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60 Cards in this Set
- Front
- Back
What is the equation for cardiac output?
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Stroke volume x HR
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Stroke Volume is determined by what three things?
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Myocardial contractility, afterload, preload
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Heart rate is increased by the beta1-adernergic receptors and decreased by what?
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The parasympathetic system via the vagus nerve
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Define Cardiac Output?
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Amount of blood pumped from the ventricle per minute
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What is the load against which the myocardium must eject against?
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Afterload
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Does afterload deal w/ resistane/pressure or prefussion?
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Resistance & pressure
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What is the number one problem of preload?
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Prefussion
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Is fluid in the lungs, crackles, cough, orthopenea, COPD, JVD a afterload or preload problem?
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Preload
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Preload is known as the __________ applied to muscle prior to contraction, the greater the filling pressure the greater the _________?
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STRETCH, CONTRACTION
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How is cardiac output increased?
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Increase stroke volume or heart rate
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Preload is equal to End Diastolic or systolic pressure?
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End Diastolic Volume
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Afterload is equal to End-systolic wall stress or?
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Resistance
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List the four things that regulate arterial pressure in order to fastest responses to slowest?
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Autonomic Nervous System (w/in seconds), Renin-angiotension-aldosterone system (days), Kidneys (days-wks), Natriuretic peptides (volume overload)
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What are a protective measure for the cardiovascular system during volume overload or hypervolemia?
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Natriuretic Peptides
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What three things do natriuretic peptides?
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Suppress rennin-angiotension-aldosterone system (BNP & ANP), inhibit myocytes, promotes dilation of arterioles & veins
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How does the Renin-Angiotensin-Aldosterone System aid in regulating blood pressure, blood volume, & fluid & electrolyte balance?
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Vasoconstriction, release of aldosterone
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How does aldosterone regulate blood volume & blood pressure?
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Aldosterone causes sodium retention & excretion of potassium & hydrogen
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Can the RAAS system cause cardiac remodeling & fibrosis?
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Yes, can cause hypertrophy & remodeling
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What is released secondary to a decrease in blood pressure, bv, plasma sodium, or renal perfusion pressure?
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Renin
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What enzyme catalyzes the conversion of angiotensin I into angiotensin II?
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ACE (Angiotensin-Converting Enzyme)
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Why are ACE inhibitors used in tx of hypertension, heart failure, diabetic nephropathy, & myocardial infarction?
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They can reduce levels of Angio II, increase levels of bradykinins, can dilate vessels, reduce BV
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Can ACE inhibitors prevent or reverse pathologic changes in the heart caused by RAAS system?
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Yes
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Why are ACE inhibitors used to tx hypertension?
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Minimal orthostatic hypotension, used in pt. w/ asthma, can exercise, no lethargy, reduce risk of cardiovascular mortality caused by HTN
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What benefits do Ace inhibitors produce when txing HF?
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Lower arterial tone, improve regional blood flow reduce cardiac afterload, increase cardiac output, dilate renal blood vessels
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How do Ace inhibitors suppress aldosterone and local production of angio II in the heart?
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Prevent or reverse pathologic changes in cardiac structures
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What is the number one ACE drug?
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Captopril
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What drug is approved for people w/ a risk for stroke, CAD, diabetes, peripheral vascular disease?
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Ramipril
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What are the three main adverse effects of ACE inhibitors?
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First dose hypotension, cough (persistent, dry, irritating, nonproductive), Hyperkalemia (because of the inhibition of aldosterone-causes K retention)
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Nearly all ACE inhibitors are administered orally except for which one?
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Enalaprilat (Vasotec)
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Except for which ACE drugs can be taken w food?
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With the exception for which ACE inhibitor, all have prolonged half-lives, and can be administered just once or twice a day?
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Catopril
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ACE inhibitors block the production of angio II, How do ARB’s effect Angio II?
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ARB’s block the ACTION of angio II
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Which ARB is used for hypertension?
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All ARB’s are approved and have equal effects to ACE inhibitors
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Which ARB is approved for Heart Failure & MI?
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Valsartan (Diovan)
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Which ARB is used for stroke prevention & Diabetic Nephropathy?
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Losartan(Cozaar)
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Name the three main adverse effects of ARB’s?
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Angioedema, fetal harm, renal failure
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Do ARB’s have bradykinin accumulation or problems w/ hyperkalemia?
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NO
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What are the two Aldosterone Antagonists used in the tx. of hypertension and heart failure?
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Spironolactone & Eplerenone
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What are Elerenone’s?
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new class of selective aldosterone receptor blockers
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Do Aldosterone Antagonists prevent or reverse pathologic effects of aldosterone on cardio structure & fxn?
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THEY may
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How do Aldosterone Antagonists work?
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They block the receptors for aldosterone, this blockade produces retention of K & the loss of Na & H2O
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How long do Aldosterone Antagonists take to have optimal results in txing hypertension?
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4 weeks
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How do Calcium Channel Blockers work?
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Prevent Ca ions from entering the cells
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Where does calcium play a critical role?
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In the function of the vascular smooth muscle (regulate contraction in VSM) & heart
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If Ca channels are blocked, what will happen to contraction?
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Contraction will be prevented & vasodilation will result
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Calcium blockade regulate the function of what three things on the heart?
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Myocardium, SA node, AV node
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What do Calcium Channel Blockers do to the myocardium?
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Decrease the force of contraction
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What do Calcium Channel Blockers do to the SA & AV nodes?
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SA: decrease in heart rate, AV: decrease in velocity of conduction
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What Calcium channel blocker is approved to act on vascular smooth muscle & the heart?
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Verapamil
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What are the adverse effects of Therapeutics?
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Constipation, dizziness, facial flushing, headache, GINGIVAL HYPERPLASIA, bradycardia
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What type of CCB cause significant blockade of calcium channels in blood vessels & minimal blockade of calcium channels in the heart?
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Dihydropydridines
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What is the drug prototype for Dihydropyridines?
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Nifedipine
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Dihydropyridines activate baroreceptors which causes what to occur?
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Sympathetic stimulation of the heart, increases HR & contractile force
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If a Dihydropyridines dilate veins, it will reduce ventricular filling and decrease what?
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Cardiac preload
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What CCB has selective dilation of arterioles, but no effect on veins?
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Hydralazine
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When is Hydralazine used?
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Essential in HTN (used to lower blood pressure) & HF
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What are the adverse effects of Hydralazine?
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Reflex tachycardia, Increased blood volume, systemic lupus erythematosus like syndrome
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What are the drug of choice for hypertensive emergencies, because they are an extremely effective vasodilator?
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Sodium Nitroprusside (Nipride)
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Does Sodium Nitoprusside cause venous or arteriolar dilation?
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Both & does not cause reflex tachycardia
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What are the two adverse effects of Sodium Nitoprusside?
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Hypotension, Cyanide poisoning
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