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CRRAB FINAL REVIEW > PBL Pharm- Trachte > Flashcards

PBL Pharm- Trachte Flashcards

1
Q

Digoxin

A

Inhibits Na/K ATPase Positive Inotrope (increases contractility= positive inotrope)

  • Inhibits Na/K ATPase
  • Increased intracellular Na
  • Reduces NCX activity because of high Na levels
  • Decreased expulsion of Ca from cell because don’t want MORE Na brought in
  • Increased intracellular Ca
  • Increased contraction of cardiac sarcomere

NOTE* Ca+ overload can lead to delayed after-depolarizaiton = arrhythmia (why this isn’t first choice!!)

Also a negative chronotrope (decreases SA nodal rate –> HR)

Used in acute CHF management (wehn furosemide and enalapril are not controlling symptoms

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2
Q

Metoprolol

A

Specific B1 blocker

Decrease heart rate and contractility thus decreasing myocardial oxygen demand

Decreases BP

Used for chronic management in CHF

(Contraindicated in acute CHF, need to perserve heart function and complete diuresis first)

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3
Q

Propranolol

A

Non-specific B1 and B2 blocker

Decrease heart rate and contractility thus decreasing myocardial oxygen demand

Decreases BP

Used for chronic management in CHF

(Contraindicated in acute CHF, need to perserve heart function and complete diuresis first)

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4
Q

Enalapril

A

ACE inhibitor

SUprresses RAAS system by inhibiting conversion of angiotensin 1 to angiotensin II

NET EFFECTS:

Decreased aldosterone release - decreased Na+ reabsorption -decreased fluid retention - decreases blood volume and preload

Decreased vasoconstriction - decreased afterload

USE FOR CHRONIC MANAGEMENT OF CHF

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5
Q

Nitroglycerine

A

Converted to NO by aldehyde dehydrogenase on endothelium - binds smooth muscle g-protein coupled receptor - activates guanylyl cylcase - increased cGMP - decrease in intracellular Ca+ concentration - relaxes smooth muscles

Vasodilator of VEINS!

Acute CHF management

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6
Q

Isosorbide Dinitrate

A

Same mechanism as nitroglycerine but longer half life (60-90 minutes)

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7
Q

Lisinopril

A

ACE inhbitor

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8
Q

Metoprolol

A

Specific B1 blocker

Main activity on heart is to decreased heart rate and contractility thus decreasing myocardial oxygen demand

Decreased BP

Used in MI to reduce ischemia

Chronic management of CHF (NOT ACUTE!)

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9
Q

Eplerenone

A

Aldosterone receptor antagonists

Blockes aldosterone action

Net effects:

Decreases Na+ reabsorption in the kidney - decreases blood volume and preload

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10
Q

Spirinolactone

A

Aldosterone receptor antagonists

Blockes aldosterone action

Net effects:

Decreases Na+ reabsorption in the kidney - decreases blood volume and preload

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11
Q

Furosemide

A

Inhibits NKCC2

Decreases Na and Cl reabsorption

Increased Na and H20 excretion

Decreased blood volume

Decreased Preload

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12
Q

Ceftriaxone

A

Binds penicillin binding protein (transpeptidase) and prevents peptidoglycan synthesis

Gram + and - bacteria

Less susceptible to penicillianases

Bactericidal

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13
Q

Penicillin G

A

IV/IM

binds penicillin binding proteins (transpeptidase) and inhibts cross-linking of peptidoglyan

Gram + ONLY

Sensitive to B-lactamases (specifically penicillinases)

Bactericidal

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14
Q

Vancomycin

A

froms H-bonds with D-ala-D-alanine and prevents the incorporation of NAM/NAG peptide subunits into peptidoglycan matrix (inhibits synthesis)

Broad spectrum for Gram + and -

Bactericidal

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15
Q

Morphine

A

Analgesic

Works on mu receptor

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16
Q

Nitroglycerin

A
  • forms free radical NO
  • Activates guanylyl cyclse
  • Increases cGMP
  • Dephosphorylation of myosin light chains
  • Smooth muscle relaxation
  • Vasodilation
  • Affects veins more than arteries
  • Decreases preload
17
Q

Aspirin

A

irreversibly inhibits COX1 & COX2

Inhibits TXA2 synthesis

Inhibits platelet aggregation

18
Q

Clopidogrel

A
  • Irreversible ADP receptor antagonist that prevents activation of ADP receptor (lasts the lifetime of the platelet)
  • Inactiavtion of ADP receptor prevents more GpIIbIIIa receptors from being exposed
  • Decreases plateles adhesion
19
Q

Heparin

A

Enhances activity of antithrombin III in the degradation of thrombin and factor 10

Since thromin is inhibited fibrinogen is not converted to fibiring to form the clot

20
Q

Eptifibatide

A
  • Fibrinogen analgogue that binds GpIIbIIIa receptor and prevents binding of adhesive glycoproteins such as fibrinogena nd vWF to activated platelets
21
Q

Alteplase (tPA)

A
  • ACtivates plasminogen (preferentially that is bound to fibrin so you don’t get systemic activation)
  • Dissolbes existing thrombi
22
Q

Hydrochlorothiazide

A

Diuretic

Blocks sodium ion transport across the renal epithelium

Blocks Chloride transport as well (via unknown mechanism)

Results in more NaCl and H20 excretetion

Used to treat = Hypertension and CHF

23
Q

Losartan

A

Angiotensin II Receptor Blocker

Reversibly and non-competitvely binds AT1, thus blocking directly the vasoconstriction of Angiotensin II and secondarily the actions of Aldosterone

***Decrease in systemic vascular resistance without and increase in HR

Used for HYPERTENSION

24
Q

Hyzaar

A

Combo durg of Losartan and Hydroclororthiazide

Small dose of diuretic greatly increases an ARBs efficacy

Losartan also reduced Potassium loss from HCTZ

Used for HYPERTENSION

25
Q

Amlodipine

A

Ca+ Channel Blocker

Dihydropyridine

Main action is on the arteriolar vasculature - vasodilates

Blocks Ca+ influx thus decreasing basal contractility of coronary and systemic arteries

Decreased coronary resistance and increased O2 delivery to myocardium

NOTE** decreased pressure and vasodilation may lead to an increase in caridac stimulation = reflex tachycardia…..can greatly increased myocaridal O2 demand. THUS NOT used for angina

26
Q

Fluticasone/ Salmerterol

A

Fluticasone - acts on intracellular receptors to alter transcription resulting in:

  • Decreased inflammatory allergen response by decreasing histamine, eosinophil chemotactic factor, PGs, bradykinins, & others
  • Also up-regulates B-receptors

Salmeterol - B-2 agonist

  • B2 activation -> Gs -> adenylyl cyclase -> increased cAMP -> PKA -> dephosphorylates MLCs -> BRONCHODILATION

USED FOR ASTHMA/ COPD

27
Q

STATINS

A

Inhibit cholesterol synthesis

  • HMG-CoA Reductase inhibitors = decreases mevalonic acid a precursor of cholesterol
  • Decreased de novo synthesis also increases LDL reuptake/clearance
28
Q

Cilstazol

A

Platelet aggregate inhibitor with vasodilator abilities

  • Blocks Phosphodiesterase
  • Increases intracellular cAMP
  • Decreased platelet activation by ADP, AA, collagen, etc.

Used for intermitent claudication

29
Q

Niacin

A

Lipid-lowering Agent

Inhibits lipolysis in adispose tissue, reduces hepatic VLDL synthesis

Decreases LDL, and Triglycerides

Increases HDL

30
Q

Bile Acid Resins

(Cholestyramine Colestipol, Colesevelam)

A

Lipid-lowering agents

Prevents intestinal reabsorption of bile acids

Liver must used cholesterol to make more

Decreases LDL

Slightly increases HDL and Triglycerides

31
Q

Ezetimibe

A

(Cholesterol Absorbtion Blockers)

Prevent cholesterol absorption at small intesting brush border

Decrease LDL, no effect on HDL, Triglycerides

32
Q

Gemifbrozil (Fibrates)

A

Upregualtes lipoprotein lipase

Increase TG clearance

Activates PRAR-alpha to induce HDL synthesis

Decrease LDL, Increase HDL, REALLY Decrease Tri

33
Q

Aliskiren

A

Direct Renin Inhibitor

Binds to S3 binding site, decreases activity of enzyme.

Less conversion of angiotensinogen to angiotensin I

34
Q
A

CRRAB FINAL REVIEW (12 decks)

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