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133 Cards in this Set
- Front
- Back
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3 classes of diuretics
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- thiazides
- loop diuretics - k+ sparing agents |
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example of thiazide
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hydrochlorothiazide
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3 examples of loop diuretics
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- furosemide
- torsemide - bumetenide |
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3 examples of k+ sparing agents
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- amiloride
- triamterene - spironolactone |
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site of action for furosemide, torsemide
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loop of henle
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site of action for hydrochlorothiazide
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distal convoluted tubule
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site of action for spironolactone, amiloride
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collecting duct
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what is the drug of first choice for hypertension
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hydrochlorothiazide (diuretic)
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dental considerations for diuretics
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- gingival bleeding
- higher incidence of infection - xerostomia |
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alpha-2 receptors mediate ______________
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vasodilation
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example of an alpha-2 agonist
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clonidine
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effect of clonidine
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vasodilation --> lower arterial pressure
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beta blockers are almost always used with ___________
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diuretics
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beta blockers improve ____________
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survival (in hypertension)
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examples of beta blockers
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- propranolol
- metoprolol - toprol - atenolol - carvedilol |
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alpha-1 receptors mediate __________
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vasoconstriction
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examples of alpha-1 antagonists
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- prazosin
- terazosin |
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prazosin is usually used in combination with ______________________
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propranolol and/or a diuretic
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2 examples of vasodilators
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- hydralazine
- minoxidil |
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effects of vasodilators
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- decrease peripheral resistance
- increase heart rate - increase cardiac output |
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vasodilators are co-administered with __________________
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beta-blocker and diuretic
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vasodilators are only used in ___________________
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refractory hypertension
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examples of Ca 2+ channel blockers
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- verapamil
- diltiazem - nifedipine |
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when are calcium channel blockers recommended
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when beta blockers and diuretics are not useful or are contraindicated
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examples of ace inhibitors
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drugs that end with 'pril'
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examples of angiotensin II receptor inhibitors
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drugs that end with 'sartan'
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angiotensin II receptor inhibitors effect _________________
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AT1 receptors
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order of hypertension treatments from first to last
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1- diuretics
2- beta blockers 3- ace inhibitors 4- ca channel blockers if all else fails |
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_____________ potentiate the hypotensive effects of alpha and beta blockers
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opioids
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special dental considerations for hypertension meds
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ca channel blockers: gingival enlargement
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class IA mechanism and effect
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mechanism: Na channel blocker
effect: slows phase 0 depolarization |
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class IB mechanism and effect
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mechanism: Na channel blocker
effect: Shortens phase 3 repolarization |
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class IC mechanism and effect
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mechanism: Na channel blocker
effect: slows phase 0 depolarization |
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class II mechanism and effect
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mechanism: Beta blocker
effect: suppresses phase 4 depolarization |
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class III mechanism and effect
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mechanism: K channel blocker
effect: prolongs phase 3 repolarization |
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class IV mechanism and effect
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mechanism: Ca channel blocker
effect: shortens action potential |
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treatments for sinus bradycardia
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- atropine
- isoproterenol - epinephrine |
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isoproterenol is a ___________
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beta agonist
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treatment for sinus tachycardia
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propranolol
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in sinus bradycardia and tachycardia, depolarization originates at the
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sa node
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beta blockers prolong ___________
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A-V conductance
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___________ is most commonly used to treat arrhythmias
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propranolol
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what is a multifocal atrial tachycardia
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depolarization originates at several atrial foci at irregular intervals - so the P-R interval varies
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treatments for multifocal atrial tachycardia
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- straining as if lifting a heavy object
- massaging the carotid - cold cloth on face - ca channel blocker (verapamil) - beta blocker - quinidine (IA) |
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class I agents block _______________
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voltage-sensitive Na channels
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examples of class IA
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- quinidine
- procainamide - disopyramide |
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examples of class IB
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- lidocaine
- mexiletine - tocainide |
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effect of class IB is only on _______________
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depolarized or rapidly firing cells
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effects of class IB
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- shorten phase 3 repolarization, decrease duration of action potential
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class IC block ________________
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resting channels instead of open channels
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examples of IC
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flecainide, propafenone
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treatments of atrial flutter or fibrilation
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- digoxin
- propranolol - verapamil - procainamide |
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examples of class IV
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- verapamil
- diltiazem |
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class IV drugs prolong the ___________
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effective refractory period
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treatments for A-V reentry
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- digoxin
- propranolol - verapamil |
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what is ventricular premature depolarization
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spontaneous depolarization of ectopic focus in ventricle
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describe the electrocardiogram in ventricular premature depolarization
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wide, tall QRS complex; prominent T wave
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treatment of ventricular premature depolarization
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- no treatment if assymptomatice
- lidocaine |
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treatments of ventricular tachycardia
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acute: lidocaine, procainamide, bretylium
chronic: sotalol, class I drugs |
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examples of class III
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sotalol
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most class III drugs are also _________ and have ________ effects also
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class II, class I
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__________________ should be used in all patients with heart failure due to left ventricular systolic dysfunction
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afterload reducing agents (vasodilators)
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examples of vasodilators useful in CHF
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- ace inhibitors
- angiotensin II receptor inhibitors - minoxidil, hydralazine |
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_______________ improve CHF symptoms significantly but have no net effect on survival
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cardiac glycosides - digitalis/digoxin
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digoxin inhibits _______________. How does this help?
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Na/K ATPase - since Na/K pump is inhibited, there is more intracellular Na. Since there is more intracellular Na, the Na/Ca antiport is less active meaning less Na in and less Ca out. Therefore more intracellular Na means more intracellular Ca. That means more stored Ca. So each time there is a stimulus for contraction more Ca is released. More calcium released ---> stronger contractions.
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how do you prevent cardiac glycoside toxicity
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- monitor drug and K plasma levels
- antibodies that bind to free drug |
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digoxin cannot be used with
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- quinidine and verapamil (displaces digoxin from plasma binding proteins)
- corticosteroids and thiazide/loop diuretics |
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nonspecific vasodilators are always used with _______________
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beta blocker
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uses for dobutamine
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- CHF, hypotension (only for short term management in hospital)
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what is drug of first choice in pregnant women with hypertensive crisis
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nonspecific vasodilators (hydralazine)
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examples of phosphodiesterase inhibitors
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- amrinone
- milrinone |
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net effect of phosphodiesterase inhibitors
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- increase cardiac function
- induce vasoconstriction |
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organic nitrates act as _____________
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vasodilators
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half life of nitroglycerin
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5 minutes
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name 3 treatment strategies in hyperlipidemia
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- decrease synthesis of lipoproteins
- increase degradation of lipoproteins - increase removal of cholesterol from body |
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function of niacin
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inhibits lipolysis in adipose tissue
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effects of niacin on lipids
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- decrease plasma levels of cholesterol and triglycerides
- increase HDL cholesterol |
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examples of fibrates
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- clofibrate
- gemfibrizol |
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mechanism and effect of fibrates
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mechanism: unknown
effect: reduced triglycerides and VLDL's |
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example of a bile acid binding resin
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cholestyramine
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adverse effects of cholestyramine
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- tooth discoleration
- enamel erosion - premature tooth decay |
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cholestyramine reduces the bioavailability of _______________________
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penicillin G and tetracyclines
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mechanism of statins
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HMG CoA reductase inhibitors
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name the top 2 drugs of choice for hyperlipidemia
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1- statins
2- fibrates |
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adverse effects of statins
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rhabdomyolysis (10x's when mixed with fibrates)
- don't take with grapefruit juice |
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treatment for restricted airways/clearance in COPD
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bronchodilators
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3 classes of bronchodilators
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- methylxanthines
- beta agonists - anticholinergics |
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2 examples of methyxanthines
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- theophylline
-caffeine |
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4 examples of beta agonists
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- epinephrine
- isoproterenol - salmeterol - albuterol |
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example of an anticholinergic
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ipratropium
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what is the most commonly used beta agonist
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albuterol
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what is the most commonly used long acting beta agonist
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salmeterol
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most common side effect of beta agonists
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muscle tremors in skeletal muscle (problematic in elderly patients)
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contraindications of beta agonists
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- not used in patients with arrhythmias
- not used with beta blockers - MAO inhibitors or tricyclic antidepressants |
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mechanism of methylxanthines
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- inhibit cyclic amp phosphodiesterase
- bronchodilation |
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adverse effects of methylxanthines
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same as beta blockers
- muscle tremors - tachycardia - headaches - insomnia, NV |
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M3 muscarinic receptors mediate
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smooth muscle contraction
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what are the most effective bronchodilators in COPD
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anticholinergics
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adverse effects of ipratropium
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can't see, can't spit, can't piss
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mechanism of corticosteroids in lung disease
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- inhibit cytokine production
- inhibit leukotriene and prostaglandin production - decrease recruitment of inflammatory cells |
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corticosteroids are usually used with
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beta agonists (except in children)
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effect of leukotrienes
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bronchoconstriction
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leukotrienes are derived from
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arachidonic acid
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leukotrienes are key mediators for:
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- eosinophil and neutrophil action
- allergen-induced responses |
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all leukotriene receptors mediate
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inflammation/bronchoconstriction
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example of 5-lipoxygenase inhibitor
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zileuton
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3 leukotriene receptor antagonists
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- zafirlukast
- montelukast - pranlukast |
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which histamine receptors mediate bronchoconstriction, vasodilation, itching, etc.
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H1
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what is the main difference between old antihistamines and new antihistamines
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new antihistamines don't cross the blood-brain barrier very well, so they aren't sedative
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mechanism of cromones
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stabilize mast cells
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which are the drugs of choice for asthma prophylaxis
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cromones (also in simple allergies)
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mucolytics
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- '-cysteine'
- rhDNase |
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4 drugs contraindicated in airway disease
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- NSAIDs
- beta blockers - sedatives - ACE inhibitors |
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risk factors for CKD
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- diabetes mellitus
- hypertension - cardiovascular disease - family history of ESRD |
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best predictor of CKD and its progression
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proteinurea (albumin-to-creatinine ratio)
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complications of CKD
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- cardiovascular problems
- anemia - osteodystrophy |
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treatment for CKD
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inhibit renin-angiotensin system
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which classes of drugs inhibit the renin-angiotensin system
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- ace inhibitors
- angiotensin II receptor antagonists - renin inhibitors |
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adverse effects of ace inhibitors
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- hypotension
- cough - abnormal taste - hyperkalemia - teratogenic |
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angiotensin II receptor antagonists are cleared by the
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liver
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adverse effects of angiotensin receptor antagonists
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- hypotension
- muscle soreness - impotence - teratogenic (including breast feeding) |
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effect of general anesthetics on CKD
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- may increase K levels leading to increased risk of cardiovascular incident
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effect of midazolam on CKD
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increased sedation
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effect of CKD on NSAIDs
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- damage kidneys further
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effect of CKD on pentazocine
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confusion, hallucinations
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effect of CKD on propoxyphene
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CNS and respiratory depression
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effect of CKD on meperidine
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hallucinations, seizures, stupor
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effect of CKD on morphine
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no major effect
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effect of CKD on oxycodone
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hallucinations
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effect of CKD on codeine
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hypotension and sedation
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effect of CKD on tramadol
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prolonged half-life, doubles effect
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best choice for perioperative analgesia with CKD
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morphine, fentanyl
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best choice for postoperative analgesia with CKD
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tramadol, or codeine
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