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Exam 3
Lecture 2
50
Art History
10th Grade
04/29/2013

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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
weakness
fatigue
Term
what two system compensate for HF
Definition
RAS
SNS
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
venous volume overload
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
gout
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
tolvaptan
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
doesnt change it
Term
tolvaptan is indicated for HF pateints with addioitonal
Definition
hypervolemia/ euvolemic hyponatremia
Term
can you take tolvaptan with food
Definition
yes
Term
tolvaptan is metabolized by
Definition
CYP 450
Term
ADEs of tolvaptan- 4
Definition
thirst
frequent peeing
hypotension
hyperglycemia
Term
which medicaiton can cause osmotic demyelination
Definition
tolvaptan
Term
osmotic demylination is when hyponatremia is corrected more than-
Definition
12 mEq/L/24 hrs
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
ACEi
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
PDE 5 inhibitor
Term
whcih vasodilator is a prodrug that converts into NO and cyanide
Definition
nitroprusside
Term
what drug is a prodrug that converts into only NO
Definition
nitroglycerin
Term
how do you administer Nitroglycerin?
Definition
Iinfused IV
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
headaches!
Term
long infusions of nitroglycerin can adversely increase blood what concentration
Definition
EtOH
Term
how do you adminster Na nitroprusside
Definition
IV
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
artery adn veins
IV
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
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