Pharm

Question 1

What drug class is used to treat Raynauds disease?

Answer 1

Dihydropyridines (Ca2+ channel blockers) that work to decrease BP by decreasing CA2+ influx into vascular smooth muscle and therefore decrease systemic vascular resistance
Nifedipine, amlodipine, Felodipine

Question 2

T/F: ABPs and ACE-I are safe to use in pregancy?

Answer 2

False, they are teratogenic

Question 3

Minoxidil and hydrlazine are what class of drugs? Important side effects?

Answer 3

They are direct vasodilators that relax smooth muscle of peripheral arterioles causing vasodilation
Minoxidil (rogaine)
Side effects include reflex tacchycardia which is why they are given with B-blockers

Question 4

Drug-induced postural (orthostatic) hypotension is usually due to venous pooling or excessive diuresis and inadequate blood volume. Venous pooling is normally prevented by _______ in vascular smooth muscle; thus, orthostatic hypotension is caused or exacerbated by ______

Answer 4

α-receptor activation
α1 blockers such as Terazosin, Doxazosin
MOA: Blocks post-synaptic α1-adrenergic receptor antagonist on vascular smooth muscle

Question 5

A significant number of patients started on ACE inhibitor therapy for hypertension are intolerant and must be switched to a different class of drug. What is the most common manifestation of this intolerance?
(A) Angioedema
(B) Glaucoma
(C) Headache
(D) Incessant cough
(E) Ventricular arrhythmias

Answer 5

Chronic, intolerable cough is an important adverse effect of captopril and other ACE inhibitors. It may be reduced or prevented by prior administration of aspirin
ACE-I:
(“-pril” suffix)
Captopril, lisinopril, benozapril, quinapril, ramipril, enalapril

Question 6

Do ACE-I and ARBs cause hyper or hypokalemia?

Other side effects?

Answer 6

Aliskiren (direct renin inhibitor) and other inhibitors of the renin-angiotensin-aldosterone system (ACE-I and ARB) may cause hyperkalemia, not hypokalemia.
ACE-I cause dry cough
ARBs do NOT cause cough
Both cause angioedema

Question 7

Verapamil and Diltiazem are what class of drugs and may cause what side effects?

Answer 7

Verapamil and Diltiazem are Ca2+ channel blockers (non-dihydropyramidines) and fcn as negative ionotropes

they often causes constipation, probably by blocking L-type calcium channels in the colon.
Also: Leg edema, bradycardia, AV nodal blockade, hypotension, worsening heart failure

Question 8

T/F: Beta blockers do not cause orthostatic hypotension.

Answer 8

True

Question 9

T/F: alpha-1 blockers do not cause orthostatic hypotension.

Answer 9

False, alpha-1 blockers such as Terazosin, Doxazosin, or clonidine can cause orthostatic hypotension

Question 10

To decrease HR, would a beta blocker or alpha blocker work?

Answer 10

Beta blocker

Question 11

How do Beta blockers decrease BP?

Answer 11

Decrease HR
Decrease SV
Decrease CO (due to neg chronotropic and inotropic effects)
Decreases renin (therefore decreases aldo retention of H20 in nephron…inhibiting water retention)

Question 12

How do beta blockers help in patients with HTN?

Answer 12

B blockers to reduce CO (neg inotropic and chronotropic) and reduce renin secretion by blocking B receptors on JGA cells

Question 13

How do beta blockers help in patients with angina pectoris?

Answer 13

↓ O2 consumption by ↓ heart rate and contractility

Question 14

Why should Non-selective ß1 and ß2 antagonists (propanolol) should be avoided in patients with asthma and COPD?

Answer 14

Because of the risk of bronchoconstriction caused by ß2 blockade.

Question 15

_______ is a potassium sparking diuretic that blocks aldosterone receptors in distal nephron. It also has anti-androgenic effects that can lead to gynecomastia

Answer 15

Spironolactone

Question 16

What class of drugs are useful in controlling HTN in a patient with diabetic neuropathy, heart failure, and hyperuricemia?

Answer 16

ACE-inhibitors have been shown to slow the progression of renal disease, which is why they are the most preferred antihypertensive medication in diabetic patients.
Beta-blockers (B1) are not recommended in patients with diabetes since it can block the normal signs and symptoms of hypoglycemia

Question 17

T/F: Thaizides and loop diuretics can cause gout?

Answer 17

True

Gout is characterized by hyperuricema and pain and inflammation.

Question 18

T/F: Loop diuretics, thiazides and B-blockers like metropolol can cause dyslipidemia?

Answer 18

True.

Question 19

In the presence of an agonist, which receptor would cause increase in preload? (alpha 1, alpha 2, beta 1, or beta 2)?

Answer 19

alpha 1 agonist will constrict veins, causing increase in venous return and thus increase in preload

Question 20

In the presence of an agonist, which receptor would cause increase renin release? (alpha 1, alpha 2, beta 1, or beta 2)?

Answer 20

B1

Question 21

In the presence of an agonist, which receptor would cause increase in conduction velocity? (alpha 1, alpha 2, beta 1, or beta 2)?

Answer 21

B1 via AV node (positive dromotropy)

Question 22

In the presence of an agonist, which receptor would cause increase in HR? (alpha 1, alpha 2, beta 1, or beta 2)?

Answer 22

B1 (positive chronotropy)

Question 23

In the presence of an agonist, which receptor would cause increase contractile force? (alpha 1, alpha 2, beta 1, or beta 2)?

Answer 23

B1 causes increase in force of contraction (positive inotropy), conduction velocity, and increase in CO and O2 consumption

Question 24

In the presence of an agonist, which receptor would cause decrease in renin? (alpha 1, alpha 2, beta 1, or beta 2)?

Answer 24

alpha1

Question 25

In the presence of an agonist, which receptor would cause increase in afterload? (alpha 1, alpha 2, beta 1, or beta 2)?

Answer 25

Alpha 1 agonism will contract arterioles (skin, viscera) causing an increase in TPR and therefore an increase in diastolic pressure and thus an increase in afterload

Question 26

In the presence of an agonist, which receptor would cause bronchiolar dilation? (alpha 1, alpha 2, beta 1, or beta 2)?

Answer 26

B2 agonism will cause increase in bronchiolar dilation, which is useful for patients with COPD or asthma. This is why non-selective B-blockers (propranolol) should be avoided when treating a patient with COPD/Asthma for HTN, since it may worsen respiratory symptoms.

Question 27

T/F: In a patient with CHF symptoms in need of a HTN medication, verapimil (Ca2+ channel blocker) is a good option?

Answer 27

False Verapamil is a L-type Ca2+ channel blocker that has been associated with an accelerated progression of CHF because of its strong negative inotropic effects (decreased contractile force)

Question 28

Aspirin, clopidogrel, prasugrel, ticagrelor, and ticlopidine all have anti-_____ effects

Answer 28

Anti-platelet

Question 29

``` Which antiplatelet medication functions by selectively and irreversibly inhibiting ADP binding to P2Y12 (blocks ADP-dependent activiation of glycoprotein IIb/IIIa)? Aspirin Clopidogrel Ticlopidine Cilostazol Dipyradimole ```

Answer 29

Clopidogrel Thienopyridine antiplatelet agent Great antithrombotic; standard of care w/ stent Side effect is bleeding, but not as severe as with prasugrel

Question 30

``` Which antiplatelet medication functions by Irreversibly binds P2Y12 receptor (G protein-coupled chemoreceptor for ADP) but has a massive risk of bleeding Aspirin Clopidogrel Prasugrel Cilostazol Dipyradimole ```

Answer 30

Prasugrel Reduce thrombotic events in those w/percutaneous coronary intervention (e.g., stent) Drug is limited to patients under 75 in age, greater than 60 Kg in weight, and no history of stroke or TIA.

Question 31

``` Which antiplatelet medication functions by reversibly blocking ADP receptors and is a great antitrhombotic but requires bid dosing? Clopidogrel Ticagrelor Prasugrel Cilostazol Dipyradimole ```

Answer 31

Ticagrelor

Question 32

``` Which angina drug is used for treatment for claudication with peripheral vascular disease by Inhibits platelet aggregation via increasing cAMP levels Clopidogrel Ticagrelor Prasugrel Cilostazol Dipyradimole ```

Answer 32

Cilostazol contraindicated in heart failure

Question 33

``` Which angina drug causes Increases platelet intracellular cAMP (inhibits phosphodiesterase 5, activates adenylate cyclase, inhibits uptake of adenosine from vascular endothelium and RBCs)...used to decrease peripheral vascular disease and in stress test of heart? Clopidogrel Ticagrelor Prasugrel Cilostazol Dipyradimole ```

Answer 33

Dipyradimole Pyrimido-pyrimidine antiplatelet agent Use is limited in CAD because it vasodilates coronary arteries which can enhance exercise induced ischemia Is used in cerebral artery disease

Question 34

How to beta blockers help treat MI/angina/ischemia?

Answer 34

Bind to beta receptors and block effects of Epi and NE, which means that catecholamines cant bind to the myocardium and you don't get increase in HR or contractility and therefore decrease myocardial O2 demand. Main point is that you are decreasing O2 demand by heart with these drugs therefore in conditions where thre are issues with O2 demand (blockage of vessels) these help minimize the effect

Question 35

Most beta-blockers used in CAD are beta1 or beta2 selective?

Answer 35

Most beta-blockers used in CAD are beta-1 selective | By decreasing contractility and heart rate, myocardial oxygen demand is decreased

Question 36

What are some of the contraindications for B blocker use?

Answer 36

Severe bradycardia (B blockers slow HR and this would compound this) High degree AV block (will worsen AV block) Unstable LV failure Asthma/COPD Other side effects: they make you fatigued, lethargic, decrease exercise tolerance, impotence

Question 37

What role does ACE inhibitors play in vasoconstriction/dilatation?

Answer 37

Angiotensin II is responsible for vasoconstriction (elevated bradykinin levels, which is a vasodilator) Angiotensin II also stimulates the release of ADH/vasopressin that causes an increase in h2o reabsorption...blocking this (ACE-I) will cause less reabsorption and more water loss in urine...decreasing BP