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Ane Class Practice > Pathopharm Exam 2-S4 > Flashcards

Pathopharm Exam 2-S4 Flashcards

1
Q

This receptor affects the arteries more than veins.
-Increases vascular tone by vasoconstriction to increase Blood pressure?

A

Alpha-1 receptor

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2
Q

This receptor is found primarily on heart and increases heart rate and contractility.
-Also increases risk of arrhythmias?

A

Beta-1 receptor

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3
Q

This receptor is found in arteries and veins and inhibits adenyl cyclase to decrease norepinephrine release and increase parasympathetic outflow?

A

Alpha-2 receptor

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4
Q

This receptor causes smooth muscle relaxation and should be avoided with asthmatic patients?

A

Beta-2 receptor

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5
Q

This drug is an alpha-1 and alpha-2 agonist.
- Endogenous catecholamine.
- Arterial and Venous constriction
- Increase BP, SVR and PVR
- may slow HR due to baroreceptor mechanism
- Does not increase myocardial O2 consumption
- Dose not cross BBB

A

Norepinephrine (Levophed)

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6
Q

This drug is an alpha-1 agonist
- Causes vasoconstriction, bradycardia
- Coronary vasoconstrictor
- Increase BP, SVR, PVR, and afterload.
- May need to add dopamine to keep HR up.
- Often used in neurologic shock
- Contraindicated w narrow angle glaucoma

A

Neosynephrine (Phenylephrine)

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7
Q

This drug is a beta-1 agonist
- Synthetic catecholamine
- reduced preload and afterload
- increases contractility, CO, HR and BP.
- Also increases myocardial O2 demand.
- May drop BP if patient is dehydrated.

A

Dobutamine

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8
Q

This drug is a beta-1 and alpha-1 agonist and works at DA receptors
- First line agent for shock
- Naturally occurring catecholamine
- Precursor to norepi
- Dilates/increases renal blood flow

A

Dopamine

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9
Q

Low dose Dopamine affects what?
1-3 mcg/kg/min

A

Renal, coronary and cerebral vasodilation. Increased urinary output

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10
Q

Mid dose Dopamine affects what?
3-10 mcg/kg/min

A

Beta-1 stimulation with positive ionotropic effect.
Increased HR and small BP increase

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11
Q

High dose Dopamine affects what?
>10 mcg/kg/min

A

Alpha-1 stimulation with potent vasoconstriction.
Increased BP and increased SVR

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12
Q

This drug is a beta-1 and alpha-1 agonist
- Endogenous catecholamine
- causes peripheral and global vasoconstriction
- Bronchodilation
- NOT first line treatment
- Increases cardiac contractility and O2 demand.
- Increased HR, MAP, CO, SVR, PVR
- Risk of arrhythmia development
- Systolic increase and diastolic decrease
- Does not cross BBB

A

Epinephrine

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13
Q

This drug is a VP-1 agonist
- ADH
- causes smooth muscle constriction
- Used in ACLS for pulseless VT and VF
- Less constriction at coronary and renal beds
- Vasodilates cerebral vasculature
- May enhance platelet aggregration in septic shock
- Increases BP, MAP, SVR, and UO

A

Vasopressin

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14
Q

This drug is a vasopressin analog, agonist at VP-1
- IV only
- Control of Low BP
- Used for patients who do not respond to Norepi
- Useful to treat bleeding esophageal varices
- avoid use in hypoxic patients

A

Terlipressin

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15
Q

This drug is a PDE-3 inhibitor
- Positive inotrope and vasodilator
- Cleared by liver, can accumulate with liver dz
- Increases cAMP causing increased Ca into cells to improve myocardial contractility and inhibit vasoconstriction.
- Increases CO
- Decreases CVP, SVR

A

Milrinone

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16
Q

This drug is indicated for severely low BP in septic or distributive shock
- very short half life (1 min)
- IV infusion only
- titrate BP to proper range
- May cause clots and DVTs
- Must be given with anti-clotting therapeutics

A

Angiotensin II acetate (Giapreza)

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17
Q

This drug is a Na/K ATPase inhibitor
- narrow therapeutic window
Used in systolic heart failure with decreased CO
- Used with atrial fib and SVT
- Increases Cardiac output
- Increases voltage at rest.
- Used more in outpatient PO

A

Digoxin

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18
Q

NE > EPI > DA > ISO

A

Alpha-1 agonist potency

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19
Q

EPI > NE > DA > ISO

A

Alpha-2 agonist potency

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20
Q

ISO > EPI = NE > DA

A

Beta-1 agonist potency

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21
Q

ISO > EPI > NE > DA

A

Beta- 2 agonist potency

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22
Q

ISO = NE > EPI > DA

A

Beta-3 agonist potency

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23
Q

Muscarinic receptor structure/function?

A

G-protein

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24
Q

Nicotinic receptor structure/function?

A

Ionophore

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25
Q

Alpha and Beta receptor structure/function?

A

G-protein

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26
Q

This drug is a selective central acting alpha-2 agonist
- analog of Clonidine but 7x more selective
- can be used as anesthetic

A

Dexmedetomidine (precedex)

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27
Q

This drug is last line treatment for HTN treatment
- Forms A-methyl NE
- False transmitter
- contraindicated with hepatic dz
- Decreases norepi release

A

Methyldopa

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28
Q

This drug is an Alpha-1 and Beta-1 agonist and mild at Beta-2
- causes peripheral norepi release
- relaxation of smooth muscle and cardiac stimulation and increased blood pressure.
- High abuse, can make meth

A

Ephedrine

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29
Q

This drug is an irreversible-covalent bind alpha-1 and alpha-2 antagonist.
- Lasts 3 days
- Most effective at smooth muscle and exocrine glands
- Pre-op treatment for pheochromocytoma to block HTNcrisis
- Oral

A

Phenoxybenzamine (Dibenzyline)

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30
Q

This drug is an alpha-1 and alpha-2 competitive antagonist.
- shorter duration of action than phenoxybenzamine
- used for pheochromocytoma diagnosis

A

Phentolamine (oraverse)

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31
Q

This drug is a selective alpha-1 antagonist
- used to treat HTN
- less risk of reflexive tachycardia than other alpha blockers

A

Prazosin (minipress)

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32
Q

Terazosin, Doxazosin, Alfuzosin, and Tamsulosin are all alpha-1 blockers than can be used to treat HTN and what else?

A

Benign prostatic hyperplasia (BPH)

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33
Q

This drug is a non-selective beta blocker beta-1 and beta-2.
- treats HTN, speaker nerves, angina
- contraindicated in shock, asthma, bradycardia
- bronchospasm side effect

A

Propanolol

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34
Q

Timolol is a non-selective beta blocker most often used for treating what?

A

Ocular hypertension and wide angle glaucoma

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35
Q

This drug is a non-selective Alpha-1, Beta-1 and B-2 antagonist.
- treating HTN
- contraindications with asthma and CHF

A

Labetalol

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36
Q

This drug is a non-selective Alpha-1, Beta-1 and B-2 antagonist.
- treating HTN
- Higher beta: alpha block than labetalol
- contraindications with bronchospasm, COPD, bradycardia

A

Carvedilol (coreg)

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37
Q

This drug is a selective Beta-1 antagonist
- treat HTN and angina pectoris

A

Metoprolol (lopressor)

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38
Q

This drug is a selective Beta-1 antagonist used to decrease BP and control ventricular arrhythmias
- side effects of alopecia

A

Acebutolol

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39
Q

This drug is a selective Beta-1 antagonist
- IV infusion due to short half life
- treatment of atrial fib or flutter, paroxysmal SVT

A

Esmolol

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40
Q

Sodium Channel blockers are which antiarrhythmic drug class?

A

Class Ia-Ic

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41
Q

Class Ia-Ic antiarrhythmic class?

A

Sodium Channel Blockers

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42
Q

Beta-adrenergic blockers are which antiarrhythmic drug class?

A

Class II

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43
Q

Class II antiarrhythmic class?

A

Beta-adrenergic blockers

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44
Q

Calcium Channel blockers are which antiarrhythmic drug class?

A

Class IV

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45
Q

Class IV antiarrhythmic class?

A

Calcium Channel blockers

46
Q

Class III antiarrhythmics?

A

Potassium Channel blockers

47
Q

What is the normal AV nodal delay in ms?

A

0.15 seconds or 150 ms

48
Q

What neurotransmitter shortens the conduction time of action potential through AV node propagation?

A

Acetycholine (Catecholamines)

49
Q

During the cardiac cycle which structure directly delivers action potential to the ventricular myocardium?

A

Purkinje fibers

50
Q

The cardiac electrical impulse normally begins spontaneously in the SA node because of what?

A

It depolarizes more rapidly than other automatic cells of the heart.
SA node is first

51
Q

Which period follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated?

A

Absolute Refractory Period

52
Q

Where in the heart are the receptors for neurotransmitters located?

A

Myocardium and coronary vessels

53
Q

What enables electrical impulses to travel in a continuous cell to cell fashion in myocardial cells?

A

Intercalated disks

54
Q

Older children with unrepaired cardiac septal defect experience cyanosis because of which factor?
- Right to left shunt
- Left to right shunt?

A

Right to left shunt

55
Q

The atria squeeze in which sequence?

A

Top down contraction

56
Q

The ventricles squeeze in which sequence?

A

Bottom up contraction

57
Q

The purkinje fibers stimulate what first?

A

The apex

58
Q

Transmembrane potential is determined by which 3 ionic gradients?

A

Na
K
Ca

59
Q

The maintenance of electrogenic ionic gradients and membrane potential comes from what?

A

NA/K ATPase pump
3 Na out for 2 K in

60
Q

This ionic gradient is responsible for the resting membrane potential, it is relatively permeable?

A

K
Potassium. -90mv membrane potential

61
Q

Which phase corresponds to Na channel activation with rapid flow in?

A

Phase 0
Voltage now +10mv

62
Q

Which phase corresponds to an early repolarizing K current in which Na channels close and K channel open?

A

Phase 1

63
Q

Which phase is a combination of inward depolarizing Ca balanced by an outward repolarizing K current?

A

Phase 2

64
Q

Which phase is repolarizing due to outward K current increasing which inward Ca current decreases?

A

Phase 3

65
Q

Which phase is a balance between inward Na current and outward K current. The membrane potential drifts towards threshold?

A

Phase 4

66
Q

Spontaneous depolarization is also called what?

A

Automaticity

67
Q

Any change to which phase alters conduction?

A

Phase 4

68
Q

Electrical gradient wants to _____ potassium which the concentration gradient wants to ______ potassium?

A

Electrical- hold in

Concentration- push out

69
Q

Ectopic pacemaker is facilitated by what?
Treated by what?

A

Facilitated by hypokalemia

Increasing potassium slow/stop ectopic activity

70
Q

Increasing the maximum diastolic membrane potential can diminish automaticity by which two drugs?

A

Adenosine
Acetylcholine

71
Q

Decreasing the slope of phase 4 depolarization can diminish automaticity by which drugs?

A

Beta blockers

72
Q

Increasing the action potential duration can diminish automaticity by which drugs?

A

K channel blockers

AIDS

73
Q

Raising the membrane threshold potential can diminish automaticity by which drugs?

A

Na channel blockers and
Ca channel blockers

74
Q

Which condition is caused by an accessory conduction pathway?

A

Wolf-Parkinson-White syndrome

75
Q

Which drugs prolong nodal refractoriness and slow conduction?
Can treat WPW syndrome

A

Ca channel blockers
Beta blockers
Digitalis glycosides
Na channel blockers

76
Q

This drug class is primarily used to slow the rate of action potential rise and prolong ventricular effective refractory period?

A

Sodium channel blockers Ia

77
Q

This drug is a class Ia
- Na channel blocker (activated only)
- Used to terminate reentry arrhythmia
- Antimalarial and antipyretic effects
- Must be given slow IV
- Accumulated in hepatic/renal dz pts
- can also block K channels
- Affects Phase 0 and Phase 4
- treat WPW syndrome
- Cinchonism (N/V/D, blurred vision)
- Antimuscarinic action on heart
- Can develop Torsades de Pointes

A

Quinidine

78
Q

This drug is a class Ia
- Na channel blocker
- long term use associated with Lupus
- Cardioactive metabolite (NAPA) may lead to Torsades de Pointes
- Does not exhibit antimuscarinic activity like Quinidine
- Ganglionic blocking activity

A

Procainamide

79
Q

Procainamide-induced Lupus syndrome occurs more frequently in which population?

A

Slow acetylators
Europeans

80
Q

This drug is a class Ia
- Na channel blocker
- Greater anti-muscarinic effects
- Used for ventricular arrhythmias
- Not an alpha- adrenergic blocker

A

Disopyramide (Norpace)

81
Q

This drug is a class Ib
- Na channel blocker
- Blocks activated and inactivated
- Reduces the phase 4 slope and increases threshold
- requires IV administration due to extensive first pass
- Rapidly dissociates in normal tissue (low affinity)
- Remains bound in ischemic tissue (high affinity)
- Major side effect is Seizure in rapid administration and cardiac depression

A

Lidocaine (Xylocaine)

82
Q

This drug is a class Ib
- Na channel blocker
- Chronic treatment of Ventricular tachyarrhythmias
- Amine analog of Lidocaine
- Oral administration

A

Mexiletine Hydrochloride

83
Q

This drug is a class Ib
- Na channel blocker
- effective in suppression of ventricular arrhythmias associated with digitalis toxicity
- Least effective Na channel blocker
- Shortens QT more than any agent
- Can cause CNS disturbances (sedation, nystagmus, confusion, ataxia).
- Causes hirsitism (hair growth)

A

Phenytoin (Dilantin)

84
Q

Barbituates do what to phenytoin levels?

A

Lower phenytoin levels due to metabolizing enzyme induction

85
Q

Warfarin, Isoniazid do what to phenytoin levels?

A

Increase phenytoin levels due to metabolism inhibition

86
Q

This drug is a class Ib piperazine deriv
-also blocks K and Ca conductance
- used to treat chronic angina
- decreases late Na inward current and intracellular Ca conc
- Increases refractory period used for ventricular arrhythmias
- Metabolized by CYP3A4 avoid grapefruit juice

A

Ranolazine (Ranexa)

87
Q

This drug is a class Ic
- Na channel blocker
- more effective than Ia or Ib
- suppresses pvcs and v-tach
- effective in managing atrial tachyarrhythmias
- effective in WPW syndrome treatment
- Reserved for management of life threatening arrhythmias.
- Not 1st line treatment
- Proarrhythmic dangerous with MI patients

A

Flecainide Acetate

88
Q

This drug is a class Ic
- Na channel blocker
- weak beta blocker
- weak Ca channel blocker
- active metabolite via liver metabolism
- Proarrhythmic dangerous with MI patients

A

Propafenone (Rythmol)

89
Q

This drug is a class II
- beta blocker
- decreases the slope of phase IV
- Increases AV conduction time
- treatment of atrial flutter and atrial fibrillation
- can lead to bronchospasm, worsen CHF

A

Propranolol (Inderal)

90
Q

This drug is a class II
- beta blocker
- very short acting (IV admin)
- cardioselective
- decreases the slope of phase IV
- Increases AV conduction time
- treatment of atrial fibrillation with RVR

A

Esmolol (Brevibloc)

91
Q

This drug is a class III
- potassium channel blocker
- delays repolarization and prolongs action potential
- increases refractory period
- orthostatic hypotension with chronic use
- increased ventricular action potential duration
- Initial catecholamine release
- used to manage serious ventricular arrhythmias caused by lidocaine or procainamide
- Not first line treatment

A

Bretylium Tosylate

92
Q

This drug is a cross between class I and III
- K channel blocker
- Na channel blocker
- prolongs action potential duration
- Treatment of ventricular arrhythmias
- Can cause hypo/hyperthryoidism due to iodine content
- Long term therapy can lead to pulmonary fibrosis (fatal)
- Postoperative pulmonary edema
- sinus arrest (risky drug)

A

Amiodarone (Nexterone)

93
Q

This drug is a cross between class I and III
- Increasing refractory period
- alternative to amiodarone for atrial fib/flutter treatment
- Black Box warning with CHF
- greatest effect on K channels

A

Dronedarone (Multaq)

94
Q

This drug acts as a class II and III
- Nonselective beta blocker
- K channel blocker
- Prolongs refractory period
- may cause HTN or vasospasm
- Avoid in asthmatics
- treats atrial fib/flutter

A

Sotalol (Betapace)

95
Q

This drug is a class V
- G-protein coupled
- activates acetylcholine K current
- decreases action potential duration
- Rapidly terminates SVT

A

Adenosine

96
Q

This drug is a class IV
- Ca channel blocker
- blocks the inward Ca current to slow conduction through AV node and decrease phase IV depolarization
- Main action on the heart
- used to convert atrial fib/flutter to NSR
- Hypotension side effect
- constipation

A

Verapamil and
Diltiazem (Cardizem)

97
Q

Which classes/drugs are ideal to treat Atrial fibrillation?

A

Calcium channel blockers- Verapamil/Diltiazem
Beta blockers- Propranolol
Digitalis glycosides- Digoxin

98
Q

Which classes/drugs are ideal to treat and maintain Normal Sinus Rhythm?

A

Class Ia Sodium channel blockers
Quinidine and Procainamide

99
Q

Which classes/drugs are ideal to treat Paroxysmal SVT?

A
  1. Valsalva maneuver
  2. Alpha receptor agonist
  3. Digoxin
    Adenosine, Verapamil, Diltiazem, Esmolol or Cardioversion.
100
Q

Thiazide diuretics work in this part of the kidney?

A

Distal renal tubule
Hydrochlothiazide

101
Q

Potassium sparing diuretics work in which part of the kidney?

A

Late distal tubule and Collecting duct
Amiloride, Triamterene, Spironolactone

102
Q

High Ceiling Loop diuretics work in which part of the kidney?

A

Thick ascending limb in loop of Henle
Lasix, Bumetanide

103
Q

Which beta blocker’s vasodilation affect includes potentiating Nitric Oxide?

A

Nebivolol (Bystolic)

104
Q

Which drug works primarily to vasodilate the arteries thus having greater effect on diastolic BP?

A

Hydralazine

105
Q

Minoxidil was once an orally active form of direct arteriole smooth muscle relaxation for HTN treatment but is now used for what?

A

Hair growth in women

106
Q

This drug has a Ferrous iron center complex with 5 cyanide (44% by weight), requires IV administration due to short duration. Requires A-line monitoring and may result in coronary steal?

A

Nitroprusside

107
Q

What is the active mediator responsible for direct nitroprusside vasodilating effect?

A

NItric oxide

108
Q

The body sulfur stores can detoxify how many mg of nitroprusside into cyanide ions?

A

50mg

109
Q

Which drug is most often used for hypertensive emergencies?

A

Nitroprusside

110
Q

Which class of drugs can potentiate NMBA agents and make them last longer?

A

Calcium channel blockers

111
Q

This drug is a diagnostic marker for ALL leukemia?

A

Entresto
Neprilysin Inhibitor

Ane Class Practice (21 decks)

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