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Pharm 32-42

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mhewett's version from 2016-07-13 02:48

Chapter 32: Inotropic Drugs

Question Answer
All inotropic agents have a similar final mechanism of action, and that is that they all increase the amount of intracellular _____.Calcium
How do cardiac glycosides enhance the contractility of the heart?Inhibit the Na-K pump, which in turn inhibits the Na-Ca exchanger (this causes increased intracellular calcium)
What is often the first sign of glycoside toxicity?Change in vision (objects appear yellow)
What is the preferred cardiac glycoside? What glycoside is approved for use in patients with liver failure?Digitoxin; Digoxin
How do beta agonists enhance the contractility of the heart?Activate adenyl cyclase, which in turn increases cAMP (this causes increased intracellular calcium)
How do phosphodiesterase inhibitors enhance the contractility of the heart?Decrease phosphodiesterase activity, which in turn increases cAMP (this causes increased intracellular calcium)
What are the three major drug classes used as inotropic agents?(1) Glycosides (2) Beta agonists (3) Phosphodiesterase inhibitors
What is the drug of choice for the treatment of CHF?Glycosides (e.g. digitoxin, digoxin)
What is the drug of choice for cardiogenic shock?Dobutamine
What enzyme produces cAMP? What enzyme breaks down cAMP?Adenylyl cyclase; Phosphodiesterase
In general, does cAMP make cells more active or inactive?Active
memorize

Chapter 33: Asthma

Question Answer
What are the four types of asthma? What type is the most common?(1) Intrinsic (2) Extrinsic (3) Exercise-induced (4) Drug-induced; Extrinsic (type 1 hypersensitivity)
How would you classify asthma that occurs less than 2 days per week?Greater than two days per week, but not daily? Intermittent; Mild persistent
How would you classify asthma that occurs daily?How would classify asthma that is continuous? Moderate persistent; Severe persistent
What is the treatment for intermittent asthma?Short-acting beta-2 agonists (e.g. albuterol)
What is the treatment for mild persistent asthma?Inhaled glucocorticoids + Short-acting beta-2 agonists
What is the treatment for moderate persistent asthma?Inhaled glucocorticoids + Long-acting beta-2 agonists + Short-acting beta-2 agonists
What is the treatment for severe persistent asthma?Inhaled glucocorticoids + Oral glucocorticoids + Long-acting beta-2 agonists + Short-acting beta-2 agonists
What drug class do formoterol and salmeterol belong to?Are these short-acting or long-acting? Beta-2 agonists; Long-acting
What drug is used for the prophylaxis of asthma? What is its mechanism of action?Cromolyn; Stabilizes mast cells
What is the corticosteroid of choice for status asthmaticus?Methylprednisolone (IV)
What is the first line therapy for acute anaphylactic shock?Epinephrine
What is the drug of choice for any obstructive lung disease?Beta-2 agonists
What enzyme is inhibited by steroids?Phospholipase A2
What type of receptor triggers dilation of muscle arterioles and bronchi? Are these sympathetic or parasympathetic responses?Beta 2; Sympathetic
What type of receptor causes an increased HR, increased conductance, and increased force of heart contraction? Are these sympathetic or parasympathetic responses?Beta 1; Sympathetic
memorize

Chapter 34: Insulins

Question Answer
Which of the following is NOT a short-acting insulin? A) Regular insulin B) Lente C) Insulin lispro D) Insulin aspart E) Insulin glulisineB) Lente
Which of the following is NOT an intermediate-acting insulin? A) Neutral protamine hagedorn B) Lente C) Humulin 70/30 D) Ultralente E) None of the aboveD) Ultralente
Which of the following is NOT a long-acting insulin? A) Ultralente B) Insulin glargine C) Insulin lispro D) Protamine zinc insulin E) Insulin detemirC) Insulin lispro
What are the three populations of patients treated with insulin?(1) Type II diabetic for whom oral medications and diet are not effective (2) Hospitalized patients with transient hyperglycemia (3) All type I diabetics
What is the alternative name for regular insulin?Crystal zinc insulin (CZI)
What class of insulins are frequently used for daily, regular diabetes treatment?Intermediate-acting insulins
memorize

Chapter 35: Antihyperglycemic and Hypoglycemic Medications

Question Answer
What is the first line medication for patients diagnosed with Type 2 diabetes mellitus? What is its mechanism of action?Metformin (a biguanide); Decrease hepatic glucose production and increase glucose uptake by adipose tissue and skeletal muscle
What are the four different criteria used to diagnose diabetes mellitus?(1) A random glucose ≥200mg/dL with symptoms (2) A fasting glucose ≥126mg/dL (3) A serum glucose test ≥200 mg/dL 2 hours after administration of oral glucose (4) HbA1C ≥ 6.5%
What drug class do acarbose and miglitol belong to?Alpha-glucosidase inhibitors
What is the most common adverse effect of alpha-glucosidase inhibitors?Flatulence
What drug class do pioglitazone and rosiglitazone belong to?Thiazolidinediones
What is the FDA black box warning associated with rosiglitazone?Rosiglitazone may be associated with increased risk of MI
What are meglitinides?(nateglinide, repaglinide) non-sulfonylurea insulin secretagogues -- cause increased insulin release by beta-islet cells
What anti-obesity drug is an amylin analog and known to decrease gastric emptying?Pramlintide
What two anti-obesity drugs are a GLP-1 agonist?(1) Exenatide (2) Liraglutide
What drug class do sitagliptin, saxagliptin, linagliptin, and alogliptin belong to?Dipeptidyl peptidase-4 (DDP-4) inhibitors
What is the mechanism of action for sulfonylureas and meglitinides?Promote insulin release
Patients who are approaching diabetes Type 2, but still do not have the criteria for that diagnosis, are said to have _____.Metabolic syndrome
What are SGLT2 inhibitors?(canagliflozin, dapagliflozin) block reabsorption of glucose from PCT, increasing glucose loss via urine
memorize

Chapter 36: Hyperlipidemias

Question Answer
What are the three etiologies of type I hyperlipidemia?(1) Lipoprotein lipase deficiency (2) Abnormal lipoprotein lipase (3) apo-CII defects
What is the primary etiology of type IIa hyperlipidemia?Defect of the LDL receptor
What is the primary etiology of type IIb hyperlipidemia?Mutant apoprotein B100
What is the primary etiology of type III hyperlipdiemia?Mutant apo E
What is the primary etiology of type IV hyperlipdiemia?Overproduction of VLDL
What is the most common type of inherited hyperlipdiemia?Type IV hyperlipdiemia (Familial hypertriglyceridemia)
What is the most common type of hypercholesterolemia?Polygenic hypercholesterolemia
What type of hyperlipidemia is represented by Familial lipoprotein lipase deficiency? By Familial dysbetalipoproteinemia?Type I; Type III
What type of hyperlipidemia is represented by Familial hypercholesterolemia? By Familial hypertriglyceridemia?Type II; Type IV
How are most of the familial hyperlipdiemias inherited?Autosomal dominant
Will familial lipoprotein lipase deficiency cause an increase, decrease, or no change in the levels of chylomicrons? VLDLs? LDLs? HDLs?Increase; Increase; Decrease; Decrease
Will type IIa familial hypercholesterolemia cause an increase, decrease, or no change in the levels of chylomicrons? VLDLs? LDLs? HDLs?No change; No change; Increase; No change
Will familial dysbetalipoproteinemia cause an increase, decrease, or no change in the levels of chylomicrons? VLDLs? LDLs? HDLs?Increase; Increase; Increase; Decrease
memorize

Chapter 37: Hyperlipidemia Drugs

Question Answer
Hypertriglyceridemia is typically defined as a serum triglyceride level in excess of _____ mg/dL.>150 mg/dL;
Patients with CHD or equivalent should have an LDL goal of less than _____ mg/dL. These patients require drug therapy once LDL values exceed _____ mg/dL.<100 mg/dL; >100 mg/dL;
Patients with 2 or more risk factors should have an LDL goal of less than _____ mg/dL. These patients require drug therapy once LDL values exceed _____ mg/dL.<130 ; >160 mg/dL
Patients with 1 or fewer risk factors should have an LDL goal of less than _____ mg/dL. These patients require drug therapy once LDL values exceed _____ mg/dL.<160 mg/dL; >190 mg/dL
What are the two drug classes of first choice for the treatment of hypercholesterolemia?(1) HMG-CoA reductase inhibitors (statins) (2) Bile acid sequestrants
What drug decreases LDLs and triglycerides, while simultaneously increasing HDLs?Niacin (nicotinic acid)
What is the most common adverse effect of niacin (nicotinic acid)?Severe flushing and pruritis
What class of drug do gemfibrozil and fenofibrate belong to?Fibrates (fibric acid derivatives)
What is the drug of choice for hypertriglyceridemia?Fibrates (e.g. gemfibrozil and fenofibrate)
What class of drug do colestipol, cholestyramine, and colesevelam belong to? What is the major contraindication to this drug class?Bile acid sequestrants; Hypertriglyceridemia
What drug class causes an increase in hepatic VLDL and as a result, increase triglycerides?Bile acid sequestrants
What drug class blocks the rate-limiting step in cholesterol biosynthesis?HMG-CoA reductase inhibitors
What organ toxicity do all HMG-CoA reductase inhibitors share?Hepatotoxicity
Besides hepatotoxicity, statins are known to cause signficant _____.Myopathy (which may progress to rhabdomyolysis)
What drug class, commonly used to treat hyperlipidemia, is also known to have anti-hypertensive and anti-inflammatory effects?HMG-CoA reductase inhibitors
memorize

Chapter 38: Peptic Ulcers

Question Answer
What three agents cause hydrogen ion deposition in the stomach lumen?(1) Histamine (2) Acetylcholine (3) Gastrin
What drug used to treat peptic ulcer disease is associated with gynecomastia, galactorrhea, and decreased sperm count?Cimetidine
What drug class ends in the suffix -tidine?H2-blockers
What drug, used to prevent NSAID induced ulcers, is an abortifacient?Misoprostol (causes uterine contractions)
What is the drug of choice for peptic ulcers? What drug class does it belong to?Omeprazole; Proton pump inhibitors
What drug or drug class reacts with hydrochloric acid to neutralize gastric acid in the stomach?Antacids
Antacids containing _____ cause constipation. Antacids containing _____ cause diarrhea.Aluminum; Magnesium
What antacid is associated with alkalosis?Sodium bicarbonate
What drug is most effective for the treatment of infectious diarrhea?Bismuth
What drug, used to treat and prevent peptic ulcers, requires a low pH to become activated?Sucralfate
memorize

Chapter 39: Adrenergic Drugs

Question Answer
Do adrenergics act on the sympathetic or parasympathetic nervous system? Are they inhibitory or stimulatory?Sympathetic; Stimulatory
What are the two classes of receptors most notably affected by adrenergic drugs?(1) Alpha receptors (2) Beta receptors
What sympathetic receptor serves to cause vasoconstriction and increased peripheral resistance?Alpha-1 receptor
What sympathetic receptor serves to increase blood pressure, dilate the pupils, and increase internal bladder sphincter tone?Alpha-1 receptor
What sympathetic receptor serves to decrease norepinephrine and insulin release?Alpha-2 receptor
What sympathetic receptor serves to cause tachycardia and increased cardiac contractility?Beta-1 receptor
What sympathetic receptor serves to increase lipolysis?Beta-1 receptor
What sympathetic receptor causes vasodilation in vessels of skeletal and cardiac muscle?Beta-2 receptor
What sympathetic receptor causes bronchodilation and relaxes the uterus?Beta-2 receptor
What sympathetic receptor increases gluconeogenesis and glycogen release?Beta-2 receptor
Which of the dopamine receptors causes renal and mesenteric vasodilation? Norepinephrine release?D1; D2
What are the three catecholamines?(1) Norepinephrine (2) Epinephrine (3) Dopamine
What is the mechanism of action of phentolamine? How about prazosin and terazosin?Non-selective alpha antagonist; Alpha-1 antagonist
What is the mechanism of action of clonidine?Alpha-2 agonist
What class of anti-adrenergic will cause bronchoconstriction?Beta-2 antagonists
What is the mechanism of action of terbutaline and albuterol?Beta-2 agonists
memorize

Chapter 40: Cholinesterase Inhibitors

Question Answer
Do cholinesterase inhibitors act on the sympathetic or parasympathetic nervous system? Are they inhibitory or stimulatory?Parasympathetic; Stimulatory
What is the antidote for overdose with TCAs and atropine?Physostigmine
What is the antidote for organophosphate toxicity?Atropine, Pralidoxime
What are six signs/symptoms of cholinergic overdose?(1) Salvation (2) Lacrimation (3) Urination (4) Defecation (5) GI upset (6) Emesis; MNEMONIC: SLUDGE
What is the antidote for cholinergic crisis?Atropine
What drug is used to diagnose patients with myasthenia gravis?Edrophonium
What class of cholinesterase inhibitor is used to treat closed angle glaucoma?Organophosphates
What is the mechanism of action of physostigmine and neostigmine? Which is associated with an adverse effect of spastic paralysis?Inhibit cholinesterase; Neostigmine
What is the primary used for physostigmine and neostigmine?Treatment of myasthenia gravis
memorize

Chapter 41: Direct Cholinergic Drugs

Question Answer
Do direct cholinergic drugs act on the sympathetic or parasympathetic nervous system? Are they inhibitory or stimulatory?Parasympathetic; Stimulatory
What type of receptors do most cholinergic drugs affect?Muscarinic receptors
What are six signs/symptoms of cholinergic overdose?(1) Salvation (2) Lacrimation (3) Urination (4) Defecation (5) GI upset (6) Emesis; MNEMONIC: SLUDGE
What direct cholinergic is often used for atonic bladder, especially when the patient is postpartum?Bethanechol
What direct cholinergic is the most potent stimulator of glandular secretion (i.e. increases salivation, etc.) if used systemically?Pilocarpine
memorize

Chapter 42: Anti-Muscarinic Drugs

Do anti-musarinic drugs act on the sympathetic or parasympathetic nervous system? Are they inhibitory or stimulatory? Parasympathetic; Inhibitory
What is the antidote to edrophonium overdose? Atropine
What are the two belladonna alkaloids we discussed? What are their mechanism of action? (1) Atropin (2) Scopolamine; Block muscarinic receptors
What is the primary adverse effect of scopolamine at low doses? At high doses? Sedation; Excitement