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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
atherosclerosis, HTN, valve problem, dilated cardiomyopathy, congenital heart diseases cause what disease?
underlying causes of CHF
26
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
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
27
Categories employed for CHF - 6
ACE/ARB, Beta blockers, diuretics, vasodilators, inotropic agents, aldosterone antagonists
28
Category of HTN meds used to treat MILD CHF
Beta blockers- selective or non selective
29
Type of diuretic only used in ACUTE emergency cases of CHF, safe in diabetes
Loop Diuretics - Furosemide
30
CHF patients with history of ARRHYTHMIAS require a combo of what two types of HTN drugs?
loop diuretic (furosemide) and aldosterone antagonist (spironolactone)
31
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.
ACE inhibitors
32
Smooth muscle relaxant that dilates veins to decrease preload and increase capacitance
Nitrates
33
Smooth muscle relaxant for arterial and arteriolar dilation
Hydralazine
34
2 Categories of diuretics used to relieve pulmonary congestion and peripheral edema, usedful in reducing symptoms of volume overload: orthopnea and paroxysmal nocturnal dyspnea
Diuretics: Carbonic Anhydrase Inhibitors- acetazolamide, and Loop Diuretics- Furosemide, Bumatedine, Ethacrynic acid, Torsemide
35
Category of Diuretics that cause hyperglycemia, can be paired with potassium sparing diuretics
thiazides- chlorothiazide, hydrochorothiazide, indapamide, metolazone
36
3 potassium sparing diuretics - AST
amiloride, spironolactone, triamterene
37
2 osmotic diuretics- decrease osmotic pressure- MU
Mannitol and Urea
38
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)
Inotropic drugs
39
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
DIGOXIN and digitoxin- not usually employed
40
Inotropic beta adrenergic agonist
dobutamine
41
Inotropic glycoside with rapid onset and short live due to less albumin binding, better treatment of toxic reactions
Digoxin
42
Inotropic glycoside that binds strongly to plasma proteins, metabolized in the liver and metabolites excreted in bile
Digitoxin
43
SE of glycoside inotropic agents
toxicity, severe dysrhythmias, no appetite, Cinchonism, headaches,
44
How is severe toxicity to digoxin treated ?
specific antibody to the drug
45
B1 Adrenergic Agent, 2nd most common inotropic, cause vasodilation and positive inotropism, parenteral in emergencies, opens slow Ca channels , works on cAMP
Dobutamine
46
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
Angina Pectoris
47
anti anginal organic nitrates, cant be used with recent MI- Iso, mono, nitro
Isosorbide dinitrate/monoinitrate, nitroglycerine
48
anti angingal beta blockers, no respiratory or diabetes conditions- PMAA
Popranolol, metoprolol, atenalol, Acebutolol
49
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
NITROGLYCERIN is the DOC sublingual, oral nitro and isosorbide dinitrate/mononitrate are used for more chronic conditions
50
CONTRAINDICATIONS Of BETA BLOCKERS
DIABETES AND RESPIRATORY CONDITIONS
51
Ca channel blocker DOC in prinzmental angina because etiology is increased smooth muscle contraction , arterial vasodilators, oral and sublingual, does not replace
Nifedipine (or diltiazem for prinz)
52
Ca channel blocker for angina that slows cardiac conduction to decrease O2 consumption, CI in electrical conduction abnormalities and CHF
Verapamil
53
Ca channel blocker for angina that is useful in episodes of CORONARY SPASM - Prinzmetal Angina
Diltiezem - (also Nifedipine for prinz)
54
Fast upstroke phase, Na channels open
Phase 0
55
Partial repolarization, inactivation of Na channels, K channels open
Phase 1
56
Plateau, Ca++ channels open, K leaks out slowly
Phase 2
57
Repolarization, Ca++ channels close, K channels open
Phase 3
58
Forward Current, increase depolarization from increased sodium permeability, brings cell to threshold
Phase 4
59
Tachycardia is above what HR and Bradycardia is below what HR?
100, 60
60
Phases targeted to avoid re-entry in attempt to control arrythmias
0,1,2,3
61
3 Classes of antiarrythmics that target Na channel blockers
1A- phase 0 depolarize, 1B - Phase 3 repolarize, 1C- Phase 0 depolarize
62
Class 1A drug that slows rate of Phase 0, variety of arrythmias, may increase digoxin concentration, cardiotoxicity exacerbated by HYPERKALEMIA, SE CINCHONISM, tinnitus
Quinidine
63
H2 blocker that inhibits metabolism of quinidine (1A for arrythmia)
Cimetidine-
64
Lupus-like Syndrome in 25 - 30 % butterfly rash, is a side effect of this a 1A anti arrythmic
Procainamide
65
1A anti arrythmic alternative to quinidine and procainamide, has ANTICHOLINERGIC REACTIONS - xerostomia, urinary retention, blurred vision, constipation
Disopiramide

Summer Pharmacology 2 (11 decks)

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