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Drugs Review Cards > Pharmacology for Systems > Flashcards

Pharmacology for Systems Flashcards

1
Q

Hyperlipidemia: Statins inhibit _________ resulting in decreased synthesis of cholesterol and increased LDL receptor expression.

A

HMG coA reductase

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2
Q

Hyperlipidemia: Statins are metabolized by _____ enzymes and have a 2-3 hour 1/2 life. They peak in the _______.

A

Metabolized by CYP 3A enzymes

Peak in Evening

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3
Q

Hyperlipidemia: What are the side effects of statins?

A
  1. LIver toxicity
    (inc. ALT enzymes)
  2. Muscle
    (myalgia, myosisis, rhabdomyolisis)
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4
Q

Hyperlipidemia: What are contraindications of statins?

A
  1. erythromycin
  2. azoles
  3. anti-depressants
  4. HIV protease inhibitors
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5
Q

Hyperlipidemia: Bile acid binding resins include

  1. Colestipol
  2. Colestyramine
  3. Cholesevelam

What is their MOA?

A

Bind bile acids

  • -inhibiti bile acid resorption
  • -inc. cholesterol usage
  • -inc. LDL receptors
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6
Q

Hyperlipidemia: Bile acid binding resins are not metabolized in the gut. Because of this, when is it best to take them?

A

Before meals, bedtime

*oral

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7
Q

Hyperlipidemia: What is the main side effect of bile acid binding resins?

A

Constipation

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8
Q

Hyperlipidemia: What are contraindications of bile acid binding resins?

A

absorption of digoxin and TH

NOTE: bile acid binding resins most useful in patients who don’t tolerate other drugs

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9
Q

Hyperlipidemia: Ezetemibe inhibits ____ reabsorption in the small intestine (brush border). It increases HDL and lowers LDL and TG’s.

A

sterol reabsorption

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10
Q

Hyperlipidemia: How is ezetemibe metabolized?

A

conjugated with glucuronate

  • 80% excreted (feces)
  • can be used alone or combined with statin
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11
Q

Hyperlipidemia: Fibrates are taken orally to treat hypertriglyceridemia and in cases of low HDL.

What are its actions?

A

Binds PPAR-a receptor

Inc. Lipoprotein Lipase
Inc. HDL apoprotein

Thus, Dec. TG’s, Inc. VLDL clearance, Inc. HDL

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12
Q

Hyperlipidemia: What are the adverse effects of fibrates?

A

Myopathy, rhabdomyolisis, bone marrow

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13
Q

Hyperlipidemia: Niacin is used to treat hypercholesterolemia and hyper-TG-emia.

It acts to decrease TG’s and LDL by inhbiiting _____ from the liver. It also increases HDL and decreases lipolysis.

A

Inhibits VLDL from the liver

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14
Q

Hyperlipidemia: What are the adverse effects of Niacin?

a. cutaneous flushing
b. gastric irritation
c. myopathy
d. cough

A

A-C

*also glucose intolerance

Cx: diabetic patients

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15
Q

Hyperlipidemia: What drugs may be used to treat hypercholesterolemia and hyperTG?

A

statins + niacin

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16
Q

Thromboembolic drugs: Anti-coagulants act on coagulation factors.

Warfarin is an example. It is an oral drug that acts by inhibiting ______, preventing thrombin formation from prothrombin.

A

Inhibits Vit. K reductase

*CYP 450 metab.

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17
Q

Thromboembolic drugs: When does warfarin have its max effect on the system?

A

3-5 days after beginning treatment

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18
Q

Thromboembolic drugs: Heparin is given by I.V. It indirectly increases AT-III, which inhibits ___ and ____.

A

inhibits thrombin and Xa

NOTE: enox, dalte, fondaparinuz are subcutaneous

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19
Q

Thromboembolic drugs: Rivaroxaban (oral) and Bivalirudin (injection) are anti-coagulants that directly inhibit thrombin. What are their mechs of action?

A
  1. Rivaroxaban
    - -inhibits Xa
    - -similar to warfarin, less monitoring
  2. Bivalirudin
    - –inhibits thrombin
    - -coronary intervention or heparin-induced thrombocytopenia
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20
Q

Thromboembolic drugs: Anti-platelet drugs include:

  1. aspirin
  2. clopidogrel, prasugrel
  3. eptifibitide, tirofiban

Which of the above acts by decreases thromboxane a-2 by inhibiting COX-1?

A

Aspirin

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21
Q

Thromboembolic drugs: Anti-platelet drugs include:

  1. aspirin
  2. clopidogrel, prasugrel
  3. eptifibitide, tirofiban

Which of the above decreases GP receptors by inhibiting ADP (P2Y12)?

A

clopidogrel, prasugrel

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22
Q

Thromboembolic drugs: Anti-platelet drugs include:

  1. aspirin
  2. clopidogrel, prasugrel
  3. eptifibitide, tirofiban

Eptifibitide and Tirofiban act to decrease fibrinogen crosslinking by inhibiting ____ and ___.

A

inhibit GPIIb, IIIa

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23
Q

Thromboembolic drugs: Fibrinolytics function to lyse clots and increase plasmin.

True/False: Alteplase, Reteplase and Tenecteplase increase plasminogen (clot-bound).

A

True

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24
Q

Thromboembolic drugs: Fibrinolytics function to lyse clots and increase plasmin.

Streptokinase and Anistreplase play a role in non-specific plasminogen binding. What is an adverse effect?

A

Inc. risk of bleeding

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25
Q

Thromboembolic drugs: Which of the following may be used for treatment of pulmonary embolism?

a. heparin
b. fibrinolytic
c. aspirin
d. clopidogrel/prasugrel

A

heparin and fibrinolytic

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26
Q

Thromboembolic drugs: Which of the following may be used for coronary angioplasty?

a. LMW heparin
b. bivalirudin
c. eptibifitide
d. aspirin
e. clopidogrel

A

all of the above

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27
Q

Thromboembolic drugs: Which of the following may be used to treat unstable angina/non-STE ACS?

a. aspirin
b. LMW heparin
c. clopidogrel
d. eptifibitide

A

Al of the above

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28
Q

Thromboembolic drugs: Which of the following can be used to treat STEMI?

a. fibrinolytic
b. aspirin
c. heparin
d. Vit. K

A

A-C

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29
Q

Anti-arrhythmics: Class 1A (open channels) include the drugs:

  1. Quinidine
  2. Disopyramide
  3. Procainamide

_______ is used for life threatening arrhythmias. It restores normal sinus rhythm, and prolongs QT.

A

Quinidine

*pregnancy ok

30
Q

Anti-arrhythmics: Quinidine (class 1A) is used for life threattning arrhythmias.

What are adverse effects of quinidine?

A
  1. torsades
  2. inc. digoxin
  3. inc. mortality
31
Q

Anti-arrhythmics: A class 1A drug that is given either IM or I.V. It can induce lupus like symptoms, but can be used in pregnancy.

A

Procainamide

32
Q

Anti-arrhythmics: Class 1B drugs are “inactivated” channels. They include:

  1. Mexilitine
  2. Lidocaine

____ is used for acute ventricular arrhythmias. It can be used in pregnancy

A

Lidocaine

  • NOT 1st choice
  • heart block, bradycardia
33
Q

Anti-arrhythmics: A class 1B drug that is used as long term prophylaxis

A

Mexilitine

*oral

34
Q

Anti-arrhythmics: Fleicanide is a class I C drug that is used for what?

A

Fetal SVT and Pregnancy

35
Q

Anti-arrhythmics: What are adverse effects of FLeicanide?

A

Bronchospasm, Seizure

36
Q

Anti-arrhythmics: Propafenone is a class 1C drug that has what adverse effects?

A

agranulocytosis, anemia

37
Q

Anti-arrhythmics: Class III drugs are associated with K+ channels. They prolong effective refractory period.

  1. Amiodarone
  2. Ibutilide
  3. Dofetilide

What is a contraindication for CLass III drugs?

A

Pregnancy

*amiodarone can in cases of life threatening arrhythmias

38
Q

Anti-arrhythmics: Amiodarone (Class III) is a short term drug that can be administered either

  1. oral (long term)
  2. acute w/ epinephrine

True/False: Amiodarone is the major form of treatment for torsade

A

False

*NOT for torsade

39
Q

Anti-arrhythmics: Adverse effects of amiodarone include

a. blue-gray discoloration
b. thyroid issues
c. pulmonary fibrosis

A

all of the above

40
Q

Anti-arrhythmics: This class III drug is administered via I.V.

It is used to treat A-fib/flutter and torsades.

A

Ibutilide

*significant patient harm

41
Q

Anti-arrhythmics: This class III drug blocks IKr. It is NOT for use with QTc > 440.

A

Dofetilide

  • can treat torsade
  • must be titrated
42
Q

Anti-arrhythmics: Sotalol is a class II/III drug that can be used to treat torsades.

What are its contraindications?

A

Not for QTc > 440

*bronchospasm

43
Q

Anti-arrhythmics: True/False - Beta blockers are the only drugs that decreased mortality in asymptomatic patients

A

true

44
Q

Class IV drugs are calcium channel blockers. They block calcium channels in the heart and in SM, and prevent re-entry in the AV node.

  1. Verapamil
  2. Diazepam

What are the most often used to treat?

A

SVT **

45
Q

Anti-arrhythmics: Which of the class IV drugs is most often used in pregnancy?

A

Verapamil

46
Q

Anti-arrhythmics: The number 1 drug for torsades

A

MgS

47
Q

Anti-arrhythmics: This drug is a nucleoside that is adminstered as an IV bolus. It acts to convert paroxysmal supraventricular tachycardia

A

Adenosine

48
Q

Anti-arrhythmics: Which of the following best describes digoxin?

a. Na/K+ pump inhibitor
b. + inotrope
c. - chronotrope
d. good for pregnancy

A

all of the above

49
Q

Anti-arrhythmics: List the antiarrhythmics that can be used for pregnancy

A

Lidocaine
Adenosine
Verapamil
Digoxin

50
Q

Anti-arrhythmics: List the drugs that can be used to treat torsades

A

Quinidine
SOtalol
Ibutilide
Dofetilide

51
Q

Heart failure: List the drugs for Tx of angina

A

Nitrates, CCB (variant angina)

52
Q

Heart failure: List the drugs used to decrease preload

A

Digoxin, ACE, ARBS, nitrates (low dose), diuretics

53
Q

Heart failure: List the drugs used to decrease afterload

A

ACE/ARBs, CCB, Nitrates, Hydralazine, a-agonist

54
Q

Heart failure: Positive inotropes include:

  1. Digoxin
  2. B-agonists
  3. PDE-1

Digoxin acts by inhibiting _____, leading to increased free calcium and increased contractility of the heart.

A

inhibits Na/K pump

  • taper
  • doesn’t dec. mortality
55
Q

Heart failure: What are the adverse effects of digoxin?

A

Hyperkalemia-induce arrhythmia

56
Q

Heart failure: B-agonists include dobutamine and dopamine.

Which of the above is more specific for the B1 receptors?

A

Dobutamine

B1 > B2 > a

57
Q

Heart failure: True/False: Dopamine increases renal perfusion, but is nonspecific.

A

True

D1 = D2 > B > a

58
Q

Heart failure: PDE-I’s include Milrinone. Milrinone acts to increase CAMP and contractility by inhibiting _____.

A

Inhibits PDE-3

59
Q

Heart failure: What are adverse effects of Milrinone? What are contraindications?

A

Adverse:
-nausea, vomiting

CX;

  • -furosamide
  • -selenide
  • -selegiline
60
Q

Heart failure: Non-positive inotropes include

  1. Vasodilators
  2. B-blockers
  3. Diuretics

List the vasodilators

A
  1. ACE/ARBs
  2. Hydralazine (arteriodilation)
  3. Nitrates (nitroprusside; venodilation)
  4. Neprilysin inhibitor (sacubitril + ARB)
61
Q

Heart failure: ______ can be used to treat HF by acting as vasodilators. They decrease heart remodeling, wall thinning and overall morbidity.

A

ACE

  • inc. ventricular performance
  • cough; renal artery stenosis
62
Q

Heart failure: Hydralazine is NOT for monotherapy. It is a direct vasodilator used MC for

A

acute HF

63
Q

Heart failure: _______ like carvedilol and metoprolol decrease mortality with low dose. Must titrate up

A

B-blockers

64
Q

Heart failure: Diuretics decrease edema and heart size without increasing the risk of arrhythmya.

Spironolactone is often used for severe heart failure, however, it can cause what adverse side effect?

A

ototoxicity

65
Q

Angina drugs: What is a useful drug for treating patients with aspirin sensitivity?

A

clopidogrel

66
Q

Angina drugs: CCB’s can be used in the treatment of angina.

  1. DHP’s decrease arterial tone and TPR. This helps to relieve wall tension and decrease O2 demand.
  2. non-DHP’s are good for the heart and vessels. They decerase heart rate and contractility.

Which of the above is not approved for the treatment of HF?

A

non-DHP’s

67
Q

Angina: Nitrates are effective drugs for the treatment of angina.

  1. _____ may be used as an immediate treatment for angina. It is administered sublingually.
A

Nitroglycerin - sublingual

oral, buccal, transdermal - maintenance

*don’t give nitrates with viagra

68
Q

Angina: B-blockers are effective for treating what type of angina?

A

stable

  • dec. HR, b.p, contractility
  • prevent reflex tachycardia

carvedilol, labetalol, metoprolol

69
Q

Angina: Last choice therapy for treating angina. It inhibits Na influx

A

Ranolazine

70
Q

Review Psych Drugs

A

q

Drugs Review Cards (1 decks)

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