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Pharmacology II Flashcards

1
Q

EDRF

A

Endothelial-Derived Relaxing Factor

(now presumed to be nitric oxide)

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2
Q

Normal Blood Pressure range

A

90-120 / 60-80

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3
Q

Stage I Hypertension range

A

140-160 / 90-100

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4
Q

Angiotensin Converting Enzyme Inhibitors

A

treatment for Hypertension

  • no bronchospasm, bradycardia, or CHF
  • no electrolyte abnormalities
  • no rebound hypertension
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5
Q

Describe the Renin-Angiotensin-Aldosterone system

A

a decrease in renal perfusion triggers:

  • liver to secrete angiotensinogen
  • kidney secretes renin to convert angiotensinogen into angiotensin I
  • endothelium secretes ACE to convert angiotensin I to angiotensin II
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6
Q

Effects of Renin-Angiotensin-Aldosterone system

A
  • increase sympathetic activity
  • Na and Cl reabsorption and K excretion
  • aldosterone secretion
  • arteriolar vasoconstriction and increased blood pressure
  • Water absorption and retention
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7
Q

(4) ACE inhibitor examples

A
  • Captopril (capoten)
  • Enalapril (vasotec)
  • Lisinopril (prinivil)
  • Ramipril (altace)
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8
Q

Side effects of ACE inhibitors

A
  • cough
  • hypotension with induction/spinal/epidural
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9
Q

(4) Angiotensin Receptor Blockers

A
  • Candesartan (atacand)
  • Losartan (cozaar)
  • Valsartan (diovan)
  • Telmisartan (micardis)
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10
Q

Effects of Angiotensin Receptor Blockers

A
  • block vasoconstrictive action of Angiotensin II
  • does NOT inhibit breakdown of bradykinin
  • no cough or allergy symptoms
  • Hypotension with induction/spinal/epidural
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11
Q

(1) Direct Renin Inhibitor

A

Aliskiren (teckturna)

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12
Q

Side effects of Beta Blockers

A
  • bradycardia and heart block
  • congestive heart failure
  • bronchospasm
  • masking of hypoglycemia
  • sedation
  • impotence
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13
Q

Where and how is Nitric Oxide synthesized?

A

endothelial cells from L-arginine

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14
Q

Half-life of Nitric Oxide

A

5 seconds

(binds to the iron of heme-based proteins)

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15
Q

Nitric Oxide as a Pulmonary Dilator

A

administered by inhalation to treat primary pulmonary hypertension

  • improves ventilation-perfusion mismatching
  • only approved for pediatric lung injury
  • Not effective if given IV because it is bound too quickly by iron
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16
Q

Complications of Nitric Oxide

A
  • methemoglobinemia
  • withdrawal symptoms
    • rebound hypoxemia
    • rebound pulmonary hypertension
  • NO oxidizes to NO2
    • pulmonary toxin (“silo-filler’s disease”)
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17
Q

Silo-Filler’s Disease

A

caused by inhalation of nitrogen dioxide

  • symptoms similar to acute respiratory distress syndrome
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18
Q

Sodium Nitroprusside

A

direct-acting, nonselective peripheral vasodilator

  • relaxes arterial and venous smooth muscle
  • immediate onset and short duration
  • releases cyanide and NO
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19
Q

Dose and Administration of SNP

A

0.3 mcg/kg/min

  • protect from light
  • must have art-line in place
  • cyanide toxicity at 2 mcg/kg/min
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20
Q

Cardiovascular side effects of SNP

A
  • baroreceptor mediated tachycardia
  • increased contractility from afterload reduction
    • decreased SVR, PVR, right atrial pressure
  • dilates coronary arteries
    • may cause coronary “steal”
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21
Q

Diagnosis of Cyanide Toxicity

A

tachyphylaxis, metabolic acidosis, and increased mixed venous PO2

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22
Q

Treatment of Cyanide Toxicity due to SNP

A
  • 100% oxygen
  • sodium thiosulfate 150 mg/kg IV
  • sodium nitrate 5 mg/kg IV
  • methylene blue 1-2 mg/kg over 5 niutes
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23
Q

Nitroglycerin

A

venodilator and large coronary artery dilator

  • used in cardiac ischemia, CHF, and controled hypotension
  • large doses cause arterial and pulmonary artery dilation
  • IV, SL, TC, and oral
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24
Q

Nicardipine

A

cerebral and coronary vasodilator

  • IV infusion for control of blood pressure
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25
Q

Hydralazine

A

direct arterial vasodilator

  • reflex increases heart rate and contractility
  • helpful in CHF
  • useful in pre-existing slow heart rate
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26
Q

Fenoldopam

A

Dopamine-1 Agonist

  • increases renal blood flow
    • increases urine output
  • reflex tachycardia and increases IOP
  • increases splanchnic blood flow
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27
Q

Diuretics and their site of action

(picture)

A
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28
Q

(1) Carbonic Anhydrase Inhibitor example

A

Acetazolamide

(diamox)

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29
Q

Carbonic Anhydrase Inhibitor

A

diuretic acting on proximal tubules and collecting duct

  • Treats glaucoma, pseudotumor cerebri, and altitde sickness
  • sulfonamide drug
  • causes metabolic acidosis
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30
Q

(2) Loop Diuretic examples

A

Flurosemide and Bumetanide

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31
Q

Loop Diuretics

A

inhibit Na+, K+, and Cl- in the thick ascending loop of Henle

  • most potent diuretic
  • first line therapy in CHF
  • decreases CSF production
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32
Q

Furosemide

A

Loop diuretic

  • oral or IV
  • rapid onset
  • less potent than Bumetanide
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33
Q

Side effects of Loop Diuretics

A
  • Hypokalemia
  • Nephrotoxicity
    • aminoglycoside antiniotics and Cephalosporn
  • increases Lithium levels
  • Ototoxicity
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34
Q

(2) Thiazide diuretic examples

A

Hydrochlorthiazide and Chlorthalidone

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35
Q

Thiazide Diuretics

A

used for long-term treatment of hypertension

  • inhibits Na+ reabsorption
  • vasodilatory effect
  • long half-life
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36
Q

Side effects of Thiazide diuretics

A
  • hypokalemia
  • hypochloremia
  • metabolic alkalosis
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37
Q

(4) Osmotic Diuretic examples

A

mannitol, urea, isosorbide, and glycerin

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38
Q

Osmotic Diuretics

A

inert substances that do not undergo metabolism

  • filtered by golmerulus
  • effects proximal tubules and Loop of Henle
  • increase plasma and renal fluid osmolality
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39
Q

Manntiol

A

osmotic diuretic

  • draws fluid from intracellular to extracellular space
    • may cause CHF
  • increases renal blood flow
  • decreases ICP
40
Q

Side effects of Mannitol

A
  • rebound intracranial hypertension
  • hyperosmolarity
    • hypernatremia
  • hypovolemia
41
Q

(2) Types of Potassium-Sparing Diuretics

A

Pteridine analogs and Aldosterone blockers

42
Q

Pteridine analogs

A

type of K+-sparing diuretic that prevents Na+ reabsorption

  • examples: triamterene, amiloride
43
Q

Aldosterone receptor blockers

A

Type of K+-sparing Diuretic

  • prevents synthesis and activation of the aldosterone dependent Na-K-ATPase pump
  • examples: spironolactone
44
Q

Nesiritide

A

synthetic natriuretic pepide used in the treatment of CHF

45
Q

PNS and the Respiratory System

A

regulates airway caliber, glandular activity, and microvasculature via the Vagus nerve

  • Ach activates the muscarinic receptors
    • bronchoconstriciton
  • anticholinergics
    • bronchodilation
46
Q

(3) systemic adrenergic agonists

A

Terbutaline, Epinephrine, and Albuterol

47
Q

Short-acting Inhaled Adrenergic Agonists

A

albuterol, levalbuterol, metaproterenol

48
Q

long-acting inhaled adrenergic agonists

A

salmeterol, formoterol, arformoterol

49
Q

short-acting inhaled cholinergic antagonists

A

ipatropium

50
Q

long-acting inhaled cholinergic antagonist

A

tiotropium

51
Q

systemic cholinergic antagonists

A

atropine, scopolamine, and glycopyrrolate

52
Q

(2) Leukotriene Antagonists

A

montelukast and zafirlukast

53
Q

(1) Leukotriene inhibitor

54
Q

Methylxanthines

A

phosphodiesterase inhibitor for bronchodilation

  • examples: theophylline and aminophylline
  • may improve diaphragmatic function
  • requires monitoring of blood levels
55
Q

What is the most common reason for a lung transplant?

A

primary pulmonary hypertension

56
Q

Ketamine

A

NMDA antagonist

  • stimulates release and inhibits uptake of catecholamines
  • maintains SVR and coronary perfusion pressure
  • bronchodilating effects
  • used in pulmonary HTN
57
Q

Propofol

A

GABA agonist

  • decreases SVR and coronary perfusion
    • leads to right heart failure
  • increases right to left shunt
58
Q

Etomidate

A

GABA agonist

  • relaxant effect on pulmonary arteries
  • no change in SVR
  • coronary perfusion pressure maintained
59
Q

Which neuromuscular blocker increases PVR?

A

Pancuronium

60
Q

Medications for quick relief of asthma

A

short-acting beta agonists and anticholinergics

61
Q

sympathetic stimulation generally _____ PVR

62
Q

Nitric Oxide for Respiration

A

improves perfusion to alveoli that are participating in gas exchange

  • forms nitrogen dioxide
  • approved for infants with RDS
  • must monitor methemoglobin
63
Q

(3) Phosphodiesterase Inhibitors

A

milrinone, sildenafil, and tadalafil

64
Q

Phosphodiesterase Inhibitors

A

prevents the degredation of cGMP to cAMP

65
Q

How do anesthetic drugs affect HPV?

A
  • IV agents
    • no effect
  • volatile agents
    • inhibit
    • mordern agents less than previous
  • Nitrous oxide
    • inhibits
    • usually avoided in throacic and cardiac surgery
  • NTG and SNP
    • inhibit
    • may see a decrease in PaO2
  • Thoracic Epidural
    • no effect
66
Q

Serotonin (5HT)

A

produced by chromaffin cells in the gut

  • metabolized by lung
  • high 5HT levels in right heart causes myocardial and valvular injury
  • acute PE causes degranulation of platelets and release of 5HT
    • bronchoconstriction
67
Q

Thrombin

A

converts fibrinogen to fibrin

68
Q

Factor XIII

A

promotes crosslinking of fibrin polymers for a stable clot

69
Q

Endothelial inhibition of Coagulation

A

increase shear forces across endothelium releases anticoagulation agents

  • NO, prostacyclin, and antithrombin
70
Q

Thrombomodulin

A

endothelium bound protein that activates Protein C and keeps thrombin at site of injury

71
Q

Protein C

A

activated by thrombin

  • binds to protein S
  • complex inhibits factors Va and VIIIa
72
Q

Prothrombin Time

A

extrinsic (initiation) pathway and the common final pathway

  • affected by reductions in prothrombin, V, VII, and X
  • vitamin K deficiency
  • hepatic dysfunction
73
Q

INR

A

International Normalized Ratio

  • standardizes the measurements of PT
  • normal 0.8 - 1.2
74
Q

Partial Thromboplastin Time (PTT)

A

assess intrinsic pathway

  • heparin
75
Q

Activated Clotting Time (ACT)

A

used to measure high doses of heparin

76
Q

When is Thrombin TIme prolonged?

A

fibrinogen abnormalities

77
Q

Bleeding Time

A

general measure of platelet function

  • normal 3 - 10 minutes
  • affected by
    • asprin, vonWillebrands, thrombocytopenia, DIC, and uremia
78
Q

Laboratory Findings in Vitamin K deficiency

A

prolonged PT

79
Q

Laboratory Findings in DIC

A

prolonged PT, PTT, and Bleeding time

decreased platelet count

80
Q

Laboratory Findings in vonWillebrand’s disease

A

prolonged PTT and bleeding time

81
Q

Laboratory Findings in Hemophilia

A

prolonged PTT

82
Q

Laboratory Findings in Liver failure

A

prolonged PT

(end stage prolongs PT, PTT, and bleeding time)

83
Q

DIC

A

Disseminated Intravascular Coagulation

  • consumption of clotting factors resulting in coagulopathy and bleeding
  • widespread clot formation
  • 10-50% mortality
84
Q

Diagnosis of DIC

A
  • continued bleeding
  • petechiae
  • low fibrinogen levels
  • D-dimer levels
85
Q

What may cause thrombocytopenia due to decreased production of platelets?

A

bone marrow failure, vitamin B12 deficiency, sepsis

86
Q

Hemophilia A

A

factor VIII deficiency

87
Q

Hemophilia B

A

factor IX deficiency

88
Q

Type A Blood

A

has anti-B antibodies with Antigen A

89
Q

Uses for FFP

A

urgernt reversal of warfarin therapy

90
Q

Uses for Cryoprecipitate

A
  • vonWillebrand’s when unresponsive to DDAVP
  • bleeding patients with fibrinogen levels < 80 mg/dL
91
Q

a “unit” of blood

A

10% of a pateint’s estimated blood volume

  • in 70kg male, about 500cc
92
Q

Why would you want Leukoreduction in RBC?

A
  • decreases exposure to non-ABO antigens
  • decreases CMV exposure
  • less immune modulation
93
Q

TRALI

A

Transfusion Related Acute Lung Injury

  • capillary leak syndrome
  • 50% of transfusion related deaths
  • within 6 hours
  • risk
    • plasma > plaetlets > RBCs
94
Q

What measures the intrinsic pathway?

95
Q

aPTT

A

activated plasma thromoplastin time

  • normal 30-35 seconds
  • Heparin

Quarter 4 (15 decks)

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