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Pharmacology Exam 2 > Drugs Week 6-11 > Flashcards

Drugs Week 6-11 Flashcards

1
Q

Which drug categories are considered ANTIHYPERTENSIVES? (7)(8)

A
  • Diuretics
  • Calcium Channel Blockers
  • Beta Blockers
  • ACEi Inhibitors
  • ARB
  • (Direct Renin Inhibitor)
  • Central Acting Alpha Agonist
  • Nitrates
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2
Q

What are diuretics used for?

A

-Limit water and sodium reabsorption, this causes increased excretion of NA+ and water by kidneys.

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3
Q

What is the recommended initial therapy for all HTN patients?

A

Diuretics

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4
Q

What are the three main classifications of diuretics?

Short explanation of each.

A

Loop diuretics:

 - acts on ascending limb of loop of Henle
 - inhibits reabsorption of Na/K/2CL, thus preventing reabsorption of water that follows

Thiazide diuretics:

 - acts on the early part of the distal convoluted tubes
 - inhibits mechanisms that favor Na+ reabsorption, resulting in Na and K excretion and reabsorption of Ca+
  • Potassium-sparing diuretics
    • acts on the late part of the distal convoluted tubes
    • inhibits the sodium potassium pump, thus limiting the reabsorption of Na+ and excretion of K+
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5
Q

What is the biggest AE in all diuretics?

A

Dehydration

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6
Q

What are the other AE besides dehydration associated with Loop Diuretics?

A
  • hypokalemia (K+)
  • hyponatremia (Na+)
  • hypocalcemia (Ca+)
  • ototoxicity (ear)
  • hyperglycemia
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7
Q

What is an example of a Loop Diuretic?

A

furosemide (Lasix)

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8
Q

What are the AE associated with Thiazide Diuretics?

A
  • Same as loop diuretics except:
    • hypercalcemia
    • significant loss of K+
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9
Q

What is an example of a Thiazide Diuretic?

A

hydrochlorothiazide (HCTZ)

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10
Q

Why are Thiazide Diuretics helpful for older adults?

A

Thiazide diuretics reabsorb calcium unlike loop diureteics. This helps maintain bone density and prevent kidney stones.

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11
Q

What is the biggest AE associated with Potassium Sparing Diuretics?

A

Hyperkalemia

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12
Q

What is an example of a Potassium Sparing Diuretic?

What is different about this drug?

A
  • spiranolactone
  • It blocks aldosterone receptors which can produce:
    • gynecomastia in males
    • menstrual irregularities in females
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13
Q

Which diuretic is the most common?

Which diuretic is less effective in producing diuresis?

A
  • Thiazide

- Potassium Sparing

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14
Q

All diuretics reduce plasma volume. What does this cause?

A

-hyperglycemia

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15
Q

What drugs counteract diuretics?

A

NSAIDs (Na+ retention)

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16
Q

What are calcium channel blockers used for?

A

Block Ca2+ entrance into vascular smooth muscles, thus disallowing excitability, which in return causes vasodilation.

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17
Q

What are the AE assoiated with all calcium channel blockers?

A
  • HA
  • dizziness
  • hypotension
  • bradycardia
  • reflex tachycardia
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18
Q

What are the three classes of Ca+ Channel Blockers?

What do they each act on?

A

Dihydropyridines:
-reduce arteriolar tone

Phenylalkyamines:
-affect the heart

Benzothiazepines:
-affect heart and vasculature

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19
Q

When are Ca+ Channel Blockers useful?

A

When Beta Blockers are contraindicated.

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20
Q

What is an example of a dihydropyridine?

A

amlodipine

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21
Q

What is an example of a benzothiazepine?

A

diltiazem

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22
Q

How do Beta Blockers work?

What does this result in?

A

Block the effect of (nor)epinephrine. Act as a competitive antagonist of Beta adrenoceptors

Results in negative inotropic effect (SV)
Results in negative chronotropic effet (HR)

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23
Q

What does it mean when a Beta Blocker is nonselective?

A

It blocks both B1 and B2 adrenoceptors.

If it were selective it would only block B1.

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24
Q

Ultimately, Beta Blockers job is to reduce _________ influences. This in return means a reduce in what?

A

Sympathetic

Workload of the heart

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25
Q

What is an example of a NONSELECTIVE Beta Blocker drug?

A

-propranalol

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26
Q

What are the 2 cardioSELECTIVE (B1) Beta Blockers?

A
  • metropolol

- carvedilol

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27
Q

When a patient is on a Beta Blocker, should we monitor exercise tolerance by HR?

A

No, must use a different rate

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28
Q

What do Beta Blockers usually end in?

A

“-lol”

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29
Q

How do ACEi drugs work?

A

They block the conversion of angiotensin I to angiotensin II

angiotensin II acts to constrict blood vessels, ACEi drugs inhibit this

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30
Q

What do ACEi drugs usually end with?

A

“-pril”

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31
Q

What are the AE associated with ACEi drugs?

A

Common

  • Dry cough
  • Hypotension
  • Hyperkalemia

Rare, serious AE:

  • Acute renal failure
  • Angioedema
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32
Q

What patients would be on an ACEi drug for an extended amount of time?

A

Stroke victims

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33
Q

What are some examples of ACEi drugs?

A
  • lisinopril
  • enalapril
  • ramipril
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34
Q

How do ARBs work?

A

Blocks the binding of angiotensin II at AT1 receptor

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35
Q

What are the AE of ARBs?

A

Same as ACEi but without the dry cough

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36
Q

What do ARBs end in?

A

“-sartan”

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37
Q

When are ARBs used?

A

When ACEi intolerant, or when a cough is developed while on ACEi

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38
Q

What are some examples of ARBs?

A
  • losartan

- valsartan

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39
Q

What type of drug is the best tolerated of all HTN medications?

A

ARBs

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40
Q

What is considered the triply whammy?

A

ACEi, Diuretic, NSAID

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41
Q

How do Direct Renin Inhibitors work?

A

Block conversion of angiotensinogen to angiotensin I

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42
Q

What are the AE of Direct Renin Inhibitors?

A

Similar to ACEi/ARB

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43
Q

Should we take RAAS inhibitors in combination with other drugs?

A

No, due to increased AE

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44
Q

How do Central-Acting Alpha Agonists work?

A

Directly act on the CNS presynaptic neurons to cause a negative feedback loop resulting in less norepinephrine production.

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45
Q

What are the AE of Central-Acting Alpha Agonists?

A
  • Dizziness
  • Drowsiness
  • Fatigue
  • HA
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46
Q

What is an example of a Central-Acting Alpha Agonist drug?
What is it reserved for?
AE?
Route?

A

clonidine

  • reserved for resistant HTN
  • dry mouth, rash with patch
  • PO or weekly patch
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47
Q

How do Nitrates work?

A
  • Work directly on smooth muscle instead of a receptor (MOA unknown)
  • Appears to decrease preload and afterload which in return reduces the workload of the heart
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48
Q

What are the forms of nitrate?

Which are long acting and which are short acting?

A

Long acting:

  • oral
  • transdermal

Short acting:

  • sublingual
  • chewable tablet
  • IV
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49
Q

What are some examples of nitrates?

A
  • nitroglycerin

- isosorbide mononitrate

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50
Q

What is different about ISMN (isosorbide mononitrate) and ISDN (isosorbide dinitrate)?

A

ISDN undergoes significant first-pass metabolism and has a half-life of 1 hour.
ISMN has a half-life of 4-6 hours

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51
Q

What is unique about the storage of nitrates?

A
  • Limited light exposure (kept in brown bottle)
  • Short shelf life (6m unopened, 3m opened)
  • Tingling sensation as drug dissolves= active drug
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52
Q

Dosing of nitrates:

  • After 1st dose, relief should occur in ____.
  • 2nd dose if symptoms are still present after ___ (up to _ doses in __ minutes)
A

-1-2 minutes

5 minutes/ 3 doses in 15 minutes

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53
Q

What is possible if no relief occurs?

A

Possible MI

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54
Q

What are the AE of nitrates?

A
  • reflex tachycardia
  • dizziness
  • OH
55
Q

What situations are nitrates used in?

A

Angina and HTN (adjunct treatment)

56
Q

What other drugs are used to treat angina?

A

Beta Blockers and Calcium Channel Blockers

57
Q

END ANTIHYPERTENSIVE DRUGS

A

END ANTIHYPERTENSIVE DRUGS

58
Q

List of need to know ANTITHROMBOTIC drugs.

A
  • Aspirin
  • Clopidogrel (Plavix)
  • Enoxaparin (Lovenox)
  • Apixaban (Eliquis)
  • Rivaroxaban (Xarelto)
59
Q

What are some examples of conditions that would need Antithrombotic drugs?

A

Venous thrombosis:

  • Superficial- UE or LEs, due to varicose veins
  • Deep- 3rd most common CV disease

Pulmonary Emboli

  • often originate in deep veins of pelvis and legs
  • lodges in lung capillaries
60
Q

Pulmonary emboli can happen ______ ________.

A

Without warning

61
Q

What are the three subclasses of antithrombotics?

A
  • Antiplatelets
  • Anticoagulants
  • Fibrinolytics
62
Q

L8S26 HEMOSTASIS

63
Q

How do antiplatelets work?

A

Prevent the aggregation of platelets

64
Q

How does the Antiplatelet Aspirin work?

A
  • Inhibits COX-1 and COX-2 which decreases the production of thromboxane A2 which inhibits platelet aggregation
  • At low doses (81mg), COX-1 is the primary one inhibited for CV protection
65
Q

How do Antiplatelets- ADP Receptor Inhibitors (Irreversible) work?

A
  • active metabolite irreversibly blocks P2Y12 receptors on platelets
  • blocks ATP binding
  • blocks activation of GP IIb/IIIa receptor complex
  • decreases platelet aggregation

In Short:

  • blocks ADP binding
  • blocks GP IIb/IIIa
  • decreases aggregation
66
Q

Since these drugs are irreversible, how long will they last after discontinuing the drug?

A

lifespan of the platelet (7-10 days)

67
Q

What is an example of a ADP Receptor Inhibiting (Irreversible) Antiplatelet?

A

clopidogrel (Plavix)

68
Q

Plavix is a ________ and ________ antagonist

A

noncompetitive and irreversible

69
Q

What is the biggest concerns with these drugs?

A
  • Bleed, avoid falls

- DD interactions can impact efficacy of these drugs

70
Q

What is the difference between a Reversible and Irreversible ADP Receptor Inhibitor?

A

Reversible can have a shorter impact, most everything else is the same.

71
Q

When are ADP Receptor Inhibitor Antiplatelets used?

A
  • ACS (acute coronary syndrome)

- stroke= only Plavix

72
Q

What are the Parenteral Anticoagulants?

What are the PO Anticoagulants?

A

Parenteral

  • Heparin
  • Low-molecular weight heparin (LMWH)
  • Fondaparinux (Arixtra)
  • Direct thrombin inhibitors

PO

  • Vitamin K antagonist
  • Direct thrombin inhibitor
  • Factor XA inhibitors
73
Q

How does Heparin work?

A

Potentiates antithrombin which inactivates thrombin and FXa.

This results in the preventing the conversion of fibrinogen to fibrin.

74
Q

How does LMWH work?

A

Works like Heparin but has a greater effect on inhibiting FXa than thrombin

75
Q

Is Heparin or LMWH preferred?

76
Q

What is the most common LMWH?

A

enoxaparin (Lovenox)

77
Q

How do IV Direct Thrombin Inhibitors work?

A

Bind directly and reversibly to thrombin

78
Q

Which 2 drugs are more specific to factor Xa?

A

LMWH and fondaparinux (Arixtra)

79
Q

How does Warfarin (VKA) work?

A

Binds to KORC1, an enzyme that converts inactive vitamin K to active vitamin K, depletes vitamin K stores, which in return inhibits synthesis of Factors… and protein C and S

80
Q

What is the reversal agent of Warfarin?

81
Q

Does Warfarin have an immediate effect?

A

No, 3-5 days for full effect. Longer to stabilize dose.

82
Q

Warfarin is considered a ___ drug, meaning it requires frequent monitoring of INR (normal~1).

83
Q

What is considered normal INR for AF and VTE?

84
Q

Warfarin has ____ drug and food interactions

85
Q

How do Factor XA inhibitors work?

A

selectively and reversibly binds to FXa which stops further coagulation cascade

86
Q

What do factor XA Inhibitors end in?

A

“-xaban”

87
Q

What are some examples of XA Inhibitors that are commonly prescribed?

A
  • rivaroxaban (Xarelto)

- apixaban (Eliquis)

88
Q

What are the main things to monitor for when taking antiplatelets or antithrombotics?

A
  • Bleeding

- Clotting

89
Q

How do Fibrinolytics work?

A

Breaks fibrin links in the thrombus

90
Q

When do we use Fibrinolytics?

A

After stroke, MI, PE

91
Q

Fibrinolytics are the only meds that do what?

A

Break up a clot

92
Q

What is atherosclerosis?

What kind of LDL and HDL numbers do we want?

A

-Narrowing and hardening of the arteries

  • LDL= want it low
  • HDL= want it high
93
Q

What are the medication used to treat atherosclerosis?

A
  • HMG-CoA Reductase Inhibitors (Statins)
  • PCSK9 Inhibitors
  • Bile Acid Sequestrants
  • Fibrates
  • Omega-3 Fatty Acids
  • Niacin
94
Q

How do HMG CoA REDUCTACE INHIBITORS “Statins” work?

A

Block HMG-CoA reductase= blocks cholesterol synthesis.

95
Q

What is the most common AE of Statins?

96
Q

What are other AE of Statins?

A
  • Dyspepsia
  • HA
  • increase liver function enzymes\
  • possible tendon rupture
97
Q

What are some examples of some Statins?

A
  • Atorvastatin (Lipitor)
  • Rosuvastatin (Crestor)
  • Simvastatin
  • Pravastatin
98
Q

What are some other cardiac meds that are used?

A
  • sacubitril/valsartan (Entresto) (ARNI class)
  • Digoxin
  • Amiodarone
99
Q

Both sacubitril and valsartan act to do what?

A

Increase vasodilation

100
Q

How does digoxin work?

A
  • Inhibits Na+/K+ ATPase pump in myocardial cells.

- Helps the heart beat stronger and with a more regular rhythm

101
Q

What is Digoxin mainly used for?

A

Symptom control

102
Q

What is the main S/Sx of toxicity with Digoxin?

A

Visual changes (halos around yellow-green color spectrum)

103
Q

Who is mainly at risk for toxicity?

A
  • Low body weight

- Advanced age

104
Q

What is arrhythmia?

A

A disturbance of HR or rhythm

105
Q

What is arrhythmia classified by? (3)

A

Origin-ventricular or atrial
Pattern- fibrillation or flutter
Speed/rate- brady or tachy

106
Q

Arrhythmia means there is a dysfunction in the what?

107
Q

What is an example of a drug used to treat arrhythmia?

A

amiodarone

108
Q

How does amiodarone work?

A

Prolongs the duration of the action potential by blocking K+ channels.

Used for ventricular arrhythmias

109
Q

Important AE to note with amiodarone?

A
  • Bluish discoloration on exposed areas of the skin

- LFTs, TFTs, PFTs

110
Q

Does amiodarone have a short or long half life?

A

Long (50 days)

111
Q

INHALED MEDICATIONS are divided into what subclasses?

A
  • Inhaled Beta Agonist Medications
  • Inhaled Antimuscarinic (antocholinergic)
  • Inhaled Corticosteroids
  • Combination Inhaled Medications
  • Inhaled Mucolytic
112
Q

How do Inhaled Beta Agonists work?

A

Agonize B2 receptor= bronchodilation

113
Q

What do Inhaled Beta Agonists end in?

A

“-terol”

114
Q

Inhaled Beta Agonists are divided into what 2 categories?

115
Q

What is an example of a Inhaled Beta Agonist?

A

albuterol (ProAir, Ventilon)

116
Q

How do Inhaled Antimuscarinics work?

A

Bind M3 in airway smooth muscle; antagonizes ACh actions at these sites= bronchodilation

117
Q

Inhaled Antimuscarinics are divided into what 2 categories?

118
Q

What are the AE of Inhaled Antimuscarinics?

A

Dry mouth

generally well tolerated

119
Q

What is an example of a Inhaled Antimuscarinic?

Is it a SAMA or a LAMA?

A

tiotropium (Spiriva)

Long Acting

120
Q

What are Inhaled Corticosteroids usually used for?

A

Exacerbations or more severe disease

121
Q

What is the main AE of Inhaled Corticosteroids?

A

oral candidiasis

122
Q

What do most Inhaled Corticosteroids end in?

A

“-asone”

123
Q

What is an example of a Inhaled Corticosteroid?

A

fluticasone (Flovent)

124
Q

What is the purpose of Combination Products?

A

May increase effect with lower AE as compared to increase in dose of a single product

125
Q

What are some examples of Combination Products?

A
  • fluticasone/salmeterol (ICS/LABA) (Advair)
  • formoterol/budesonide (LABA/ICS) (Symbicort)
  • albuterol/ipratropium (SABA/SAMA) (Combivent)
126
Q

How do Inhaled Mucolytics work?

A

Cleave DNA thus decreasing mucous viscocity which improves airflow

127
Q

What are the AE of Inhaled Mucolytics?

A
  • chest pain
  • cough
  • voice disorder
  • skin rash
128
Q

What are some examples of Inhaled Mucolytics?

A
  • hypertonic saline

- dornase alfa (Pulmozyme)

129
Q

How do Leukotrine Modifiers work?

A

Release from mast cells and eosinophils to play a role in airway edema

130
Q

What is an example of a Leukotrine Modifier?

A

-montelukast (Singulair)

131
Q

What is montelukast used for?

A

Asthma

-take once daily in evening (for allergies can only use in the AM)

132
Q

How do Immunomodulators: Anti IgE work?

A

binds IgE antibodies which prevents IgE binding to receptors on mast cells and basophils

133
Q

What are the AE of Immunomodulators?

A

HA, injection site reaction

134
Q

What is an example of an Immunomodulator: Anti IgE?

A

omalizumab (Xolair)

Pharmacology Exam 2 (7 decks)

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