Pharm 5 Cardio pt2 Flashcards Preview

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Flashcards in Pharm 5 Cardio pt2 Deck (25)
1

Do all Diuretics work in the same place in the nephron?
What do they trigger?

Each one works in a different place in the nephron. (therefore have diff advantages, side effects)
These drugs cause Na+ (and therefore also water) to be excreted.

2

In resistant edema, what 3 kinds of diuretics are indicated?

loop diuretics, K+-sparing diuretics, and metolazone

3

A concern about taking Diuretics.

electrolyte imbalances. A good chance you will excrete too much K+, and must be checked periodically in these patients on diuretics.

4

Diuretics are used in the management of (3)

Hypertension
Glaucoma
edema associated with cardiovascular, renal and endocrine abnormalities

5

For Hypertension, what's your first choice of a diuretic? Next 2 choices?

Thiazide (first choice), Loops, and sometimes K+ Sparing.

6

Diuretics: Contraindications, Precautions, A/S Effects

(lower the blood pressure too much)

Contraindicated in anuria
electrolyte depletion
Pregnancy Cat. C
Monitor electrolytes (esp. K+), fluids, blood, BUN
K+ supplements may be needed
Some classes contraindicated in sulfanomide allergies
Caution in hepatic or renal dysfunction, DM, gout, SLE
Interaction w/ digitalis, lithium
May alter excretion of salicylates, lithium
Potentiates anti-hypertensives (that’s good!)

7

a poison from a plant called foxglove. What can it cause?

Digitalis
cardiac dysrhythmias

8

What other element gets excreted by Diuretics besides Na/K?

Lithium - in the same periodic table group as Na.

9

Prototypical Thiazide Diuretic
Example
Route of Entry
Indication
What's the reality?

Hydrochlorthiazide aka HCTZ (PO - tabs)
Indication: edema
Reality is: this drug is rarely written in this formulation anymore b/c this is only for monotherapy. Reality: it’s used with other drugs.

10

Prototypical Loop Diuretic
Example, route of admin
Indication
What's its half life?
What's the reality?

Furosemide (Lasix®) - IV
Indication: edema
Half life: 6 hours (laSIX)
It’s a good drug for edema in an in-hospital setting. Not a good drug for hypertension b/c of how quickly/dangerously it removes water from the body.

11

Potassium-sparing Diuretic
Example, route of admin
Indication
When would you give this?

Triamterene (PO tabs)
Indication: edema
You tried a regular HCTZ and are having trouble with K+ levels. The particular patient can’t be properly supplemented with K+, so you give this.
May be combined with HCTZ

12

Thiazide diuretics (Hydrochlorthiazide): consideration

Best in low-dose forms

13

How are all b blockers similar? (2)
Different? (4)

Similar: All b-blockers have a similar mechanism of action
b-blockers assert their effect on the Symp Nervous System
Different: beta-selectivity, alpha-blocking activity, membrane-stabilizing activity (MSA), intrinsic sympathomimetic activity (ISA)

14

ß-Adrenoceptor blockers
Mechanism of Action:
Why blood pressure reduction? (3)

Mechanism of Action: ß-adrenoceptor antagonism (blockade)
Heart rate slows down -> cardiac output decreases -> reduction of renin release & reduction of sympathetic outflow.

15

6 physiologic benefits of beta blockers

provide antihypertensive, antianginal, and antiarrhythmic effects
increases the density of beta-1 receptors
inhibit catecholamine toxicity
decrease neurohormonal activation
decrease heart rate
antioxidant and antiproliferative effects

16

Where are beta-1,2 receptors located, and what do they do? (3)

beta1-receptors predominate in cardiac tissue and increase heart rate and contractility
beta2-receptors predominate in the bronchial and vascular smooth muscle and cause vasodilation
beta2-receptors located in the liver promote glucogenesis

17

As a result of beta-blockade, __ and __ are decreased
Slowing of the atrioventricular conduction system prevents an increase in cardiac automaticity and prolongs the refractory period

Cardiac output & Heart rate

18

Can you list all 11 (FDA-approved) Indications for beta blockers???

Hypertension
Angina
Early tx, reduction in mortality in MI
Selected cases of CHF
Migraine prophylaxis
Open-angle glaucoma
Thyroidtoxicosis
Subaortic stenosis
Anxiety
Essential tremor
Selected arrhythmias

19

What is the only beta-blocker NOT indicated for hypertension?

Sotalol

20

What is the only beta-blocker indicated for hypertensive crisis?
What is it?
What's the route of admin?

Labetolol (an injectable beta-blocker/alpha1-blocker)

21

the only beta-blockers indicated for heart failure (2)
Which is more common?

Carvedilol or Nebivolol
Carvedilol is more common than the much newer Nebivolol.

22

**How to use beta-blockers in CHF

Slow titration (up & down)
decrease symptoms of HF
improve left ventricular function
improve exercise tolerance

23

5 adverse effects of beta-blocker drugs

Bradycardia
Bronchospasm
Sexual dysfunction
Fatigue
Glucose metabolism?

24

3 types of beta-blockers
What's the prototypical drug for each type? (1,1,2)

Non selective: Propranolol
Cardioselective: Metoprolol
Third Generation/Vasodilating: Carvedolol, Nebivolol

25

Are non-selective beta blockers as good as cardioselective beta-blockers in reducing blood pressure?

Non selective (propanolol) and cardioselective (Metoprolol) ß-blockers are equally effective in reducing blood pressure