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Pharmacology > 1-8 and 9 > Flashcards

1-8 and 9 Flashcards

1
Q

True or False: TNF-a, CRP, CK-MB, Trop T/I, and BNP are all biomarkers for cardiac injury

A

True

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2
Q

How is initial cardiac dysfunction exhibited in HF/CHF?

A

Decrease in cardiac output

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3
Q

In HF/CHF, there is ultimately decreased perfusion of vessels and tissues, leading to ___deprivation and increased oxygen demand for the ____muscle (due to decreased coronary perfusion)

A

O2; heart

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4
Q

True or False: Activation of the RAAS System and Sympathetic Nervous System is an adaptive mechanism in HF/CHF

A

True

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5
Q

Eventually the compensatory mechanisms fail in CHF/HF, accompanied by ___ dysfunction

A

baroreceptor

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6
Q

In HF/CHF, increased RAAs activity results in what three effects?

A

1) Edema
2) Vascular dysfunction
3) Cardiac tissue damage

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7
Q

HF is accompanied by increased ____ and decrease ____

A

resistance; SV

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8
Q

Healthy heart muscles have HIGH adaptability to changing ____by regulating their own ___, as stated by Frank Starling

A

EDV; SV
(note: failing hearts do not follow this rule and this adaptive mechanism is lost)

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9
Q

What are the two types of CHF?

A

1) HF with reduced EF - Systolic Heart Failure
2) HF with preserved EF - Diastolic HF

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10
Q

In Heart Failure with Reduced Ejection Fraction (Systolic HF), there is impaired __ function and LCEF is ___ than 40%

A

systolic ; less than 40%

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11
Q

Which type of heart failure is associated with preserved ejection fraction and systolic function?

A

Disatolic Heart Failure (HF with preserved ejection fraction)

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12
Q

LVEF is greater than 50% in what type of HF?

A

Diastolic HF (HF w preserved EF)

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13
Q

What type of heart failure is associated with weakened pump and blood that backs up, overloading the heart

A

Systolic Heart Failure

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14
Q

Which type of heart failure is associated with thickened or stiff walls, as well as abnormal relaxation and inability to allow enough blood to fill heart prior to squeezizng?

A

Diastolic HF

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15
Q

Most common cause of acute decompensated HF?

A

LV or Diastolic Dysfunction

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16
Q

What is the compensation in acute decompensated HF? Why does it ultimately fail?

A

Compensation = increase in sympathetic activation, which results in increase in ventricular filling pressure

-Leads to leakage of fluids into lung alveoli and intersitium (congestion)

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17
Q

True or False: Acute decompensated HF is associated with rapid fluid accumulation in the lungs

A

True

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18
Q

What are two positive intotropic agents?

A

Digoxin, Lanoxin

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19
Q

___ inhibit the phosphorylated alpha subunit of the plasma membranes residing Na/K ATPase channel

A

Digoxin (and other positive introtropic agents)

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20
Q

How does Digoxin affect Na efflux via Na/K ATPase?

A

Decreases sodium efflux, increase cytosolic sodium

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21
Q

When digoxin acts, it increases cytosolic sodium, which REDUCES the requirement of Na entry through ___. As a result there is ___ retention in all cells, leading to increase in cytosolic ___, along with release of Ca2+ stores by ___, leading to myocyte contraction.

A

NCX; ca2+;ca2+;SERCA2

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22
Q

Chronic use of cardiac glycosides, like Digoxin, can result in ____ drug action. Why?

A

decreased drug action
- increased extracellular K promotes dephosphorylation of Na/K ATPase alpha subunit

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23
Q

Digoxin only has the ability to act on the ______ alpha subunit

A

phosphorylated state

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24
Q

How is digoxin typically excreted?

A

Renal route

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25
Q

What is the safe dose for digoxin maintenance therapy?

A

< 1 ng/mL

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26
Q

True or False: Digoxin has DDI with verapamil and spironolactone

A

True

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27
Q

True or False: Dopamine is an inotrope with vascular effects that acts on D1 and D2 receptors

A

True

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28
Q

How does dopamine behave at very low doses?

A

-Induces cAMP
-Vasorelaxation

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29
Q

In sympathetic neurons, dopamine acts via ___ receptors, inhibit __ release

A

D2; NE

30
Q

How does dopamine behave at moderate doses (2-5 ug/kg/min)>

A

-Directly stimulates cardiac B1 receptors
-Increase cardiac contractility
-Increases sympathetic neuronal NE release

31
Q

How does dopamine behave at higher doses?

A

-Stimulates alpha adrenergic receptors in arteries and veins
-Vasoconstriction

32
Q

Clinical indications for high dose of dopamine infusion?

A

Circulatory collapse

33
Q

Where is PDE-5 commonly found?

A

Lung

34
Q

How can revatio/viagra be used in HF?

A

-Used to treat right ventricular systolic failure (due to: pulmonary artery hypertension)

35
Q

___ is approved for short term in advanced CHF and can improve ventricular contractility and CO?

A

Inamrinone (PD3 Inhibitor)

36
Q

True or False: Inamrinone is effective as a short term inotropic

A

True

37
Q

AE for PDE3 Inhibitors (Inamrinone)?

A

Thrombocytopenia

38
Q

What drug class do Inamirone and Sildenafil belong to?

A

PDE Inhibitors (includes PDE3 and 5 Inhibitors)

39
Q

How does inhibiting PDE enzymes in HF affect cAMP levels?

A

-Raise or upregulate cellular cAMP

40
Q

True or False: PDE results in a negative intropice effect in cardiac tissue, along with increases resistance in both arteries and veins

A

False

41
Q

Clinical Benefits of PDE Inhibitors in HF?
(hint: preload/afterload)

A

Reduces preload and afterload

42
Q

___is a non-specific beta agonist that can stimulate b1 receptors in cardiac tissue, resulting in increased contractility

A

Dobutamine

43
Q

Dobutamine acts on ___ receptors on VSM, which results in ____ and ___ in vessel resistance

A

beta 2; vasodilation/decrease in vessels resistance

44
Q

True or False: Dobutamine could be used to decrease inotropic effect and cause vasodilation

A

False - while Dobutamine can be used to cause vasodilation, it will INCREASE inotropic effect

45
Q

Tolerance may develop follow 1 week of treatment with ____ due to increased PDE activity. Under those conditions ___ inhibitor addition will yield better pharmacological results.

A

Dobutamine; PDE3

46
Q

What is the major role of diuretics in HF?

A

Decrease pre-load
Decrease edema

47
Q

___: agents known to decrease ventricular filling pressure due to ability to decrease ECF volume

A

Diuretics

48
Q

True or False: Diuretics typically decrease pre-load without significantly changing CO

A

True

49
Q

What class of drugs are preferred for maintaining euvolemic state for patients suffering from hypervolemia?

A

Diuretics

50
Q

What type of doses are initially required for diuretics, when used in CHF?

A

High doses

51
Q

Since diuretics can cause hypokalemia, ___ are preferred in HF

A

K+ sparing diuretics

52
Q

True or False: Bumetamide is a Loop Diuretic

A

True

53
Q

What class of drugs are used to treat HYPERVOLEMIC patients with edema

A

Loop Diuretics

54
Q

Why are Loop Diuretics also known as high ceiling diuretics?

A

They can expel max. Na/Cl/water

55
Q

True or False: Thiazides result in loss of Na and K

A

True

56
Q

True or False: Thiazides are only recommended for combinatorial therapy in CHF

A

True

57
Q

Which drug class causes volume depletion and minimal K/Mg loss?

A

K Sparing Diuretics

58
Q

True or False: MR Antagonists protect against cardiac/renal fibrosis, ischemia, and help prevent endothelial and vascular smooth muscle contraction, as well as damage/loss of elasticity

A

True

59
Q

True or False: CHF patients have almost ___ more aldosterone in their circulation

A

20%

60
Q

MR Antagonists, such as spironolactone, can be given in CHF. However, what is the AE associated?

A

Gynecomastia
- If this happens, substitute for Eplerenone

61
Q

MR Antagonists can be used to treat CHF. However, about 2% of people develop ____. How can it be treated?

A

Hyperkalemia
-IV calcium OR glucose/insulin combination (IV)
-eventually switch to loop diuretics

62
Q

Why does Diuretic Resistance occur in CHF treatment?

A

1) Non-adherence to na/fluid restriction
2) Non-compliance w med dose
3) Compensatory increase in sodium reabsorption following na loss from body by RAAS activation (mostly seen in Loop Diuretics)

63
Q

____ and ___ are channel activating proteases (CAP1) present in tubular lumen that cleave GAMMA subunit of ENaC and activates it, resulting in enhanced reabsorption of __

A

Na
(Used if resistance to K sparing diuretics)

64
Q

The endogenous prostaglandins enhance __ via RAAS

A

renal perfusion

65
Q

Inhibition of prostaglandins (aspirin, NSAID) can decrease ____ and attenuate diuretic efficacy (there will be LESSER amount of filtrate in lumen)

A

renal perfusion

66
Q

Hydralazine is also known as

A

Bidil

67
Q

Bidil/Hydralizine is a ___

A

arterial dilator

68
Q

Organic Nitrate primarily acts as a __dilator, thus reducing both ___ and ____

A

pre and afterload

69
Q

What are two visodilators used in CHF?

A

1) Isosorbide Dinitrate
2) Hydralazine

70
Q

____, a vasodilator used in CHF, gets converted to NO using ER residing CYP450 system

A

Isosorbide Dinitrate

71
Q

____, an arterial dilator, decreases release of calcium from intracellular pools by inhibiting IP3 pathway and decreasing vascular contraction

A

Hydralazine

Pharmacology (53 decks)

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