Pharmacology Flashcards
1
Q
Drugs for Primary (essential) HTN
A
Diuretics, ACE-Is, ARBs, CCB
2
Q
HTN with CHF
A
Diuretics, ACE-Is, ARBs, beta-blockers (compensated CHF), aldosterone antagonists
3
Q
Contraindicated in Cardiogenic Shock
A
Beta-blockers
4
Q
HTN with diabetes
A
ACE-I/ARBs, CCB, diuretics, alpha and beta-blockers
5
Q
Protective against diabetic nephropathy
A
ACE-I/ARBs
6
Q
Dihydropyridines
A
Amlodipine, minodipine, nifedipine
7
Q
MoA of CCB
A
Block voltage-dependent L-type calcium channels of cardiac and smooth muscle, thereby decreased muscle contractility
8
Q
CCB toxicity
A
cardiac depression, AV block, peripheral edema, flushing, dizziness, hyperprolactinemia and constipation
9
Q
Used for subarachnoid hemorrhage (prevents cerebral vasospasm)
A
Nimodipine
10
Q
Calcium channel blockers with predominate effect on arteriole dilation
A
Nifedipine, amlodipine, nimodipine (dihydropyridines)
11
Q
Calcium channel blockers with predominant effect on the heart
A
Verapamil, diltiazem (non-dihydropyridines)
12
Q
HTN, angina, atrial fibrillation/flutter
A
Verapamil, diltiazem (non-dihydropyridines)
13
Q
Used from HTN, angina, and Raynaud
A
Nifedipine, amlodipine (not nimodipine)
14
Q
1st line therapy for HTN in pregnancy
A
Hydralazine with methyldopa
15
Q
MoA of Hydralazine
A
Direct vasodilator of arteriolar smooth muscle by increasing cGMP and inhibit IP3-induced calcium release from the sarcoplasmic reticulum
16
Q
S/E of Hydralazine
A
Lupus-like syndrome
17
Q
Added to hydralazine to prevent reflex tachycardia
A
Beta-blocker
18
Q
MoA of Nitroprusside
A
short acting, increase cGMP via direct release of NO
19
Q
MOA and effect of nitric oxide
A
Stimulates cGMP, leads to vascular smooth muscle relaxation
20
Q
IV nitrate used in hypertensive crisis
A
Nitroprusside
21
Q
Nitroprusside vasodilates
A
Arteries and veins
22
Q
Side effect of nitroprusside
A
Cyanide Poisoning
23
Q
Fenoldopam
A
D1 receptor agonist, coronary, peripheral, renal and splanchnic vasodilation
decreases BP and increases natriuresis
24
Q
Two drugs that may be used off-label for ischemia and gangrene caused by ergot alkaloids overdose
A
Nitroprusside, nitroglycerin
25
Primarily dilates veins, decreases preload
Nitroglycerin, isosorbide dinitrate
26
For angina, acute coronary syndrome and pulmonary edema
Nitroglycerin, isosorbide dinitrate
27
Monday disease
Toxicity of Nitroglycerin, isosorbide dinitrate, develop tolerance of vasodilating action during the work week and loss of tolerance on the weekend resulting in tachycardia, dizzy, and HA on re-exposure
28
Affect Preload
Nitrates
| they decrease EDV, BP and MVO2
29
Affect Afterload
Beta-blockers
| they increase EDV and ejection time but DECREASE contractility, HR, and MVO2
30
partial beta-agonists C/I in angina
Pindolol and Acebutolol
31
Selective beta 1 receptor blockers useful for treating cardiac conditions in patients with asthma
Acebutolol, betaxolol, esmolol, atenolol, metoprolol (A BEAM)
32
Blocks alpha 1 and beta receptors and indicated for the treatment of CHF
Labetalol and carvedilol
33
Beta blockers with partial agonist activity, can bronchodilate and may have an advantage treating patients with asthma
Pindolol and acebutolol
34
Non-selective beta blocker that lacks local anesthetic activity, indicated for glaucoma
Timolol
35
Short-acting beta blocker that can be given parenterally
Esmolol
36
Clinical uses of these agents include treatment of hypertension, angina, arrhythmias, and chronic congestive heart failure
Beta-blockers
37
Side effects of beta blockers
Bradycardia, AV block, impotence, dyslipidemia, exacerbation of COPD
38
Beta-blockers should be used cautiously in
Asthma (bronchospastic effects), diabetes (block signs of hypoglycemia) and peripheral vascular disease
39
Beta blockers' effect on the heart in antianginal therapy
Reduce heart rate, blood pressure, contractility, and increase end-diastolic volume
40
Beta blockers are used for this type of angina attack
Classic (exertional) angina
41
A nonselective beta blocker with alpha 1 blocking effect indicated for congestive heart failure
Carvedilol
42
This class of drugs inhibit angiotensin-converting enzyme
ACE inhibitors
43
Captopril and enalapril (-PRIL ending) are
ACE inhibitors
44
Side effects of angiotensin converting enzyme inhibitors
Dry cough, hyperkalemia, angioedema
45
Inactivated by angiotensin converting enzyme, contributes to dry cough and angioedema
Bradykinin
46
Angiotensin converting enzyme inhibitors are contraindicated in
Pregnancy, hyperkalemia
47
Mechanism of action of losartan and valsartan
Block AT1 receptors
48
Side effect associated with angiotensin converting enzyme inhibitors but not angiotensin receptor blockers
Dry cough
49
Alpha 2 agonist used in pregnant women with hypertension
methyldopa
50
Side effects of methyldopa
Positive Comb's hemolytic anemia, SLE-like syndrome, CNS depression
51
Methyldopa is contraindicated in
Geriatrics due to its CNS (depression) effects
52
Side effect of clonidine
Rebound hypertension, sedation, dry mouth
53
Arterial vasodilator that works by opening K+ channels
Minoxidil
54
Side effect of minoxidil
Hypertrichosis
55
MOA and effect of nitric oxide
Stimulates cGMP, leads to vascular smooth muscle relaxation
56
Mechanism of action of sildenafil
Inhibits phosphodiesterase-5, enhancing effects of nitric oxide-activated increases in cGMP
57
Drugs used in the management of exertional (classic) angina
Nitrates, calcium channel blockers, beta blockers
58
Aspirin reduces mortality in unstable angina by
Inhibiting platelet aggregation
59
Mechanism of action of organic nitrates
Requires enzymatic release of NO, relaxes vascular smooth muscle of veins
60
Nitrate free intervals are needed due to
Tolerance
61
Side effects of nitrates
Reflex tachycardia, hypotension, flushing, and throbbing headache due to meningeal artery dilation
62
Mechanism of action of cardiac glycosides (eg. digoxin)
Inhibit Na+/K+ ATPase and indirectly increase intracellular calcium and cardiac contractility
63
Indication of digoxin
Atrial fibrillation and congestive heart failure
64
Digoxin toxicity can be precipitated by
Hypokalemia
65
Phosphodiesterase (PDE3) inhibitors indicated for acute congestive heart failure; long term use is associated with increased mortality
Amrinone and milrinone
66
Side effect of amrinone and milrinone
Thrombocytopenia
67
Agent used in acutely decompensated congestive heart failure resembling natriuretic peptide
Nesiritide
68
Mechanism of action of class I antiarrhythmics
Sodium channel blockers
69
Mechanism of action of class II antiarrhythmics
Beta -blockers
70
Mechanism of action of class III antiarrhythmics
Potassium channel blockers
| amiodarone, Ibutilide, dofetilide, sotalol
71
Mechanism of action of class IV antiarrhythmics
Calcium channel blockers
72
Limiting side effect of class Ia and III antiarrhythmics
Prolongs QT interval
73
Most common side effects of quinidine that limits its use
Cinchonism
74
Major drug interaction with quinidine
Increases concentration of digoxin
75
Side effect of procainamide
Systemic lupus-like syndrome
76
Contraindication of disopyramide use
heart Failure
77
Used as last line antiarrhythmic agents due to proarrhythmic property; strongest sodium channel blocker
Class IC (flecainide, propafenone)
78
Anti-arrhythmic agents that decrease mortality
Beta-blocker
79
Used intravenously for acute tachycardia during and post- surgery
Esmolol
80
Drug of choice for management of acute ventricular tachycardia
Amiodarone
81
Antiarrhythmic effective in most types of arrhythmia
Amiodarone
82
Class III antiarrhythmic that exhibits properties of all 4 classes
Amiodarone
83
Side effects of Amiodarone
Thyroid dysfunction, corneal deposits, liver damage and pulmonary fibrosis
84
Antiarrhythmic that exhibits Class II and III properties
Sotalol
85
Side effect of sotalol
prolongs QT interval
86
Life threatening cardiac event that prolong QT leads to
Torsades de pointes
87
Drug of choice for narrow complex paroxysmal supraventricular tachycardia (PSVT)
Adenosine
88
Mechanism of action of adenosine
Activates G-protein coupled K+ channels in atrium, SA and AV node
89
Anti-arrhythmic with <10 second duration of action
Adenosine
90
Drug of choice for early after depolarizations (Torsade)
Magnesium sulfate
91
Mechanism of action of statins
inhibits HMG COA reductase
92
HMG CoA reductase inhibitors are contraindicated in
Pregnancy
93
Two side effects of HMG COA reductase inhibitors
Rhabdomyolysis and Hepatotoxicity
94
Two parameters to obtain before initiation of statins
LFT's, creatine kinase
95
How grapefruit juice increases statin effect
Inhibit CYP450 3A4
96
Concurrent use of fibrates and statins increases risk of
Rhabdomyolysis
97
Class of agents for cholestyramine, colestipol, colesevalem
Bile acid-binding resins
98
Major nutritional side effect of bile acid-binding resins
Impair absorption of fat soluble vitamins (A,D,E,K)
99
Fibrates increase activity of
Lipoprotein lipase
100
Side effect of fenofibrate and gemfibrozil
Gallstone formation
101
Mechanism of action involves indirect reduction of liver triglyceride synthesis
Niacin, fibrates
102
Side effects of niacin
Cutaneous flush
103
Cutaneous flush due to niacin can be reduced by pretreatment with
NSAIDs
104
Inhibits intestinal cholesterol absorption by inhibiting Niemann Pick C1 Like 1 (NPC1L1) Protein
Ezetimibe
105
Mechanism of action of aspirin
Irreversibly blocks COX1 and COX2
106
Agent used to treat myocardial infarction (MI) and to reduce incidence of subsequent MI
Aspirin
107
Side effect of aspirin
GI bleeding
108
Antiplatelet drug reserved for patients allergic to aspirin
Ticlopidine
109
Side effect for ticlopidine
Neutropenia and agranulocytosis
110
Irreversible inhibitor of platelet P2Y12 receptors; effective in preventing transient ischemic attack
Clopidogrel and ticlopidine
111
Phosphodiesterase inhibitor indicated for intermittent claudication
Dipyridamole, cilostazol
112
Block glycoprotein IIb/IIIa involved in platelet cross-linking
Abciximab, tirofiban and eptifibatide
113
Vitamin K dependent anticoagulant with zero-order kinetics of elimination
Warfarin
114
Route of administration of warfarin
Oral
115
Contraindication of warfarin
Pregnancy
116
Anticoagulant of choice in pregnancy
Heparin
117
Heparin (PTT) increases activity of
Antithrombin 3
118
Routes of administration of heparin
IV and SC
119
Side effect of both warfarin and heparin
Bleeding
120
Specific side effect of heparin
Heparin induced thrombocytopenia (HIT)
121
Two anticoagulant used for prophylaxis and treatment of thrombosis in patients with heparin-induced thrombocytopenia
Bivalirudin, argatroban
122
Thrombolytic used for acute myocardial infarction and ischemic (non-hemorrhagic) cerebral vascular accident (stroke)
Alteplase
123
Mechanism of action of thrombolytics
Lyse thrombi by catalyzing the formation of plasmin which cleaves fibrin
124
Side effect of tissue plasminogen activators
Cerebral Hemorrhage
125
Indications for thrombolytics
Pulmonary embolism, severe deep vein thrombosis
126
Thrombolytic that can cause allergic reaction and non-selective systemic fibrinolysis
Streptokinase
127
Hyperglycemia (acanthosis nigricans) and Hyperurecemia (exacerbates gout)
Niacin
128
Activates PPAR-alpha to induce HDL synthesis
Fibrates (gemfibrozil, clofibrate, bezafibrate, fenofibrate)
129
Antidote for Digoxin
slowly normalize potassium, cardiac pacer, anti-digoxin Fab fragments, magnesium
130
Class IA antiarrhythmics
Quinidine, Procainamide, Disopyramide
131
Clinically used or both atrial and ventricular arrhythmias, esp re-entrant and ectopic SVT and VT
Class IA antiarrhythmics
132
Increase AP duration, increases effective refractory period, increase QT interval
Class IA antiarrhythmics
133
Class IB antiarrhythmics
Lidocaine, Mexiletine
134
Used for post-MI acute ventricular arrhythmias
Class IB antiarrhythmics (Lidocaine and Mexiletine)
135
Decreases AP duration
Class IB antiarrhythmics (Lidocaine and Mexiletine)
136
Contraindicated in structural and ischemic heart disease
Class IC antiarrhythmics (Flecainide, Propafenone)
137
Decrease slope of phase 4, increase PR interval
Beta blockers
138
May mask hypoglycemia
Beta blockers
139
May exacerbate vasospasm in Prinzmetal angina
Propranolol
140
Tx of beta blocker overdose
Glucagon
141
Toxicity of Amiodarone
pulmonary fibrosis, hepatotoxicity, corneal deposits, skin deposits (blue/gray) resulting in photodermatitis, neurologic effects, constipation, bradycardia, heart block, CHF)
142
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