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Unit 5 Flashcards

1
Q

Alpha 2 agonist- Centrally acting

A

Clonidine
Methyldopa

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2
Q

Alpha 2 agonist MOA

A

decrease in peripheral outflow of NE, leading to decreases in peripheral resistance, renal vascular resistance, heart rate, and blood pressure

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3
Q

Alpha 2 ADR

A

drowsiness, dry mouth, constipation, urinary retention, headache, and disturbances in sexual function

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4
Q

Clonidine precautions

A

should not be prescribed to patients at risk or with history of bradycardia or sinus node dysfunction.
Increased risk of depression.

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5
Q

Methyldopa contraindication

A

Hepatic disease and use of MAOIs. Can cause hemolytic anemia in rare cases

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6
Q

Clonidine and Methydopa precautions

A

Crosses blood-brain barrier and should be used with caution in cerebrovascular disease

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7
Q

Clonidine and methyldopa drug interaction

A

Should not be prescribed in conjunction with a beta -adrenergic blocker bc of risk of life threatening HTN if abruptly discontinued

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8
Q

Alpha 1 adrenergic antagonists

A

Doxazosin
Prazosin
Terazosin

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9
Q

Alpha 1 adrenergic antagonist MOA

A

block postsynaptic alpha1 receptors in the vasculature causing a decrease in both arterial and venous vasoconstriction

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10
Q

Alpha 1 adrenergic antagonist precaution

A

Intraoperative floppy iris syndrome
Orthostatic hypotension

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11
Q

Alpha 1 adrenergic antagonist ADR

A

Syncope w sudden LOC

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12
Q

Doxazosin, prazosin, and terazosin

A

Second-line agents for treatment of htn in older men with concomitant BPH.

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13
Q

Prazosin DDI

A

Beta-adrenergic blockers- may cause acute postural hypotension

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14
Q

Beta Adrenergic antagonists(Blockers)

A

Beta blockers occupy beta-receptor sites reducing the sympathetic nervous system activity by preventing and competing with catecholamines and other beta agonists

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15
Q

Nonselective beta blockers- Block beta 1 and beta 2 receptors

A

Nadolol
Propanolol

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16
Q

Beta blockers cardiac effect

A

Blocks SA node, decreasing HR, contractility, velocity, and in AV junction, slowing conduction

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17
Q

Beta blockers renal effect

A

Reduces renin, decreasing the activation of RAS causing less angiotensin II(mediated vasoconstricion) and aldosterone(mediated volume expansion)

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18
Q

Beta blockers respiratory effect

A

causes bronchial constriction

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19
Q

Beta blockers endocrine effect

A

Used in liver cirrhosis to reduce portal pressure. Can prevent variceal bleeding in treatment of cirrhosis

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20
Q

Beta blockers contraindications

A

AV block, PVD, respiratory conditions such as asthma

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21
Q

Propanolol DDI

A

Acetaminophen
Gabapentin
Haldol
Loop diuretics
Phenothiazines
Warfarin

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22
Q

Selective beta1 blockers (except at high doses will have an effect on beta 2 receptors)

A

Metoprolol
Atenolol
Nebivolol

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23
Q

Nebivolol

A

Unlike other beta blockers, also produces endothelium-derived nitric oxide-dependent vasodilation

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24
Q

Beta blockers precautions

A

Hypotension and bradycardia
May mask symptoms of hypoglycemia
May mask clinical signs of hyperthyroidism such as tachycardia.
Should not be stopped before surgery.
Increased risk of MI with use of anesthesia for patients who take beta blockers chronically.

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25
Propanolol and metoprolol DDI(different than propanolol alone)
Ranitidine Hydralazine MAOIs Propafenone Benzos Serotonin reuptake inhibitors Thyroid hormone
26
Combined alpha and beta adrenergic antagonists
Carvedilol Labetalol
27
Combined alpha and beta adrenergic antagonist MOA
Alpha1 blockade is predominant, which makes these medications less likely to cause significant bradycardia or decrease in cardiac output. Decreases the reflex vasoconstriction that is noted with beta blockers alone.
28
Carvedilol
Used to reduce progression of HF and to treat LV dysfunction after MI
29
Labetalol contraindication
Patients with bronchospastic dx
30
Carvedilol DDI
Use with caution with other CYP2D6 inhibitors such as amiodarone. Can increase the blood levels of carvedilol Rifampin. Dyphenhydramine
31
Carvedilol anesthesia precaution
Anesthesia medications, such as ether, cyclopropane, and trichloroethylene, should be used with caution with carvedilol because of depressed myocardial function
32
RAS inhibitors- Angiotensin Converting Enzyme inhibitors(ACE) inhibitors
Captopril Enalapril Benazepril Lisinopril Ramipril
33
ACE inhibitor MOA
Reduces production of angiotensin II and aldosterone
34
Angiotensin II
Increases vasomotor tone by directly stimulating vascular smooth muscle contraction and through the inhibition of endothelial nitric oxide and prostaglandin release, raising BP and decreasing blood flow through arteries. Increases intravascular volume through stimulating sodium and water retention (with aldosterone), shifting of the pressure–natriuresis relationship, and altering glomerular hemodynamics. It is also produced in response to tissue injury
35
Aldosterone
Hormone produced by the adrenal glands. Plays a crucial role in regulation bp by controlling the balance of sodium and potassium in the blood
36
ACE inhibitors and ARB contraindication
bilateral renal artery stenosis angioedema pregnancy hyperkalemia
37
ACE inhibitors ADR
angioedema in 0.2% of people taking dry hacking cough within first week of taking
38
Angiotensin receptor blockers (ARBs)
Losartan Candesartan Olmesartan Telmisartan Valsartan
39
Angiotensin receptor blockers (ARBs) MOA
Act by blocking the AT II receptor. They have similar action to ACEIs on vasoconstriction and aldosterone secretion but no activity related to bradykinin
40
Losartan DDI
Levels are significantly lowered by inhibitors of CYP 450 3A4 and 2C9 Potassium supplements, potassium-sparing diuretics
41
Cardiac glycoside
Digoxin
42
Cardiac glycoside MOA
All CGs are strong and highly selective inhibitors of the sodium–potassium–adenosine triphosphatase (ATPase) system—the “sodium pump.” Inhibition of this pump results in sodium and calcium buildup inside the cell. The combination of the changes in sodium and calcium results in increased velocity of the shortening of cardiac muscle. Increases stroke volume(positive inotropy)
43
Digoxin precautions and contraindications
AV block and uncontrolled ventricular arrhythmia because their action on the AV node may worsen the arrhythmia. They are used for rate control only after trying a BB, when verapamil or diltiazem cannot be used or are inadequate to achieve the desired rate range. severe renal impairment.
44
Dig toxicity symptoms
n/v/d, arrhythmias, palpitations, confusion, dizziness, weakness, and visual disturbances
45
Dig toxicity antidote
digibind
46
Class IA antiarrhythmics
Depress phase 0 an prolong the action potential duration - sodium channel blocker
47
Class IA med
Disopyramide
48
Disopyramide MOA
Blocks sodium channels, prolongs action potential duration, increases effective refractory period
49
Disopyramide monitoring
Monitor ECG for QT prolongation and arrhythmias, electrolytes (especially potassium), and liver function tests
50
Disopyramide side effects
Anticholinergic effects (dry mouth, constipation, urinary retention), blurred vision, hypotension, heart failure exacerbation, arrhythmias
51
Disopyramide major adverse side effect
Proarrhythmic effects, exacerbation of heart failure, anticholinergic effects
52
Class IB
Depress phase 0 slightly and may shorten the action potential duration- also works on sodium channels
53
Class IB med
Mexiletine
54
Mexiletine MOA
Blocks sodium channels, shortens action potential duration.
55
Mexiletine monitoring
Monitor ECG for QT prolongation, liver function tests, and signs of CNS toxicity
56
Mexiletine side effects
Nausea, dizziness, tremor, CNS effects (confusion, hallucinations), gastrointestinal upset
57
Mexiletine major side effects
CNS effects, gastrointestinal disturbances, proarrhythmic effects.
58
Class IC
Depress phase 0. Slowing of conduction- potent sodium channel blockade
59
Class IC meds
Flecainide Propafenone
60
Flecainide monitoring
Monitor ECG for QT prolongation, assess renal and hepatic function regularly
61
Flecainide side effects
Arrhythmias (including proarrhythmic effects), dizziness, blurred vision, gastrointestinal upset
62
Flecainide black box warning
Increased mortality in post-MI patients (supraventricular arrhythmias)
63
Flecainide and popafenone major side effects
Proarrhythmic effects, exacerbation of arrhythmias, CNS effects
64
Propafenone monitoring
Monitor ECG for QT prolongation, liver function tests, and signs of proarrhythmia
65
Propafenone side effects
Dizziness, metallic taste, gastrointestinal upset, arrhythmias (including exacerbation).
66
Class II antiarrhythmics
Depress phase 4 depolarization
67
Class II med
Propanolol
68
Propanolol MOA
Non-selective beta-adrenergic receptor blocker, reduces sympathetic tone, decreases heart rate and contractility
69
Propanolol monitoring
Monitor blood pressure, heart rate, signs of bronchospasm (if non-selective), and glucose levels in diabetic patients
70
Propanolol side effects/ major side effects
Bradycardia, hypotension, bronchospasm (in asthma patients), fatigue, depression, sexual dysfunction. Exacerbation of heart failure, CNS effects
71
Class III MOA
Produce a prolongation of Phase 3 (repol)- K channel blocker
72
Class III meds
Amiodarone Dronedarone Saltalol
73
Amiodarone MOA
Blocks potassium channels, sodium channels, and calcium channels; prolongs action potential duration and refractory period.
74
Amio monitoring
Regular monitoring of pulmonary function (due to risk of pulmonary toxicity), thyroid function, liver function, and ECG
75
Amio side effects
Pulmonary toxicity (pneumonitis, fibrosis), thyroid dysfunction (hypothyroidism or hyperthyroidism), liver toxicity, photosensitivity, corneal deposits.
76
Amio black box warning
Pulmonary toxicity, hepatotoxicity, potentially fatal arrhythmias
77
Dronedarone monitoring
Regular ECG monitoring, liver function tests, and signs of heart failure exacerbation
78
Dronedarone side effects
GI upset, liver toxicity, bradycardia, QT prolongation, exacerbation of arrhythmias.
79
Dronedarone black box warning
Increased risk of death, stroke, and heart failure in patients with decompensated heart failure or permanent atrial fibrillation.
80
Soltalol monitoring
Monitor ECG for QT prolongation, renal function (since excreted unchanged in urine), and signs of proarrhythmia
81
Soltalol side effects
Bradycardia, torsades de pointes, hypotension, GI upset, dizziness.
82
Soltalol black box warning
Proarrhythmic effects (torsades de pointes).
83
Class IV
Depress phase 4 depolarization and lengthen phases 1 and 2 of repolarization- ca channel blocker
84
Class IV meds
Diltiazem Verapamil
85
Dilt/verapamil MOA
Blocks calcium channels, reduces SA and AV nodal conduction, decreases myocardial contractility
86
Dilt monitoring
Monitor ECG for AV conduction disturbances, blood pressure, signs of heart failure exacerbation
87
Dilt side effects/ major side effects
Hypotension, bradycardia, peripheral edema, constipation, dizziness. AV block, exacerbation of heart failure
88
Verapamil monitoring
Monitor ECG for AV conduction disturbances, blood pressure, signs of heart failure exacerbation
89
Verapamil major side effects
AV block, exacerbation of heart failure, hypotension.
90
Vasodilators- drug acting through Nitric Oxide
Hydralazine
91
Hydralazine MOA
Direct relaxation and dilation of arteriolar smooth muscle, reducing peripheral vascular resistance (PVR). Acts through nitric oxide release
92
Hydral monitoring
Monitor blood pressure regularly. Assess for signs of fluid retention (weight gain, edema). Check for lupus-like syndrome symptoms (e.g., joint pain, fever).
93
Hydral side effects/major adverse effects
Hypotension, reflex tachycardia, headache, lupus-like syndrome (rare), gastrointestinal upset.
94
Vasodilators- K channel stimulants
Minoxidil
95
Minoxidil MOA
Direct arteriolar vasodilation by stimulating potassium channels, resulting in decreased peripheral vascular resistance.
96
Minoxidil monitoring
Monitor blood pressure regularly. Assess for fluid retention and symptoms of pericardial effusion (if used off-label for severe hypertension).
97
Minoxidil side effects
Hypotension, fluid retention, pericardial effusion (off-label use), hypertrichosis (excessive hair growth).
98
Ca channel blockers-Dihydropyridines
Nifedipine Amlodipine Felodipine
99
Nifedipine MOA
Inhibit calcium ion influx into vascular smooth muscle and myocardium, resulting in vasodilation and decreased myocardial contractility.
100
Nifedipine monitoring
Monitor blood pressure regularly. Assess for peripheral edema, gingival hyperplasia, and signs of heart failure exacerbation.
101
Nifedipine adverse side effects
Hypotension, peripheral edema, exacerbation of heart failure symptoms (if used in heart failure).
102
Amlodipine monitoring
Monitor blood pressure regularly. Assess for peripheral edema and signs of heart failure exacerbation
103
Amlodipine major adverse effects
Hypotension, peripheral edema, exacerbation of heart failure symptoms (if used in heart failure).
104

Pharm (6 decks)

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