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Pharmacology II > Quiz 2 > Flashcards

Quiz 2 Flashcards

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1
Q

Name the types of diuretics

A
  1. Thiazide
  2. Thiazide-like
  3. Loop
  4. Potassium-sparing
  5. Osmotic
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2
Q

What are the thiazide diuretics?

A
  1. Hydrochlorothiazide
  2. Chlorothiazide (IV)

sulfonamide molecule
1-3 wks to show drop in BP

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3
Q

Which diuretics are the ‘ceiling’ diuretics?

A

thiazide

inc. the dose beyond the normal dose does not inc. diuretic effect

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4
Q

What are the ADRs of thiazide diuretics?

A
  1. Hyponatremia
  2. Hyperuricemia
  3. Volume depletion
  4. Hypercalcemia
  5. Hypersensitivity
  6. Hyperglycemia
  7. Hyperlipidemia
  8. Hypokalemia
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5
Q

What are the thiazide-like diuretics?

A
  1. Chlorthalidone
  2. Metolazone
  3. Indapamide
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6
Q

What are the loop diuretics?

A
  1. Bumetanide
  2. Torsamide
  3. Furosemide

high-ceiling diuretics

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7
Q

What are the high-ceiling diuretics?

A

loop diuretics

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8
Q

What are the effects of loop diuretics?

A
  1. Inc. excretion of Na & Cl
  2. Loss of K
  3. Loss of Mg
  4. Inc. urinary Ca excretion
  5. Reduced renal vascular resistance/inc. renal blood flow

potassium & magnesium supplementation

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9
Q

When are loop diuretics mainly used?

A
  1. Heart failure
  2. Nephrotic syndrome
  3. Acute & chronic renal insufficiency
  4. Cirrhosis

onset relatively rapid w/ Sx relief w/in hours to days

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10
Q

Where do the loop diuretics work?

A

ascending loop of Henle

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11
Q

Where do the thiazide diuretics work?

A

distal convoluted tubule

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12
Q

What are the potassium sparing diuretics?

A 
Na channel blockers
1. Triamterene 
2. Amiloride
Aldosterone antagonists
3. Spironolactone
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13
Q

What are the ADRs of Na channel blocking potassium sparing diuretics?

A
  1. Leg cramps
  2. Inc. BUN
  3. K retention
  4. Inc. uric acid
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14
Q

What are the ADRs of aldosterone antagonist potassium sparing diuretics?

A
  1. Gastric upset
  2. Gynecomastia
  3. Menstrual irregularities
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15
Q

How often should you monitor electrolytes when giving diuretics?

A
  1. Baseline
  2. 1 week
  3. 1 month
  4. Periodically
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16
Q

Which diuretics are safely used in children?

A
  1. Thiazides

2. Spirinolactone

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17
Q

How do you treat heart failure?

A
  1. beta-blocker to dec. pathologic sympathetic stimulation
  2. Diuretic to reduce load on failing heart
  3. ACEi to address issues w/ RAAs
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18
Q

What is systolic heart failure?

A

Drop in ejection fraction
Impaired LV contractility

Tx - diuretics ACEi, digoxin & vasodilators

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19
Q

What is diastolic heart failure?

A

Normal or higher ejection fraction
Problems w/ ventricular filling or inability of ventricle to relax

Tx - diuretics, vasodilators, inotropic drugs, beta-blockers, hydralazine/nitrates

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20
Q

Stage A of heart failure

A

High risk for heart failure w/o structural heart disease or Sx of heart failure

  1. HTN
  2. Atherosclerosis
  3. Diabetes
  4. Obesity
  5. Metabolic syndrome
  6. Pts using cardiotoxins
  7. Fx of cardiomyopathy
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21
Q

Stage B of heart failure

A

Structural heart disease w/o Sx of heart failure

  1. Previous MI
  2. LV remodeling - LVH & low ejection fraction
  3. Asymptomatic valvular disease
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22
Q

Stage C of heart failure

A

Structural heart disease w/ prior or current Sx of heart failure

  1. Known structural heart disease
  2. SOB & fatigue, reduced exercise tolerance
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23
Q

Stage D of heart failure

A

Refractory heart failure needing interventions

  1. Sx w/ max. therapy
  2. Hospitalized & can’t be discharged

need heart transplants

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24
Q

Tx of Stage A HF

A
  1. Tx HTN
  2. Smoking cessation
  3. Tx lipid disorders
  4. Encourage regular exercise
  5. Discourage EtOH, drug use
  6. Control metabolic syndrome

Drugs - ACEi/ARB

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25
Tx of Stage B HF
Same under Stage A | Plus beta-blockers
26
Tx of Stage C HF
Same under A & B Dietary salt reduction Plus diuretics In certain Pts: 1. Aldosterone antagonists 2. ARB 3. Digoxin 4. Hydralazine/nitrates Maybe Biventricular pacing/implantable defibrillators
27
Tx of Stage D HF
Same under A, B & C 1. Compensated end-of-life care/hospice 2. Heart transplant 3. Permanent mechanical support 4. Experimental surgery/drugs
28
Beta-blockers w/ HF
Slows progression of disease, dec. post MI mortality Can reverse cardiac remodeling -dec. in systolic/diastolic volumes & inc. in LV EF
29
Aldosterone antagonists w/ HF
Aldosterone levels may inc. 20-fold in HF Check electrolytes/creatinine w/in 1 wk of start, then monthly until Pt potassium levels stabilize
30
What do hydralazine/nitrates do with HF?
improvement in LV EF helpful for those who can't use ACEi/ARBs due to renal impairment
31
What type of drug is Digoxin & how does it work?
Cardiac glycoside Inc. force of contraction & dec. rate of contration +inotrope, -chronotrope Narrow therapeutic range drug Serum levels don't mean efficacy
32
What should Digoxin levels be below?
1ng/mL
33
Who should use Digoxin?
Pts w/ LV EF<40% who still have Sx to other drugs NOT for: 1. Asympomatic Pts w/ LV dysfunction & normal sinus rhythm 2. Primary therapy for stabilization of Pts w/ acutely decompensated HF
34
ADRs of Digoxin
``` 1. Bradycardia/tachycardia Drug interactions Inc. levels 1. Antacids 2. Metoclopramide 3. St. John;s wort Dec. levels 1. Amiodarone 2. Alprazolam (Xanax) 3. Verampimil 4. Spironolactone ```
35
What type of drug is dobutamine & how does it work?
Inotrope Stimulation of beta-1 receptors of heart, mild chronotropic, hypertensive, arrhthmogenic & vasodilative effects For critical care Pts
36
ADRs of dobutamine
1. Inc. HR, BP, Vent ectopic activity, HOTN, premature vent beats 2. Beta-blockers can antagonize the cardiac effects resulting in unopposed inc. vascular resistance
37
What is milrinone & how does it work?
Phosphodiesterase inhibitor | +inotrope & vasodilatory effect
38
L vs. T type Calcium channels
L - sustain AP T - initiate AP
39
Goals of antiarrhythmics
1. Dec./Inc. conduction velocity 2. Alter the excitability of cardiac cells by changing the during of the effective refractory period 3. Suppress abnormal automaticity
40
Class I antiarrhythmics
1. Fast Na+ channel blockers 2. Slows Phase 0 depolarization - lidocaine - quinidine
41
Class II antiarrhythmics
1. Beta-blockers 2. Suppresses Phase 4 depolarization - metoprolol
42
Class III antiarrhythmics
Prolongs phase 3 repolarization | -amiodarone
43
Chass IV antiarrhythmics
1. Ca channel blockers 2. Shortens AP - verapimil - diltiazem
44
Class V antiarrhthmics
1. Ca accumulation 2. Vagal effect - digoxin
45
Class IA antiarrhythmics
Quinidine 1. Atrial tachyarrhythmias 2. AV-junctional & vent. arrhythmias ADRs 1. Diarrhea 2. Hemolytic anemia 3. Aggravate HF 4. Liver failure 5. Digoxin interaction - CYP2D6
46
Class IB antiarrhythmics
Lidocaine 1. Vent. arrhythmias ADRs 1. Worsen certain arrhythmias 2. Seizures 3. CNS effects 4. Contraindicated in 2/3rd degree heart block Short 1/2 life ~8mins
47
Class IC antiarrhythmics
Propafenone 1. For life-threatening Vtach/Vfib 2. Tx of refractory PSVT ADRs 1. Potential to worsen HF 2. Drug-drug interactions that can raise warfarin & digoxin levels 1st pass metabolism, adjust dose w/ liver impairment CYP2D6 metabolism
48
Who should not use Beta-blockers w/ arrhythmias?
1. HR <100 mmHg | 4. Moderate to severe HF
49
What is Esmolol?
Selective inhibitor of beta-1 receptors | used for immediate beta receptor blockade
50
What is amiodarone used for & ADRs?
Class III antiarrhythmic Block K channels - prolonging repolarization 1. Supraventricular arrhythmias 2. Afib/Aflutter 3. Prevent recurrence of Vtach/Vfib ADRs 1. Dose dependent 2. Pulmonary toxicity (Check FEV at start) 3. Photosensitivity 4. Bradycardia 5. Thyroid toxicity
51
What about Dofetilide?
``` Class III antiarrhythmic Prolongs AP in atria & ventricles Blocks rapid K channels Renally excreted - CrCl CYP3A4 ``` ADR - QT prolongation check K, Mg, EKG
52
How does sotalol work?
Class III antiarrhythmic Inhibits non-selective beta blocking activity inc. in AP duration dec. sinus rate & AV conduction Renal excretion - adjust dose ADR - QT prolongation
53
What does Verapimil do & ADRs?
Class IV antiarrhythmic Ca channel blocker 1. Slows vent/ response to Afib/flutter 2. Terminates PSVT ADR 1. Bradycardia 2. HOTN 3. Contraindicated in WPW
54
What does diltiazem do & ADRs?
``` Class IV antiarrhythmic Ca channel blocker Inhibits Ca-dependent slow APs in the SA & AV nodes Slow diastolic repolarization Reduction of vent. responses to Afib ``` Avoid in advanced HF, HOTN becomes refractory 1. PSVT 2. Afib/flutter
55
Uses for adenosine
Tx of PSVT w. WPW ADR 1. Chest pressure 2. Flushing 3. Tightness in throat 4. Don't use w/ 2/3rd degree heart lock short 1/2 life - 8s
56
How do you Tx PSVT in WPW?
Adenosine
57
Tx PSVT
1. Adenosine 2. Beta-blocker 3. Ca channel blocker
58
What drugs do you need for STEMI?
1. Aspirin 2. Antiplatelet oral 3. Antiplatelet IV 4. Nitroglycerin 5. Beta-blocker 6. Antithrombin 7. Fibrinolytic
59
What to do w/ acute coronary syndrome?
``` ONAM!!! Oxygen Nitroglycerin Aspirin Morphine ```
60
Name the oral antiplatelets?
Same MOA for all 1. Ticlopidine - Ticlid 2. Clopidogrel - Plavix 3. Prasugrel - Effient 4. Ticagrelor - Brilinta
61
Which antiplatelets are prodrugs?
1. Clopidogrel - Plavix...2C19 | 2. Prasugrel - Effient
62
Name the IV antiplatelets
1. Abciximab - ReoPro 2. Eptifibatide - Integrilin 3. Tirofiban - Aggrastat
63
When do you use Eptifibatide?
Pts in hospital who will undergo PCI IV antiplatelet
64
Name the nitrates & ADRs
1. Isosorbide dinitrate - Isodril 2. Isosorbide mononitrate - ImDUR 3. Nitroglycerin ADRs 1. HA 2. Dizziness, weakness, postural HOTN
65
Name the anticoagulants
1. Unfractionated heparin 2. Low molecular weight heparins 3. Factor Xa inhibitors 4. Direct thrombin inhibitors
66
What do you have to monitor w/ Heparin?
aPTT | 1.5-2 times the control
67
Which anticoagulants do you have to adjust for renal function?
1. LMWH | 2. Factor Xa inhibitors
68
Name the fibrinolytics
1. Alteplase - Activase 2. Reteplase - Retevase 3. Tenecteplase - TNKase
69
Contraindications to fibrinolytics
1. Any prior intracranial hemorrhage 2. Structural cerebral vascular lesion 3. Malignant intracranial neoplasm 4. Ischmic stroke w/in 3 months except acute ischemic stroke w/in 3 hours 5. Suspected aortic dissection 6. Active bleeding 7. Significant closed-head or facial trauma w/in 3 months
70
What are the uses for fibrinolytics?
1. Reperfusion w/ ACS 2. Mgmt of acute ischemic stroke 3. Mgmt of acute PE
71
What should Post-ACS care be?
1. Aspirin 2. Beta-blocker 3. ACEi 4. HMG-CoA reductase inhibitors
72
MOA & uses of Epinephrine
1. May restore electrical activity in asystole 2. Causes heart to contract faster & more forcefully due to beta stimulation 3. Vasoconstriction due to alpha stimulation 4. Bronchodilation due to beta2 effect Uses: all types of cardiac arrest, anaphylaxis, acute asthma attacks
73
MOA & uses of Vasopressin
1. Vasocontrictor 2. Inc. contractility for smooth muscle Use - alternative to Epi
74
MOA & uses of atropine
Enhancement of conduction through AV junction by parasympathetic blockade Uses: 1. Sinus bradycardia 2. w/ PVCs, systolic BP<90 mmHg or other signs of dec. perfusion 3. Asystole 4. Bradycardic PEA Avoid if Afib/flutter w/ rapid vent. response
75
Uses & ADRs of magnesium sulfate
1. Torsades 2. Vfib/Vtach w/ hypomagnesemia & severe refractory Vfib ADRs 1. Circulatory collapse 2. Respiratory paralysis 3. Dec. reflexes 4. Flaccid paralysis
76
Uses of Sodium Bicarbonate
1. Metabolic acidosis 2. Hyperkalemia 3. Drug overdose
77
1st measures w/ poisoning
1. Airway 2. Ventilation 3. Maintenance of vital signs 4. Temps 5. Count respiratory rate
78
Toxic drug syndromes w/ anticholingergic-effect agents
Delirium, tachycardia, dilated pupils, dry/flushed skin 1. Antihistamines 2. Antiparkinson drugs 3. Antipsychotics 4. Muscle relaxants
79
How do you Tx muscle relaxant OD?
1. Activated charcoal 2. Benzodiazepines 3. Sodium bicarb 4. Fluids
80
Toxic drug syndromes w/ sympathomimetic agents
Delusions, paranoia, tachycardia, HTN, hyperpyrexia, diaphoresis, mydriasis, hyper-reflexia 1. Cocaine 2. Amphetamines 3. Decongestants 4. Diet aids Tx 1. Benzodiazepines 2. Nitroglycerin 3. Lidocaine 4. Sodium bicarb
81
Bath salt OD
CNS stimulant | Tx like amphetamines
82
Toxic drug syndromes w/ depressant drugs
Coma, respiratory depression, miosis, HOTN, bradycardia, diminished bowel sounds, hyporeflexia 1. Opiates 2. Barbituates 3. Benzodiazepines 4. Ethanol Tx 1. Opiods - naloxone 2. Benzos - flumazenil
83
Toxic drug syndromes w/ cholinergic-like agents
Confusion, CNS depression, weakness, salivation, lacrimation, urinary/fecal incontinence, pulmonary edema, seizures 1. Organophosphates 2. Acetylcholinesterase inhibitor Tx 1. Atropine 2. Pralidoxime
84
What are the diuretics to know for the prueba?
1. Thiazide- HCTZ 2. Thiazide-like - Chlorthalidone 3. Loop - Furosemide 4. K-sparing - Spironolactone 5. Osmotic - Mannitol
85
When shouldn't you use a K-sparing diuretic?
if serum creatinine >2.5 | potassium >5

Pharmacology II (10 decks)

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