Pharm Exam 2 Flashcards
What are the indications for ACE inhibitors?
Hypertension (HTN), Heart failure with reduced ejection fraction (HFrEF), Post-myocardial infarction (MI) to reduce mortality, Chronic kidney disease (CKD) with proteinuria, Diabetic nephropathy
These conditions are treated with ACE inhibitors to improve patient outcomes.
What are the contraindications for ACE inhibitors?
Pregnancy, History of angioedema, Bilateral renal artery stenosis, Hyperkalemia, Severe hypotension
These contraindications are crucial to avoid serious adverse effects.
What is the mechanism of action (MOA) of Calcium Channel Blockers (CCBs)?
CCBs block L-type calcium channels, reducing calcium influx into vascular smooth muscle and cardiac myocytes, leading to vasodilation, decreased myocardial contractility, and reduced conduction velocity in the heart
This action helps in managing hypertension and other cardiovascular conditions.
What are the adverse drug effects (ADEs) of dihydropyridine CCBs?
Reflex tachycardia, Peripheral edema, Flushing, Dizziness, headache
These effects are common with dihydropyridine CCBs like amlodipine and nifedipine.
What are the adverse drug effects (ADEs) of non-dihydropyridine CCBs?
Bradycardia, AV block, Worsening heart failure, Constipation
Non-dihydropyridines such as verapamil and diltiazem have these specific ADEs.
Fill in the blank: Non-dihydropyridine CCBs primarily act on the _______ while dihydropyridine CCBs act on _______.
Heart; Vascular smooth muscle
What are the first-line treatment options for hypertension in non-Black patients?
ACE inhibitors or ARBs, Thiazide diuretics, CCBs
These medications are recommended for managing hypertension effectively.
What is the role of the Renin-Angiotensin-Aldosterone System (RAAS) in hypertension?
RAAS causes vasoconstriction, stimulates aldosterone release (increases Na⁺ & water retention), and enhances sympathetic activity, leading to increased blood pressure
Chronic activation of RAAS contributes to hypertension and heart failure.
List the selective beta-blockers.
Metoprolol, Atenolol, Nebivolol, Bisoprolol, Acebutolol, Betaxolol, Esmolol
These agents are primarily used for conditions like hypertension and heart failure.
What are the first-line agents indicated in the treatment of heart failure (HF)?
ACE Inhibitors / ARBs, Beta-Blockers, Mineralocorticoid Receptor Antagonists (MRAs), ARNI
These medications improve mortality and morbidity in patients with HF.
What are the contraindications of non-dihydropyridine CCBs in heart failure?
HFrEF, Severe hypotension
Non-dihydropyridine CCBs are contraindicated due to their negative inotropic effects.
What are the adverse effects of loop diuretics?
Hypokalemia, Hypomagnesemia, Ototoxicity, Hypovolemia
Loop diuretics like furosemide are potent but have significant side effects.
What monitoring is recommended for patients on ACE inhibitors?
Monitor BP, serum creatinine, potassium
Regular monitoring helps prevent complications from these medications.
What is the mechanism of action of statins?
Inhibit HMG-CoA reductase, decreasing LDL-C production and increasing LDL receptor expression
This action is crucial for managing cholesterol levels and reducing cardiovascular risk.
What are the adverse effects of statins?
Myopathy, Rhabdomyolysis, Hepatotoxicity, New-onset diabetes, GI disturbances, Cognitive impairment
Awareness of these ADEs is important for patient safety.
Fill in the blank: Ezetimibe primarily lowers _______ levels.
LDL-C
What differentiates unfractionated heparin (UFH) from low molecular weight heparin (LMWH)?
UFH inactivates Factor IIa and Xa; LMWH primarily inactivates Factor Xa
This difference impacts their clinical use and monitoring requirements.
What factors does UFH primarily inactivate?
Factor IIa (Thrombin) & Factor Xa
What is the onset of action for SubQ administration of LMWH?
20-30 min
What type of monitoring is required for UFH?
aPTT required (dose-dependent effect)
Which reversal agent provides full reversal for UFH?
Protamine sulfate
How is LMWH typically dosed?
Fixed SubQ dosing once or twice daily
What is the half-life of UFH?
Short (~1.5 hours)
What are the clinical uses of LMWH?
- DVT
- PE
- ACS
- VTE prophylaxis in surgery
- Pregnancy
What is a common adverse effect of UFH?
Heparin-Induced Thrombocytopenia (HIT)
What are the contraindications for Heparin / LMWH?
- Active bleeding
- HIT
- Severe thrombocytopenia
What is the mechanism of action of Heparins?
Enhances Antithrombin III (ATIII) → Inhibits Factor Xa & IIa (thrombin)
Which class of drugs does Warfarin belong to?
Vitamin K Antagonists
What is a key clinical use of Direct Oral Anticoagulants (DOACs)?
Stroke prevention in AFib
What is the mechanism of action of aspirin?
Irreversibly inhibits cyclooxygenase-1 (COX-1) → ↓ Thromboxane A2 (TXA2) → ↓ platelet aggregation
What is the effect of Class I antiarrhythmics on action potential?
Slow depolarization (Phase 0)
What is the half-life of Amiodarone?
15–100 days
What is the primary target for Class II antiarrhythmics?
β-blockers
What is a common adverse effect of Metformin?
Gastrointestinal (GI) distress
What is the primary mechanism of action of SGLT2 inhibitors?
Inhibits sodium-glucose cotransporter 2 (SGLT2) in the proximal renal tubule
Which supplement is indicated for pernicious anemia?
Vitamin B12
What is a risk associated with intravenous iron administration?
Anaphylaxis
What is the role of nitrates in stable angina management?
↓ Myocardial O₂ demand by reducing preload
What is the mechanism of action of DPP-4 inhibitors?
Inhibit dipeptidyl peptidase-4 (DPP-4), enhancing endogenous incretin activity
Which drug class is known for causing weight loss in T2DM patients?
GLP-1 Receptor Agonists
What should be monitored for Vitamin B12 supplementation?
Serum B12 levels, MMA, homocysteine levels
Fill in the blank: The half-life of Esmolol is _______.
9 min
True or False: Long-acting nitrates do not require a nitrate-free interval.
False
What is a common adverse effect of iron supplementation?
GI distress, constipation
What is the mechanism of action of Class III antiarrhythmics?
K⁺ channel blockade → Prolongs AP duration & QT interval
What is the clinical use of short-acting nitrates?
Acute angina attacks, prophylaxis before exertion
What do DPP-4 inhibitors degrade?
GLP-1 and GIP
What do DPP-4 inhibitors enhance?
Endogenous incretin activity, increasing insulin secretion and reducing glucagon levels
What is the clinical use of DPP-4 inhibitors?
Used as a second-line therapy for patients who cannot tolerate metformin or need an additional agent
What is the weight effect of DPP-4 inhibitors?
Weight neutral (neither causes weight gain nor weight loss)
What is the hypoglycemia risk of DPP-4 inhibitors compared to sulfonylureas?
Lower hypoglycemia risk than sulfonylureas
What is a significant advantage of DPP-4 inhibitors over GLP-1 receptor agonists?
Oral formulation, making it more convenient than GLP-1 receptor agonists (which are injectable)
What is the renal safety profile of linagliptin?
Safe in renal impairment (linagliptin does not require dose adjustment)
What is the mechanism of action of thiazolidinediones (TZDs)?
Activate peroxisome proliferator-activated receptor gamma (PPAR-γ) in adipose tissue, skeletal muscle, and liver
What do TZDs increase in the body?
Insulin sensitivity, improving glucose uptake and reducing hepatic glucose production
What are TZDs used for in diabetes management?
Alternative to metformin in patients with significant insulin resistance
What cardiovascular benefit does pioglitazone provide?
Reduces stroke risk in patients with diabetes
What are the contraindications for TZDs?
- Heart failure (NYHA Class III or IV) due to fluid retention risk
- History of bladder cancer (pioglitazone may increase bladder cancer risk)
- Active liver disease due to potential hepatotoxicity
What is a common adverse effect of TZDs?
Weight gain due to fluid retention and fat accumulation
What is a key consideration when choosing diabetes medications?
Match drug class with patient profile and contraindications
What is the role of basal insulin?
Provides steady insulin levels throughout the day to control fasting glucose
What is the primary use of mealtime insulin?
Taken before meals to cover the postprandial rise in blood glucose
What types of insulin are classified as rapid-acting?
- Lispro
- Aspart
- Glulisine
What is the onset time for rapid-acting insulin?
10-30 minutes
What is the duration of action for short-acting insulin?
5-8 hours
What is the primary characteristic of long-acting insulin?
Provides steady glucose control with duration of over 24 hours
Which insulins can be mixed with NPH?
- Rapid-acting insulins (lispro, aspart)
- Short-acting insulin (regular insulin)
What should never be mixed with long-acting insulins?
Other insulins (e.g., glargine, detemir, degludec)
What is the most common adverse effect of insulin?
Hypoglycemia
What is lipodystrophy?
Injection site changes due to repeated injections in the same spot
What are the effects of glucocorticoids on glucose metabolism?
Increase gluconeogenesis in the liver, contributing to hyperglycemia
What is the preferred therapy for hypothyroidism?
Levothyroxine (T4)
What is the half-life of levothyroxine?
Approximately 7 days
What are the main antithyroid medications for hyperthyroidism?
- Methimazole (MMI)
- Propylthiouracil (PTU)
What is the mechanism of action of Methimazole?
Inhibits thyroid peroxidase (TPO) to prevent T4/T3 synthesis
What adverse effect is associated with both Methimazole and PTU?
Agranulocytosis
What is the risk associated with rapid discontinuation of glucocorticoids?
Acute adrenal insufficiency
What is a characteristic effect of glucocorticoids on bone health?
Inhibits osteoblast activity, leading to osteoporosis
What is important about tapering glucocorticoids?
Required to allow adrenal recovery after long-term use
What is the role of progestin in hormonal contraceptives?
Suppresses ovulation by inhibiting luteinizing hormone (LH) secretion
What is the role of progestin in hormonal contraceptives?
Progestin suppresses ovulation, thickens cervical mucus, alters the endometrium, and reduces tubal motility.
Progestin is a synthetic form of progesterone.
What are the types of progestin-containing contraceptives?
- Progestin-Only Pills (POPs)
- Injectable Progestins (e.g., Depo-Provera)
- Implant (e.g., Nexplanon)
- Intrauterine Devices (IUDs)
- Emergency Contraception (EC)
Each type has unique characteristics and effectiveness.
What is a key characteristic of Progestin-Only Pills (POPs)?
Must be taken at the same time daily due to a shorter half-life.
Less effective at suppressing ovulation compared to combination pills.
What is the duration of effectiveness for Injectable Progestins like Depo-Provera?
Provides contraception for 3 months per injection.
Can cause delayed return to fertility after discontinuation.
What is a major risk associated with estrogen in contraceptives?
Increased risk of venous thromboembolism (VTE).
This includes deep vein thrombosis (DVT), pulmonary embolism (PE), and stroke.
Which women are at highest risk for VTE when using estrogen-containing contraceptives?
Smokers, obese individuals (BMI ≥30), and those over 35 years old.
Transdermal patches may have a higher VTE risk than oral contraceptives.
What are absolute contraindications to estrogen-containing contraceptives?
- History of thromboembolic disease
- Migraine with aura
- Uncontrolled hypertension
- Smoking in women over 35
- Current or history of breast cancer
- Severe liver disease
These contraindications are outlined by the U.S. Medical Eligibility Criteria (MEC).
What are contraindications for progestin-only contraceptives?
- Active liver disease
- History of breast cancer
- Undiagnosed abnormal vaginal bleeding
Requires further evaluation for abnormal vaginal bleeding.
True or False: Progestin-only methods carry higher cardiovascular risks than estrogen-containing methods.
False.
Progestin-only methods have fewer cardiovascular risks.
What changes does progestin induce in the endometrium?
Makes it less suitable for implantation.
This is part of its role in preventing pregnancy.
What is the effectiveness duration of Levonorgestrel-releasing IUDs?
Provides contraception for 3–7 years.
It also reduces menstrual bleeding and cramps.
What is the effectiveness window for Levonorgestrel (Plan B One-Step) as emergency contraception?
Effective within 72 hours post-intercourse.
Ulipristal acetate (Ella) is effective up to 5 days post-intercourse.
What is a potential complication of long-term use of hormonal contraceptives?
Higher risk of complications requiring careful monitoring.
This includes issues like osteoporosis prevention and glucose monitoring.
In critical illness or stress, what may be required for patients on hormonal contraceptives?
Stress dosing to prevent adrenal crisis.
This is particularly important in acute situations.
