Pharm 5 Cardio pt4

Question 1

Combination/Vasodilating Selective a- and ß-Adrenergic Blockers (3 examples and their route of admin)

Answer 1

Oral only: Carvidilol, Nebivolol

IV/Oral: Labetolol

Question 2

Side effects of a-blockers (3)

Answer 2

Postural hypotension, especially with first dose(s)
Tachycardia
Increased mortality

Question 3

2 Centrally Acting Sympatholytics: a2-Adrenoceptor Agonists

Answer 3

Clonidine

Methyldopa

Question 4

Central action of alpha-2 adrenoceptor agonists

Answer 4

Stimulation of 2 adrenoceptors in the brainstem reduces sympathetic tone, causing a centrally mediated vasodilatation and reduction in heart rate

Question 5

Clonidine is useful in: (3)

Answer 5

Diagnosis of pheochromocytoma
Hypertensive patients IN WITHDRAWAL*
Also available in a once-weekly, trans-dermal

Question 6

the only hyptertensive drug that is available in a patch-formulation.
For ppl who have difficulty remembering their medications.

Answer 6

Clonidine

Question 7

5 classes (route of entry) of Common Nitrate Formulations (Vasodilators)

Answer 7

SL, TOP, TransDermal Patch, PO, IV

all Prototypical version is Nitro

Question 8

Sublinguals are Absorbed within __ seconds

Answer 8

15-20 seconds

Question 9

Nitro tablets are weakened by __ and __, so…

Answer 9

air & light, so it’s kept in a brown bottle.

Question 10

Note about TOP Nitro

Answer 10

*Ointment is flammable. Nitro ointment on a patient’s chest must be wiped off before using AED b/c you’ll set them on fire.
If it’s dermal, don’t wipe it off with your hand – you’ll get a wicked headache, feel dizzy, and possibly pass out b/c it’s a vasodilator that makes you hypotensive.

Question 11

Where is IV Nitro mainly used?

Answer 11

IV is used more often in ED and ICU

Question 12

What is Nitro approved for? What causes this problem? How does it work?

Answer 12

FDA approved to alleviate chest pain - vasodilate coronary arteries to supply greater blood supply to the heart. The problem is ppl’s coronary arteries are hard (from calcium), and can’t be dilated.
? Peripheral arteries and arterials are dilated. This dec venous return, dec CO, reduces chest pain

Question 13

Prototypical ORAL Nitrate
Example
Indication

Answer 13

Isosorbide

Indications: prophylaxis and treatment of angina; NOT for acute attacks

Question 14

Prototypical S/L Nitrate
Example
Indication

Answer 14

Nitroglycerine

Indications: prophylaxis and treatment of angina including acute attacks

Question 15

Prototypical Topical Nitrate
Example
Indication

Answer 15

Nitroglycerine

Indications: prophylaxis of angina; not indicated for acute attacks

Question 16

Drugs On the Renin-angiotensin System (3)

Answer 16

ACE-I, ARBs, DRIs

Question 17

Clinical Indications for ATII Antagonists (ARBs) (4)

Answer 17

Hypertension
DM in those intolerant of ACE-I
Heart failure
Decreases re-stenosis rate following angioplasty

Question 18

Pimp question: Why do people have a cough from Ace Inhibitors?

Answer 18

B/c it’s a buildup of bradykinin that causes the cough.

ARBs and DRIs don’t build up bradykinin therefore no cough happens.

Question 19

ACE Inhibitors

Mechanism of Action

Answer 19

Inhibition of angiotensin II formation
reducing vascular tone - vasodilating
and reduced aldosterone secretion (loss of negative feedback because of decreased angiontensin II - less Na-K secretion & slight increase in serum K+

Question 20

5 labeled uses of ACE-I

Answer 20

Hypertension
Heart failure
Myocardial infarction
Left ventricular dysfunction
Diabetic nephropathy

Question 21

4 off-label uses of ACE-I

Answer 21

Hypertensive crisis
Rheumatoid arthritis
Idiopathic edema
Raynaud’s syndrome

Question 22

All ACE-I’s end in

Answer 22

-pril

Question 23

Among the advantages of ACE-I (and ARBs) is their relative freedom from:

Answer 23

freedom from serious adverse metabolic, respiratory, or CNS side effects
do not affect serum lipid levels and reports of sexual dysfunction are almost non-existent
Abrupt withdrawal does not result in rebound hypertension
None of the ppl who get the ACE-I cough get it from ARB

Question 24

potentially serious, but rare, problems of ACE-i (not the cough) (3)

Answer 24

Hyperkalemia, Hypotension, ARF

Question 25

If a patient wants to take a med to lower their heart rate but go to the gym, what’s better?

Answer 25

Beta-blocker and go to the gym: you feel exhausted. B/c you can’t increase your heart rate now.
ARBs don’t block your heart rate so you can exercise normally.