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71 Cards in this Set
- Front
- Back
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Pts with CHF can have their survival increased by tx of what 2 things?
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1)increased SNS activity
2)elevated renin-angiotension-aldosterone system |
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What 3 types of drugs increase survival in CHF pts?
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1)ACE inhibitors
2)Beta blockers 3)Aldosterone antagonists (spironolactone and epelerone |
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What are the 3 currently accepted management regimes for CHF pts?
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1)increased contractility
2)decrease afterload 3)decrease preload |
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What 3 drugs work to increase contractility?
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1)digoxin
2)dobutamine 3)milirone |
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What is important to remember about milirone and dobutamine?
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both are reserved for the tx of acute CHF; milirone has been shown to increase mortality if used chronically
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What is the MOA of dobutamine?
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beta-1 agonist
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What is the MOA of milirone?
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PDE-3 blocker
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What 2 drug classes can be used to decrease afterload?
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1)ACE inhibitors
2)hydralazine |
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What are the two key side effects of ACE inhibitors? What population of people are at greatest risk?
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angioedema and dry cough; African Americans
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What is the major side effect of hydralazine? What population of people are at greatest risk?
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SLE; slow acetylators
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What 2 drugs can be used to help decrease preload?
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1)furosemide
2)isosorbide mononitrate |
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What is an adverse drug rx seen with isosorbide mononitrate?
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can cause dangerously low BP when used in combination with PDE-5 inhibitors
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What is the MOA for furosemide?
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causes vasodilation through synthesizing prostaglandins and also quickly causes diuresis
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An increased chance of what drug toxicity can be seen with furosemide?
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digoxin
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What is the suffix for all ACE inhibitors?
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-PRIL
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What is the suffix for AII receptor blockers?
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-SARTAN
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What 3 types of drugs should not be used in CHF pts?
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1)Na+ retention increasing drugs (NSAIDS, corticosteroids, and liqourice)
2)drugs that decrease myocardial contractility (CCBs, beta blockers) 3)Herceptin (trausumab) |
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What is MOA for digoxin?
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affects the Na+/K+ ATPase by decreasing Na+ extrusion from cell which decreases driving force for Na+/Ca++ exchanger resulting in increased cytosolic Ca++
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Decreasing extracellular K+ has what effect on digoxin binding?
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increases binding and can lead to toxicity
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Increasing extracellular K+ has what effect on digoxin binding?
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decreases binding
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What drug toxicity can cause an elevated T wave on EKG, N/V, diarrhea, and seeing yellow spinning halos?
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digoxin
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What is the tx for digoxin overdose?
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digoxin specific Abs
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What 4 drugs are contraindicated in pts on digoxin?
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1)amiodarone
2)quinidine 3)verapamil 4)spironolactone |
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What 3 categories of drugs that reduce the formation of fluid in the eye and are helpful in tx of glaucoma?
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1)beta blockers
2)alpha-2 agonists 3)CA inhibitors |
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What 3 categories of drugs act by increasing the outflow of fluid in the eye and are helpful in the tx of glaucoma?
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1)prostaglandins
2)muscarinic agonists 3)non-selective adrenergic agonists |
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*What is the important beta blocker used for the tx of glaucome?
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timolol
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What is the important alpha-2 agonist used for the tx of glaucoma?
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apraclonidine
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What are the 2 important CA inhibitors used for glaucoma tx?
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acetazolamide
dorzolamide |
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*What is the important prostaglandin used to tx glaucome?
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latanoprost
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What are 2 parasympathomimetics used to tx glaucoma?
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pilocarpine
carbachol |
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What are the 3 non-selective alpha agonists used in glaucoma tx?
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epinephrine
dipivefrin |
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What type of glaucoma is a medical emergency?
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closed angle glaucoma - lens moves anteriorly due to pressure
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*What drugs are contraindicated in closed angle glaucoma?
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muscarinic agonists for example atropine
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What is the suffix for H2 receptor antagonists?
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-TIDINE
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What is the MOA for H2 receptor antagonists?
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reduce volume of gastric acid secretion and pepsin secretion
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*Which H2 receptor antagonist inhibits cytochrome p450?
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cimetidine
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What is the suffix for PPIs?
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-PRAZOLE
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What is the MOA for PPIs?
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irreversibly inhibit K+/H+ ATPase in parietal cells and greatly reduces acid secretion
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*What 2 PPIs inhibits cytochrome p450?
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omeprazole
lansoprazole |
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*What drug is used to prevent NSAID-induced gastric injury?
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misoprostol
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Can misoprostol be used during pregnancy?
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no
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What is the MOA of sucralfate in the tx of gastric ulcers?
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provides a protective barrier by forming a gel that adheres to ulcer crater
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What are the MOA of the bismuth compounds?
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form a protective coating, increase prostaglandin production, have anti- H.pylori activity
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What tx for gastric ulcers should be used with caution in CHF and HTN pts?
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antacids; you don't want pts to retain Na+ and water
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What is metoclopramide?
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prokinetic agent used to tx GERD; increases release of Ach which results in increased LES pressure and increased gastric emptying
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What can chronic GERD lead to?
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Barrett's esophagus which can be a precursor to esophageal cancer
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What is the most important complication seen in pts w/ diarrhea?
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acute salt and water depletion that can lead to dehydration and/or electrolyte imbalance
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When should you prescribe nonspecific antidiarrheals?
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in mild cases of diarrhea with painful cramps, but with NO FEVER AND NOT FOR >3 DAYS
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Which pts should not use antimotility agents (opioids) for diarrhea?
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pts with acute, severe colitis as manifested by bloody, mucoid diarrhea
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What is the effect of opioids acting on mu receptors?
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reduced motility, increased transit time which increases time for absorption of water and salts
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What is the effect of opioids acting through delta receptors?
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decreased secretion and/or increased absorption of water and salts
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Which opioid can enter the CNS? Which can't?
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diphenoxylate
loperamide |
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Which drug is useful for preventing and tx traveler's diarrhea? What are the 2 side effects of this drug?
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bismuth subsalicylate; can cause dark stools and staining of teeth
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What drug can be used to reduce diarrhea caused by functioning GIT tumors?
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octreotide
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What are the 2 ways that the drugs used to tx constipation can work?
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either by increasing the bulk in the intestinal lumen or by softening the stool
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What are the 2 saline and osmotic laxatives?
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Mg(OH)2 and lactulose
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What are the 2 stimulant laxatives?
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bisacodyl and castor oil
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What are the 2 bulk forming laxatives?
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bran and psyllium
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What are the 2 surfactant and emollient laxatives?
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docusate and mineral oil
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What are the contraindications for the use of laxatives?
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pts with cramps, colic, N/V, undiagnosed abd pain, or symptoms of appendicitis
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What is the drug used for IBS with constipation?
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tegaserod (5HT4 agonist)
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What is the drug used for IBS with diarrhea?
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alosetron (5HT3 antagonist)
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What is the drug used for chronic constipation?
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lubiprostone
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What is the anti-cholinergic drug used for vomiting?
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scopolamine
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What are the 2 H1 antagonists used for vomiting?
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diphenhydramine and promethazine
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What are the 2 D2 antagonists used for vomiting?
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droperidol and metoclopramide
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What is the cannibinoid drug used for vomiting?
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nabilone
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What is the corticosteroid drug used for vomiting?
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dexamethasone
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What is the suffix for 5HT3 antagonist?
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-SETRON
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What is the use of 5HT3 antagonists in cancer pts?
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can help reduce vomiting
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What drugs can be used for "anticipatory vomiting" in cancer pts?
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benzodiazepines
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