Pharm Test 3

Front 1

Carbonic Anhydrase Inhibitor MOA

Back 1

Inhibition of CA leads to decrease in symport Bicarb and Na transport on Basolateral surface

Front 2

Carbonic Anhydrase inhibitor Drugs

Back 2

Acetazolamide and Methazolamide

Front 3

Adverse reactions of CAI

Back 3

Marrow Suppression, rash, Bicarbonaturia/Metabolic acidosis. May worsen acidosis so avoid in pt's with COPD and renal failure

Front 4

Loop Diuretic MOA

Back 4

Inhibition of Na/K/Cl symport on luminal surface

Front 5

Adverse effects of Loop

Back 5

Wasting of Ca, Mg and Na
Acute (uricosuria) Chronic (hyperuricemia)

Front 6

Why do loops cause hypo Mg and Ca ?

Back 6

Loss of charge gradient btw lumen and basolateral surface (no Cl- transport=no Mg or Ca via paracellular)

Front 7

Why hyperuricemia in Loops?

Back 7

Uric acid and loops compete for the same Organic acid secretory pathway

Front 8

List Loop Drugs and rank by potency

Back 8

Bumetanide> Toresemide >Furosemide > Ethacrynic acid

Sulfa Drugs= rash rxn

Front 9

How does dosage change for Loops when pt's with renal insufficiency ?

Back 9

Larger doses, b/c Organic Acid Secretory to lumen side is compromised.

Front 10

Loops Adverse reactions

Back 10

Hypokalemia (arrhythmias)
Hypocalcemia (tetany)
Hypomagnesiemia (arrhythmia)
metabolic alkalosis
Ototoxicity (high doses of ethacrynic acid)

Front 11

Atypical thiazides

Back 11

Chlorthalidone
Indapamide
Metolazone

Front 12

Loops and thiazides affect on Ca and Mg

Back 12

Loops lose Ca and Mg
Thiazides lose only Mg

Front 13

Thiazides Adverse reactions

Back 13

ED, Metabolic Alkalosis
Impaired Glucose Tolerance
Sulfonamide allergy

Front 14

Therapeutic Uses of Thiazides

Back 14

HTN (1st line)
Edema
Ca Nephorlithiasis
Nephrogenic Diabetes Insipidus!

Front 15

2 subtypes of Potassium Sparing Diuretics

Back 15

KSD
ARA(Aldosterone receptor antagonist)

Front 16

MOA of KSDs

Back 16

Block Na Channel on Luminal side at Collecting Duct. Without Na influx K efflux less favorable

Front 17

MOA of ARAs

Back 17

Bind cytoplasmic MRs, which is the site where Aldosterone binds to exert its effect on the cellular transcription of mRNA associated with Na reabsorption (slow onset of Action!)

Front 18

Endogenous levels of Aldosterone effects the amount of natriuresis of which diuretic?

Back 18

ARAs
Spironolactone & Eplerenone

Front 19

Amiloride & Triamterene

Back 19

KSDs

Front 20

Spironolactone & Eplerenone

Back 20

ARAs

Front 21

Which KSDs can you not give in patients with Liver failure

Back 21

Triamterene, b/c it must be converted in the liver to active form 4-hydroxytriamterene (which is renally excreted!

Front 22

Adverse Effects of KSDs

Back 22

Hyperkalemia, metab acidosis (Dec H secretion via intercalated Cell depolarization)
N/V, Triamterene inhibits folic acid pathway(megaloblastic anemia) as well as causing hyperglycemia, interstitial nephritis, renal stones and photosensitivity

Front 23

Adverse Effects of ARAs

Back 23

Hyperkalemia (caution rx causing inc K ~NSAIDS, ACEI) and metabolic acidosis, D/Gastritis (caution in PUD)
Steroid structure: gynecomastia, impotence, decreased libido. Maybe not so much in Eplerenone

Front 24

Therapeutic uses of KSDs

Back 24

Used in combo more potent diuretics to dec hypokalemia
Aerosolized Amiloride- CF patients (limit Na/H20 reabsorption for lung clearance)
Diabetes Insipidus 2ndary to Li Toxicity... blocks lithium transport into tubule
Not used in Pregnancy!

Front 25

Therapeutic uses of ARAs

Back 25

Decreases mortality in CHF
primary and secondary hyperaldosteronism (cirrhosis /w ascities)
Not used in Pregnancy!

Front 26

Arginine Vasopressin (ADH) amount release is associated with what?

Back 26

Increases with Osmolality and hypotension (20% vol. loss).

Front 27

ADH MOA

Back 27

V2 Stimulation Increases H20 permeability via insertion of AQP2 at medullary CD, up-regulates Na/K/2Cl symporter of TAL

Front 28

Promoters of ADH release

Back 28

Ang II/III
Nicotine, EPI, SSRI, TCAs

Front 29

Inhibitors of ADH release

Back 29

ETOH, phenytoin, Glucocorticoids, haloperidol,

Front 30

ADH preps

Back 30

Pitressin (IV, IM, SC)
Desmopressin (IC, SC, nasal)

Front 31

Central Diabetes Insipidus

Back 31

Lack of ADH, give ADH preps

Front 32

Nephrogenic Diabetes Insipidus

Back 32

Rx's can cause (Li, Foscarnet, cloazapine, demeclocycline)
Tx: Amiloride for lithium induced, or Thiazides

Front 33

Adverse Affects of exogenous ADH

Back 33

V1 mediated: vasoconstiction,
GI (N/belching/Cramping/Urge to deficate),
Coronary vasocontriction (CAD!)
V2 mediated: H20 intox (hyponatremia)

Front 34

Tolvaptan

Back 34

V2 antagonist, (dec H20 reabsorption)
Tx: hyponatremia (must start in Hospital, CYP3a substrate=many interactions)

Front 35

Inotropic action MOA

Back 35

Inactivate Na/K pump so Na/Ca pump takes over, thereby increasing intra-cellular Ca2+ to increase force and velocity of contraction (inc EF)

Front 36

EKG Changes with Inotropic drug

Back 36

T wave diminished amplitude
J point Depression
PR Interval: prolong
QT Interval: Shortened

Front 37

Digitalis effect on sympathetic tone for CHF and normal heart

Back 37

CHF: reduced tone
Normal Heart: Increased tone

Front 38

Effects of digitalis

Back 38

Slow AV conduction
Prolonged ERP of AV Node

Front 39

Factors increasing the AV depressive effects of Digitalis

Back 39

hypokalemia
CCB
BB

Front 40

Effects of Digitalis on Area Postrema

Back 40

Dec seizure threshold
N/V, arrhythmias

Front 41

IV administration of Digitalis

Back 41

can cause vasoconstriction (but only transiently)

Front 42

Dopamine effects by dose levels

Back 42

Low dose- Vasodilation
Moderate dose- Inc PP (inc SBP with no change in DBP)
High dose- Vasoconstriction

Front 43

Dobutamine site of action

Back 43

Beta 1 agonist (+ isomer)
Increase PP, with inc HR

Front 44

Uses of Epi

Back 44

Relieve bronchospasm, hypersensitivity reactions, cardiac arrest, NOT CHF

Front 45

Uses of Norepi

Back 45

Cardiogenic Shock
NOT CHF