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Found. Pharm > Pharmacy Care Application > Flashcards

Pharmacy Care Application Flashcards

1
Q

Trends in pharmacotherapeutic management of chronic hypertension

A
  • 1st line therapy are ACE-1/ARB, Thiazide, and Calcium Channel Blocker
  • Beta blocker are considered the second line agents for the management of HTN (hypertension) alone
  • Alpha blockers are generally used for resistant hypertension (Used more frequently for the management of benign prostate hyperplasia (BPH))
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2
Q

LOL, OLOL, ALOL, ILOL

A

Chemical Nomenclature: Aryloxypropanolanimes
- Multi-ring structures
Pharmacologic Nomenclature: Beta-adrenergic receptor blockers (beta-blockers)
– MOA: act at B-receptors located invidious organs in the body

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3
Q

B1 Vs B2 receptors

A
  • Catecholamines (norepinephrine) bind to B1 receptor and cause cardia automaticity and conduction velocity (increased heart rate)
    – Also release renin which learn to BP elevation
    – Likely located on the cardiac muscle but not exclusively
  • B2 receptor cause relaxation of smooth muscles such as lungs
    –Result in peripheral vasodilation
    – Skeletal muscle stimulation (tremors)
    – Work primarily in the pulmonary tissue and the periphery
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4
Q

Alpha 1-receptor

A
  • Involved in the bronchodilation and vasoconstriction effect
  • Some Beta blockers exhibit alpha blocking properties
    – Labetalol
    – Carvedilol
    They are referred to as mixed alpha/beta blockers
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5
Q

B-blocker MOA

A
  • Decrease BP by competitively blocking both B1, and B2 adrenergic receptors
    – Result in decreased HR and myocardial contractility
  • Some block Alpha 1 receptor: Decrease peripheral vasoconstriction (Lower BP)
  • Intrinsic sympathomimetic activity (ISA)-CAPP
    – Partially stimulate beta receptors while blocking catecholamines
    – Do not lower HR to the same degree as other beta blockers
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6
Q

Cardio-Selective Beta Blocker

A

Target B1 receptors preferentially
- Most become non selective in nature at higher dose
- Cause larger effect on HR
- Have smaller effect on BP
Does not always correlate with what the specific B-blocker are used for

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7
Q

Non Cardio-Selective Beta Blocker

A

Do not lower HR as much as selective Beta Blockers
- Cause BP to lower more by either alpha-blocking or nitric oxide vasodilation
- Can cause bronchoconstriction
– Avoid patient with a history of asthma
– Used with caution in patient with COPD

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8
Q

Therapeutic Categorization and Indication (Beta Blockers)

A

Hypertension
- Beta blocker only recommended as 2nd line treatment unless patient has another indication requiring beta blockers:
– Angina pectoris (help increase O2 supply)
– Cardiac arrhythmias (atrial fibrillation)
– Myocardial infarction
– Migraine Prophylaxis
– Heart Failure
– Tremors

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9
Q

Contraindication/Warning(Beta Blockers)

A

Contraindication
- 2nd and 3rd degree AV block or sick sinus syndrome
- Cardiogenic shock
- Cardiac failure/decompensation
Warning
- Caution in patient with diabetes (mask signs of hypoglycemia except for sweating)
- Use caution with bronchospastic diseases
- Peripheral vascular disease
- CNS depression
- Use in acute decompensated heart failure

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10
Q

ADR

A
  • Bradycardia
  • Hypotension
  • Fatigue
  • Dizziness
  • Depression
  • Decreased Libido
  • Impotence
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11
Q

DDI

A
  • Diltiazem/Verapamil
  • Digoxin
  • Carvedilol, metoprolol, and propranolol are major substrates of CYP2D6 (Any drug that induce or inhibit 2D6 need to be watched out for)
  • Carvedilol and propranolol are inhibitors of p-gp
    – Cyclosporine, dabigatran, digoxin, ranolazine
  • Diabetes medication
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12
Q

Counseling Points

A
  • Do not abruptly discontinue beta blockers after using for extended time
    – It can lead to rebound tachycardia (increase HR)
  • Taper beta blockers slowly to avoid rebound effect
  • If symptoms of HF appear (SOB, Dyspnea, Swelling of ankles)
  • Masks signs of hypoglycemia (will still have sweating and hunger)
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13
Q

Non-selective individual Compounds

A
  • ‘67 - propranOLOL (Inderal-IV available)
  • ‘78 - timOLOL (Blocadren)
  • ‘79 - nadOLOL (Corgard)
  • ‘82 - pindOLOL (Visken)
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14
Q

Cardio-Selective Beta Blockers

A
  • MetoprOLOL tartrate (Lopressor, Toprol XL)
  • AtenOLOL (Tenormin)
  • AcebutOLOL (Sectral)
  • EsmOLOL (Brevibloc-IV available)
  • BetaxOLOL (Kerlone)
  • BisoprOLOL (Zebeta)
  • NebivOLOL (Bystolic)
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15
Q

Mixed non-selective and Alpha1 blockers

A
  • CarvedILOL (Coreg) most commonly non selective
  • LabetALOL (Trandate, Normodyne) commonly used for pregnant women as it is most safe in that regard
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16
Q

Ophthalmic Beta Blocker

A
  • LevobunOLOL (Betagan Liquifilm)
  • BetaxOLOL (Betoptic)
  • MetiparanOLOL (Optipranolol)
  • CarteOLOL (Ocupress)
  • TimOLOL Maleate (Timoptic)
  • LevobetaxOLOL (Betaken)
    Glaucoma is their sole indication
17
Q

Darone Products

A
  • AmioDARONE Hydrochloride (got two I in it’s structure)
  • DroneDARONE Hydrochloride
18
Q

Amiodarone Indications

A

Anti-arrhythmic agent used primarily for ventricular arrhythmias:
- Non-sustained ventricular tachycardia (VT)
- Sudden cardiac arrest dur to ventricular fibrillation/pulseless VT
Off Label:
- Pharmacological cardio version in atrial fibrillation (Afib)
- Maintenance of sinus rhythm
- Prevention of post operative atrial arrhythmias
Dose used is dependent on the type of arrhythmias being treated
- Lower doses are generally used for atrial arrhythmias

19
Q

Amiodarone MOA

A
  • Class III Antiarrhythmic
  • Inhibits adrenergic alpha and beta receptors
  • Affect sodium, potassium and calcium channels
    – Prolongs the action potential and refractory period and decreases AV conduction and sinus node function
  • Hald life is 40 to 55 days
20
Q

Amiodarone: Adverse events

A

Most side effect is seen after an extended period of time
- Affect several systems
– Pulmonar - fibrosis, pneumonitis
– Thyroid - hypo/hyperthyroidism
– Ophthalmic - blurred vision, visual halos
– Gastrointestinal - anorexia, causes, vomiting
– Cardiovascular - hypotension, bradycardia, QT prolongation
– Dermatologic - photosensitivity
– Hepatic - abnormal LFTs

21
Q

BBW (Amiodarone)

A
  • Hepatotoxicity
  • Pulmonary toxicity
  • Ability to worsen arrhythmias
  • Use should be limited to patient with life threatening arrhythmias
22
Q

Interactions (Amiodaron)

A
  • Drugs that prolong QTc
  • Warfarin
  • Substrate: CYP3A4, CYP2C8
  • Inhibits: CYP2C9, CYP2D6, CYP3A4 (grapefruit juice)
23
Q

Availability

A

Brand Names
- CardarONE
- PacerONE
Got 50 mg/mL IV injection

24
Q

Dronedarone

A
  • Class III anti arrhythmic agent-indicated to reduce the risk of cardiovascular hospitalization
  • For patient with:
    – Paroxysmal
    – Persistent atrial fibrillation
    – Atrial flutter with recent episode
  • Associated risk factors:
    – Age>70
    – HTN
    – Diabetes
    – Prior stroke
    – Structurally similar to amiodarone but lack iodine moiety
  • Only available as 400 mg tablets under brand name MUTAQ
25
Q

Dronedarone: Side effects

A

Better profile when compared to amiodarone
- Lack thyroid toxicity
- Other side effects are similar

26
Q

Dronedarone: BBW

A
  • Increase risk of death when used with patients with class III or IV congestive heart failure (CHF)
  • Increase risk of death in patients with chronic atrial fibrillation
27
Q

(Z)OSIN:Chemical Nomenclature

A
  • Quinazolines (with a piperazine ring and acyl moiety)
  • Aryl Sulfonamides (only (Z)OSIN have it)
28
Q

(Z)OSIN: Pharmacologic Nomenclature

A
  • Alpha blocker with two distinct types
    – Alpha 1 and Alpha 1a - Adrenergic receptor blockers
  • MOA:
    – Selectively block a1 receptors on smooth muscle cells of peripheral vasculature (decrease BP by vasodilation and total peripheral resistance)
    – Increase urine flow and decrease frequency in BPH because a1 receptors ON prostate
29
Q

(Z)OSIN: Indications

A
  • Hypertension
  • Benign Prostatic Hyperplasia (BPH) - only alpha 1a blocker
30
Q

(Z)OSIN: Warning and ADR

A
  • Priapism (especially with alpha 1a blocker) a rare but serious ADR resulting in a painful prolonged penile erection, leading to permeant impotence if not treated immediately
  • Orthostatic hypotension
  • Retrograde ejaculation
  • Nasal Congestion, Dissiness, Tiredness
  • Sulfonamide allergy (tamsulosin)
31
Q

Available Products (ZOSIN)

A

TeraZOSIN HCI (Hytrin)
PraZOSIN HCI (Minipress)
DoxaZOSIN mesylate (Cardura/XL)
TamsulOSIN HCI (Flomax)
AlfuZOSIN HCI (Uroxatral)
SilodOSIN (Rapaflo)

32
Q

Asteride: Chemical Nomenclature

A

4-azasteroids - synthetic steroid like structures

33
Q

Asteride: Pharmacologic Nomenclature

A
  • Androgen hormone inhibitors/5-alpha Reductase inhibitors
34
Q

Asteride: MOA

A

Competitively inhibit type-II 5-alpha reductase
- Inhibit reduction of testosterone to dihydrotestosterone

35
Q

Asteride: Indication

A

Benign Prostatic Hyperplasia (BPH)
Alopecia (baldness)

36
Q

Asteride: Warning/ADR

A
  • Pregnancy category X
  • Use with care in patient with diminished urinary flow (obstructive uropathy)
  • Use with caution in patient with hepatic insufficiency
  • Not indicated in the US for the prevention of prostate cancer
37
Q

Asteride: Available products

A

FinASTERIDE (Prosper, Propecia)
DutASTERIDE (Avodart)

Found. Pharm (14 decks)

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