Pharm1 - Pharm1

Question 1

MOA mannitol

Answer 1

creates an osmotic diuresis because it can’t leave the tubule inhibits Na and Cl reabsorption in PC and ascendin loop

Question 2

clinical uses of mannitol

Answer 2

to decrease intractranial pressure or intraocular pressure through volume depletion

Question 3

side effects of mannitol

Answer 3

can cause pulmonary edema d/t extracellular volume expansion, pulling water out of cells hypernatremia

Question 4

contraindications of mannitol

Answer 4

CHF pulmonary edema anuria severe renal failure severe dehydration

Question 5

how is mannitol administered?

Answer 5

parenterally (poorly absorbed PO)

Question 6

MOA spironolactone

Answer 6

K sparing diuretic, antagonizes aldosterone in the DCT, inhibiting Na reabsorption

Question 7

what effect does spironolactone have on Ca

Answer 7

decreases serum Ca levels by directly inhibiting its transport in the DCT

Question 8

clinical uses of spironolactone

Answer 8

HTN pulmonary edema edema from CHF or cirrhosis, nephrotic syndrome primary hyperaldosteronism

Question 9

side effects of spironolactone

Answer 9

gynecomastia (and other anti-androgenic effects) hyperkalemia hyponatremia hypochlroemic acidosis (blocks aldosterone’s effect on Na/H antiporter)

Question 10

MOA amiloride

Answer 10

K sparing diuretic, directly inhibits Na reabsorption, independent of aldosterone increased Ca reabsorption

Question 11

uses of amiloride

Answer 11

treats ca stones

Question 12

differences between amiloride and triamterene?

Answer 12

MOA similar, but triampterene has shorter t1/2

Question 13

MOA furosemide

Answer 13

loop diuretic, blocking NKCC increased urinary excretion of K, Mg, Ca increases RBF without altering GFR

Question 14

clinical uses for furosemide

Answer 14

edema to increase urine output in ARF (although it doesn’t alter the course of ARF) hypercalcemia hyperkalemia

Question 15

side effects of furosemide

Answer 15

K wasting metabolic alkalosis Mg depletion ototoxicity hyperuricemia

Question 16

why does hyperuricemia result from furosemide use?

Answer 16

increases urate reabsorption d/t increased proximal Na reabsorption

Question 17

contraindication of furosemide

Answer 17

sulfa allergy

Question 18

which is the only loop diuretic without a sulfa group?

Answer 18

ethacrynic acid

Question 19

MOA HCTZ?

Answer 19

block NaCl transport at the DCT Enhanced Ca reaborption (because Na and Ca compete for ATP dependent reabsorption at DCT)

Question 20

clinical uses of HCTZ?

Answer 20

HTN edema DI (by inducing mild volume depletion) to stop recurrent renal calcium stones

Question 21

contraindication of HCTZ

Answer 21

sulfa allergy

Question 22

side effects of HCTZ

Answer 22

hyperglycemia hyperlipidemia hyperuricemia hypercalcemia melabolic alkalosis Mg depletion

Question 23

MOA acetazolamide

Answer 23

Carbonic anhydrase inhibitor so it inhibits the reabsorption of HCO3- in PCT also CA is in ciliary body of eye and in choroid plexus cells, so it decreases aqueous humor production and increases CSF production

Question 24

uses for acetazolamide

Answer 24

acute altitude sickness glaucoma treatment for alkalosis facilitate eexcretion of weak acid (as seen in tumor lysis syndrome)

Question 25

side effects of acetazolamide

Answer 25

encephalopathy (from decreased excretion of NH3 in urine) renal stones b/c calcium phosphate is less soluble in alkaline urine hyperchloremic metabolic acidosis

Question 26

contraindications of acetazolamide

Answer 26

sulfa allergy hepatic or renal dz hyperchloremic acidosis hyponatremia hypokalemia

Question 27

what effect does furosemide have on the following serum levels: K HCO3 Ca Mg urate

Answer 27

decreased increased decreased decreased increased

Question 28

what effect does thiazide have on the following serum levels: K HCO3 Ca Mg urate

Answer 28

decrease increase increased decreased increased

Question 29

what effect does spironolactone have on the following serum levels: K HCO3 Ca Mg urate

Answer 29

increased decreased decreased none none

Question 30

what effect does amiloride have on the following serum levels: K HCO3 Ca Mg urate

Answer 30

increased decreased increased none none

Question 31

what effect does acetazolamide have on the following serum levels: K HCO3 Ca Mg urate

Answer 31

decreased decreased none none none

Question 32

which diuretics decrease Mg?

Answer 32

furosemide HCTZ

Question 33

which diuretics increase urate?

Answer 33

furosemide HCTZ

Question 34

contraindication of spironolactone

Answer 34

acute renal failure

Question 35

MOA nitroprusside

Answer 35

vasodilation of arteries and veins contact with RBC --> decomposition of drug and release of NO NO, via activation of guanylate cyclase --> vasodilation

Question 36

clinical uses of nitroprusside

Answer 36

HTN crisis aortic dissection (must be given with B blocker) CHF

Question 37

side effects of nitroprusside

Answer 37

hypotension reflex tachy CN release

Question 38

contraindications for nitroprusside

Answer 38

known inadequate cerebral circulation hepatic/renal dz (increases thiocyanate toxicity)

Question 39

MOA nitroglycerine

Answer 39

via guanylate cyclase --> increase cGMP which activates cAMP protein dependent kinases and leads to dephosphorylation of myosin light chains and decreased intracellular Ca --> relaxation of veins and increased venous capacitance

Question 40

uses of nitroglyceride

Answer 40

treats angina (decresae coronary asospasm) CHF HTN

Question 41

side effects of nitroglycerine

Answer 41

hypotension, tachycardia, throbbing HA from meningeal arterial dilation

Question 42

MOA captopril

Answer 42

ACE inhibitor blocks formation of AII and degradation of bradykinin so, inhibits constriction of efferent arteriole, and potentiates vasodilation caused by bradykinin also causes venous vasodilation

Question 43

uses of captopril

Answer 43

HTN CHF ischemic heart disease decreases proteinuria and progression of nephropathy in diabetics

Question 44

side effects of captopril

Answer 44

cough from increased bradykinin can cause renal insufficiency b/c GFR is not increased in low volume states

Question 45

contraindications of captopril

Answer 45

renal insufficiency bilateral renal artery stenosis

Question 46

MOA losartan

Answer 46

AII receptor blocker

Question 47

uses of losartan

Answer 47

HTN CHF

Question 48

side effects of losartan

Answer 48

no cough can't maintain GFR by vasodilation of efferent arterioles

Question 49

MOA milrinone

Answer 49

inhibits PDE III --> dilation of arteries and veins PDE III inactivates cAMP, so this process is inhibited --> increased Ca reflux in myocardium, with increased cardiac contractility

Question 50

uses of milrinone

Answer 50

refractory CHF can increase mortality, and should ONLY be used if diuretics, digoxin, and vasodilators have failed a-fib

Question 51

side effects of milrinone

Answer 51

ventricular arrhythmias hypotension hepatotoxicity

Question 52

MOA sildenafil

Answer 52

blocks PDE V action (thus potentiating the action of cGMP dependent kinases that activate phosphatases that encourage the relaxation of smoooth muscle) also decreases the Ca concnetration --> smooth muscle relaxation

Question 53

MOA digoxin

Answer 53

blocks the Na-K pump --> increased Na intracellularly this inhibits the Na concentration gradient from forming, blocking the Ca from leaving the cells this improves cardiac contractility also slows the conduction through AV node

Question 54

uses of digoxin

Answer 54

CHF a fib, a flutter (slows conduction through AV node)

Question 55

side effects of digoxin

Answer 55

narrow therapeutic window visual disturbances, nausea, blurred vision a-tac and AV block can result

Question 56

contraindication of digoxin

Answer 56

hypokalemia 2nd/3rd degree heart block WPW who develop a-fib --> increased impulses through accessory pathway --> VF

Question 57

what abnormalities can be seen on the EKG on a person taking digoxin

Answer 57

incresaed PR, decreased QT, scooping of ST segments, T wave inversion