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CPR II > Week 3 (Exam 1) > Flashcards

Week 3 (Exam 1) Flashcards

1
Q

ACE inhibitors and pregancy

A

No no no!

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2
Q

Eplerenone

A

More selective (than spironolactone) aldosterone antagonist for Post-MI HF or for HTN

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3
Q

Caution in giving Chlorthalidone in patients with

A

Gout

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4
Q

Clinical uses for a-Methyldopa

A

HTN, but notably its a drug of choice for Gestational HTN

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5
Q

b1 Adrenergic Receptors

A

Increase HR, contractility, Renin

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6
Q

Clinical applications for Amiloride

A

Counteracts K+ loss from other diuretics given for HTN or heart failure

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7
Q

a1 Adrenergic Receptors

A

Vasoconstriction (increased Veinous Return)

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8
Q

Candesartan

A

Irreversibly binding Angiotensin II receptor Inhibitor

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9
Q

Nebivolol MOA

A

Induces NO (cardioselective and vasodilatory)

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10
Q

Phentolamine

A

HTN emergency drug

induces catecholamine excess

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11
Q

Amlodipine

A

Dihydropyridine CCB used in CAD and HT, but its got a super long 30-50 hour half life

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12
Q

Toxicities of Catopril

A

Cough and Angioedema

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13
Q

Valsartan

A

Non-ProDrug Angiotensin II Receptor Inhibitor

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14
Q

Major toxicities associated with a-Methyldopa

A

Positive Coombs Test, SLE-like Sx

Angina, Bell’s, Rash, amenorrhea, impotence, anemia…

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15
Q

Where do Sodium channel blockers and Spironolactone act on the Loop of Henle?

A

Cortical Collecting Duct

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16
Q

Major Toxicities associated with Hydrochlorothiazide

A

Sulfonamide: associated hypersensitivity

Hypokalemia, -magnesemia, -natremia, -chloremic acidosis

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17
Q

Effects of Clonidine

A

Transient increase in BP when given IV

Reduced Sympathetic Outflow

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18
Q

Nifedipine Clinical Applications

A

First line treatment for HTN (being a Ca channel blocker)

Off label use for HTN emergency in pregnancy and Pulmonary HTN

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19
Q

a2 Adrenergic Receptors

A

In brain and periphery, decrease sympathetic tone

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20
Q

Clinical applications for Cilostazol

A

Intermittent Claudication

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21
Q

Clevidipine

A

HTN emergency drug

Contraindications: soy, egg allergies and lipid metabolism problems

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22
Q

Losartan MOA

A

Nonpeptide angiotensin II receptor antagonist

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23
Q

What does aliskirin do?

A

Prevents Angiotensinogen cleavage to Angiotensin I via Direct Renin Inhibition

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24
Q

Dobutamine receptor target

A

B1 receptors of the heart for increased rate and contractility, peripheral vasodilation

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25
Q

Toxicities of Diltiazem

A

Edema, Headache mostly

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26
Q

DA target in treating Shock

A

b-receptors at lower doses

+a-receptors at high doses

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27
Q

First line treatment of HTN with Aortic Disease

A

b-Blockers

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28
Q

Clinical applications of Spironolactone

A

Counteracts K+ Loss from other diuretics in HTN/HF
Reduces Fibrosis in HFrEF and Post-MI HF
Off label for HFpEF hirsutism, acne, female alopecia

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29
Q

How to treat black adults for HTN (as long as they don’t have HF or CKD)

A

Thiazide-type diuretic or CCB

Try for 2+ antihypertensives

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30
Q

Esmolol

A

HTN emergency drug
Contraindicated with b-blocker use, bradycardia, decompensated HF
High doses block b2 and hurt lungs in reactive airway dz

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31
Q

What Angiotensin II effects are spared by ARBs?

A

Vasodilation, cell growth, apoptosis

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32
Q

Clinical Uses for Verapamil

A

IV: supraventricular Tach
Oral: HTN
Off Label: Migraine Prevention, Cardiac Hypertrophy

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33
Q

Prazosin MOA

A

Competitive a1-adrenergic antagonist

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34
Q

Systolic Murmurs

A

Mr As

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35
Q

Differentiate presentations of platelet defects vs clotting factor defects

A

Platelet: Mucocutaneous bleeding, petechiae
Factor: Deep tissue bleeding, delayed

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36
Q

Nitroprusside MOA

A

Direct Venous and Arteriolar SM Dilation

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37
Q

Nicardipine

A

HTN emergency drug

Contraindicated in advanced aortic stenosis

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38
Q

Labetalol

A

HTN emergency drug
Contraindicated with reactive airway disease or chronic obstructive pulmonary disease.
Really great for Hyperandrenergic syndromes
May worsen HF and shouldn’t be given w 2/3 heart block or bradycardia

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39
Q

Diltiazem MOA

A

Non-Dihydropyridine Slow Channel Ca Blocker

Cardioselective

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40
Q

Effects of Diltiazem

A

Coronary Vascular SM relaxation / Dilation

Slows AV conduction

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41
Q

Hydrochlorothiazide MOA

A

K+-Losing Thiazide Diuretic

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42
Q

What is the half-life of Catopril?

A

1.7 hours (longer in renal impairment)

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43
Q

Clinical applications of Prazosin etc

A

HTN: Late choice because you can get a stroke and CHF with doxazosin compared to chlorthalidone
Off label for PTSD

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44
Q

Clinical uses for Clonidine

A

HTN (not initial)
XRs for ADHD
Cancer Pain, Opioid withdrawal

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45
Q

Where do Osmotic Diuretics act on the Loop of Henle?

A

Thin Descending Loop

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46
Q

Benazepril

A

ACE inhibitor with longer half life with 1xday dosing

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47
Q

Key Differences between Nifedipine and Verapamil

A

Nifedipine Increases HR and CO (SNS reflex activation)

B/c more dilation w/ less inoptropy and no chronotropy

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48
Q

a-1 Blockers Side Effect

A

Orthostatic Hypotension

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49
Q

Preferred thiazide diuretic

A

Chlorthalidone

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50
Q

Drug related to pedal edema

A

Dihydropyridines (CCB)

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51
Q

Where do Vaptans act on the Loop of Henle?

A

Collecting Duct (ADH-related water absorption)

52
Q

Na Nitroprosside

A

HTN emergency drug
Monitor BP for overshoot, lower it for oldies
Prolonged use might do cyanide toxicity, tx w/ thiosulfate

53
Q

Diastolic Murmurs

A

Ms Ts Ar/i

54
Q

What do ARBs do?

A

Prevent Angiotensin II from binding AT1 receptors
AT1: Vasoconstriction, aldosterone secretion, sodium retention, Sympathetics, vasopressin, angiogenesis, feedback inhibition of renin

55
Q

PAD and ABI

A

Ankle-branchial index: PAD indicated below 0.9

1 - 1.4 is normal

56
Q

First line treatment of HTN with Stable Ischemic Heart Disease

A

b-Blocker, then a CCB if needed

57
Q

Cilostazol Effects

A

Inhibits platelet aggregation

Vasodilates

58
Q

Reasons to discontinue ACE inhibitor

A

Cough, Angioedema (deadly)

59
Q

Antiplatelet MOA

A

Block Arterial White Clot Formation

60
Q

Hydralazine

A

HTN emergency drug

61
Q

Side effects of prazosin etc

A

Orthostatic HPTN

Retrograde Ejaculation

62
Q

Catopril MOA

A

ACE inhibitor (lowers Angiotensin II)

63
Q

Phenoxybenzamine

A

Old a-adrenergic blocker that’s a non-competitive antagonist with side effects like phentolamine plus mitosis and angioedema

64
Q

Lisnopril

A

ACE inhibitor with longer half life with 1xday dosing

65
Q

Phenylephrine receptor target

A

a-receptors, increase in BP can reflexly decrease HR and contractility due to withdrawal of sympathetic tone

66
Q

Clinical Applications of Diltiazem

A

IV: A Fib and PSVT
Oral: Primary HTN and Chronic Stable Angina
Off Label: Anal Fissures, Reynaud

67
Q

What is the indication for Ethacrynic Acid?

A

Non-sulfonamide Loop Diuretic just for people with a Sulfa Allergy

68
Q

Toxicities associated with Amiloride

A

Hyperkalemia!

Hyponatremia, hypovolemia, hyperchloremic metabolic acidosis

69
Q

Triamterene

A

Similar to Amiloride for edema and off-label HTN

70
Q

Guanethidine

A

Displaces NE from synaptic vesicles (sparing EPI)
Decreases CO, TPR, RBF, GFR
Causes bad orthostatic HPTO, BP slowly increases

71
Q

Propanalol MOA

A

b1 blocker: Decreases HR/BP

b2 blocker: blunts bronchodilator and vasodilation in SM

72
Q

Amiloride MOA

A

Blocks ENaC channels in Collecting duct (responsible for (Na/K exchange), so there’s a small increase in Na excretion.

73
Q

Thiazide Diuretic MOA

A

Blocks Na-Cl Cotransporter in DCT, resulting in more Ca reabsorption in PCT

74
Q

Fenoldopam

A

HTN emergency drug

Contraindicated with intraocular pressure or intracranial pressure and sulfite allergy

75
Q

Minoxidil MOA

A

Relaxes SM arterioles via cAMP

Stimulates hair growth secondarily to vasodilation

76
Q

b2 Adrenergic Receptors

A

Skeletal muscle vasodilation

77
Q

Bisoprolol

A

Highest b-1 blockade effects

78
Q

How to treat HTN in pregnancy

A

Can use: Methyldopa, Nifedipine, Labetalol

Cant use: ACE inhibitors, ARBs, Direct Renin Blockers

79
Q

Side Effects of Nifedipine

A

Flushing, Peripheral Edema
Palpitations
Gingival Hyperplasia

80
Q

In what circumstances can you use Phenylephrine to treat shock?

A

Only if NE causes arrhythmias or continue to have high CO with low TPR

81
Q

a-methyldopa MOA

A

a2-adrenergic AGONIST: sympatholytic for HTN

82
Q

Cilostazol Black Box Warning

A

Patients with Heart Failure: Decreased survival of Class III and IV patients

83
Q

Off-Label use for Losartan

A

Marfan syndrome

84
Q

Enalapril (enalaprilat)

A

ACE inhibitor prodrug, taken IV

85
Q

In what circumstance can you substitute DA for NE to treat shock?

A

With Bradycardia

86
Q

NE target in treating shock

A

a and b1 receptors in heart and kidney

NOT b2 receptors

87
Q

Clinical application of Hydrochlorothiazide

A

HTN, not in patients with low GFR

Off-label for Calcium Nephrolithiasis

88
Q

Anticoagulant MOA

A

Block Thrombin Activation / Fibrin Formation: Red Clots

89
Q

Serum creatinine increases with:

A

Falling GFR from ACE inhibition

90
Q

Effects of Spironolactone

A

K+ sparing diuretic: blocks aldosterone-regulated Na-K exchange in the collecting duct (decreased Na entry though luminal Na channels, decreased basolateral NaK ATPase)
Decreases Fibrosis effects of Aldosterone

91
Q

Phentolamine

A

Old a-adrenergic blocker with a short half life, that caused HPTN episodes and orthostatic HPTN, Tachycardia, arrhythmias, nasal stuffiness and diarrhea

92
Q

Nitroglycerin

A

HTN emergency drug
Only with acute coronary syndrome, Pulmonary Edema
Don’t use with volume depleted patients

93
Q

Metabolic Syndrome Criteria

A

3 of: Abdominal Obesity, TAGs over 150, HDL below 40(m)/50(f), BP above 130/85, fasting glucose below 100

94
Q

Where do Loop Diuretics act

A

Thick Ascending Loop

95
Q

Resperine

A

Blocks NE incorporation into synaptic vesicles
Least effective sympatholytic
Crosses BBB to make you depressed and want to kys

96
Q

What is a major contraindication for b-blockers like propanalol?

A

People with peripheral vascular disease

this is because it can cause cold extremities

97
Q

Verapamil MOA

A

Non-Dihydropyridine Slow-Channel Ca Blocker

Cardioselective

98
Q

Whats so special about tamsolusin, terazosin, etc?

A

Like prazosin except marketed for BPH and helping pass kidney stones

99
Q

Atenolol MOA

A

b-1 Selective blocker: decreases HR/BP

100
Q

When would you use dobutamine to treat shock?

A

Refractory shock/systolic HF when there’s low cardiac output despite adequate filling pressure

101
Q

First line treatment of HTN with CKD

A

b-Blocker, than an ACE inhibitor if needed

102
Q

Nifedipine MOA

A

Dyhydropyridine Ca Channel Blocker

103
Q

What is the MOA of clonidine?

A

a2-adrenergic angtagonist

Crosses BBB!

104
Q

Vasopressin receptor targets

A

V1, V2 (kidneys)

Vasoconstrictor

105
Q

Longer lasting version of Hydrochlorothiazide?

A

Chlorthalidone (40-60 hr half life)

106
Q

Where do Thiazide Diuretics Act on the Loop of Henle?

A

DCT

107
Q

Hydralazine

A

Direct arteriole vasodilation used to treat HF, but especially Hypertensive Emergency in Pregnancy

108
Q

Hexamethonium MOA and adverse effects

A

Nn receptor blocker in both SNS and pSNS
SNS: difficult to maintain CO/BP when upright
pSNS: Higher resting HR/BP (SLUDGEM)

109
Q

Cilostazol MOA

A

Type 3 PDE inhibitor: prolongs cAMP in platelets and cells

110
Q

Enalaprilat

A

HTN emergency drug
Contraindicated in pregnancy, acute MI, bilateral renal artery stenosis.
Really great for high plasma renin.
slow onset, unpredictable BP response

111
Q

The role of Corticosteroids in septic shock

A

Only improves shock reversal: without shock, corticosteroids are useless in septic patients

112
Q

Metoprolol

A

b-1 Selective blocker with more likely CNS effects

113
Q

Toxicities of Clonidine

A

Drowziness
Xerostomia
Rebound HTN with missed dose

114
Q

Where in the loop of Henle do Osmotic Diuretics and Carbonic Anhydrase Inhibitors act?

A

PCT

115
Q

Antidote to Heparin

A

Protamine

116
Q

Why is unfreactionated Heparin given parenterally

A

Highly negatively charged, cannot cross membranes

117
Q

Enoxaparin (delteparin, tinazeparin) MOA

A

Low molecular weight heparin (cannot complex with thrombin and antithrombin III, but inhibits Xa)
Prevents Red Clots

118
Q

Fondaparinux MOA

A

Synthetic Super Low Weight Heparin (inhibits Xa)

Like Enoxaparin with more bleeding

119
Q

Indications for Fondaparinux

A

Give with warfarin for DVT or PE
Sub Q daily but not reversible with Protamine
Does not cause HIT

120
Q

Bivalirudin MOA

A

Synthetic Direct Reversible Thrombin Blocker

121
Q

Indications for Bivalirudin

A

Given with aspirin for those doing coronary angioplasty
IV, Expensive, Doesn’t require antithrombin, less blood
No Antidote

122
Q

Argatroban MOA

A

Direct Thrombin Inhibitor at Catalytic Site

123
Q

Indications for Argatroban

A

HIT

124
Q

Warfarin MOA

A

Vit K antagonist
Decreases Ca-Dependent F-II, VII, IX, X, S, C
Crosses Placenta

125
Q

Cutaneous Necrosis from a drug

A

Warfarin

126
Q

Rivaroxaban MOA

A

Direct Factor X (thrombin) Inhibitor
Like warfarin but better
Andexanet Alfa recently approved as antidote
CYP3A4

127
Q

Dabigatran MOA

A

Reversible Direct Thrombin Inhibitor

Idarucizumab is the antidote

CPR II (8 decks)

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