sepsis, HTN, CHF, angina

Question 1

intra-abdominal infection treatment

Answer 1

cefazolin or ceftriaxone or tobramycin + metronidazole (E. coli and B. frag.)

Question 2

metronidazole MOA

Answer 2

MOA: disrupt nucleic acid synthesis via free radical release

Question 3

metronidazole ADME

Answer 3

prodrug activated by microbes

oral absorption; excellent penetration and well tolerated

Question 4

metronidazole use

Answer 4

Gr- anaerobes (B. frag)

Question 5

Dopamine MOA

Answer 5

low dose - beta 1 and beta 2 agonist; D1 agonist (increase contractility, HR, and vasodilate renal arteries)
high dose - beta 1, beta 2, and alpha 1 agonist

Question 6

Dobutamine MOA

Answer 6

beta 1 agonist, moderate beta 2 agonist (increase contractility, HR)

Question 7

epinephrine MOA and use

Answer 7

low dose - beta 1, beta 2 agonist
high dose - beta 1, alpha 1 agonist
use: cardiac arrest

Question 8

norepinephrine MOA

Answer 8

beta 1 and alpha 1 agonist

use: septic hypotension

Question 9

vasopressin (ADH, AVP) MOA

Answer 9

V1 - vasoconstrict
V2 - increase renal water reabsorption
alpha 1 - vasoconstrict

Question 10

-thiazides and chlorthalidone MOA

Answer 10

inhibit Na+ transporters in distal tubule -> decreased H2O reabsorption

Question 11

-thiazides and chlorthalidone use

Answer 11

first line in HTN treatment, esp. blacks

Question 12

-thiazides and chlorthalidone ADME

Answer 12

enhance efficacy of virtually all other HTN medications

distal tubule -> least potent

Question 13

-thiazides and chlorthalidone AE’s

Answer 13

low: Mg, Na, K
high: Ca, uric acid, cholesterol
postural hypotension, decreased glucose tolerance

Question 14

drug suffix for: 
ACE-I
ARB
alpha 1 blocker
beta blocker
distal diuretic
vasodilatory CCBs

Answer 14

ACE = -pril
ARB = -sartan
alpha 1 antagonist = -osin
beta blocker = -olol
distal diuretic = -thiazide
vasodilatory CCB = -dipine

Question 15

ACE-I and ARB MOA:

Answer 15

ACE-I = block conversion of angiotensin I to angiotensin II by Angiotensin Converting Enzyme
ARB = aldosterone receptor blocker
-> decrease SVR, blood volume, SNS effects, cardiac and vascular hypertrophy, and bradykinin breakdown

Question 16

ACE-I and ARB AE’s

Answer 16

hypotension, high K, birth defects, decreased renal function

ACE-I: cough, angioedema (due to bradykinin buildup)

Question 17

ACE-I and ARB use:

Answer 17

CKD

Question 18

CCB’s MOA

Answer 18

verapamil, diltiazem: inhibit Ca++ entry in cardiac muscle -> decrease contractility and HR
-dipines: inhibit Ca++ entry in smooth muscle -> vasodilate

Question 19

CCB use:

Answer 19

first line for HTN

prevention of variant angina

Question 20

CCB AE’s

Answer 20

cardiac depression: cardiac arrest, bradycardia, AV block, heart failure; more likely if given with a beta blocker
minor: flushing, dizziness, nausea, edema, constipation (esp. with verapamil)

Question 21

beta blockers MOA

Answer 21

metoprolol, atenolol: beta 1 selective blockade
carvedilol, labetalol: non-selective beta blockade and alpha 1 blocade
-> decrease contractility, HR by blocking SNS
-> decrease BP by inhibiting renin release via blocking receptors on juxtaglomerular cells

Question 22

alpha 1 blockers MOA

Answer 22

vasodilate

Question 23

alpha 2 agonists MOA

Answer 23

stimulate alpha 2 autoreceptors -> negative feedback and decreased NE release -> vasodilation
decreased PVR via stimulation in CNS vasomotor center
analgesia via stimulation of dorsal horn spinal cord receptors

Question 24

alpha 2 agonists agents

Answer 24

methyldopa, clonidine

Question 25

nitroprusside MOA and AEs

Answer 25

vasodilation via NO group | nausea, vomiting, muscle twitching, cyanide toxicity

Question 26

Hydralazine MOA

Answer 26

K+ channel agonist -> hyperpolarization and constriction blockage -> vasodilate

Question 27

hydralazine use

Answer 27

eclampsia (HTN emergency in pregnancy)

Question 28

hydralazine AE

Answer 28

tachycardia, flushing, HA, vomiting, angina, aggrevation

Question 29

``` drugs to avoid in this condition: gout asthma heart block heart failure hyperkalemia pregnancy ```

Answer 29

``` diuretic beta blocker beta blocker, CCB CCB ACE-I, ARB ACE-I, ARB ```

Question 30

digitalis (digoxin, cardiac glycosides) MOA

Answer 30

inhibit Na/K ATPase -> decreased Na/Ca exchange -> Ca buildup and increased contractility and HR

Question 31

digoxin use

Answer 31

``` increased contractility (CHF) arrhythmias due to low HR and slow AV nodal conduction ```

Question 32

cardiac glycoside t1/2

Answer 32

40 hours - give every 24-48 hours

Question 33

digoxin AE's

Answer 33

nausea, vomiting, bradycardia, AV block and other arrhythmias cardiac AE's increase with hypokalemia antidote: Digoxin Immune FAB (digiband)

Question 34

PDE-3 inhibitors MOA

Answer 34

inhibit phosphodiesterase-3 which degrades cAMP -> increase cAMP levels -> increase contractility and vasodilation

Question 35

PDE-3 agents

Answer 35

milrinone, inamrinone

Question 36

PDE-3 administration

Answer 36

constant IV infusion

Question 37

lusitropy

Answer 37

beta 1 agonist effect | increased diastolic relaxation so that EDV can be maintained even as HR increases

Question 38

spironolactone MOA

Answer 38

aldosterone antagonist

Question 39

``` effects on FS curve of: oral nitrates, loop diuretics ACE / ARB fluids (saline) digoxin ```

Answer 39

shift leftward along same curve (decrease LV filling pressure for a given SV curve) shift leftward and upward to a new curve (decrease LV filling pressure and increase SV) shift rightward along the same curve (increase SV and LV filling pressure) shift upward to a new curve (increase SV for a given LV filling pressure)

Question 40

nitrates agents

Answer 40

nitroglycerin, isosorbide mononitrate (dinitrate)

Question 41

nitrate MOA

Answer 41

activation of guanylyl cyclase -> increased cGMP -> dephosphorylation of myosin light chain -> venodilation

Question 42

nitrate use:

Answer 42

acute angina symptoms

Question 43

nitrate AE's

Answer 43

orthostatic hypotension, tachycardia, HA, tolerance

Question 44

nitrate contraindications

Answer 44

elevated intracranial pressure | PDE-5 inhibitor (viagra)

Question 45

beta blocker AE's

Answer 45

bradycardia, CNS effects (depression, mood changes, dizziness, lethargy)

Question 46

beta blocker contraindications

Answer 46

vasospastic disease or asthma severe bradycardia AV block or ventricular block

Question 47

ACE / ARB contraindications

Answer 47

pregnancy | hyperkalemia