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Pharmacology 1 > Exam 5 > Flashcards

Exam 5 Flashcards

1
Q

These drugs block the sympathetic nervous system response:

A

Adrenergic antagonists

They lower BP
Reduce HR, CO
Dilate arterioles

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2
Q

When would you use direct acting vasodilator?

A

Emergency situations.

Serious side effects.

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3
Q

Collapse of alveoli:

A

Atelectasis

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4
Q

Inflammation of the lung from stasis or pooling of secretions:

A

Hypostatic pneumonia

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5
Q

What is a second-line drug?

A

Any therapeutic agent that is not the drug of choice.

Only used to treat disease that is resistant to first line therapy.

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6
Q

This drug is a direct vasodilator that acts directly on the arteriole smooth muscle - selective for arterioles:

A

hydralazine (Apresoline)

  • Acts directly on the arterial smooth muscle to cause peripheral vasodilation-selective for arterioles
  • Used to treat moderate to severe HTN
  • orthostatic hypotension not an issue
  • Veins don’t dilate
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7
Q

Adverse effects of hydralazine:

A
  • Headache
  • Reflex tachycardia-compensatory increase in HR
  • Palpitations
  • Flushing
  • Nausea & Diarrhea
  • Exacerbates lupus like symptoms
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8
Q

This direct vasodilator is used to treat HTN that is unresponsive to other meds:

A

minoxidil (Loniten)

More toxic than hydralazine-same adverse effects

Causes hypertrichosis= elongates, thickens, increased pigmentation of hair

Topical form of drug used to treat male pattern baldness, hair loss (Rogaine)

Other systemic adverse effects not seen-not absorbed into systemic circulation

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9
Q

This direct vasodilator is used to treat hypertensive crisis (diastolic > 120 mm Hg):

A

nitroprusside sodium (Nitropress)

Lowers BP instantaneously
Dilates BOTH arteries and veins

Patients must be continuously monitored due to risk of severe hypotension, lack of perfusion to organs

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10
Q

How do you dose HTN treatment drugs?

A
  • Initial LOW dose (High dose would increase Adverse Effects)
  • Gradually increase (When BP reduced slowly baroreceptors gradually reset to lower BP)
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11
Q

Condition where there is an inadequate oxygen supply to the heart, most often secondary to CAD:

A

Angina

Sudden pain beneath the sternum, often radiating to the left shoulder and arm. Can also radiate to jaw.

Can be constant or crushing sensation. Feeling of impending doom.

Women experience more obscure symptoms.

Pallor, dyspnea, diaphoresis, tachycardia, HTN.

Precipated by exertion on heart (exercise, emotionally charged event)

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12
Q

Risk factors of Angina?

A

Same as coronary artery disease… lifestyle factors.

  • Smoking
  • High cholesterol
  • Hypertension
  • Diabetes
  • Obesity
  • Physical inactivity
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13
Q

Goal of anti-anginal drugs:

A
  • Increase oxygen delivery
  • Decrease oxygen demand by:
    decrease workload of heart
    reducing the heart rate
    reducing the afterload
  • Prevent vasospasms (because that reduces blood flow)
  • Reduce pain
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14
Q

This organic nitrate drug is old and is the preferred drug of choice to treat an acute attack of angina and exercise-induced angina:

A

Nitroglycerin (Nitrostat, Nitro-Bid)

Comes in MANY forms of administrations.

Nitroglycerin forms nitric oxide which causes a release of Calcium ions in smooth muscle which relaxes both arteriole and venous smooth muscle causing vasodilation.

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15
Q

This anti-hypertensive causes hypertrichosis:

A

minoxidil (Loniten)

also used topically for male pattern baldness - Rogaine.

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16
Q

What do we call it when the heart is unable to punch sufficient blood to meet the metabolic needs of the body?

A

Heart Failure (HF)

May occur on the LT or the RT side of the heart or combination of both.

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17
Q

What may cause HF?

A

Chronic HTN

MI

Mitral stenosis (narrowing of MV)

CAD

Diabetes

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18
Q

What is LT sided HF often referred to as?

A

Congestive Heart Failure (CHF)

Characterized by fluid accumulation in the pulmonary capillaries.

See LT ventricular hypertrophy to compensate for the increased work load. Having difficulty getting the blood pumped out.

19
Q

When blood is pooling in the veins that is a sign for what?

A

Right-sided HF

Will see peripheral edema from insufficient return of veins… backing up.

Will also see organ-engorgement. Especially the liver.

20
Q

Contraindications of Atenolol (Tenormin):

A

Patients with ischemic heart disease.

Don’t want to abruptly cease administration because the angina can worsen and lead to MI. Must gradually taper off for these patients.

21
Q

Causes hypertrichosis:

A

minoxidil (Loniten)

also used topically for male pattern baldness - Rogaine.

22
Q

What do we call it when the heart is unable to punch sufficient blood to meet the metabolic needs of the body?

A

Heart Failure (HF)

May occur on the LT or the RT side of the heart.

23
Q

What may cause HF?

A

Chronic HTN

MI

Mitral stenosis

CAD

Diabetes

24
Q

What is LT sided HF often referred to as?

A

Congestive Heart Failure

Characterized by fluid accumulation in the pulmonary arteries.

25
Q

When blood is pooling in the veins that is a sign for what?

A

Right-sided HF

Will see peripheral edema from insufficient return of veins… backing up.

26
Q

Thromboembolic Disorders:

A 
Venous thromboembolism (VTE) occurs when blood flow in the veins is slow and stagnant. 
AKA : Veinous stasis.

2 manifestations: Deep V thrombosis (mostly in legs from: immobility, trauma, hyper-coagulated states, some drugs, and surgery)

Pulmonary embolism is from a dislodged clot that migrates to the pulmonary vessels.

27
Q

Only direct Thrombin Inhibitor, that does not require constant lab monitoring:

A

Dabigatran

Binds directly to thrombin.

No osteoporosis

No labs

No mechanical heart valves

Black box: spinal/epidural hematomas

Stop dosage slowly to prevent thrombolytic event.

28
Q

This anticoagulant is the drug of choice to treat thrombolytic disease:

A

Heparin

Given parenterally in emergencies.

Derived from animal tissue (its a carbohydrate)

Okay for pregnancy

Inhibits thrombin - factor Xa
Prevents NEW clots not old

May be given in form of low molecular-weith heparin - called Lovenox - SQ injection in abdomen, more predictable results.

29
Q

Nursing interventions regarding Heparin adverse effects:

A

H.I.T. unusual clotting

ATTP lab values
Monitor platelets
Used for Hep Lock

30
Q

Adverse effects of Heparin:

A

Hemorrhage, may be fatal

Heparin Induced Thrombocytopenia (HIT):

31
Q

What is the most common oral anticoagulant on the market?

A

Warfarin (Coumadin)

Mechanism of action: Inhibits 2 enzymes that form vitamin K (vitamin K is needed to make certain clotting factors)

This doesn’t affect the clotting factors already circulating in the blood… have to wait 3-4 days to see therapeutic effect.

32
Q

What conditions would you give Heparin for?

A

Deep Vein Thrombosis

Pulmonary Embolism

Unstable angina

MI

Prevention of thrombosis in high risk patients

To keep clots from forming in peripheral/central lines (“hep lock”)

33
Q

How often do warfarin patients need to have their blood drawn?

A

Every week or month. To monitor PT-INR values.

34
Q

Action taken to prevent disease, especially by specified means or against a specified disease:

A

Prophylaxis

35
Q

When would you use Warfarin?

A

Prophylaxis of arterial thromboembolism

Stroke - TIAs

MI

Afib

Treatment and prevention of DVT/PE in surgery patients

Prosthetic heart valves

36
Q

Adverse effects of Warfarin?

A
  • Abnormal bleeding
  • Systemic microembolization: pieces of plaque released into circulation that can occlude small vessels leading to gangrene and amputation.
  • Osteoporosis and bone fractures
  • Fetal abnormalities and death
37
Q

This anticoagulant is more expensive and cannot be used by patients with mechanical heart valves:

A

Dabigatran (Pradaxa)

New oral med approved in 2010.

Adverse effects: Bleeding, abrupt discontinuation can increase thrombotic event.

38
Q

Three antiplatelets used to reduce aggregation properties of platelets:

A

Aspirin

Adenosin diphosphate (ADP) receptor blockers - Clopidogrel (Plavix)

Glycoprotein IIb/IIIa receptor blockers - Abciximab (Reopro)

39
Q

This antiplatelet’s mechanism of action is binding to the COX enzyme in platelets which inhibit platelet aggregation:

A

Aspirin - approved in 1939

A single dose can last as long as a week!

40
Q

When would you use Aspirin?

A

MI prophylaxis

Suspected coronary thrombosis before arrival to ER.

Adverse effects:

  • Hypersensitivity/anaphylaxis
  • Stomach irritation/Pain
  • GI bleed
  • Thrombocytopenia
  • Hemolytic anemia
  • Tinnitus, hearing loss - high doses
41
Q

This ADP blocking antiplatelet inhibits platelet function that can last several days after administration:

A

Clopidogrel (Plavix)

Mechanism of action: Blocks ADP on platelets (ADP is needed to promote platelet aggregation).

42
Q

When would you use Clopidogrel (Plavix)?

A

Prophylaxis for arterial thromboembolism, stroke, MI

Adverse effects: bleeding, same tolerability as aspirin, few adverse effects.

43
Q

Which antiplatelet has a mechanism of action of binding to GP IIb/IIIa receptor sites on platelets, preventing fribrinogen/von Willebrand factor/other procoagulants?

A

Abciximab (Reopro)

ONLY given IV

44
Q

When would you use Abciximab (Reopro)?

A

Used to treat PCI -coronary angioplasty procedures, revascularization of arteries.

Adverse effects: abnormal bleeding at access site.

Pharmacology 1 (16 decks)

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