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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
Tubocurarine
[NMJ non-depolarizing competitive antagonist] Skeletal muscle relaxation during surgery
26
Succynylcholine | * AE
[NMJ depolarizing blocker] Rapid intubation/ECT | * Malignant hyperthermia (excessive Ca release from SR when given with halogenated anesthetic); treat with dantrolene
27
Dantrolene
Treatment for anesthesia-induced malignant hyperthermia
28
Hemicholinium
[Pre-syn chol antag] prevents uptake of choline (CHT)
29
Vesamicol
[Pre-syn chol antag] prevents ACh storage [ACh-H+ antiport]
30
Botox
[Pre-syn chol antag] prevents ACh release [spasm/wrinkles]
31
Low dose epi vs. Large dose epi [baroreceptor reflex]
Low dose: no baroreceptor reflex (because B2 >> Alpha 1)
32
NE * Receptors * Reflex brady? How to overcome?
Alpha 1, Alpha 2, Beta 1 | Reflex bradycardia: pre-treat with atropine
33
Dopamine | * Treatment of choice for shock?
Treatment of choice for shock; prevents renal shutdown
34
Phenylephrine
[A1 Ag] vasoconstrictor: nasal decongestant, dilate pupil, shock, SVT
35
Clonidine | * AE
[Central A2 Ag] Decrease BP [lethargy, sedation, xerostomia]
36
Methyldopa
[Central A2 Ag] Treatment of choice for pregnancy-induced HTN
37
Brimodine
[Alpha 2 Ag] Glaucoma (decreases production/ increases outflow)
38
Isoproterenol
[B Ag] B1: increase HR; B2: dilate arterioles
39
Dobutamine
[B1 Ag] Acute management of CHF; increases CO without increasing HR and oxygen demand of the heart
40
Albuterol & Terbutaline Salmeterol & Formoterol * AE
Asthma short acting vs. Long action | AE: tremor, restlessness, apprehension, anxiety, tachycardia (less likely with inhaled)
41
Amphetmine
[NE release + potentiate NE] Increase BP
42
Methylphenydate
[NE release + potentiate NE] ADHD
43
Tyramine
[NE release + potentiate NE] Cheese/Wine metabolized by MAO -- MAOI serious side effects
44
Cocaine
[Uptake inhibitor]
45
Atomoxetine
[Uptake inhibitor] ADHD
46
Ephedrine
[Mixed NE release/adrenergic receptor] Pressor (hypotension during spinal anesthesia); MG treatment; bronchial asthma treatment; not metabolized by COMT
47
Pseudoephedrine
[Mixed NE release/adrenergic receptor] OTC decongestant
48
Phenoxybenzamine | Phentolamine
Phenoxy: irreversible pheo Phentolamine: reversible; STM pheo/HTN crisis; withdrawal clonidine
49
Epinepherine reversal?
Phenoxybenzamine/Phentolamine
50
Prazosin, Terazosin, Doxazosin, Tamsulosin * First dose? * AE?
[A1 antagnonist] BPH & HTN except tamsulosin * First dose exaggerated response * Orthostatic hypotension
51
Yohimbine
[A2 Antagonist] past treatment for ED (replaced by phosphodiesterase inhibitors)
52
Propranolol is contraindicated in...
[B-blocker] Asthmatics, DM (may impair recovery from hypoglycemia & mask the tachycardia associated with hypoglycemia)
53
Timolol
[B-blocker] Glaucoma, HTN, migraine
54
Why shouldn't beta-blockers be withdrawn abruptly?
Tachycardia, HTN, ischemia 2/2 upregulation of beta-receptors
55
Nadolol
[B-blocker] Longer duration of action; Angina/HTN
56
Atenolol, metoprolol | * AE
[B1-Antag] HTN patients with impaired pulmonary function; DM patients on insulin/oral hypoglycemic * Still avoid in asthmatics b/c beta-2 effects
57
Esmolol
[B1-Antag] 1/2 life 10 minutes: SVT, thyrotoxicosis, peri-operative HTN, myocardial ischemia in acutely ill patients
58
Labetalol, Carvediol
[A1 & beta blockers] HTN, HTN/CHF
59
Pindolol
[Partial agonist] HTN in pts with impaired cardiac reserve and a propensity for bradycardia
60
Metyrosine
Competitive inhibitor of tyrosine-hydroxylase; malignant pheo/perioperative management
61
Reserpine
Damages VMAT irreversibly; no storage of NE/dopamine in vesicles
62
Guanethidine
Displaces NE from vesicles; inhibits release of NE
63
Cromolyn, Nedocromil
Histamine release inhibitor
64
Fexofenidine
Second generation H-1 antagonist (less sedative side effects 2/2 increased lipophilicity)
65
Loratidine
Second generation H-1 antagonist (less sedative side effects 2/2 increased lipophilicity)
66
Cetrizine
Second generation H-1 antagonist (less sedative side effects 2/2 increased lipophilicity)
67
Cimitidine | * AE
H-2 antagonist [inhibit gastric acid secretion -- peptic ulcer, acute stress ulcer, GERD] Inhibits CYP450, Anti-Androgen; IV/ICU can induce renal/hepatic dysfunction
68
Ranitidine
[Zantac] H-2 antagonist [inhibit gastric acid secretion -- peptic ulcer, acute stress ulcer, GERD]
69
Famotidine
[Pepcid AC] H-2 antagonist [inhibit gastric acid secretion -- peptic ulcer, acute stress ulcer, GERD]
70
Nizatidine
H-2 antagonist [inhibit gastric acid secretion -- peptic ulcer, acute stress ulcer, GERD]
71
Chlorpheniramine
First generation H-1 antagonist; Allergies, motion sickness, somnifacents
72
Cyclizine
First generation H-1 antagonist; Allergies, motion sickness, somnifacents
73
Diphenhydramine
First generation H-1 antagonist; Allergies, motion sickness, somnifacents
74
Dimenhydrinate
First generation H-1 antagonist; Allergies, motion sickness, somnifacents
75
Hydroxyzine
First generation H-1 antagonist; Allergies, motion sickness, somnifacents
76
Meclizine
First generation H-1 antagonist; Allergies, motion sickness, somnifacents
77
Promethazine
First generation H-1 antagonist; Allergies, motion sickness, somnifacents
78
Terfenadine | * AE
First generation H-1 antagonist; Allergies, motion sickness, somnifacents [removed from market: block K+ channels -- fatal arrhythmias]
79
Astemizole | * AE
First generation H-1 antagonist; Allergies, motion sickness, somnifacents [removed from market: block K+ channels -- fatal arrhythmias]
80
Sumatriptan
5-HT 1B/D Agonist: acute severe migraine
81
Metoclopramide
5-HT 4 Agonist: prokinetic
82
Cisapride
5-HT 4 Agonist: prokinetic [removed from market/cards effects]
83
Cyproheptadine
5-HT 2 Antagonist: allergic rhinitis, vasomotor rhinitis, serotonin syndrome [Also H1 blocker]
84
Ondansetron
5-HT 3 Antagonist: anti-emetic/cancer-CTX
85
Ergotamine
``` Ergot Alkaloid (alpha, 5-HT, CNS dopamine) * Migraine pain ```
86
Dihydroergotamine
``` Ergot Alkaloid (alpha, 5-HT, CNS dopamine) * Migraine pain ```
87
Bromocriptine
``` Ergot Alkaloid (alpha, 5-HT, CNS dopamine) * Hyperprolactinemia ```
88
Carbergoline
``` Ergot Alkaloid (alpha, 5-HT, CNS dopamine) * Hyperprolactinemia ```
89
Ergonovine
``` Ergot Alkaloid (alpha, 5-HT, CNS dopamine) * Post-partum hemorrhage (w/ oxytocin); provokes coronary artery spasm in angina patients ```
90
Methylergonovine
``` Ergot Alkaloid (alpha, 5-HT, CNS dopamine) * Post-partum hemorrhage (w/ oxytocin); provokes coronary artery spasm in angina patients ```
91
Drugs to be used in systolic CHF
ACEi, diuretics, spironolactone, beta-blocker, vasodilator, inotrope
92
Candesartan, Valsartan
ARB's for CHF
93
AE's of Spionolactone
Hyperkalemia, GI/CNS/Endocrine (anti-androgen) abnormalities
94
Which drug causes a lupus-like syndrome?
Hydralizine (Vasodilator for HTN/CHF)
95
Drugs to be used in diastolic CHF
Beta-blocker, Ca channel blocker, diuretics
96
Carvedilol, Metoprolol
Beta-blockers for CHF
97
Which drug class can initially exacerbate CHF symptoms?
Beta-blocker
98
ACEi target arteries and veins. Describe targets of CHF vasodilators.
Hydralizine (A); Nitrates (V)
99
Black patients with advanced heart failure could benefit from:
Vasodilator therapy (Hydralizine, Nitrates)
100
Which drugs can displace digoxin from protein binding sites?
Quinidine, verapamil, amiodarone
101
What are some precipitating factors for digoxin AE's?
Hypokalemia, hypoMg/hyperCa, hyperthyrosis, abnormal renal function, CS
102
How do you treat digoxin-induced V tach?
Lidocaine, Mg++, Adjust K+ to high normal
103
Severe digoxin-induced toxicity treated with…
Digitalis-Ab; temporary PM
104
What are the 6 classes of diruetics? Give examples of each class.
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
AE CAI
Malaise, fatigue, depression, GI upset, drowsiness, paresthesia
106
Indications Loop Diuretics
1. Hrt/Renal/Hepatic failure (acute pulmonary edema) 2. HTN 3. Hypercalcemia 4. Hyperkalemia
107
AE Loop Diuretics
1. Ototoxicity 2. Hyperuricemia 3. Acute hypovolemia 4. Hypokalemia 5. Hypomagnesemia 6. Allergic reaction
108
Indications Thiazide diuretics
1. Mild-to-moderate heart failure 2. HTN alone or with ACE-inhibitor/beta-blocker 3. Hypercalciuria 4. DI 5. Pre-menstrual edema
109
AE Thiazide diuretics
1. Hyperglycemia 2. Hyperlipidemia 3. Hypersensitivity S/A Loop diuretics
110
Which diuretic decreases renal vascular resistance and which diuretic decreases total peripheral resistance?
Renal: loop diuretics TPR: thiazide diuretics (Na-induced)
111
Indications K+ sparing diuretics (aldosterone antag)
``` Hyperaldosteronism HTN Heart failure (refractory edema) ```
112
AE K+ sparing diuretics (aldosterone antag)
Gastric upset/peptic ulcers Anti-androgen effects Hyperkalemia Nausea/confusion/lethargy
113
AE K+ sparing diuretics (Na blockers)
Hyperkalemia Hyponatremia Leg cramps, GI upset Dizziness, pruritis, headache, vision loss
114
Indications osmotic diuretics
Maintain urine flow in ARF Decrease ICP/cerebral edema Increase excretion of toxic substances
115
AE osmotic diuretics
EC volume expansion (hyponatremia) | Tissue dehydration
116
Indications ADH antagnoists
Euvolemic and hypervolemic hyponatremia SIADH Heart Failure: last resort
117
AE ADH antagnosists
``` Inhibits CYP Infusion site reaction Thirst AFib GI/electrolyte disturbances Nephrogenic DI ```
118
Which diuretic inhibits CYP?
Conivaptan (ADH antagonist)
119
Contraindications ADH antagonists
Hypovolemic hyponatremia | Renal failure
120
Acetazolamide
CAI
121
Furosemide, Toresemide
Loop diuretics
122
HCTZ, chlorthalidone, metolazone
Thiazide diuretics
123
Triamterene, Amiloride
Na-channel blockers (K+-sparing diuretic)
124
Spironolactone, eplerone
Aldosterone-antagonist (K+-sparing diuretic)
125
Conivaptan
ADH antagonist
126
Laptopril, Enalapril, Lisinopril AE & Contraindications Blacks?
ACEi AE: dry cough/angioedema (bradykinin) Contraindications: pregnancy, BL renal stenosis Blacks: add a diuretic
127
Losartan, Valsartan
ARB
128
Aliskiren
Renin inhibitor
129
Verapamil | Contraindications
Non-dihydropyridine: Ca-channel blocker heart/vasc [angina, SVT, HTN, migraine] Contra: CHF (negative inotrope)
130
Diltiazem | Contraindications
Non-dihydropyridine: Ca-channel blocker heart/vasc [angina, SVT, HTN, migraine] Contra: CHF (negative inotrope)
131
Nifedipine | Blacks?
Dihydropyridine 2nd generation: Ca-channel blocker vasc | Good for blacks; AE = peripheral edema, bradycardia
132
Amlodipine | Blacks?
Dihydropyridine 2nd generation: Ca-channel blocker vasc | Good for blacks; AE = peripheral edema, bradycardia
133
T/F Thiazide diuretics can cause hyperglycemia
True
134
AE's of beta-blockers used to treat HTN
Bradycardia, hypotension, high TAG's, hypoglycemia (mask an episode of hypoglycemia in a diabetic)
135
T/F Beta-blockers inhibit the release of renin
True
136
AE's of alpha-blockers used to treat HTN
Orthostatic hypotension, reflex tachycardia, dizziness, drowsiness
137
T/F You can use a beta-blocker to blunt the STM reflex tachycardia of an alpha-blocker
True
138
Which anti-HTN drug causes a positive-Coombs test: hemolytic anemia, hepatitis, drug fever?
Central-acting alpha-2 agonist: clonidine; methyldopa
139
Drugs of choice for pregnancy in hypertension.
Pindolol, Labetalol, methyl-dopa; HYDRALAZINE: pre-eclampsia treatment
140
Does labetalol cause reflex tachycardia?
No because it is a mixed alpha-1 and beta blocker.
141
Hydralazine | * Use & AE
Direct vasodilator: can be used for pre-eclampsia; causes fluid-retention, LUPUS-like syndrome
142
Minoxidil
PO treatment of malignant hypertension; can cause hypertrichosis: topical treatment of male pattern baldness
143
Drugs of choice for treating pulmonary HTN
1. Epoprostenol (PGI2) | 2. Bosentan (endothelin R blocker) -- category X pregnancy
144
The principle of treatment of malignant HTN.
1. ICU/A-line | 2. Short acting titratable drugs to prevent sudden drop in BP --> MI/Stroke/Vision loss
145
Drugs used to treat malignant hypertension
``` Na nitroprusside Labetalol Fenoldopam: D1 agnoist Nicarpidine: CCB Nitroglycerin: vaso/venodilator Diazoxide: a. dilator Phentolamine Esmolol Hydralizine ```
146
What is the treatment of choice for aortic dissection and/or post-op hypertension?
Esmolol
147
Zileuton
LOX inhibitor
148
Zafirlukast, Montelukast
LTD-4 inhibitor
149
Epoprosterenol
PGI2 agonist; treatment of severe pulmonary HTN; prevent platelet aggregation in dialysis machines
150
Alprostadil
PGE1 agonist; patency PDA & treatment of impotence
151
Latanoprost
PGF2-alpha: glaucoma treatment
152
Dinoprostone
PGE2 agonist: ripen cervix @/near term, abortifacient
153
Misoprostol
PGE1 agonist: ripen cervix @/near term, abortifacient, post-partum hemorrhage; also prevent peptic ulcers in patients taking high-dose NSAIDS
154
What drug can be used to prevent peptic ulcers in patients taking high-dose NSAIDS?
Misoprostol (PGE1 agnoist)
155
Carboprost trimethamine
PGF2-alpha agonist: post-partum hemorrhage, abortifacent
156
Type IA anti-arrhythmics are most effective at treating...
SV & ventricular arrhythmias
157
Type IB anti-arrhythmics are most effective at treating...
Ventricular arrhythmias
158
Type IC anti-arrhythmics are most effective at treating...
SV & ventricular arrhythmias
159
Type II anti-arrhythmics are most effective at treating...
Tachycardias in which nodal tissues are involved
160
Type III anti-arrhythmics are most effective at treating...
SV & ventricular arrhythmias
161
Type IV anti-arrhythmics are most effective at treating...
Tachycardias in which nodal tissues are involved
162
Digoxin is good choice for patients with CHF & what type of arrhythmia?
A fib
163
Adenosine is most effective at treating...
SVT
164
Atropine is most effective at treating...
bradycardias
165
Which class of anti-arrhythmic drug is not commonly used 2/2 AE's?
Class IA
166
A Fib: Rate control vs. Rhythm control anti-arrhythmics
Rate: Verapamil | Siinus rhythm: Flecanide
167
The 5 classes of anti-hyperlipidemia drugs.
1. HMG CoA reductase 2. Niacin 3. Bile acid binding resins 4. Fibrates 5. Cholesterol absorption inhibitors.
168
In addition to their effects in lowering LDL, statins also...
1. Improve endothelial function 2. Decrease platelet aggregation 3. Stabilize ath plaque 4. Decrease inflammation
169
AE's statins
1. High AST/ALT (check baseline, 1 month, 6-12 months) 2. Myopathy/myoglobinuria 3. Category X pregnancy
170
Which HLD drug is category X pregnancy?
Statins
171
Niacin primarily...
Increases HDL and lowers Lp(a)
172
AE's niacin
Hepatotoxicity, hyperglycemia, hyperuricemia | Also: cutaneous flush treat w/ ASA (PGE mediated), acanthosis migrans
173
DOC for the treatment of severe hypertriglyceridemia
Fibrates (gemfibrozil, fenofibrate)
174
What are AE's of fibrates?
GI/Myositis/Lithiasis * Gemfibrozil decreases hepatic uptake of statins (competes with gluconryl transferase) can lead to toxic levels of both --> rhabdo
175
MOA Fibrates
Activate peroxisome prolferation activated receptor-alpha | * Increase FA oxidation, decrease TG synthesis; increase FA uptake in muscle (LPL)
176
The 2 cholesterol drugs most effective at rising HDL
Niacin, Fibrates
177
The cholesterol drug most effective at lowering LDL
Statins
178
The 2 cholesterol drugs most effective at decreasing TG's
Niacin, Fibrates
179
Cholesterol drug of choice in pregnancy
Bile acid binding resins, ex/ colesevelam (less AE's vs. cholestyramine/colestipil): can increase TG's
180
Cholesterol absorption inhibitor MOA
Ezetimibe 1. Cholesterol synthesis increases 2. Less chylomicron remnants --> liver 3. Upregulation LDL receptor
181
Which omega-3 FA is FDA approved?
Lovaza (increase HDL, decrease TG biosynthesis)
182
Cholesterol drugs of choice (first and second line) for increased LDL, LDL+TG, decreased HDL, severe elevated TG
1. LDL: statin (niacin, resin, ezetimibe) 2. LDL/TG: Statin (niacin, fibrate) 3. HDL: Statin (niacin) 4. TG: Fibrate/Niacin
183
MOA Niacin
Decreased LPL, HSL
184
Absolute contraindication to the use of nitrates
Sildenafil (PDE5 inhibitor)

Term 5 (9 decks)

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