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Summer Pharmacology 2 > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

Part of the kidney acted on by Thiazides

A

Distal convoluted tubule

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2
Q

Part of kidney affected by acetazolamide- HCO3-

A

Prozimal convoluted tubule

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3
Q

Part of the kidney affectd by Bumetanide, furosemide, torsemide, ethacrynic acid

A

Ascending loop of henle

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4
Q

Part of kidney affected by spironolactone, amiloride, triamterene

A

collecting duct

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5
Q

Weak diuretics decreasing sodium and water, widely used and very effective, usually in combo, SE hyperglycemia - caution in DIABETES

A

Thiazides

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6
Q

Drug paired with Thiazides because of its ability to spare Potassium K+

A

Spironolactone

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7
Q

Strong Loop diuretic prefered in patients with renal failure

A

Furosemide

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8
Q

Category that treats HTN by decreasing peripheral resistance, usual choice in diabetics, Persistent cough, hyperkalemia

A

ACE Inhibitors

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9
Q

Category that treats HTN by decreasing peripheral resistance but does not cause persistent cough

A

ARBs

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10
Q

HTN category, selective (asthma and COPD, or diabetes) and non selective, can cause sexual dysfunction, used in patients with history of MI or heart disease, renal disease, CAUTION in patients with heart failure and diabetic

A

Beta blockers

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11
Q

Category of HTN drugs, more affects than beta blockers but do not affects pancreas, safe for prinzmental angina

A

Calcium channel blockers

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12
Q

Diphenylalkylamine Ca Channel blocker, choice for prinzmental angina, dual action, not good for CHF

A

Verapamil

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13
Q

Can you use Ca channel blockers with Beta blockers?

A

yes if there is no ischemic heart disease

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14
Q

(3) Alpha adrenergic blocking agents, produce relaxation of arterial venus smooth muscle, used WITH BETA BLOCKERS to avoid REFLEX TACHYCARDIA, -osin

A

Prazosin, Oxazosin, Terazosin

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15
Q

Centrally acting agent used in combo with diuretic, SE xerostomia and sedation

A

Cloniodine

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16
Q

Centrally acting agent alpha adrenergic agonist SE drowsiness and sedation

A

Methyldopa

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17
Q

210/ 150 mmHg, or presence of Encephalopathy, cerebral hemorrhage, left ventricular failure, aortic stenosis, goal is to decrease BP QUICKLY

A

Hypertensive Emergency

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18
Q

Potent vasodilator for emergency HTN by IV, metabolized to cyanide, combines with sodium thiosulfate producing thiocyanate, usually first choice in emergency

A

Sodium Nitroprusside

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19
Q

HTN emergency drug, direct acting arteriolar vasodilator, useful in hypertensive encephalopathy and ECLAMPSIA, used in combo with beta blocker to decrease reflex tachycardia

A

Diazoxide

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20
Q

HTN emergency drug that is an Alpha AND Beta blocker, doesnt cause reflex tachy cardio but beta actions are non selective, used in less extreme cases

A

Labetolol

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21
Q

HTN emergency drug that is a peripheral dopamine 1 receptor inhibitor, used IV which maintains renal perfusion while lowering BP, CI in GLAUCOMA

A

Fenlodopan

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22
Q

HTN emergency drug, Ca channel blocker used IV

A

Nicardipine

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23
Q

Clinical condition in which the heart is unable to perform its work as a pump failing to meet the requirements of the body, usually referring to left ventricle function

A

CHF

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24
Q

Etiology of CHF that is most common

A

Low output failure- dilated cardiomyopathy- Left ventricle systolic dysfunction

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25
Q

atherosclerosis, HTN, valve problem, dilated cardiomyopathy, congenital heart diseases cause what disease?

A

underlying causes of CHF

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26
Q

CONCEPT: Cardiac output decreases, leading to decreased blood pressure, leading to decreased renal blood flow, increasing renin, increase aldosterone, increase edema, increased capillary filtration, ultimately causing increased venous pressure

A

What happens when the heart needs to maintain perfusion in CHF, compensatory response - Vasodilators fix the last step, ultimate goal is to increase cardiac output

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27
Q

Categories employed for CHF - 6

A

ACE/ARB, Beta blockers, diuretics, vasodilators, inotropic agents, aldosterone antagonists

28
Q

Category of HTN meds used to treat MILD CHF

A

Beta blockers- selective or non selective

29
Q

Type of diuretic only used in ACUTE emergency cases of CHF, safe in diabetes

A

Loop Diuretics - Furosemide

30
Q

CHF patients with history of ARRHYTHMIAS require a combo of what two types of HTN drugs?

A

loop diuretic (furosemide) and aldosterone antagonist (spironolactone)

31
Q

DOC in CHF - category- blocks conversion of angiotensin 1 into 2 and aldosterone secretion, may be used in combo with diuretics and digoxin, SE hyperkalemia and persistent dry cough.

A

ACE inhibitors

32
Q

Smooth muscle relaxant that dilates veins to decrease preload and increase capacitance

A

Nitrates

33
Q

Smooth muscle relaxant for arterial and arteriolar dilation

A

Hydralazine

34
Q

2 Categories of diuretics used to relieve pulmonary congestion and peripheral edema, usedful in reducing symptoms of volume overload: orthopnea and paroxysmal nocturnal dyspnea

A

Diuretics: Carbonic Anhydrase Inhibitors- acetazolamide, and Loop Diuretics- Furosemide, Bumatedine, Ethacrynic acid, Torsemide

35
Q

Category of Diuretics that cause hyperglycemia, can be paired with potassium sparing diuretics

A

thiazides- chlorothiazide, hydrochorothiazide, indapamide, metolazone

36
Q

3 potassium sparing diuretics - AST

A

amiloride, spironolactone, triamterene

37
Q

2 osmotic diuretics- decrease osmotic pressure- MU

A

Mannitol and Urea

38
Q

SEVERE CHF drug category used to enhance contractility to increase output, results from increased intracytoplasmic Ca++, blocks sodium/potassium pump to promote sodium/calcium pump. NO USE IN RIGHT VENTRICULAR DYSFUNCTION, left side low output ONLY, low output (increased muscle mass, while high output is beating too fast)

A

Inotropic drugs

39
Q

2 inotropic agents cardiac glycosides, most common, increase cardiac contractility but have LOW therapeutic index, regulate cytosolic CA+ to increase force of contraction causing HIGHER EJECTION FRACTION

A

DIGOXIN and digitoxin- not usually employed

40
Q

Inotropic beta adrenergic agonist

A

dobutamine

41
Q

Inotropic glycoside with rapid onset and short live due to less albumin binding, better treatment of toxic reactions

A

Digoxin

42
Q

Inotropic glycoside that binds strongly to plasma proteins, metabolized in the liver and metabolites excreted in bile

A

Digitoxin

43
Q

SE of glycoside inotropic agents

A

toxicity, severe dysrhythmias, no appetite, Cinchonism, headaches,

44
Q

How is severe toxicity to digoxin treated ?

A

specific antibody to the drug

45
Q

B1 Adrenergic Agent, 2nd most common inotropic, cause vasodilation and positive inotropism, parenteral in emergencies, opens slow Ca channels , works on cAMP

A

Dobutamine

46
Q

Episodic chest pain under stress, 2 types- 1. stable: prinzmental - no calcifications, vasospasm, younger population, pain from exercise 2. unstable - califications, risk for MI, both types have atherosclerosis but prinzmental does not

A

Angina Pectoris

47
Q

anti anginal organic nitrates, cant be used with recent MI- Iso, mono, nitro

A

Isosorbide dinitrate/monoinitrate, nitroglycerine

48
Q

anti angingal beta blockers, no respiratory or diabetes conditions- PMAA

A

Popranolol, metoprolol, atenalol, Acebutolol

49
Q

Organic nitrate for angina, DOC for episodes precipitated by exercise or emotional stress (not prinz), Dilates large vessels and coronary vasculature, these effects combined decreases oxygen consumption, work through secondary mesangers to regulate cAMP, sublingual for emergencies due to rapid onset, chronic use associated with ANASTAMOSIS of coronary vessels, headaches are a SE but subside with time

A

NITROGLYCERIN is the DOC sublingual, oral nitro and isosorbide dinitrate/mononitrate are used for more chronic conditions

50
Q

CONTRAINDICATIONS Of BETA BLOCKERS

A

DIABETES AND RESPIRATORY CONDITIONS

51
Q

Ca channel blocker DOC in prinzmental angina because etiology is increased smooth muscle contraction , arterial vasodilators, oral and sublingual, does not replace

A

Nifedipine (or diltiazem for prinz)

52
Q

Ca channel blocker for angina that slows cardiac conduction to decrease O2 consumption, CI in electrical conduction abnormalities and CHF

A

Verapamil

53
Q

Ca channel blocker for angina that is useful in episodes of CORONARY SPASM - Prinzmetal Angina

A

Diltiezem - (also Nifedipine for prinz)

54
Q

Fast upstroke phase, Na channels open

A

Phase 0

55
Q

Partial repolarization, inactivation of Na channels, K channels open

A

Phase 1

56
Q

Plateau, Ca++ channels open, K leaks out slowly

A

Phase 2

57
Q

Repolarization, Ca++ channels close, K channels open

A

Phase 3

58
Q

Forward Current, increase depolarization from increased sodium permeability, brings cell to threshold

A

Phase 4

59
Q

Tachycardia is above what HR and Bradycardia is below what HR?

A

100, 60

60
Q

Phases targeted to avoid re-entry in attempt to control arrythmias

A

0,1,2,3

61
Q

3 Classes of antiarrythmics that target Na channel blockers

A

1A- phase 0 depolarize, 1B - Phase 3 repolarize, 1C- Phase 0 depolarize

62
Q

Class 1A drug that slows rate of Phase 0, variety of arrythmias, may increase digoxin concentration, cardiotoxicity exacerbated by HYPERKALEMIA, SE CINCHONISM, tinnitus

A

Quinidine

63
Q

H2 blocker that inhibits metabolism of quinidine (1A for arrythmia)

A

Cimetidine-

64
Q

Lupus-like Syndrome in 25 - 30 % butterfly rash, is a side effect of this a 1A anti arrythmic

A

Procainamide

65
Q

1A anti arrythmic alternative to quinidine and procainamide, has ANTICHOLINERGIC REACTIONS - xerostomia, urinary retention, blurred vision, constipation

A

Disopiramide

Summer Pharmacology 2 (11 decks)

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