Exam 2 Flashcards
1
Q
What are the 3 drugs for Cushing Syndrome?
A
- ketoconazole: inhibits glucocorticoid synthesis, hepatotoxic
- Pasireotide: inhibits ACTH secretion
- osilodrostat: inhibits glucocorticoid synthesis
2
Q
which is shorter acting: meglitinides or sulfonylureas?
A
meglitinides
must be taken with meals!
3
Q
what are the two alpha glucosidase inhibitors
A
acarbose
miglitol
4
Q
Whats the AE of nifedipine as a tocolytic?
A
Decrease uteroplacental blood flow
5
Q
What is the AE of indomethancin?
A
Can precipitate premature closing of ductus arteriosus
6
Q
What drug is used to prevent preterm labor
A
Hydroxyprogesterone caproate
7
Q
What 3 things can misoprostol be used for?
A
Postpartum hemorrhage, induction of labor, abortion (w/ mifepristone)
8
Q
3 sulfonylureas
A
Glimepiride
Glipizide
Glyburide
9
Q
What do sulfonylureas do?
A
Bind and block ATP k+ channels in panceeatic beta cells allowing for a a Ca+ influx and insulin release
10
Q
What are the 2 meglitinides
A
Nateglinide
Repaglinide
11
Q
Incretin
A
Hormone that stimulates glucose dependent insulin release and suppresses glucagon release post meals
12
Q
Which drugs increase incretin effects
A
Dipeptidyl peptidase 4 inhibitors
13
Q
What drugs mimic incretin
A
Glucagon like peptide 1 receptor agonists (the tides)
14
Q
Eztimibe MOA
A
Acts on brush border of small intestine and inhibits dietary cholesterol absorption and absorption of cholesterol in the bile
15
Q
Fibric acid derivatives MOA
A
Inhibit hepatic extraction of free fatty acids so the liver cant synthesIze as many TGs
16
Q
2 enzymes involved in cholesterol synthesis
A
HMG-Coa
ACL
17
Q
Indications for direct thrombin inhibitors
A
A fib
Knee and hip replacement
18
Q
Which direct thrombin inhibitor cant be given PO
A
Bivalirudin
19
Q
T/F: warfarin is contraindicated in pregnancy
A
True
20
Q
What kind of drug is rivaroxaban
A
Direct Xa inhibitor
21
Q
Which p2y12 receptor antagonist is reversible
A
Ticagrelor
22
Q
Most powerful antiplatelets
A
Gp IIb/IIIa receptor antagonists
23
Q
What drug removes thrombins that already exist
A
Alteplase = tissue plasminogen activator
24
Q
What do you use calcium gluconate for
A
Hyperkalemia and hyper magnesemia
Offsets hyper k effects on the heart
25
What are the two thiomaides (drugs for hyperthyroidism)?
Methimazole
| PTU
26
What are the SERMs
Tamoxifen
Raloxifene
Bazedoxifene
27
What are the non oral drugs for ED
Alprostadil
| Papverine + phentolamine
28
What are the two testosterone esters
Testosterone enanthate
| Testosterone cypionate
29
Metformin MOA
- inhibits glucose production in the liver
- sensitizes insulin receptors in target tissues
- reduces glucose absorption in the gut
30
Sulfonylurea MOA
-binds and blocks ATP K+ channels in pancreatic beta cell membranes → Ca+ influx and insulin release
31
meglitinide MOA
- stimulate pancreatic beta cell release of insulin
- shorter acting than sulfonylureas
- taken with meals only
32
glitazones MOA
Activate PPAR gamma → glitazones turn on insulin responsive genes in the cell nucleus that regulate carbohydrate and lipid metabolism → cellular insulin response are increased → promotes glucose uptake by skeletal muscle and adipose cells and decreases glucose production by the liver
33
Sodium Glucose Cotransporter 2 inhibitors MOA
-inhibits SGLT2 in renal tubules which allows increased renal excretion of glucose in proximal tubules → excrete excess glucose
34
effect of myelin mimetic
delays gastric emptying, suppression of glucagon
| -to decrease glucose rise post meals
35
amiodarone
K+ channel blocker
36
adenosine MOA
Binds to A1 receptors → activates opening of K+ channels → hyperpolarization, inhibition of pacemaker cells
potent vasodilator
37
what drug treats BPH and ED?
tadalafil
38
what are the 4 direct thrombin inhibitors
- dabigatran
- desirudin
- bivalirudin (IV infusion)
- argatrobin
39
Protease Activated Receptor 1 (PAR-1) Antagonist
vorapaxar
40
GP IIb/IIIa Receptor antagonists (3)
- abciximab
- tirofiban
- eptifibatide
41
P2Y12 ADP Receptor Antagonists (3)
- clopidogrel (irreversible)
- prasugrel (irreversible)
- ticagrelor (reversible)
42
HTN of pregnancy drugs
labetalol or methyldopa
43
side effect of sodium nitroprusside
cyanide toxicity d/t long term use
44
AE of digoxin
Too much: Cardiac dysrhythmias
Most common cause: hypoK+
GI effects: anorexia, N/V
CNS effects: fatigue and visual disturbances
**GI and CNS effects will precede dysrhythmias and act as a warning sign
45
how long does it take for spironolactone to act and why?
Onset is 48 hours - lifecycle of current exchange proteins needs to die off
46
osmotic diuretic indications
Only used in certain situations like severely increased ICP or Intraocular pressure
47
which diuretic is best for decreased GFR?
loop
48
what increases risk for gout (increased uric acid crystals)?
ACL inhibitors
| thiazide diuretics
49
contraindication of osmotic diuretics
Caution with HF and pulmonary edema risk
50
beta blockers effects
decreased HR, decreased contractility, decreased node conduction velocity
51
life threatening adverse effect of ACE inhibitors?
angioedema
| neutropenia
52
AE of hydralazine
- SLE like syndrome
- HA
- dizziness
- fatigue r/t hypotension
- fluid retention with long term use
53
for what drugs is heart block a contraindication?
digoxin
nondihyradpyrodines (vera and dil)
adenosine (high grade heart block)
54
important dosing info for nitroglycerin
use lowest effective dose because tolerance can develop rapidly
55
pros of tight glucose control
decreased CKD
decreased neuropathy
decreased opthalamic complications
decreased CV events
56
risks of tight glucose control
hypoglyemia and hypoglycemic coma
57
bile acid sequestrants MOA
Nonabsorbable resin that binds bile acids and other substances in GI tract, prevents absorption and promotes excretion of LDL cholesterol
*bile acids are made from cholesterol
58
Monoclonal antibody PCSK9 inhibitors MOA
-PCSK9 = protein that binds LDL receptors in the liver → inhibition = freed receptors = more LDL uptake
59
Ezetimibe AE
- myopathy/rhabdo
- hepatitis, pancreatitis
- thrombocytopenia
60
Which lowers LDL levels the most when used alone?
Monoclonal antibody PCSK9 inhibitors
61
signs and symptoms of myopathies
aches, tenderness, weakness) → can lead to CK + K+ increase which can lead to renal injury
62
what triggers intrinsic pathway
blood makes contact with a collagen that has been exposed as a result of trauma to blood vessel wall
Collagen contact simulations XII to XIIa → activates XI which activates IX which activates X
63
what triggers extrinsic pathway
damage to vascular wall → release of tissue factor → combines with VII → activates factor X → catalyzing of factor II (pro thrombin) and IIa (thrombin)
64
indications for direct Xa inhibitor
- PE/DVT prevention after ortho procedures
- CVA prevention with a fib
- DVT/PE prevention
- treatment of DVT / PE
65
how to treat acute hemorrhage?
- whole blood replacement
- FFP
- aminocaproic acid - will prevent further plasminogen activation
66
MOA of thyroid hormone
```
iodine uptake via TSH stimulation
iodine gets converted to iodide via peroxidase
binding of iodide and tyrosine
coupling of MIT and DIT
T3 and T4 created
T4 converts to T3
```
67
what drugs does levothyroxine alter
- warfarin - increased effects b/c increases breakdown of vit K clotting
- catecholamines - increases sensitization of myocardium
68
What are your biggest concerns when monitoring your patient taking PTU?
- Can result in goiter
| - severe: agranulocytosis, hepatotoxicity, other: vasculitis rash, arthralgias
69
cause of Toxic Nodular Goiter
Thyroid adenoma
| s/s same as Graves except exophthalmos
70
absolute CIs for OCs/HT
```
Pregnancy
Breast or endometrial CA
Acute liver disease
Uncontrolled HTN
Thrombosis
Undiagnosed vaginal bleeding
```
71
Dihydropyridines
- arteriole vasodilation → decreases afterload, lowers arterial pressure
- reflex tachycardia/contractility increase
72
Antiarrhythmic drugs 4 classes
Class I: Na+ channel blockers
Class II: BB
Class III: K+ channel blockers
Class IV: Ca++ channel blockers
73
what glucocorticoid is identical to cortisol
hydrocortisone
74
antiarrythmics used for ventricular tachycardia - what to use?
Na+ blockers or K+ blockers
75
antiarrythmics originating above the AV node - what to use?
Ca+ blockers or beta blockers
76
what would you use if patient has severe tachycardia but you don't know why?
adenosine
77
what BPH drugs target mechanical obstruction
PDE 5 inhibitors
78
which BPH drugs target dynamic obstructin (smooth muscle)
Alpha 1 adrenergic antagonists
- selective: silodosin, tamsulosin
- Nonselective - doxazosin, terazosin
79
what solution would you give if blood is hypertonic?
1/2 NS (.45% NaCl)
80
if you blood is isotonic, what solution do you give?
0.9% NS
D5W
D5LR
81
if blood hypotonic, what solution do you give?
3 or 5% NaCl
| D10W
82
eplerenone
aldosterone antagonist
83
adverse effects of metformin
- GI upset
- decrease folic acid/B12 absorption
- lactic acidosis - inhibits mitochondrial oxidation of lactic acid (rare)
84
INR
INR normal values - .8-1.1
| Therapeutic INR for warfarin is 2-3
85
drugs for preload
Diuretics
| ACE, ARBs, aldosterone antagonists
86
drugs for afterload
ACE, ARBs
BB - would reduce already reduced contractility
Arteriolar vasodilators
