Blocks calcium entry into vascular
smooth muscle cell
2. Decreased vascular resistance
3. Tends to decrease HR and myocardial
contractile force

back 75

calcium channel blockers

front 76

specific agents of calcium channel blockers

back 76

  • amlodipine
  • benidipine
  • diltiazem
  • barnidipine
  • felodipine
  • lacidipine
  • isradipine
  • manidipine
  • nicardipine
  • nisoldipine
  • nifedipine
  • verapamil

front 77

Adverse Effects of calcium channel blockers

back 77

  • Excessive Vasodilation
  • Orthostatic Hypotension
  • Reflex Tachycardia
  • Abnormal HR
  • Dizziness, Headache, Nausea