Quiz 2 Reverse Flashcards
(85 cards)
1
Q
- Thiazide2. Thiazide-like3. Loop4. Potassium-sparing5. Osmotic
A
Name the types of diuretics
2
Q
- Hydrochlorothiazide2. Chlorothiazide (IV)sulfonamide molecule 1-3 wks to show drop in BP
A
What are the thiazide diuretics?
3
Q
thiazide inc. the dose beyond the normal dose does not inc. diuretic effect
A
Which diuretics are the ‘ceiling’ diuretics?
4
Q
- Hyponatremia2. Hyperuricemia3. Volume depletion4. Hypercalcemia5. Hypersensitivity 6. Hyperglycemia7. Hyperlipidemia8. Hypokalemia
A
What are the ADRs of thiazide diuretics?
5
Q
- Chlorthalidone2. Metolazone3. Indapamide
A
What are the thiazide-like diuretics?
6
Q
- Bumetanide2. Torsamide3. Furosemidehigh-ceiling diuretics
A
What are the loop diuretics?
7
Q
loop diuretics
A
What are the high-ceiling diuretics?
8
Q
- Inc. excretion of Na & Cl2. Loss of K3. Loss of Mg4. Inc. urinary Ca excretion5. Reduced renal vascular resistance/inc. renal blood flowpotassium & magnesium supplementation
A
What are the effects of loop diuretics?
9
Q
- Heart failure2. Nephrotic syndrome3. Acute & chronic renal insufficiency4. Cirrhosisonset relatively rapid w/ Sx relief w/in hours to days
A
When are loop diuretics mainly used?
10
Q
ascending loop of Henle
A
Where do the loop diuretics work?
11
Q
distal convoluted tubule
A
Where do the thiazide diuretics work?
12
Q
Na channel blockers1. Triamterene 2. AmilorideAldosterone antagonists3. Spironolactone
A
What are the potassium sparing diuretics?
13
Q
- Leg cramps2. Inc. BUN3. K retention4. Inc. uric acid
A
What are the ADRs of Na channel blocking potassium sparing diuretics?
14
Q
- Gastric upset2. Gynecomastia3. Menstrual irregularities
A
What are the ADRs of aldosterone antagonist potassium sparing diuretics?
15
Q
- Baseline2. 1 week3. 1 month4. Periodically
A
How often should you monitor electrolytes when giving diuretics?
16
Q
- Thiazides2. Spirinolactone
A
Which diuretics are safely used in children?
17
Q
- beta-blocker to dec. pathologic sympathetic stimulation2. Diuretic to reduce load on failing heart3. ACEi to address issues w/ RAAs
A
How do you treat heart failure?
18
Q
Drop in ejection fractionImpaired LV contractilityTx - diuretics ACEi, digoxin & vasodilators
A
What is systolic heart failure?
19
Q
Normal or higher ejection fractionProblems w/ ventricular filling or inability of ventricle to relax Tx - diuretics, vasodilators, inotropic drugs, beta-blockers, hydralazine/nitrates
A
What is diastolic heart failure?
20
Q
High risk for heart failure w/o structural heart disease or Sx of heart failure 1. HTN2. Atherosclerosis3. Diabetes4. Obesity5. Metabolic syndrome6. Pts using cardiotoxins7. Fx of cardiomyopathy
A
Stage A of heart failure
21
Q
Structural heart disease w/o Sx of heart failure1. Previous MI2. LV remodeling - LVH & low ejection fraction3. Asymptomatic valvular disease
A
Stage B of heart failure
22
Q
Structural heart disease w/ prior or current Sx of heart failure 1. Known structural heart disease2. SOB & fatigue, reduced exercise tolerance
A
Stage C of heart failure
23
Q
Refractory heart failure needing interventions1. Sx w/ max. therapy2. Hospitalized & can’t be dischargedneed heart transplants
A
Stage D of heart failure
24
Q
- Tx HTN2. Smoking cessation3. Tx lipid disorders4. Encourage regular exercise5. Discourage EtOH, drug use 6. Control metabolic syndrome Drugs - ACEi/ARB
A
Tx of Stage A HF
25
Same under Stage A Plus beta-blockers
Tx of Stage B HF
26
Same under A & B Dietary salt reductionPlus diureticsIn certain Pts:1. Aldosterone antagonists2. ARB3. Digoxin4. Hydralazine/nitratesMaybe Biventricular pacing/implantable defibrillators
Tx of Stage C HF
27
Same under A, B & C 1. Compensated end-of-life care/hospice2. Heart transplant3. Permanent mechanical support4. Experimental surgery/drugs
Tx of Stage D HF
28
Slows progression of disease, dec. post MI mortality Can reverse cardiac remodeling -dec. in systolic/diastolic volumes & inc. in LV EF
Beta-blockers w/ HF
29
Aldosterone levels may inc. 20-fold in HF Check electrolytes/creatinine w/in 1 wk of start, then monthly until Pt potassium levels stabilize
Aldosterone antagonists w/ HF
30
improvement in LV EF helpful for those who can't use ACEi/ARBs due to renal impairment
What do hydralazine/nitrates do with HF?
31
Cardiac glycosideInc. force of contraction & dec. rate of contration +inotrope, -chronotrope Narrow therapeutic range drug Serum levels don't mean efficacy
What type of drug is Digoxin & how does it work?
32
1ng/mL
What should Digoxin levels be below?
33
Pts w/ LV EF<40% who still have Sx to other drugsNOT for:1. Asympomatic Pts w/ LV dysfunction & normal sinus rhythm 2. Primary therapy for stabilization of Pts w/ acutely decompensated HF
Who should use Digoxin?
34
1. Bradycardia/tachycardiaDrug interactionsInc. levels1. Antacids2. Metoclopramide3. St. John;s wortDec. levels1. Amiodarone2. Alprazolam (Xanax)3. Verampimil4. Spironolactone
ADRs of Digoxin
35
InotropeStimulation of beta-1 receptors of heart, mild chronotropic, hypertensive, arrhthmogenic & vasodilative effectsFor critical care Pts
What type of drug is dobutamine & how does it work?
36
1. Inc. HR, BP, Vent ectopic activity, HOTN, premature vent beats2. Beta-blockers can antagonize the cardiac effects resulting in unopposed inc. vascular resistance
ADRs of dobutamine
37
Phosphodiesterase inhibitor +inotrope & vasodilatory effect
What is milrinone & how does it work?
38
L - sustain APT - initiate AP
L vs. T type Calcium channels
39
1. Dec./Inc. conduction velocity2. Alter the excitability of cardiac cells by changing the during of the effective refractory period3. Suppress abnormal automaticity
Goals of antiarrhythmics
40
1. Fast Na+ channel blockers2. Slows Phase 0 depolarization -lidocaine-quinidine
Class I antiarrhythmics
41
1. Beta-blockers2. Suppresses Phase 4 depolarization-metoprolol
Class II antiarrhythmics
42
Prolongs phase 3 repolarization-amiodarone
Class III antiarrhythmics
43
1. Ca channel blockers2. Shortens AP-verapimil-diltiazem
Chass IV antiarrhythmics
44
1. Ca accumulation2. Vagal effect-digoxin
Class V antiarrhthmics
45
Quinidine1. Atrial tachyarrhythmias2. AV-junctional & vent. arrhythmiasADRs1. Diarrhea2. Hemolytic anemia3. Aggravate HF4. Liver failure5. Digoxin interaction - CYP2D6
Class IA antiarrhythmics
46
Lidocaine1. Vent. arrhythmias ADRs1. Worsen certain arrhythmias2. Seizures3. CNS effects4. Contraindicated in 2/3rd degree heart block Short 1/2 life ~8mins
Class IB antiarrhythmics
47
Propafenone1. For life-threatening Vtach/Vfib 2. Tx of refractory PSVTADRs1. Potential to worsen HF2. Drug-drug interactions that can raise warfarin & digoxin levels 1st pass metabolism, adjust dose w/ liver impairmentCYP2D6 metabolism
Class IC antiarrhythmics
48
1. HR <100 mmHg4. Moderate to severe HF
Who should not use Beta-blockers w/ arrhythmias?
49
Selective inhibitor of beta-1 receptorsused for immediate beta receptor blockade
What is Esmolol?
50
Class III antiarrhythmicBlock K channels - prolonging repolarization1. Supraventricular arrhythmias2. Afib/Aflutter3. Prevent recurrence of Vtach/VfibADRs1. Dose dependent2. Pulmonary toxicity (Check FEV at start)3. Photosensitivity4. Bradycardia5. Thyroid toxicity
What is amiodarone used for & ADRs?
51
Class III antiarrhythmicProlongs AP in atria & ventricles Blocks rapid K channels Renally excreted - CrClCYP3A4 ADR - QT prolongationcheck K, Mg, EKG
What about Dofetilide?
52
Class III antiarrhythmic Inhibits non-selective beta blocking activity inc. in AP durationdec. sinus rate & AV conductionRenal excretion - adjust dose ADR - QT prolongation
How does sotalol work?
53
Class IV antiarrhythmic Ca channel blocker1. Slows vent/ response to Afib/flutter2. Terminates PSVT ADR1. Bradycardia2. HOTN3. Contraindicated in WPW
What does Verapimil do & ADRs?
54
Class IV antiarrhythmicCa channel blockerInhibits Ca-dependent slow APs in the SA & AV nodesSlow diastolic repolarization Reduction of vent. responses to AfibAvoid in advanced HF, HOTNbecomes refractory1. PSVT2. Afib/flutter
What does diltiazem do & ADRs?
55
Tx of PSVT w. WPW ADR 1. Chest pressure2. Flushing3. Tightness in throat4. Don't use w/ 2/3rd degree heart lock short 1/2 life - 8s
Uses for adenosine
56
Adenosine
How do you Tx PSVT in WPW?
57
1. Adenosine2. Beta-blocker3. Ca channel blocker
Tx PSVT
58
1. Aspirin2. Antiplatelet oral3. Antiplatelet IV4. Nitroglycerin5. Beta-blocker6. Antithrombin7. Fibrinolytic
What drugs do you need for STEMI?
59
ONAM!!!OxygenNitroglycerinAspirinMorphine
What to do w/ acute coronary syndrome?
60
Same MOA for all1. Ticlopidine - Ticlid2. Clopidogrel - Plavix3. Prasugrel - Effient4. Ticagrelor - Brilinta
Name the oral antiplatelets?
61
1. Clopidogrel - Plavix...2C19 2. Prasugrel - Effient
Which antiplatelets are prodrugs?
62
1. Abciximab - ReoPro2. Eptifibatide - Integrilin3. Tirofiban - Aggrastat
Name the IV antiplatelets
63
Pts in hospital who will undergo PCIIV antiplatelet
When do you use Eptifibatide?
64
1. Isosorbide dinitrate - Isodril2. Isosorbide mononitrate - ImDUR3. Nitroglycerin ADRs1. HA2. Dizziness, weakness, postural HOTN
Name the nitrates & ADRs
65
1. Unfractionated heparin2. Low molecular weight heparins3. Factor Xa inhibitors4. Direct thrombin inhibitors
Name the anticoagulants
66
aPTT1.5-2 times the control
What do you have to monitor w/ Heparin?
67
1. LMWH2. Factor Xa inhibitors
Which anticoagulants do you have to adjust for renal function?
68
1. Alteplase - Activase2. Reteplase - Retevase3. Tenecteplase - TNKase
Name the fibrinolytics
69
1. Any prior intracranial hemorrhage2. Structural cerebral vascular lesion3. Malignant intracranial neoplasm4. Ischmic stroke w/in 3 months except acute ischemic stroke w/in 3 hours5. Suspected aortic dissection6. Active bleeding 7. Significant closed-head or facial trauma w/in 3 months
Contraindications to fibrinolytics
70
1. Reperfusion w/ ACS2. Mgmt of acute ischemic stroke3. Mgmt of acute PE
What are the uses for fibrinolytics?
71
1. Aspirin2. Beta-blocker3. ACEi4. HMG-CoA reductase inhibitors
What should Post-ACS care be?
72
1. May restore electrical activity in asystole2. Causes heart to contract faster & more forcefully due to beta stimulation3. Vasoconstriction due to alpha stimulation4. Bronchodilation due to beta2 effect Uses: all types of cardiac arrest, anaphylaxis, acute asthma attacks
MOA & uses of Epinephrine
73
1. Vasocontrictor2. Inc. contractility for smooth muscle Use - alternative to Epi
MOA & uses of Vasopressin
74
Enhancement of conduction through AV junction by parasympathetic blockadeUses:1. Sinus bradycardia2. w/ PVCs, systolic BP
MOA & uses of atropine
75
1. Torsades2. Vfib/Vtach w/ hypomagnesemia & severe refractory Vfib ADRs1. Circulatory collapse2. Respiratory paralysis3. Dec. reflexes4. Flaccid paralysis
Uses & ADRs of magnesium sulfate
76
1. Metabolic acidosis2. Hyperkalemia3. Drug overdose
Uses of Sodium Bicarbonate
77
1. Airway2. Ventilation3. Maintenance of vital signs4. Temps5. Count respiratory rate
1st measures w/ poisoning
78
Delirium, tachycardia, dilated pupils, dry/flushed skin1. Antihistamines2. Antiparkinson drugs3. Antipsychotics4. Muscle relaxants
Toxic drug syndromes w/ anticholingergic-effect agents
79
1. Activated charcoal2. Benzodiazepines3. Sodium bicarb4. Fluids
How do you Tx muscle relaxant OD?
80
Delusions, paranoia, tachycardia, HTN, hyperpyrexia, diaphoresis, mydriasis, hyper-reflexia 1. Cocaine2. Amphetamines3. Decongestants 4. Diet aids Tx1. Benzodiazepines2. Nitroglycerin3. Lidocaine4. Sodium bicarb
Toxic drug syndromes w/ sympathomimetic agents
81
CNS stimulant Tx like amphetamines
Bath salt OD
82
Coma, respiratory depression, miosis, HOTN, bradycardia, diminished bowel sounds, hyporeflexia 1. Opiates2. Barbituates3. Benzodiazepines4. EthanolTx1. Opiods - naloxone2. Benzos - flumazenil
Toxic drug syndromes w/ depressant drugs
83
Confusion, CNS depression, weakness, salivation, lacrimation, urinary/fecal incontinence, pulmonary edema, seizures 1. Organophosphates2. Acetylcholinesterase inhibitorTx1. Atropine2. Pralidoxime
Toxic drug syndromes w/ cholinergic-like agents
84
1. Thiazide- HCTZ2. Thiazide-like - Chlorthalidone3. Loop - Furosemide4. K-sparing - Spironolactone5. Osmotic - Mannitol
What are the diuretics to know for the prueba?
85
if serum creatinine >2.5potassium >5
When shouldn't you use a K-sparing diuretic?
