Module 2 Quiz

Blood pressure (Formula)

Cardiac Output x Systemic vascular resistance

What are the things that INFLUENCE Cardiac Output?

Cardiac Factors: Heart Rate, contractibility

Circulating Volume: Salt, Aldosterone

What are the things that INFLUENCE Systemic Vascular Resistance?

Hormones: Vasodilators, Vasoconstrictors

Peripheral Sympathetic Receptors: Constrictors, Dilators

CNS

Local “Receptors”

What are Drugs that affect Cardiac Factors in regards to Cardiac Output (Heart rate, Contractibility)?

1. Beta blockers

2. Calcium channel blockers

3. Centrally acting adrenergic

What are Drugs that affect Circulating Volume in Blood Vessels in regards to Cardiac Output (Salt, Aldosterone)?

1. ACE Inhibitors

2. Diuretics

What are Drugs that affect Hormones in regards to Systemic Vascular Resistance (Vasodilators, Vasoconstrictors)?

1. Vasodilators

2. Prostaglandins

3. ACE inhibitors

4. Calcium Channel blockers

5. Angiotensin II blockers

What are Drugs that affect Peripheral Sympathetic Receptors in regards to Systemic Vascular Resistance (Dilators, Constrictors)?

1. Alpha₁ Blockers

2. Beta Blockers

What are Drugs that affect the CNS in regards to Systemic Vascular Resistance?

Centrally acting adrenergics (alpha₂)

What are Drugs that affect the Local Receptors in regards to Systemic Vascular Resistance?

Peripherally acting adrenergics

Groups of Antihypertensive Drugs

ACE Inhibitors

ARBs

Beta Blockers

Calcium Channel Blockers

Adrenergic Drugs (Selective alpha-1 antagonist)

Selective aldosterone blockers

SA Node modulators

What do Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin Receptor Blockers (ARBs) do?

Inhibit the renin-angiotensin-aldosterone system (RAAS)

Both commonly used for HTN and heart disease

How do Angiotensin-converting enzyme (ACE) Inhibitors work? What is the mechanism?

ACE inhibitors bind to (and inhibit) ACE;

Prevents Angiotensin II production AND Bradykinin catabolysm

Angiotensin II = powerful vasoconstrictor; Bradykinin = powerful vasodilator;

IMPROVES RENAL FUNCTION AND LOWERS BP

How do Angiotensin II Receptors Blockers (ARBs) work? What is the mechanism?

ARBs blocks Angiotensin II binding to blood vessels

Reduces Aldosterone secretion (strong vasoconstrictor)

Examples of Angiotensin-converting enzyme (ACE) Inhibitors

Captopril (Capoten)

Enalapril (Vasotec)

Fosinopril (Monopril)

Lisinopril (Prinivil, Zestril)

Examples of Angiotensin II Receptors Blockers (ARBs)

Irbesartan (Avapro)

Losartan (Cozaar)

Valsartan (Diovan)

Side Effects of Angiotensin-converting enzyme (ACE) Inhibitors

COUGH

Hypotension

Angioedema (swelling in deep layers of skin)

Side Effects of Angiotensin II Receptors Blockers (ARBs)

Dizziness, headache, fatigue, diarrhea, hyperkalemia

What do Beta Blockers do (function)?*

Lower BP by reducing heart rate and CO

How do Beta Blockers work? What is the mechanism?

Prevents adrenaline and noradrenaline from activating beta I & II adrenergic receptors by competitively binding to them

β1-ARs Inhibition (heart) = decrease heart rate, myocardial contraction force, CO

Decreases BP by vasodilation and reducing heart rate

β2-ARs (lungs, muscles) = decrease tremors

Examples of Selective/Nonselective Beta Blockers. What do all of them effect?

Selective: atenolol (Tenormin), metoprolol (Lopresor), carvedilol, Nebivolol, labetalol (Trandate)

Nonselective: Nadolol, pindolol, sotalol, propranolol (Inderal)

Side Effects of Beta Blockers

bradycardia, hypotension, dizziness, fatigue, cold hands and feet, difficulty sleeping, nightmares, sexual dysfunction

What do Calcium Channel Blockers do?

Decrease peripheral resistance/lower BP by relaxing blood vessel walls

How do Calcium Channel Blockers (CCBs) work? What is the mechanism?

bind to specific calcium channels (L-type channels) in the cell membrane of the heart and blood vessels; inhibits influx of calcium ions

Slows heart rate by reducing force and rate of contractions; vasodilation (reduces BP); reduces muscle tension

reduce blood flow to heart (alleviates angina/chest pain)

Examples of Non-dihydropyridine/Dihydropyridine Calcium Channel Blockers

Nondihydropyridine— Diltiazem, verapamil

Dihydropyridine— Nifedipine, amlodipine, nicardipine, manidipine, barnidipine, lercanidipine, felodipine

Side Effects of Calcium Channel Blockers (include which drugs illicit these side effects)

constipation (verapamil)

peripheral edema (amlodipine, nifedipine)

bradycardia and hypotension (diltiazem);

also fatigue, flushing, and dizziness

What do Adrenergic Drugs (Alpha-1 Adrenergic Blockers) do?

Treats HTN and benign prostatic hyperplasia (BPH) by…

opposing effects of sympathetic nervous system, resulting in decreased smooth muscle contraction (including decreased vasoconstriction, mydriasis [pupil dilation], ejaculation, and bladder constriction

Side Effects of Adrenergic Drugs (Alpha-1 Adrenergic Blockers)

Orthostatic Hypotension

Vertigo

Palpitations (heart racing)

Nasal congestion

Sexual dysfunction

Examples of Selective/Non-selective Adrenergic Drugs (Alpha-1 Adrenergic Blockers) *Doesn’t have categories*

Doxazosin (Cardura), Clonidine (Catapres), Methyldopa (Aldomet), Tamsulosin, Alfuzosin, Terazosin, Prazosin

What do Selective Aldosterone Blockers (Selective Aldosterone Receptor Antagonist [SARA]) do? What is their mechanism?

Blocks aldosterone receptors to treat hypertension, heart failure, and other cardiovascular conditions

Examples of Selective (and non-selective) Aldosterone Blockers (Selective Aldosterone Receptor Antagonist [SARA])

eplerenone (Inspra), spironolactone (aldactone; non-selective)

Side effects of Selective Aldosterone Blockers (Selective Aldosterone Receptor Antagonist [SARA]) do?

Dizziness, nausea/vomiting, insomnia, headaches, coughing

What do SA Node Modulators do? What are their mechanisms? What class of meds are they in?

Change activity of heart SA nodes to control heart’s rate and rhythm;

Class = Hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blockers

Example of SA Node Modulators

Ivabradine (Lancora)

What do Cardiac/digitalis Glycosides do? What is it’s mechanism? What is an example of a drug?

(ex: digoxin) increases myocardial force and cholinergic (related to acetylcholine) stimulation from the parasympathetic nervous system…

To treat Afib, Aflutter, CHF

Side/Adverse Effects of Cardiac/digitalis Glycosides

Unusual tiredness/fatigue, anxiety, hallucinations;

Visual disturbances, nausea/vomiting, arrhythmias, electrolyte imbalances

What do Vasodilators do? What is the mechanism of action?

(Hydralazine and isosorbide together) Treats blood pressure (vasodilate) and heart failure;

Increases blood flow/O₂ decreases heart workload and increases kidney/limb blood flow;

Increases stroke volume and left ventricular ejection fraction

Side Effects Cardiac/digitalis Glycosides

Headaches, dizziness, hypotension

What do Angiotensin Receptor-Neprilysin Inhibitors (ARNi) do? What is this class associated with? Why?

Reduce heart workload by decreasing blood volume and vascular resistance;

Combination of ARBs and Neprilysin Inhibitors

Examples of Angiotensin Receptor-Neprilysin Inhibitors (ARNi). How do they work?

Valsartan/Sacubitril (Entresto);

Valsartan antagonizes the angiotensin I–induced vasoconstriction, aldosterone release, and catecholamine (hormone class related to epinephrine) release

Sacubitril inhibits neprilysin → increases natriuretic peptides (vasodilatory and natriuretic effects)

Contraindictions of Angiotensin Receptor-Neprilysin Inhibitors (ARNi)

Pregnancy category D drug (affects fetus)

angioedema due ACE inhibitor/ARB therapy and/or ACE inhibitor within the last 36 hours.

What do Diuretics do?

Help remove excess fluid and fluid volume in heart;

What are the different types of Diuretics? How do they relate to what they do?

1. Osmotic diuretics

2. Carbonic anhydrase inhibitors

3. Loop diuretics

4. Thiazide diuretics

5. Potassium-sparing diuretics

Side Effects of Loop Diuretics

Hypokalemia, Hyponatremia, Hypochloremia, Hypomagnesemia;

Additionally, dehydration, orthostatic hypotension, dizziness, and fatigue

Examples Drugs of Loop Diuretics

Furosemide (Lasix), Bumetanide (Bumex)

Example Drugs of Thiazide Diuretics AND Side Effects

Hydrochlorothiazide (HCTZ);

Hypokalemia, hyponatremia, metabolic alkalosis, hypercalcemia, hyperglycemia, and hyperuricemia

Example Drugs of Potassium Sparing Diuretics AND Side Effects

Example: Spironolactone (Aldactone)

Side Effects: Hyperkalemia (levels above 5.5 mmol/L) (does not cause symptoms unless severe) (if severe: palpitations, arrythmias, muscle pain, muscle weakness, numbness)

What do Nitrates do? Mechanism of action?

Vasodilation (improving blood flow to heart / decrease cardiac workload); decreases angina symptoms

Platelet aggregation inhibition and increased anti-inflammatory activity

Nitric oxide production (potent vasodilator) → also relaxes smooth muscle, and reduce myocardial O₂ demand;

Side Effects of Nitrates AND Examples of Drugs

Side Effects: Headache, flushing, hypotension

Examples: nitroglycerin (angina / HF), isosorbide mononitrate and isosorbide dinitrate (similar to nitroglycerin)

What do Anticoagulants do? Example drugs?

Prevent blood clot formation to prevent strokes and pulmonary embolism;

Warfarin, heparin, and (ENOXAPARIN [Lovenox]: low molecular weight heparin)

What do Anntiplatelet Agents do? Example drugs?

Prevent platelet coagulation to prevent heart attacks and strokes;

Aspirin, clopidogrel

What do Thrombolytics do? Example drugs?

Lyse thrombi for emergencies (i.e. acute MI or ischemic stroke);

Alteplase (Genentech, tissue plasminogen activator (t-PA); Reteplase (Retavase)

What are the Side Effects of ALL Coagulation Modifier Drugs (Anticoagulants, Antiplatelets, Thrombolytics)?

bleeding

What do Statins do? Example drugs?

Lower LDL cholsterol by inhibiting its production in liver;

Atorvastatin (Lipitor), Fluvastatin (Lescol), Lovastatin (Altoprev), Pravastatin (Pravachol), and Rosuvastatin (Crestor)

Major Side Effects of Statins and other Contrainidications

Muscle pain, liver damage, digestive issues;

Grapefruit interferes processes of some statins

What do Bile Acid Sequestrants do? Example drugs?

Bind to bile acids, indirectly lowering cholesterol levels;

Cholestyramine (Questran)

Major Side Effects of Bile Acid Sequestrants

GI issues (constipation, bloating, gas)

What do Fibrates do? Example drugs?

Lower triglycerides and modestly increase HDLs to treat dyslipidemia;

Gemfibrozil (Lopid)

Major Side Effects of Fibrates

Liver / muscle / GI issues AND skin reactions

Complete the Table

Electrolyte	Function	Imbalance Consequences
Sodium
Potassium

Calcium

Electrolyte	Function	Imbalance Consequences
Sodium	Fluid balance, nerve function	Hyponatremia or hypernatremia
Potassium	Heart rhythm, muscle contraction	Hypokalemia or Hyperkalemia

Calcium	Bone health, blood clotting	Hypocalcemia or Hypercalcemia

Hair Failure Drugs: Supporting Cardiac Function

ACEIs, ARBS, and Beta Blockers

Cardiac or Digitalis Glycosides

Vasodilators: Hydralazine and Isosorbide

Anntianginal Drugs: Relieving Chest Pain

Nitrates

Beta Blockers

Calcium Channel Blockers

Coagulation Modifier Drugs: Managing Blood Clots

Anticoagulants

Antiplatelet Agents

Thrombolytics

Antilipemic Drugs: Controlling Cholesterol Levels

Statins

Bile Acid Sequestrants
Fibrates