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Term 5 > Pharm: ANS, Autacoids, Diuretics, HTN, CHF, Angina > Flashcards

Pharm: ANS, Autacoids, Diuretics, HTN, CHF, Angina Flashcards

1
Q

H1 receptor is similar to…

A

M3 receptor (endothelium, smooth muscle, nerve endings) Gq

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2
Q

H2 receptor is similar to…

A

Beta-2 receptor (gastric mucosa, heart, immune cells) Gs

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3
Q

Low dose ACh vs. High dose ACh [barorecepror reflex]

A

Low dose: M3 hypotension, reflex tachycardia

High dose: M2 bradycardia

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4
Q

Cholinergic agnonists activating both M & N

A

Carbachol, arecoline

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5
Q

Methacholine

A

[M ag] Diagnosis of bronchial airway hyperactivity in patients without clinically apparent asthma

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6
Q

Carbachol

A

[M ag] Miosis; decrease IOP

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7
Q

Bethanachol

A

[M ag] Acute post-op urinary retention, neurogenic bladder

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8
Q

Pilocarpine

A

[M ag] Sialagogue, Miosis, decrease IOP

* Acute glaucoma

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9
Q

Edrophonium

A

[Anti-AChE] Diagnosis MG, reverse NM effect of non-depolarizing blocker

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10
Q

Physostigmine

* AE

A

[Anti-AChE] Trmt for OD on anti-cholinergic drugs

* Do not treat a TCA overdose patient: depress cards conduction

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11
Q

Neostigmine

A

[Anti-AChE] Stimulate bladder, antidote to competitive antagonist at NMJ, treatment MG

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12
Q

Pyridostigmine

A

[Anti-AChE] MG treatment

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13
Q

Echothiophate

A

[Anti-AChE] Glaucoma

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14
Q

Pralidoxime

A

Re-activator of AChE: must use before aging in organophosphate poisoning

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15
Q

Donepezil, rivastigmine, tacrine, galantamine

A

[Anti-AChE] Alzheimer’s treatment

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16
Q

Among the anti-cholinesterases, which group forms the strongest covalent bond?

A

Organophosphates

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17
Q

Atropine is contraindicated in…
What is the surgical use of atropine?
Atropine flush?

A

Angle-closure glaucoma, BPH, elderly

  • Block respiratory secretions
    • Given in high doses
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18
Q

Scopalamine (2 uses)

A

[M antag] Motion sickness

Block STM memory - anesthetic

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19
Q

Ipratropium & Tiotropium

A

[M antag] COPD & Asthma

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20
Q

Homatropine, Cyclopentolate, Tropicamide

A

[M antag] Mydriasis with cycloplegia [better than atropine, because shorter duration of action]

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21
Q

Benztropine & Trihexyphenidyl

A

[M antag] Parkinsonism & effects of anti-psychotics

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22
Q

Glycopyrrolate PO vs. IV

A

[M antag] PO: decreased GI motility; IV: prevent bradycardia during surgery

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23
Q

Tolterodine

A

[M antagonist] Overactive bladder

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24
Q

Hexamethonium, mecamylamine, trimethaphan

A

[N ganglion blockers] Reverse the dominant control, i.e. sympa reversal of arteries, veins, sweat glands [dilation/dilation/anhydrosis]

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25
Q

Tubocurarine

A

[NMJ non-depolarizing competitive antagonist] Skeletal muscle relaxation during surgery

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26
Q

Succynylcholine

* AE

A

[NMJ depolarizing blocker] Rapid intubation/ECT

* Malignant hyperthermia (excessive Ca release from SR when given with halogenated anesthetic); treat with dantrolene

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27
Q

Dantrolene

A

Treatment for anesthesia-induced malignant hyperthermia

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28
Q

Hemicholinium

A

[Pre-syn chol antag] prevents uptake of choline (CHT)

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29
Q

Vesamicol

A

[Pre-syn chol antag] prevents ACh storage [ACh-H+ antiport]

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30
Q

Botox

A

[Pre-syn chol antag] prevents ACh release [spasm/wrinkles]

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31
Q

Low dose epi vs. Large dose epi [baroreceptor reflex]

A

Low dose: no baroreceptor reflex (because B2&raquo_space; Alpha 1)

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32
Q

NE

  • Receptors
  • Reflex brady? How to overcome?
A

Alpha 1, Alpha 2, Beta 1

Reflex bradycardia: pre-treat with atropine

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33
Q

Dopamine

* Treatment of choice for shock?

A

Treatment of choice for shock; prevents renal shutdown

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34
Q

Phenylephrine

A

[A1 Ag] vasoconstrictor: nasal decongestant, dilate pupil, shock, SVT

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35
Q

Clonidine

* AE

A

[Central A2 Ag] Decrease BP [lethargy, sedation, xerostomia]

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36
Q

Methyldopa

A

[Central A2 Ag] Treatment of choice for pregnancy-induced HTN

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37
Q

Brimodine

A

[Alpha 2 Ag] Glaucoma (decreases production/ increases outflow)

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38
Q

Isoproterenol

A

[B Ag] B1: increase HR; B2: dilate arterioles

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39
Q

Dobutamine

A

[B1 Ag] Acute management of CHF; increases CO without increasing HR and oxygen demand of the heart

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40
Q

Albuterol & Terbutaline
Salmeterol & Formoterol
* AE

A

Asthma short acting vs. Long action

AE: tremor, restlessness, apprehension, anxiety, tachycardia (less likely with inhaled)

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41
Q

Amphetmine

A

[NE release + potentiate NE] Increase BP

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42
Q

Methylphenydate

A

[NE release + potentiate NE] ADHD

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43
Q

Tyramine

A

[NE release + potentiate NE] Cheese/Wine metabolized by MAO – MAOI serious side effects

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44
Q

Cocaine

A

[Uptake inhibitor]

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45
Q

Atomoxetine

A

[Uptake inhibitor] ADHD

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46
Q

Ephedrine

A

[Mixed NE release/adrenergic receptor] Pressor (hypotension during spinal anesthesia); MG treatment; bronchial asthma treatment; not metabolized by COMT

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47
Q

Pseudoephedrine

A

[Mixed NE release/adrenergic receptor] OTC decongestant

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48
Q

Phenoxybenzamine

Phentolamine

A

Phenoxy: irreversible pheo
Phentolamine: reversible; STM pheo/HTN crisis; withdrawal clonidine

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49
Q

Epinepherine reversal?

A

Phenoxybenzamine/Phentolamine

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50
Q

Prazosin, Terazosin, Doxazosin, Tamsulosin

  • First dose?
  • AE?
A

[A1 antagnonist] BPH & HTN except tamsulosin

  • First dose exaggerated response
  • Orthostatic hypotension
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51
Q

Yohimbine

A

[A2 Antagonist] past treatment for ED (replaced by phosphodiesterase inhibitors)

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52
Q

Propranolol is contraindicated in…

A

[B-blocker] Asthmatics, DM (may impair recovery from hypoglycemia & mask the tachycardia associated with hypoglycemia)

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53
Q

Timolol

A

[B-blocker] Glaucoma, HTN, migraine

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54
Q

Why shouldn’t beta-blockers be withdrawn abruptly?

A

Tachycardia, HTN, ischemia 2/2 upregulation of beta-receptors

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55
Q

Nadolol

A

[B-blocker] Longer duration of action; Angina/HTN

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56
Q

Atenolol, metoprolol

* AE

A

[B1-Antag] HTN patients with impaired pulmonary function; DM patients on insulin/oral hypoglycemic
* Still avoid in asthmatics b/c beta-2 effects

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57
Q

Esmolol

A

[B1-Antag] 1/2 life 10 minutes: SVT, thyrotoxicosis, peri-operative HTN, myocardial ischemia in acutely ill patients

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58
Q

Labetalol, Carvediol

A

[A1 & beta blockers] HTN, HTN/CHF

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59
Q

Pindolol

A

[Partial agonist] HTN in pts with impaired cardiac reserve and a propensity for bradycardia

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60
Q

Metyrosine

A

Competitive inhibitor of tyrosine-hydroxylase; malignant pheo/perioperative management

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61
Q

Reserpine

A

Damages VMAT irreversibly; no storage of NE/dopamine in vesicles

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62
Q

Guanethidine

A

Displaces NE from vesicles; inhibits release of NE

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63
Q

Cromolyn, Nedocromil

A

Histamine release inhibitor

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64
Q

Fexofenidine

A

Second generation H-1 antagonist (less sedative side effects 2/2 increased lipophilicity)

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65
Q

Loratidine

A

Second generation H-1 antagonist (less sedative side effects 2/2 increased lipophilicity)

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66
Q

Cetrizine

A

Second generation H-1 antagonist (less sedative side effects 2/2 increased lipophilicity)

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67
Q

Cimitidine

* AE

A

H-2 antagonist [inhibit gastric acid secretion – peptic ulcer, acute stress ulcer, GERD]
Inhibits CYP450, Anti-Androgen; IV/ICU can induce renal/hepatic dysfunction

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68
Q

Ranitidine

A

[Zantac] H-2 antagonist [inhibit gastric acid secretion – peptic ulcer, acute stress ulcer, GERD]

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69
Q

Famotidine

A

[Pepcid AC] H-2 antagonist [inhibit gastric acid secretion – peptic ulcer, acute stress ulcer, GERD]

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70
Q

Nizatidine

A

H-2 antagonist [inhibit gastric acid secretion – peptic ulcer, acute stress ulcer, GERD]

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71
Q

Chlorpheniramine

A

First generation H-1 antagonist; Allergies, motion sickness, somnifacents

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72
Q

Cyclizine

A

First generation H-1 antagonist; Allergies, motion sickness, somnifacents

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73
Q

Diphenhydramine

A

First generation H-1 antagonist; Allergies, motion sickness, somnifacents

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74
Q

Dimenhydrinate

A

First generation H-1 antagonist; Allergies, motion sickness, somnifacents

75
Q

Hydroxyzine

A

First generation H-1 antagonist; Allergies, motion sickness, somnifacents

76
Q

Meclizine

A

First generation H-1 antagonist; Allergies, motion sickness, somnifacents

77
Q

Promethazine

A

First generation H-1 antagonist; Allergies, motion sickness, somnifacents

78
Q

Terfenadine

* AE

A

First generation H-1 antagonist; Allergies, motion sickness, somnifacents [removed from market: block K+ channels – fatal arrhythmias]

79
Q

Astemizole

* AE

A

First generation H-1 antagonist; Allergies, motion sickness, somnifacents [removed from market: block K+ channels – fatal arrhythmias]

80
Q

Sumatriptan

A

5-HT 1B/D Agonist: acute severe migraine

81
Q

Metoclopramide

A

5-HT 4 Agonist: prokinetic

82
Q

Cisapride

A

5-HT 4 Agonist: prokinetic [removed from market/cards effects]

83
Q

Cyproheptadine

A

5-HT 2 Antagonist: allergic rhinitis, vasomotor rhinitis, serotonin syndrome [Also H1 blocker]

84
Q

Ondansetron

A

5-HT 3 Antagonist: anti-emetic/cancer-CTX

85
Q

Ergotamine

A 
Ergot Alkaloid (alpha, 5-HT, CNS dopamine)
* Migraine pain
86
Q

Dihydroergotamine

A 
Ergot Alkaloid (alpha, 5-HT, CNS dopamine)
* Migraine pain
87
Q

Bromocriptine

A 
Ergot Alkaloid (alpha, 5-HT, CNS dopamine)
* Hyperprolactinemia
88
Q

Carbergoline

A 
Ergot Alkaloid (alpha, 5-HT, CNS dopamine)
* Hyperprolactinemia
89
Q

Ergonovine

A 
Ergot Alkaloid (alpha, 5-HT, CNS dopamine)
* Post-partum hemorrhage (w/ oxytocin); provokes coronary artery spasm in angina patients
90
Q

Methylergonovine

A 
Ergot Alkaloid (alpha, 5-HT, CNS dopamine)
* Post-partum hemorrhage (w/ oxytocin); provokes coronary artery spasm in angina patients
91
Q

Drugs to be used in systolic CHF

A

ACEi, diuretics, spironolactone, beta-blocker, vasodilator, inotrope

92
Q

Candesartan, Valsartan

A

ARB’s for CHF

93
Q

AE’s of Spionolactone

A

Hyperkalemia, GI/CNS/Endocrine (anti-androgen) abnormalities

94
Q

Which drug causes a lupus-like syndrome?

A

Hydralizine (Vasodilator for HTN/CHF)

95
Q

Drugs to be used in diastolic CHF

A

Beta-blocker, Ca channel blocker, diuretics

96
Q

Carvedilol, Metoprolol

A

Beta-blockers for CHF

97
Q

Which drug class can initially exacerbate CHF symptoms?

A

Beta-blocker

98
Q

ACEi target arteries and veins. Describe targets of CHF vasodilators.

A

Hydralizine (A); Nitrates (V)

99
Q

Black patients with advanced heart failure could benefit from:

A

Vasodilator therapy (Hydralizine, Nitrates)

100
Q

Which drugs can displace digoxin from protein binding sites?

A

Quinidine, verapamil, amiodarone

101
Q

What are some precipitating factors for digoxin AE’s?

A

Hypokalemia, hypoMg/hyperCa, hyperthyrosis, abnormal renal function, CS

102
Q

How do you treat digoxin-induced V tach?

A

Lidocaine, Mg++, Adjust K+ to high normal

103
Q

Severe digoxin-induced toxicity treated with…

A

Digitalis-Ab; temporary PM

104
Q

What are the 6 classes of diruetics? Give examples of each class.

A
  1. CAI: Acetazolamide
  2. Loop diuretics: Furosemide, Torsemide
  3. Thiazide diuretics: HCTZ, chlorthalidone, metolazone
  4. K+ sparing (aldosterone antagnoist): Spironolactone, Eplerenone K+ sparing (Na-blocker): Amiloride, triamterene
  5. ADH antagonist: canivaptan
  6. Osmotic agents: mannitol
105
Q

AE CAI

A

Malaise, fatigue, depression, GI upset, drowsiness, paresthesia

106
Q

Indications Loop Diuretics

A
  1. Hrt/Renal/Hepatic failure (acute pulmonary edema)
  2. HTN
  3. Hypercalcemia
  4. Hyperkalemia
107
Q

AE Loop Diuretics

A
  1. Ototoxicity
  2. Hyperuricemia
  3. Acute hypovolemia
  4. Hypokalemia
  5. Hypomagnesemia
  6. Allergic reaction
108
Q

Indications Thiazide diuretics

A
  1. Mild-to-moderate heart failure
  2. HTN alone or with ACE-inhibitor/beta-blocker
  3. Hypercalciuria
  4. DI
  5. Pre-menstrual edema
109
Q

AE Thiazide diuretics

A
  1. Hyperglycemia
  2. Hyperlipidemia
  3. Hypersensitivity
    S/A Loop diuretics
110
Q

Which diuretic decreases renal vascular resistance and which diuretic decreases total peripheral resistance?

A

Renal: loop diuretics
TPR: thiazide diuretics (Na-induced)

111
Q

Indications K+ sparing diuretics (aldosterone antag)

A 
Hyperaldosteronism
HTN
Heart failure (refractory edema)
112
Q

AE K+ sparing diuretics (aldosterone antag)

A

Gastric upset/peptic ulcers
Anti-androgen effects
Hyperkalemia
Nausea/confusion/lethargy

113
Q

AE K+ sparing diuretics (Na blockers)

A

Hyperkalemia
Hyponatremia
Leg cramps, GI upset
Dizziness, pruritis, headache, vision loss

114
Q

Indications osmotic diuretics

A

Maintain urine flow in ARF
Decrease ICP/cerebral edema
Increase excretion of toxic substances

115
Q

AE osmotic diuretics

A

EC volume expansion (hyponatremia)

Tissue dehydration

116
Q

Indications ADH antagnoists

A

Euvolemic and hypervolemic hyponatremia
SIADH
Heart Failure: last resort

117
Q

AE ADH antagnosists

A 
Inhibits CYP 
Infusion site reaction
Thirst 
AFib
GI/electrolyte disturbances
Nephrogenic DI
118
Q

Which diuretic inhibits CYP?

A

Conivaptan (ADH antagonist)

119
Q

Contraindications ADH antagonists

A

Hypovolemic hyponatremia

Renal failure

120
Q

Acetazolamide

A

CAI

121
Q

Furosemide, Toresemide

A

Loop diuretics

122
Q

HCTZ, chlorthalidone, metolazone

A

Thiazide diuretics

123
Q

Triamterene, Amiloride

A

Na-channel blockers (K+-sparing diuretic)

124
Q

Spironolactone, eplerone

A

Aldosterone-antagonist (K+-sparing diuretic)

125
Q

Conivaptan

A

ADH antagonist

126
Q

Laptopril, Enalapril, Lisinopril
AE & Contraindications
Blacks?

A

ACEi
AE: dry cough/angioedema (bradykinin)
Contraindications: pregnancy, BL renal stenosis
Blacks: add a diuretic

127
Q

Losartan, Valsartan

A

ARB

128
Q

Aliskiren

A

Renin inhibitor

129
Q

Verapamil

Contraindications

A

Non-dihydropyridine: Ca-channel blocker heart/vasc [angina, SVT, HTN, migraine]
Contra: CHF (negative inotrope)

130
Q

Diltiazem

Contraindications

A

Non-dihydropyridine: Ca-channel blocker heart/vasc [angina, SVT, HTN, migraine]
Contra: CHF (negative inotrope)

131
Q

Nifedipine

Blacks?

A

Dihydropyridine 2nd generation: Ca-channel blocker vasc

Good for blacks; AE = peripheral edema, bradycardia

132
Q

Amlodipine

Blacks?

A

Dihydropyridine 2nd generation: Ca-channel blocker vasc

Good for blacks; AE = peripheral edema, bradycardia

133
Q

T/F Thiazide diuretics can cause hyperglycemia

A

True

134
Q

AE’s of beta-blockers used to treat HTN

A

Bradycardia, hypotension, high TAG’s, hypoglycemia (mask an episode of hypoglycemia in a diabetic)

135
Q

T/F Beta-blockers inhibit the release of renin

A

True

136
Q

AE’s of alpha-blockers used to treat HTN

A

Orthostatic hypotension, reflex tachycardia, dizziness, drowsiness

137
Q

T/F You can use a beta-blocker to blunt the STM reflex tachycardia of an alpha-blocker

A

True

138
Q

Which anti-HTN drug causes a positive-Coombs test: hemolytic anemia, hepatitis, drug fever?

A

Central-acting alpha-2 agonist: clonidine; methyldopa

139
Q

Drugs of choice for pregnancy in hypertension.

A

Pindolol, Labetalol, methyl-dopa; HYDRALAZINE: pre-eclampsia treatment

140
Q

Does labetalol cause reflex tachycardia?

A

No because it is a mixed alpha-1 and beta blocker.

141
Q

Hydralazine

* Use & AE

A

Direct vasodilator: can be used for pre-eclampsia; causes fluid-retention, LUPUS-like syndrome

142
Q

Minoxidil

A

PO treatment of malignant hypertension; can cause hypertrichosis: topical treatment of male pattern baldness

143
Q

Drugs of choice for treating pulmonary HTN

A
  1. Epoprostenol (PGI2)

2. Bosentan (endothelin R blocker) – category X pregnancy

144
Q

The principle of treatment of malignant HTN.

A
  1. ICU/A-line

2. Short acting titratable drugs to prevent sudden drop in BP –> MI/Stroke/Vision loss

145
Q

Drugs used to treat malignant hypertension

A 
Na nitroprusside
Labetalol
Fenoldopam: D1 agnoist
Nicarpidine: CCB
Nitroglycerin: vaso/venodilator
Diazoxide: a. dilator
Phentolamine
Esmolol
Hydralizine
146
Q

What is the treatment of choice for aortic dissection and/or post-op hypertension?

A

Esmolol

147
Q

Zileuton

A

LOX inhibitor

148
Q

Zafirlukast, Montelukast

A

LTD-4 inhibitor

149
Q

Epoprosterenol

A

PGI2 agonist; treatment of severe pulmonary HTN; prevent platelet aggregation in dialysis machines

150
Q

Alprostadil

A

PGE1 agonist; patency PDA & treatment of impotence

151
Q

Latanoprost

A

PGF2-alpha: glaucoma treatment

152
Q

Dinoprostone

A

PGE2 agonist: ripen cervix @/near term, abortifacient

153
Q

Misoprostol

A

PGE1 agonist: ripen cervix @/near term, abortifacient, post-partum hemorrhage; also prevent peptic ulcers in patients taking high-dose NSAIDS

154
Q

What drug can be used to prevent peptic ulcers in patients taking high-dose NSAIDS?

A

Misoprostol (PGE1 agnoist)

155
Q

Carboprost trimethamine

A

PGF2-alpha agonist: post-partum hemorrhage, abortifacent

156
Q

Type IA anti-arrhythmics are most effective at treating…

A

SV & ventricular arrhythmias

157
Q

Type IB anti-arrhythmics are most effective at treating…

A

Ventricular arrhythmias

158
Q

Type IC anti-arrhythmics are most effective at treating…

A

SV & ventricular arrhythmias

159
Q

Type II anti-arrhythmics are most effective at treating…

A

Tachycardias in which nodal tissues are involved

160
Q

Type III anti-arrhythmics are most effective at treating…

A

SV & ventricular arrhythmias

161
Q

Type IV anti-arrhythmics are most effective at treating…

A

Tachycardias in which nodal tissues are involved

162
Q

Digoxin is good choice for patients with CHF & what type of arrhythmia?

A

A fib

163
Q

Adenosine is most effective at treating…

A

SVT

164
Q

Atropine is most effective at treating…

A

bradycardias

165
Q

Which class of anti-arrhythmic drug is not commonly used 2/2 AE’s?

A

Class IA

166
Q

A Fib: Rate control vs. Rhythm control anti-arrhythmics

A

Rate: Verapamil

Siinus rhythm: Flecanide

167
Q

The 5 classes of anti-hyperlipidemia drugs.

A
  1. HMG CoA reductase
  2. Niacin
  3. Bile acid binding resins
  4. Fibrates
  5. Cholesterol absorption inhibitors.
168
Q

In addition to their effects in lowering LDL, statins also…

A
  1. Improve endothelial function
  2. Decrease platelet aggregation
  3. Stabilize ath plaque
  4. Decrease inflammation
169
Q

AE’s statins

A
  1. High AST/ALT (check baseline, 1 month, 6-12 months)
  2. Myopathy/myoglobinuria
  3. Category X pregnancy
170
Q

Which HLD drug is category X pregnancy?

A

Statins

171
Q

Niacin primarily…

A

Increases HDL and lowers Lp(a)

172
Q

AE’s niacin

A

Hepatotoxicity, hyperglycemia, hyperuricemia

Also: cutaneous flush treat w/ ASA (PGE mediated), acanthosis migrans

173
Q

DOC for the treatment of severe hypertriglyceridemia

A

Fibrates (gemfibrozil, fenofibrate)

174
Q

What are AE’s of fibrates?

A

GI/Myositis/Lithiasis
* Gemfibrozil decreases hepatic uptake of statins (competes with gluconryl transferase) can lead to toxic levels of both –> rhabdo

175
Q

MOA Fibrates

A

Activate peroxisome prolferation activated receptor-alpha

* Increase FA oxidation, decrease TG synthesis; increase FA uptake in muscle (LPL)

176
Q

The 2 cholesterol drugs most effective at rising HDL

A

Niacin, Fibrates

177
Q

The cholesterol drug most effective at lowering LDL

A

Statins

178
Q

The 2 cholesterol drugs most effective at decreasing TG’s

A

Niacin, Fibrates

179
Q

Cholesterol drug of choice in pregnancy

A

Bile acid binding resins, ex/ colesevelam (less AE’s vs. cholestyramine/colestipil): can increase TG’s

180
Q

Cholesterol absorption inhibitor MOA

A

Ezetimibe

  1. Cholesterol synthesis increases
  2. Less chylomicron remnants –> liver
  3. Upregulation LDL receptor
181
Q

Which omega-3 FA is FDA approved?

A

Lovaza (increase HDL, decrease TG biosynthesis)

182
Q

Cholesterol drugs of choice (first and second line) for increased LDL, LDL+TG, decreased HDL, severe elevated TG

A
  1. LDL: statin (niacin, resin, ezetimibe)
  2. LDL/TG: Statin (niacin, fibrate)
  3. HDL: Statin (niacin)
  4. TG: Fibrate/Niacin
183
Q

MOA Niacin

A

Decreased LPL, HSL

184
Q

Absolute contraindication to the use of nitrates

A

Sildenafil (PDE5 inhibitor)

Term 5 (9 decks)

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