Pharm Exam 2

Front 1

What is angina?

Back 1

Chest pain on exertion. Can't supply the heart's demand for oxygen

Front 2

What is CHF?

Back 2

Heart doesn't pump hard enough due to damage from previous MI, and get edema (fluid in lungs..throughout body).

Front 3

Define Myocardial Infarction

What two problems can it lead to later?

Back 3

Heart attack. Deficiency in oxygen supply to heart, but some sections are getting NO OXYGEN. Get permanent tissue damage.

CHF and Cardiac Arrhythmias (especially ventricular)

Front 4

What is the recommended ratio of LDL/HDL?

Back 4

Under 2.0.

(2 LDL : 1 HDL) no higher than this.

Front 5

BP reading to be considered hypertensive?

Back 5

140/90.

But even 130 can mean increased chance for bleeding/stroke.

Front 6

Which drugs for hypertensive / prehypertensive people work by lowering lipids?

Back 6

STATINS.

They inhibit the rate-limiting step in cholesterol synthesis.

Front 7

What drug helps prevent MI's by inhibiting platelet aggregation?

Back 7

Baby apsirin

Front 8

When are thrombolytic drugs used?

Back 8

EMERGENCY ROOM ONLY! Given via IV for OCCLUSIVE STROKES (not bleeding strokes). Breakup a thrombus.

Front 9

What drugs are used for CHF? Do they have any issues?

Back 9

Digitalisglycosides

VERY low T-index (3-4). Involved in a lot of ADRs

Front 10

What drug types are used for cardiac arrhythmias?

Back 10

Beta blockers
Ca-channel blockers
IV Lidocaine (during fib)

*Mentioned warfarin/dicumerol, but didn't say it really treats an arrhythmia.

Front 11

Sublingual nitroglycerin (Nitrostat)

How is it used? What does it do

Back 11

ACUTE drug for angina attacks.

No 1st pass effect, works almost as fast as IV.
Gives off NO in blood --> stim cGMP --> vasodilate everywhere
Decreases MYO O2 DEMAND via decreasing heart workload and periph. resistance.

Front 12

Name some bad characteristics of sublingual nitroglycerin.

Back 12

Orthostatic / postural hypotension
Overdose: get a reflex tachycardia (bad)
Strongly oxidizing: can cause METHEMOGLOBANEMA.

Front 13

Name some nitrates people take daily?

Back 13

Isorbide & Erthldinitrate.

These are taken on a fixed schedule to PREVENT attacks by keeping bv's open. These are "prophylactic" nitrates.

Front 14

An alternative to nitrates to take chronically for angina?

Back 14

Beta blockers, they reduce myo-oxygen damand.

Front 15

What is intermittent claudication?

What drugs make it worse?

Back 15

People that have rigid RBCs that have trouble going through occluded blood vessels in legs. Get severe leg pain/cramps.

Beta2 blockers! Receptors here would normally vasodilate, now they can't and are constricted.

Front 16

Name the uses for beta blockers

Back 16

Lowers BP/CO
Fight arrhythmias
Performance anxiety
Migraine headaches - blocks the vasodilatory phase of the spasm

Front 17

How will you remember ca-channel blockers used prophylactically?

Back 17

the -PINES!

But the pines don't touch the heart. Only vasodilate blood vessels!

Therefore, NOT good to treat an acute attack, only prophy

Front 18

What Ca-channel blockers act on both blood vessels AND the heart?

Back 18

Verapamil & Diltiazem

Vasodilate bv's AND decrease HR/C.force

Front 19

Baddies from taking ca-channel blockers?

Back 19

Gingival hyperplasia
Orthostatic hypotension
Interaction with grapefuit / alcohol: levels of drug skyrocket (severe hypotension)

With -pines: see a REFLEX TACHY. (not as much with vera and dilt, bec they are helping heart)

Front 20

What type of person takes CHF drugs?

Back 20

Have had a heart attack and damaged heart muscle, you have low exercise tolerance. Without treatment your heart will FAIL in about a year.

Front 21

How do CHF drugs work?

Back 21

Poison/Block the Na-K-ATPase pump. (which normally pumps K in and Na out)

Block = increases Ca inside cardiac cells, increases C.FORCE

Front 22

What are a secondary effects of CHF drugs that are actually a good thing?

Back 22

Parasympathomimetic: prevent increases in HR

Increase fluid excretion @ kidney: helps with edemas

Front 23

Tight monitoring of CHF drugs: what if drug levels too low? too high?

Back 23

Low = get CHF
High = cardiac arrhythmias

Front 24

Side effects and baddies of CHF drugs?

Back 24

Tight tight monitoring, Tindex of 3. Need to play with dose to get it just right and monitor.

Early side effects: salivation/diarrhea/color and light sensitivity
Worst: ventricular arrythmias

Front 25

Digoxin: what's a problem with this CHF drug?

Back 25

10% of ppl have "eubacterium lentum": which DEACTIVATES 30% of the drug. Need to take higher dose of digoxin to have good effect.

BUT if on ANTIBIOTICS: drug levels of digoxin spike to fatal levels.

Front 26

Digitoxin: what's a problem with it?

Back 26

metabolized by liver more than digoxin, so it has interactions (erythromycin/barbituates..), INCREASE drug levels

Front 27

What else can be used for CHF besides digoxin and digitoxin?

Back 27

Loop Diuretics!! (thiazides used moreso for BP)
Fursemide. Used in addition to digitalglycosides to help with the edemas.

Front 28

Problems with diuretics?

Back 28

Xerostomia / gout / causes increased glucose levels (diabetes), and also excrete too much POTASSIUM.

Low potassium = v.arrhythmias, and digitalis drugs increase the risk further!

Front 29

Potassium sparing diuretics?

Back 29

Sporanolactone (aldosterone inhibitor)

Front 30

Besides digitalis drugs and diuretics, what else for CHF??

Back 30

Alpha blockers! Block a1 receptor, relax bv's.

Another use for them: men with enlarged prostates.

Front 31

ACE inhibitors: what is their main use?

Back 31

Lower BP.

These are the "-prils"

Blocks angio1-->2 conversion. Angio2 normally increases HR via CNS (crosses BBB)

Front 32

Problem with ACE inhibitors?

Back 32

They block breakdown of bradykinin (natural vasodilator), but increase bradykinin leads to unproductive cough in some people, and they hate it (might stop taking the drug).

Also cause "angioedema" - swollen face.

Front 33

Angiotensin 2 receptor blockers

Back 33

Do NOT block the conversion from angio1-->2. Doesn't affect bradykinin breakdown.

These are the "SARTINs" *check*

Used to lower BP!!

Front 34

What drugs to use for arrhythmias?

Back 34

Beta blockers
Ca-channel blockers: NOT the pines, "Veraparnil and diltazen"
Phenytoin - for ppl with epilepsy, which is kind of like an arrhythmia in the brain.

Front 35

Phenytoin: uses and bad effects?

Back 35

Used for arrhythmias

Gingival hyperplasia effect
Lots of sedation with it, crosses the BBB and slows e-activity.

Front 36

Name some a1/b1/b2 blockers:

Back 36

Carvedilol
Labetalol

Front 37

What are Na-channel blockers used for?

Back 37

Emergency situations:

Lidocaine
Procainamide
Amiodarone

Front 38

How do erectile drugs work?

Back 38

Inhibit PDE5 (phosphodiesterase5), and PDE5 normally inactivates cGMP. Leads to elevated cGMP levels --> vasodilates.

Front 39

Basic q: what drug types are A-S-H?

How do they exert effects?

Back 39

Benzo's and Barbs

CNS Depressants, act below the cortex (reticular activating system / limbic system.

@ high doses: will depress the cortex.

Front 40

Define antianxiety

Back 40

Takes the edge off, but can still talk. DON'T DRIVE though.

Front 41

Define sedation

Back 41

Patient is sleepy, but still have protective reflexes.

Front 42

Define hypnosis

Back 42

Induces SLEEP, but patient is STILL ROUSABLE.

If deep enough, you CAN lose protective reflexes.

Front 43

True/False: A-S-H drugs produce some analgesia.

Back 43

FALSE NO ANESTHESIA.

MUST use local or general, something with analgesic effects.

Front 44

Difference between deep sedation and general anesthesia?

Back 44

Deep sedation = in and out of consciousnes. General = you're OUT cold.

Front 45

Problems with barbituates?

Back 45

LOW Tindex
Enzyme inducers (drug interactions)
Hyperalgesic (increased pain)

Front 46

What's the name of the "ultra short acting" barbituate?

Back 46

Methohexital (Brevital)

- still need to use local

Front 47

What are the A-S-H "others" categories?

What is their TI like?

Back 47

Alcohol, Antihistamines, and Carbamates.

Alc/Carb: Ti is inbetween benzos and barbs.

Front 48

How do "muscle relaxants" work?

Back 48

They work on pathways from BRAIN. They do not act on muscles (like curare/dantrolene do)

Front 49

How do the classic antihistamines work (the ones that make you drowsy?)

Back 49

Block H1 receptors.

Front 50

How antihistamines that treat ulcers/reduce GI secretion work?

Back 50

Block H2 receptors

Front 51

Chemical structure mods:
Phenol group on R2?
Putting lots of C's on? ("organics")
Sulfur groupos?

Back 51

Phenol = enhances anti-convulsant activity
Carbons: enhances the CNS depressant effect
Sulfur = increased lipid sol (fast onset/offset)

Front 52

What is thiopentyl (aka Pentohal) used for?

Bad side effect?

Back 52

IV general anesthetic. As an INDUCER, before being put on volatile liquid.

Works FAST, helps get them out within 20 seconds, don't have to wait.

Hangs around lipids for a few days, get a "hangover" effect

Front 53

Compare Midazolam (Versaid) to Diazapam (Valium)

Back 53

Midazolam: short-lived metabolites! And WATER soluble

Diazapam: active metabolites (lasts a long time), dissolve in propylene glycol (burns on injection...'thrombophlebitis')

Front 54

What are some issues with barbituates?

Back 54

Coughing/hiccups after waking up

Tolerance/Abuse!, both pharmacodynamic+kinetic. Dec in post-syn receptors, and barbs induce enzymes to break themselves down

Messes up REM sleep!

Front 55

What is Fiorinal?

Back 55

Combo of ASA (aspirin) + Butalbital.

Treats headaches/migraines.
Withdrawal is BAD.

Front 56

What's worse: withdrawal from opioids or barbituates?

Back 56

BARBS. (+alcohol..)

Get opposite effect, so you see heavy seizures. Don't see this in opioid withdrawal.

Front 57

Antagonist for barbituates?

What happens during overdose?

Back 57

NO ANTAGONIST.

Overdose = resp depression (don't respond to increased CO2), lose protective reflexes. Ensure airway isn't blocked.

Front 58

Antagonist for Benzos? *drum roll*

Back 58

Flumazenil!

Front 59

Methohexatol / Thiopentathol

Back 59

know these..look up info

Front 60

Benzo receptors:
BZ1?

BZ2?

Back 60

BZ1 = sleep! Stim = sleep

BZ2 = cognition/memory/anticonvulsant activity/muscle relax (via CNS)

Front 61

DEA classes:
Barbs vs Benzo?

Back 61

Barbs: many are Class II

Benzos: Class IV. Can still become dependent, but not as often, and withdrawal isn't as bad (no seizures etc)

Front 62

What are some Benzo Benefits!

Back 62

No enzyme induction
More selective than barbs: easier to get anti-anxiety without pushing into sedation
Don't screw up REM sleep
Better at muscle-relaxation

Front 63

Weird drug, and "Inverse Agonist" benzo: what's it called? What does it produce?

Back 63

Beta-Carboline

BINDS to the benzo receptor, but PRODUCES anxiety and convulsions!! (does the opposite of an agonist)

Front 64

When is the one time barbituates beat out benzos as a top choice drug?

Back 64

Treatment of hyperthyroidism...makes epi/NE work better? (?)

Front 65

Use for Clonazepam (Klonopin)?

Back 65

panic attacks

Front 66

Use for Triazolam (Halzion)?

Back 66

"Sleep dentists" : given sublingually, works fast.

Some dentists giving too much of it, levels still rising when they leave office.

Front 67

Use for Alprazolam (Xanax)?

Back 67

Given to people with anxiety/depression.

Front 68

How do you get tolerance from benzo?

Back 68

Downregulation of post-syn receptors. (NOT from enzyme-inducing)

Front 69

Pregnancy category for benzo?

Back 69

D or X. BAD!

Causes cleft palates

Front 70

What drugs can cause anterograde amnesia?

Back 70

Benzodiazepenes

Front 71

Remember: All locals can cause seizures at high enough doses!!

Back 71

woot

Front 72

What's a bad thing to do if you're a patient taking benzos or barbs at home?

Back 72

Drink alcohol. DOUBLE DEPRESSION WHAMMY :'( :'(

Front 73

Benzo structure:

What do the newer ones have?

Back 73

Amidazole ring and random halogens stuck on = increases lipid sol AKA POTENCY

Also: shorter duration (less active metabolites)

Front 74

Benzo structure:

What feature does Flumazenil LACK (that is responsible for activating the receptor?)

Back 74

A benzene ring on the bottom

Front 75

How do benzo receptors and GABA receptors interact?

Back 75

Benzo's INCREASE GABA's affinity for its own receptor. Makes it WORK BETTER!

Remember: each has their own receptor on the Cl-channel. Bound = increased Cl opening freq for Cl influx --> hyperpolarized aka inhibited.

Front 76

What is the receptor for alcohol and barbs?

Back 76

Unknown!

Aside: Chloral Hydrate = jack daniels for kids.

Front 77

What can you give to an alcoholic going through some rough withdrawal symptoms?

Back 77

A-S-H drugs! Benzos or Barbs. There is CROSS TOLERANCE

Also mentioned: antihistamines have no cross tolerance.

Front 78

What makes barbituates/alcohols more dangerous than benzos?

(think mechanisms)

Back 78

Benzos = just increase Cl opening frequency

Barbs = Cl openings PLUS:
physically open Cl channels without GABA present
AND depress excitatory aa's (glutamate)

Front 79

Is giving midazolam/triazolam safe for children?

Back 79

Yes, but WATCH yourself bad things can happen. Can get resp depression (O2 saturation levels plummet)

Kids can also get "gate ataxia"

Kids also more likely to obstruct their our airway during deep sedation

Front 80

Blood pressure indication for hypertension?

Back 80

140/90.

Front 81

Unmodifiable Risk Factors for High BP?

Back 81

Genetics
Increased age
Male
African American
Diabetes

Front 82

Modifiable risk factors for high BP?

Back 82

High sodium (high salt = retained water, get high BP)
Losing weight lowers BP
3-5 drinks a day = increased risk
Smoking (vasoconstricts/inc HR)
Exercise/Stress

Front 83

Mean Arterial Blood Pressure = ?

Back 83

PVR x CO

PVR: bv diameter, type of vessel, stiffness

Front 84

What drugs lower BP by lowering PVR?

Back 84

Alpha 1 blockers
Ca blockers
Nitrates (in emergency situations)
Mentioned later:
Angio2 receptor antagonists / ACE inhibitors

Front 85

What determines CO?

What drugs lowers BP by lowering CO?

Back 85

C.force / HR / Preload

Beta blockers, and some Ca channel blockers (via HR/C.Force)
Preload lower: diuretics

Front 86

3-4 General ways to lower BP:

Back 86

Depress the CNS
Open the pipes (vasodilate)
Depress the pump (b-block/ca-block)
Decrease fluid volume

Front 87

Name the two non-selective alpha blockers mentioned in lecture to tx high BP.

What is an undesired effect of these drugs?

Back 87

phentolamine and phenoxybenzamine

Block A2 = increased NE, get reflex tachycardia

Front 88

What happens when you push the dose of Epi w/ patient on an alpha blocker?

Back 88

BP DECREASES

Get pure beta 2 effects. Called "epinephrine reversal"

Front 89

How will you know a drug is and alpha-1 selective block?

Back 89

ends in "-tocin"

Front 90

Where do thiazides work? What are they used for?

Back 90

Distal tubule: decrease re-ab of Na/H2O (but also decrease re-ab of potassium..can be a problem, cause arrhythmias)

Used for lowering BP. Loop diuretics = for CHF.

Front 91

What is clonidine used for?

Back 91

A 2nd/3rd line drug for antihypertension.

Also used to treat withdrawal from CNS depressants