Exam 1: Pharm (Blood pressure meds & antibiotics for UTI)

Question 1

Lisinopril (Zestril)

Answer 1

ACE inhibitor

Slows progression of kidney injury in pts with diabetes

AEs: persistent cough, hyperkalemia (blocks aldosterone, no more K excreted), teratogenic, angioedema (any time, can’t treat with benadryl), hacking cough

Question 2

Losartan (Cozaar)

Answer 2

Angiotensin Receptor Blocker

AEs: Teratogenic, angioedema, hyperkalemia **No ACE-I induced cough

Question 3

Amlodipine (Norvasc)

Answer 3

Calcium Channel Blocker (Dihydropyridine)

Dilates smooth muscles

AEs: can cause reflex tachycardia, peripheral edema

Question 4

Hydralazine

Answer 4

Direct acting vasodilator (PO/IV)

Causes arterial vasodilation

AEs: reflex tachycardia, systemic lupus erythematosus-like reaction; rash (doesn’t itch, pink, always there)

Question 5

Metoprolol (lopressor)

Answer 5

Sympatholytic; beta adrenergic blocker

Decreased cardiac output; suppresses reflex tachycardia caused by vasodilators; reduces release of renin (RAAS) - better for HR than for BP

AEs: bradycardia (50-60), heart block, bronchoconstriction

NCs: long-term use reduces peripheral vascular resistance

Question 6

Labetalol (trandate)

Answer 6

Sympatholytic: combination Beta and Alpha blocker

Decreased cardiac output; suppresses reflex tachycardia caused by vasodilators; reduces release of renin (RAAS) - better for HR than for BP; vasodilation (alpha blocker)

AEs: bradycardia (50-60), heart block, bronchoconstriction

NCs: long-term use reduces peripheral vascular resistance

Question 7

Nitrofurantoin (Macrobid, Macrodantin)

Answer 7

Nitrofuran antibiotic; bacteriostatic (may be bactericidal at high concentrations

Only get therapeutic concentrations in urine, only for UTI; Damages bacterial cell DNA; reduced by bacterial flavoproteins to reactivate intermediates, which then activate or alter bacterial ribosomal proteins

AEs: can turn urine brown; GI disturbances (anorexia, N/V/D), pulmonary reactions, agranulocytosis, peripheral neuropathy, hepatotoxicity

Question 8

Trimethoprim/Sulfamethoxazole (Bactrim, Spetra) Aka TMP/SMX

Answer 8

Sulfonamide antibiotic; Bacteriostatic - broad spectrum

Inhibits both folate synthesis and reduction: SMX blocks synthesis of dihydorfolic acid; TMP blocks production of tetrahydrofolic acid; synergistic effect; gram -/+ activity (UTIs, Penumocystis carinii, bronchitis, Otitis media); targets rapidly turning over cells (platelets, RBCs, anything from bone marrow)

AEs: **Hyperkalemia, thrombocytopenia, neutropenia, megoblastic anemia, kernicterus (avoid in pregnant women near temr, nursing mothers, peds <2 months), renal dysfunction, hypersensitivity reaction (Stevens-Johnson syndrome)

Drug Interactions: WARFARIN (bleeding, risk for INR creeps up)

NCs: treat Stevens-Johnson syndrome like a burn (dry mucous membranes)