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maintain homeostasis depending on the continuous & controlled movement of blood thru capillaries Consists: Heart & Blood vessels (AVC)

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CVS – aka blood-vascular, circulatory system

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PHARMACOLOGY 2 - Leaderboard

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PHARMACOLOGY 2 - Details

Levels:

1) CVS View
2) Heart Failure View
3) Disorders of Blood View
4) DISEASES OF BLOOD View
5) LIPIDS DISORDER View
6) AUTACOIDS View
7) wk12-13 Antimicrobials,antifungals.pptx View
8) ANTIVIRAL View

Questions:

422 questions

🇬🇧		🇬🇧

Maintain homeostasis depending on the continuous & controlled movement of blood thru capillaries Consists: Heart & Blood vessels (AVC)

CVS – aka blood-vascular, circulatory system

Where the blood performs its ultimate transport function

Microscopic capillaries

The organ that keeps the blood moving through the vessels. If it loses its pumping effectiveness for even a few minutes, the individual's life is jeopardized pumps about 5 liters of blood every minute throughout life

Heart

Blood Circulation IN ORDER

1 S / I vena cava 2 Right atrium 3 Tricuspid valve 4 Right ventricle 5 Pulmonary artery 6 Lungs 7 Left atrium 8 Mitral valve 9 Left ventricle 10 Aorta 11 Distribute to tissues

Which has thicker walls? 1 Left or Right ventricles ? 2 Left or Right atrium ?

1 Left ventricles 2 Left atrium

Which has thicker walls? Left or Right atrium

Left

1 The only part that carry deoxygenated blood 2 The only part that carry oxygenated blood

1 Pulmonary artery 2 Pulmonary vein

Rhythmic beat of the heart is __

Myogenic

Heart is influenced by the Autonomic Nervous System. 1 Increases the heart rate 2 Decreases the heart rate

. 1 Norepinephrine 2 Acetylcholine

Rhythmic beat of the heart depends mostly on this Pacemaker of the heart most rapidly beating part of the heart Controls heart rhythm and initiates contraction of the heart

Sinoatrial Node

Impulse of the Heart (In order)

1 Sinoatrial Node 2 Atrio-ventricular Node 3 Atrio-ventricular Bundle 4 Ventricles

1 Chronotrophic effect 2 Volume of blood ejected by the heart per beat 3 Inotropic Effect

1 Tachycardia (fast heart rate) 2 Stroke volume 3 Increased force of contraction

Volume of blood pumped in one minute; depends on the heart rate and stroke volume

Cardiac Output HR x SV

1 thick-walled chambers that forcefully pump blood out of the heart 2 thin-walled chambers that receive blood from the veins.

1 ventricles 2 atria

1 receives oxygenated blood from the pulmonary veins 2 receives deoxygenated blood from systemic veins

1 left atrium 2 right atrium

Channels or conduits through which blood is distributed to body tissues. It make up two closed systems of tubes that begin and end at the heart

Blood vessels

1 carry blood away from the heart. 2 Blood is pumped from the ventricles into large elastic arteries that branch repeatedly into smaller and smaller arteries until the branching results in microscopic arteries called __ play a key role in regulating blood flow into the tissue capillaries.

1 Arteries 2 arterioles

The smallest and most numerous of the blood vessels, form the connection between the vessels that carry blood away from the heart (arteries) and the vessels that return blood to the heart (veins). The primary function is the exchange of materials between the blood and tissue cells

Capillaries

1 carry blood toward the heart 2 After blood passes through the capillaries, it enters the smallest veins, called __

1 Veins 2 venules

1 transport blood that has a low oxygen content from the right ventricle to the lungs. 2 transport oxygenated blood from the left ventricle to the body tissues

1 Pulmonary arteries 2 Systemic arteries

1 transport blood that has a low oxygen content from the right ventricle to the lungs. 2 transport oxygenated blood from the left ventricle to the body tissues

1 Pulmonary arteries 2 Systemic arteries

1 transport blood from the lungs to the left atrium of the heart. This blood has a high oxygen content because it has just been oxygenated in the lungs. 2 transport blood from the body tissue to the right atrium of the heart. This blood has a reduced oxygen content because the oxygen has been used for metabolic activities in the tissue cells.

1 pulmonary veins 2 Systemic veins

Is defined as either a sustained systolic blood pressure of greater than 140 mm Hg or a sustained diastolic blood pressure of greater than 90 mm Hg. results from increased arteriolar resistance and reduced capacitance of the venous system.

Hypertension

Is the force of blood pressing against the walls of your arteries. When it's too high, your heart has to work harder. This can cause serious damage to your arteries.

Blood pressure

Normal

Less than 120/80 mmHg

Elevated

120-129/80 and below

Stage I

130-139/80-89 mmHg

Stage II

Above 140 /90mmHg

They are responsible for the rapid, moment-to moment regulation of blood pressure act by changing the activity of the sympathetic nervous system

Baroreflexes

A fall in BP causes __ to send fewer impulses to CV centers in the spinal cord. This prompts a reflex response of increased sympathetic and decreased parasympathetic output to the heart and vasculature, resulting in vasoconstriction and increased cardiac output. These changes result in a compensatory rise in BP

Pressure-sensitive neurons (baroreceptors in the aortic arch and carotid sinuses)

Decrease in Blood Pressure Responses (Decrease or Increase) 1 Sympathetic Activity 2 Renal Blood Flow 3 Renin 4 B1 adrenoceptors

. 1 Increase 2 Decreased 3 Increase 4 Increase

Baroreceptors in the kidney respond to reduced arterial pressure (and to sympathetic stimulation of β1-adrenoceptors) by releasing the enzyme __ Low sodium intake and greater sodium loss also increase __

Renin

Converts angiotensinogen to angiotensin I, which is converted in turn to angiotensin II, in the presence of ACE. angiotensin II is a potent circulating vasoconstrictor, constricting both arterioles and veins, resulting in an increase in BP

Renin

Stimulates aldosterone secretion, leading to increased renal sodium reabsorption and increased blood volume, which contribute to a further increase in blood pressure.

Angiotensin II

Primary Prevention (Hypertension) First Line:

Thiazide diuretic, ACE Inhibitors or ARB or combo

Diabetes Mellitus First Line: Sequential Therapy:

First Line: ACE Inhibitors (Angiotensin-converting enzyme inhibitors) Sequential Therapy: Thiazide, CCB or Beta blocker

Chronic Kidney Disease First Line:

ACE Inhibitors (Angiotensin-converting enzyme inhibitors)

Coronary Artery Disease First Line: Sequential Therapy:

First Line: ACE Inhibitors (Angiotensin-converting enzyme inhibitors) or ARB or B-blockers Sequential Therapy: Thiazide (BP CONTROL) CCB or Beta blocker (ISCHEMIA CONTROL)

Prior Ischemic Stroke First Line:

ACE Inhibitors (Angiotensin-converting enzyme inhibitors) and Thiazide

Left Ventricular Dysfunction First Line: Sequential Therapy:

First Line: ACE Inhibitors (Angiotensin-converting enzyme inhibitors), Thiazide and B-blockers Sequential Therapy: 1 Aldosterone Antagonist (SEVERE HEART FAILURE) 2 Hydralazine & Isosorbide

Traditionally, the first choice for the initial treatment of chronic hypertension.

Thiazide-type diuretic or a ß-adrenergic receptor blocker

More recently some physicians prefer to start therapy with an __. If the first agent is ineffective or poorly tolerated, another agent is substituted. If more than one agent is needed, a __ is added.

1 ACE inhibitor or a CCB 2 diuretic

__ is indicated in hypertensive emergencies, usually with nitroprusside or diazoxide; IV labetalol or SL nifedipine are also suitable.

Parenteral therapy

Are useful antihypertensive drugs when employed alone, or in combination therapy, as it potentiate the action of the other hypotensive drugs and it is believed to result from their ability to produce a negative Na+ balance

Diuretic agents

Most frequently used diuretics

Thiazides

Produce greater diuresis than the thiazides, but have a weaker antihypertensive effect and can cause SEVERE ELECTROLYTE BALANCE

Furosemide, ethacrynic acid, bumetanide- loop diuretics

Useful in combination with a thiazide diuretic, whose effects they potentiate and they minimize K+ loss; K+-sparing diuretics

Spironolactone, triamterene, amiloride

1 primary function is to generate a concentration gradient between the inner medulla and outer cortex 2 the control of osmotic pressure through regulation of water and solute levels.

1 loop of Henle 2 Osmoregulation

Principal function of Loop of Henle

The recovery of water and sodium chloride from urine.

Vasoconstriction up Peripheral Resistance up Blood Pressure Mydriasis up Closure Bladder

Alpha 1

Inhibits Norepinephrine release Inhibits Acetylcholine release Inhibits Insulin release

Alpha 2

Up Heart Rate up Lipolysis up Myocardial Contractility up Renin

Beta 1

Vasodilation down Peripheral Resistance Bronchodilation up Glycogenolysis up Glucagon release Relaxes uterine smooth muscles

Beta 2

Are a treatment option for hypertensive patients with concomitant heart disease or heart failure. MOA: reduce blood pressure by: 1 decreasing cardiac output 2 decrease sympathetic outflow from the CNS 3 inhibit release of renin from the kidneys, thus decreasing the formation of angiotensin II and the secretion of aldosterone

Β-ADRENOCEPTOR–BLOCKING AGENTS (BB)

The prototype β-blocker which acts at both β1 and β2 receptors.

Propranolol

Selective β1 blockers , the most commonly prescribed βB

Metoprolol, atenolol

Is a selective β1 receptors blocker, which also increases the production of nitric oxide, leading to vasodilation

Nebivolol

Nonselective BB causes bronchoconstriction thus not to be used in __ patients due to their blockade of β2-mediated bronchodilation.

Asthmatic can precipitate bronchospasm in patients with bronchial asthma

Adverse effects of BB

1 Common effects: bradycardia, hypotension, and CNS side effects such as fatigue, lethargy, and insomnia βB may decrease libido and cause erectile dysfunction, which can severely reduce patient compliance. 2 Alterations in serum lipid patterns 3 Drug withdrawal: Abrupt withdrawal may induce ANGINA, MI, and even sudden death in patients with ischemic heart disease.

Lower blood pressure by reducing peripheral vascular resistance without reflexively increasing cardiac output, heart rate, or contractility.

ACE INHIBITORS (ACEIn)

Ace inhibitors block the enzyme __ the ACE which cleaves angiotensin I to form the potent vasoconstrictor angiotensin II.

Peptidyl dipeptidase

Enalapril and lisinopril

Is responsible for the breakdown of BRADYKININ, a peptide that increases the production of nitric oxide and prostacyclin by the blood vessels. Both are potent vasodilators. ACE inhibitors decrease angiotensin II and increase bradykinin levels.

ACE

Cause coughing as its breakdown is prevented by ACEIn, it is a potent vasodilator Common S/E include dry cough, rash, fever, altered taste, hypotension (in hypovolemic states), and hyperkalemia The dry cough, which occurs in up to 10% of patients, is thought to be due to increased levels of this

Bradykinin

A rare but potentially life-threatening reaction that may also be due to increased levels of bradykinin.

Angioedema

While on ACE Inhibitors, we should monitor __

1 Potassium Levels K supplements and K-sparing diuretics should be used with caution due to the risk of hyperkalemia. 2 Serum Creatinine Levels particularly in patients with underlying renal disease.

ACE inhibitors can induce __ and should not be used by pregnant women

Fetal malformations

Are alternatives to the ACE inhibitors.

Losartan and irbesartan (ANGIOTENSIN II RECEPTOR BLOCKERS(ARBs))

They block the AT1 receptors, decreasing the activation of AT1 receptors by angiotensin II. Their pharmacologic effects are similar to those of ACEIn by producing arteriolar and venous dilation and block aldosterone secretion, thus lowering BP and decreasing salt and water retention.

ANGIOTENSIN II RECEPTOR BLOCKERS(ARBs)

Adverse effects of ARBs

1 Do no increase BRADYKININ Levels 2 May be used as first-line agents for HTN, esp in patients with a compelling indication of DM,HF, or CKD. 3 Similar effects as ACEIn, although the risks of cough and angioedema are significantly decreased.

It directly inhibits renin and, thus, acts earlier in the renin–angiotensin–aldosterone system than ACE inhibitors or ARBs. It lowers bp about as effectively as ARBs, ACE inhibitors, and thiazides. It should not be routinely combined with an ACE inhibitor or ARB.

RENIN INHIBITOR

Is a selective renin inhibitor, available for the treatment of hypertension.

Aliskiren

Renin Inhibitor Side Effects

Diarrhea, cough, angioedema, Not for Pregnant (Fetal Toxicity)

CALCIUM CHANNEL BLOCKERS (CCBs)

Classes of CCB

1 Diphenylalkylamines: Verapamil 2 Benzothiazepines: Diltiazem 3 Dihydropyridines : Nifedipine (prototype), Amlo,felo,isra,nicar,nisol

Are used in the treatment of atrial fibrillation.

Diltiazem and verapamil

Competitively block of α1-adrenoceptors decrease peripheral vascular resistance and lower arterial BP by causing relaxation of both arterial and venous smooth muscle.

Α-ADRENOCEPTOR–BLOCKING AGENTS Drugs: Prazosin, doxazosin , and terazosin

Have been shown to reduce morbidity and mortality associated with heart failure.

Α-/β-ADRENOCEPTOR–BLOCKING AGENTS Drugs: Labetalol and carvedilol block α1, β1, and β2 receptors.

Used in the management of gestational hypertension and hypertensive emergencies.

Labetalol

Have been shown to reduce morbidity and mortality associated with heart failure.

Carvedilol, & metoprolol succinate, bisoprolol

Primarily for the treatment of hypertension that has not responded adequately to treatment with two or more drugs. leads to reduced total peripheral resistance and decreased BP

Clonidine CENTRALLY ACTING ADRENERGIC DRUGS

An α2 agonist that is converted to methylnorepinephrine centrally to diminish adrenergic outflow from the CNS the most common s/e are sedation and drowsiness. Its use is limited due to adverse effects and the need for multiple daily doses. It is mainly used for management of hypertension in pregnancy, where it has a record of safety.

Methyldopa

Are direct-acting smooth muscle relaxants, not used as primary drugs to treat hypertension. act by producing relaxation of vascular smooth muscle, primarily in arteries and arterioles thus decr peripheral resistance and, therefore, blood pressure.

Hydralazine, Minoxidil VASODILATORS

Treatment causes hypertrichosis (the growth of body hair). This drug is used topically to treat MALE PATTERN BALDNESS

Minoxidil

Hydralazine A/E

Include headache, tachycardia, nausea, sweating, arrhythmia, and precipitation of angina.A lupus-like syndrome can occur with high dosages, but it is reversible upon discontinuation of the drug.

Rare but life-threatening situation characterized by severe elevations in BP (systolic ↑180 mm Hg or diastolic ↑ 120 mm Hg) with evidence of progressive target organ damage (for example, stroke, myocardial infarction). require timely BP reduction with treatm administered IV to prevent or limit target organ damage.

HYPERTENSIVE EMERGENCY

HYPERTENSIVE EMERGENCY medications

CCB (nicardipine and clevidipine) nitric oxide vasodilators (nitroprusside and nitroglycerin), adrenergic receptor antagonists (phentolamine, esmolol, and labetalol), vasodilator hydralazine dopamine agonist fenoldopam.

BP that remains elevated (above goal) despite admin of an optimal three-drug regimen that includes a diuretic. most common causes are poor compliance, excessive ethanol intake, concomitant conditions (diabetes, obesity, hyperaldosteronism, high salt intake, and/or metabolic syndrome), concomitant medications( sympathomimetics, nonsteroidal anti-inflammatory drugs, or antidepressant medications), insufficient dose and/or drugs, and use of drugs with similar mechanisms of action

RESISTANT HYPERTENSION

__ therapy may lower BP more quickly with minimal adverse effects.

Combination therapy with separate agents or a fixed-dose combination pill

Initiating therapy with two antihypertensive drugs should be considered in patients with blood pressures that are more than __

20/10 mm Hg above the goal

Is the inability of the heart to meet the metabolic requirements of the peripheral system. Symptoms: Major symptoms include weakness, fatigue, and dyspnea

Congestive heart failure (CHF)

1 an increase and growth of muscle cells. 2 restricted blood flow 3 relates heart performance to the size of the individual

1 Hypertrophy 2 Ischemia 3 Stroke volume index (SVI)

Pathophysiology 1 Myocardial cell loss due to regional __ results in deterioration of systolic and diastolic performance. 2 When confronted by an increased load, the remaining normal heart __ to maintain adequate cardiac performance. 3 __ develop to maintain cerebral and coronary perfusion.

. 1 ischemia or myopathy 2 hypertrophies 3 Vasoconstrictor compensatory mechanisms

Vasoconstrictor compensatory mechanisms includes:

1) Stimulation of the sympathetic nervous system 2) Stimulation of the renin-angiotensin system

1 The __ of an unstimulated muscle cell is polarized—that is, the inside of the sarcolemma is negatively charged with respect to the outside. 2 The unstimulated state of the muscle cell, called the __, is created by the presence of large, negatively charged proteins and nucleic acids inside the cell.

1 sarcolemma (plasma membrane) 2 resting potential

1 A balance between K+ inside the cell and Na + outside the cell contributes to the __ 2 During an action potential, the balance of Na + and K + is upset so that the cell becomes __

1 polarization 2 depolarized.

Cardiac Muscle Contraction (in order)

1 Rapid depolarization occurs when fast‐opening Na + channels in the sarcolemma open and allow an influx of Na + ions into the cardiac muscle cell. The Na + channels rapidly close. 2 A plateau phase occurs during which Ca 2+ enters the cytosol of the muscle cell. Ca 2+ enters from the sarcoplasmic reticulum (endoplasmic reticulum) within the cell and also from outside the cell through slow‐opening Ca 2+channels in the sarcolemma. the Ca 2+ channels open, K + channels, which normally leak small amounts of K + out of the cell, become more impermeable to K + leakage. 3 Repolarization occurs as K + channels open and K + diffuses out of the cell. At the same time, Ca 2+ channels close. These events restore the membrane to its original polarization, except that the positions of K + and Na + on each side of the sarcolemma are reversed. 4 A refractory period follows, during which concentration of K + and Na + are actively restored to their appropriate sides of the sarcolemma by Na +/K + pumps. The muscle cell cannot contract again until Na + and K + are restored to their resting potential states.

Are the combination of an aglycone, or genin, and one to four sugars.

Cardiac glycosides

1 is the pharmacologically active portion of the glycosides. 2 is frequently used to refer to the entire group of cardiac glycosides.

1 aglycone 2 digitalis

Is frequently used to refer to the entire group of cardiac glycosides.

Digitalis