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Patho/Pharm > Pharm Exam 2 and 3 Hypertension and Heart Failure > Flashcards

Pharm Exam 2 and 3 Hypertension and Heart Failure Flashcards

1
Q

What are the uses for hypertonic solutions?

A

Move fluid from inside the cell to out
hyponatremia or hypoglycemia

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2
Q

digoxin therapeutic levels

A

.5-2ng/ml

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3
Q

Hydralazine (apresoline)
action
dosing
Uses
Adverse effects

A

antihypertensive, vasodilator
3-4 times a day
moderate to severe HTN, off label, HTN emergencies and heart failure with reduced ejection fraction
flushing, headache, GI issues

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4
Q

When are thiazides not effective?

A

When urine flow is scant

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5
Q

What factors affect electrolyte absorption?

A

concentration gradients
binding proteins
contents of the GI tract
pH of intestinal content
medications
surgical removal of GI tract

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6
Q

What qualifies as high BP

A

> 80mmHg diastolic
130mmHg systolic

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7
Q

Mechanism of action of crystalloid solutions?

A

Small molecules flow across semipermeable membranes allowing transfer from the bloodstream into cells.

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8
Q

For lifestyle modifications, what is the ideal amount of daily sodium?

A

1500mg or less.

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9
Q

Uses for D5W

A

should not be used alone to treate low fluid volume
resuscitation
increased ICP
hypernatremia

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10
Q

Causes of hypokalemia

A

decreased dietary potassium
shift from ECF into cells
increased excretion

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11
Q

what are the two types of calcium channel blockers?

A

DHP (vascular selective) and Non-DHP (myocardial selective)

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12
Q

What is the most common loop diuretic?

A

Furosemide (Lasix)

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13
Q

How do diuretics work?

A

block sodium and chloride reabsorption

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14
Q

What are the four types of IV solutions?

A

crystalloids, colloids, isotonic, and hypertonic

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15
Q

digoxin pharmacokinetics

A

rapid absorption and wide distrubution
lipophilic
rapid onset

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16
Q

Adverse effects of mannitol

A

edema, headache, N/V, and fluid/electrolyte imbalance

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17
Q

What effects on the heart does Digoxin have?

A

strengthens contraction, slows heart rate and conduction velocity

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18
Q

Hyponatremia causes

A

Too much water from excessive ADH release, excess water intake, or decreased Na intake
Too much salt being lost from thiazide diuretics and salt wasting renal disease

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19
Q

Uses for .9% NaCl

A

treat low extracellular fluid from fluid loss
shock, mild hyponatremia, metabolic acidosis, and hypercalcemia

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20
Q

Uses for digoxin

A

congestive heart failure: improves contractility
arrhythmias: slows conduction velocity through SA node and the refractory period at the AV nodes, decrease HR

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21
Q

Who should not be given lactated ringers?

A

People who cannot metabolize lactate like liver disease or lactic acidosis

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22
Q

Which electrolytes are higher inside the cell?

A

potassium, magnesium, and phosphate

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23
Q

Effects of Beta 2 blocking

A

bronchoconstriction, vasoconstriction, and inhibits glycogenolysis

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24
Q

Adverse effects of furosemide?

A

OTOXICITY
decreased sodium, potassium, chloride, calcium, and magnesium
dehydration
Hypotension due to loss of BV and relaxation of venous smooth muscle
hyperglycemia
hyperuricemia (uric acid)
disrupts lipid metabolism and reduces HDL, increases LDL and triglycerides

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25
Q

Therapeutic uses for spironolactone (potassium-sparing)

A

Hypertension
Edema
heart failure
primary hyperaldosteronism
PMS
PCOS
acne in women

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26
Q

What are the adverse effects of thiazides?

A

increased renal excretion of sodium, chloride, potassium, and water
elevate levels of uric acid and glucose

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27
Q

hyponatremia treament

A

treat cause, reduce water intake, Na tabs

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28
Q

treatement of digoxin toxicity

A

temporary pacemaker and digibind

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29
Q

Are the adverse effects of sudden stoppage of beta blockers?

A

hypertensive crisis
bronchodialation
rebound tachycardia
hypoglycemia

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30
Q

What are calcium channel blockers effective for treating?

A

HTN and symptoms of angina

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31
Q

treatment for hyperkalemia

A

potassium removal
Kayexalate

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32
Q

Uses for lactated ringer’s

A

fluid replacement for burn patients, acute blood loss or hypovolemia

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33
Q

Adverse effects of spironolactone

A

increased potassium
tumors
endocrine effects

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34
Q

Lisinopril- type of drug
absorption
onset/peak
duration
excretion
dosing

A

ACEi
good absorption
onset in 60 min/peak 6 hours
24 hour duration
kidneys
daily

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35
Q

Which electrolytes are higher outside the cell?

A

sodium, chloride, bicarbonate ions

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36
Q

Hypernatremia causes

A

More salt than water-dehydration
Loss of more water than salt-hyperventilation, diabetes insipidus (not enough ADH), prolonged diarrhea/vomiting

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37
Q

Causes of hyperkalemia

A

increased IV intake, shift from cells to ECF, and decreased excretion

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38
Q

Mechanism of action of colloid solutions?

A

Remain in blood and increases fluid in blood.

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39
Q

Symptoms of hyperkalemia

A

!ascending muscle weakness and dysrhythmias and cardiac arrest
intestinal cramping, diarrhea, finger and lips tingling

40
Q

hydrochlorothiazide drug interactions

A

digoxin
intensifies hypertensive medications
lithium
NSAIDS
ototoxic drugs

41
Q

mechanism of action for mannitol (osmotic diuretic)

A

promotes diuresis by creating osmotic forces within the lumen of the nephron

42
Q

Digoxin toxicity signs and potassium component

A

early: anorexia, nausea, double vision, yellow vision, halos around objects
late: arrhythmias, AV or complete heart block
Must keep potassium above 3.2 or cardiotoxicity occurs.

43
Q

What are the four anatomical locations BP drugs work on?

A

heart, blood vessels, CNS, and PNS

44
Q

Hypernatremia treatment

A

treat cause, IV d5W (dextrose), increase water intake

45
Q

What is the location of action for hydrochlorothiazide?

A

proximal section of the distal convoluted tubule

46
Q

What is the onset for furosemide?

A

IV 5 mins
PO 60 mins

47
Q

What is systolic hypertension caused by?

A

stiff aorta and arteries

48
Q

What is the onset of hydrochlorothiazide?

A

4-6 hours

49
Q

Calcium channel blocker actions

A

blocks calcium channels in vascular smooth muscle, lowers arterial pressure, and indirectly activates baroreceptor reflex (maintains BP).

50
Q

Should furosemide be used in pregnancy?

A

Probably not

51
Q

Hyponatremia symptoms (x<135mEq)

A

!seizures, coma, cerebral herniation
confusion
N/V
muscle weakness/fatigue
headaches
restless/irritable

52
Q

Losartan (cozaar)
type of drug
half life
duration
metabolism
elimination

A

angiotension II receptor antagonists (ARB)
1.5-2 hours
24 hours
P450 to active metabolite
urine and feces

53
Q

treatment for hypokalemia

A

potassium replacement (IV or oral)

54
Q

Furosemide drug interactions

A

Digoxin
Ototoxic drug (aminoglycosides)
Potassium-sparing diuretics
Lithium
antihypertensive agents
NSAIDs

55
Q

Therapeutic uses of mannitol

A

prophylaxis of renal failure
reduction of intracranial pressure
reduction of intraocular pressure

56
Q

Adverse effects of lisinopril

A

bradykinin (dry cough)
!first dose hypotensive effect
hyperkalemia
angioedema
pregnancy harm crosses placenta/breast milk

57
Q

Hypokalemia symptoms

A

!respiratory paralysis, bilateral muscle weakness, and dysrhythmias (sudden death)
abdominal distention and diminished bowel sounds
polyuria

58
Q

spironolactone drug interactions

A

thiazide and loop diuretics
agents that raise potassium levels (ACEi)

59
Q

What are the adverse effects of hydrochlorothiazide?

A

Decreased sodium, chloride, and potassium
Increased uric acid and glucose
Dehydration

60
Q

Examples of isotonic solutions

A

.9% NaCl, lactated ringers, 5% dextrose in water, and ringer’s solution

61
Q

What is the mechanism of action for spironolactone?

A

blocks aldosterone in the distal nephron, retains potassium, increased excretion of sodium

62
Q

What are the four major categories of diuretics?

A

loop, thiazide, osmotic, and potassium sparing (non/aldosterone antagonists)

63
Q

For lifestyle modifications, what is the ideal amount of daily potassium?

A

3500-5000 mg

64
Q

Can mannitol be taken orally?

A

no

65
Q

What are the effects of ACE inhibitors?

A

arteriolar and venous dilation, suppression of aldosterone release, and reduced cardiac remodeling.

66
Q

Side effects of beta blockers

A

bradycardia
bronchioconstriction
CNS depression
hypotension
fatigue
sexual dysfunction
masks symptoms of hypoglycemia

67
Q

Hypernatremia symptoms (x>145mEq/L)

A

!seizures, coma, cerebral hemorrhage
confusion, lethargy, thirst, weight gain, and increased BP

68
Q

What are the therapeutic uses or hydrochlorothiazide?

A

essential hypertension, edema, diabetes insipidus

69
Q

Cardiac glycoside

A

Digoxin

70
Q

Name the 6 lines of heart failure medication?

A
  1. diuretics
  2. ACE inhibitors
  3. beta blockers
  4. digoxin if needed
  5. aldosterone antagonist
  6. vasodialators if angina is present
71
Q

Nisoldipine (sular)
Type of CCB
Use
Dosing
Adverse effects

A

DHP CCB
HTN
daily
headache, peripheral edema, dizziness, pharyngitis

72
Q

What percentage of hypertension is primary?

A

90%

73
Q

What are the uses for furosemide?

A

pulmonary edema, edematous states, hypertension

74
Q

What are the four types of beta blockers?

A

Atenolol- B1
Carvedilol- A1, B1,B2
Metoprolol- B1
Propranolol-B1, B2

75
Q

Normal values for potassium?

A

3.5-5 mEq/L

76
Q

Effects of B1 blocking

A

reduced HR, decreased contraction, suppresses impulse conduction and renin secretion

77
Q

What is the mechanism of action of furosemide?

A

acts on ascending loop of Henle to block the reabsorption of Na+

78
Q

What is the most effective diuretic?

A

furosemide

79
Q

What is the normal range of sodium?

A

135-145 mEq/L

80
Q

Colloid solution examples

A

albumin, dextrans, and hydroxyethyl starches

81
Q

lisinopril drug interactions

A

diuretics, NSAIDS, and other HTN agents

82
Q

What are the adverse effects of diuretics?

A

hypovolemia, acid-base imbalance, and electrolyte imbalance

83
Q

which three types of drugs cause hyperkalemia?

A

potassium-sparing diuretics, ace inhibitors, and ARBS

84
Q

does digoxin prolong life?

A

no

85
Q

What enzyme does digoxin act on?

A

Na/K ATPase

86
Q

What causes digoxin-induced ventricular dysrhythmias?

A

Decreased automaticity of the SA node, decreased impulse conduction through the AV node, spontaneous discharge of Purkinje fibers, and shortening of the effective refractory period in the ventricle muscle.

87
Q

how do you manage digoxin induced dysrhythmias?

A

withdraw digoxin and K+ wasting diuretics
monitor serum K+
antidysrhythmic drug
Treatment with Digifab or activated charcoal

88
Q

the therapeutic range of digoxin

A

.5-.8 ng/mL

89
Q

ace inhibitors

A

lisinopril, captopril, enalapril

90
Q

aldosterone antagonist

A

spironolactone

91
Q

inotropics

A

digoxin

92
Q

alpha and beta blockers

A

carvedilol

93
Q

vasodilators

A

isosorbide and apresoline

94
Q

human B natriuretic peptide

A

nesiritide IV only

95
Q

verapamil- drug type
uses
side effects/contraindications
dosing/administration

A

calcium channel blocker
reduce heart rate, reduce AV conduction, reduce heart contractility
HTN for people with afib, angina, supraventricular tachycardia, and cluster headaches
constipation and not for nursing mothers
PO/IV

Patho/Pharm (11 decks)

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