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Flashcards in More drugs Deck (80):
1

Effects of reserpine: (4)

decreased TPR
decreased CO
decreased renin
decreased BP

2

Side effects of reserpine:

sedation
depression
increased incidence of ulcers

3

Effects of
prazosin (minipress)
terazosin (hytrin)

(alpha-1 blocker, so:)
decrease TPR
decreased BP
increase HDL
decrease LDL
beneficial effect on insulin resistance

4

Used in older men with HTN and BPH:

terazosin (hytrin)

5

Effects of BB: (5)

decrease HR + contractility (thus CO)
decrease renin/ATII
*no Na/H2O retention
with chronic use: decrease TPR
decreased production of aq. humor
*glaucoma
treats stage fright

6

Pindolol does NOT affect levels of ___ like other BB

renin/ATII

7

BB are useful in patients with HTN and:

CHF
MI or ischemic heart disease
hyperthyroidism
migraines

8

Beta-1 cardioselective drugs

metoprolol
atenolol

9

Partial beta-agonists; less effective than other BB:

pindolol

10

Side effects of BB: (7)

cold extremities (due to alpha action)
bradycardia
bronchospasm
CNS (bad dreams, depression)
drug withdrawal syndrome
block glycogenolysis
increase LDL/decrease HDL

11

Should not be given with verapamil or diltiazem (non-DHP)

beta blockers

12

Nonselective beta and alpha 1 antagonists

labetalol
carvedilol (coreg)

13

Effects of nebivolol (bystolic)

promotes NO vasodilation
very beta-1 selective =
decreases BP
decreases HR
decreases TPR

14

Effects of ACEI:

decrease BP
decrease TPR
vasodilation

15

What patients have a greater response to ACEI?

those with elevated renin or Na depletion
(greater decrease in BP)

16

Renoprotective: delays renal disease in type I diabetics

captopril
lisinopril

17

increases synthesis of prostaglandins (vasodilation) in vascular and renal endothelium

captopril

18

ACEI activated by deesterification

ramipril

19

Side effects of ACEI's:

1. angioedema
2. fetal toxicity (not for 2nd/3rd trimester)
3. dry cough
4. hyperkalemia
5. hypotension (if hypovolemic +/or Na depleted), possibly 1st dose

20

ATII receptor antagonists end in the suffix...

-sartan

21

Effects of ARBs

vasodilation
increased Na/water excretion
decrease TPR
decrease BP/CO

22

What do you do if one anti-HTN med causes a dry cough?

switch patient to ARBs

23

ARBs block the action of ATII on _____ receptors

AT type 1

24

What beta blocker is likely to have drug-drug interactions?

carvedilol

25

Competitive TXA2 receptor antagonist

losartan

26

Attenuates platelet aggregation

losartan

27

increases uric acid excretion

losartan

28

ARB that inhibits CYP

losartan

29

Side effects of ARBs

1. hyperkalemia
2. fetal toxicity
3. hypotension (hypovolemic +/or Na depleted patients)

30

ARB that causes hepatic dysfunction

losartan

31

Effect of renin inhibitors
(aliskiren)

decrease BP **dose-dependent

32

(CCBs)
phenylalkylamines are ~selective for:
dihydropyridines selectively block:

L-type Ca channels in myocardium
L-type Ca channels in blood vessels

33

Effects of dihydropyridines:

decrease systemic vascular resistance
decrease arterial pressure
NO/MILD changes in HR (except short acting dihy's)

34

CCBs most effectively control BP in what type of patient?

patients with low renin HTN
(this is more common in AA and elderly)

35

Side effects of dihydropyridines:

peripheral edema
hypotension
constipation

36

Reflex tachy occurs in patients taking what dihydropyridine?

nifedipine (procardia), short acting

37

Side effects of hydralazine?

palpitations (tachy, may lead to angina)
Autoimmune reactions

(not a s/e, but causes water retention)

38

What drugs are direct vasodilators?

minoxidil
nitroprusside

39

Side effects of minoxidil:

increases renin
hirsutism

40

How does minoxidil affect BP?

opens K-ATP channels, which causes relaxation of arteriolar smooth muscle
**dilates arterioles NOT veins

41

Effects of nitroprusside:

forms NO, causing vasodil (arteries/veins)
Decreases TPR
Decreases CO in normal

42

Side effects of nitroprusside:

1. excessive hypotension
2. palpitations/tachycardia
3. metabolized to cyanide (cyanate/thiocyanate toxicity: give small dose for small period)

43

Nitroprusside is used to treat:

HTN emergencies in patients with ventricular failure
**why does this seem to contradict??

44

clonidine acts on what receptors?

postsynaptic alpha-2A adrenoreceptors in the rostral ventrolateral medulla

(decreases symp impulses from RVLM to heart and vessels)

45

Effects of clonidine

decrease peripheral vasc resistance
decrease HR

46

Because it releases endogenous opiates, this drug is used as an analgesic in neuropathic pain

clonidine

47

Treats ADHD

clonidine

48

Side effects of clonidine

sedation
contact dermatitis, if patch form
clonidine withdrawal (HTN)

49

Effects of bosentan:
What is this indicated for?

vasodilation (by blocking endothelin 1 and 2 receptors)

pulmonary HTN

50

_____ (alone or with beta-blockers) decrease mortality in patients with HTN

duiretics

51

Which drug class has the advantage of decreasing HTN wile improving lipid profile and insulin resistance?

alpha 1 blockers

52

Offers secondary protection in CAD (plus anti-HTN)

beta blockers

53

_____ should not be stopped abruptly--taper down doses

beta blockers

54

ACEI are the 1st choice drug for patients with:

high renin
diabetes
nephropathy
CHF-propensity

55

Angina is treated by: (approaches)

1. increase blood blow
2. decrease oxygen consumption
3. prevent platelet aggregation (**Aspirin)

56

(Nitrates) Venodilation causes reduced preload, which results in:

1. decreased ventricular pressure in diastole
2. decreased oxygen demand
3. increased subendocardial blood flow

57

(Nitrates) Coronary vasodilation results in:

1. blood flow to ischemic areas
2. selective dilation of epicardial/collateral coronary vessels
3. prevention/reversal of vasospasm

58

(Nitrates) Overall effects on hemodynamics:

decreased pulmonary vascular resistance
slightly reduced CO

59

Adverse effects of nitrates:

hypotension (due to arterial vasodil)
Orthostatic hypotension (reduced preload)
headache (dilation of meningeal arteries)

60

Drug reactions with nitrates

viagra and other type V PDE inhibitors
(causes hypotension and MI)

61

Nitrates are abosorbed (quickly/slowly) and metabolized (quickly/slowly)

quickly
quickly (via 1st pass**)

62

Side effect of abrupt discontinuation of nitrates

vasospasm

63

What type of CCBs target smooth muscle cells? Cardiac cells?

DHPs
non-DHPs

64

How do non-dihydropyridine CCB's treat angina?

decrease oxygen demands by decreasing HR, contractility and afterload

~coronary vasodilation prevents or reverses vasospasm

65

How do dihydropyridine CCB's treat angina?

reduces oxygen demand by reducing afterload

***coronary vasodilation (causes reflex cardiac stimulation)

66

Side effects of DHP CCB's?

GI irritation
peripheral edema
exacerbation of angina (coronary steal)

67

Side effects of non-DHP CCB's?

bradycardia
asystole
AV block
constipation

DO NOT USE IN CHF

68

How do beta blockers treat angina?

1. decrease HR and contractility in response to exercise
2. decreases afterload

69

Why combine nitrates or DHP CCB's with beta blockers treat angina?

BB prevent reflex tachycardia and contractility

70

4 drugs used in combo for unstable angina

BB
nitrates
ASA
heparin

71

BB are useless in what type of angina?

vasospastic

72

When would you use CCB's instead of BB in angina?

DHP:
valvular insuff (reduce afterload)
sinus brady/AV block

non-DHP:
depression
asthma
DM with variable glu levels

73

Expensive, late Na-current inhibitor that increases oxygen utilization in heart

ranolazone/renexa

74

Drugs that reduce CHD event

beta blockers

75

Reduces CHD, reinfarction and stroke after MI or unstable angina

ASA

76

Improves survival post MI in patients with LV dysfunction

ACEI

77

Reduces HR
Reduces contractiliy
Indirectly reduces afterload (via decr renin)

beta blockers

78

coronary vasodilation
reduced preload
reduced afterload

nitrates

79

coronary vasodilation
reduced afterload

nifedipine

80

coronary vasodilation
reduced HR
reduced contractility
reduced afterload

verapamil
diltiazem