Pharm 5 Cardio pt2

Question 1

Do all Diuretics work in the same place in the nephron?

What do they trigger?

Answer 1

Each one works in a different place in the nephron. (therefore have diff advantages, side effects)
These drugs cause Na+ (and therefore also water) to be excreted.

Question 2

In resistant edema, what 3 kinds of diuretics are indicated?

Answer 2

loop diuretics, K+-sparing diuretics, and metolazone

Question 3

A concern about taking Diuretics.

Answer 3

electrolyte imbalances. A good chance you will excrete too much K+, and must be checked periodically in these patients on diuretics.

Question 4

Diuretics are used in the management of (3)

Answer 4

Hypertension
Glaucoma
edema associated with cardiovascular, renal and endocrine abnormalities

Question 5

For Hypertension, what’s your first choice of a diuretic? Next 2 choices?

Answer 5

Thiazide (first choice), Loops, and sometimes K+ Sparing.

Question 6

Diuretics:Contraindications, Precautions, A/S Effects

lower the blood pressure too much

Answer 6

Contraindicated in anuria
electrolyte depletion
Pregnancy Cat. C
Monitor electrolytes (esp. K+), fluids, blood, BUN
K+ supplements may be needed
Some classes contraindicated in sulfanomide allergies
Caution in hepatic or renal dysfunction, DM, gout, SLE
Interaction w/ digitalis, lithium
May alter excretion of salicylates, lithium
Potentiates anti-hypertensives (that’s good!)

Question 7

a poison from a plant called foxglove. What can it cause?

Answer 7

Digitalis

cardiac dysrhythmias

Question 8

What other element gets excreted by Diuretics besides Na/K?

Answer 8

Lithium - in the same periodic table group as Na.

Question 9

Prototypical Thiazide Diuretic
Example
Route of Entry
Indication
What's the reality?

Answer 9

Hydrochlorthiazide aka HCTZ (PO - tabs)
Indication: edema
Reality is: this drug is rarely written in this formulation anymore b/c this is only for monotherapy. Reality: it’s used with other drugs.

Question 10

Prototypical Loop Diuretic
Example, route of admin
Indication
What's its half life?
What's the reality?

Answer 10

Furosemide (Lasix®) - IV
Indication: edema
Half life: 6 hours (laSIX)
It’s a good drug for edema in an in-hospital setting. Not a good drug for hypertension b/c of how quickly/dangerously it removes water from the body.

Question 11

Potassium-sparing Diuretic
Example, route of admin
Indication
When would you give this?

Answer 11

Triamterene (PO tabs)
Indication: edema
You tried a regular HCTZ and are having trouble with K+ levels. The particular patient can’t be properly supplemented with K+, so you give this.
May be combined with HCTZ

Question 12

Thiazide diuretics (Hydrochlorthiazide): consideration

Answer 12

Best in low-dose forms

Question 13

How are all b blockers similar? (2)

Different? (4)

Answer 13

Similar: All b-blockers have a similar mechanism of action
b-blockers assert their effect on the Symp Nervous System
Different: beta-selectivity, alpha-blocking activity, membrane-stabilizing activity (MSA), intrinsic sympathomimetic activity (ISA)

Question 14

ß-Adrenoceptor blockers
Mechanism of Action:
Why blood pressure reduction? (3)

Answer 14

Mechanism of Action:ß-adrenoceptor antagonism (blockade)

Heart rate slows down -> cardiac output decreases -> reduction of renin release & reduction of sympathetic outflow.

Question 15

6 physiologic benefits of beta blockers

Answer 15

provide antihypertensive, antianginal, and antiarrhythmic effects
increases the density of beta-1 receptors
inhibit catecholamine toxicity
decrease neurohormonal activation
decrease heart rate
antioxidant and antiproliferative effects

Question 16

Where are beta-1,2 receptors located, and what do they do? (3)

Answer 16

beta1-receptors predominate in cardiac tissue and increase heart rate and contractility
beta2-receptors predominate in the bronchial and vascular smooth muscle and cause vasodilation
beta2-receptors located in the liver promote glucogenesis

Question 17

As a result of beta-blockade, __ and __ are decreased
Slowing of the atrioventricular conduction system prevents an increase in cardiac automaticity and prolongs the refractory period

Answer 17

Cardiac output & Heart rate

Question 18

Can you list all 11 (FDA-approved) Indications for beta blockers???

Answer 18

Hypertension
Angina
Early tx, reduction in mortality in MI
Selected cases of CHF
Migraine prophylaxis
Open-angle glaucoma
Thyroidtoxicosis
Subaortic stenosis
Anxiety
Essential tremor
Selected arrhythmias

Question 19

What is the only beta-blocker NOT indicated for hypertension?

Answer 19

Sotalol

Question 20

What is the only beta-blocker indicated for hypertensive crisis?
What is it?
What’s the route of admin?

Answer 20

Labetolol (an injectable beta-blocker/alpha1-blocker)

Question 21

the only beta-blockers indicated for heart failure (2)

Which is more common?

Answer 21

Carvedilol or Nebivolol

Carvedilol is more common than the much newer Nebivolol.

Question 22

**How to use beta-blockers in CHF

Answer 22

Slow titration (up & down)
decrease symptoms of HF
improve left ventricular function
improve exercise tolerance

Question 23

5 adverse effects of beta-blocker drugs

Answer 23

Bradycardia
Bronchospasm
Sexual dysfunction
Fatigue
Glucose metabolism?

Question 24

3 types of beta-blockers

What’s the prototypical drug for each type? (1,1,2)

Answer 24

Non selective: Propranolol
Cardioselective: Metoprolol
Third Generation/Vasodilating: Carvedolol, Nebivolol

Question 25

Are non-selective beta blockers as good as cardioselective beta-blockers in reducing blood pressure?

Answer 25

Non selective (propanolol) and cardioselective (Metoprolol) ß-blockers are equally effective in reducing blood pressure