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Pharamcology > Week 7 > Flashcards

Week 7 Flashcards

1
Q

calcium channel blockers ___ blood pressure but due to recent study they did not show as much reduction in cardiovascular mortality as other antihypertensive and they are used as ____ line drugs

A

lower

second

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2
Q

what two groups are calcium channel blockers divided into to.

A

Dihydropyridines (nifedipine, amlodipine)

Non-dihydropyridines (Verapamil, dilitiazem)

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3
Q

all ca channel blockers produce vasodilation of ___ ____ ____. The non-dihydropyridine family also affect the ___ muscle and caused decreased heart rate and conduction through the ____ node

A

Vascular smooth muscle
heart
av

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4
Q

_______ achieve better reduction in blood pressure with long acting Ca channel blockers (amlodipine) than with ACE inhibitors or beta blockers

A

african americans

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5
Q

______ is a dihydopyridine thus blocks ____ but not heart muscle. It is the preferred Ca channel blocker in patients with poor _____ function or ___ heart block. clinical data of this drug that it does not reduce mortality rate even though it reduces BP has resulted in greatly reduced use.

A

Nifedipine
VSM
cardiac
AV

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6
Q

Nifedipine is also used for a____, m_____ and prevention of p____ ______

A

angina
migraines
premature parturition.

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7
Q

A bad side effect of nifedipine similar to phenytoin is ____

A

gingival hyperplasia

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8
Q

_____ is a #12 prescription and is a Dihydropyridine which produces selective blockade of Ca channels in the ____ with little direct effect on the heart. It has a long half life (___-_____hrs) thus is QD. adverse effects include h_____, p____ and f_____ edema and dizziness. Recent study suggest does not decrease mortality rate

A 
Amlodipine
arterioles
30-50
headaches
peripheral and facial
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9
Q

the dihydropyridine drugs are all similar in that they decrease blood pressure pretty much equally by 14mm hg. A long acting form of nifedipine is _______-___

A

Procardia-Xl

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10
Q

Lottery is a combination of _____ and ________

A

Norvasc

lotensin

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11
Q

______ is a non-dihydropyridine with blocks Ca channels in both ____ and ____ rate. Typically there is little change in heart rate. Adverse effects of this drug include c_____, H_____, e____ of ___ and _____ and av heart block

A 
Verapamil
VSM and heart
constipation
headaches
edema of ankles and feet
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12
Q

______ is similar in action to verapamil but has less incidence of constipation.

A

diltiazem

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13
Q

Verapamil and diltiazem are also used for treating angina and controlling atrial fibrillations. There is some unlabelled use for prophylactic treatment of ____ as well as for hypertension.

A

migraines

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14
Q

______ is a non-dihydropyridine that inhbits the sympathetic system in CNS. It is also used during menopause to reduce menopausal hot flashes. For percent of patients experience ____ and _____. It is the only anti-hypertensive available as a patch.

A

Clonidine
drowsiness
sedation

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15
Q

______ is a non-dihydropyridine and a vasodilator. It is combined with with a diuretic for serve hypertension. It is also used for hypertensive crises associated with e______. An adverse effect is lupus syndrome

A

Hydralazine

eclampsia

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16
Q

______ is a non-dihydropyridine and adverse effects include cardiovascular dysrhythmias and excessive hair growth. This is marketed in topical form as _______

A

Minoxidil

Rogaine

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17
Q

treatment of a hypertensive crisis includes d____, h_____, L________. The most used drug is the hospital is ______

A

Diltiazem
hydralazine
labetalol
labetalol (combined alpha and beta antagonist)

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18
Q

______ is characterized by sudden pain beneath the sternum, often radiating to left shoulder and arm.

A

Angina

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19
Q

what are two forms of angina

A

Classic angina

Variant angina

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20
Q

______ occurs during physical exertion or sometimes during periods of emotional excitement. arteries are occluded and can not provide enough oxygen thus higher occlusion leads to a higher frequency of angina.

A

classic angina

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21
Q

_____ results from a c_____ ____ ______. This is not associated with physical exertion.

A

Variant angina

coronary artery vasospasm

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22
Q

What type of angina occurs 95% of the time

A

classic angina

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23
Q

what are there drug families used in the treatment of angina

A

Organic nitrates
Ca channel blockers
Beta blockers

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24
Q

_______ is an organic irate and has been used since 1879 to treat angina. It promotes vasodilation primarily in ____ and to lesser extent in the ______. It is used to treat with types of angina.

A

Nitroglycerin
veins
arteries

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25
Q

When nitroglycerin is used in classic angina it _____ veins ________ venous return to the heart, _______ ventricular filling and decreases wall tension. As a result the heart doesn’t work as hard and oxygen demand is reduced thus reducing angina.

A

dilates
decreases
decreases

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26
Q

When nitroglycerin is used in variant angina, vasodilation relaxes the ______ of coronary arteries, thus increasing oxygen supply

A

vasospasm

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27
Q

Nitroglycerin is metabolized very quickly by the ____. It is not given orally because the ____ ___ ____ takes place. Its half life is only __-___ minutes. Metabolic tolerance develops rapidly. Nitroglycerin reacts with a ___ ____ of the amino acid cysteine in glutathione to produce nitric oxide, the active vasodilating molecule which also occurs naturally in the body. when ___ ____ are used up, NO is no longer produced and nitroglycerin no longer produces any vasodilating effects until sulfhydryl groups are regenerated.

A 
liver
first pass effect
5-7
sulfhydryl groups
sulfhydryl groups
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28
Q

Nitroglycerin is very lipid soluble thus it is available in a transdermal patch known as ____ It is given 12 hours on and 12 off to reduce tolerance

A

Nitro-dur

29
Q

Nitroglycerin side effects include O____ _____
r_____ _____
headache and dizziness

A

orthostatic hypertension

reflex tachycardia

30
Q

____ _____ and _____ are organic nitrates and are similar in action to nitroglycerin, producing the active nitric oxide molecule, but has slower metabolism, so it can be taken orally. Thus it is used _____ and may be taken sublingually

A

Isosorbide mononitrate and dinitrate

prophylactically

31
Q

____ is no longer used even though it was made to treat angina. It is no longer used because it was used a drug to increase orgasm intensity and is referred to as a popper or snapper from the glass vials. other nitrates are marketed as bathroom deodorants , rush, locker room

A

Amyl

32
Q

____, _____ and ____ have been heavily used to treat erectile dysfunction. They work by producing ___ ____ which causes vasodilation especially in the penis. they can cause synergistic NO effect. The off label use is in ____ for pulmonary hypertension

A

Viagra, Cialis and Levitra
nitric oxide
pediatrics

33
Q

Ca channel blockers such as ____ and ____ causes relaxation of ___ ___ ___ especially in the arteries. They increase cardiac oxygen supply by decreasing after-load in classic angina; they relax the arterial vasospasm in va vasospastic angina. Long acting beta blockers are used for prophylactic.

A

diltiazam and procardia

vascular smooth muscle

34
Q

Beta blockers such as ____, ___, and _____ work by slowing down the heart rate, thus reducing oxygen demand by the heart. They only work for ____ angina not for vasospastic angina which may in fact intensify it.

A

metoprolol, atenolol, and propranolol

classic

35
Q

______ _____ _____ occurs when the hearts pumping efficacy decreases due to lowered contractility. this results in many ramifications.

A

congestive heart failure

36
Q

What is one treatment of congestive heart failure.

A

diuretics

37
Q

Diuretics are used to treat CHF because reduce ____ by increasing urine flow and to decrease blood volume. _____ is os occasionally used for mild CHF but ______ is most commonly used

A

edema
HCTZ
furosemide

38
Q

______ increases contractility of the heart (positive ___ effect) while slowing down the SA node and slowing conduction through the AV node. Thus giving the ventricle more time to fill. Also doesn’t increase life expectancy

A

Digoxin

inotropic

39
Q

Digoxin is isolated from _____ a common wildflower in western oregon. It has a very small TI. thus monitoring is needed.

A

foxglove

40
Q

Digoxin has been used in the form of _____ leaves at least since the 1600’s. Recently a tea known as _____ was contaminated with digitalis leaves

A

digitalis

chomper

41
Q

Digoxin side include ___ in 45% of men, and Av heart block (________ increases this and can easily occur when someone is on a diuretic) and nausea

A

impotence

hypokalemia

42
Q

__ ________ cause ateriovasodilation. They act primarily on the after load pressure. as a result the heart is working less against resistance and this appears to _____ mortality rates with patients with CHF

A

ACE inhibitors

decrease

43
Q

__________ lowers mortality rate of severe CHF patients by 30%

A

spironolactone

44
Q

______ if the clot blocks a coronary artery
___ ____ if it cerebral vessel brain
___ _____ _____ if it occurs in one of the veins
___ ____ if the clot occurs in the lungs

A

Myocardial infarction
Ischemic stroke
Deep vein thrombosis
Pulmonary embolism

45
Q

When pieces of the thrombus breaks off this is known as an ______

A

embolus

46
Q

The enzyme _____ breaks down clots and it is made from the inactive form plasminogen. Several enzymes can catalyze this activation of plasminogen _____ and _____ and ______

A

plasmin

streptokinase and alteplase and urokinase

47
Q

______ is a large polysaccharide and is inactivated by HCL in the stomach and can not be absorbed through the GI tract. Hence it is given IV. Subcutaneous can be given when transitioning between this drug and to coumadin.

A

Heparin

48
Q

Heparin works by augmenting the effect of ____ __ suppressing fibrin formation. Short half od 1.5 hrs. Also heparin has a low TI and requires labs. The labs measure ___ ____ ____ (PTT)

A

antithrombin III

partial thromboplastin time

49
Q

What converts fibrinogen to fibrin

A

thrombin

50
Q

Heparin is used in treatment of PE, DVT, open heart surgery, and renal dialysis to prevent thrombosis. Can be used as a ____ before surgeries to decrease the risk of an embolism immediately after surgery.

A

prophylactic

51
Q

Heparin is isolated from ___ and ___ and is coming from china. Adulteration with cheap _____ sulfate from china lead to 146 death

A

cow lungs and pig intestines

chondroitin..

52
Q

____ is a low molecular weight heparin and is slowly replacing heparin. It requires less monitoring and has a half life of 3-6 hours thus can be taken twice a day at home

A

enoxaparin

53
Q

______ was first isolated from rotting clover hay. it is an antagonist of _____ _. This drug is very non-polar and is absorbed readily through membranes. Its effect are delayed because it inhibits further synthesis of clotting factors thus takes8-12 hours for ____ effects and ___ for maximal efficacy. When stopped it take 2-5 days for vitamin K levels to return to normal

A

coumadin.
vitamin K
initial
maximal

54
Q

Vitamin K can be found in many ___ ____ foods

A

green leafy

55
Q

Coumadin has a low ti and is monitored by a ratio of ___ ___ (PT) to _____ ____ ____. This is called ______ _____ ____ (INR). The INR doctors strive for is 2.0 to 3.5 and is higher than healthy individuals. Higher the INR the less tendency to from a thrombus

A

Prothrombin time
normal prothrombin time
international normalized ratio

56
Q

Coumadin is ______ and should not be used while pregnant. ____ should be used instead of coumadin. Breast feeding transfers Coumadin so nO!

A

teratogenic

herparin

57
Q

_____ reduces blood viscosity and thus improves blood flow, although its mechanism of action is not known. IT is commonly used in treatment of _________ clotting. Given PO tid

A

Trental

intermittent

58
Q

One baby aspirin inhibits synthesis of ______ ____ which is involved in platelet aggregation

A

thromboxane A2

59
Q

_____ irreversibly inhibits platelet aggregation and is commonly prescribed to people who have suffered an MI or stroke to reduce risk of further clotting. this drug was the 11th most commonly prescribed drug in 2008

A

Clopidogrel (plavix)

60
Q

Clopidogrel is commonly combined with ___ for 12 month after implantation of drug-eluting stents to prevent formation of clots on the stent. ____ an anticancer drug is most commonly used for this

A

aspirin

paclitaxel

61
Q

_____ a monoclonal antibody that binds to a glycoprotein on human platelets and decreases the tendency for them to aggregate. Used after angioplasty to reduce clot formaition.

A

Reo-pro

62
Q

_______ modeled after anticoagulant found in snake venom. FDA approval being applied for

A

Tirofiban

63
Q

______ inhibits thrombin but scary because there is no antidote

A

Pradaxa

64
Q

______ drugs are used to dissolve a clot that has already formed. they are used after ischemic strokes and MI to dissolve thrombi. Sooner the better. 1hr good 3 hrs bad. Studied showed that emergency angioplasty with stents had a better survival than use of the type of drugs

A

Thrombolytic

65
Q

____-____ ____ ____ the human enzyme made by genetic engineering. Hemorrhage is the major adverse effect. Also approved for use in treatment of strokes.

A

TPA- tissue plaminogen activator

66
Q

Cholesterol is converted into ____ _, sex hormones, corticosteroids and bile salts. Cholesterol is carried to tissue primarily inside ____ _____ _____(LDL). The outside of this protein is coated with a phospholipid lecithin.

A

vitamin D

low density lipoproteins

67
Q

the average cholesterol in a adult is ____-_____. LDL levels over ____ mg/dl or total cholesterol over ____mg/dl are regarded as a significant concern. Some people with bad genetics have it over 4000 and are at risk for MI in their 40’s or even younger.

A

180-200
135
200

68
Q

Transport proteins called ___ ____ _____ can scavenge excess cholesterol from artery walls and tissue and return it back to the liver for recycling. ____ ______ can form if LDL levels are high and HDl levels are low thus causing a MI ir stroke.

A

high density lipoproteins

atherosclerotic plaque

69
Q

The risk factor is measured LDL+HDL/HDL. Average for male is 5 and females is 4.5. Lower the number the better because higher levels of HDL.

A

DONE!!!!!

Pharamcology (12 decks)

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