u pharm Flashcards

1
Q

low vd

A

3 5 liters

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2
Q

medium vd

A

14 to 16 liters

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3
Q

large vd

A

41 liters

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4
Q

n-acetyl transerase drugs

A

hydralazine, procainimid, isoniazid, dapson

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5
Q

how long to reach stead state?

A

4 to 5 half lives

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6
Q

low levels of active metabolites of tamoxifen in relapsed cancer patients

A

cypp450 polymorphism

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7
Q

aziathiprine and 6 mercaptopurine polymorphism

A

thipurine methyltransferase

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8
Q

anesthetic well vascularized compartments

A

brain, kidney, liver, lungs, heart

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9
Q

annesthetic poorly vascualarize compartment

A

skeletal muscle, bone, fat

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10
Q

a child with allergic rhinitis who has flushed cheeks and dilated pupils

A

receiving an atntagonist of muscarnic recptors (like diphenhydramine for his allergies)

antagonism of h1 was a choice but is not the answer

said this was common side effect of anticholinergics

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11
Q

side effect of anticholinergic in eldery

A

constipation, dry mouth

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12
Q

special property of rectal deposits

A

partial first pass avoidance because goes through the middle and inferior rectal veins, avoiding th e liver

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13
Q

who has greatest blood flow?

A

the small intestine

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14
Q

who has greatest surface area?

A

the small intestine

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15
Q

what makes something suitable for renal excretion?

A

hypopihlic (low vd) -> excreted directly

indicated metabolized first in the liver often

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16
Q

what makes something something suitable for liver metabolism?

A

high liphilicity, can penetrate the liver membranes and the can be excreted in bile or urine

these compounds would have high vd and good tossue penetration (including cns)

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17
Q

questions showed respireidone casuing?

A

NMS

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18
Q

kid with fever and status epileptogenic

A

treat for status epilotogenic

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19
Q

receptor x is stimualted and na/ca influx and k efflux

A

receptor x is nicottinic

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20
Q

central affects of l-dope

A

anxiety, agitation, insomnia, confusion, delusions, hallucinations

dopa decarboxylase inhbitor will not help these

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21
Q

ritodrine

A

b2 agonist for utereus

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22
Q

comt inhibitors in parkinsons

A

currently used for wearing off phenomenon

only use with sinemet

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23
Q

antimuscarinic?

A

blocking the effects of acetycholin

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24
Q

durgs causing DRESS syndrome

A

anticonvulsants (phenytoin, carbamazine), allopurinol, sulfonomide, antibiotics (minicycline, vancomycin)

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25
Q

dress syndrom features

A

fever, generalized lymphadenopathy, facial edema, diffuse sking rash, eosionophilia, and internal organ dysfunction

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26
Q

sings of jimsin weed poisoning

A

very similar to atropin

some extra ones mentioned

bronchodilation, detrusor relaxation and sphintor contraciton, secretions decreased lacrinmation, salication, sweating

CNS: hallucinations, agitation, delirium

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27
Q

mu delta and kappa receptors linked to?

A

inhibitor g proteins which than go and close ca channels or open k channels

happens and spinal and suprnail levels

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28
Q

exam findings in opiod OD

A

decreased bowel sounds bradycardia and hypotension (histamine release)

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29
Q

what do you treat restless leg syndrome with?

A

dopamine agonist (ropinirole, pramipexole)

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30
Q

physical exam findings in malignant hyperthermia

A

question just told you fever, muscle rigidity (muscle stiffness), and cyanotic skin mottling

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31
Q

od of insecticides atropine given, still at risk for?

A

muscle paralysis

od can causes E for emesis

B for bradycardia

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32
Q

selegiline proceeses?

A

MPTP to MPP+

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33
Q

in comparison to benzos zopidem lacks?

A

anticonculsant properties, no muscle relaxing effects and not used for anethesia

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34
Q

sinement drug response is

A

unpredictable

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35
Q

an old man with BPH has suprapubic tenderness and decreased urine output, what drug causes it?

A

TCA due to urinary retention

was taking it for diabetic neuropathy or insomnia

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36
Q

tizanidine

A

alpha 2 adrenergic agonist, used for spasticity in MS

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37
Q

i man sitting around develops chest pain, he is treated and it shows that drugs x lowers BP and HR, but then he devlops shortness of breath

A

beta blocker being used in the emergent treatment of MI

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38
Q

a man his develops flushing, diaphoresis, nausea, with a BP of 100/70 and hr of 55. Pupils are constricted but reactive to light. was treat for?

A

atonic bladder

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39
Q

a man has a stroke (65 years old) and is prescribed benzo for muscle spasticity, what drug should he avoid?

A

avoid other sedating agents.

alcohol, barbituates, neuroleptics, and 1st generation antihistamines

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40
Q

a man has sudden SOB and chest tightness. has a history of noncomliant htn. bibasilar crackles. bp is 195/115

A

htn emergency

treated with nitroglycerin mechanism -> myosin dephosphorylation

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41
Q

a diabetic taking lisinopril has try cough

A

give a sartan

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42
Q

man gets treated for afib and devlops lightheadedness, weakness, and presyncope.

he has sinus bradycardia, qt prolongation, self resolved torsades was cause of symptoms

A

he was on sotalol

his afib was giving him palpitations and chest pressure, and were paroxysmal. why he started the meds.

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43
Q

a woman gets pneumonia and then devlops hypotension and lactic acidosis. she is treated with norepi IV and tissues around IV blanch and become cold and hard. What should you inject?

A

the norepinephrine has extravasated and is causing intense alpha 1 effects

block with phentolamine

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44
Q

nitrates and angina

A

coronary arterioles are already maximally dilates in general so hard to dilate more (just a tid bit)

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45
Q

adenosine mechanism

A

acts on at1 receptors -> causese K to go out, hyperpolzarized membrane stays negative longer in the sinus and av node

slow sinus rate and decreased av node conduction

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46
Q

a 23 yearold man comes in complaing of SOB and chest pain while running. family history of an uncle who died suddenly. he has a crescnedo decrescedno systolic murmur. how would you treat this patient.

A

its HCM

negative inotropes are beneficial in treating the LVOT and also his angina. so use beta blockers (meoprolol) and nondehydropirying CCB (verapamil)

AVOID
Vasodilators such as dyhydropyridien CCbs, nitroglycerine, ACE inhibitors -> decreased vascular resistance) i think nitroglycerin would also have decreased preload

Dueretics -> decreased preload

All of the above will worse the LVOT

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47
Q

a man has an MI its complicated with sever acute HF how to treat

A

dobutamine

works on b1 receptors and minimal activity on b2 and a1

positive inotrope
weakly positive chronotrope
both of these things -> increased o2 consumption, but which can worsen iscemia, but in this case benefits outweight

also causes a mild vasodilation because the b2 activity is greater than b1

the net results are a decrease in systemic vascular resistance and an increase in contractility without a change in arterial pressure

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48
Q

dopamine factoids

A

remember d1 - b1 - a1

low dose -> increased in renal blood flow and gfr

medium does -> now beta 1 leads to increase contractility and pulse pressure and systolic BP rise while diastolic stays the same.

higher doses -> co decreases due to increased TPR from a1 effects

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49
Q

a man has a total cholesterol of 290 and triglycerides of 675 what to treat?

A

treat with fibrate because of the moderately eleveated triglycerides > 50 mg/dl

PPAR-A receptor activation decreases hepativc VLDL production and increases LPL activitive

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50
Q

mechanism of omega 3 fatty acids

A

lower triglycerides by decreasing VLDL output and decreasing production of apob

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51
Q

43 year old woman has ocasional squeezing sensatin lasting for ten to 15 minutes. not htn but active smoke. no ischemia with exercise. an ambulatroy ecg monitor shows transient st elevation in 1 avl and v1 v4 at night.. what would provoke this symptoms?

A

this woman has pritzmetal angina

avoid dihydroergotamine (an ergot alkaloid i think like bromocriptine) which is used to treat migraine headaches. it is vasospastic

also avoid triptans

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52
Q

triggers of pritzmetal

A

cigs, coaine,amphetamine, dihydroergotamine/triptans.

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53
Q

treatment of pritzmetal

A

tobacco and drug cessation and vasodilators (nitrates and CCBs)

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54
Q

a1 blockers and -dipines work mainly?

A

on arterioles

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55
Q

drugs that prolong the qt

A

class 1a and 3 antiarrythymics, antibiotics (macrolides and fluroquinolones, methadone, and antipsychotics (eg haloperidol)

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56
Q

cortisol and epinephrine are?

A

cortisol shows permissiveness because of upregulation of a1.

it isnt synergistic because it has no intrinsice vasoactive properties of its own

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57
Q

question involving phenyleprhine infusino like in FA.

what would happen?

A

decreased AV node conduction velocity.

points out that the kidneys have alpha 1 and their perfusion would decrease with phenyephrine infusion, just as would the sphlanich circ would too

pheynyephrine would increased increased PCWP due to increased arteriolar and venous constriction

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58
Q

what to treatnonischemic cardiomyopathy HF wiht?

A

same as ischemic

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59
Q

how to fix first doese hypotension of alpha blockers?

A

give small doses act first

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60
Q

DOC for hypertension and CAD and heartfailure

A

B blockers

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61
Q

drug of choice for diabetes and hypertension

A

ace

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62
Q

1st line for esssential HTN

A

thiazide

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63
Q

CCB adverse

A

dizziness and lightheadedness

64
Q

a third effect of beta blockers you have been wondering about

A

they decrease vascular resistance by decreasing RAAS and endothelin (did not explain endotheln)

do not initiate B blockers in acute heart failure

65
Q

three places to avoid nitrates

A

HCM
person on phosdieastarse inhibitors
right ventricular infarction

66
Q

nitrates can cause

A

lgith headedness

67
Q

sildenafil acts similar too?

A

BNP which binds the ANP receptors that activate guanylates cyclase (same thing NO activates). this causes vasocilation

68
Q

thiazides cause

A

hypomagnesemia

69
Q

a1 antagnist does what?

A

blunts the usual reflex upon standing

70
Q

watch your what in pharmcokinetics problems?

A

UNITS!!! the time was in hours and minutes

71
Q

man treated with two drugs for angina and gets low bp and hr

A

beta blockers and CCB

72
Q

a drug that inccreases TPR, increases systolic BP, decreases pulse pressure, and decreases HR. what am i?

A

phenylephrine

Pulse pressure decreases because of reflex decrease in stroke volume and increased afterload

73
Q

a woman gets a venous thromboembolism in pregnancy, how to treat

A

DOC is LMWH like enoxaparin

74
Q

how could you medical treat gallstones if preferred?

A

bile acid supplement - ursodeoycholic acid

decreases cholesterol secretion and increases total bile

75
Q

anticholinergic side effects of antihistamines

A

blurry vision, dry mouth, urinary retetion, constipation

76
Q

girl consumed two bottles of insecticide. nausea, vomiting, abdominal pain, and copious diarrhea

A

Arsenic poinsoning

77
Q

arsenic mech

A

binds to sufhydrl groups on PDH inhibiting cellular respiratorin

78
Q

where can arsenic exposure occur?

A

pesticides/insecticides, contaminated water, pressure treated wood, matellurgy, glass making.

79
Q

arsenic clinical features

A

abdominal pain, vomiting, sever watery diarrhea, delirium, hypotension from diarrhea. qtc prolongation from dehydration -> torsades. and a garlic odor.

These where in bold:
Sever watery diarrhea
Hypotension
Qtc prolongation
garlic odor
80
Q

arsenic treatment?

A

dimercaprol

81
Q

cyanide presentation

A

cherry red skin, confusion, abdominal pain, vomiting

82
Q

how do fibrates cause gallstones?

A

inhibit cholesterol 7 alpha hydroxylas and increase cholesterol solubility

83
Q

two common things that precipitate hepatic encephloapthy

A
  1. gi bleed

2. heavy meal

84
Q

a person has a gastrojejunumy where the duodenum is resected, what will be deficient?

A

iron

85
Q

what to give a cystic fibrosis pt for malabsorption?

A

pancreatice lipase

86
Q

what are the independent effects of a bile acid resin and statin on cholesterol synthesis?

A

bile acid increase and statin decreases

statins works by decreasing intra liver cholesterol and upreguatling LDL receptors

the bile acid resin binds to the bile and causes its excretion, this upregulates more bile to be made, this causes increased LDL receptors and overall a decrease in choelsterol in the liver -> activates cholesterol synthesis

use statin to counteract and cause SYNERGISTIC action

87
Q

what not to use loperamide or diphenoxylat ein?

A

invasive or toxin producing bugs like shigella, salmonella, c diff

88
Q

what can induce COX2

A

il-1 and tnf a-> causes increased expression in inflammatory cells

89
Q

a 26 yearold professional athelete prevents with acne, what is going on?

A

he is taking methytestosterone.

hes too old to have acne

90
Q

dmard of choice for rheumatoid

A

methotrexate

91
Q

initial treatment of rheumatoid

A

NSAIDs for symptoms relief

92
Q

Most rapid relief of RA

A

prednisone (nsaid wasnt a choic)

neither are demards

DMARD therapy typical takes weeks to work

93
Q

DMARDS

A

methotrexate (first line), sulfasalazine, hydroxychloroquine, minocycline, tnf a inhibitors.

relieve pain and inflammation and also modyify disease progression but takes weeks to show effect

94
Q

first line for gout long term

A

xanthine oxidase inhibitors

95
Q

what is a contraindiaction of uricosuric agents in gout?

A

renal colic - kidney stones

96
Q

succnycholine hyperkalemia in

A

burns, myopathies (stem described quadrapelegic man), crush injuries, and denervation

97
Q

succinycholine heart effects

A

bradycardia from parasympathetic stim or tachycardia from sympathetics being stimualte

98
Q

lyme disease stages

A

early lyme disease you get flu like symptoms and erythema migrans (treat with doxycyline)

second stage you get av block and facial palsy (treat with ceftriaxone to prevent progression)

late disease features asymetric large joint arthritis and encephalopathy

99
Q

desmopressure also called?

A

DDAVP

100
Q

desmopression uses

A

mild hemophilia A and type 1 von willebrand disease (increases circulating factor 8 and endothelial secretin of vmf)

central diabetes insipidus and noctunral enuresis (binds v2 receptor in kidney tubules)

101
Q

abciximab mimics what disease?

A

glanzmann thrombocytopenia

102
Q

description of HIT

A

sever foot pain and right toe paleness

103
Q

what substance will accumulate in the cell with methotraxate therapy?

A

so once inside methotrexate becomes polyglutamated keeping it in the cell

it inhibits DHF reductase causing, causing DHF to accumulate which becomes polyglutamted or something like that

folic acid would also accumulate, see diagram u drew in FA

104
Q

vincristine causes?

A

finger numbness and tingling

105
Q

man develops mouth ulcer on methotrexate. what to do?

A

give folinic acid

106
Q

imagine the curves for insulins

A

rapid acting, regular, nph, determir, glargine

107
Q

theophyllin cane cause?

A

seizures and tachy arrythmia

108
Q

a man treated with coticosteroid cream for eczema for a number of years might devlop?

A

dermal atrophy

109
Q

an elevtive hernia repair and high post void residual urine?

A

give bethanechol

110
Q

female patient has acne and wants to take isotrentinoid, what should you do?

A

check for b hcg

111
Q

a woman is diagnosed with panic disorder and is given a drugs that works in an hour and whats the action

A

benzo, binds allosterically to gaba

112
Q

a man develops digoxin toxicity, what age related change would cause this?

A

a decreae in renal clearence, even in the presence of normal creatinine

113
Q

an old man develops hives after eating some strawberries, he has cognitive problems. what to do?

A

give laratadine and avoid first gen antihistamines

114
Q

a man has psoriasis and is prescribed a medication that activates a nuclear transccription factor, what was prescribed?

A

calcipotriene

others could be calcitriol, tacalcitol

bnind to vit d receptor and inhibit kertitinocyte proliferation and stimulate kertinocyte differntiation

115
Q

a woman has a baby with pulmonary defects and potter syndrome, what caused it?

A

acei

get getal anuria, oligohydroaminos, pulmonary hypolasia, limb contractures (he had a shortned limb), calvirum defects (said they were underdevloped), falte facies

116
Q

why does rebound congestion occur in phenylephrine use?

A

th nerve respond by synthesis less norepinephrine

117
Q

a 2 day old girl has persistent crying termors tachpynea sneezing and diarrhea. what to treat with?

A

its neonatal abstinence syndrome from with of maternal opiates

treat with methadone

can also get irritability, jittery movements, vomiting,

118
Q

meds with anticholinergic properties

A
antihistamines 
TCA
1st gen low potency antipsychotic
2nd gen antipsychotic clozapine
antiparkinsons drugs (benztropine and triphenxidyl)
belladonna alkaloids (atropine)
119
Q

a woman on paroxetine devlops serotonin syndrome because she was treated with a drug for cellulitis. what drug?

A

linezolid

120
Q

a man has zoster and the viruses are found to lack viral phosphorylating enzymes, what drug would treat?

A

codfovir, out of the options it was the only one that didnt need to be phosphorylated by the virus, doscarnet wasnt an option

121
Q

timolol acts where?

A

ciliary epithelium

122
Q

what to treat wet age related macular degenraion wiht?

A

smoking cessation and anti vegf (ranibizumab, bevacizumab)

123
Q

a beta blockers would cause what effects?

A

a decrease in renin, at1, at2, aldosterorone, but no change in bradykinin

124
Q

a man is on a mao inhibitor, wnat to switch to ssri, what must you do?

A

give time for presynaptic mao to be resynthezised

125
Q

what would cause arrythymia in amphoterricin b?

A

renal tubular ydsufxn leading to electroyte problems

126
Q

a man with HTN that is treated devlops sever cramping in the lower legs, whats the problem?

A

he was treated with a diuretic that caused hypokalemia by decreased volume and increased RAAS which can cause hypokalemia and metabolic alkalosis

127
Q

a woman on respireidone devlops ammonehra and breat tenderness

A

answer in explnation

128
Q

if more people were treated wiht penicillin for strep thorat what would u need to decrease?

A

cardiac surgery

129
Q

why does acei cause an increase in creatinine?

A

decreased renal filtration fraction

130
Q

side effects of EPO therapy

A

htn and thromboembolic events

131
Q

homrone effects of acei

A

increased renin, at1, decreased at2 and aldosterone, increased bradkykinin

132
Q

best med for primary and 2nd preventi of cardiovascular disease?

A

even if the hdls are low, it is still best to use hmgcoareductase inhibitor

133
Q

effects of atenolol on cardiomycote(camp) jg (camp) and vacular (camp)

A

decreased decreased and no effects

134
Q

acei hyperkalemia most common in?

A

renal insufficiency and pts taking k sparing diuertics

135
Q

a man has exertional chest pain and is diagnosed with angina, given aspirin for secondary CVD prevention but has shortness of breath and wheezing. what to substitue with?

A

clopidogrel

136
Q

a man on statins devlopes muscle pain, fatigue, and dark urine, what caused it?

A

erythromycin (cyp inhibiton) caused statin myopathy, and he had rhabdomyolysis which caused acute renal failure

137
Q

dont use milrinon pharmacology in whom?

A

severly hypotensive people because it also raises cAMP in arterioles causing vasofilation

138
Q

effects of selevtive artiolar vasodilator? and often given with?

A

reflex sympathetic activation which casues tachycardia and edema (from RAAS activation).

often given with sympatholytics and diuretics

139
Q

dobutamine actions

A

b1 receptor action and weak activity on b2 and alpha 1 recptors.

140
Q

a man with an acute MI is treated with alteplase and a low dose beta blocker. also given a single dose of morphine for pain. devlops an irregular breathing pattern, asymetric pinpoint pupils, and comatose.

A

intracranial hemmorhage from alteplase

141
Q

man has acute MI and COPD history what to treat with? as far as beta blockers go?

A

treat him with a selective b1

142
Q

absolute CI in OCPs

A
  1. history of thromboembolic event or stroke
  2. history of estrogen depedent tumpr
  3. women over 35 who smoke heavily
  4. hypetriglyceridemia
  5. decompensated or acute liver disease (would impair steroid metabolism)
  6. pregnancy
143
Q

why does isosorbide dinitrate have such a low bioavilabilty?

A

high first pass metabolism

144
Q

what is the major cause of first doese hypotension in acei initioation

A

volume depletion due to dieruetic use or HF, so in these pts start therapy at low dose

145
Q

when to use b blocker for htn

A

migraine, esential tremor, anginapectoris/prior mi, a fib

146
Q

how do beta blockers lower bp?

A

they do so by decreases myocardial contractility and also decreasing RAAS (would lead to decrease resistance remember)

147
Q

phosphodiestares type 3 vs type 5

A

i think type 3 about camp and type 5 about cgmp

148
Q

a man treated for depression has low bp and pulse of 100, mouth is dry and face is flushed, had grs prolongation and ventricular beats. what to treat cardiac stuff with?

A

sodium bicarb because hes OD on tca

149
Q

adneosine can be used in?

A

stress test

150
Q

lidocaine vs amiodiarone is acute magement of ventricular arrythymias during MI

A

amirodarone has replaced

151
Q

treatment of PAD?

A

cilostazol and should also receive aspirin or clopidogrel for 2nd prevention of coronary heart disease and stroke

152
Q

when do you really want to use fenoldopam?

A

in HTN emergency and renal inssuficiency

promotes renal perfusion, diuresism and natriuresis

153
Q

statin increases?

A

ldl receptor density

154
Q

stroke prevention after tia?

A

use statin, aspirin, and bp control

155
Q

prevent mortality in hf patients?

A

acei, b beta, sprionaconte

to prevent the aldosterone remodeling

156
Q

nitroglycerin tab effects? on lvedp, peripheral venous capacitence, svr

A

decreased, increase, decreased (slightly)