Term
| what are the 4 drug classes for HF |
|
Definition
diuretics
vasodilators
postive ionotropes
beta antagonists |
|
|
Term
| if the tissue perfusion is limited- what are 2 side effects |
|
Definition
|
|
Term
| what two system compensate for HF |
|
Definition
|
|
Term
| Epi compensates what in HF-2 |
|
Definition
| contracitlity and heart rate |
|
|
Term
| NE compensates for what in HF? |
|
Definition
| vasoconstriciotn/ increase in PR |
|
|
Term
| RAS compensates for what- 2 |
|
Definition
increased PR
increased Na and water |
|
|
Term
| what do diuretics help with? |
|
Definition
|
|
Term
where do the loop diuretics work?
what do they work on? |
|
Definition
thick ascending loop
Na/K/Cl symporter |
|
|
Term
| what ions do loop diuretics effect and how? |
|
Definition
Na, Mg, Ca, K, Cl
increase secretion |
|
|
Term
where do thiazide diuretics work?
on what? |
|
Definition
distal tubule
Na/Cl symporter |
|
|
Term
| chronic use of thiazides results in- 2 |
|
Definition
decrease uric acid secretion
decreased Ca excretion |
|
|
Term
| use of thiazides increases your risk for what disease? |
|
Definition
|
|
Term
where are aldosterone recptors located?
then where does this complex go and do? |
|
Definition
cytoplasm
to nucleus and stimualte expression of aldosterone protein synthesis |
|
|
Term
| 5 things to worry about with aldosertone |
|
Definition
hypertensive
Na retention
thrombosis
ventricular arrythmias
K and Mg loss |
|
|
Term
vasopression is produced where?
what 2 things does it eventually increase |
|
Definition
pituitary
arterial pressure & blood volume |
|
|
Term
what are teh vasopression antagonists
which is the V2 anatagonist |
|
Definition
conivaptasn
tolvaptan
tolvaptan |
|
|
Term
| which vasopressin antagonist is oral formulation |
|
Definition
|
|
Term
| main effects of tolvaptan on urine excretion- 3 |
|
Definition
decreases urine osmolality
increased Na conc.
free water clearence |
|
|
Term
what drug has an effect of aquaresis
why and how? |
|
Definition
tolvaptan
excretes water only
through aquaporin channels |
|
|
Term
| how does tolvaptan affect excretion of electrolytes |
|
Definition
|
|
Term
| tolvaptan is indicated for HF pateints with addioitonal |
|
Definition
| hypervolemia/ euvolemic hyponatremia |
|
|
Term
| can you take tolvaptan with food |
|
Definition
|
|
Term
| tolvaptan is metabolized by |
|
Definition
|
|
Term
|
Definition
thirst
frequent peeing
hypotension
hyperglycemia |
|
|
Term
| which medicaiton can cause osmotic demyelination |
|
Definition
|
|
Term
| osmotic demylination is when hyponatremia is corrected more than- |
|
Definition
|
|
Term
the main thing ACEi do is -
side effects of this-4 |
|
Definition
reduce Ang II production
reduce PR, reduce Na and H20 retention, decrease sympathetic tone, decrease aldosterone |
|
|
Term
besides its main action- ACEi increase what 2 things
what do these decrease? |
|
Definition
bradykinin
Ang 1,7
Peripheral resistance |
|
|
Term
| which do you use first, ARB or ACEi |
|
Definition
|
|
Term
| what are the direct vasodilators-3 |
|
Definition
nitroglycerin
Na nitroprusside
Nesiritide |
|
|
Term
what 2 vasodilators make NO
what does this then do? |
|
Definition
nitroprusside
nitroglycerin
stimulates guanylyl cyclase |
|
|
Term
Nesiritide works on what receptor
what does this then do? |
|
Definition
NP receptor A
increase guanyl cyclase |
|
|
Term
direst vasodilators increse cGMP which then stimulates what?
whagt are the 2 big ending functions of this stimulation?
the big ending result is- |
|
Definition
cGMP kinase
decrease intracell Ca & dephos MLC
smooth muscle relax |
|
|
Term
nesiritide has what other 2 functions besides vasodilation?
why? |
|
Definition
natiuresis
diuresis
bc also recptor in kidney |
|
|
Term
| if using a direct vasodilator, what other med don't you use |
|
Definition
|
|
Term
| whcih vasodilator is a prodrug that converts into NO and cyanide |
|
Definition
|
|
Term
| what drug is a prodrug that converts into only NO |
|
Definition
|
|
Term
| how do you administer Nitroglycerin? |
|
Definition
|
|
Term
nitroglycerin is selctive for what vessels?
this measn a great reduction in what? |
|
Definition
venouos capacitance
left ventricluar filling pressure |
|
|
Term
| what is the major reason for not adhering to nitroglycerin? |
|
Definition
|
|
Term
| long infusions of nitroglycerin can adversely increase blood what concentration |
|
Definition
|
|
Term
| how do you adminster Na nitroprusside |
|
Definition
|
|
Term
Na nitroprusside dilates what vessels?
this measn a reduction in what 2 things |
|
Definition
arteries AND veins
ventricular filling pressure AND PR |
|
|
Term
| what are the 2 limitations of nitroprusside |
|
Definition
hypotension
toxicity from cyanide |
|
|
Term
| cyanide toxicity can cause what acid-base disorder |
|
Definition
| metabolic acidosis with elevated anion gap |
|
|
Term
nitroprusside + hemoglobin can cause-
nitroprusside's cyanide + met-Hb ->-2
" " + cytochrome oxidase->
" " thiosulfate-> -2 |
|
Definition
tissue hypoxia
cyanmet and decreased oxidative metab
decreased oxidative metabolsim
thiocyante + liver/renal tox |
|
|
Term
brain natriuretic peptide is endogenously secreted by what?
due to what? |
|
Definition
cardiomyocytes
response to stretch |
|
|
Term
nesiritide causes vasoldialtion of what vessels?
how do you admin it? |
|
Definition
|
|
Term
| limitations of nesiritide-3 |
|
Definition
expensive
hypotension
debatable effect |
|
|
Term
what is the new vasodilator that is made endogensously to modulate cardiovasc during pregnancy?
what type of molcule is it? |
|
Definition
serelaxin
recombinant human relaxin |
|
|
