Pharm Flashcards
1
Q
Aliskiren
A
- Potent Renin Inhibitor
- Long half-life (>24 hours)
- Orally Active
- Low Bioavailability
- MOA
- Supression of plasma renin activity → decreasing the levels of Ang I and II
- Induces compensatory increase renin secretion
- Indication
- Primary hypertension (Not a first-line agent)
- Contraindication
- Pregnancy
- Bilateral Renal Artery Stenosis
- Adverse Effects
- GI Disturbances
- Headache
- Dizziness
- Angioedema
- Cough
2
Q
Captopril
A
- ACE Inhibitor
- Shortest half-life
- MOA
- Inhibits conversion of Ang I to Ang II → Reducing levels of circulating and locally formed Ang II
- Indication
- Hypertension (First-Line)
- Heart Failure
- Acute MI
- Chronic Renal Failure
- Reduce Adverse Cardiovascular Events in High-Risk Patients
- Contraindications
- Pregnancy
- Bilateral Renal Artery Stenosis
- Adverse Effects
- Hypotension
- Hyperkalemia
- Renal Function Impairment
- Dry Cough
- Skin Rash (Vessel Relaxation)
- Dizziness
- Headache
- Impaired Taste
- GI Disturbances
- Angioedema (Serious, but Rare)
- Proteinuria
- Neutropenia
- Glycosuria
- Hepatotoxicity
- Drug Interactions
- NSAIDs - may impair hypotensive effects
3
Q
What are the consequences of taking an ACE Inhibitor?
A
- Compensatory increase in plasma renin activity and Ang I levels due to removal of feedback inhibition of Ang II
- Decrease in aldosterone levels
- Generation of Ang II by alternative pathways
4
Q
What are the benificial effects of ACE Inhibitors?
A
- Lower BP
- Improve Arterial Compliance
- Decrease Afterload
- May prevent/reverse vascular and ventricular remodeling and hypertrophy
- Improve Renal Perfusion
- Lower Intraglomerular Pressure
- May Improve Insulin Sensitivity and Glucose Metabolism
5
Q
Enalapril
A
- ACE Inhibitor
- Prodrug converted to enalaprilat by an esterase in liver
- Enalaprilat may be administered via I.V. in hypertensive emergencies
- MOA
- Inhibits conversion of Ang I to Ang II → Reducing levels of circulating and locally formed Ang II
- Indication
- Hypertension (First-Line)
- Heart Failure
- Acute MI
- Chronic Renal Failure
- Reduce Adverse Cardiovascular Events in High-Risk Patients
- Contraindications
- Pregnancy
- Bilateral Renal Artery Stenosis
- Adverse Effects
- Hypotension
- Hyperkalemia
- Renal Function Impairment
- Dry Cough
- Skin Rash (Vessel Relaxation)
- Dizziness
- Headache
- Impaired Taste
- GI Disturbances
- Angioedema (Serious, but Rare)
- Proteinuria
- Neutropenia
- Glycosuria
- Hepatotoxicity
- Drug Interactions
- NSAIDs - may impair hypotensive effects
6
Q
Lisinopril
A
- ACE Inhibitor
- Lysine derivative of enalaprilat
- Enalaprilat may be administered via I.V. in hypertensive emergencies
- MOA
- Inhibits conversion of Ang I to Ang II → Reducing levels of circulating and locally formed Ang II
- Indication
- Hypertension (First-Line)
- Heart Failure
- Acute MI
- Chronic Renal Failure
- Reduce Adverse Cardiovascular Events in High-Risk Patients
- Contraindications
- Pregnancy
- Bilateral Renal Artery Stenosis
- Adverse Effects
- Hypotension
- Hyperkalemia
- Renal Function Impairment
- Dry Cough
- Skin Rash (Vessel Relaxation)
- Dizziness
- Headache
- Impaired Taste
- GI Disturbances
- Angioedema (Serious, but Rare)
- Proteinuria
- Neutropenia
- Glycosuria
- Hepatotoxicity
- Drug Interactions
- NSAIDs - may impair hypotensive effects
7
Q
Losartan
A
- AT1 Receptor Blocker (Ang II Receptor Blocker)
- Highly bound to plasma proteins
- Poorly/Do NOT Cross the BBB
- Orally Active
- Undergoes extensive first-pass hepatic metabolism
- Active metabolite longer half-life than parent compound
- MOA
- Selectively block AT1 Receptors
- Indication
- Hypertension
- Heart Failure
- Diabetic Nephropathy
- Patients Intolerant to ACE Inhibitors
- Contraindications
- Pregnancy
- Bilateral Renal Artery Stenosis
- Adverse Effects
- Hypotension (First-Dose)
- Hyperkalemia
- Renal Function Impairment
- Skin Rash (Vessel Relaxation)
- Dizziness
- Headache
- Impaired Taste
- GI Disturbances
- Less Chance of Angioedema compared to ACE Inhibitors
8
Q
Candesartan
A
- AT1 Receptor Blocker (Ang II Receptor Blocker)
- Highly bound to plasma proteins
- Poorly/Do NOT Cross the BBB
- Prodrug
- MOA
- Selectively block AT1 Receptors
- Indication
- Hypertension
- Heart Failure
- Diabetic Nephropathy
- Patients Intolerant to ACE Inhibitors
- Contraindications
- Pregnancy
- Bilateral Renal Artery Stenosis
- Adverse Effects
- Hypotension (First-Dose)
- Hyperkalemia
- Renal Function Impairment
- Skin Rash (Vessel Relaxation)
- Dizziness
- Headache
- Impaired Taste
- GI Disturbances
- Less Chance of Angioedema compared to ACE Inhibitors
9
Q
Olmesartan
A
- AT1 Receptor Blocker (Ang II Receptor Blocker)
- Highly bound to plasma proteins
- Poorly/Do NOT Cross the BBB
- Prodrug
- MOA
- Selectively block AT1 Receptors
- Indication
- Hypertension
- Heart Failure
- Diabetic Nephropathy
- Patients Intolerant to ACE Inhibitors
- Contraindications
- Pregnancy
- Bilateral Renal Artery Stenosis
- Adverse Effects
- Hypotension (First-Dose)
- Hyperkalemia
- Renal Function Impairment
- Skin Rash (Vessel Relaxation)
- Dizziness
- Headache
- Impaired Taste
- GI Disturbances
- Less Chance of Angioedema compared to ACE Inhibitors
10
Q
Icatibant
A
- Bradykinin B2 Antagonist
- MOA
- Blocks bradykinin B2 receptors, reducing vascular permeability
- Indication
- Acute Hereditary and ACE Inhibitor-Associated Angioedema
- Reduced symptoms more rapidly than glucocoticoids and antihistamines
- Acute Hereditary and ACE Inhibitor-Associated Angioedema
11
Q
Bosentan
A
- Endothelin Receptor Antagonist
- Nonselective ETA/ETB antagonist
- Orally Active
- MOA
- Block ET receptors, relaxing vascular smooth muscle
- Indication
- Pulmonary Arterial Hypertension
- Contraindication
- Pregnancy (Teratogenic)
- Adverse Effects
- Headache
- Flushing
- Hypotension
- Peripheral Edema
- Palpitations
- Elevation of Liver Enzymes (Chronic Therapy)
12
Q
Macitentan
A
- Endothelin Receptor Antagonist
- Nonselective ETA/ETB antagonist
- Orally Active
- MOA
- Block ET receptors, relaxing vascular smooth muscle
- Indication
- Pulmonary Arterial Hypertension
- Contraindication
- Pregnancy (Teratogenic)
- Adverse Effects
- Headache
- Flushing
- Hypotension
- Peripheral Edema
- Palpitations
- Elevation of Liver Enzymes (Chronic Therapy)
13
Q
Ambrisentan
A
- Endothelin Receptor Antagonist
- Selective ETA antagonist
- MOA
- Block ET receptors, relaxing vascular smooth muscle
- Indication
- Pulmonary Arterial Hypertension
- Contraindication
- Pregnancy (Teratogenic)
- Adverse Effects
- Headache
- Flushing
- Hypotension
- Peripheral Edema
- Palpitations
- Elevation of Liver Enzymes (Chronic Therapy)
14
Q
Nesiritide
A
- Natriuretic Peptide Agonist
- Recombinant Human BNP
- Given via I.V.
- Indications
- Acute Decompensated Congestive Heart Failure
- Pharmcological Effects
- Relax arteries and veins
- Promote diuresis and natriuresis
- Decrease cardiovascular remodeling
- Lower blood pressure
15
Q
Sacubitril
A
- Neprilysin Inhibitor
-
Prodrug
- Activated to LBQ657 by de-ethylation via esterases
- MOA
- Inhibits neprilysin (responsible for ANP and BNP degradation)
16
Q
Entresto
A
- Sacubitril and Valsartan
- MOA
- Enhance effects of ANP and BNP
- Block Effects of Ang II
- Indication
- Chronic Heart Failure w/ Reduced Ejection Fraction
- Contraindication
- Hypersensitivity to sacubitril or valsartan
- History of Angioedema
- Concomitant use of ACE Inhibitors, AT1 Antagonist, or Aliskiren
17
Q
Acetazolamide
A
- Carbonic Anhydrase Inhibitor
- MOA
- Inhibit Carbonic Anhydrase
- Promotes HCO3- and Na+ Excretion → Increased Urine pH and Volume
- Tolerance develops after 3-4 days due to metabolic acidosis caused by HCO3- excretion
- Reduce formation of HCO3- in aqueous humor and cerebrospinal fluid
- Decreases rate of formation of aqueous humor and cerbrospinal fluid
- Lowers Intraocular Pressure and Cerbrospinal Pressure
- Rapidly Absorbed/NOT Metabolized/Max Action @ 2 hours/Persists for 12 Hours
- Indications
- Glaucoma
- Urinary Acidosis
- Metabolic Alkalosis
- Acute Mountain Sickness
- Adverse Effects
- Metabolic Acidosis
- Renal Stones
- Renal Potassium Wasting
18
Q
Furosemide
A
- Loop Diuretic
- Most Efficacious of All Diuretics
- Sulfonamide
- Pharmacokinetics
- Rapidly absorbed
- Half-Life = 2 hours
- Onset of Effect
- Lasts 6-8 hours
- Peaks 1-2 hours
- Within 1 hour
- Can be given parenterally
- Extensively bound to plasma proteins
- Secreted by organic acid secretory system in Proximal Tubule
- Competes w/ Uric Acid
- May induce gout attack
- 60-65% Eliminated via Renal Route
- 35-40% Eliminated by Metabolism
- MOA
- Inhibits Na/K/2Cl cotransport in thick ascending limb → increased excretion of NaCl
- Increases Na delivery to distal convoluted tuble and collecting tubule
- Enhance Ca and Mg excretion
- Increase K Secretion
- Increased excretion of NaCl, H2O, Mg, and Ca in urine
- Inhibits Na/K/2Cl cotransport in thick ascending limb → increased excretion of NaCl
- Adverse Effects
- Hypokalemic Metabolic Alkalosis
- Hypomagnesemia
- Hyperuricemia
- Hyperglycemia
- Hyperlipidemia
- Ototoxicity
- Hyponatremia
19
Q
Bumetanide
A
- Loop Diuretic
- Most Efficacious of All Diuretics
- Sulfonamide
- Pharmacokinetics
- Rapidly absorbed
- Half-Life = 1-1.5 hours
- Onset of Effect
- Within 30-60 Minutes
- Peaks 1-2 hours
- Lasts 4-6 hours
- Extensively bound to plasma proteins
- Secreted by organic acid secretory system in Proximal Tubule
- Competes w/ Uric Acid
- May induce gout attack
- 60-65% Eliminated via Renal Route
- 35-40% Eliminated by Metabolism
- MOA
- Inhibits Na/K/2Cl cotransport in thick ascending limb → increased excretion of NaCl
- Increases Na delivery to distal convoluted tuble and collecting tubule
- Enhance Ca and Mg excretion
- Increase K Secretion
- Increased excretion of NaCl, H2O, Mg, and Ca in urine
- Inhibits Na/K/2Cl cotransport in thick ascending limb → increased excretion of NaCl
- Adverse Effects
- Hypokalemic Metabolic Alkalosis
- Hypomagnesemia
- Hyperuricemia
- Hyperglycemia
- Hyperlipidemia
- Ototoxicity
- Hyponatremia
20
Q
Ethacrynic Acid
A
- Loop Diuretic
- Most Efficacious of All Diuretics
- Pharmacokinetics
- Rapidly absorbed
- Half-Life = 1 hour
- Onset of Effect
- Within 30 Minutes
- Peaks 2 hours
- Lasts 6-8 hours
- Extensively bound to plasma proteins
- Secreted by organic acid secretory system in Proximal Tubule
- Competes w/ Uric Acid
- May induce gout attack
- 60-65% Eliminated via Renal Route
- 35-40% Eliminated by Metabolism
- MOA
- Inhibits Na/K/2Cl cotransport in thick ascending limb → increased excretion of NaCl
- Increases Na delivery to distal convoluted tuble and collecting tubule
- Enhance Ca and Mg excretion
- Increase K Secretion
- Increased excretion of NaCl, H2O, Mg, and Ca in urine
- Inhibits Na/K/2Cl cotransport in thick ascending limb → increased excretion of NaCl
- Adverse Effects
- Hypokalemic Metabolic Alkalosis
- Hypomagnesemia
- Hyperuricemia
- Hyperglycemia
- Hyperlipidemia
- Ototoxicity
- Hyponatremia
21
Q
Torsemide
A
- Loop Diuretic
- Most Efficacious of All Diuretics
- Sulfonamide
- Pharmacokinetics
- Rapidly absorbed
- Half-Life = 3-4 hours
- Onset of Effect
- Within 1 hour
- Peaks 1-2 hours
- Lasts 12-16 hours
- Extensively bound to plasma proteins
- Secreted by organic acid secretory system in Proximal Tubule
- Competes w/ Uric Acid
- May induce gout attack
- 70% Eliminated via Hepatic Metabolism
- 30% Eliminated by Renal Route
- MOA
- Inhibits Na/K/2Cl cotransport in thick ascending limb → increased excretion of NaCl
- Increases Na delivery to distal convoluted tuble and collecting tubule
- Enhance Ca and Mg excretion
- Increase K Secretion
- Increased excretion of NaCl, H2O, Mg, and Ca in urine
- Inhibits Na/K/2Cl cotransport in thick ascending limb → increased excretion of NaCl
- Adverse Effects
- Hypokalemic Metabolic Alkalosis
- Hypomagnesemia
- Hyperuricemia
- Hyperglycemia
- Hyperlipidemia
- Ototoxicity
- Hyponatremia
22
Q
Hydrochlorothiazide
A
- Thiazide Diuretics
- Chemically Related to Sulfonamides
- Pharmacokinetics
- Bound to plasma proteins
- Secreted by organic acid secretory system in PT (compete w/ uric acid)
- Primarily excreted in urine
- MOA
- Inhibit Na/Cl cotransporter in distal convoluted tubule leading to decreased Na and Cl reabsorption
- Enhance Ca reabsorption in PT and DCT
- Adverse Effects
- Hypokalemic metabolic alkalosis and hyperuricemia
- Hypersensitivity reactions
- Hypercalcemia
- Hyperlipidemia
- Hyperglycemia
- Chronic Dilutional Hyponatremia
- Indications
- Edema
- Chronic Heart Failure
- Acute Pulmonary Edema
- Nonedematous
- Hypertension
- Diabetic Insipidus
- Nephrolithiasis and Osteoporosis
- Hypercalcemia
- Edema
23
Q
Indapamide
A
- Thiazide-Like Diuretics
- Pharmacokinetics
- Don’t accumulate in patients w/ renal impairment
- MOA
- Block Na-Cl reabsorption in the distal convoluted tubule
- Block Na reabsorption in proximal tubule
- Adverse Effects
- Hypokalemic metabolic alkalosis and hyperuricemia
- Hypersensitivity reactions
- Hypercalcemia
- Chronic Dilutional Hyponatremia
- Indications
- Can be combined w/ loop diuretics to induce urine formation in patients with <20 ml/min GFR
24
Q
Metolazone
A
- Thiazide-Like Diuretic
- Pharmacokinetics
- Don’t accumulate in patients w/ renal impairment
- MOA
- Block Na-Cl reabsorption in the distal convoluted tubule
- Block Na reabsorption in proximal tubule
- Adverse Effects
- Hypokalemic metabolic alkalosis and hyperuricemia
- Hypersensitivity reactions
- Hypercalcemia
- Chronic Dilutional Hyponatremia
- Indications
- Can be combined w/ loop diuretics to induce urine formation in patients with <20 ml/min GFR
25
Spironolactone
* Aldosterone Receptor Antagonist
* Non-selective Antagonist
* Potassium Sparing
* Prodrug
* Metabolized to canrenone (active metabolite)
* MOA
* Reduce Na reabsorption subsequently K excretion
* Decrease H secretion
* Pharmacokinetics
* Rapid absorption
* \>90% bound to plasma protein
* Rapidly/Extensively metabolized
* Onset = 24-48 Hours
* Duration = 48-72 Hours
* Half-Life = 1.6 hours Spironolactone 10-35 hours Canrenone
* Primarily Excreted in Urine
* Only diuretic that DOES NOT need to get into the lumen of the renal tubule
* Indication
* Hyperaldosteronism
* Primary
* Secondary
* Hepatic Cirrhosis
* Chronic Heart Failure
* Edema
* Hypertension
* Adverse Effects
* Hyperkalemia
* Metabolic Acidosis
* Gynecomastia
* Contraindication
* Renal Insufficiency
* Serum K+ \>5.0 mEq/L
* Treatment w/ other K-sparing diuretics
* Oral potassium supplement
26
Eplerenone
* Aldosterone Receptor Antagonist
* Selective Antagonist
* Potassium Sparing
* Prodrug
* Metabolized to canrenone (active metabolite)
* MOA
* Reduce Na reabsorption subsequently K excretion
* Decrease H secretion
* Pharmacokinetics
* Rapid absorption
* \>90% bound to plasma protein
* Rapidly/Extensively metabolized
* Onset = 24-48 Hours
* Duration = 48-72 Hours
* Half-Life = 1.6 hours Spironolactone 10-35 hours Canrenone
* Primarily Excreted in Urine
* Only diuretic that DOES NOT need to get into the lumen of the renal tubule
* Indication
* Hyperaldosteronism
* Primary
* Secondary
* Hepatic Cirrhosis
* Chronic Heart Failure
* Edema
* Hypertension
* Adverse Effects
* Hyperkalemia
* Metabolic Acidosis
* Gynecomastia
* Contraindication
* Renal Insufficiency
* Serum K+ \>5.0 mEq/L
* Treatment w/ other K-sparing diuretics
* Oral potassium supplement
27
Triamterene
* Potassium Sparing Diuretic
* Na Channel Blocker
* MOA
* Block Na channels in luminal membrane of late distal tubules and collecting tubules
* Thus inhibiting Na influx and K secretion
* Pharmacokinetics
* Rapid Absorption
* Bound to proteins
* Onset of Action = 2-4 Hours
* Peak Effect = 6-8 Hours
* Duration of Action = 12-16 Hours
* Metabolized to sulfate conjugate and hydroxyltriamterene (active metabolite)
* Half-Life = Approx. 3 Hours
* Primarily Excreted by Glomerular Filtration and Organic Base Transport System Secretion
* Indications
* Edema
* Hypertension
* Contraindication
* Renal Insufficiency
* Serum Potassium \>5.0 mEq/L
* Treatment w/ other potassium sparing diuretics
* Oral admin of potassium
* Adverse Effects
* Hyperkalemia
28
Amiloride
* Potassium Sparing Diuretic
* Na Channel Blocker
* MOA
* Block Na channels in luminal membrane of late distal tubules and collecting tubules
* Thus inhibiting Na influx and K secretion
* Pharmacokinetics
* Rapid Absorption
* Bound to proteins
* Onset of Action = 2 Hours
* Peak Effect = 6-10 Hours
* Duration of Action = 24 Hours
* Half-Life = 6-9 Hours
* Excreted unchanged in urine and feces
* Secreted into proximal tubule by organic base transport
* Indications
* Edema
* Hypertension
* Contraindication
* Renal Insufficiency
* Serum Potassium \>5.0 mEq/L
* Treatment w/ other potassium sparing diuretics
* Oral admin of potassium
* Adverse Effects
* Hyperkalemia
29
Patiromer
* Used to treat Hyperkalemia
* MOA
* Binds to excess K+ in the colon promoting K+ excretion
* Indication
* Non-life threatening hyperkalemia
*