Term
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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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Term
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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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Term
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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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Term
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Definition
| defined hemodynamically as the product of cardiac output and total peripheral resistance |
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Term
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Definition
| Influencing the rate of rhythmic movement |
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Term
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Definition
| human biological variations of rhythm within a 24-hour cycle |
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Term
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Definition
| Measurement of the renal clearance if endogenous creatinine per unit time |
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Term
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Definition
| Covalently cross-linked degradation fragments of cross-linked fibrin polymer during plasmin-mediated fibrinolysis |
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Term
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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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Term
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Definition
| Blood pressure above 180/120 without signs or symptoms of acute target organ complications |
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Term
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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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Term
| 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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Term
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Definition
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Term
| 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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Term
| 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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Term
| 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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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 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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