PHARM

Question 1

Which drug class ends in -pril?

Answer 1

Angiotensin converting enzyme inhibitors ACEI

Question 2

Which drug class ends in -sartan?

Answer 2

Angiotensin receptor blockers ARB

Question 3

Alpha 1 blocker drug names end in what?

Answer 3

-osin “there’s a ocean of blood vessels to constrict”

doxazosin

Question 4

Which drug class ends in -olol, -alol, -ilol

Answer 4

Beta blockers

Question 5

-dipines indicate what?

Answer 5

vasodilators DHP dihydropyridine Calcium channel blockers (CCB), as opposed to Non DHP CCB verapamil and diltiazem that work on the heart rather than in the periphery

Question 6

Which drug paradoxically treats CHF by decreasing cardiac contractility?

Answer 6

Beta blockers

Question 7

List two single agents and some combination therapies for the treatment of intra-abdominal or pelvic infections for both E.coli (aerobe) and B. frag. (anaerobe).

Answer 7

piperacillin/tazobactam
Ertapenem (carbapenem)
Cefazlolin/ceftriaxone, or Tobramycin + Metronidazole

Question 8

vasopressin has two different receptors. Describe the effect of their binding to these various receptors.

Answer 8

V1 (VwF release) Incresed SVR

V2 Increased blood volume

Both = increased arterial pressure.

Question 9

How does your first choice vasopressor for sepsis differ for a crash cart code?

Answer 9

NE for sepsis

Epi for code

Question 10

When is doBUTamine indicated for use?

Answer 10

When someone has low CO and ongoing hypoperfusion despite achieving adequate intravascular volume and MAP.

Question 11

What are some major side effects of Beta blockers and why?

Answer 11

Arrythmias, due to increased myocardial O2 demand

Question 12

What are the major determinants of cardiac O2 demand?

Answer 12

HR, Contractility, wall stress (pre and afterload)

Question 13

What is extravasation and how can it be avoided?

Answer 13

Pumping of IV fluids outside the vein and into the tissue, which in the case of vasoconstrictors can cut off blood flow to an area of the body; more common in peripheral veinipuncture. This can be avoided with a central line.

Question 14

Explain the receptor selectivity of the following drugs:

EPI, NE, Dopamine, DoBUTamine, Isoproterenol, ADH, phenylephrine

Answer 14

EPI=  (At low dose) Beta more than alpha; high dose equal
NE= Beta 1 and alpha 1 
Dopamine= Beta and D1  (low dose) alpha 1 (high dose) 
DoBUTamine= Beta only 
Isoproterenol = Beta  only  
ADH = alpha 1 
Phenylephrine= pure alpha

Question 15

Name two drugs that stimulate B receptors only

Answer 15

DoBUTamine and Isoproterenol

Question 16

Name two drugs that stimulate alpha receptors only

Answer 16

AHD and phenylephrine

Question 17

Which drug stimulates beta receptors more than alpha at low doses but at high doses stimulation is equal?

Answer 17

Epinephrine

Question 18

Which drug stimulates Beta and alpha 1 receptors only?

Answer 18

NE

Question 19

Dopamine has what receptor effect and low and high concentrations

Answer 19

low D1 and Beta

High alpha 1

Question 20

Name two potassium sparing agents that block the action of aldosterone

Answer 20

spir-ono-lactone
e-pler-enone

Aldosterone increases K+ excretion and by blocking aldosterone potassium is spared

Question 21

What are some of the effects of ACEI, ARB, and DRI?

Answer 21

Reduced preload (decreased blood volume diuretic effect)

Reduced afterload (decreased pressure; vasodilation. Inhibits cardiac and vascular hypertrophy)

Decreased sympathetic activity

Question 22

What are some side-effects of ACEI, ARB, DRI, Diuretics (ADR)

Answer 22

Hypotension, decreased renal function
hyperkalemia (aldosterone inhibition)
Cough (ACEI)
Angioedema (ACEI (mostly), ARB) 
Teratogenic

Question 23

You just started your 30 y/o f patient on a drug for hypertension because of their chronic kidney disease, but they’re having a persistent cough. Their chart indicated some mild childhood asthma, and you’re thinking about switching their medication. What would be the next best choice?

A) ARB
B) Thiazide
C) CCB
D) ACEI

Answer 23

A) ARB

ARB and ACEI are recommened for CKD, but ACEI are more likely to give someone a persistant cough. The next best option is ARB.

WARN THEM ABOUT THE POTENTIAL FOR BIRTH DEFECTS! (ACEI, ARB and DRI)

Question 24

Under what circumstances might you consider using a Beta 1 selective blocker? What drugs would you use?

Answer 24

In a patient with asthma to avoid the effects of blocking beta 2 receptors: bronchioconstriction and vasoconstriction

atenolol and metoprolol

Question 25

you have a patient with BPH and hypertension. Which drug combination would work best for them? A) metoprolol and ACEI B) carvedilol and CCB C) labetalol D) ARB and ADH

Answer 25

C: labetalol and carvedilol both are non-selective beta blockers that have alpha 1 blocking effects as well. Giving just one of these drugs could kill two birds with one stone.

Question 26

The sublingual administration of which -dipine should be avoided in acute HTN?

Answer 26

Nifedipine

Question 27

You have a patient that took too much digoxin and needs to be treated for it's toxic side effects. Which drug would potentially exacerbate this condition most? A) ADH B) ACEI C) 0.9% saline D) NO

Answer 27

B-ACEI because its contraindicated in cases of hyperkalemia which is a common side effect of digoxin toxicity.

Question 28

Which heart condition would be negatively affected by a beta blocker? A) AV block B) reflex tachycardia C) post MI tx D) all of the above

Answer 28

A) AV block: 2nd and 3rd degree blocks would be worse then a first degree block, but any existing block could progress These patients should avoid beta blockers and CCB (non-DHP) Beta blockers can cause 1st degree blocks as seen by prolonged PR interval but this condition is benign and acceptable