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mhewett's version from 2016-07-09 22:05

Chapter 22 Antihypertensive Drugs

Question Answer
Normal BP120/80
Prehypertension120-139/80-89
Stage 1 Hypertension140-159/90-99
Stage 2 Hypertension160+/100+
Hypertensive urgency170+/100+
Hypertensive emergency210+/150+
Malignant hypertensiveany BP causing end organ damage
What class of antihypertensive ends in -lol?Beta-blockers
What class of antihypertensives are best for controlling blood pressure in diabetics?ACE inhibitors
What are the three indications for beta-blockers?(1) Hypertension (2) CHF (3) Hyperthyroidism
Nonselective beta-blockers are contraindicated in patients with what two diseases?(1) Asthma (2) COPD
What part of the renal tubule do thiazide diuretics affect? What is the most commonly used thiazide diuretic?Distal convoluted tubule; Hydrochlorothiazide
What drug class includes diltiazem, nifedipine, and verapamil?Calcium channel blockers
Does diltiazem affect the heart, vasculature or both? Nifedipine? Verapamil?Both; Vasculature only; Both
What class of antihypertensive ends in -pril?ACE inhibitors
What class of antihypertensive is associated with dry cough, altered taste, and angioedema?ACE inhibitors
What class of antihypertensive drug decreases total peripheral resistance and is associated with reflex tachycardia?Alpha blockers
What class of antihypertensive ends in -sartan?Angiotensin II receptor antagonists (ARBs)
What class of antihypertensive increases bradykinin?ACE inhibitors
What is first line treatment for essential hypertension?Lifestyle modifications
What is the target blood pressure for the general population? What is the drug of choice for essential hypertension in the general public?<140/90; Thiazides
What is the target blood pressure for a patient with high risk coronary artery disease? What is the drug of choice for the treatment of hypertension in these patients?<130/80; Thiazides
What is the drug of choice for hypertension in patients with diabetes or chronic renal failure?ACE inhibitors
What is the target blood pressure for a patient with a history of coronary artery disease? What is the treatment for hypertension in these patients?<130/80; Beta-blockers + ACE inhibitors OR Angiotensin II receptor antagonists (ARBs)
What is the target blood pressure for a patient with heart failure? What is the treatment for hypertension in these patients?<120/80; Beta-blockers + ACE inhibitors OR Angiotensin II receptor antagonists (ARBs) + Loop diuretic OR Thiazide
What blood pressure classifies stage II hypertension?Systolic BP > 160 OR Diastolic BP > 100
How do beta-beta blockers affect renin production?Decrease renin production
What type of beta receptor to selective beta-blockers affect?Beta-1 receptors
How do thiazide diuretics affect serum sodium, potassium, and calcium levels?Decrease sodium; Decrease potassium; Increase calcium
In terms of blood pressure, diastolic is a measure of the _____, while systolic is a measure of the _____.Vasculature; Heart
What is the drug of choice for the management of hypertension in pregnant women?Alpha-methyldopa
What antihypertensive is associated with hypertrichosis? Cyanide poisoning?Minoxidil; Nitroprusside
What is the drug of choice for heart failure?Digoxin
memorize

Chapter 23 Anti-Angiotensins

Question Answer
What are the three classes of drugs that fall under the category anti-angiotensins?(1) ACE inhibitors (2) Angiotensin II receptor antagonists (ARBs) (3) Aldosterone antagonists
Which has a greater ability to reduce blood pressure, ACE inhibitors or angiotensin II receptor antagonists? Which is associated with a dry cough?ACE inhibitors; ACE inhibitors
Do angiotensin II receptor antagonists affect bradykinin production? What affect does this have?No, therefore no dry cough is associated with the drug. However, blood pressure reduction is not as great.
What drug class does spironolactone belong?Aldosterone antagonists
How does spironolactone (an aldosterone antagonist) affect potassium levels and body pH?Increase potassium (hyperkalemia), Decrease pH (metabolic acidosis)
What are the two indications for anti-angiotensins?(1) Hypertension (2) CHF
What is the mechanism of action of ARBs?Block angiotensin II receptor
What part of the renal tubule does spironolactone affect?Late distal convoluted tubule and collecting duct
memorize

Chapter 24: Ergot Alkaloids, Migraine Medications, and Serotonin Receptor Modulators

Question Answer
What are the two mechanisms by which antimigraine medications induce vasoconstriction?(1) 5-HT1 receptor stimulation (2) 5-HT2 receptor inhibition
What is the mechanism of action of ergotamine? What are the three populations in which this drug is contraindicated?5-HT2 receptor antagonist; (1) Pregnancy (2) Peripheral vascular disease (3) Coronary artery disease
What drug class ends in -triptain? What is their mechanism of action?Triptans; 5-HT1 agonists
Do triptans promote vasodilation or vasoconstriction? What are the three populations in which this drug is contraindicated?Vasoconstriction; (1) Prinzmetal's angina (2) Peripheral vascular disease (3) Uncontrolled hypertension
What class of anti-migraine medication is contraindicated in patients on SSRIs, SNRIs, and MAOIs because of a risk of serotonin syndrome?Triptans
What type of headache is cyproheptadine most commonly used for? What is its mechanism of action?Cluster headaches; 5-HT2 receptor antagonist
What is the affect of stimulating the following serotonin receptors: 5HT1? 5HT2? 5HT3? 5HT4?5HT1: Vasoconstriction; 5HT2: Vasodilation; 5HT3: Vomiting; 5HT4: Increased GI motility
What is the mechanism of action of metoclopramide?5HT4 agonist (increases GI motility)
memorize

Chapter 25: Bromocriptine

Question Answer
What is the mechanism of action bromocriptine?Dopamine receptor agonist, so it stimulates post-synaptic dopamine receptors
What is the primary use for bromocriptine?Treatment of hyperprolactinemia
Does bromocriptine cause vasoconstriction or vasodilation? Does it increase or decrease prolactin release?Vasoconstriction; Decreases
In general, does the relationship between acetylcholine and dopamine have a positive or negative correlation?Negative (i.e. as one increases the other decreases)
memorize

Chapter 26: Diuretics

Question Answer
What does carbonic anhydrase do?enzyme necessary for CO2 + H20 --> H2CO3 (carbonic acid); with carbonic anhydrase present, carbonic acid spontaneously dissociates to H + HCO3
How do CAIs work?normally H is exchanged for Na in PCT; with CAIs, H and Na are not exchanging and Na is not being reabsorbed there so water follows and you get mild diuresis (mild bc Na is absorbed in other places too)
What class of diuretics does acetazolamide belong to? What is its primary use?Carbonic anhydrase inhibitors; Treatment of open angle glaucoma (same H/Na exchanger is responsible for aqueous humor production within eye).
How do carbonic anhydrase inhibitors affect potassium levels and body pH?Decrease potassium (hypokalemia); Decrease pH (metabolic acidosis)
What part of the kidney do loop diuretics affect?Ascending loop of Henle
What is the most commonly used loop diuretic?Furosemide
What do loop diuretics block?Na/K/Cl co transport system
How do loop diuretics affect potassium levels, body pH, and calcium levels?Decrease potassium (hypokalemia); Increase pH (metabolic alkalosis); Decrease calcium (hypocalcemia)
Loop diuretics are contraindicated in patients with _____ allergies.Sulfa allergies
Loop diuretics are DOC for?edema in those with renal disease; they are the most efficient diuretic
What are the most widely used class of diuretics?Thiazides
What part of the kidney do thiazides affect?Distal tubule; inhibits Na/Cl symporter
What is the most commonly used thiazide?Hydrochlorothiazide
What pts are thiazides effective in?those with fully functional kidneys bc the thiazides need to be excreted into the tubular lumen to be effective
Thiazides are first line drug for tx ofhypertensive pts (except those with renal disease
How do thiazides affect potassium levels, body pH, and calcium levels?Decrease potassium (hypokalemia); Increase pH (metabolic alkalosis); Increase calcium (hypercalcemia)
What part of the kidney do potassium sparing diuretics work?(1) Collecting tubule (2) Late distal collecting duct
What class of diuretics does spironolactone belong to? What is its mechanism of action?Potassium sparing diuretics; Inhibits aldosterone (hormone that enhances Na reabsorption in late distal tubule and collecting duct)
How do potassium sparing diuretics affect potassium?Increase (hyperkalemia)
How do triamterene and amiloride work?directly block principal cell Na channels in late distal tubule and collecting duct
Primary indication of K sparing diuretics?hypertension
What are the two most commonly used osmotic agents?(1) Mannitol (2) Urea
What are osmotic agents?hydrophilic agents filtered through the glomeruli, dragging water with them.
When are osmotic agents used?acute renal failure d/t shock or trauma
What is the drug of choice for hypertension in hypertensive patients without renal disease, DM, CHF, or coronary artery disease?Thiazides
What class of diuretics is associated with menstrual irregularities, gynecomastia, leg cramps, and hyperkalemia?Potassium sparing diuretics
memorize

Chapter 27: Antianginal Drugs

Question Answer
What are three classes of antianginal drugs?(1) Nitrates (2) Beta-blockers (3) Calcium channel blockers
What are the four drugs used for the acute presentation of chest pain of suspected cardiac origin?(1) Sublingual nitroglycerin (2) Oxygen (3) Aspirin (4) Morphine
What is the drug of choice for prompt relief of angina due to exertion or emotional stress?Nitroglycerin
What are the five contraindications to nitrates?(1) Hypotension (2) Severe bradycardia (<50bpm) (3) Tachycardia (>100bpm) (4) Right ventricular MIs (5) Patients on erectile dysfunction therapy
What is the most common side effect of nitrates?Headache
What is the drug of choice for Prinzmetal's angina?Calcium channel blockers
What drug class includes diltiazem, nifediine, and verapamil?Calcium channel blockers
Does diltiazem affect the heart, vasculature or both? Nifediine? Verapamil?Both; Vasculature only; Both
memorize

Chapter 28: Platelet Aggregation Inhibitors

Question Answer
What platelet aggregation inhibitor irreversibly acetylates cyclooxygenase?Aspirin
What is the drug of choice for stroke prevention in those with carotid artery disease?Aspirin
What enzyme is inhibited by dipyridamole?Phosphodiesterase
What is the moa of clopidogrel?inhibits the ADP-mediated platelet aggregation process
What platelet aggregation inhibitor is often given to patients who receive stents? What are other uses?Clopidogrel; prophylaxis of MI and CVA
What receptor on platelets aids in platelet-to-platelet aggregation?Glycoprotein IIbIIIa
What drug class do eptifibatide, abciximab, and tirofiban belong to?Glycoprotein IIbIIIa antagonists
What molecule is known to increase platelet stickiness?Thromboxane A2
memorize

Chapter 29: Anticoagulants

Question Answer
What coagulation factors are inhibited by heparin? What protein does it activate?Factors 2, 9, 10, 11, 12; Antithrombin III
What is the major drug for pulmonary embolus and deep vein thrombosis?Heparin
What is the antidote for heparin toxicity?Protamine
What coagulation factors are inhibited by low molecular weight heparin?Factor 10
What drug class do dalteparin and enoxaparin belong to?Low molecular weight heparin (LMWH)
What coagulation factors are inhibited by warfarin and dicumarol?What coagulation factor has the shortest half-life? Factors 2, 7, 9, 10; Factor 7
What is the antidote for warfarin or dicumarol toxicity?Vitamin K
What coagulation factors are inhibited by fondaparinux?Factor 10
What coagulation factors are inhibited by argatroban, bivalirudin, lepirudin, and dabigatran?Factor 2 (thrombin)
In the coagulation cascade, what cofactor helps convert factor 9 to factor 10? Factor 10 to factor 2?Factor 8; Factor 5
What test is used to monitor the affects of warfarin, PT or PTT?PT
Why does warfarin require the co-administration of heparin for the first few days of therapy?Warfarin inhibits proteins C and S (anticoagulants) before it inhibits coagulation factors (i.e. it initially causes hypercoagulation)
memorize

Chapter 30: Thrombolytics

Question Answer
What thrombolytic agent only activates plasmin that is already bound to fibrin?Tissue type plasminogen activator (tPA) (also tenecteplase and reteplase)
What enzyme is activated by both streptokinase and urokinase?Plasminogen
What coagulation factors are degraded by streptokinase?Factors 1, 5, 7
What is the main difference in the mechanism of action between streptokinase and TPA?tPA only activates plasmin already bound to fibrin, while streptokinase activates all plasmin regardless if it is bound to fibrin or not.
What are the three primary thrombolytic agents?(1) Streptokinase (2) Urokinase (3) tPA
memorize

Chapter 31: Antiarrhythmic Drugs

Question Answer
What class of drug are class I antiarrhythmics? Class II? Class III? Class IV?Sodium channel blockers; Beta blockers; Potassium channel blockers; Calcium channel blocker; MNEMONIC: Silly Bunnies Punch Cats
What class of antiarrhythmics do quinidine and procainamide compose?Class IA
What class of antiarrhythmics do lidocaine and phenytoin compose?Class IB
What class of antiarrhythmics does flecainide compose?Class IC
Class I antiarrhythmics can be subdivided based on their effect on the action potential in the heart. What subclass mildly slows phase 0 (i.e. depolarization)?Class IA
Class I antiarrhythmics can be subdivided based on their effect on the action potential in the heart. What subclass mildly slows phase 0 (i.e. depolarization) while significantly shortening phase 3 (i.e. repolarization)?Class IB
Class I antiarrhythmics can be subdivided based on their effect on the action potential in the heart. What subclass significantly shortens phase 0?Class IC
What is the preferred class II antiarrhythmic? What is the number one cause of death following an MI?Metoprolol; Arrhythmia
What phase of an cardiac action potential is effected by class II antiarrhythmics?Phase 4 (i.e. resting membrane potential)
What is the major class III antiarrhythmic? What are its two major adverse effects?Amiodarone; (1) Pulmonary fibrosis (2) Thyroid dysfunction
What class of antiarrhythmics do verapamil and diltiazem compose?Class IV (calcium channel blockers)
What part of a cardiac action potential is characterized by phase 0? 1? 2? 3? 4? 0: Depolarization; 1: Inactivation of Na channels; 2: Plateau; 3: Repolarization; 4: Resting membrane potential
memorize