2. Autonomic drugs - Antidyslipidemic Flashcards
1
Q
DOA acetylcholine
A
5-30 s
rapidly hydrolyzed by Ache
2
Q
used as a miotic during ocular surgery
A
acetylcholine
3
Q
used for bladder and bowel atony (post surgery or spinal cord injury)
A
betanechol
4
Q
cholinomimetic
resistant from Ache
A
betanechol
5
Q
carbachol use
A
glaucoma as a miotic
6
Q
cholinomimetic
muscarinic
act on M receptors only
A
Betanechol
7
Q
m3 selective
A
cevimeline
8
Q
used in glaucoma, Sjogren syndrome, Sicca syndrome
A
Pilocarpine, Cevimeline
9
Q
what is sjogren syndrome
A
xerostoma dry mouth
xerophthalmia dry eyes
rheumatoid arthritis
10
Q
cholinomimetic direct acting
nicotinic
A
nicotine
vaernicline
11
Q
used for smoking cessation
A
varenicline
nicotine
12
Q
side effect of varenicline and nicotine
A
generalized ganglionic stimulation : hypertension tachycardia nausea vomiting diarrhea
13
Q
overdose of nicotine and varenicline leads to
A
convulsions, paralysis and coma
14
Q
DOA
nicotine
A
1-6 hours
15
Q
varenicline
DOA
A
12- 24 hours
16
Q
nicotinic CNS toxicity
A
stimulation (convulsions) followed by CNS depression
17
Q
direct acting cholinomimetics
A
nicotine varenicline betanechol carbachol acetylcholine pilocarpine cevimeline (M3 selective)
18
Q
indirect acting cholinomimetics
A
edrophonium neostigmine pyridostigmine physostigmine ambenonium demecarium (carbamates) echothiophate malathion parathion
19
Q
DOA of malathion and parathion
A
7-30 days
20
Q
used for tensilon test (Myasthenia gravis)
A
edrophonium
21
Q
DOA of edrophonium
A
5-15 mins
22
Q
treatment of myasthenia gravis
A
neostigmine
23
Q
used to differentiate cholinergic crisis and myasthenic crisis
A
edrophonium
24
Q
DOA of edrophonium
A
5-15 mins
25
cholinomimetic
indirect acting
used for glaucoma
physostigmine
echothiopate
demecarium
26
cholinomimetic
indirect acting
with good lipid solubility
physostigmine
able to enter CNS 4-8 hour
27
longest duration
cholinomimetic
indirect acting
echothiopate
| 2-7 days
28
autoimmune destruction of nicotinic Ach receptors characterized by fluctuating muscle weakness, ocular symptoms, bulbar symtoms
proximal muscle weakness
myasthenia gravis
29
acute worsening of symptoms due to
infection
stress
UNDERmedication
myashenic crisis
30
symtoms due to excessive activation of cholinoceptors (skeletal, parasympathetic signs) due to overmedication
cholinergic crisis
31
how edrophonium differentiate Myasthenic crisis and cholinergic crisis
Improves- muscle strength in myasthenic crisis
| weakens muscle strength in cholinergic crisis
32
cholinomimetic
indirect acting
used for alzheimer’s disease
Rivastigmine
Galantamine
Donepezl
Tacrine
33
Donepezil is combined with this NMDA antagonist forAlzheimer’s dementia
Memantine
34
signs and symptoms of organophosphate poisoning
DUMBBELSS
```
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Excitation (skeletal muscle and CNS)
Lacrimation
Sweating
Salivation
```
35
this alzheimer’s disease tx has transdermal patch
Rivastigmine
36
NMDA receptor blockwee used for moderate to severe dementia
Memantine
37
Treatment of organophosphate poisoning
Atropine - cholinergic antagonists (muscarinic )
| Pralidoxime - cholinesterase regenerator
38
MOA of atropine competitively blocks
competitively blocks all muscarinic receptors
39
first choice for organophosphate posisoning
atropine
40
cholinesterase regenator , antidote
pralidoxime
41
binds phosphorus of organophosphate
| breaks down organophosphate bond with cholinesterase
pralidoxime
42
antidote for early stage cholinesterase inhibitor poisoning (organophosphate and nerve gas)
can relieve skeletal muscle and end plate block
pralidoxime
43
no effect on nicotinic signs of toxicity of organphosphates
atropine
44
pralidoxime must be administered before __ hours of organophosphate bond
6-8 hours
45
what group in pralidoxime has high affinity for phosphorus
oxime
46
prototype non selective blocker
atropine
47
cholinoceptor blockers
| muscarinic
Atropine
Homatropine
Cylopentolate
Tropicamide
Benztropine
Biperiden
Trihexyphenidyl
Ipratropium
Tiotropium
Umeclidinium
Glycorronium
Scopolamine
Dicyclomine (Hyosyamine, Glycopyrrolate)
Oxybutynin (Darifenacin, solifernacin, tolteradine , trospium, imidafenacin)
48
atropine toxicity
| signs and symptoms
```
atropine fever (hyperthermia )
atropine flush (cutaneous vasodilation)
decrease secretions
tachycardia
arrhythmias (intraventricular conduction block)
constipation
blurred vision
CNs toxicity
```
```
HOT as a hare
DRY as a bone
RED as a beet
BLIND as a bat
MAD as a hatter
```
49
```
cholinergic antagonist (muscarinic)
used for parkinson’s disease
```
Benztropine
Biperiden
Trihexyphenidyl
50
blocks muscarinic receptors in bronchial smooth muscle
| prevents vagal stimulated bronchoconstriction
ipratropium
tiotropium
umeclidinium
glycoyrrhonium
51
ipratropium use
acute asthma
| COPD
52
is the preferred bronchodilator in patients with comorbid COPD and heart disease
Ipratropium - less likely to cause tachycardia and cardiac arrhthymias
53
used for motion sickness
| decrease acid secretion, nausea, vomiting
scopolamine , transdermal patch
54
used for IBS , minor diarrhea,
| decreased acid secretion in GITY
dicyclomine
hyoscyamine
glycopyrrolate
55
```
cholinergic antagonist with SE
increased IOP
Tachycardia
confusion
urinary retention
```
Dicyclomine
56
cholinergic antagonist
| competitivelty blocks M3
Dicyclomine (Hyoscyamine, Glycopyrrolate)
57
MOA
| slightly blocks M3 receptors, reduces detrusor muscle tone
```
Oxybutynin
Darifenacin
Solifenacin
Tolteradine
Trospium
Imidafenacin
```
58
USed for urge incontinence and post operative spasms
```
Oxybutynin
Darifenacin
Solifenacin
Tolteradine
Trospium
Imidafenacin
```
59
```
cholinergic antagonist with SE
increased IOP
Tachycardia
constipation
xerostomia
```
```
Oxybutynin
Darifenacin
Solifenacin
Tolteradine
Trospium
Imidafenacin
```
60
CI to muscarinic blockers
infants (cautious use)
acute angle -closure glaucoma
benign prostatic hyperplasia
61
competitive pharmacologic antagonists at nicotinic acetylcholine receptors
ganglion blockers
62
first successful agents for tx of htn
ganglion blockers
63
ganglion blockers used to tx htn (obsolete)
| htn emergencies
hexamethonium
trimethaphan
mecamylamine
64
SE of ganglion blockers
hexamethonium
trimethaphan
mecamylamine
```
postural hypotension
dry mouth
blurred vision
constipation
sexual dysfunction
```
65
used for producing complete skeleta muscle relaxation during surgery
neuromuscular blockers
66
non depolarizing neuromuscular blockers
tubocurarine
pancuronium
atracurium
vecuronium
67
depolarizing neuromuscular blockers
succinylcholine
68
primary neurotransmitter at sympathetic postganglionic neuron effector cell synapses in most tissues
norepinephrine
69
effect of dopamine on renal blood vessels
vasodilation
70
effect of norepinephrine on renal blood vessels
vasoconstriction
71
amino acid precursor of NE
tyrosine
72
synthesis of DOPA from tyrosine is inhibited by
metyrosine
73
synthesis of NE
tyrosine- hydroxylated by tyrosine hydroxylase to DOPA
DOPA is decarboxylated to dopamine
Dopamine is hydroxylated to NE
74
storage of NE and dopamine is inhibited by
| ___ through inactivation
monoamine oxidase (cytoplasm)
75
promote increased stores of NE and dopamine
MAOIs
76
NE and Dopamine transport is inhibited by
reserpine
77
release of NE and dopamine from vesicles is inhibited by
guanethidine
78
release of NE and dopamine from vesicles is promoted by
amphetamines
| tyramine
79
proteins involved in release of NE and dopamine
SNARE proteins (VAMPs and SNAPs)
80
diffusion and reuptake of NE via ____
NET and DAT in synaptic cleft
81
reuptake of NE is inhibited by
cocaine and TCAs
82
which substances are responsible for metabolism of NE
MAO and COMT
| NE-> metanephrines and VMA
83
metabolism of NE is inhibited by
MAOi and COMTi
84
cholinergic inhibitor : synthesis
hemicholinium
85
cholinergic inhibitor : storage
vesamicol
86
cholinergic inhibitor : release
botulinum
87
adrenergic inhibitor : synthesis
metyrosine
88
adrenergic inhibitor : storage
reserpine
89
adrenergic inhibitor : release
guanethidine
90
adrenergic inhibitor : metabolism
will prevent metabolism of NE
MAOIs , COMIs
91
cholinergic inhibitor : metabolism
neostigmine
92
inhibit reuptake of NE
cocaine and TCAs
93
G protein and effectors of alpha 1
| 2nd mess
Gq : phospholipase C
| 2nd mess :inc IP3 , DAG
94
G protein and effectors of alpha 2
| 2nd mess
Gi : adenylyl cyclase
calcium channels
potassium cannels
2nd mess: dec cAMP
95
G protein and effectors of beta
2nd mes
Gs : adenylyl cyclase
calcium channels
2nd mess: inc. cAMP
96
receptor of JG apparatus
Beta 1
97
receptor of adipose cels
beta 3 - inc. lipolysis
| alpha 2- inhibit lipolysis
98
receptor in platelets
alpha 2 - stimulates aggregation
99
liver receptor in rats
alpha 1 - glycogenolysis
100
receptor in pupils
| mydriasis
alpha 1
101
erects pilomotor smooth muscle
| receptor
alpha 1
102
most vascular smooth muscle - contraction
| receptor
alpha 1
103
increase heart rate and force
| receptor
beta 1
104
increase renin release
beta 1
105
airways, uterine, vascular smooth muscle - relax
receptor
beta 2
106
liver (human) glycogenolysis
beta 2
107
stimulates insulin release - liver
| receptor
beta 2
108
adrenergic receptor causes tremors in somatic motor neuron terminals (voluntary muscles)
beta 2
109
dopamine receptors promote ___ in renal and other splanchnic blood vessels
dilates (dec. resistance)
110
D2 adrenergic effects in nerve terminals
inhibits adenylyl cyclase
111
epinephrine effects on fetus
can cross placenta
| mayc cause fetal anoxia
112
non selective adrenergic agonists
epinephrine ( alpha 1, beta )
norepinephrine ( alpha 1, beta )
dopamine (alpha 1, beta 1, D1)
isoproterenol (B1, B2)
113
DOC for anaphylaxis
epinephrine
114
used for cardiac arrest, anaphylaxis, asthma , COPD , hemostasis
epinephrine
115
used for neurogenic shick, cardiogenic shock (last resort)
norpinephrine
116
used for heart failure and cardiogenic shock
dopamine
117
this adrenergic agonist drug is very effective in renal failure associated with shock
dopamine
118
dose of dopamine for vasodilation in splanchnic and renal vascular beds via D1
low dose (1-5 mcg/kg/min)
119
dose of dopamine for inc. renal blood flow, HR, cardiac output via B1
medium dose (5-15 mcg/kg/min)
120
dose of dopamine for vasoconstriction and inc blood pressure via alpha
high dose (>15 mcg/ kg / min)
121
sympathomimetic beta nonselective
isoproterenol
122
uses of isoproterenol
asthma
123
selective alpha 1 agonists
```
Phenylephrine
Pseudoephedrine
Oxymetazoline
Tetrahydrozoline
Midodrine
Naphazoline
Xylometazoline
```
alpha 1 -> vasoconstriction, inc bp
124
uses of selective alpha 1 (phenylephrine)
```
nasal decongestant
mydriatic
drug induced hypotension
orthostatic hypotension
spinal shock
```
125
this will cause mydriasis without cycloplegia (loss of accomodation)
alpha 1 agonists like phenylephine
126
DOC for alpha 1 agonist overdose
phentolamine
127
pseudoephedrine
| 1st trimester risk
gastroschisis
128
selective alpha 2 agonists
clonidine
```
methyldopa
guanfacine
guanabenz
dexmedetomidine
tizanidine
```
apraclonidine
129
clonidine is indicated for
hypertension
cancer pain
opioid withdrawal
130
alpha 2 agonists effects
decreases central sympathetic outflow
131
clonidine side effects
sedation , rebound hypertension
| dry mouth
132
how to avoid rebound hypertension with cloniidine
taper use prior to discontinuation
133
rebound hypertension when discontinuing clonidine
| tx
phentolamine
134
```
methyldopa
guanfacine
guanabenz
dexmedetomidine
tizanidine
```
is used for
pre-eclampsia
gestational hypertension
sedative (dexmedetomidine)
muscle relaxant (tizanidine)
135
side effects of
```
methyldopa
guanfacine
guanabenz
dexmedetomidine
tizanidine
```
```
sedation
hemolytic anemia (positive coomb’s test)
```
136
alpha 2 selective drug used for glaucoma
apraclonidine
137
selective beta 1 agonists
dobutamine - inc HR and contratilty
138
dobutamine is used for
acute heart failure
| cardiogenic shock
139
has SE of hypertension, arrhythmias , eosinophilic myocarditis, premature ventricular beats, angina, dyspnea, fever, headache, nausea
dobutamine
140
maybe used in cardiac stress testing
dobutamine
141
selective beta 2 agonists
albuterol/salbutamol
terbutaline
ritodrine
isoxuprine
142
DOC for acute asthma attacks
salbutamol
143
used for tocolysis for preterm labor
| beta agonists
terbutaline
ritodrine
isoxuprine
144
used as a vasodiltor in Raynaud’s phenomenon
isoxuprine
145
side effecrt of isoxuprine
| in mothers
pulmonary edema
146
selective beta 2 agonists my precipitate arrythmia in patients with
concurrent COPD and heart diseasem
147
sympathomimetic of choice :
acute heart failure
septic shock
B1 and D1 agonist- to increase cardiac output
148
sympathomimetic of choice :
| hypertension
alpha 2 agonist- decrease bp
149
sympathomimetic of choice :
| glaucoma
alpha 2 agonist
150
sympathomimetic of choice :
hemostasis
decongestion
spinal shock
alpha 1 agonist
151
sympathomimetic of choice :
bronchospasm
premature labor
beta 2 agonist
152
used mainly as a nasal vasoconstrictor and an appetite suppresant
phenylpropanolamine
153
phenylpropanolamine is used with caution because it may cause
hemorrhagic stroke esp among women
154
non selective alpha blockers
phenoxybenzamine
phentolamine
tolazoline
155
irreversible blocks alpha adrenergic (alpha 1> alpha 2)
`phenoxybenzamine
156
indication of phenoxybenzamine
pheochromocytoma (pre -surgical)
157
reversibly blocks all alpha adrenergic receptors
phentolamine , tolazoline
| alpha 1 more than alpha 2 block
158
uses of phentolamine , tolazoline
pheochrmocytoma (pre surgical)
antidote to agonist ovedose
rebound hypertension
159
selective alpha 1 antagonist
```
prazosin
doxazosin
terazosin
tamsulosin
silodosin
alfuzosin
`
```
160
selective alpha 1 antagonist
| uses
BPH
| hypertension
161
most selective drug for prostatic smooth muscle
tamsulosin
162
what is the pharmacologic advantage of alpha 1 selectivity
reflex tachycardia is less common and less severe
163
is isoproterenol a beta blocker
NO
non selective beta agonist
I sorry! kala ko beta blocker
164
non selective beta blockers
```
pindolol
timolol
labetalol
carvedilol
nadolol
levobunolol
metipranolol
carteolol
```
165
beta blocker effects on renin
reduce renin release
166
Indications of nonselective beta blockers
```
angina prophylaxis
Hypertension
Arrhythmias,
Migraine
Performance anxiety
Hyperthyroidism
Glaucoma
```
167
side effects of non selective beta blockers
```
bronchospasm
AV block
Heart failure
CNS sedation
erectile dysfunction
```
168
non selective beta blocks masks symptoms of ____ in diabetes
hypoglycemia
169
these non selective beta blockers can be used in pheochromocytoma
carvedilol and
labetalol
because of combined alpha and beta blockade
170
propranolol effects on fetus
IUGR
small placenta
congenital abnormalities
171
non selective beta blocker used for glaucoma
metipranolol
172
symptoms of hypoglycemia form insulin overdosage that can be masked by beta blockers
tachycardiac
tremor
anxiety
173
beta blockers in diabetic patients
mask hypoglycemia
| impaired hepatic mobilization
174
beta blockers with intrinsic sympathomimetic activity (partial agonist activity)
```
acebutolol
pindolol
carteolol
bopindolol
oxyprenolol
celiprolol
penbutolol
```
175
disadvantage of using beta blockers topically in the eye
increases risk of corneal ulceration via local anesthetic activity
176
beta blockers - increases risk of corneal ulceration via local anesthetic activity except which beta blockers
timolol and betaxolol
177
timolol and betaxolol
| indication
glaucoma
178
this beta blocker has the longest half life
nadolol
| Nasa DOLO
179
beta blocker
| shortest half life
esmolol
180
carvedilol on pregnancy
C - 2nd tri
| D- 3rd tri
181
esmolol in pregnancy
C - 2nd tri
| D- 3rd tri
182
selective B1 blockers
```
betaxolol
esmolol
acebutolol
metoprolol
alprenolol
nebivolol
bisoprolol
```
atenolol
183
indication of selective b1 blockers
angina
hypertension
heart failure
184
indication of esmolol
supraventricular tachycardia
185
selective b1 antagonist used for glaucoma
betaxolol
186
using atenololduring pregnancy
lower birthweight
| impair fetal growth
187
ANS which controls pupillary dilator muscle
SANS
188
ANS which controls pupillary constrictor
PANS
189
this muscle controls accomodation
ciliar muscle
190
ciliary is primarily controlled by this ANS
PANS
191
flow of aqueous humor
ciliary body -> posterior chamber -> anterior chamber angle -> pupil ->trabecular meshwork -> canal of schlenmm -> uveoscleral veins
192
treatment of glaucoma
| MOA: decreased secretion of aqueous humor from ciliary epithelium
beta blockers- timolol
osmotic agents - mannitol
alpha 2 agonists - apraclonidine
carbonic anhydrase inhibitors - acetazolamide, dorzolamide
193
treatment of glaucoma
| MOA:ciliary muscle contractin, opening of trabecular meshwork, increased outflow `
cholinomimetics - pilocarpine, physostigmne
194
treatment of glaucoma
| MOA: increased outflow through canal of schlemm
latanofrost - prostaglandins
195
treatment of glaucoma
| MOA: inc outflow via uveoscleral veins
nonselective alpha agonists - epinephrine
196
JNC 7 blood pressure goals
no comorb: <140/90
diabetes mellitus : <130/80
chronic kidney disease : <130/80
197
Antihypertensive agents for pregnant women
```
methyldopa
lobetalol
nifedipine
oral hydralazine
nifedipine - later pregnancy
```
198
DOC for htn in pregnant women
methydopa - does not alter maternal CO or blood flow to the kidneys or uterus
199
has been shown to be effective in pre-eclampic or non proteinuric hypertension in pregnancy
labetalol
200
can be used as monotherapy or add on to methyldopa in chronic hypertension in pregnancy
oral hydralazine
201
best studied oral CCBs for pregnant women
nifedipine
202
important SE with hydralazine
reflex tachycardia
203
antihypertensives CI during pregnancy
ACEI
ARBS
Diuretics - reduce maternal plasma voume, electrolyte disturbance
204
Thiazide diuretics
Hydrochlorothiazide
Chlorthalidone
Indapamide
Metolazone
205
Loop diuretic
Furosemide
Bumetanide
Torsemide
Ethacrynic acid
206
MOA of thiazide diuretics
inhibit Na/Cl transporter in DCT
reduced excretion of calcium
moderate diuresis
207
indication of thiazide diuretics
```
hypertension
heart failure
hypercalciuria
renal calcium stones
Nephrogenic diabetes insipidus
```
208
SE of thiazide diuretics
```
hypokalemic metabolic alkalosis
dilutional hyponaremia
K wasting
hyperglycemia
hyperlipidemia
hyperuricemia
hypercalcemia
sulfa allergy
```
209
this thiazide may appear in cor blood, crosses placenta, may cause hypokalemia, hyponatremia, hyopoglycemia, jaundice, thrombocytopenia
metolazone
210
Loop diuretic MOA
inhibit Na/K / 2Cl transporter in thick ascending limb of loop of Henle
211
Indication of loop diuretics
```
heart failure
pulmonary edema
hypertension
hypercalcemia
acute renal failure
anion overdose
```
212
side effects of loop diuretics
```
Hypokalemic metabolic alkalosis
Potassium wasting
dehydration
ototoxicity
sulfa allergy
```
nephritis
hyperuricemia
hypomagnesemia
hypocalcemia
213
decrease venous return , dec HR, dec contraction, dec CO, dec TPR
sympathoplegic
214
CNS sympathetic outflow blocker
clonidine
| methyldopa
215
MOA clonidine, methyldopa
activates alpha 2 adrenergic receptors -> dec central sympathetic outflow
216
indication of methyldopa
pre-eclampsia
217
this autonomic drug has positive coomb’s test
Methyldopa (hemolytic anemia )
218
ganglion blockers
| sympathoplegic
hexamethonium
trimethaphan
mecamylamine
219
nerve terminal blockers
| sympathoplegic
reserpine
guanethidine
guanadrel
220
irreversibly blocks the vesicular monoamine transporter (VMAT)
reserpine
221
side effect of reserpine
sedation
severe psychiatric depression
suicidal ideation
222
MOA inhibit vesicular release of NE from presynaptic neuron
guanethidine
| guanadrel
223
first dose SE of prazosin
orthostatic hypotension
224
drug induced lupus
Hydralazine
isoniazid
procainamide
penicillamine
225
Older oral vasodilators
Hydralazine
Minoxidil
Diazoxide
226
MOA : alters intracellular ca metabolism
relax arteriolar smooth muscle -> vasodilation
dec afterload
hydralazine
227
for heart failure
| Hydralazine is combined with
ISDN
this combo is more effective than ACEi in blacks
228
Uss of hydralazone `
Htn
HF
Pre-eclampsia
229
MOA - opens K channels in vasc smooth muscle causing HYPERPOLARIZATION ->vasodilation
diazoxide
| minoxidil
230
uses of minoxidil
htn
| alopecia
231
SE of minoxidil, diazoxide
```
Edema
reflex tachy
angina
pericarditis
pulmonary htn
hypertrichosis
hirsutism
salt and water retention
```
232
how does minoxidil cause excessive hair growth
simulation of hair follicles in telogen phase to diff into growth follicles (anagen phase)
233
calcium channel blockers
verapamil
diltiazem
```
nifedipine
amlodipine
felodipine
nicardipine
nisoldifine
clevdipine
isradipine
levamlodipine
lacidipine
lercanidipine
```
234
block voltage gated L type CA channels (Cardiac > vascular)
verapamil
| diltiazem
235
block voltage gated L type CA channels (vascular > cardiac)
Dihydropiridine calcium channel blocker
| Nifedipine
236
indications of verapamil and diltiaze
angina
htn
SVT
Migraine
237
side effects of verapamil
```
constipation
pretibial edema
nausea
flushing
dizziness
gingival hyperplasia
heart failure
AV block
sinus node depression
```
238
indications of nefedipine
angina
| htn
239
SE of nidefipine
```
constipation
pretibial edema
nausea
flushing
dizziness
```
240
Parenteral vasodilators
Nitroprusside
| Fenoldopam
241
MOA : relaxes VENOUS and arteriolar smooth muscle by Increasing Nitric oxide -> Inc cGMP -> vasodilation
nitroprusside
242
MOA: causes arteriolar vasodilation of the afferent and efferent arterioles -> inc renal blood flow
fenoldopam
243
use of nitroprusside
hypertensive emergency
acute heart failure
cardiogenic shock
controlled hypotension
244
uses of fenoldopam
hypertensive emergency
245
side effects of nitroprusside
hypotension
headache
cyanide toxicity
246
side effects of fenoldopam
hypotension
| hypokalemia
247
DOA fenoldopam
10 mins
248
nitroprusside is given as
continuous infussion
249
captopril in pregnancy
C,D in 2nd and 3rd
250
Ace inhibitors
```
enalapril
captopril
benazepril
fosinopril
lisinopril
quinapril
ramipril
transdolapril
moexipril
peridopril
imidapril
```
251
MOA of ACEI
Inhibits ACE
formation Angiotensin II
Dec aldosterone secretion
252
Uses of ACEI
Hypertension
Heart failure
Post myocardial infarction
Diabetic nephropathy
253
SE of captopril (ACEI)
```
cough
taste disturbance
Angioedema
Hypotension
Teratogen
HYPERKALEMIA
```
254
Captopril in heart failure
slows ventricular remodeling and
| inc survival in heart failure
255
captopril in diabetes
delays progression of diabetic nephropathy
dec albumin excretion and slow progression from micro - macroalbuminuria
renoprotective effect
256
effects of captopril in fetus
reduce renal function -> inc fetal and neonatal morbidity and death
```
fetal hypotension
neonatal skull hypoplasia
anuria
heart failure
renal dysplasia
```
257
captopril effects on the kidneys
| why CI in ren artery stenosis
dec GFR in px with renal artery stenosis bec of dilation of efferent arterioles
258
MOA : blocks angiontensin (A1)receptors in vascular smooth muscle and adrenal cortex; dec aldosterone secretion
```
losartan
candesartan
valsartan
irbesartan
eprosartan
telmisartan
azilsartan
olmesartan
```
259
Uses of losartan (ARBS)
Htn
HF
diabetic nephropathy
260
ARBS in HF
slows ventricular remodeling and
| inc survival in heart failure
261
ARBS in diabetic nephropathy
delays progression
262
Why ACEI and ARBS produce hyperkalemia
reduced aldosterone levels -> potassium retention
263
renin antagonist
aliskiren
264
aliskiren MOA
inhibits renin
| prevents conversion of angiotensinogen to angiotensin I
265
SE of ARBS
```
Hypotension
teratogen
hyperkalemia
hypoglycemia
anemia
diarrhea
```
266
SE of aliskiren
```
headache
diarrhea
cough
rash
hyperkalemia
inc in serum creatinine
renal impairment
angioedema
```
267
accelerated form of severe hypertension associated with rising BP and rapidly progressing end organ damage
malignant hypertension
268
management of malignant hypertension
powerful vasodilators (nitroprusside, fenoldopam)
diuretics (furosemide )
beta blockers to lower BP to 140-160/90-110
269
3 types of angina pectors
atherosclerotic
vasospastic
unstable angina
270
angina of effort or classic angina
atherosclerotic angina
271
constitutes 90% of angina cases
Atherosclerotic angina
272
other name for vasospastic angina
rest angina
variant angina
Prinzmetal’s angina
273
cresqcendo angina
Unstable angina
274
Unstable angina result from
atherosclerotic plagues, platelet aggregation
| vasospasm
275
angina
| immediate precursor of MI
unstable angina
276
2 therapeutic goals in angina
inc oxygen delivery
| reducing oxygen requirement
277
Drugs for tx of angina
```
I. Vasodilators
a. nitrates - amyl nitrite, nitroglycerin
II. CCB
III. Beta blockers
IV. Metabolism modifiers -
a. trimetazidine
b. ranolazine
c. ivabradine
```
278
uses of amyl nitrite
cyanide poisoning
279
SE from amyl nitrite
Relex tachcyardia
Orthostatic hypotension
Headache
Methhemoglobinemia
280
Which portion of the electron transport chain is affected by CYANIDE?
Complex IV (cytochrome oxidase) - of the electron transport chain
281
Monday disease is due to
due to occupational exposure to nitrates
282
Uses of nitroglycerin
angina
| acute coronary syndromes
283
Nitroglycerin poses dangerous hypotension with ___
PDE inhibitors (Sildernafil)
284
SE of nitroglycerin
```
reflex tachycardia
orthostatic hypotension
Headache
tolerance (transdermal)
dec platelet aggregation
```
285
Why patients taking nitrate usually experience throbbing headache
due to meningeal vessel vasodilation
286
this CCB is used for raynaud’s phenomenon
Diltiazem
287
CCB used for SVT
verapamil
| diltiazem
288
this ccb enters breast milk
diltiazem
289
what drugs can cause gingival hyperplasia
Nifedipine
Cyclosporine
Phenytoin
Verapamil
NapaCa Pangit ng giginVa mo
290
metabolism modifiers
trimetazidine (cytoprotective agent)
ranolazine
ivabradine
291
MOA : inhibit beta oxidartion of FA by inhibiting 3-ketoacyl thiolase which enhances glucose oxidation.
prevent dec in ATP in ischemic and hypoxic state
Trimetazidine
292
uses of trimetazidine
angina pectoris
tinnitus
dizziness
293
SE Trimetazidine
EPS
gait instability
restless leg syndrome
294
reduces a late prolonged Na current in myocardial cells -> dec intracelular Na -> inc calcium expulson via Na- Ca exchanger -> dec intracellular Ca
-> dec cardiac force and work
may modify FA oxidation
Ranolazine
295
inhibits Na current in NA node , dec hyperpolarization -> induces inward pacemaker current -> dec hr and cardiac work
ivabradine
296
fundamental physiologic defect in Congestive heart failure
dec in cardiac output
297
CHF frequently associated with
chronic hypertension
valvular disease
coronary artery disease
cardiomyopathies
298
therapeutic strategies for CHF
removal of retained salt and water with diuretics
reduction of afterload , salt and water retention by means of ACE inhibitors
reduction of excessive sympathetic stimulation by means of beta blockers
reduction of preload and afterlad with vasodilators
direct augmentation of depressed cardiac contractility with positive inotropic drugs
299
acute heart failure management
tx with loop diuretic
very severe- prompt -acting positive inotropes (beta agonists or PDE inhibitors) and vasodilators
300
chronic heart failure treatment
tx with diuretics + ACE inhibitor
if tolerated + beta blocker
if systolic dysfunction is prominent - use digitalis
301
Heart failure which presents with
orthopnea
PND
pulmonary congestion
left- sided heart failure
302
HF which presents with hepatomegaly
edema
engorged neck veins
right sided heart failure
303
cardiac glycoside MOA
inhibits Na/K ATPase
inc intracellular calcium
icn cardiac contractility
304
uses of digitoxin
heart failure
| nodal arrhythmias
305
digitoxin
| se
```
narrow therapeutic index
arrhythmias
vomiting
diarrhea
visual changes
```
306
reduces clearance when combined with digoxin
```
quinidine
amiodarone
cyclosporine
diltiazem
verapamil
```
307
digoxin
| inc arrthymogenesis with
hypokalemia
hypomagnesemia
hypercalcemia
loop diuretics and thiazides -> hypokalemia
digitalis induced vomiting -> deplete serum magnesium
308
drugs with narrow therapeutic index
```
warfarin
aminoglycosides
lithium
amphotericin B
Carbamazepine
phenobarbital
phenytoin
vancomycin
theophylline
digoxin
```
WALA na Cyang Papa, VasTeD na
309
DOC for digitalis toxicity
| antiarrhythmic DOC
lidocaine
310
severe cases of digitals toxicity might required
electronic pacemaker
311
tx of digitalis toxicity
correction of potassium/ magnesium deficiency
lidocaine
digoxin antibodies - Fab fragments
312
first line therapy for both systolic and diastolic failure
diuretics
313
for immediate reduction of pulmonary congestion and severe edema associated with acute heart failure
diuretics
314
this diuretics have significant long term benefits and can reduce mortality in chronic failure
spironolactone
| eplerenone
315
first line drugs for chronic heart failure
Angiotensin antagonists
316
dec ventricular remodeling
reduce mortality and morbidity in chronic HF
first line for chronic heart failure
angiotensin antagonists
317
Beta 1 selective sympathomimetics
dobutamine and dopamine
role in HF
useful in acute
| not for chronic - bec of tolerance, lack of oral efficacy, and arryhthmogenic effects
318
reduce progression of chronic heart failure
not used in acute HF
```
carvedilol
labetalol
bisoprolol
nebivolol
metoprolol
```
detrimental to acute HF if systolic dysfunction is marked
319
phosphodiesterase inhibitors
inamrinone
| milnirone
320
vasodilators nitroprusside or nitroglycerin is indicated for this HF
acute severe failure with congestion
321
these drugs have been shown to improve survival in cases of heart failure
ABA Buhay ka pa
ACE inhibitors
Beta blockers
Aldosterone antagonists
322
MOA of phosphodiesterase inhibitors
inhibition of breakdown of phosphodiesterase -> inc cAMP-> increase intracellular calcium -> vasodilation
323
this combinatio of drugs for HF have been shown to reduce mortality in african americans
hydralazine and ISDN
324
calcium channel blockers in CHF
no value
325
BNP analog that may be used for acute decompensated failure , no shown reduction in mortality
nesiritide
326
this drug will inhibit neprilysin
neprilysin ->degrades atrial and natriuretic peptide (bp lowering) and bradykinin (inflammation, vasodilation)
sacubitril
combined with valsartan for HF
327
arrhythmogenic mechanisms
abnormal automaticity
| abnormal conduction
328
torsades de pointes is often inducewd by
antiarrhythmics and other drugs that change the shape of action potential and prolong QT interval
329
torsades de pointes is associated with this disease
long QT syndrome
330
what proteins are mutated with long QT syndrome
Ik and Ina channel proteins
331
classification of the antiarrhythmics which subdivides the drugs on the basis of their activity on the myocardial action potential.
Singh- Vaughan Williams Classification
332
Singh- Vaughan Williams Classification
Class 1 Sodium channel blockers
Class 2 beta adrenoceptor blockers
Class 3 Potassium channel blockers
Class 4 Calcium channel blockers
333
what are effects of class I antiarrthymics on Action potential duration
Class IA : prolong
Class IB: shorten
Class IC: No effect
334
local effect of class I antiarrhythmic
local anesthetic
335
Class I antiarrhythmics act on this phase of cardiac AP
phase 0
336
most selective agents of class I antiarrhythmics
Group IB
337
amiodarone has this antiarrhythmic activity
class IA
338
Class IA antiarrhythmics
Procainamide
Disopyramide
Quinidine
I am the Queen who proclaimed Diso’s pyramid
339
this class I antiarrhythmic has SE of lupus like syndrome
procainamide
340
this class I antiarrhythmic has SE of antimuscarinic effects, HF
disopyramide
341
```
this class I antiarrhythmic has SE of torsades,
cinchonism (headache, vertigo, tinnitus)
Autoimmune rxn (ITP)
```
Quinidine
342
```
class IA this class I antiarrhythmic
reduce clearance of digoxin
```
quiniine
343
```
class IA antiarrhythmic
used for malaria
```
quinidine
344
cinchonism is
headache
vertigo
tinnitus
345
tx of class IA overdose
sodium lactate
346
this class of antiarrhythmic have little effect on ECG
Class IB
347
MOA of Group IB antiarrhythmic
reduces AP duration
prolongs ERP
blocking k channels
348
Class IB antiarrhythmic
Lidocaine
mexiletine
tocainide
Phenytoin
349
use and state dependent block of sodium channel, some block of potassium channels
Class I antiarrhythmic
350
antiarrhythmic with SE of agranulocytosis
tocainide
351
DOC for ventricular antiarrhythmia post MI
used for digoxin -induced arrthymias
Lidocaine
mexiletine
tocainide
Phenytoin
352
is the least cardiotoxic among conventional antiarrhythmic
lidocaine
353
phenytoin teratogenic effects
orofacial clefts
cardiac defects
fetal hydantoin syndrome
354
this class of antiarrhythmic is best post MI
class IB
355
what are the drugs that can cause agranulocytosis
clozapine
cotrimoxazole
colchicine
aminopyrine
```
phenylbutazokne
PTU
Indomethacin
Tocainide
Methimazole
```
CCCAPPIT Mel
356
powerful depressants of sodium current
slow conduction velocity in atrial and ventricular cells
slowed pacemaker activity
ECG efefct inc QRS duration
Class IC antiarrhythmic
357
Class IC antiarrhythmic
Flecainide
Propafenone
Encainide
Moricizine
Chicken ay Pagkain For Enrico
358
this class of antiarrhythmic is contraindicated post MI
class IC
359
for all types of arrhymias
Class IA
360
for acute ventricular arrhymias, esp post MI
class IB
361
refractory arrthymias
Class IC
362
arrthymias in acute phase of myocardial infarction
class IA
363
indicated for WPW syndrome
amiodarone
| procainamide
364
Class 2 antiarrhythmic
| MOA
cardiac beta adrenoreceptor blockade and reduction in cAMP -> dec both Na and calcium current
-> suppression of abnormal pacemakers
365
this node is particularly sensitive to class 2 antiarrhythmics
AV node
366
```
class 2 antiarrhythmic
act on this cardiac phase
```
phase 4
367
Class 2 antiarrhythmic
propranolol
metoprolol
timolol
esmolol
368
effect of class 2 antiarrhythmic on ECG
PR is prolonged
369
```
uses of propranolol
as class 2 antiarrhythmic
```
post MI prophylaxis against sudden death
| thyrotoxicosis
370
```
uses of esmolol as
class 2 antiarrhythmic
```
acute perioperative and thyrotoxic antiarrhythmias
| SVT
371
this beta blocker antiarrhythmic has class 3 properties
sotalol
372
these beta blockers are concentrated in breats milk
metoprolol and timolol
373
Class 3 antiarrhythmic
| act on this phase
phase 3
374
morphology in ECG of class 3 Class 3 antiarrhythmic
inc in QT interval
375
MOA class 3 Class 3 antiarrhythmic
prolong AP duration
blockade of Ik potassium channels -> repolarization of AP
-> Inc ERP and reduces ability of the heart to respond to rapid tachycardias
376
Class 3 antiarrhythmic
dofetilide
ibutilide
sotalol
amiodarone
377
indication of dofetilide
| ibutilide
tx and prophylaxis of atrial fibrillation
378
SE of dofetilide
| ibutilide
torsades de pointes
379
sotalol MOA
potassium channel block
| beta adrenoreceptor block
380
indication sotalol
ventricular arrhythmias
atrial fibrillation
SVT
381
SE of sotalol
dose related torsade de pointes
| excessive beta blockade (sinus bradycardia , asthma)
382
indication of amiodarone
refractory arrthymia
383
SE amiodarone
```
microcrystalline deposits in cornea and skin
thyroid dysfunction (hyper or hypo)
paresthesias
tremor
pulmonary fibrosis
```
384
most efficacious of all antiarrhythmic drugs
amiodarone
385
longest t 1/2
| antiarrhythmic drug
amidarone
386
fetal effects of amiodarone
```
cardiac,
thyroid
neurodevelopmental
neurological
growth defects
```
387
ECG morphology of class 4 antiarrhythmic
PR interval is consistently increased
388
why dihydropyridines are not effective antiarrhythmic drugs
evoke compensatory sympathetic discharge -> facilitates arrhytmia
389
this CCB must be avoided in ventricular tachycardia
diltiazem
390
DOC for paroxysmal supraventricular tachycardia
adenosine
391
indications of adenosine
AV nodal arrhythmias
| DOC for paroxysmal supraventricular tachycardias
392
SE of adenosine
Flushing
hypotension
transient chest pain
dyspnea
393
this electrolye must be normalized in tx of arrhythmias
```
serum K (hypokalemia - associated with arrhythmias;
excessive potassium depress conduction - cause reentr arrhythmias )
```
394
electrolytes which depress pacemaker
potassium
| magnesium
395
site of action of carbonic anhydrase inhibitors
proximal convoluted tubule
396
60-70% iof NaCl and NaHCO3 reabsorption
| site of uric acid transport
PCT
397
Carbonic anhydrase inhibitors
```
Acetazolamide
Dorzolamide
Brinzolamide
Dichlorphenamide
Methazolamide
```
398
MOA of carbonic anhydrase inhibitor
Inhibits carbonic anhydrase in PCT
Glaucoma: secretion of aq humour is reduced
mountain sickness : metabolic acidosis inc respiration
399
indications of carbonic anhydrase inh
glaucoma
mountain sickness
edema with alkalosis
400
SE of carbonic anh inh
| acetazolamide
```
drowsiness
paresthesias
sulfa allergy
renal calcium stones
K wasting
hyperchloremic metabolic acidosis
hepatic encephalopathy in cirrhotic patients
```
401
what are the causes of non anion gap metabolic acidosis
MUDPILES
```
Methanol
Uremia
DKA
Paraldehyde
Isoniazid, Iron
Lactic Acid
Ethanol
Ethylene glycol
Salicylates
```
```
HARDUP
Hyperalimentation
Acetazolamide
RTA
Diarrhea
Ureteral diversion
PAncreatic fistula
```
402
Acetazolamide causes
a. alkalosis
b. acidosis
acidosis = acidazolamide
403
SE of loop diuretics
```
hear failure
pulmoary edema
htn
hypercalemia
acute renal failure
anion overdose
```
404
SE of loop diuretis
```
Hypokalemic metabolic alkalosis
K wasting
dehydration
ototoxicity
sulfa allergy
hyperuricemia
hypocalcemia
hypomagnesemia
nephritis
```
405
ths produces synergistic ototoxicity with aminoglycosides
Loop diuretics
406
loop diuretic toxicitie
```
OH DANG
Ototoxicity
Hypokalemia
Dehydration
Allergy to sulfa
nephritis
Gout
```
407
diuresis with acetazolamide is self limiting after ___ days
2-3 days
408
site of action of thiazide diuretics
DCT
409
carrier at DCT
Na/Cl carrier
410
responsible for 5-8% sodium reabsorption
DCT
411
calcium is reabsorbed in DCT segment under the control of
PTH
412
Thiazide diuretics side efects
```
HYPER GLUC
Hyperglycemia
Hyper lipidemia
Hyperuricemia
hypercalcemia
```
```
Hypokalemic metabolic alkalosis
dilutional hyponatremia
K wasting
HyperGLUC
Sulfa allergy
```
413
last tubular site of sodium reabsorption
cortical collecting duct
414
responsible for reabsorbing 2-5% of total filtered Na
CCT
415
site of action of K sparing diuretics
CCT
416
primary site of acidification of urine
CCT
417
last site of potassium excretion
CCT
418
K sparing diuretics
Spironololactone
Eplerenone
Amiloride
Triamterene
419
aldosterone antagonist
| K sparing diuretic
Eplerenone
| Spironolactone
420
this diuretic reduces progression of DM nephropahty and reduces mortality post MI
eplerenone
421
steroid inhibitors of cytoplasmic aldosterone receptor in CCT
eplerenone
| spironolactone
422
uses of spironolactone
hypokalemia
Hperaldosteronism
Htn
HF
423
SE spironolactone , eplerenone
Hyperkalemia , gynecomastia (spironolactone only)
impotence
BPH
Hyperchloremic metabolic acidosis
424
triamterene, amiloride should never be given with ___
K supplements
425
inhibitor of ENaC epithelial sodium channels in CCT
reduces Na reabsorption and K excretion
amiloride
| triamterene
426
drugs which cause gynecomastia
```
Some Drugs Create Awesome Knockers
Spironolactone
Digoxin
Cimetidine
Alcohol
Ketoconazole
```
427
MOA of osmotic diuretics
remains in the lumen and holds water by virtue of its osmotic effect
reabsorption of water is reduced in the proximal tubule, descending limb of the loop of Henle and collecting tubule
428
osmotic diuretics
glycerin
isosorbide
urea
429
indications of osmotic diuretics
rhamdomyolysis
hemolysis
increased intracranial pressure
acute glaucoma
430
medullary collecting duct occurs under the control of
antidiuretic hormone (ADH)
431
ADH agonist
vasopressin
desmopressin
terlipressin
432
site of action of ADH agonists and antagonists
Medullary Collecting Duct
433
uses of vasopressin
central diabetes insipidus
nocturnal enuresis
hemophilia
von willebrand disease
434
MOA of vasopressin
ADH agonist at V1 and V2 ADH receptors
Activate insertion of aquaporin water channels in collecting tubule
Vasoconstriction - increases pressure in arterioles - Inc BP
435
Side effects of vasopressin
hyponatremia
| hypertension
436
indications of vasopressin
central diabetes insipidus
nocturnal enuresis
mild hemophilia - inc factor VIII activity
von willebrand’s disease
437
ADH agonost CI in pregnancy
Telipressin - not recommended - cause uterine contractions in early pregnancy and decrease uterine blood flow
438
ADH antagonist
```
conivaptan
tolvaptan
lixivaptan (orphan drug)
demeclocycline
lithium
```
439
indications of conivaptan
SIADH
| Hyponatremia
440
MOA
```
conivaptan
tolvaptan
lixivaptan
demeclocycline
lithium
```
ADH antagonist
| Antagonist at V1 and V2 receptors
441
SE of conivaptan
```
infusion site reactions
hyperkalemia
nephrogenic diabetes insipidus
renal failure (Lithium , demeclocycline)
bone and teeth abnormalities (demeclocycline)
```
Central pontine myelinosis - w/ rapid correction of hyponatremia
442
dual endothelin antagonst used in tx of pulmonary artery hypertension
bosentan
443
CI Bosentan
Pregnancy (X)
| hepatically impaired patients
444
naturally occuring derivative of canitine - metabolism of both carbs and lipids -> inc ATP generation
Propionyl-L-carnitine
445
indications of L-carnitine
Peripheral arterial cardiovascular disease
chronic heart failure
stable angina esp when Diabetes is present
446
MOA of L carnitine
antiraical effect
| protective effects in cardiac and endothelial dysfunction
447
Urapidil moa
sympatholytic antihypertensive
A1 adrenoceptor antagonist
5HT1A receptor agonist
weak B1 antagonistic activity - no reflex tachycardia
448
stabilizes cell membranes and reduces free radicals
may activate central cholindergic system -> for alzheimer’s disease
inc ACTH, TSH, GH, LH
citicoline
449
citicoline indications
```
traumatic brain injuries
stroke
vascular dementia
Parkinson’s disease
brain aging
```
Alzheimer’s disease
450
Isoxuprine drug class
B2 adrenoceptor agonist - relaxation of uterine and vascular smooth muscle
451
isoxuprine uses
tx of premature labor
vasodilator for cerebra vascular insufficiency
Raynaud’s phenomenon
452
isoxuprine used with caution with
sedatives and hypnotics
453
isoxuprine
| SE
inc HR
changes in BP
irritate GIT
454
MOA of cinnarizine
antihistamine
CCB
promote cerebral blood flow
455
cinnarizine uses
```
nausea
vomiting due to motion sickness
chemotherapy
vertigo
Meniere’s disease
```
456
Pathogenesis of hyperliproteinemia
>premature atherosclerosis - elevated lipoproteins
1. elevated LDL
2. depressed HDL
3. hypertriglyceridemia
> hyperchylomicronemia - associate with high incidence of acute pancreatitis
457
Tx strategies of dyslipidemia
1. diet
> avoid cholesterol and saturated fats
>avoid alcohol - alc raises triglycerides and VLDL
2. drugs
lower LDL >statins, resin, ezetimibe. niacin
lower triglycerides, VLDL, raising HDL > niacin, fibrates
458
LDL lowering drugs
statins, resin, ezetimibe. niacin
459
loweringtriglycerides, VLDL,
| raising HDL
niacin, fibrates
460
MOA of statins
compensatory response from the liver- inc high affinity LDL receptors -> clear LDL and VLDL remnants from the blood
direct anti-atherosclerotic effects
prevent bone loss
inhibit HEPATIC cholesterol synthesis (small amount of drug effect)
461
Statins/ reversible HMG COA reductase inhibitors
```
Statins
Atorvastatin
Rosuvastatin
Pluvastatin
Pravastatin
Lovastatin
Pitavastatin
```
462
rate limiting enzyme in cholesterol synthesis
HMG COA reductase
463
indications of statins
Hypercholesterolemia (high LDL)
acute coronary syndromes / atherosclerotic vascular diseases -> Primary/secondary prevention
ischemic stroke
464
SE of simvastatin
```
Hepatotoxicity
myopathy
rhabdomyolysis
Gastrointestinal distress
teratogen
```
465
Simvastatin has inc risk of when myopathy and
| rhabomyolysis used with
fibrates
466
statins are given at this time
before bedtime
467
which statins are pro drugs
simvastatin
| lovastatin
468
which statins have greater maximal effect
rosuvastatin
simvastatin
atorvastatin
469
this drug decreases absorption of statins
resins (given 1 hour before of 4 hours after resin administration)
470
metabolism of statins
CYP450 dependent metabolism
471
why are statins used in management of coronary artery diseases?
for stabilization of atherosclerotic plaques
472
MOA of resins
resins bind to bile acids and prevent their intestinal absorption
> inc cholesterol utilization for replacement
> compensatory increase in high-affinity LDL receptors inc LDL removal (modest effect)
473
bile acid binding resin
cholestyramine
colesevelam
colestipol
474
Uses of cholestyramine
Hypercholesterolemia (high in LDL)
pruritus in cholestasis
digitalis toxicity
475
side effect of cholestyramine
```
constipation
bloating
gritty taste
steatorrhea
gallstones (rare)
malabsorption (vit K)
```
476
how to manage constipation as a side effect of cholestyramine
fiber supplements/ psyllium
477
hypercholesterolemia with high TG is CI with
cholestyramine
| inc TG and VLDL
478
sterol absorption blocker
ezetimibe
| sitosterol
479
MOA of ezetimibe
converted in the liver to the active glucuronide form
inhibits NPC1L1 transporter (jejunal enterocyte) -mediates gastrointestinal uptake of cholesterol and phytosterols
prevents absorption of dietary cholesterol and cholesterol that is excreted in bile
480
uses of ezetimibe
hypercholesterolemia (high LDL)
| phytosterolemia
481
SE of ezetimibe
hepatotoxicity (inc with statins use)
| myositis
482
this sterol absorption blocker has synergistic effect with statins
ezetimibe
483
cholesterol analog
sitosterol
484
uses of sitosterol
hypercholesterolemia (high LDL)
| phytosterolemia
485
SE of sitosterol
gastrointestinal upset
bloating
impotence (rare)
coronary events
486
most effective agent for inc HDL levels
| reduces LDL cholesterol , TG and VLDL
niacin
487
Uses of niacin
hypercholesterolemia (low HDL, high LDL/ VLDL)
488
SE of niacin
```
flushing
pruritus
rashes
acanthosis nigricans
gastrointestinal irritation
hepatotoxicity (mild)
hyperuricemia
impaired glucose tolerance
arrhythmia
Ambylopia
```
489
this drug reduces flushing caused by niacin
aspirin
490
niacin is CI with this condition
peptic ulcer disease
491
effect of niacin with antihypertensives
potentiates vasodilators and
| ganglion blockers
492
drugs that cause cutaneous flushing
```
VANC
Vancomycin
Adenosine
Niacin
CCB
```
493
ligands for peroxisome proliferator activated receptor alpha protein
PPAR alpha protein -> inc synthesis by adipose tissue of lipoprotein lipase -> enhance clearance of TG
liver -> stimulates FA oxidation -> dec VLDL, TG
-> dec expression of apoC-III -> impedes clearance of VLDL, inc expression of apoA-I and apoA-II -> inc HDL levels
lower TG, dec secretion of VLDL, inc HDL
fibrates
494
DOC for hypertriglyeridemia
gemfibrozil
fenofibrate
bezafibrate
495
fibrates
gemfibrozil
fenofibrate
bezafibrate
496
Indications of fibrates
hypertriglyceridemia
Hypercholesterolemia (low HDL, high LDL)
Fat redistribution syndrome
497
SE gemfibrozil
nausea
rashes
leukopenia
hemoconcentration (inc risk of cholesterol gallstones)
498
gemfibrozil has higher risk of gallstone formation when given with
resins
499
gemfibrozil has higher risk of myopathy and rhabomyolysis when given with
statins
500
Gemfibrozil CI in
hepatic and renal dysfunction
| familial combined hyperlipoproteinemia -> inc LDL
501
Upregulate lipoprotein lipase
fibrates
502
synergistic combination for familial hypercholesterolemia
Niacin + statin
statin + ezetimibe
FH
NS
SE
503
synergistic combination for
| familial combined hypercholesterolemia
niacin + resin
statin + fibrate
FCH
NR
SF
504
Fibrate + Resin
Inc risk of cholelithiasis
505
Statin + Resin
impaired statin absorption
506
Statin + Fibrate
Inc risk of myopathy and rhabdomyolysis
507
an antioxidant which can inhibit the oxidation of LDL and lowers the level of cholesterol in the blood stream by inc rate of LDL catabolism in the final metabolic pathway for cholesterol elimination from the body
inhibit tissue deposition of LDL -> inhibit atherogenesis
probucol
