pharmacology (all) Flashcards
what is the first drug therapy that should be used with patients with hypertension
thiazide diuretics (hydrochlorothiazide)
how can hypertension be resolved without drug therapy
diet
stop smoking
less salt
exercise
after thiazide diuretics, what is the next logical pharmacuetical option for hypertension
ACE inhibitors
how do ACE inhibitors work
they inhibit angiotensin converting enzyme from synthesizing angiotensin 2, a potent vasoconsrictor. angiotensin 2 also causes aldosterone to be secreted. which is an antidiuretic. increasess blood volume and pressure
what do ACE inhibitors end in
-pril
what do angiotensin 2 receptor blockers end in
-sartan
what is the benefit of angiotensin 2 blockers over ACE inhibitors
they don’t cause a dry cough
what is the adrenergic drug for hypertension that can be used in pregnancy
clonidine (catapres)
how do beta blockers work
they reduce heart rate by blocking beta receptors in the heart. they also reduce renin secretion, thus aldoseterone II and angiotensin
decrease blood pressure
can patients abruptly stop taking antihypertension medication
no because it can cause a rebound hypertensive effect, which can lead to a stroke
what do calcium channel blockers end in
ipine
what drug is used for a hypertensive emergency
sodium nitropresside (nitride) and IV diazoxide (they are peripheral vasodilators
what causes angina pectoris
insufficient oxygen to the heart
what are the three types of angina
chronic stable (classic or effort) angina
unstable (preinfarction) angina
vasospastic (prinzmetals) angina
what are the characteristics of stable angina
no pain while resting
pain starts by exercise, stress, emotion or heavy metals
caused by atherosclerotic plaques
what are the characteristics of unstable angina
unpredictable even at rest
more intense pain longer lasting
risk MI and death
caused by atherosclerotic plaque rupture/blockage
what are the characteristics of vasospastic angina
caused by intense coronary arterial spasms
pain may come at rest
smoking, hyperinsulinemia, and insulin resistance are factors
what are nitrates for
they are used to prevent angina, since they cause potent dilation of coronary arteries. they are used for acute angina, and prevention of angina
what is the main side effect of nitrates
headaches (also orthostatic hypotension)
what is the most common calcium channel blocker
niphedipine (procardia)
what is the most common side effect of niphedipine
constipation (tell them to eat fiber)
what is nitroglycerine for
it is a vasodilator that decrease bp and helps with angina
what is the process for taking nitroglycerine with angina
when angina occurs, sit down and take one sublingually. wait five minutes, take another if angina persists. call 911 get an ambulance. take third 5 minutes later if angina persists
when should you not give someone nitroglycerine
with someone who has a systolic blood pressure below 90
what type of drugs are used for long term management of angina
beta blockers and calcium channel blockers
what type of drugs are used for acute angina management
nitroglycerines
what is a mild diuretic
thiazide
what is a powerful diuretic
forosimide (lacic)
what should be instructed of patients taking diuretics
increase electrolytes, especially potassium
what are potassium sparing diuretics
spirolactone and aldolactone
what shouldn’t be done with potassium sparing diuretics
you shouldn’t increase potassium (can lead to hyperkalemia)
when should diuretics be taken
in the morning (don’t wake up to pee)
what is the drug of choice for ventricular dysrhythmias
lidocaine,xylicaine
why is a beta blocker a bad idea for a women with a slow heart beat
because they slow down the heart rate
what is a dysrhymia
any deviation from the normal rhythm of the heart
what causes dysrhythmias
ischemia/MI
toxicants
drugs
hypokalemia
what is the normal level of digoxin
.5-2 ng/dl
what are the effects of digoxin
positive ionotrope
negative chromotrope
negative dronotrope
what are the side effects of digoxin overdose
nausea diarrhea vomiting seeing halos hypokalemia
what happens with digoxin and a diuretic
hyperkalemia
what things shouldn’t someone on warfarin/coumadin do
anything that can cause bleeding
shaving, flossing
what tests are used to test the effects of warfarin
prothrombin time and INR
PT-INR
what are the signs and symptoms of serious side effects of warfarin
bleeding skin rashes fever nausea diarrhea dermatitis alopecia urticaria abdominal cramps anorexia
what pain killer should be taken with warfain/coumadin
tylenol/acetometaphen
what is the antidote for warfarin/coumadin
vitamin K
what is the mechanism of action for anticoagulants
prevent clot formation, don’t break down current clots
why would LMWH be administered
because it has a more predictable anticoagulant response
it doesn’t require prolonged aPTT
it doesn’t require prolonged lab tests
what is LMWH
low molecular weight heparin
what is the lab test used to monitor heparin effects
aPTT activated partial thromboplastin time
what is the first choice antiplatelet drug
aspirin, because it is the least powerful
why do we use clopdogrel
its a powerful antiplatelet that we use so we don’t have to use an anticoagulant
at what point do we call a doctor if on antihypertensive drugs and we are in hypotension
if systolic is less than 90
what must we caution our patient about antihypertensive drugs,
they need to watch for orthostatic hypotension
what is primary hypertension
idopathic, cause unknown
what is secondary hypertension
hypertension due to a secondary cause, it goes away once the other problem is fixed
concerning pulse, when should we call the doctor
if its less than 60 or more than 100
when taking calcium channel blockers what tests do we check to observe renal function
BUN and creatinine
what is verapamil
calcium channel blocker
ways to reduce cholesterol
diet
exercise
what is the first line drug of choice for hypercholesterolemia
statins
what are ideal LDL values
less than 100 (190 is very high)
what are ideal HDL values
more than 60 (less than 40 is bad)
what are ideal total cholesterol values
less than 200 (more than 240 is bad)
treatment for digoxin overdose
digoxin immune fab (digibind) therapy
