Pharmacology Test 2

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Author:
rekline
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266110
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Pharmacology Test 2
Updated:
2014-03-14 16:00:20
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cardiology anticoagulant mens health womens
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PHARM
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  1. Common adverse effects of diuretics:
    • Hypovolemia - elctrolyte changes
    • Hyperglycemia
    • Increased cholesterol and triglycerides
    • Decreased potassium (except with PS)(Affects NaCL/K+ pump)
    • Hyperuricemia - gout
    • Increase calcium with thiazides
    • Decrease calcium with loops
    • Impotence
  2. Loops: Increase Dose
    Increases Response
  3. Thiazides: increase dose
    • side effects increase
    • response plateaus
  4. Drug interactions with Diuretics:
    • Digoxin
    • Lithium
    • NSAIDS
    • ACE inhibitors
    • K+ Supplements
  5. Potential Problems with Diuretics:
    • Resistance
    • Thiazide sensitivity to renal function
  6. Beta 1 Receptors:
    Increase: heart rate, contractility, renin release (vasoconstriction)
  7. Beta 2 Receptors:
    Relaxation of vascular, bronchial and uterine smooth muscle; increase glycogenolysis, increase insulin release, increase tremor
  8. Alpha 1 Receptors:
    Vasoconstriction, mydriasis, piloerection, and increase glycogenolysis
  9. Alpha 2 Receptors:
    decrease neuronal transmitter release, increase platelet aggregation, decrease lipolysis, decrease insulin release
  10. Beta Blockers MOA
    • Antagonize (block) the b1 and b2
    • receptors:
    • –Decrease heart rate

    –Decrease contractility

    • –Decrease renin release (decrease
    • angiotensin II) Major vasoconstriction
  11. Beta Blockers MOA for HF
    • Restore heart rate variability - pt may feel worse initially
    • Prevent arrhythmia (common cause of death in HF) occurrence by stopping NE at the site
    • Prevent/slow remodeling process
    • Inhibit renin secretion
  12. Beta Blocker adverse effects:
    • Bronchospasm
    • Heart failure
    • Bradycardia/bradyarrhythmias
    • Vasospasm
    • Metabolic abnormalities
    • Hyperglycemia/¯ insulin sensitivity
    • Decreased HDL
    • Depression (all BP drugs increase risk for depression especially BB)
    • Withdrawal syndrome (d/c over 1-2 wks) - huge risk for rebound HTN because of increased sensitivity
  13. Cardio Selective Beta Blockers:
    • Metropolol
    • Atenolol
    • Bisoprolol
    • Betaxolol
    • Nibivolol
    • Acebutolol
    • Esmolol
  14. Non-Selective Beta Blockers:
    • Pindolol
    • Carvedilol
    • Labetilol
    • Propanolol
  15. Intrinisic Sympathomimetic Activity (ISA) Beta Blockers:
    • Acebutolol
    • Pindolol
    • NEVER USE IN HF
  16. Vasodilating Beta Blockers:
    • Carvedilol (Alpha1 Antagonist)
    • Nibivolol (increased NO )
    • Labetolol (Alpha 1 Antagonist)
  17. Calcium Channel Blockers:
    • Inhibit calcium influx @ SA/AV node to slow conduction
    • cause vasodilation &/or decreased HR & strength of contraction
  18. Non-DHP Calcium Channel Blockers:
    • Verapamil 
    • Diltiazem
    • *Cause other drugs to be metabolized differently
  19. Dihydropyradines - Calcium Channel Blockers
    • Amlodipine
    • Nicardipine
    • Clevidipine
    • Nifedipine
    • Felodipine
    • Nimodipine
    • Isradipine
    • Nisoldipine
  20. Effects special to diltiazem and verapamil:
    Negative inotropic and chronotropic effects
  21. Effects special to dihydropyridines:
    No effects on conduction in vivo
  22. Calcium Channel Blockers Adverse Effects:
    • Headache
    • Flushing
    • Pedal Edema
    • Constipation
    • Hypotension
    • Reflex tachycardia - DHP
    • Bradycardia, CHF, AV Block - Non-DHP
  23. ACE Inhibitor Side Effects:
    • Hypotension/dizziness
    • Cough/Angioedema (bradykinin?)
    • Renal Dysfunction
    • Highest risk of ARF: Volume depleted, Renal vascular disease, vasoconstricting drugs
    • HyperKalemia: Usual increase <1, greatest risk when SCr >1.6
  24. ACE Inhibitors Drug Interactions:
    • K+ Supplements
    • NSAIDS (especially with diuretic and/or LFV)
    • Cyclosporine
  25. ACE inhibitors:
    • Benazapril
    • Captopril
    • Enalapril
    • Fosinopril
    • Moexipril
    • Perindopril
    • Quinapril
    • Ramipril
    • Trandolipril
    • *When inhibiting ACE you prevent vasoconstriction
  26. Diuretics Important Facts:
    • all work in nephron
    • Do NOT work in PCT because NaCL would be reabsorbed further down the line
    • Loops work regardless of renal function
    • Thiazides are sensitive to renal function
    • *Make all BP meds work better; preferred initial agent
    • *For HF symptomatic improvement only
  27. ACE Inhibitors Facts:
    • Useful step one or two HTN agent - especially those with DM, post-MI, or high CAD risk
    • All pt's with EF <40%
    • Start low dose and increase slowly "Target Dose"
    • Benefits take time
    • Opens efferent arteriole
    • DO NOT take during pregnancy especially later
  28. ARB's facts:
    • Work later in the RAAS system
    • Don't affect bradykinin - no cough/angioedema
    • -artan
  29. Aldosterone Antagonists
    • Spironolactone and Eplerenone
    • Much more expensive option
    • choice in low-renin HTN
    • Block aldosterone in kidney, hold K+, excrete NaCL
    • Bigger effect on HF - decreased mortality and morbidity, reduced NaCL H2O retention, reduced Myocardial and vascular fibrosis
  30. ARB's
    • Candesartan
    • Spresartan
    • Irbesartan
    • Losartan - preferred in pt's with gout
    • Olmesartan
    • Telmisartan
    • Valsartan
    • Azilsartan
  31. Aldosterone antagonist Adverse effects:
    • Hyperkalemia.  DO NOT USE IF: K+>5.0, impaired renal function, DM with microalbumuria, using K+ diuretic or K+ supplement
    • Gynecomastia (not gender specific)
    • Drug interactions
  32. Renin inhibitors
    • Aliskiren - works on renin by inhibiting renin activity.  Effects last at least 1 month after d/c
    • Efficacy comparable to ACEI's and ARB's
    • Long absorption and elimination
  33. Alpha Blockers (drugs)
    Doxazosin, Terazosin, Prazosin
  34. Alpha blockers MOA:
    • Vasodilate (bc they block constriction) via alpha1 receptor antagonism
    • *significant postural hypotension risk.  Risk decreases over time.
    • **Never use alone, use with diuretic
    • Combination therapy for BPH
  35. Centrally Acting Sympathetic Agonists (Drugs)
    Clonidine, Guanifacine, Guanabenz, Methyldopa
  36. Centrally Acting Sympathetic Agonists:
    • Turn off sympathetic outflow
    • MUST BE USED IN COMBINATION WITH DIURETIC BC sodium/H2O retention
  37. Methyldopa (centrally acting sympathetic agonists): Special considerations
    • requires metablism to methylnorepinephrine
    • AE's include hemolytic anemia, hepatotoxicity
  38. centrally acting sympathetic agonists: adverse effects
    • sedation, dry mouth, bradycardia, partial tachyphylaxis, orthostatic hypotension, constipation, impotence
    • **Withdrawal is a big deal - more so than with BB
  39. Vasodilators (drugs)
    • Hydralazine
    • minoxidil
  40. Vasodilators SE:
    • fluid retention
    • reflex tachycardia
    • headache/flushing
    • lupus syndrome - rash, joint pain
    • hypertrichosis (minoxidil) - hair growth
  41. Non-DHP CCB - effect
    Strong effect on heart - weak vasodilatory effect
  42. DHP - effects
    Strong vasodilation - weak effect on heart (increases HR to compensate for vasodilation)

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