Lec 38 CVS Pharma HPN and HF

Question 1

Alpha blockers that are more sensitive to alpha1 than alpha 2

Answer 1

Prazosin, Terazosin, Doxazosin (BASICALLY MGA SIN)

Question 2

Facilitates urinary outflow

Answer 2

Alpha1 blockers (mga sin)

Question 3

Toxicities of Alpha blockers

Answer 3

Orthostatic hypotension (alpha-1 is responsible in maintaining BP in postural changes)

Question 4

Manifests with the first dose phenomenon

Answer 4

Alpha1 blockers (mga sin)

Question 5

NERVE TERMINAL BLOCKERS

Answer 5

Reserpine and Guanethedine

Question 6

Inhibits the Ca2+-dependent release of norepinephrine

Answer 6

Guanethedine

Question 7

Toxicities of Guanethedine

Answer 7

Severe orthostatic hypotension and sexual dysfunction

Question 8

Blocks vesicular amine transporter

Answer 8

Reserpine

Question 9

Toxicities of Reserpine

Answer 9

Psychiatric depression and GI disturbances (Lowering the levels of NE, DA, 5-HTwill impair brain and gut functions)

Question 10

Competitively block nicotinic cholinoceptors in both sympathetic and parasympathetic ganglia

Answer 10

Hexamethonium

Question 11

Centrally acting sympathoplegic drugsthat reduce sympathetic flow and inhibit NE

Answer 11

Alpha2 agonists

Question 12

Best for refractory hypertension as a last resort

Answer 12

Alpha2 agonists

Question 13

Examples of Alpha 2 agonists

Answer 13

Clonidine, Methyldopa

Question 14

Withdrawal of Methyldopa causes____.

Answer 14

Rebound hypertension

Question 15

Examples of Beta 1 blockers

Answer 15

Acebutolol (partial agonist), Betaxolol, Esmolol,Atenolol, Metoprolol (A BEAM of beta1 blockers)

Question 16

Examples of nonselective Alpha and Beta antagonists

Answer 16

Labetalol, Carvedilol (Curb Love)

Question 17

Drugs with intrinsic sympathomimetic properties

Answer 17

Partial agonists (Pindolol, Acetabulol)

Question 18

Toxicity of beta blockers

Answer 18

Increased triglycerides, hyperglycemia (can cause new onset DM)

Question 19

Nonselective ? blocker

Answer 19

propanolol

Question 20

Oral vasodilator that cause NO release and can be used by women since it does not cross placenta

Answer 20

Hydralazine

Question 21

Vasodilator that dilates Arterioles NOT veins

Answer 21

Hydralazine and Minoxidil

Question 22

Toxicities of Hydralazine

Answer 22

Angina, tachycardia, Lupus-like syndrome

Question 23

Oral vasodilator that cause opens K channels in vascular smooth muscle

Answer 23

Minoxidil

Question 24

Toxicities of Minoxidil

Answer 24

Angina, tachycardia, headache, sweating, hirsutism (now used as topical for baldness)

Question 25

Examples of parenteral vasodilators

Answer 25

NITROPRUSSIDE, FENOLDOPAM, DIAZOXIDE

Question 26

Parenteral vasodilators that release NO

Answer 26

Nitroprusside

Question 27

Parenteral vasodilators that activates D1 receptors

Answer 27

Fenoldopam

Question 28

Parenteral vasodilators that open K channels

Answer 28

Diazoxide

Question 29

Toxicities of nitroprusside

Answer 29

excessive BP lowering and accumulation of cyanide

Question 30

What type of calcium channels do CCBs inhibit?

Answer 30

L-type

Question 31

CCBs with more affinity to heart particularly the SA node

Answer 31

non-DHPs VERAPAMIL, DILTIAZEM

Question 32

greatest depressant effect on the heart; may cause supraventricular arrhythmia

Answer 32

Verapamil

Question 33

CCBs that reduce vascular resistance and have more affinity to smooth muscles

Answer 33

DHPs (NIFEDIPINE, AMLODIPINE)

Question 34

Examples of ACE inhibitors

Answer 34

Captopril, Enalapril, Lysinopril (mga pril)

Question 35

Mode of action of ACE inhibitors

Answer 35

blocks bradykinin breakdown

Question 36

ACE inhibitor that is a prodrug and thus NOT the active drug

Answer 36

Enalapril

Question 37

Toxicities of ACE inhibitors

Answer 37

ARF with bilateral renal artery stenosis, Contraindicated during second and third trimester of pregnancy

Question 38

Example of ARBs

Answer 38

LOSARTAN, VALSARTAN

Question 39

No effect in bradykinin metabolism and hence don't cause cough

Answer 39

ARBs

Question 40

inhibits renin action

Answer 40

Aliskiren ("Alis ka renin")

Question 41

Contraindications of Aliskiren

Answer 41

Pregnancy (because of the toxicity of ACE inhibitors and ARBs)

Question 42

First line drug in chronic heart falure

Answer 42

HYDROCHLOROTHIAZIDES

Question 43

What is the mode of action of Thiazides?

Answer 43

Inhibit NaCl transport predominantly in the distal convoluted tubule

Question 44

Toxicities of Thiazides

Answer 44

hyperGLUC (Glycemia, Lipidemia, Uricemia, Calcemia)

Question 45

Most potent diuretics available

Answer 45

Loop diuretics

Question 46

Inhibit NaCl reabsorption in thick ascending loop of Henle (Na+/K+/2Cl- transporter)

Answer 46

Loop diuretics

Question 47

Example of loop diuretics

Answer 47

IV Furosemide

Question 48

Toxicities of loop diuretics

Answer 48

Hypokalemic metabolic alkalosis, Allergy, Nephritis, Dehydration, Ototoxicity, Gout (HANDOG)

Question 49

Example of potassium sparing diuretics

Answer 49

Spironolactone

Question 50

Mode of action of Spironolactone

Answer 50

Competitive antagonist of aldosterone

Question 51

Treatment goals of HF drugs

Answer 51

Enhance oxygen delivery, Temper compensatory mechanisms, Prevent progressive cell death and structural deterioration to decrease morbidity and mortality

Question 52

What is the mechanism of action of digoxin

Answer 52

Direct inhibition of Na+/K+ ATPase; Stimulates vagus nerve

Question 53

What are the clinical applications of digoxin?

Answer 53

CHF (inc contractility), Atrial fibrillation

Question 54

What is the mode of excretion of digoxin?

Answer 54

Urinary excretion

Question 55

Toxicities of digoxin

Answer 55

Bigeminal rhythm, hypokalemia, tachycardia, fibrillation

Question 56

Mechanism of action of digoxin

Answer 56

vasodilator, inotropic, chronotropic

Question 57

Major excretion products of dobutamine in the urine

Answer 57

conjugates of dobutamine and 3-O-methyl dobutamine

Question 58

most widely used selective beta1-agonist in heart failure

Answer 58

dobutamine

Question 59

Where is dopamine metabolized?

Answer 59

liver, kidney, and plasma by MAO and catechol-O-methyltransferase

Question 60

The drug choice for patients with congestive heart failure, hypotension and oliguria.

Answer 60

Dopamine

Question 61

Mode of action of Milrinone

Answer 61

Inhiibt phosphodiesterase (PDE3) which inactivates camP and thus leads to increased cAMP

Question 62

T or F Milrinone has a greater cardiac than vascular effect

Answer 62

F. Milrinone has a greater vascular than cardiac effect so that arterial pressure is lowered in the presence of augmented cardiac output.

Question 63

Most common side effect of Milrinone

Answer 63

Ventricular arrhythmias

Question 64

Example of a Vasopressin antagonist

Answer 64

Conivaptan

Question 65

What is the mode of action of Nesiritide?

Answer 65

Increases cGMP in smooth muscles

Question 66

Adverse effects of Nesiritide

Answer 66

excessive hypotension; reports of significant renal damage and deaths