Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm 2 Exam > drug high points > Flashcards

drug high points Flashcards

1
Q

which muscarinic agonist is contraindicated in narrow angle glaucoma and iritis

A

Cevimeline (Evoxac)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

which muscarinic agonist is linked to an increased incidence of UTIs

A

Cevimeline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what topical muscarinic agonist is used to treat glaucoma

A

Pilocarpine

also approved for xerostomia from Sjogren syndrome or from salivary gland damage from radiation therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

treatment of Muscarinic poisoning

A

Atropine and supportive therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

drug of choice for treating poisoning by atropine and other drugs that cause muscarinic blockade such as antihistamines and phenothiazine antipsychotics but not tricyclic antidepressants (due to r/o causing seizures and cardiotoxicity)

A

Physostigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

drug sometimes used in diagnosis of MG or to distinguish between myasthenic or cholinergic crisis

A

Edrophonium (Enlon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what 3 reversible cholinesterase inhibitors are approved for management of Alzheimer Disease

A

Donepezil (Aricept)
Galantamine (Razadyne)
Rivastigmine (Exelon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

which reversible cholinesterase inhibitor is approved for mgmt of Alzheimer Disease and Dementia of Parkinson Disease

A

Rivastigmine (Exelon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

irreversible cholinesterase inhibitors are only approved for
what drug?

A

treatment of glaucoma

Echothiophate (Phospoline Iodide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

pharm treatment of irreversible cholinesterase inhibitor poisoning

A

Atropine to reduce muscarinic stim

pralidoxime to reverse inhibition of cholinesterase

Benzodiazepine such as diazepam to suppress convulsions

Resp depression from cholinesterase inhibitors - mechanical ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

drug of choice for MG

A

Pyridostigmine (Mestinon, Regonol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

which drug is used in keratoconjunctivitis sicca

A

Cevimeline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

when should you take muscarinic agonists and cholinesterase inhibitors in relation to food and why

A

1 hr before meals or 2h after to decrease incidence of n/v

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the diff between cholinergic and muscarinic

A

they are the same. 2 diff terms mean the same

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what class
Bethanechol
Cevimeline

A

Muscarinic Agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q 
What class 
Pyridostimine
physostigmine
A

reversible cholinesterase Inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q 
what class
echothiophate
A

irreversible cholinesterase inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q 
what class
Atropine
Scopolamine
Ipratropium (Atrovent)
Dicyclomine
Oxybutynin
Solifenacen
Darifenacin
Tolterodine
Fesoterodine
Trospium
A 
muscarinic Antagonists
(can also be interchangeably called parasympatholytic drugs, antimuscarinic drugs, muscarinic blockers, anticholinergic drugs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what anticholinergic is safe to take in pregnancy

A

Oxybutynin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Can you give antimuscarinic drugs to older adults

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

antidote to anticholinesterase poisoning

A

Atropine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what drug is used for treatment of sinus bradycardia

and AV block

A

Atropine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the problems associated with xerostomia

A

dry mouth promotes tooth, gum problems and oral infections.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pt ed for Xerostomia

A

sipp fluids
chew sugar free gum
use salivary stimulants (citrus-flavored or tart sugarless candies, maltose lozenges)
salivary substitutes such as biotene dry mouth spray and Xylimelts are available OTC

Avoid sugary gum and hard candy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How can someone decrease urinary retention when taking atropine

A

void before taking med

same for all muscarinic antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Pt ed on constipation

A

increase dietary fiber and fluids and physical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

contraindications for taking muscarinic antagonists

A 
glaucoma due to increased iop
intestinal Atony
MI
BPH - urinary retention
urinary tract obstruction
MG pt - can precipitate myasthenic crisis
use caution in pt with preexisting tachycardia
use caution in asthmatics

such as Atropine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Pt is taking a muscarinic antagonist. It is summer time and they have a trip planned with their family. What important education would you give

A

This can cause anhidrosis. Sweating is necessary for cooling and someone who cannot sweat is at risk for hyperthermia. Avoid activities that might lead to overheating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

drug interactions for muscarinic antagonists due to their significant muscarinic blockade

A

tricyclic antidepressants (TCA)
antihistamines
phenothiazine antipsychotics

“Don’t feed anyone on Atropine TAPAs!”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

muscarinic antagonist that is used for motion sickness

A

Scopolamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Muscarinic antagonist (anticholinergic) used to treat asthma, COPD, rhinitis caused by allergies or the common cold

A

Ipratropium (Atrovent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

anticholinergic for IBS or hypermotility

A

Dicyclomine (Bentyl)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

pneumonic/ way to remember Atropine or anticholinergic adverse effects

A

Can’t see, Can’t pee, Can’t Shit, Can’t Spit

blurred vision/photophobia/elevated IOP
urinary retention
Constipation
Xerostomia
Anhidrosis

Tachycardia
Thickening of bronchial secretions and causes bronchial plugging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

3 ways to reduce side effects for anticholinergics

A

1) using long acting formulas
2) using drugs that dont cross BBB
3) using drugs that are selective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

highly selective M3 med for OAB

A

Darifenacin (Enablex)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Primarily M3 selective med for OAB

A

Oxybutynin

Solifenacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Nonselective drugs for OAB

A

Fesoterodine
Tolterodine
Trospium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

M1 affects what when activated/blocked

A

salivary glands - > salivation -> dry mouth

CNS ->enhanced cognition -> confusion/hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

M2 affect what when activated/blocked

A

Heart - > Bradycardia ->tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

M3 affects what when activated/blocked

A

Salivary glands -> Salivation->dry mouth
Bladder-> voiding ->urinary retention
GI smooth muscle -> increased tone/motility -> constipation
eyes -> miosis, accomodation, tearing ->mydriasis, blurred vision, dry eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what drug for OAB caused hallucinations and agitation that were prominent among pediatric and hallucinations, confusion and sedation with older adults pts

A

Oxybutynin (Ditropan XL, Gelnique, Oxytrol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

which two drugs for OAB has a side effect of Headache

A

Darifenacin and Solifenacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Which drugs for OAB have the side effect of prolonging QT interval

A

Solifenacin

Tolterodine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

which OAB drug is not metabolized by CYP enzymes

A

Trospium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Which OAB has the lowest bioavailability and lacks CNS effects

A

Trospium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Which OAB has been associated with angioedema of the face, lips, tongue and larynx

A

Solifenacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

which OAB drugs should be avoided in severe liver impairment

A

Darifenacin

Solifenacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

CYP3A4 inhibitors

A

azole antifungal drugs (ketoconazole, itraconazole)
certain protease inhibitors for HIV/AIDS (ritonavir, nelfinavir)
Macrolide abx such as Clarithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

drug interactions for Trospium

A

Trospium is eliminated by the kidneys, we can assume it may compete with other drugs that undergo renal tubular excretion.

Among these are
Vancomycin 
Metformin
Digoxin
Procainamide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what is the only OAB drug not available in Extended release or long acting

A

Solifenacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How is Solifenacin taken?

A

swallowed intact with liquid

with or without food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

which 2 OAB drugs don’t effect CNS

A

Darifenacin (no effect on memory, reaction time, word recognition or cognition)

Trospium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

antidote to antimuscarinic poisoning

A

physostigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

how to differentiate between a true psychotic episode and antimuscarinic poisoning

A

a true psychotic episode is not associated with signs of excessive muscarinic blockade
-dry mouth
hyperthermia
dry skin, ect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q 
Name that class
Epinephrine
Norepinephrine
Isoproterenol
Dopamine
Dobutamine
Phenylephrine
Albuterol
Ephedrine
A

Adrenergic Agonists
catecholamines and noncatecholamines

all are catecholamines except
Phenylephrine
Albuterol
Ephedrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Catecholamines vs Noncatecholamines

A

Catecholamines

1) cant be taken orally (MAO and COMT)
2) Short duration of action
3) Do not act on CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what catecholamine is safe in pregnancy

A

Dobutamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Which catecholamines/noncatecholamines has a adverse effect of hyperglycemia in diabetics and which receptor is responsible for this

A

Epinephrine
Isoproterenol

Albuterol
Ephedrine

B2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

which catecholamine works on all 4 adrenergic receptors

A

Epinephrine

“The Es include everybody”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Which non-catecholamine works on all 4 adrenergic receptors

A

Ephedrine

“The Es include everybody”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What do you give for A1 adrenergic agonist extravates

A

phentolamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what catecholamines can cause tissue necrosis if extravated

A

Epinephrine
norepinephrine
dopamine (if high doses)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Alpha1 receptors cause

A

Vasoconstriction of blood vessels

Mydriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Alpha2 receptors cause

A

Reduction in sympathetic outflow to heart and blood vessels

Severe pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Beta1 receptors affect

A

Heart

Kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Beta2 receptors affect

A

Lungs
Uterus
Liver and skeletal muscle – glycogenolysis which can cause hyperglycemia in DM II patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Dopamine receptors

A

Dilation of renal vasculature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what drugs interact with catecholamines

A

MAO inhibitors (inactivates epi)

Tricyclic antidepressants -block uptake and prolong epi effects

several inhalation anesthetics - tachydysrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

noncatecholamine that is used to reduce nasal congestion, raise BP and dilate the eyes. Also used coadministered with local anesthetics to delay anesthetic absorbtion

A

Phenylephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Adverse effects of Albuterol in high doses

why?

A

Tremors
Tachycardia

high doses affect B1 in addition to B2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

adverse effect that Ephedrine has but Epinephrine does not share

A

insomnia due to Ephedrine crossing CNS and Epinephrine not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Alpha adrenergic antagonists approved in children

A

OraVerse - agent for reversal of local anesthesia following dental surgery

phentolamine for prevention of tissue damage post extravation of iv vasopressors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Alpha Adrenergic antagonists approved during pregnancy

A

There are 3 but they are only approved for BPH so irrelevant. no others are approved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

older adults are esp vulnerable to what side effect of alpha blockers

A

first dose effect.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Beers criteria specifically identifies what a1 blockers as innapropriate for older adults

A

doxazosin
prazosin
terazosin

due to high incidence of orthostatic hyypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Alpha blockers are associated with worsening of what in women and increases what for both genders in older adults?

A

urinary incontinence

syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

what is the most significant adverse effect associated with A2 blockade

A

reflex tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Phenoxybenzamine

Phentolamine

A

nonselective A adrenergic blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q 
Alfuzosin
Doxazosin
Prazosin
Silodosin
Tamsulosin
Terazosin
A

A1 selective adrenergic blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q 
Carteolol
Nadolol
Pindolol
Propanolol
Sotalol
Timolol
A

1st gen nonselective B Blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Carvedilol

Labetalol

A

Vasodilating B Blockers

acts on B1, B2, A1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q 
Acebutolol
Atenolol
Betaxolol
Bisoprolol
Esmolol
Metoprolol
Nebivolol
A

2nd gen B1 selective Blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Prazosin is approved only for

A

HTN and BPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

which A blockers (adrenergic antagonists) have the first dose effect as an adverse effect

A

Prazosin
Terazosin
Doxazosin

These 3 also have orthostatic hypotension, reflex tachycardia and nasal congestion listed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

what 3 A blockers are approved for HTN and BPH

A

Prazosin
Terazosin
Doxazosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

what are the 3 A blockers that are only approved for BPH

A

Tamsulosin (Flomax)
Alfuzosin (Uroxatral)
Silodosin (Rapaflo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Max benefits of Tamsulosin develop within

A

2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What A blocker approved only for BPH does not interfere with ejaculation

A

Alfuzosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What A blocker approved only for BPH can prolong QT

A

Alfuzosin with doses four times greater than recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

first dose effects need to know

A

1% of pt lose consciousness 30-60 min after pt receiving initial dose. To minimize initial dose should be small (no more than 1mg in Prazosin). Subsequent doses gradually increased with little risk for fainting. Pt who are starting treatment should avoid driving or other hazardous activities 12 -24 hrs. Take first dose right before going to bed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

drug interaction for Alfuzosin

A

CYP3A4 inhibitors such as erythromycin, clarithromycin, itraconazole, ketoconazole, nefazodone, HIV protease inhibitors such as ritonavir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

drug interaction for Tamsulosin

A

combined with cimetidine increases drug levels

combined with hypotensive drugs such as PDE-5 inhibitors (Viagra)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

B Blockers for Heart failure

A

Carvedilol
Bisoprolol
metoprolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Propanolol is contraindicated in

A 
AV heart block
Heart failure
bradycardia
Asthma
COPD
dangerous in diabetics - use with caution
history of anaphylaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

B Blockers in pregnancy -

A 
other than labetalol
may put neonate at risk for 3-5 days
Bradycardia
resp distress
hypoglycemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

3 antihypertensives save in pregnancy

A

labetalol
methyldopa
nifedipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What antihypertensive should be avoided in pt with history of anaphyhlaxis

A

Propanolol

blocks epinephrine being able to help in anaphylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Drug interactions Propanolol

A

Verapamil and diltiazem - cardiac effects are identical to propanolol so can cause excessive cardiosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

what b blocker is safer for diabetics, asthmatics and for pt with history of anaphylaxis

A

Metoprolol

bc its a selective B1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

2 B blockers that block A Adrenergic receptors in addition to B1 and B2

A

Labetalol

Carvedilol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

B Blockers considered safest in pregnancy and which is drug of choice

A

Lebetalol - DoC
acebutolol
pindolol
sotalol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

which b blocker is most secreted in Breastmilk

A

Betaxolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Black box for Sotalol (Betapace)

A

When starting or restarting solalol, pt should be in a facility that can provide continuous EkG monitoring and CPR for min of 3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What lab needs to be ordered prior to starting Sotalol

A

Creatinine clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

how are Sotalol and Esmolol different from the other B Blockers

A

very short half life of 15 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

used for emergency treatment of SVT

A

Esmolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

B blocker approved for ventricular dysrhythmias and maintenance of NSR in pt with prev a-fib or A flutter

A

Sotalol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

partial agonist that produces a limited degree of receptor activation while preventing strong agonists from binding to that receptor to cause full activation

keeps resting heart rate from not being reduced like a regular B Blocker

A

Intrinsic sympathomimetic activity

Pindolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

The abrupt discontinuation of these b blockers may cause exacerbation of angina and increase risk for MI

A

Atenolol
Metoprolol
Nadolol
Timolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Use all B Blockers with caution in Pt with a history of

A

Depression and in pt taking CCBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

abrupt withdrawal of B blockers can cause

A

tachycardia
ventricular dysrhythmias

taper off gradually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

B Blocking A adrenergic receptors, carvedilol and lebetalol can cause

A

postural hypotension.

move slowly when changing from a supine or sitting to a upright position

lie down if feel lightheaded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

B1 blockade can mask early signs and symptoms of

A

hypoglycemia by preventing common tachycardia, tremors and perspiration. Pt need to rely on other indicators such as hunger and poor concentration to identify hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

B2 blockade can prevent what in diabetics

A

glycogenolysis which is an emergency means of increasing blood glucose. Pt may need to reduce insulin dosage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

signs and symptoms of Heart failure

A

shortness of breath
night coughs
swelling of extremities

notify provider if occur while taking B Blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Clonidine class and what it is approved for

A

centrally acting A2 agonist

HTN
ADHD
Severe pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Clonidine patch pt ed

A

apply patch to hairless, intact skin on the upper arm or torso
apply a new patch every 7 days
Contain metal and must be removed prior to MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

How can someone minimize daytime sedation with Clonidine

A

Take the major portion of daily dose at bedtime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Pt monitoring for clonidine

A

have pt record BP daily and call clinic if hypotension develops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Pt ed on Clonidine

A

do not abruptly discontinue drug - may cause tachycardia and other dysrhythmias

carry an adequate supply of meds and a copy of prescription

Possible CNS depression. Avoid hazardous activities if alertness is reduced

Dry mouth can be significant. Use pt ed for dry mouth

Potential for rebound hypertension. Refill script promptly so they dont run out of medication. Warn them not to d/c without talking to PCP first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

net result of cardiac suppression and vasodilation is

A

decreased BP (orthostatic hypotension is not a concern)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Hypotensive responses to clonidine begin when

A

30-60 min after administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

can you take clonidine while pregnant

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

what central acting A2 agonist has high abuse potential

A

Clonidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Clonidine Tablet prep is called

A

Catapres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Clonidine in an extended release tablet used for mgmt of ADHD

A

Kapvay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

A2 agonist used for HTN and ADHD

A

Guanfacine (Intuniv)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What med is an indirect A2 agonist?

A

Methyldopa bc it has to be converted to methylnorpinephrine to be a alpha 2 agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

The principal mechanism of methyldopa is

A

vasodilation, not cardiosupression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

what A2 agonist does not decrease HR or Cardiac output

A

Methyldopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

How is methyldopa used in pregnancy

A

treatment of preeclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

what are the two most severe adverse effects for methyldopa

A

Hemolytic anemia and Hepatotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

What labs need to be done for methyldopa before and periodically thereafter

A

Coombs
CBC for blood counts (Hgb, HCT, Red cell count)
LFTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

A coombs test should be performed before treatment and

A

6-12 months later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

if a coombs test turns positive it usually occurs

A

6-12 mos later. Of those pts only 5% of those pts develop hemolytic anemia. If they do not develop hemolytic anemia, they can continue the drug.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

If a pt taking Methyldopa develops hemolytic anemia

A

Melthyldopa should be withdrawn. it resolves after withdrawal. Coombs test may remain positive for months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

can you use Central acting alpha blockers in older adults

A

no, beers says nobody over 65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

most potent diuretic

A

Loop diuretics

Furosemide (Lasix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

which diuretic can promote diuresis even when renal blood flow and GFR are low

A

Furosemide (Lasix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

if treatment with furosemide alone is insufficient, what can be added?

A

Thiazide Diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Furosemide can promote excessive loss of

A

sodium, chloride and water (dehydration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

what medication acts on the thick segment of the ascending loop of Henle

A

Furosemide (Lasix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

what diuretic works on the early distal convoluted tubule

A

Thiazides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

What diuretic in the late distal convoluted tubule and collecting duct (distal nephron)

A

Spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

adverse effects of loop diuretics and thiazides

A 
Hyponatremia
Hypochloremia
dehydration
Hypokalemia
Hypotension
Ototoxicity
Hyperglycemia
Hyperuricemia
reduction of HDL
Increase in LDL and triglycerides
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Rarely, loop diuretics cause hearing impairment. With _____, deafness is transient. With ______, irreversible hearing loss may occur

A

Furosemide

Ethacrynic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

diuretics and pregnancy

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Diuretics and Breastfeeding

A

decrease milk production

no data on drug transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Older adults and diuretics

A

most common cause of adverse med reactions and interactions in older adults. Monitor closely for dehydration and cardiac dysrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

when taking Digoxin, what can increase risk for ventricular dysrhythmias

A

Hypokalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

To reduce risk of dysrhythmias for pt taking Digoxin and a diuretic

A

Add a potassium sparing diuretic or potassium supplement

monitor Potassium levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

The risk for furosemide induced hearing loss is increased by concurrent use of

A

other ototoxic drugs, esp aminoglycoside antibiotics (gentamycin). Combined use should be avoided

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

ethacrynic acid (Edecrin)
torsemide (Demadex)
Bumetanide (Burinex)

A

other loop diuretics

like furosemide (Lasix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

what 2 loop diuretics are approved for HTN

A

Furosemide (Lasix)

Torsemide (Demadex)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Drug interactions for loop and thiazide diuretics

A 
Digoxin
Ototoxic drugs
Potassium sparing diuretics
lithium
antihypertensive agents
NSAIDS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

NSAIDS and loop diuretics

A

reduce sodium excretion and blunt diuretic effects of loop diuretics which exacerbate edema.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

thiazide diuretics and gout

A

can make gout worse bc promotes elevated serum uric acid levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

spironolactone , sodium, potassium

A 
increase sodium (promotes sodium uptake in exchange for potassium secretion)
decrease potassium
159
Q

hydrochlorothiazide blocks the reabsorption of

A

sodium and chloride in the early segment of the distal convoluted tubule

160
Q

GFR requirement for thiazides to promote diuresis

A

Cannot work if less than 15-20ml/min

161
Q

effects of spironolactone take

A

24-48hrs to work

162
Q

spironolactone endocrine effects

A 
gynecomastia
menstrual irregularities
impotence
hirsutism
deepening of voice
163
Q

what are agents that raise potassium

A 
potassium supplements
salt substitutes that contain potassium chloride
potassium sparing diuretics
ACEs 
ARBs
DRIs
potassium rich foods
164
Q

what is Triamterene

A

potassium sparing diuretic

165
Q

adverse effects of Triamterene

A

nausea, vomiting, leg cramps, dizziness

blood dyscrasias occur rarely

166
Q

What is Amiloride

A

potassium sparing diuretic

167
Q

diuretic for heart failure

A

Spironolactone

bc blocks aldosterone and reduces mortality and hospital admissions

168
Q

which antihypertensives have the cough and angioedema as adverse effect and why?

A

ACE inhibitors

Kinins

169
Q

If pt cannot tolerate ACE, what is second line

A

ARB

170
Q

except for ____ and ____, all oral ACE inhibitors can be administered with food

A

Captopril

moexipril

171
Q

With the exception of _____, all ACE inhibitors have prolonged half lives and can be administered just once or twice a day

A

Captopril which is given 2-3 times per day

172
Q

With the exception of _____, all ACE inhibitors are prodrugs and must undergo conversion to their active form in the small intestine and liver.

A

Lisinopril is active as given

173
Q

All ACE inhibitors are excreted by the ____with the exception of ______

A

kidneys. use renal dosing

Fosinopril

174
Q

ACE inhibitors reduce the risk for

other drugs that do this are ____ and ____

A

cardiovascular mortality caused by HTN
B Blockers
diuretics

175
Q

AFter MI, Pt should be put on ____ and stay on for at least 6 weeks.

Meds approved are

A

ACE inhibitors

trandolapril
lisinopril
Captopril

“TLC”

176
Q

the only ACE inhibitor approved for nephropathy is

A

Captopril

177
Q

Can ACE inhibitors be used for primary prevention of diabetic nephropathy?

A

no. They slow progression of established nephropathy but do not protect against early kidney damage

178
Q

what ACE inhibitor is approved for reducing the risk for MI, stroke and death from cardiovascular causes in pt at high risk for a major cardiovascular event.

high risk defined as stroke, CAD, Peripheral vascular disease or diabetes combined with at least one other risk factor such as HTN, High ldl, low hdl or cigarette smoking

A

Ramipril (Altace)

Perindopril (Aceon)

179
Q

what ACE inhibitor can reduce the risk for diabetic retinopathy in some pts with type 1 DM who do not have htn, nephropathy or established retinopathy

A

Enalapril

180
Q

what antihypertensive has First dose hypotension

A

ACE inhibitors - caused by widespread vasodilation secondary to abrupt lowering of angiotensin II levels

181
Q

if hypotension develops what should the pt do

A

assume a supine position and seek med attention if it does not resolve

182
Q

Factors that increase risk of cough in ACE inhibitors

A

Advanced age
female
Asian

183
Q

Ace inhibitor cough begins to subside ___ days after d/c and is gone within ____ days

A

3

10

184
Q

inhibition of aldosterone release can cause _____ retention by the kidney in ACE inhibitors

A

potassium

185
Q

ACE inhibitors and pregnancy

A

Big fat negative

186
Q

potentially fatal reaction for ACE inhibitors

A

Angioedema

187
Q

Angioedema develops, how do you treat

A

subcutaneous epinephrine

188
Q

If Neutropenia develops, _________ should be withdrawn immediately

A

ACE inhibitors

189
Q

ACE inhibitors and drug interactions

A

Diuretics may intensify first dose hypotension

Hypotensive effects are often additive to other antihypertensives such as diuretics, sympatholytic, vasodilators, CCBs

increase risk for hyper-k - increased by potassium supplements, potassium sparing diuretics,

ACE inhibitors can cause lithium to accumulate to toxic levels. monitor frequently

NSAIDS - may reduce the antihypertensive effects of ACE inhibitors

190
Q

lab monitoring for ACE inhibitors

A

consider checking creatinine 2-4 weeks after starting

191
Q

how are ARBS different from ACE

A

pose a much lower risk for cough or hyperkalemia

ARBs do not decrease cardiovascular morbidity as well as ACEs

192
Q

what ARBs are approved for Heart failure

A

Valsartan (Diovan)

Candesartan (Atacand)

193
Q

What ARBs are approved for managing nephropathy in hypertensive patients with Type 2DM

A

Irbesartan (Avapro)

Losartan (Cozaar)

194
Q

what ARB is approved for reducing cardiovascular mortality in post MI pt with Heart failure or LV dysfunction

A

Valsartan (Diovan)

195
Q

What ARB is approved for reducing risk for MI, stroke, death from cardiovascular causes in pt 55 and older but only if they are intolerant of ACE inhibitors

A

Telmisartan (Micardis)

196
Q

What ARB in pt with Type 1DM without established retinopathy, slows the development and progression of retinopathy

A

Losartan (Cozaar)

197
Q

Angioedema and ARB

A

incidence is lower with ARBs than with ACEs

198
Q

ARBS and pregnancy

A

no go

199
Q

renal pt for ACES and ARBS

A

contraindicated in pt with bilat renal artery stenosis or stenosis in artery to a single remaining kidney

200
Q

labs after starting ARBS

A

consider checking creatinine 2-4 weeks after starting

201
Q

-pril

A

ACE

202
Q

-sartan

A

ARB

203
Q

What DRI is approved

A

Aliskiren

204
Q

Aliskiren is approved only for

A

HTN

205
Q

food and Aliskiren

A

dosing with a high fat meal makes availability much lower in an already low bioavailable drug

206
Q

metabolism of Aliskiren

A

some metabolism by CYP3A4 but the extent is unknown

207
Q

Adverse effects of Aliskiren

A

angioedema
cough
hyperkalemia ]
low risk for all

at high therapeutic doses - diarrhea

208
Q

aldosterone Antagonists for HTN and Heart failure

A

Eplerenone (Inspra)

Spironolactone

209
Q

Side effect for Eplerenone and Spironolactone

A

Hyperkalmia

210
Q

Eplerenone effect of potassium, sodium, water

A

retention of potassium

increased excretion of sodium and water

211
Q

other adverse effects of eplerenone

A 
diarrhea
abd pain
cough 
fatigue
gynecomastia
flu like syndrome
212
Q

drug interactions Eplerenone

A

inhibitors of CYP3A4 can increase levels of eplerenone

weak inhibitors (Erythromycin, saquinavir, verapamil, fluconazole) can double levels

Strong inhibitors (ketonazole, itraconazole) can increase fivefold

213
Q

combining eplerenone with ACE inhibitors or diuretics

A

can increase levels of lithium

214
Q

which CCBS are nondihidropyridines?

where do they work?

A

Verapamil and Diltiazem (Cardizem)
act on arterioles and the heart
lower HR

215
Q

Verapamil and Diltiazem( nondihidropyridine CCBS) are approved for

A 
Angina (Vasospastic and angina of effort)
Essential HTN (second after thiazide diuretics)
cardiac dysrhythmias (slow rate with a-flutter, a-fib and paoxysmal SVT)
216
Q

Adverse effects of CCBS and which are different for nondihydropyridines vs dihydropyridines

A

Constipation - most common complaint in nondihydropyridines (more so in Verapamil than in Diltiazem (Cardizem))
dizziness - all
facial flushing - all
headache - all
edema of ankles and feet (secondary to vasodilation) - all
gingival hyperplasia - all
Bradycardia (AV node) - nondyhydropiridines
Decrease contractility (myocardium) - nondyhydropiridines
refelex tachycardia - dihydrapyridines

217
Q

Drug and food interactions for Verapamil

A

Digoxin - both suppress AV node conduction - used together increases risk of AV block. Also Verapamil increases Digoxin plasma levels by 60% so watch for dig tox

B Blockers and Verapamil both decrease HR, AV conduction and Contractility.

Grapefruit juice - can inhibit intestinal and hepatic metabolism of drug and raise levels. Less risk with Verapamil but still a potential risk

218
Q

How can you minimize risk or taking B Blockers with Verapamil

A

administer several hours apart

219
Q

which CCBs carry the highest risk of grapefruit juice raising drug levels by inhibiting metabolism of drug

A

Felodipine
Nifedipine

“I fell near the grapefruit tree”
“CCBs with F in the words….sunny florida”

220
Q

which CCB that has first pass effect in the liver

A

All of them

221
Q

which nondihidropyridine CCBS causes less constipation

A

Diltiazem (Cardizem)

222
Q

What cardiac dysfunction in pts can be exacerbated by a nondihidropyridine CCBS

A

bradycardia
sick sinus syndrome
heart failure
second degree and third degree AV block

223
Q

CCB may cause what type of rash in older adults

A

eczematous rash

224
Q

what CCB can be used in infants to convert certain cardiac dysrhythmias

A

Verapamil

225
Q

which type of CCB would you prefer to use in someone who has AV block, heart failure, bradycardia or sick sinus syndrome

A

nifedipine (dijydropyiridine CCB)

226
Q

A response that occurs with nifedipine that does not occur with verapamil

why is it a problem

how do you treat

A

reflex tachycardia - which increases cardiac oxygen demand which increases angina -

B Blocker

227
Q

what dihydropyridines are approved for essential HTN and angina

A

Amlodipine
nifedipine
nicardipine

228
Q

Which Dihydropyridine CCB are approved for HTN only

A

Isradipine
felodipine
nisoldipine

229
Q

Baseline data for CCBs

A

BP and HR
LFTs
Kidney function (BUN)
GFR

230
Q

What do you use to treat Verapamil tox

A

Atropine and glucagon for bradycardia

Norepinephrine for hypotension

231
Q

s/s of verapamil tox

A

bradycardia

hyptotension

232
Q

which CCB has highest chance of reflex tachycardia

A

Nifedipine

233
Q

which dihydropyridines have the lowest risk for reflex tachycardia and why

A

Felodipine
amlodipine

long acting drugs

234
Q

antihypertensives that fall into the vasodilator category

A

Hydralazine
Minoxidil

selective arterial vasodilators

235
Q

what pt education is important with vasodilators

A

increased risk for falls
symptoms of hypotension are lightheadedness and dizziness
Sit down or lie down if these occur
Failure to do so may result in fainting
minimize hypotension by avoiding abrupt transitions from supine or seated to and upright position

236
Q

Hydralazine is inactivated by a metabolic process known as

A

acetylation which is genetically determined

some are rapid acetylators and some are slow

237
Q

what type of acetylators are likely to have higher blood levels of Hydralizine

A

slow

238
Q

Regimen to manage HTN with oral hydralazine is usually combined with

A

B Blockers for reflex tachycardia

239
Q

when used for treatment of Heart failure, hydralazine must be combined with

A

isosorbide dinitrate (Bidil) (dilates veins)

240
Q

with long term therapy of Hydralazine, _____ delvelops

A

tolerance

241
Q

Hydralazine induced hypotension

A

causes sodium and water retention and a corresponding increase in blood volume

a diuretic can prevent volume expansion

242
Q 
Pt taking hydralazine starts experiencing 
muscle pain
joint pain
fever
nephritis
pericarditis
presence of antinuclear bodies
A

occurs most frequently in slow acetylators and rare in pt when dosage is below 200mg/day.

Systemic lupus erythematosus (SLE) - like syndrome

Hydralazine needs to be d/c
symptoms reversible but may take 6 months or more to resolve, sometimes years

243
Q

What vasodilator has more diuretic effects and more vasodilation

A

Minoxidil

244
Q

The only indication for cardiovascular reasoning for Minoxidil is

A

severe hypertension unresolved by other drugs

245
Q

which vasodilator has a side effect of pericardial effusion progressing to tamponade

A

Minoxidil

246
Q

which vasodilator has a side effect of hypertrichosis

A

Minoxidil - aka rogaine

excessive hair growth on face, arms, legs, back

247
Q

what vasodilator is used in infants as young as 1 month for management of chronic HTN

A

Hydralazine

248
Q

what vasodilator can be used in children and adolescents

A

Hydralazine

249
Q

when considering use of hydralazine and minoxidil in preg

A

benefits need to outweigh risk

250
Q

breastfeeding and vasodilators

A

no data

251
Q

older adults and vasodilators

A

monitor for falls increased risk of polypharmacy and associated orthostatic hypotension

252
Q

what drug class works to suppress rennin release

A

B Blockers

253
Q

What drug class prevents conversion of angiotensinogen to angiotensin I

A

Direct Renin INhibitor (DRI)

254
Q

What drug class prevents the conversion of angiotensin I to angiotensin II

A

ACE inhibitor

255
Q

What drug class blocks receptors for angiotensin II

A

Angiotensin II receptor blockers (ARB)

256
Q

what drug class blocks receptors for aldosterone

A

aldosterone antagonist

257
Q

what drug class helps by neutralizing renal effects on BP (When BP falls, GFR falls too, which promotes retention of sodium, chloride and water. This increases blood volume and increases venous return to heart causing an increase in cardiac output which increases arterial pressure)

A

Diuretics

258
Q

antihypertensive that suppress RAAS

A

ACE inhibitors

259
Q

4 subcategories of sympatholytic (antiadrenergic) drugs used for HTN

A

1) B Blockers
2) A1 blockers
3) A/B blockers
4) Centrally acting A2 agonists

260
Q

for initial therapy of Essential HTN without complicating factors

A

Thiazide diuretic

261
Q

4 reasons why antihypertensive therapy fails when initiated

A

non-adherence
presence of excessive salt intake
wrong dosage
presence of secondary HTN

262
Q

what is step down therapy

A

After BP has been controlled for at least 1 year, an attempt should be made to reduce dosages and number of drugs in regimen. Lifestyle mods should continue

263
Q

although all classes of antihypertensives are effective in nephrosclerosis, what 2 classes work best

what should also be used

A

ACE
ARB

in most cases a diuretic is also used

264
Q

in pt with advanced renal insufficiency, what diuretic would be ineffective and which would need to be avoided

A

Thiazide ineffective
Potassium sparing avoid
use loop

265
Q

Preferred antihypertensive drugs in pt with diabetes

in pt with diabetic nephropathy ____ and ___ can slow the progression of ___ and reduce _____

A

ACE
ARB
CCB
Diuretics (in low doses)

in pt with diabetic nephropathy ACE and ARB can slow the progression of renal damage and reduce albuminuria

266
Q

In both diabetic and non-diabetic pt, _____ and _____ can decrease morbidity and mortality

A

B blockers

diuretics

267
Q

B Blockers and diabetic pt

A

decrease morbidity and mortality
suppress glycogenolysis - increase blood sugar
mask signs of hypoglycemia such as tachycardia, tremors

268
Q

what diuretics can promote hyperglycemia

A

Thiazides

Loop

269
Q

how do ACEs compare to CCBs in pt with HTN and DM

A

CCB had a higher incidence of MI in a study done

ACES are superior

270
Q

African American lifestyle trend contribute to HTN

A

high incidence of salt sensitivity and cigarette use

271
Q

Treatment for HTN in African American Population

A

Thiazide diuretic
CCBS and A/B blockers are effective

B blockers and ACE less effective

but if have a comorbid condition follow those recomendation

272
Q

African American pt with HTN, DM, Protenuria

A

Ace

273
Q

African American pt with Hypertensive nephrosclerosis

A

ACE is superior to CCB

274
Q

By age 65, hypertensive in this group almost always presents as

A

isolated systolic HTN

Diastolic is usually normal or low

275
Q

HTN treatment recom for children age 1-18

A

ACEs
Diuretics
B Blockers
CCBS

276
Q

2 Drug of choice in treating pregnant women with mild preeclampsia

A

labetolol

methyldopa

277
Q

drug of choice to prevent seizures in severe preeclampsia

A

Magnesium sulfate

278
Q

what drug class/drug is safe in breastfeeding moms for HTN

A

B blockers such as metoprolol

diuretics appear safe but suppress lactation

279
Q

what drug classes are reasonable for older adults in HTN

A

ACE
diuretics
B Blocker

280
Q

what drug classes should be avoided in older adults for HTN

A

Central acting alpha agonists

peripheral alpha - antagonists

281
Q

hypertension that was present before pregnancy or developed before 20th week gestation

A

chronic HTN

282
Q

potential adverse outcomes of chronic HTN

A 
placental abruption
maternal cardiac decompensation
premature birth
fetal growth delay
CNS hemorrhage
renal failure
283
Q

With the exception of these 3 drug classes, antihypertensive drugs that were taken before pregnancy can be continued

A

ACEs
ARBs
DRIs

284
Q

when drug therapy is initiated during pregnancy what is the choice agents

A

Methyldopa

Labetalol

285
Q

what is the treatment threshold for initiating treatment for HTN in pregnancy

A

SBP > 160 or DBP >110

286
Q

Pt who have chronic HTN during pregnancy are at risk for developing

A

preeclampsia. Reducing BP does not lower this risk

287
Q

Preeclampsia is a multisystem disorder characterized by

A

combo of
BP >140/90 and proteinuria >300mg in 24 hrs
that develops after 20th week gestation

288
Q

If seizures develop in preeclampsia it is termed

A

eclampsia

289
Q

Risk factors for preeclampsia

A 
African Americans
chronic HTN
diabetes
collagen vascular disorders
previous preeclampsia
290
Q

risk for fetus of preeclampsia

A

intrauterine growth restriction
premature birth
death

291
Q

risk for mother in preeclampsia

A 
seizures
renal failure
pulmonary edema
stroke
death
hemorrhage 
encephalopathy
292
Q

what antihypertensive meds avoid in Heart failure and why

A

Verapamil
Diltiazem

decrease myocardial contractility and can further reduce cardiac output
(vasodilators)

293
Q

Antihypertensives to avoid in AV heart block

A

B blockers
Labetalol
Verapamil
Diltiazem

act on the heart to suppress AV conduction and can intensify AV block

294
Q

Antihypertensive to avoid in CAD and in pt with history of MI

A

Hydralazine - reflex tachycardia can precipitate an anginal attack by increasing cardiac workload and increasing heart oxygen demand

295
Q

What antihypertensives may exacerbate dyslipidemia

A

B Blockers

Diuretics

296
Q

What antihypertensives should you avoid or use in caution in renal insufficiency

A

Potassium sparing diuretics

also K supplements

297
Q

Which antihypertensives can exacerbate asthma

A

B blockers such as labetalol

298
Q

What diuretics promote hyperuricemia and can worsen gout

A

Thiazides

Furosemide

299
Q

What drugs used in HTN can cause potassium accumulation

A

K sparing diuretics
ACE inhibitors
DRIs
Aldosterone antagonists

300
Q

Which drug can precipitate a lupus erythematosus like syndrome

A

Hydralazine

301
Q

Which antihypertensive is hepatotoxic

A

Methyldopa

302
Q

for routine therapy, Heart failure is treated with 3 types of drugs. There are other agents used as well

A

Diuretics
Agents that inhibit RAAS
B Blockers

other agents
Digoxin
dopamine
hydralazine

303
Q

what class of drug is first line for all pt with signs of fluid volume overload

A

Diuretics

Thiazide if edema is not too great and pt has sufficient GFR

also principal adverse effect of thiazides is hypokalemia which increases risk for digoxin induced dysrhythmias

304
Q

what diuretic for severe HF

A

Loop

305
Q

what potassium sparing diuretic prolongs survival in pt with HF primarily by blocking receptors for aldosterone

A

Spironolactone

Eplerenone are also used from Aldosterone antagonists

306
Q

how are ACE inhibitors beneficial in long term with HF

A

suppresses production of angiotensin (which negatively affects cardiac remodeling) also suppress degradation of kinin which is largely responsible for favorable influence on cardiac remodeling.

307
Q

Why is ACE better than ARB

A

ACE suppress degradation of Kinin which helps with cardiac remodeling

308
Q

What combo med is approved for HF pt in Stages II to IV in place of an ACE or an ARB

A

Sacubitril/valsartan (Entresto)

increases natriuretic peptides while suppressing neg effects of RAAS

309
Q

Side effects of Entresto

A

similar to ARBS
angioedema
hyperkalemia
hypotension

310
Q

what aldosterone antagonists can reduce symptoms of HF, decrease hospitalizations and prolong life

A

Spironolactone
Eplerenone

this would be added on to ACE and B blocker
prevent aldosterone from worsening cardiac remodeling

311
Q

when can you not initiate or increase dosing of a B Blocker in HF

A

during an exacerbation/in fluid volume overload

312
Q

DRIs and HF

A

approved for HTN but not HF

Aliskiren

313
Q

B Blockers approved in HF

A

Carvedilol
Bisoprolol
Metoprolol (sustained release Toprolol XL)

314
Q

new drug that is maxed out on B Blockers or have a contraindication to B Blocker use. Slows HR by about 10beat per min, does not have neg inotropic effects and does not cause QT prolongation

A

Ivabradine (Corlanor)

315
Q

What drug is approved only in African Americans for treating HF

A

Bidil (Hydralazine and Isosorbide dinitrate)

316
Q

what population does Digoxin may shorten life

A

women

317
Q

Digoxin increases contractility which increases _____ and does what

A

cardiac output

1) sympathetic tone declines
2) urine production increases

318
Q

Digoxin increases contractility which increases _____ and does what

A

cardiac output

1) sympathetic tone declines
2) urine production increases
3) renin release declines

reverses signs and symptoms of HF but does not correct the underlying problem of cardiac remodeling

319
Q

the most common cause of dysrhythmias in pt receiving digoxin is

A

hypokalemia secondary to use of diuretics

320
Q

hyperkalemia and digoxin

A

can decrease therapeutic responses

321
Q

antidysrhythmic drugs used in someone who has a digoxin induced dysrhythmia

A

Phenytoin

Lidocaine

322
Q

what antidysrhythmic can cause plasma levels of digoxin to rise

A

Quinidine

323
Q

when digoxin overdose is especially severe, digoxin levels can be lowered using

IV
PO

A

Digibind, Digifab

Cholestyramine
Activated charcoal
these suppress absorption from GI Tract

324
Q

Pt who develop bradycardia or AV block from digoxin can be treated with

A

Atropine

325
Q

GI side effects Digoxin from tox

A

Anorexia, nausea, vomiting

326
Q

CNS and visual effect of digoxin from tox

A

fatigue

visual disturbances such as blurred vison, yellow tinge to vision, appearance of halos around dark objects.

327
Q

what antihypertensives can increase potassium levels

A

ACE and ARB and CCB

328
Q

what drugs act on the heart to increase rate and force of contraction and can add positive inotropic effects to digoxin

A

sympathomimetic drugs (Dopamine, dobutamine)

329
Q

what drug used to treat SVT may increase serum concentration of Digoxin

A

amiodarone - consider reducing dig dose by 30-50%

330
Q

Dig dosing and renal/liver function

A

primarily excreted by renal

renal dosing needed

331
Q

optimal rate for digoxin is

A

0.5-0.8 ng/ml

332
Q

drugs to avoid in Stage C HF

A

antidysrhythmic agents -approved is Amiodarone and dofetilide
CCBS -approved is amlodipine
NSAIDS

333
Q

Hold Digoxin for HR less than

A

50

334
Q

Stage B heart failure _____ and _____ is recommended for all pt with a reduced ejection fraction

A

ACE plus B Blocker

335
Q

Treatment for HF in Stage C has 4 goals

A

1) relief of pulmonary and peripheral congestive symptoms
2) improvement of functional capacity and quality of life
3) slowing of cardiac remodeling and progression of LV dysfunction
4) Prolongation of life

336
Q

preferred method for lowering LDL cholesterol is

A

modification of diet combined with exercise

337
Q

what meds for dyslipidemia are approved for kids

A 
avoid use of statins in kids younger than 10
lovastatin
simvastatin
pravastatin
atorvastatin
338
Q

statins and pregnancy

A

contraindicated

Ezetimibe and fibrates can be used but benefit should outweigh risk

339
Q

breastfeeding and statins

A

no, benefit vs risk

340
Q

Older adults and statins

A

good but cost benefit should be considered

341
Q

what instrument calculates 10 year risk assess

A

Framingham risk prevention score

342
Q

therapeutic lifestyle changes to lower LDL, choleseterol

A

diet

exercise

343
Q

stage A HF management

A

no symptoms of HF and No structural or functional cardiac abnormalities

reducing risk
control HTN, DM, Hyperlipidemia

cease behaviors that increase HF risk
smoking
alcohol abuse

344
Q

what is the leading cause of cardiomyopathy

A

chronic consumption of alcohol

345
Q

indicator for improvement of HF

A

BNP

346
Q

combining a statin with ______ increases risk of statin related adverse events such as muscle injury, liver injury and kidney damabe

A

fibrates such as gemfibrozil and fenofibrate

347
Q

CYP statins

A

atorvastatin
lovastatin
simvastatin

348
Q

CYP inhibitors

A 
macrolide antibiotics (erythromycin)
azole antifungal drugs (keotconazole, itraconazole)
HIV protease inhibitors (ritonavir)
amiodarone (antidysrhythmic)
cyclosporine (immunosuppressant)
Grapefruit juice
349
Q

What LDL do you start statin treatment?

what is treatment goal number

A

> or equal to 190 if no risk factor

100 goal without risk
70 with risk

350
Q

statins in pregnancy

A

stop during pregnancy

351
Q

statins available

A 
atorvastatin
fluvastatin
lovastatin
pitavastatin
pravastatin
rosuvastatin
simvastatin
352
Q

if a 30-40% drop in LDL is sufficient what statins

A

any will do

353
Q

If LDL must be lowered more than 40%

A

atorvastatin

simvastatin

354
Q

statin in significant renal impairment

A

atorvastatin

355
Q

what statin may produce twofold higher blood levels in Asians

A

rosuvastatin

356
Q

when are bile acid sequestrants used

A

adjunct therapy to statins

357
Q

colesevelam
cholestyramine
colestipol

A

Bile acid sequestrants

358
Q

Baseline data for statin

A 
total cholesterol
LDL
HDL
TGs
baseline LFT
CK
359
Q

who should not use statins

A

pregnant

pt with viral or alcoholic hepatitis

360
Q

what bile acid sequestrant is drug of choice and why

A

colesevelam (Welchol)

1) better tolerated (less gi side effects)
2) does not reduce absorption of fat soluble vitamins (ADEK)
3) it does not significantly reduce absorption of statins, digoxin, warfarin and most other drugs

361
Q

adverse effects of Ezetimibe (zetia)

A 
myopathy
rhabdomylysis
hepatitis
pancreatitis
thrombocytopenia
362
Q

benefit of Ezetimibe (zetia) over other bile acid sequestrants

A

no gi side effects

363
Q

drug interactions for Ezetimibe (zetia)

A

statins - combined increase risk for liver damage
fibrates - increase risk for gallstones
bile acid sequestrants
cyclosporine - may greatly increase levels of ezetimibe

364
Q

colesevelam and DM

A

promotes hypoglycemia

365
Q

what type of oral iron preparations are absorbed three times more readily and are more widely used

A

ferrous iron salts

ferrous sulfate
ferrous gluconate
ferrous fumarate
ferrous aspartate

366
Q

what is the major adverse effect of ferrous iron salts

A

GI disturbances - nausea, heartburn, bloating, constipation, diarrhea

367
Q

treatment of choice for iron deficiency anemia and for preventing deficiency when iron needs cannot be met by diet alone to include pregnancy or chronic blood loss

A

Ferrous sulfate

368
Q

who should not take oral iron by mouth

A

PUD
regional enteritis
ulcerative colitis

369
Q

oral iron may impart a dark green or black color to stool. What needs to happen

A

this effect is harmless and is not a sign of GI bleeding

370
Q

Iron and pt ed

A

Liquid iron can stain teeth
can be prevented by
1) diluting liquid preparations with juice or water
2) administering the iron through a straw or with a dropper
3) rinsing the mouth out after administering

371
Q

Iron tox

A

death from iron is rare in adults

in young children iron containing products is the leading cause of poisoning fatalities

372
Q

for children the lethal dose of elemental iron is

A

2-10 g

373
Q

_____ reduces absorption of iron

A

antacids

374
Q

Coadministration of iron with _______, decreases absorption of both

A

tetracyclines

375
Q

_______ promotes iron absorption but also increases its adverse effects

A

Ascorbic acid (Vit C)

offers no advantage over a simple increase in iron dosage

376
Q

what is a pure elemental iron in the form of microparticles. because of the microparticles, absorbed slowly so risk for tox is reduced

A

Carbonyl iron

377
Q

When iron therapy is successful, within 1 mth hgb levels will rise by at least 2g/dl. If they dont, what should the pt be evaluated for?

A

1) compliance
2) continued bleeding
3) inflammatory disease
4) malabsorption of oral iron

378
Q

the most prominent consequences of vit B12 deficiency are

A

anemia and injury to nervous system

anemia rapidly reverses after vit B12 administration
neurologic damage takes longer to repair and in some cases may never fully resolve

379
Q

additional effects of vit B12 deficiency are

A

gi disturbances

impaired production of WBCs and Platelets

380
Q

In the absence of ______, vit ___ is greatly reduced

A

intrinsic factor

B12

381
Q

causes of vit b12 def

A

regional enteritis
celiac disease
antibodies against Vit B12 intrinsic factor complex
Bariatric surgery

382
Q

when vit b12 deficiency is caused by an absence of intrinsic factor

A

pernicious anemia

383
Q

anemia in which large numbers of megaloblasts appear in bone marrow and macrocytes appear in blood

A

Megaloblastic anemia - B12 deficiency

384
Q

the hematologic effects of vit B12 def can be reversed with large doses of

A

folic acid

385
Q

early signs of Vit B12 def

A

paresthesias of hands and feet

reduction in deep tendon reflexes

386
Q

late developing signs of B12

A

loss of memory
mood changes
hallucinations
psychosis

if prolonged, damage can be permanent

387
Q

cyanocobalamin

A

vit B12

388
Q

treatment of severe vit B12 def

A

1) Im injection of vit B12 and folic acid
2) administration of 2-3 units of PRBCs (to correct anemia quickly)
3) transfusion of platelets
4) ABX if infection has developed

389
Q

what can mask the fact that vit B12 def still exists

A

folic acid

390
Q

causes of folic acid deficiency

A 
poor diet (esp in pt who abuse alcohol)
malabsorption secondary to intestinal disease
pregnancy
lactation
hemodialysis pt
chronic hemolytic anemias
certain drugs can cause folate def
391
Q

intestinal malabsorption disorder that decreases folic acid uptake

A

SPRUE

392
Q

symptoms of folic acid def

A

megaloblastic anemia
leukopenia
thrombocytopenia
injury to oral and gi mujcosa

393
Q

folic acid rec in preg

A

400-800ug each day

394
Q

treatment of severe folic acid def

A

IM injection of folic acid and vit B12

then continue with oral folic acid 1000u-2000ug/day for 1-2 weeks
then 400ug/day

Pharm 2 Exam (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions