Pharm Exam 3 Flashcards
Use: HTN
MOA: Adrenergic transmitter depleter
AE: Depletes NE in SNS=depression
Notes: Crosses BBB; long acting
Reserpine
Use: HTN
MOA: Adreneergic transmitter depleter
AE: Orthostatic hypotension
Notes: Depletes NE peripherally at nerve terminal
Guanethidine
Use: HTN, drug and nicotine withdrawal
MOA: Central alpha-2a agonist
AE: Dry mouth, sedation, decr libido, rebound HTN
Notes:Reduced LVH and total cholesterol
Clonidine
Use: HTN
MOA: Central alpha-2a agonist
AE: dry mouth, + Coombs test, dry mouth
Notes: Good during pregnancy!!
Alpha-methyl-DOPA
Use: Smooth musc vasodilator for HTN
MOA: Incr NO and K+ permeability
AE: tachycardia, HA, edema, nausea
Notes:Lupus-like syndrome
Hydralazine
Use: Smooth musc vasodilator in HTN
MOA: Incr K+ channel opening
AE: Hair growth, tachy, HA, edema, nausea
Minoxidil (Rogain)
Use: Smooth musc vasodilator in HTN
MOA: Metab to NO
AE: HA and nausea
Notes: IV; given in HTN crisis
Nitroprusside
Thiazied diuretics incr what macromolecules?
Cholesterol and triglycerides
Use: Mild diuretic effect
MOA: Reduce Na+ in VSM to reduce contractility
AE: High Na+ intake can reverse effect, hypokalemia, hyperglycemia, hyperuricemia
Notes: Anti-HTN effect is mild, ceiling effect=maxed out at 15mmHg
HCTZ
Use: **
MOA: K+ sparing, aldosterone antagonist
AE: hyperkalemia, gynecomastia
Notes: **Can preserve K+ in combo w/ other diuretic and get anti-HTN effect
Spironolactone
Use: **
MOA: K+ sparing
AE: Hyperkalemia
Notes: **Can preserve K+ in combo w/ other diuretic to get anti-HTN effect
Amiloride
Do Beta-blockers (incr/decr) (HDL/LDL)?
Decr HDL
Beta-blockers have what effect on triglycerides?
Increase triglycerides
What is a main drug interaction of beta-blockers?
NSAIDs=may reduce or even block anti-HTN effects
Use: HTN
MOA: Decr renin, CO, and block presynaptic beta-receptor
AE: Asthma, DM, cardiac depression
Notes: Not as good as preventing strokes as ACEIs, ARBs, or CCBs
Beta Blockers
What is a non-selective beta-blocking drug used to treat A-fib and flutter, and post-MI arrhythmias?
Propranolol and Labetolol
What is a selective beta1-receptor drug used to treat HTN and angina?
Atenolol
What drugs decr total cholesterol but have NO EFFECT on HDL levels?
Alpha-1-antagonists
What drug is selective for antagonizing alpha-1 and alpha-2 receptors, is used to tx HTN, may cause syncope, and has the potential to cause sudden death secondary to cardiac arrhythmias?
Prazosin
What drugs are used to prevent the conversion of Angiotensin I to Angiotensin II?
ACE inhibitors
What are some SEs of ACE-Is?
Cough, bronchospasm, renal complications, hypotension (w/ volume depletion), detal mortality (2nd and 3rd trimesters), and birth defects (1st trimester)
What are some drug interactions of ACE-Is?
- Dangerous hyperkalemia if combined w/ K+ apring diuretic
- Oral contraceptives incr Angiotensin I levels
- NSAIDs can reduce anti-HTN effects and may incr kidney problems
- Incr Lithium retention (Bipolar pts)
What class of drugs do Captopril, Enalapril, and Fosinopril fall under?
ACE-Is
What is the main advantage that Angiotensin II antagonists (or ARBs=Angiotensin Receptor Blocker) have over ACE-Is?
A2 antagonists do not cause cough
In what pt population are ACE-Is and ARB not as effective in?
African American populations
What class of drugs to Losartan and Valsartan fall under?
ARBs
What is the MOA of renin inhibitors?
Binds renin to prevent the conversion of renin to Angiotensinogen–>Angiotensin
What is Aliskrein?
- It is a Renin inhibitor
- Does not cause cough (similar to ARB) and CANNOT use in pregnant pts
How do CCBs tx high BP?
Reduce VSM tone to decrease peripheral resistance
Use: HTN, SVT, vasospastic angina
MOA: L-type CCB
AE: Sudden death; myocardial depression; heart block; constipation
Notes: negative inotrope=signif reflex tachy; AA populations respond well
Nifedipine
Use: HTN, suppress SA & AV nodal reentry
MOA: L-type CCB; inhibits phase 0 in nodal tissue and phase 2 in muscle tissue
AE: little reflex tachy, but dose cause cardiac depression
Notes: Constipation, AA pop responds well, negative inotrope
Verapamil
What drug is similar to verapamil but is less severe?
Diltizaem
How to Nitrovasodilators work?
- Agents are denitrated releasing NO
- NO stim guanyl cycylase–>cGMP
- cGMP promotes dephos of myosin light chains
- Results in smooth musc relaxation/vasodilation
In what ways is Nitric Oxide synthesized?
- In the brain (nNOS)
- Via cytokines (iNOS)
- Regulated by vasomotor tone (eNOS)
What is the general mechanism of Nitrates?
They decr preload and afterload; decr the amount of work the hear has to do
When is NTG indicated?
- Stable angina (symptomatic use)
- Variant angina (in conjuction w/ a CCB)
- Pulmonary congestion w/ CHF
What are the adverse effects of NTG?
- HA (almost always due to vasodilation of vessels in brain=messes w/ pressure)
- Nitrate syncope
- Decr coronary perfusion w/ excessive hypotension
What orally administered nitrate:
- is liver metab
- has a long onset of action (30 min)
- is indicated for chronic stable angina
- is combined w/ hydralazine for CHF
- causes methemoglobinemia when OD’d
Isodorbide diniatrate
What is the drug of choice for a tonic-clonic (grand-mal) seizure?
Valproate
What is/are the drug/s of choice for a partial (also secondarily generalized) seizure?
- Valproate
- Lamotrigine
What is/are the drug/s of choice for a generalized absence seizure?
- Valproate
- Ethosuximide
- Lamotrigine
What is the drug of choice for a myoclonic, atonic seizure?
Valproate
What is an alternative drug for partial onset seizures?
Topiramate (also phenytoin)
What are common drug interactions of certain anti-epileptic drugs?
Macrolide abx and azole antifungals. These drugs cause elevated levels of:
- Carbamazepine
- Phenytoin
- Valproate
- Zonisamide
What is the recommended procedure for treating Status Epilepticus?
- Lorazepam or diazepam IV
- Phenytoin or phenobarbital
- Anesthetic (if needed)
Do low potency, typical antipsychotics have more or less sedation?
More sedation (“Less is More”)
Do high potency, typical antipsychotics have more or less sedation?
Less sedation, but MORE extrapyramidal (EPS) effects
What is Neuroleptic Malignant Syndrome a/w?
Hyperthermia, diffuse muscular rigidity, autonomic dysfxn, and fluctuating levels of consciousness
What types of drugs usually (but rarely) cause Neuroleptic Malignant Syndrome?
Parenterally administered high-potency anti-psychotic agents
What is the ‘Label Warning’ for Atypical antipsychotics?
Incr risk of:
- Weight gain
- DM
- Hyperlipidemia
Many antipsychotics block alpha-receptors. Why is this important?
- Bc they have the potential to cause CNS, respiratory, and CV depression
- They also competitively inhibit CYP2D6 and 3A4
Which class/type of antipsychotic drug induces EPS effects and elevates [prolactin]?
Typical antipsychotics
Atypical antipsychotic drugs don’t normally affect serum [prolactin], however, there is one that does. Which one?
Risperidone
What are they atypical antipsychotic drugs?
- Risperidone
- Olanzapine
- Aripiprazole
- Clozapine
What are the high potency, typical antipsychotic drugs?
- Fluphenazine
- Haloperidol
What are the low potency, typical antipsychotic drugs?
Chlorpromazine
