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Exam 1 Flashcards

1
Q

ACE Inhibitor Suffix

A

-pril

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2
Q

ARB Suffix

A

-sartan

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3
Q

Calcium Channel Blockers (DHPs) Suffix

A

-dipine

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4
Q

Beta-Blocker Suffix

A

-olol

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5
Q

Statins Suffix

A

-statin

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6
Q

A chronic, dry, non-productive cough is most likely to be observed with what medication?

A

ACE Inhibitors

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7
Q

What is the mechanism of action for ACE Inhibitors?

A

Stops the production of angiotensin II

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8
Q

What compound does ACE breakdown and what does it cause?

A

Bradykinin, causing it to last in the body for longer

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9
Q

What drug classes are used in the treatment of hypertension?

A

• ACE Inhibitors
• ARBs
• Calcium Channel Blockers
• Beta Blockers
• Diuretics

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10
Q

What heart failure patients should get ACE Inhibitors?

A

ALL patients with an ejection fraction ≤ 40%

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11
Q

ACE Inhibitors are particularly useful for the treatment of hypertension in patients with what other conditions?

A

Diabetes, diabetic nephropathy, post-MI, or high risk of coronary artery disease

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12
Q

Side Effects of ACE Inhibitors

A

• Hypotension & Dizziness
• Cough - dry, constant
• Angioedema - vasodilation in lungs
• Renal Dysfunction (↓ kidney function)
• Hyperkalemia (↑Potassium)

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13
Q

How do ACE Inhibitors impact blood pressure & potassium levels?

A

• ↑ Potassium
• ↓ BP

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14
Q

ACE Inhibitor Warnings & Drug Interactions

A

• do not use during pregnancy (fetal HTN)
• do not use with bilateral renal artery stenosis

Drug Interactions

• K+ supplements - ACE retains too much K+
• NSAIDs - can lead to acute renal failure
• constrict afferent while ACE constrict efferent
• Cyclosporine - ↑ risk of heart failure

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15
Q

ACE Inhibitor Drugs

A

• Benazepril
• Enalapril
• Lisinopril
• Ramipril

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16
Q

What is the mechanism of action of ARBs?

A

allows for production of angiotensin II but does NOT allow binding of Angiotensin II to the receptor

BLOCKS THE ANGIOTENSIN II RECEPTOR

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17
Q

Side Effects of ARBs

A

• LESS cough & angioedema (than ACE inhibitors)
• Hypotension & dizziness
• Renal Dysfunction (↓ kidney function)
• Hyperkalemia (↑ K+)

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18
Q

Similarities & Differences in ACE Inhibitors & ARBs

A

• Similar morbidity & mortality
• Similar in efficacy in HF (ACE inhibitors are better)

• ARBs have less cough & angioedema

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19
Q

ARB Drug Names

A

• Irbesartan
• Losartan
• Olmesartan
• Valsartan

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20
Q

Calcium Channel Blockers: what do they do and what do they cause?

A

• Block Ca+ from entering the cardiac muscle

CAUSE:
• ↓ HR
• Vasodilation (relax smooth muscles of blood vessels)

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21
Q

What do Dihydropyridines (DHPs) work on?

A

• only affect vasculature (NOT the heart muscle)
• Strong vasodilation

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22
Q

Which calcium channel blockers are the strongest vasodilators?

A

dihydropyridines

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23
Q

Calcium Channel Blocker Drugs - Non-DHPs

A

• Dilitiazem
• Verapamil

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24
Q

What do Non-DHP Calcium Channel Blockers do?

A

• ↓ HR
• Work in the heart & vessels
• Makes the heart beat with less force

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25
What drugs are Non-DHP Calcium Channel Blockers & what do they do?
• Dilitiazem & Verapamil • ↓ HR • Work on the heart & vessels • Heart beats with less force
26
Dihydropyridine (DHP) Calcium Channel Blocker Drugs
• Amlodipine • Nifedipine
27
Common Adverse Effects of DHPs & Non-DHP Calcium Channel Blockers
DHPs • Headache • Flushing • Pedal Edema • Hypotension • Reflex Tachycardia (↑ HR due to ↓ BP) Non-DHPs • Constipation • Hypotension • Bradycardia • AV Block • CHF
28
Common Adverse Side Effects of Non-DHP Calcium Channel Blockers
• Hypotension • Constipation • Bradycardia • AV Block • CHF
29
Common Adverse Effects of DHP Calcium Channel Blockers
• Hypotension • Headache • Flushing • Pedal Edema • Reflex Tachycardia (↑ HR due to ↓ BP)
30
Drug Interactions of Non-DHP Calcium Channel Blockers
Verapamil & Diltiazem • can CAUSE many drug interactions • SLOW the breakdown of other drugs •change metabolism and/or transport of drugs
31
Drug Interactions of DHP Calcium Channel Blockers
Amlodepine • Subject of many drug interactions • Sensitive to changes caused by other drugs
32
What happens when B1 is activated by norepinephrine?
• ↑ HR • ↑ Contractility • ↑ Renin Release
33
What happens when B2 is activated by norepinephrine?
• Relaxation of vascular, bronchial, & uterine smooth muscle • ↑ insulin release • ↑ tremor • ↑ glycogenolysis • glycogen to glucose-1-phosphate & glucose
34
What happens when B3 is activated by norepinephrine?
• ↑ lipolysis • ↑ urinary bladder relaxation
35
What happens when a1 is activated by norepinephrine?
• Vasoconstriction • mydriasis • piloerection • ↑ glycogenolysis
36
What happens when a2 is activated by norepinephrine?
• ↓ neuronal transmitter release • ↑ platelet aggregation • ↓ lypolysis • ↓ insulin release
37
What is the job of beta-blockers?
block the activation of beta receptors
38
What do beta blockers do for patients with heart failure?
↓ heart rate & ↓ cardiac output, ultimately making patients feel worse at first
39
What happens when B1 & B2 receptors are antagonized (blocked)?
• ↓ heart rate • ↓ contractility • ↓ renin release (↓ angiotensin II)
40
What conditions are beta blockers used to treat?
• Hypertension • Anxiety • Tremors • Arrhythmias • Heart Failure
41
Mechanisms of Beta Blockers
• Restore HR (variability) • Prevent arrhythmia • Prevent / slow remodeling process • special dose ("start low, go slow" & "target dose")
42
Common Adverse Effects of Beta Blockers
• Bronchospasm • blocking B2 causes smooth muscle contraction • AVOID in patients with COPD, asthma, etc. • Heart failure • Bradycardia / bradyarrhythmias • Vasospasm (B2) • Metabolic Abnormalities • ↓ HDL • Hyperglycemia / ↓ insulin sensitivity • Depression • Withdrawal syndrome
43
Beta Blocker Drugs
• Metoprolol • Atenolol • Propranolol • Carvedilol • Labetolol • Nebivolol
44
What are the 3 different Beta-Blocker Drug Types?
• Selective Agents (metoprolol & atenolol) • Non-Selective Agents (Propranolol) • Vasodilating Agents (Carvedilol, Labetolol, Nebivolol)
45
What Beta Blockers are Selective Agents?
• Metoprolol • Atenolol
46
What Beta Blockers are Non-Selective Agents
• Propranolol
47
What Beta Blockers are Vasodilating Agents?
• Carvedilol • Labetolol • Nebivolol
48
What are the 3 classes of Diuretics?
• Loops - Furosemide • Thiazide & Thiazide-like - Hydrochlorothiazide • Potassium-Sparing - triamterene
49
What are Diuretics used to treat?
Hypertension (thiazides) Heart Failure & Fluid overload (loops)
50
Thiazides are mainly used to treat what condition?
Hypertension • morbidity & mortality benefits
51
Loop diuretics are mainly used to treat what condition?
Heart Failure & Fluid Overload • symptomatic improvement only (no ↑ survival)
52
Common Adverse Effects of Diuretics
• Hypovolemia - low intravascular volume • Hyperglycemia (↑ blood sugar) • ↑ Cholesterol & Triglycerides • ↑ Ca+ with Thiazides & ↓ Ca+ with Loops • ↓ Potassium (K+) • ↓ Magnesium • Hyperuricemia (↑ uric acid)
53
What is the key difference in common adverse side effects associated with thiazides vs. loop diuretics?
Thiazides ↑ Calcium Loops ↓ Calcium
54
Diuretics, ADEs, & Other Drug Problems
• Impotence • Potential problems with diuretics • diuretic resistance • thiazide sensitivity to renal function DRUG INTERACTIONS • Digoxin • Lithium • NSAIDs • ACE Inhibitors or K+ supplements
55
Drug Interactions associated with Diuretics (ADEs & Other Drugs)
• Digoxin • Lithium • NSAIDs • ACE Inhibitors or K+ Supplements
56
Diuretic Drugs
• Chlorthalidone • Hydrochlorothiazide • Triamterene • Spironolactone • Furosemide
57
Which diuretic is required for advanced heart failure and why?
Spironolactone because it blocks aldosterone
58
Statin Drugs
• Atorvastatin • Lovastatin • Pravastatin • Rosuvastatin • Simvastatin
59
What are Statins (HMG CoA Reductase Inhibitors) used to treat?
lower cholesterol, specifically LDLs
60
Mechanism of Action for HMG CoA Reductase Inhibitors (Statins)
Blocks synthesis of HMG CoA forcing bile to be made by synthesizing cholesterol from LDL in the blood
61
Key Concepts about Statins
1.) GOLD STANDARD for reducing LDL • not good for isolated high triglycerides • may even be beneficial if "normal" LDL 2.) Relatively flat dose-response curve • only 5-6% more LDL lowering for double dose • start with dose close to expected need 3.) Doses should be given in the evening or at bedtime • because statins have a short half-life
62
Adverse Side Effects of Statins (Major & Minor)
MAJOR • Myalgia (muscle pain) • Myopathy • Rhabodomyolysis (muscle tissue breakdown) MINOR • Dyspepsia / heartburn • Headache • Taste disturbances • Diabetes (?)
63
What are the Major Adverse Side Effects of Statins?
• Myalgias (muscle pain) • Myopathy • Rhabdomyolysis (muscle tissue breakdown)
64
What are the Minor Adverse Side Effects of Statins?
• Dyspepsia / Heartburn • Headache • Taste Disturbances • Diabetes
65
Mechanism of Action for Fibrates
Primary focus is on LDLs due to risk of heart disease EFFECTS ON LIPIDS • ↓ Total Cholesterol • ↓ LDLs • ↑↑ HDLs • ↓↓↓ Triglycerides
66
Common Adverse Effects of Fibrates
• Nausea • Diarrhea • Cholelithiasis (gallstones) • Phototoxicity
67
Drug Interactions of Fibrates
• ↑ risk of hepatotoxicity and/or myalgias with concurrent statins and/or niacin * DO NOT USE WITH STATINS * • Protein binding displacement (Warfarin) = ↑ rhabdo risk
68
Fibrate Drugs
• Ezetimibe (Zetia) - blocks absorption fo LDL • Gemfibrozil • Fenofibrate
69
Mechanism of Action for Ezetimibe (Zetia) - Fibrate
• Blocks absorption of LDL (cholesterol absorption inhibitor) • Modestly lowers LDL • Increases HDL
70
Which Fibrate drug interacts and cannot be taken with Statins?
Gemfibrozil
71
What is unique about Ezetimibe (Zetia)?
It is a fibrate drug that is made to be used WITH statins
72
What are Omega-3 Fatty Acids used for and what are they made up of?
• ↑ HDL • ↓ Triglycerides • can slightly increase LDL Ratio of EPA to DHA varies based on the drug
73
What are adverse side effects associated with the use of Omega-3 Fatty Acids?
• Prolonged bleeding / impaired platelet function
74
What are anti-arrhythmics used to treat?
arrhythmias / abnormal heartbeats (A-Fib, V-Fib)
75
What are the different classes of Anti-Arrhythmics and what do they each work on?
• Class I -- Na+ channels (blockade) • Class II -- Beta Receptors (blockade) • Class III -- K+ Channels (prolonged repolarization) • Class IV -- Ca+ Channels (blockade)
76
What is Amiodarone and what is unique about it?
Anti-Arrhythmic Technically Class III (K+ channels; ↑ repolarization), but it works across all classes
77
What are adverse side effects of Amiodarone?
MOST SEVERE • Pulmonary Fibrosis (irreversible) • Thyroid Toxicity (hyperthyroid & hypothyroid) OTHER • Pneumonitis • Cardiotoxicity (bradycardia, hypotension) • Liver toxicity • Ophthalmic toxicities • Dermatologic toxicity (blue/gray skin color) • Drug interactions
78
What is the most common arrhythmia caused by Class I anti-arrhythmics (think of the Amiodarone drug study)?
Torsades de Pointes (TdP) - difficult to treat, can be fatal
79
Although Amiodarone has a long list of adverse side effects, what does it have a low risk of causing?
Torsades de Pointes (TdP)
80
Anti-Arrhythmic Drugs
• Amiodarone (Class III) • Flecainide (Class IC - 1C)
81
What is the most common Anti-Arrhythmic used today?
Amiodarone
82
What do all anti-arrhythmics have a risk of causing?
Torsades de Pointes (TdP)
83
What is Flecainide used for?
treatment of A-Fib in patients WITHOUT structural heart issues
84
Common Adverse Effects of Flecainide
• Dizziness • Visual disturbances • Dyspnea • Prolonged QT waves / TdP
85
Mechanism of Action in Antiepileptic Drugs (AEDs)
Impair activation of CNS Neurons • suppress Na+ influx • suppress Ca+ influx (↓ transmitter release) • promote K+ efflux • antagonize glutamate (block excitatory NT) • enhance GABA (enhance inhibitory NT)
86
Side Effects of Antiepileptic Drugs
CNS Side Effects • Impaired cognition (speech, concentration, etc.) • Dizziness • Drowsiness • Diplopia • Ataxia • Incoordination • Weakness Suicide Risk • AEDs increase risk 2x (↑ w/ topiramate, lamotrigine) Pregnancy Risks
87
What are the CNS Side Effects of Antiepileptic Drugs?
• Ataxia • Dizziness • Diplopia • Drowsiness • Impaired Cognition (speech, concentration, etc.) • Incoordination • Weakness
88
What are the 2 classes of antiepileptic drugs?
Older (made prior to 1970s) & Newer (1990s & after)
89
What is unique about older antiepileptic drugs?
• Complicated pharmacokinetics (body gets used to drug, may have to increase dose) • High drug interaction risk • More adverse side effects • most w/ CNS depressant effects • possible negative effects on learning / cognition • Greater experience...more effective? • effective even when "new class" does NOT work
90
Older Antiepileptic Drugs
• Carbamazepine • Valproic acid / Divalproex
91
Adverse Side Effects Associated with Carbamazepine
• May cause severe skin rash (Stevens-Johnsons Syndrome) • Asians have it worse, need genetic testing
92
What is unique about Newer Antiepileptic Drugs?
• Straightforward pharmacokinetics • Generally few drug interactions • Fewer adverse effects • less significant CNS depressant effects • safer / lower risk in pregnancy • Less experience (because they're newer)
93
Which class of antiepileptic drugs are better to use in pregnancy due to them having a lower risk / being safer?
Newer Antiepileptic Drugs
94
Newer Antiepileptic Drugs
• Gabapentin • Lamotrigine (Lamictal) • Levetiracetam (Keppra) • Oxcarbazepine (Trileptal) • Pregabalin (Lyrica) • Topiramate (Topamax)
95
Side Effects & Other Considerations of Newer Antiepileptic Drugs
Gabapentin • drowsiness & nystagmus Lamotrigine (Lamictal) • rash is relatively common...serious in <1% Levetiracetam (Keppra) • IV & PO (route drug can be given) • CNS effects (drowsiness, aggression, psychosis) • ↑ BP Oxcarbazepine (Trileptal) • CNS effects (drowsiness, dizziness, ataxia) • Nausea & Vomiting Pregabalin • Weight gain • Angioedema • Euphoria (considered a schedule V (5) drug) Topiramate • Metabolic acidosis • Kidney stones
96
Side Effects of Oxcarbazepine & Carbamazepine
CNS Effects • drowsiness • dizziness • ataxia
97
Side Effects of Gabapentin
• drowsiness • nystagmus * Not a good seizure med; mainly used for nerve pain*
98
Adverse Side Effects Lamotrigine (Lamictal)
Rash is relatively common • serious in <1%
99
Adverse Side Effects of Levetiracetam (Keppra)
CNS Effects • drowsiness • aggression • psychosis ↑ BP
100
Adverse Side Effects of Topiramate
• Metabolic Acidosis • Kidney Stones
101
Other Issues with Antiepileptic Drugs
• Status epilepticus (acute ongoing seizure) • Therapeutic Drug Monitoring • Stopping therapy (avoid stopping cold turkey) • Pregnancy • some risk with all, but usually woman remain on med
102
Treatment Goals Diabetic Drugs
• Achieve & maintain HbA1C of < 7% • Reduce microvascular & microvascular complications • micro = neuropathy, retinopathy, amputation • macro = heart attack, stroke, etc.
103
How does better control of A1C affect microvascular & microvascular events?
• ↓ microvascular events • neuropathy, retinopathy, vision loss, amputate • NO ↓ in macrovascular events (stroke, MI, etc.)
104
Clinical Actions of Insulin
• ↑ glucose, amino acid, fatty acids, & K+ uptake • ↑ glycogen, protein, & triglyceride synthesis
105
Long-Acting Insulin Agents
• Detemir (Levemir) & Glargine (Lantus) are associated with LOWER risk of hypoglycemia than NPH
106
Long-Acting Insulin Drugs
• Detemir (Levemir) • Glargine (Lantus) • Degludec (Tresiba)
107
Shorter-Acting Insulin Agents
• Rapid-acting products preferred to regular insulin due to their faster onset of action & a lower risk of hypoglycemia
108
Short / Rapid Acting Insulin
• Lispro (humalog) • Aspart (novolog)
109
What is the order of Insulin Agents used to lower the risk of hypoglycemia?
1.) Rapid / short-acting 2.) Regular / long-acting 3.) NPH
110
How does insulin affect potassium?
Insulin ↓ Potassium (K+)
111
What type of Insulin can be given via IV or mixed with other insulins?
short-acting
112
Adverse Effects of Insulin
• HYPOGLYCEMIA • Lipodystrophies (bumps if you inject at same site) • Hypokalemia (↓ K+ can lead to DKA)
113
Non-Insulin Drug Therapies for Diabetes
• Glucose-lowering potency is generally similar among oral anti-diabetic drugs - non-insulin drug ↓ A1C by about 1% - insulin ↓ A1C by about 2% • Duration of Glucose Control differs by drug - not indefinite...3-6 years for most - decline in β-cell function; disease progression
114
Non Insulin Drugs
Metformin (glucophage)
115
Mechanism of Action for Metformin
• ↓ hepatic glucose production & intestinal glucose absorption • sensitizes target cells to insulin (insulin works better) - does NOT lower glucose, helps body respond better • ↓ risk of hypoglycemia • pumped into bile & renal tubule • good effects on weight, lipids, CV disease, & diabetes
116
Adverse Side Effects of Metformin
• Lactic Acidosis • Diarrhea • Anorexia • Dyspepsia / heartburn • B12 Deficiency (longer term use)
117
Patients with what condition should not take metformin?
Renal Dysfunciton
118
Sulfonylureas Mechanism of Action
BIND TO PANCREAS FORCING IT TO MAKE ↑ INSULIN • Promote insulin release - inhibit ATP-sensitive K+ channels
119
Risks associated with Sulfonylureas
• Hypoglycemia • Impaired β-cell function • Cardiovascular toxicity ↑ risk of heart disease ↑ weight • bad effects on lipids
120
Risks associated with Sulfonylureas
• Hypoglycemia • Impaired β-cell function • Cardiovascular toxicity (↑ heart disease) • ↑ weight
121
Sulfonylurea Suffix
-ide
122
Sulfonylurea Drugs
• Glipizide - stimulates release of insulin from pancreas • Glimepiride - ↑ amount of insulin released
123
How do Glipizide & Glimepiride work? (Sulfonylureas)
GLIPIZIDE: stimulates release of insulin from pancreas GLIMEPIRIDE: ↑ amount of insulin released
124
Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor Drugs
• Empagliflozin (Jardiance)
125
Sodium-Glucose Cotransport 2 (SGLT2) Inhibitor Mechanism of Action
↑ urinary excretion of glucose • blocks kidneys' ability to absorb filtered glucose
126
Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor Side Effects
• ↑ risk of urinary/genital tract infection (↑ UTI) • Hypotension (↓ BP) • Volume contraction • Dizziness
127
Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors are not recommended for patients with _________-.
severe renal dysfunction
128
What are Incretins?
a group of hormones produced by the GI system that stimulate the release of insulin from the pancreas & help preserve β-cells * only works when glucose is ↑ *
129
Drugs Acting via Incretins
• stimulate insulin release in a glucose-dependent manner • ↑ satiety & ↓ food intake • Preserve β-cells • Glucose will move from the food into the blood at a slower rate to avoid postprandial hyperglycemia
130
GLP-1 Analogs (antagonists) Potency & Side Effects
More potent (powerful) than DPP-IV inhibitors - better at lowering glucose, more side effects Side Effects • Acute Pancreatitis • Diarrhea • Nausea & Vomiting • Thyroid C-cell tumors
131
GLP-1 Receptor Agonist Drugs
Liraglutide (Victoza)
132
DPP-IV Inhibitors
• Less potent than GLP-1 analogs • Oral • Generally well-tolerated, less side effects
133
DPP-IV Inhibitor Drug
Sitagliptin (Januvia) - also co-packaged with Metformin
134
Which drug class for diabetes is considered to be a last resort?
Thiazolidinediones (TZDs)
135
Thiazolidinedione (TZDs) Drugs
Pioglitazone (actos)
136
Mechanism of Action of Thiazolidinediones (TZDs)
↓ insulin resistance - ↑ sensitivity of insulin receptors
137
Adverse Side Effects of Thiazolidinediones (TZDs)
• Weight gain • Fluid retention • Edema • ↑ BP • MI, HF, CV death, & Bladder cancer
138
Short / Rapid Acting Insulin
• Lispro (humalog) • Aspart (novolog)
139
H2-Receptor Antagonist (blocker) Mechanism of Action
• Bind to histamine receptor (H2RA - H2 receptor) - prevents histamine from stimulating parietal cells - ↓ acid (H+ ions) production = ↑ pH
140
How do H2 Receptor Antagonists impact acid production & pH?
↓ acid production (H+ ions) ↑ pH
141
H2RA Drugs (H2 Receptor Antagonists)
• Ranitidine (zantac = off market) • Ramotidine (pepcid)
142
Proton Pump Inhibitor (PPI) Mechanism of Action
Activated by the acidic inside of the parietal cell and bind to the inside of the proton pumps which blocks acid (H+ ions) from being released into the stomach.
143
Proton Pump Inhibitor Suffix
-prazole
144
Proton Pump Inhibitor (PPI) Suffix
-prazole
145
Proton Pump Inhibitor Drugs
• Esomeprazole • Lansoprazole (prevacid) • Omeprazole • Pantoprazole (protonix)
146
Side Effects of PPIs (proton pump inhibitors)
• Headache • Nausea • Diarrhea • Abdominal pain • ↑ fracture risk • Vitamin / mineral malabsorption •↑ chance of aspiration pneumonia in non-ambulatory pts
147
Which class of acid suppressants is more powerful?
Proton Pump Inhibitors
148
Antacid Mechanism of Action
Neutralize secreted acid • work quickly but only short-term
149
Common Side Effects of Antacids
• Constipation • Diarrhea • Neurotoxicity • Hypophosphatemia - ↓ phosphate levels in blood • Acid rebound - body makes ↑ acid to combat pH change • Drug Interactions • Chelation - antacids bind other meds making them inactive
150
Sucralfate Mechanism of Action
Sucrose Sulfate (sucrose + sulfated aluminum chloride) binds positively charged proteins in base of ulcers * Binds to ulcers forming a protective barrier *
151
Side Effects of Sucralfate
** Constipation ** ** Drug Interactions ** • Neurotoxicity (Al3+ accumulation) • Bezoar formation • Hypophosphatemia - ↓ phosphate levels in blood
152
What is Hypophosphatemia?
↓ levels of phosphate in the blood
153
Bronchial constriction is a concern in patients with asthma or COPD with which drugs? a.) Angiotensin Receptor Blockers b.) ACE Inhibitors c.) Dihydropyridine calcium channel blockers d.) Beta-Blockers
d.) Beta-blockers
154
Which of the drug classes is most likely to cause bradycardia? a.) All classes listed here have a similar risk b.) ACE Inhibitors c.) Dihydropyridine calcium channel blockers d.) Beta-Blockers
d.) Beta-Blockers
155
Which of these drugs can cause hyperkalemia, meaning the patient's serum potassium may need to be monitored closely? a.) Dihydropyridine calcium channel blockers b.) ACE Inhibitors c.) Beta-Blockers d.) Angiotensin Receptor Blockers
d.) Angiotensin Receptor Blockers (ARBs)
156
pendent edema is a common side effect of which drugs? a.) Beta-blockers b.) Angiotensin Receptor Blockers (ARBs) c.) Non-Dihydropyridine Ca+ channel blockers d) Dihydropyridine Ca+ channel blockers
d.) Dihydropyridine calcium channel blockers
157
Which drugs have a high risk of causing adverse metabolic effects like an increase in glucose and new-onset diabetes? a.) ACE Inhibitors b.) Beta-Blockers c.) DHP Calcium Channel Blockers d.) Non-DHP Calcium Channel Blockers
b.) Beta-Blockers
158
Metoprolol (Lopressor) is a member of what drug class? a.) Dihydropyridine calcium channel blockers b.) Beta-blockers c.) Non-Dihydropyridine calcium channel blockers d.) ACE Inhibitors
b.) Beta-blockers
159
A chronic, dry, non-productive cough is a relatively common side effect of which drugs? a.) Non-DHP calcium channel blockers b.) ACE Inhibitors c.) Angiotensin Receptor Blockers (ARBs) d.) Beta-Blockers
b.) ACE Inhibitors
160
Amlodipine (Norvasc) is what type of drug? a.) Non-DHP Calcium Channel Blockers b.) ACE Inhibitor c.) DHP Calcium Channel Blockers d.) Angiotensin Receptor Blockers (ARBs)
c.) DHP Calcium Channel Blocker
161
Benzapril (Lotensin) is a member of what drug class? a.) DHP Calcium Channel Blockers b.) ACE Inhibitors c.) Angiotensin Receptor Blockers (ARBs) d.) Beta-Blockers
b.) ACE Inhibitors
162
Which of these diuretic classes is most potent at removing fluid (increasing urine output)? a.) Potassium-Sparing b.) Loops c.) All are equally potent d.) Thiazide & Thiazide-like
b.) Loops
163
Which of these drugs act as both a diuretic and an aldosterone antagonist, giving it unique actions in treating heart failure? a.) Furosemide (Lasix) b.) Hydrochlorothiazide c.) Ezetimibe (Zetia) d.) Spironolactone
d.) Spironolactone
164
Muscle toxicity (myalgia, myopathy, rhabdomyolysis) is a concern with what drugs? a.) HMG-CoA Reductive Inhibitors ("Statins") b.) Anti-arrhythmics c.) Loop diuretics d.) Omega-3 fatty acids
a.) HMG-CoA Reductase Inhibitors (Statins)
165
Which diuretics have a relatively flat dose-response curve, increase serum calcium concentrations, and are less effective in patients with severe renal dysfunction? a.) Loop diuretics b.) Thiazide diuretics c.) Potassium-sparing diuretics d.) That describes all diuretics
b.) Thiazide diuretics
166
Which of these drug classes that can substantially reduce serum triglyceride concentrations also have the potential to impair platelet function, leading to an increased risk of bleeding or bruising and possible interaction concerns when used with other antiplatelet agents or anticoagulants? a.) Ezetimibe b.) Fibrates c.) HMG-CoA Reductase Inhibitors ("Statins") d.) Omega-3 fatty acids
d.) Omega-3 fatty acids
167
Which of these is a diuretic? a.) Rosuvastatin (Crestor) b.) Gemfibrozil (Lopid) c.) Flecainide (Tambocor) d.) Chlorthalidone (Hygroton)
d.) Chlorthalidone (hygroton)
168
Hyperthyroidism & Hypothyroidism are both possible side effects of what drug? a.) Atorvastatin (Lipitor) b.) Flecainide (Tambocor) c.) Gemfibrozil (Lopid) d.) Amiodarone (Cordarone)
d.) Amiodarone
169
Close monitoring of the QT Interval is required with the use of which of these drugs? a.) Fenofibrate (Tricor) b.) Flecainide (Tambocor) c.) Simvastatin (Zocor) d.) Furosemide (Lasix)
b.) Flecainide
170
What drug class is most likely to cause bradycardia?
Beta-Blockers
171
A dry, chronic, non-productive cough is most likely to be observed with which class of medications?
ACE Inhibitors
172
Dependent edema is a relatively common side effect of which drugs?
Dihydropyridine (DHP) Calcium Channel Blockers
173
What medication class is most closely associated with adverse metabolic effects, including increased hemoglobin A1C concentrations & new-onset diabetes?
Beta-Blockers
174
Bronchial constriction, leading to a risk of adverse pulmonary effects that may be a concern for patients with ashtma or COPD, is most likely associated with what drug?
Propranolol
175
What drug has the highest risk of causing hyperkalemia?
Lisinopril
176
Metoprolol (Lopressor) is what type of drug?
Beta-Blocker
177
What drug class is Benazepril (Lotensin) a member of?
ACE Inhibitor
178
Losartan (Cozier) is a member of what drug class?
Angiotensin Receptor Blockers
179
Which drug category is most likely to cause hypokalemia, hypomagnesemia, and other electrolyte abnormalities?
Diuretics
180
Myalgia, myopathy, and rhabdomyolysis are closely associated with which drug class?
Statins
181
Which drug is expected to cause an increase in serum calcium concentrations?
Chlorthalidone (Hygroton) = thiazide diuretic
182
What drug would be used to lower serum triglyceride concentrations and is associated with a risk for gallstones, phytotoxicity, and a serious drug interaction with statins?
Gemfibrozil (Lopid) = fibrate
183
Which drug class is the most potent diuretic, displaying a "high ceiling" and a linear dose-response curve?
Loop Diuretics
184
Gynecomastia is a side effect closely related with what drug?
Spironolactone
185
Antiplatelet effects, leading to a risk of bleeding or bruising, are most commonly associated with what drug?
Omega-3 Fatty Acids
186
What drug is a potassium-sparing diuretic?
Triamterene
187
What medications end with "-olol"?
Beta-Blockers
188
What medications end with "-pril"?
ACE Inhibitors
189
Which medications end in "-sartan"?
ARBs (angiotensin receptor blocker)
190
Hyperkalmeia is caused by which drug class?
ACE Inhibitors
191
ACE Inhibitor MOA
inhibits the production of Angiotensin II & breaks down bradykinin
192
List ACE Inhibitor Drugs
• Benazepril • Enalapril • Lisinopril • Ramipril
193
Benefits of ARBs over ACE Inhibitors
does not produce cough -could be due to the fact that ARBs do not affect bradykinin
194
List Angiotensin Receptor Blocker (ARB) Drugs
• Irbesartan • Losartan • Olmesartan • Valsartan
195
What do ACE Inhibitors do to bradykinin?
Increase bradykinin levels (cough?)
196
What is the difference in DHP & Non-DHP Calcium Channel Blockers?
DHP Calcium Channel Blockers do NOT affect HR Non-DHP Calcium Channel Blockers affect HR
197
List Non-Dihydropyridine (Non-DHP) Calcium Channel Blockers
• Diltiazam • Verapamil - can cause a lot of drug interactions because they're metabolized in the liver
198
Which Calcium Channel Blocker is more vascular selective?
Dihydropyridines - they cause vasoDILATION
199
Which Calcium Channel Blocker is more heart selective?
Non-Dihydropyridines
200
Which drug class causes an increase in potassium?
ACE Inhibitors (lisinopril) - sometimes potassium-sparing diuretics
201
Pharmakokinetics
What the body does to the drug
202
Pharmacodynamics
What the drug does to the body
203
Which drug class do Amlodepine & Nifedipine belong to?
Dihydropyridine (DHP) Calcium Channel Blockers
204
Which drug class do Verapamil & Diltiazem belong to?
Non-Dihydropyridie (Non-DHP) Calcium Channel Blockers
205
What is the primary side effect of Dihydropyridines (DHPs)?
edema
206
What is the primary side effect of non-DHPs?
bradycardia
207
Which drug is best at vasodilation?
DHP Calcium Channel Blockers
208
List Selective Beta Blocker Drugs
• Metoprolol • Atenolol
209
List Non-Selective Beta Blocker Drugs
• Propranolol
210
List Vasodilating Beta Blocker Drugs
• Carvedilol • Labetalol • Nebivolol
211
List the adverse side effects of beta-blockers
• Bradycardia • Bronchospasm • Hyperglycemia (diabetes) • ↓ insulin sensitivity • Depression • ↑ A1C
212
What is the drug class of choice for the treatment of tremors?
Beta Blockers
213
Patients with what condition(s) should not be put on Beta Blockers?
Asthma or respiratory issues
214
What drug class is the preferred INITIAL agent for the treatment of hypertension?
diuretics
215
How do loop diuretics affect calcium?
↓ Calcium
216
How do Thiazide diuretics affect calcium?
↑ Calcium
217
List Potassium-sparing diuretic drugs
• Spironolactone • Amiloride • Triamterene
218
Which class of diuretics is the most powerful?
Loop Diuretics
219
Common Adverse Side Effects of Diuretics
• ↓ K+ • ↓ Magnesium • Hyperglycemia • Hypovolemia • Electrolyte imbalance
220
Which class of diuretics has an increased sensitivity to renal function?
Thiazide Diuretics
221
Which class of diuretics has a linear response curve?
Loop diuretics
222
Which class of diuretics has a low dose response curve?
Thiazide diuretics
223
Side Effects of Antiepileptic Drugs
• Impaired cognition • Drowsiness • ↑ suicide risk • Pregnancy Risks
224
Suicide is higher with which antiepileptic drugs?
• Topirimate • Lamotrigene
225
List Older Antiepileptic Drugs
• Carbamazepine • Valproic Acid / Divalproex
226
Side Effects / Risks associated with Carbamazepine
• Severe skin reaction - worse in asians; need genetic tessting
227
List Newer Antiepileptic Drugs
• Gabapentin • Lamotrigene • Levetracetam • Oxcarbazepine • Pregabalin • Topiramate
228
Side Effects associated with Lamotrigine (Lamictal)
Rash
229
Common use for Gabapentin
nerve pain
230
Which drug class is associated with a risk for myalgia, myopathy, & rhabdomyolysis?
Statins (HMG-CoA Reductase Inhibitors)
231
Side Effects associated with Pregabalin (Lyrica)
• Weight gain • Euphoria • Angioedema
232
Side Effects associated with Levetiracetam (Keppra)
• ↑ BP • least CNS effects out of all antiepileptic drugs
233
Side Effects associated with Topiramate
• Kidney Stones • Bone Issues • Metabolic acidosis - stops body's ability to reabsorb bicarbonate
234
How should antiepileptic drug therapy be stopped?
slowly over time; no abrupt withdrawl
235
How does better control of A1C affect microvascular events?
↓ microvascular events
236
How does better control of A1C impact macrovascular events
does NOT impact macrovascular events
237
What are microvascular events?
damage to small blood vessels • neuropathy • retinopathy • amputation
238
What are macrovascular events?
damage to large blood vessels • stroke, heart attack, etc.
239
List Insulin Drugs
• Lispro • Aspart • Detemir • Glargine • Degludec
240
List Fast-Acting / Rapid-Acting Insulin Drugs
• Lispro • Aspart
241
Lispro & Aspart are what class of insulin drug?
rapid-acting
242
List long-acting / slow-acting insulin drugs
• Detemir • Glargine • Degludec
243
Detemir, Glargine, & Degludec are what class of insulin drug?
slow-acting
244
Side Effects of Insulin Drugs
• Hypoglycemia • Hypokalemia • Weight gain
245
What is the number 1 recommended non-insulin drug for diabetes?
Metformin
246
Metformin MOA
lowers A1C
247
Side Effects of Metformin
• Lactic acidosis • B12 deficiency
248
SGLT2 Inhibitor MOA
↑ glucose excretion in urine
249
What do SGLT2 inhibitors have a favorable effect on?
weight & BP
250
List an SGLT2 Inhibitor drug
Empagliflozin (jardiance)
251
GLP1 Agonist MOA
stimulate the release of insulin from the pancreas
252
Side Effects of GLP1 agonists
• Nausea • Diarrhea • Acute pancreatitis • Thyroid C-cell tumors
253
What do drugs acting via Incretins do?
• very low risk of hypoglycemia • ↑ satiety • ↓ food intake • Preserve β-cells • Control postprandial glucose
254
GLP-1 Receptor Agonist Drugs
Liraglutide
255
Are GLP-1 Agonists or DPP-IV more potent / powerful?
GLP-1 Agonists
256
List DPP-IV Inhibitor Drugs
Sitagliptin (januvia)
257
List Thiazolidinedione (TZD) Drugs
• Pioglitazone (actos)
258
Thiazolidinediones (TZDs) MOA
↑ sensitivity of insulin receptors
259
Side Effects of TZDs (Thiazolidinediones)
• Fluid Retention • Edema • Weight gain • ↑ BP • MI, HF, CV death, & Bladder cancer
260
H2RA (Histamine 2 Receptor Antagonist) MOA
blocks the histamine receptor which decreases acid production & increases stomach pH (less H+ ions)
261
Chelation
Positive ions can bind to drugs in the gut which inactivates the other drug
262
List H2RA Drugs
• Ranitidine (zantac) • Famotidine (pepcid)
263
Proton Pump Inhibitor (PPI) MOA
blocks proton pumps from inside the parietal cell which blocks acid from being released into the stomach
264
List of PPI Drugs
• Omeprazole (prilosec) • Esomeprazole (nexium) • Lansoprazole (prevacid) • Pantoprazole (protonix)
265
Suffix of Proton Pump Inhibitors (PPIs)
"-prazole"
266
Common Side Effects of PPIs
• Headache • Nausea • Diarrhea • Abdominal pain • ↑ risk of fracture • Malabsorption (of vitamins & minerals)
267
Antacid MOA
neutralize secreted acid
268
Common Side Effects of Antacids
• Constipation • Diarrhea • Neurotoxicity • Hypophosphatemia • Acid rebound (body makes ↑ acid) • Drug interactions (/ chelation)
269
What is Sucralfate used to treat?
ulcers
270
Sucralfate MOA
sucrose sulfate binds positively charged proteins in the base of ulcers * needs acidic environment *
271
Side Effects of Sucralfate
• Constipation • Hypophosphatemia • Neurotoxicity
272
Mnemonic for Newer Antiepileptic Drugs
Obese Limping Giants Purchased Little Tyrants
273
Mnemonic & Drugs for Newer Antiepileptic Drugs
Obese = Oxcarbazepine Limping = Lamotrigine (Lamictal) Giants = Gabapentin Purchased = Pregabalin (Lyrica) Little = Levetiracetam (Keppra) Tyrants = Topiramate

Pharmacology (5 decks)

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