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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
Hydralazine
direct arterial vasodilator * reflex increases heart rate and contractility * helpful in CHF * useful in pre-existing slow heart rate
26
Fenoldopam
Dopamine-1 Agonist * increases renal blood flow * increases urine output * reflex tachycardia and increases IOP * increases splanchnic blood flow
27
Diuretics and their site of action | (picture)
28
(1) Carbonic Anhydrase Inhibitor example
Acetazolamide | (diamox)
29
Carbonic Anhydrase Inhibitor
diuretic acting on proximal tubules and collecting duct * Treats glaucoma, pseudotumor cerebri, and altitde sickness * sulfonamide drug * causes metabolic acidosis
30
(2) Loop Diuretic examples
Flurosemide and Bumetanide
31
Loop Diuretics
inhibit Na+, K+, and Cl- in the thick ascending loop of Henle * most potent diuretic * first line therapy in CHF * decreases CSF production
32
Furosemide
Loop diuretic * oral or IV * rapid onset * less potent than Bumetanide
33
Side effects of Loop Diuretics
* Hypokalemia * Nephrotoxicity * aminoglycoside antiniotics and Cephalosporn * increases Lithium levels * Ototoxicity
34
(2) Thiazide diuretic examples
Hydrochlorthiazide and Chlorthalidone
35
Thiazide Diuretics
used for long-term treatment of hypertension * inhibits Na+ reabsorption * vasodilatory effect * long half-life
36
Side effects of Thiazide diuretics
* hypokalemia * hypochloremia * metabolic alkalosis
37
(4) Osmotic Diuretic examples
mannitol, urea, isosorbide, and glycerin
38
Osmotic Diuretics
inert substances that do not undergo metabolism * filtered by golmerulus * effects proximal tubules and Loop of Henle * increase plasma and renal fluid osmolality
39
Manntiol
osmotic diuretic * draws fluid from intracellular to extracellular space * may cause CHF * increases renal blood flow * decreases ICP
40
Side effects of Mannitol
* rebound intracranial hypertension * hyperosmolarity * hypernatremia * hypovolemia
41
(2) Types of Potassium-Sparing Diuretics
Pteridine analogs and Aldosterone blockers
42
Pteridine analogs
type of K+-sparing diuretic that prevents Na+ reabsorption * examples: triamterene, amiloride
43
Aldosterone receptor blockers
Type of K+-sparing Diuretic * prevents synthesis and activation of the aldosterone dependent Na-K-ATPase pump * examples: spironolactone
44
Nesiritide
synthetic natriuretic pepide used in the treatment of CHF
45
PNS and the Respiratory System
regulates airway caliber, glandular activity, and microvasculature via the Vagus nerve * Ach activates the muscarinic receptors * bronchoconstriciton * anticholinergics * bronchodilation
46
(3) systemic adrenergic agonists
Terbutaline, Epinephrine, and Albuterol
47
Short-acting Inhaled Adrenergic Agonists
albuterol, levalbuterol, metaproterenol
48
long-acting inhaled adrenergic agonists
salmeterol, formoterol, arformoterol
49
short-acting inhaled cholinergic antagonists
ipatropium
50
long-acting inhaled cholinergic antagonist
tiotropium
51
systemic cholinergic antagonists
atropine, scopolamine, and glycopyrrolate
52
(2) Leukotriene Antagonists
montelukast and zafirlukast
53
(1) Leukotriene inhibitor
zileuton
54
Methylxanthines
phosphodiesterase inhibitor for bronchodilation * examples: theophylline and aminophylline * may improve diaphragmatic function * requires monitoring of blood levels
55
What is the most common reason for a lung transplant?
primary pulmonary hypertension
56
Ketamine
NMDA antagonist * stimulates release and inhibits uptake of catecholamines * maintains SVR and coronary perfusion pressure * bronchodilating effects * used in pulmonary HTN
57
Propofol
GABA agonist * decreases SVR and coronary perfusion * leads to right heart failure * increases right to left shunt
58
Etomidate
GABA agonist * relaxant effect on pulmonary arteries * no change in SVR * coronary perfusion pressure maintained
59
Which neuromuscular blocker increases PVR?
Pancuronium
60
Medications for quick relief of asthma
short-acting beta agonists and anticholinergics
61
sympathetic stimulation generally _____ PVR
increases
62
Nitric Oxide for Respiration
improves perfusion to alveoli that are participating in gas exchange * forms nitrogen dioxide * approved for infants with RDS * must monitor methemoglobin
63
(3) Phosphodiesterase Inhibitors
milrinone, sildenafil, and tadalafil
64
Phosphodiesterase Inhibitors
prevents the degredation of cGMP to cAMP
65
How do anesthetic drugs affect HPV?
* 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
Serotonin (5HT)
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
Thrombin
converts fibrinogen to fibrin
68
Factor XIII
promotes crosslinking of fibrin polymers for a stable clot
69
Endothelial inhibition of Coagulation
increase shear forces across endothelium releases anticoagulation agents * NO, prostacyclin, and antithrombin
70
Thrombomodulin
endothelium bound protein that activates Protein C and keeps thrombin at site of injury
71
Protein C
activated by thrombin * binds to protein S * complex inhibits factors Va and VIIIa
72
Prothrombin Time
extrinsic (initiation) pathway and the common final pathway * affected by reductions in prothrombin, V, VII, and X * vitamin K deficiency * hepatic dysfunction
73
INR
International Normalized Ratio * standardizes the measurements of PT * normal 0.8 - 1.2
74
Partial Thromboplastin Time (PTT)
assess intrinsic pathway * heparin
75
Activated Clotting Time (ACT)
used to measure high doses of heparin
76
When is Thrombin TIme prolonged?
fibrinogen abnormalities
77
Bleeding Time
general measure of platelet function * normal 3 - 10 minutes * affected by * asprin, vonWillebrands, thrombocytopenia, DIC, and uremia
78
Laboratory Findings in Vitamin K deficiency
prolonged PT
79
Laboratory Findings in DIC
prolonged PT, PTT, and Bleeding time decreased platelet count
80
Laboratory Findings in vonWillebrand's disease
prolonged PTT and bleeding time
81
Laboratory Findings in Hemophilia
prolonged PTT
82
Laboratory Findings in Liver failure
prolonged PT (end stage prolongs PT, PTT, and bleeding time)
83
DIC
Disseminated Intravascular Coagulation * consumption of clotting factors resulting in coagulopathy and bleeding * widespread clot formation * 10-50% mortality
84
Diagnosis of DIC
* continued bleeding * petechiae * low fibrinogen levels * D-dimer levels
85
What may cause thrombocytopenia due to decreased production of platelets?
bone marrow failure, vitamin B12 deficiency, sepsis
86
Hemophilia A
factor VIII deficiency
87
Hemophilia B
factor IX deficiency
88
Type A Blood
has anti-B antibodies with Antigen A
89
Uses for FFP
urgernt reversal of warfarin therapy
90
Uses for Cryoprecipitate
* vonWillebrand's when unresponsive to DDAVP * bleeding patients with fibrinogen levels \< 80 mg/dL
91
a "unit" of blood
10% of a pateint's estimated blood volume * in 70kg male, about 500cc
92
Why would you want Leukoreduction in RBC?
* decreases exposure to non-ABO antigens * decreases CMV exposure * less immune modulation
93
TRALI
Transfusion Related Acute Lung Injury * capillary leak syndrome * 50% of transfusion related deaths * within 6 hours * risk * plasma \> plaetlets \> RBCs
94
What measures the intrinsic pathway?
PTT
95
aPTT
activated plasma thromoplastin time * normal 30-35 seconds * Heparin
96

Quarter 4 (15 decks)

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