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BECOM 3 > Exam #2 (Pharmacology) > Flashcards

Exam #2 (Pharmacology) Flashcards

1
Q

Use Dependence

A

drug binds in the open/inactive state (0/3)

-better effect at higher HR

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2
Q

Reverse Use Dependence

A

drug binds better to resting state (4)

-better effect at lower HR

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3
Q

Class I
Class II
Class III
Class IV

A

Class I: Na+ channel blocker
Class II: Beta blocker
Class III: K+ channel blocker
Class IV: Ca2+ channel blocker

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4
Q

EKG result
Na+ blocker
K+ blocker

A

Na+ Blocker = wider QRS

K+ Blocker = inc QT interval

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5
Q

Procainamide adverse effect

A

Drug induced Lupus Syndrome

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6
Q

Quinidine adverse effect

A

Cinchonism (headache, tinnitus, dizziness)

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7
Q

Class IA Antiarrhythmic indication

A

short term atrial and ventricular arrhythmic treatment

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8
Q

Class IB Antiarrhythmic indications

A

POST-MI ventricular arrhythmia
prevention of ventricular fibrillation
(ventricular only)

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9
Q

lidocaine vs mexiletile therapeutic index

A

Lidocaine: Wide therapeutic index
Mexiletine: Narrow therapeutic index

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10
Q

Class IC Antiarrhythmic indication

A

supraventricular arrhythmia and atrial fibrillation

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11
Q

Flecainide vs Propafenone blockage

A

Flecainide: inhibits Na+ and K+ channelsPropafenone: only inhibits Na+ channels

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12
Q

Amiodarone indication

A

severe ventricular arrhythmia

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13
Q

Amiodarone adverse effects

A
  • hypothyroidism but also hyperthyroidism
  • Bradycardia/Heart blocker
  • Hepatotoxicity
  • Photodermatitis (blue skin)
  • Pulmonary fibrosis
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14
Q

Amiodarone half life

A

58 days (stays in lipid rich tissue)

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15
Q

Dronedarone indication

A

atrial fibrillation

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16
Q

Sotalol blockage

A

K+ and beta blocker

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17
Q

1 for persistent atrial fibrillation

A

Dofetilide

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18
Q

1 for chemical conversion of atrial flutter

A

Ibutilide

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19
Q

REVERSE USE DEPENDENCE

A

Sotalol

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20
Q

-olol

A

Beta blockers

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21
Q

beta blocker adverse effects

A
  • Bronchoconstriction -> fatigue
  • Vasoconstriction -> sexual disfunction, dizziness (inhibits vasodilation)
  • Decrease CO -> arrhythmias up abrupt withdrawal, bradycardia
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22
Q

B-adrenergic Receptor Antagonist causes

A

Prolongs heart rate, AV conduction, and contractility

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23
Q

beta blocker w most B1 selectivity

A

Metoprolol

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24
Q

what to give for Acute arrhythmia that occurs during surgery

A

Esmolol

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25
Q

Acebutolol is a

A

B1 partial agonist

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26
Q

Non-dihydropyridine Ca2+channel blockers and action

A

Verapamil
Diltiazem
-reduce phase 4 spontaneous depolarization on SA and AV node

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27
Q

USE DEPENDENT drugs

A

Diltiazem

Verapamil

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28
Q

Verapamil indication

A

-prophylaxis for Paroxysmal Supraventricular Tachycardia

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29
Q

Digoxin causes

A

Increases contractility

increase vagal tone (Slows AV node conduction)

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30
Q

Adenosine indication

A

WPW syndrome and AVNRT

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31
Q

pharmacologic stress test drug

A

adenosine

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32
Q

Atropine MOA and use

A

Muscarinic receptor antagonist blocking the vagal nerve stimulation to reverse sinus bradycardia and AV nodal block

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33
Q

what drug do you give for bradycardia

A

Atropine

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34
Q

what drug do you give for torsades de pointes

A

magnesium sulfate

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35
Q

-pril

A

ACE inhibitors

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36
Q

bradykinin effect on vasodilators

A

potent vasodilator (stimulates release of NO and prostacyclin)

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37
Q

ACEi and Angiotensin II Receptor BlockersContraindication

A
  • Pregnancy (teratogenic)

- Condition that cause low renal perfusion

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38
Q

ACEi and Angiotensin II Receptor Blockers adverse effects

A 
Acute renal failure
Hyperkalemia
Angioedema
Hypotension due to hypovolemia
Alteration of taste
Neutropenia
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39
Q

ACE inhibitors Drug Interactions

A
  • potassium supplements or K+ sparing diuretics = hyperkalemia
  • NSAIDs
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40
Q 
ACE inhibitor half life
Captopril
Enalapril
Fosinopril
Lisinopril
A

Captopril: 2hr
Enalapril: 11 hrs
Fosinopril: 11.5 hrs
Lisinopril: 12 hrs

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41
Q

ACEi with….. increase risk for angioedema

A

Sacubitril and Valsartan

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42
Q

-sartan

A

Angiotensin II Receptor Blockers

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43
Q

Losartan can also be used for

A

Diabetic nephropathy

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44
Q

Neprilysin inhibitor action

A

inhibits degrades vasoactive and natriuretic peptides, bradykinin and adrenomedullin

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45
Q

Renin Inhibitor

A

Aliskiren

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46
Q

Alpha 2 Receptor Agonist drug names

A

Clonidine

Methyldopa

47
Q

Alpha 2 Receptor Agonist MOA and cause

A

MOA: binds to presynaptic alpha 2 receptor in the brainstem and activates it leading to dec NE release and dec sympathetic tone

  • Dec TPR
  • Dec renal vascular resistance
  • Dec heart rate and contractility (clonidine > methyldopa)
  • Inc parasympathetic tone
48
Q

Hypertension (ADHD) treatment

A

Clonidine

49
Q

Clonidine adverse effect

A

Rebound hypertension if sudden discontinuation

50
Q

Methyldopa prodrug derivative

A

α-methylnorepinephrine

51
Q

Methyldopa adverse effect

A

Hemolytic Anemia

52
Q

Alpha Receptor Antagonist MOA

A

antagonist of α1 adrenergic receptors leading to relaxation of smooth muscle and vessels

53
Q

Alpha Receptor Antagonist advers effect

A

orthostatic hypotension (dec baroreflex)

54
Q

Benign Prostatic Hyperplasia treatment

A

Doxazosin

55
Q

-sin and Phenoxybenzamine

A

Alpha Receptor Antagonist

56
Q

Phenoxybenzamine differs from other alpha receptor antagonists how

A

NON-SELECTIVE

-bind both a1 and a2 receptors as well as H-1 histamine, acetylcholine and serotonin receptors

57
Q

Pheochromocytoma treatment

A

Phenoxybenzamine

58
Q

Reflexive Tachycardia

A
  • Binds A1 receptors resulting in dec vasoconstriction
  • Binds A2 receptors but not an inhibitor (agonist) so NE can’t bind to give negative feed back resulting in inc NE release. NE circulates to the heart leading to inc HR.
  • in alpha antagonist
59
Q

Atenolol special bc

A

selective B1 receptor blocker

60
Q

Labetalol special bc

A

selectively blocks α1 & nonselective β1 and β2 receptor

-dose-related falls in blood pressure without reflex tachycardia and without significant reduction in heart rate

61
Q

Preferred drug of choice for hypertension

A

Calcium Channel Blockers

62
Q

Dihydropyridines drugs

A

Nifedipine

Amlodipine

63
Q

Dihydropyridines act on and action

A

mainly blood vessels by blocking Ca2+ channels dec cAMP leading to vasodilation

64
Q

-statins

A

Competitive inhibitors of HMG-COA reductase

65
Q

statins lead to

A

Dec cholesterol
Up regulation of LDL receptors
Uptake of LDL from blood
Low intracellular cholesterol -> dec VLDL production

66
Q

statin contraindications

A

Pregnant, becoming pregnant, or lactating

67
Q

statin digest facts

A
  • Best if taken at night bc thats when cholesterol production occurs
  • Absorption best when taken with food
68
Q

statin adverse

A

HEPATOTOXICITY

MYOPATHY

69
Q

statin plus what drug increase risk for myopathy

A

Amiodarone or Verapamil

70
Q

Grapefruit Juice

A

increase bioavailability of statins

71
Q

Pravastatin special bc

A

Metabolized non-P450 pathway (can be taken w other drugs)

72
Q

Bile Acid Binding Resins drug name

A

Cholestyramine

73
Q

Cholestyramine MOA

A

bind bile in the lumen of the intestines and prevents reabsorption -> loss of bile leads to increase bile acid formation from cholesterol reducing hepatic cholesterol
-dec cholesterol upregulates LDL receptors

74
Q

Cholestyramine drug interactions

A
  • Delayed/reduced absorption of oral medications

- Prevention of absorption of fat soluble vitamins (dec bile)

75
Q 
Nicotinic Acid (Niacin)
MOA
A

inhibits hormone sensitive lipase in adipose tissue preventing the breakdowns of TAGs to free fatty acids and the transport of free fatty acids to the liver
-reduction of FA transport to liver -> dec hepatic TAG synthesis -> dec secretion of VLDL by liver -> dec LDL

76
Q

main drug that increases HDL

A

niacin

77
Q

Statins indication

A

Protocol to administer after MI no matter lipid levels

78
Q

niacin + statin indignation

A

heterozygous familial hypercholesterolemia and other forms of hypercholesterolemia

79
Q

Fibric Acid Derivatives drugs

A

Gemfibrozil

Ezetimibe

80
Q

Fibric Acid Derivatives MOA

A

inhibits cholesterol absorption by enterocytes in the small intestines by inhibiting transport protein NPC1L1

81
Q

what inc/dec Ezetimibe blood level

A
  • Increase levels when given w fibrates

- Decrease levels when given w cholestyramine

82
Q

PCSK9 inhibitors drugs

A

Alirocumab/Evolocumab

83
Q

PCSK9 inhibitors MOA

A

inhibits the enzyme PCSK9 which binds to the LDL receptor targeting it for lysosomal degradation
-enhances the removal of LDL from circulation

84
Q

MTP Inhibitor drug

A

Lomitapide

85
Q

MTP Inhibitor MOA

A

Binds and inhibits microsomal triglyceride transfer protein (MTP), preventing the assembly of apo B containing lipoproteins in enterocytes and hepatocytes

86
Q

Mipomersen MOA

A

antisense oligonucleotide that binds to human messenger ribonucleic acid (mRNA) for apo B-100 preventing its translation -> dec VLDL and LDL

87
Q

binds to human messenger ribonucleic acid (mRNA) for apo B-100 drug name

A

Mipomersen

88
Q

Nitrate MOA

A

Nitrate -> NO -> inc cGMP -> activation of myosin LC phosphatase -> Dephosphorylates Myosin-LC -> inc vessel relaxation
-dilates veins more than arteries (dec preload)

89
Q

high dose nitrate

A
  • Dilation of arteries reduces afterload

- Possibility of reflex tachycardia

90
Q

Nitrate effect of platelets

A

Stimulates guanylyl cyclase in platelets preventing platelet aggregation
-inc cAMP dec adenosine binding

91
Q

nitrate Contraindications

A
  • Cant be given with Sildenafil (Viagra)
  • hypotension
  • Increase intracranial pressure or dec cranial blood flow
92
Q

Isosorbide Dinitrate

A

longer half-life than nitroglycerin (better for chronic angina)

93
Q

nitrates can cause (adverse effect)

A

headaches

94
Q

DO NOT PRESCRIBE …… FOR VASOSPASTIC ANGINA

A

BETA BLOCKERS

95
Q

Ranolazine MOA and use

A
  • blocks LATE Na+ channels leading to a reduction in intracellular Na+, this results in a decrease in action of Na+/Ca2+ exchanger -> dec contractility
  • also blocks K+ rectifying channels
  • 2nd line angina
96
Q

Dipyridamole MOA and use

A

inhibits PDE preventing the degradation of cAMP (inc) leading to decrease uptake of adenosine by RBCs and endothelial cells
-antiplatelet during angina

97
Q

what does and doesn’t benefit from fibrinolytic in angina

A

DO NOT: Unstable Angina and NSTEMI

DO: STEMI

98
Q

Treatment of Unstable Angina/MI (Dr. Lee pneumonic)

A 
MONA
Oxygen
Aspirin
Nitroglycerin
Morphine
99
Q

Systolic
(Heart Failure with Reduced Ejection Fraction)
4 main drugs

A 
-ACEi (Captopril, Enalapril, Fosinopril, Lisinopril)
ARB (Losartan, 
-Candesartan, Valsartan,
-Beta Blockers
-Aldosterone Antagonist (Spironolactone)
100
Q

Diastolic Heart Failure (Heart Failure with Reserved Ejection Fraction) treatment

A
  • No direct therapies
  • Try to treat HTN, diabetes, or a. Fib
  • Mainly diuretics
101
Q

Beta Blockers use in heart failure and dose

A
  • Reverse heart failure gene programing

- Start at low dose and increase slowly

102
Q

Spironolactone drug type and MOA

A
  • Aldosterone Antagonist

- acting primarily through competitive binding of mineralocorticoid receptors in the collecting tubule

103
Q

Spironolactone contraindications

A

Renal Impairment
Hyperkalemia
Pregnancy

104
Q

Spironolactone Adverse Effects

A

Gynecomastia

105
Q

Spironolactone Drug Interactions

A

NSAIDs
Digoxin
ACEi/ARBs can lead to hyperkalemia

106
Q

ARB (Valsartan) + Neprilysin Inhibitor used to treat

A

Heart Failure with Reduced Ejection Fraction

107
Q

Dobutamine drug type and MOA

A

B1 agonist

-positive inotrope that bind B1 receptor increasing Ca2+ sequestration in the SER leading to increase contractility

108
Q

Phosphodiesterase Inhibitor 3

A

Milrinone

Enoximone

109
Q

Phosphodiesterase Inhibitor 5

A

Sildenafil

Tadalafil

110
Q

Ivabradine MOA

A

inhibition of the Na+ funny channels leading to prolonged diastole depolarization and dec HR

111
Q

Ivabradine indication

A

HF with EF <35% with HR >70 bmp and are on max beta blockers or have contraindications to beta blockers

112
Q

inc coumarin toxicity

A

gemfibrozil

113
Q

don’t give for homo

A

cholestyramine

114
Q

give for hypertriglyceridemia which VLDL predominates

A

gemfigrozil

BECOM 3 (8 decks)

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