Ch 14 Hypertension and CHF
Vasodilators are indicated to treat hypertension and heart failure. They have an inhibitory effect on vascular ___ ____, allowing the vessel to dilate.
Smooth muscle
What is the proarrhythmic effect?
When the use of anti-arrhythmic drugs unmasks or creates new/different arrhythmias
- this is the primary problem with anti-arrhythmic drugs
What is it called when the response to L-DOPA fluctuates during the dose cycle?
The primary goal of muscle relaxants is to selectivity decrease skeletal muscle excitability, but unfortunately they cannot do this and instead they act in what way?
by producing sedation throughout the CNS
Dopamine agonists, COMT inhibitors, Anticholinergic agents, MAO-B inhibitors, and Amantadine are all drug strategies to treat what condition?
Parkinson's Disease
Which drug class binds to receptors on the heart to block the effects of epinephrin and norepinephrin?
Beta blockers
Aspirin inhibits platelet function which can decrease the risk of thrombogenesis that leads to MI and stroke. Aspirin is better at preventing _____ in men, and better at preventing ______ in women.
Aspirin is better at preventing MI in men and better at preventing stroke in women.
Parkinson's results from the degeneration of dopaminergic neurons in substantia nigra, so in order to treat symptoms we aim to replace dopamine. Why do we administer L-DOPA rather than dopamine to treat Parkinson's?
L-DOPA is able to cross the blood-brain barrier, where it is then converted to dopamine after reaching the brain. (Dopamine is unable to cross BBB)
What is the primary problem that patients experience when taking anti-spasm drugs?
sedation from these drugs can limit the patient’s ability to drive, work, etc.
Muscle relaxers are primarily used to treat ____ and _____.
1. muscle spasms
2. spasticity
Diuretics can be beneficial in treating hypertension and congestive heart failure because they decrease fluid in the vascular system. How do they do this?
They act on the kidneys to increase sodium and water excretion
How do we treat clotting deficiencies in hemophilia?
By replacing the missing clotting factor
-in hemophilia type A: factor VII
-in hemophilia type B: factor IX
Although the cause of PD is not known, free-radicals might be the cause of damage to substantia nigra neurons. Therefore _______________ might ultimately be discovered that delay or prevent this condition
anti-oxidant therapies
Botulinum toxin is injected directly into the muscle to promote relaxation/paralysis. List 3 signs of botulinum toxin overdose.
1. Drooping eyes
2. Difficulty speaking/swallowing
3. General muscle weakness
4. Respiratory distress
Statin drugs are the primary agents used to treat blood lipid disorders. Some patients taking statins spontaneously develop muscle pain & weakness. This condition is called?
Statin-induced myopathy
Drugs that improve cardiac contraction force have a 'positive ionotropic effect'. So positive ionotropes are beneficial in treating congestive heart failure. What is the primary positive ionotrope for CHF?
Digitalis
Drugs used to control cardiac arrhythmias fall into 4 categories. List these categories.
1. Sodium channel blockers
2. calcium channel blockers
3. beta blockers
4. drugs that prolong repolarization
List 5 side effects of L-DOPA therapy.
1. GI irritation
2. Hypotension
3. Psychotropic/behavioral effects
4. Dyskinesias
5. “Freezing” of gait
Baclofen is used to treat severe spasticity and is administered intrathecally. What are 3 signs of Baclofen overdose?
1. decreased respiration
2. decreased cardiovascular function
3. stupor
4. coma
Nitrates such as nitroglycerin help decrease symptoms of angina pectoris because they _______ myocardial oxygen demand by vasodilating the peripheral vasculature .
decrease
What are the two reasons patient's on digitalis (CHF medication) should be monitored?
1. digitalis can cause severe cardiac arrhythmias
2. toxic effects can occur even when blood levels are in the therapeutic range
Differentiate conventional (unfractionated) heparin from low-molecular weight heparin.
Unfractionated heparin:
-IV administration (heparin lock), requires several injections per day, and has unpredictable effects
LMWH:
-administered sub-Q, usually once/day, and is more predictable/ has a safer response
Why do doctor's debate when to begin L-DOPA treatments for patients with Parkinson's?
Patients may experience good effects from L-DOPA initially, but fluctuations in response, intolerable dyskinesias, and the eventual loss of effects can occur after 4-5 years
TRUE or FALSE: Valium was originally developed as an anti-anxiety drug but it is also used treat spasms and spasticity.
TRUE
Beta blockers can be used to treat many conditions. List 5.
1. Hypertension
2. Angina
3. Arrhythmias
4. Heart failure
5.Recovery from MI
6. Migraines
7. Situational Anxiety
8. Raynaud's