Drugs

Question 1

Nifedipine

Answer 1

Ca+ channel blocker, only works on arterioles, used with beta blocker to prevent reflex tachycardia
Long-acting preferred for prevention of MI

Question 2

verapamil

Answer 2

Ca+ channel blocker
works on heart and arterioles
Treats angina, HTN, dysrhythmias
Increases dig rates by 60%- can cause dig toxicity or AV heart block

Question 3

Amlodipine

Answer 3

Ca+ channel blocker. Similar to nifedipine but without reflex tachycardia risk. Only works on arterioles.

Question 4

Hydralazine

Answer 4

Vasodilator
Acts on arterioles
Used for essential HTN, hypertensive crisis, HF

Question 5

Nitroglycerin

Answer 5

Vasodilator

Selective dilation of veins- preload reducer

Question 6

Sodium Nitroprusside (nitropress)

Answer 6

Vasodilator- arteries and veins

Fastest-acting treatment of hypertensive crisis

Question 7

Minoxidril

Answer 7

Vasodilator similar to hydralazine (Arteriole)
but more intense
Strong adverse effects
Try hydralazine

Question 8

Labetalol

Answer 8

beta blocker used to lower blood pressure in eclampsia

Question 9

Digoxin

Answer 9

Used for heart failure
increases force of contraction, CO
Increases quality of life but not length
toxicity: GI,

Question 10

ACE & ARB with digoxin

Answer 10

good mix- may be benficial

Question 11

What offsets potassium loss and blocks aldosterone’s effect?

Answer 11

Spironolactone and elperenone

Question 12

Quinidine

Answer 12

Class I sodium channel blockers. Delay repolarization and slow conduction. Widen QRS complex and prolong QT interval. Used in supraventricular and ventricular dysrhythmias.

Question 13

Propranolol

Answer 13

Class II antidysrhythmics. Beta adrenergic blocking agents, used in supraventricular dysrhythmias

Question 14

Verapamil

Answer 14

Class IV antidysrhythmics

Question 15

Metformin

Answer 15

PO type II diabetes medication
Inhibits glucose production in the liver
Reduces glucose absorption in the gut
Good for pts who skip meals (no hypoglycemia)
Prevents type II diabetes in patients with risk

Question 16

Who should not be given metformin?

Answer 16

Pts with severe active liver or kidney disease or alcoholics- could cause lactic acidosis, may be deadly.

Question 17

Glyburide—type, mechanism, interactions

Answer 17

Type II Diabetes
Sulfonylureas- promotes insulin release.
Major side effect- hypoglycemia
Interactions: Cimetidine- hypoglycemia, beta adrenergic blocking agents- mask signs of hypoglycemia, alcohol (hypoglycemia), NSAIDS (ghypoglycemia)

Question 18

Repaglinide

Answer 18

Type II Diabetes
Meglitinide
Increases insulin release
May cause hypoglycemia

Question 19

Rosiglitazone and pioglitazone

Answer 19

Type II Diabetes
Glitazones
Reduce glucose levels by decreasing insulin resistance
Avoid in heart faiure because of fluid retention and pulmonary edema risk!

Question 20

Sitagliptin

Answer 20

Type II Diabetes
Enhances the actions of incretin hormones
Stimulates matching of insulin release with glucose levels

Question 21

Canagliflozin

Answer 21

Type II Diabetes
Blocks reabsorption of filtered glucose in the kidney- leads to glucosuria
SE: genital fungal infections, UTI, increases urination

Question 22

Colesevelam

Answer 22

Bile acid sequestrant used to lower plasma cholesterol
also may help lower blood glucose
Good for lowering blood sugar in pts with high cholesterol and type II diabetes

Question 23

Diagnostic criteria for DM

Answer 23

FPG 126mg/dL or greater

Glycosylated hemoglobin A1c 6.5 or greater (test indicates serum glucose over the past 3 months)

Question 24

insulin lispro

Answer 24

short duration, rapid acting

Question 25

insulin aspart

Answer 25

short duration, rapid acting

Question 26

insulin glulisine

Answer 26

short duration, rapid actign

Question 27

regular insulin

Answer 27

short duration, slower acting

Question 28

NPH insulin

Answer 28

intermediate duration

Question 29

insulin glargine

Answer 29

long duration- given once a day at night for next day coverage all day long steady coverage. Might be combined with short acting

Question 30

insulin detemir

Answer 30

long duration insulin

Question 31

Sliding scale insulins

Answer 31

regular and short acting, short duration insulin

Question 32

Which insulins can be mixed?

Answer 32

NPH and any short-acting

Question 33

Which insulin may be cloudy?

Answer 33

NPH

Question 34

Where to inject insulin?

Answer 34

SubQ fat in abdomen, thigh acceptable as well

Question 35

IV infusion of insulin

Answer 35

Short acting insulin may be infused. Regular insulin for operative and NPO patients.

Question 36

Storage of insulin

Answer 36

Must be refrigerated. Keep out of sunlight and heat.

Question 37

Unfractionated Heparin

Answer 37

Used for DVT, PE, evolving stroke, open heart surgery, renal dialysis, low-dose postoperatively, in pregnancy

Question 38

Heparin-induced thrombocytopenia

Answer 38

dropping platelets, DVT or PE while on heparin, ischemia of digits. Treat by discontinuing heparin, switch to a different anticoagulant.

Question 39

Protamine sulfate

Answer 39

used for heparin OD.

Question 40

Lab values for heparin

Answer 40

aPTT

Question 41

Enoxaparin

Answer 41

Low molecular weight heparin Dosage based on body weight- no aPTT measurement needed Prevention of DVT, DVT, ischemic stroke, unstable angina, MI

Question 42

Daltaparin

Answer 42

Low molecular weight heparin Dosage based on body weight- no aPTT measurement needed Prevention of DVT, DVT, ischemic stroke, unstable angina, MI

Question 43

Warfarin

Answer 43

PO anticoagulant- takes several days to work. Used for long-term prophylaxis of VT and prevention of TE, prevention of clotting in afib. Vitamin K antagonist- blocks biosynthesis of clotting factors. Antidote: vitamin K INR monitoring & prothrombin time - lab values

Question 44

Dabigatran

Answer 44

Direct thrombin inhibitor PO drug Newly approved Doesn't require monitoring, same dose for all pts regardless of weight

Question 45

Rivaroxaban

Answer 45

Binds directly with factor X to prevent clotting PO, approved in 2011 No lab monitoring required

Question 46

Aspirin

Answer 46

Antiplatelet drug Uses: ischemic stroke, TIA, stable angina, coronary stenting, acute MI Inhibition of cyclooxygenase Increased risk of GI bleeding

Question 47

Clopidogrel (Plavix)

Answer 47

Antiplatelet drug Alternative to aspirin ADP receptor antagonist Less intracranial and GI bleeding than aspirin

Question 48

abiciximab

Answer 48

GP IIb/IIIa inhibitor- "super aspirin" used for percutaneous procedures with aspirin AND heparin. Only used IV

Question 49

Alteplase (tPa)

Answer 49

Thrombolytic drug Converts plasminogen to plasmin Given for MI or CV Must be given within 2 hours of MI! Major adverse effect- major bleeding, IC bleeding Blood replacement may be necessary Minimize concurrent hep, warfarin, dabigitran!