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Pharm > Unit 5 > Flashcards

Unit 5 Flashcards

1
Q

Alpha 2 agonist- Centrally acting

A

Clonidine
Methyldopa

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2
Q

Alpha 2 agonist MOA

A

decrease in peripheral outflow of NE, leading to decreases in peripheral resistance, renal vascular resistance, heart rate, and blood pressure

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3
Q

Alpha 2 ADR

A

drowsiness, dry mouth, constipation, urinary retention, headache, and disturbances in sexual function

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4
Q

Clonidine precautions

A

should not be prescribed to patients at risk or with history of bradycardia or sinus node dysfunction.
Increased risk of depression.

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5
Q

Methyldopa contraindication

A

Hepatic disease and use of MAOIs. Can cause hemolytic anemia in rare cases

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6
Q

Clonidine and Methydopa precautions

A

Crosses blood-brain barrier and should be used with caution in cerebrovascular disease

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7
Q

Clonidine and methyldopa drug interaction

A

Should not be prescribed in conjunction with a beta -adrenergic blocker bc of risk of life threatening HTN if abruptly discontinued

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8
Q

Alpha 1 adrenergic antagonists

A

Doxazosin
Prazosin
Terazosin

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9
Q

Alpha 1 adrenergic antagonist MOA

A

block postsynaptic alpha1 receptors in the vasculature causing a decrease in both arterial and venous vasoconstriction

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10
Q

Alpha 1 adrenergic antagonist precaution

A

Intraoperative floppy iris syndrome
Orthostatic hypotension

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11
Q

Alpha 1 adrenergic antagonist ADR

A

Syncope w sudden LOC

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12
Q

Doxazosin, prazosin, and terazosin

A

Second-line agents for treatment of htn in older men with concomitant BPH.

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13
Q

Prazosin DDI

A

Beta-adrenergic blockers- may cause acute postural hypotension

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14
Q

Beta Adrenergic antagonists(Blockers)

A

Beta blockers occupy beta-receptor sites reducing the sympathetic nervous system activity by preventing and competing with catecholamines and other beta agonists

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15
Q

Nonselective beta blockers- Block beta 1 and beta 2 receptors

A

Nadolol
Propanolol

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16
Q

Beta blockers cardiac effect

A

Blocks SA node, decreasing HR, contractility, velocity, and in AV junction, slowing conduction

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17
Q

Beta blockers renal effect

A

Reduces renin, decreasing the activation of RAS causing less angiotensin II(mediated vasoconstricion) and aldosterone(mediated volume expansion)

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18
Q

Beta blockers respiratory effect

A

causes bronchial constriction

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19
Q

Beta blockers endocrine effect

A

Used in liver cirrhosis to reduce portal pressure. Can prevent variceal bleeding in treatment of cirrhosis

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20
Q

Beta blockers contraindications

A

AV block, PVD, respiratory conditions such as asthma

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21
Q

Propanolol DDI

A

Acetaminophen
Gabapentin
Haldol
Loop diuretics
Phenothiazines
Warfarin

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22
Q

Selective beta1 blockers (except at high doses will have an effect on beta 2 receptors)

A

Metoprolol
Atenolol
Nebivolol

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23
Q

Nebivolol

A

Unlike other beta blockers, also produces endothelium-derived nitric oxide-dependent vasodilation

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24
Q

Beta blockers precautions

A

Hypotension and bradycardia
May mask symptoms of hypoglycemia
May mask clinical signs of hyperthyroidism such as tachycardia.
Should not be stopped before surgery.
Increased risk of MI with use of anesthesia for patients who take beta blockers chronically.

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25
Q

Propanolol and metoprolol DDI(different than propanolol alone)

A

Ranitidine
Hydralazine
MAOIs
Propafenone
Benzos
Serotonin reuptake inhibitors
Thyroid hormone

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26
Q

Combined alpha and beta adrenergic antagonists

A

Carvedilol
Labetalol

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27
Q

Combined alpha and beta adrenergic antagonist MOA

A

Alpha1 blockade is predominant, which makes these medications less likely to cause significant bradycardia or decrease in cardiac output.
Decreases the reflex vasoconstriction that is noted with beta blockers alone.

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28
Q

Carvedilol

A

Used to reduce progression of HF and to treat LV dysfunction after MI

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29
Q

Labetalol contraindication

A

Patients with bronchospastic dx

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30
Q

Carvedilol DDI

A

Use with caution with other CYP2D6 inhibitors such as amiodarone. Can increase the blood levels of carvedilol
Rifampin.
Dyphenhydramine

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31
Q

Carvedilol anesthesia precaution

A

Anesthesia medications, such as ether, cyclopropane, and trichloroethylene, should be used with caution with carvedilol because of depressed myocardial function

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32
Q

RAS inhibitors- Angiotensin Converting Enzyme inhibitors(ACE) inhibitors

A

Captopril
Enalapril
Benazepril
Lisinopril
Ramipril

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33
Q

ACE inhibitor MOA

A

Reduces production of angiotensin II and aldosterone

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34
Q

Angiotensin II

A

Increases vasomotor tone by directly stimulating vascular smooth muscle contraction and through the inhibition of endothelial nitric oxide and prostaglandin release, raising BP and decreasing blood flow through arteries.

Increases intravascular volume through stimulating sodium and water retention (with aldosterone), shifting of the pressure–natriuresis relationship, and altering glomerular hemodynamics. It is also produced in response to tissue injury

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35
Q

Aldosterone

A

Hormone produced by the adrenal glands. Plays a crucial role in regulation bp by controlling the balance of sodium and potassium in the blood

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36
Q

ACE inhibitors and ARB contraindication

A

bilateral renal artery stenosis
angioedema
pregnancy
hyperkalemia

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37
Q

ACE inhibitors ADR

A

angioedema in 0.2% of people taking
dry hacking cough within first week of taking

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38
Q

Angiotensin receptor blockers (ARBs)

A

Losartan
Candesartan
Olmesartan
Telmisartan
Valsartan

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39
Q

Angiotensin receptor blockers (ARBs) MOA

A

Act by blocking the AT II receptor. They have similar action to ACEIs on vasoconstriction and aldosterone secretion but no activity related to bradykinin

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40
Q

Losartan DDI

A

Levels are significantly lowered by inhibitors of CYP 450 3A4 and 2C9

Potassium supplements, potassium-sparing diuretics

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41
Q

Cardiac glycoside

A

Digoxin

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42
Q

Cardiac glycoside MOA

A

All CGs are strong and highly selective inhibitors of the sodium–potassium–adenosine triphosphatase (ATPase) system—the “sodium pump.” Inhibition of this pump results in sodium and calcium buildup inside the cell. The combination of the changes in sodium and calcium results in increased velocity of the shortening of cardiac muscle. Increases stroke volume(positive inotropy)

43
Q

Digoxin precautions and contraindications

A

AV block and uncontrolled ventricular arrhythmia because their action on the AV node may worsen the arrhythmia. They are used for rate control only after trying a BB, when verapamil or diltiazem cannot be used or are inadequate to achieve the desired rate range.

severe renal impairment.

44
Q

Dig toxicity symptoms

A

n/v/d, arrhythmias, palpitations, confusion, dizziness, weakness, and visual disturbances

45
Q

Dig toxicity antidote

A

digibind

46
Q

Class IA antiarrhythmics

A

Depress phase 0 an prolong the action potential duration - sodium channel blocker

47
Q

Class IA med

A

Disopyramide

48
Q

Disopyramide MOA

A

Blocks sodium channels, prolongs action potential duration, increases effective refractory period

49
Q

Disopyramide monitoring

A

Monitor ECG for QT prolongation and arrhythmias, electrolytes (especially potassium), and liver function tests

50
Q

Disopyramide side effects

A

Anticholinergic effects (dry mouth, constipation, urinary retention), blurred vision, hypotension, heart failure exacerbation, arrhythmias

51
Q

Disopyramide major adverse side effect

A

Proarrhythmic effects, exacerbation of heart failure, anticholinergic effects

52
Q

Class IB

A

Depress phase 0 slightly and may shorten the action potential duration- also works on sodium channels

53
Q

Class IB med

A

Mexiletine

54
Q

Mexiletine MOA

A

Blocks sodium channels, shortens action potential duration.

55
Q

Mexiletine monitoring

A

Monitor ECG for QT prolongation, liver function tests, and signs of CNS toxicity

56
Q

Mexiletine side effects

A

Nausea, dizziness, tremor, CNS effects (confusion, hallucinations), gastrointestinal upset

57
Q

Mexiletine major side effects

A

CNS effects, gastrointestinal disturbances, proarrhythmic effects.

58
Q

Class IC

A

Depress phase 0. Slowing of conduction- potent sodium channel blockade

59
Q

Class IC meds

A

Flecainide
Propafenone

60
Q

Flecainide monitoring

A

Monitor ECG for QT prolongation, assess renal and hepatic function regularly

61
Q

Flecainide side effects

A

Arrhythmias (including proarrhythmic effects), dizziness, blurred vision, gastrointestinal upset

62
Q

Flecainide black box warning

A

Increased mortality in post-MI patients (supraventricular arrhythmias)

63
Q

Flecainide and popafenone major side effects

A

Proarrhythmic effects, exacerbation of arrhythmias, CNS effects

64
Q

Propafenone monitoring

A

Monitor ECG for QT prolongation, liver function tests, and signs of proarrhythmia

65
Q

Propafenone side effects

A

Dizziness, metallic taste, gastrointestinal upset, arrhythmias (including exacerbation).

66
Q

Class II antiarrhythmics

A

Depress phase 4 depolarization

67
Q

Class II med

A

Propanolol

68
Q

Propanolol MOA

A

Non-selective beta-adrenergic receptor blocker, reduces sympathetic tone, decreases heart rate and contractility

69
Q

Propanolol monitoring

A

Monitor blood pressure, heart rate, signs of bronchospasm (if non-selective), and glucose levels in diabetic patients

70
Q

Propanolol side effects/ major side effects

A

Bradycardia, hypotension, bronchospasm (in asthma patients), fatigue, depression, sexual dysfunction.

Exacerbation of heart failure, CNS effects

71
Q

Class III MOA

A

Produce a prolongation of Phase 3 (repol)- K channel blocker

72
Q

Class III meds

A

Amiodarone
Dronedarone
Saltalol

73
Q

Amiodarone MOA

A

Blocks potassium channels, sodium channels, and calcium channels; prolongs action potential duration and refractory period.

74
Q

Amio monitoring

A

Regular monitoring of pulmonary function (due to risk of pulmonary toxicity), thyroid function, liver function, and ECG

75
Q

Amio side effects

A

Pulmonary toxicity (pneumonitis, fibrosis), thyroid dysfunction (hypothyroidism or hyperthyroidism), liver toxicity, photosensitivity, corneal deposits.

76
Q

Amio black box warning

A

Pulmonary toxicity, hepatotoxicity, potentially fatal arrhythmias

77
Q

Dronedarone monitoring

A

Regular ECG monitoring, liver function tests, and signs of heart failure exacerbation

78
Q

Dronedarone side effects

A

GI upset, liver toxicity, bradycardia, QT prolongation, exacerbation of arrhythmias.

79
Q

Dronedarone black box warning

A

Increased risk of death, stroke, and heart failure in patients with decompensated heart failure or permanent atrial fibrillation.

80
Q

Soltalol monitoring

A

Monitor ECG for QT prolongation, renal function (since excreted unchanged in urine), and signs of proarrhythmia

81
Q

Soltalol side effects

A

Bradycardia, torsades de pointes, hypotension, GI upset, dizziness.

82
Q

Soltalol black box warning

A

Proarrhythmic effects (torsades de pointes).

83
Q

Class IV

A

Depress phase 4 depolarization and lengthen phases 1 and 2 of repolarization- ca channel blocker

84
Q

Class IV meds

A

Diltiazem
Verapamil

85
Q

Dilt/verapamil MOA

A

Blocks calcium channels, reduces SA and AV nodal conduction, decreases myocardial contractility

86
Q

Dilt monitoring

A

Monitor ECG for AV conduction disturbances, blood pressure, signs of heart failure exacerbation

87
Q

Dilt side effects/ major side effects

A

Hypotension, bradycardia, peripheral edema, constipation, dizziness.

AV block, exacerbation of heart failure

88
Q

Verapamil monitoring

A

Monitor ECG for AV conduction disturbances, blood pressure, signs of heart failure exacerbation

89
Q

Verapamil major side effects

A

AV block, exacerbation of heart failure, hypotension.

90
Q

Vasodilators- drug acting through Nitric Oxide

A

Hydralazine

91
Q

Hydralazine MOA

A

Direct relaxation and dilation of arteriolar smooth muscle, reducing peripheral vascular resistance (PVR). Acts through nitric oxide release

92
Q

Hydral monitoring

A

Monitor blood pressure regularly. Assess for signs of fluid retention (weight gain, edema). Check for lupus-like syndrome symptoms (e.g., joint pain, fever).

93
Q

Hydral side effects/major adverse effects

A

Hypotension, reflex tachycardia, headache, lupus-like syndrome (rare), gastrointestinal upset.

94
Q

Vasodilators- K channel stimulants

A

Minoxidil

95
Q

Minoxidil MOA

A

Direct arteriolar vasodilation by stimulating potassium channels, resulting in decreased peripheral vascular resistance.

96
Q

Minoxidil monitoring

A

Monitor blood pressure regularly. Assess for fluid retention and symptoms of pericardial effusion (if used off-label for severe hypertension).

97
Q

Minoxidil side effects

A

Hypotension, fluid retention, pericardial effusion (off-label use), hypertrichosis (excessive hair growth).

98
Q

Ca channel blockers-Dihydropyridines

A

Nifedipine
Amlodipine
Felodipine

99
Q

Nifedipine MOA

A

Inhibit calcium ion influx into vascular smooth muscle and myocardium, resulting in vasodilation and decreased myocardial contractility.

100
Q

Nifedipine monitoring

A

Monitor blood pressure regularly. Assess for peripheral edema, gingival hyperplasia, and signs of heart failure exacerbation.

101
Q

Nifedipine adverse side effects

A

Hypotension, peripheral edema, exacerbation of heart failure symptoms (if used in heart failure).

102
Q

Amlodipine monitoring

A

Monitor blood pressure regularly. Assess for peripheral edema and signs of heart failure exacerbation

103
Q

Amlodipine major adverse effects

A

Hypotension, peripheral edema, exacerbation of heart failure symptoms (if used in heart failure).

104
Q
A

Pharm (6 decks)

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