Final Exam Drugs

Question 1

Diuretics MOA

Answer 1

inc Renal sodium/H2O excretion
Most effective for symptomatic relief of edema
Don’t prolong survival of HF pts; just tx symptoms of dz

Question 2

Cardiac Glycoside Example

Answer 2

Digoxin

Indic: HF

Question 3

Cardiac Glycoside MOA

Answer 3

blocks Na+-K+ ATPase pump (binds to the K+ extracellular binding site)

• -> dec Na+ gradient
• -> dec NCX
• -> inc SR Ca2+ stores
• -> inc IS

Also, inc parasymp tone to heart (dec symp tone)
Does not prolong survival (symptomatic use). Not a first line drug

Question 4

Cardiac Glycosides AE

Answer 4

Cardiac arrhythmias (some due to increased cytosolic Ca2+ overload or increased parasymp tone)
GI: nausea
Visual distrubances (blurry yellow vision) CNS (e.g., disorientation).
Inc toxicity if hypokalemic because less competition w digoxin w extracellular K+
Narrow therapeutic index, so common to test plasma drug levels

Question 5

ACEIs Examples

Answer 5

Captopril, Enalapril

Indic: HF, HTN

Question 6

ACEI MOA

Answer 6

block angiotensin converting enzyme (ACE) on capillary endothelium

• -> dec Angiotensin II & inc Bradykinin
• -> dec AT1 receptor stimualation
• -> dec vasoconstriction, dec aldosterone, dec cardiac remodeling
• -> dec in aldosterone causes dec sodium retention and contributes to dec cardiac remodeling
• -> dec cardiac remodeling prolongs survival

Question 7

ACEI AE

Answer 7

Hypotension
Hyperkalemia (from decreased Aldosterone effects on MR in the kidney)
Acute Kidney Injury (in patients with decreased renal perfusion)

Inc Bradykinin causes:
Cough
Angioedema

Question 8

ARB Examples

Answer 8

Losartan, Valsartan

Indic: HF, HTN

Question 9

ARB MOA

Answer 9

Block AT1 receptors

• -> dec AT1 receptor stimulation
• -> dec vasoconstriction, dec aldosterone, dec cardiac remodeling
• -> dec in aldosterone causes sodium retention and contributes to cardiac remodeling
• -> cardiac remodeling prolongs survival

Question 10

ARBs AE

Answer 10

Hypotension
Hyperkalemia (from decreased Aldosterone effects on MR in the kidney)
Acute Kidney Injury (in patients with decreased renal perfusion)

Bradykinin does not increase –> cough and angioedema are super low

Question 11

Neprilysin Inhibitor Example

Answer 11

Sacubitril

Indic: HF

Question 12

Neprilysin Inhibitor MOA

Answer 12

Inhibitis the enzyme neprilysin
–> dec breakdown of bradykinin and other vasodilating peptides

Given in combo with Valsartan

Question 13

AE caused by Sacubitril & Valsartan Combo

Answer 13

Hypotension
Hyperkalemia (from decreased Aldosterone effects on MR in the kidney)
Acute Kidney Injury (in patients with decreased renal perfusion)

Inc in Bradykinin causes:
Cough
Angioedema

Question 14

Beta Blocker Example

EVIDENCE BASED

Answer 14

Metoprolol (Succinate): Beta 1 selective blocker

Carvedilol: Nonselective Beta blocker (3rd Gen)

Indic: HF, HTN

Question 15

Beta Blocker MOA

Answer 15

Block cardiac beta-1 receptors

• -> Dec cardiac remodeling
• -> Prolong survival

Because of negative inotropic effect, need to titrate slowly up to therapeutic dose to avoid worsening HF

Question 16

Beta Blocker AE

Answer 16

Block Beta-1:
HF
Hyperkalemia
AV block, hypoglycemic unawareness, risk of sudden death if abruptly discontinued

Beta-1 Blocking:
Exacerbation of asthma/COPD, impairment of peripheral circulation from vasoconstriction
blocks skeletal muscle tremors from increased EPI release
during hypoglycemia (“hypoglycemic unawareness”) hyperkalemia (decrease K+ uptake by skeletal muscle)

Question 17

Mineralocorticoid Receptor Antagonist Example

Answer 17

Spironolactone

Are weak diuretic, not given for those effects

Can used for acne, hirutuism, HTN, HF

Question 18

Mineralocorticoid Receptor Antagonist MOA

Answer 18

Blocks MR (steroid receptor for aldosterone) on the kidney and heart

• -> dec sodium retenion (mild)
• -> dec cardiac remodeling
• -> Prolong survival

Question 19

Mineralocorticoid Receptor Antagonist AE

Answer 19

Hyperkalemia

Gynecomastia, ED (males) due to blocking androgen receptor