Pharm Test2

Front 1

Normal blood pressure

Back 1

Normal <120 and <80

Front 2

Prehypertension

Back 2

120-139 or 80-89

Front 3

Stage 1 HTN

Back 3

140-159 or 90-99

Front 4

Hypertension stage 2

Back 4

>160 or >100

Front 5

RAAS-Renin Angiotensin Aldosterone System

Back 5

Anigotensinogen is released by the liver
Renin then converts it to
Angiotensin I
ACE converts Anigotensin to
Angiotensin 2 This causes
Increased sympathetic activity
Increase NA, CL, and Water retention
Increase Aldosterone secretion which causes this
Arteriolar vasoconstriction
Increased ADH secretions (which increase water absorption)
Potassium retention, vasodilation, and cardiac/vascular remodeling

Front 6

ACE Inhibitors “pril”

Back 6

Pharm: these block the ACE converter which reduces/stops the production of Angiotensin 2 leading to a decrease in blood pressure, water+salt rention, aldosterone
Adverse effects: first-dose hypotension, cough, angioedema, hyperkalemia, dysgeusia,rash, kidney failure
Drug interactions: diuretics, antihypertensions drugs, drugs that increase potassium levels, NSAID

Front 7

Angiotensin II receptor blockers “tan”

Back 7

Pharm: blocks the effects of angiotensin II. This does not cause a increase levels of bradykinin, and kinase I. Has all the other effects
Adverse effets:Anigoedema, fetal harm, renal failure

Front 8

Aldosterone Antagonisit

Back 8

Pharm:selective blockade of aldosterone receptors. This causes holding onto potassium, but losing water
Side effects: hyperkalemia

Front 9

Calcium Channel Blockers
Phenylalamine

Back 9

Verapamil (heart and arterioles). Causes vasodilation, reduced arterial pressure, increased coronary perfusion. Side Effects: HB, Constipation, dizziness, headache, facial flushing, ginvival hyperplasia. Interactions=Beta Blockers, Digi.

Front 10

Calcium Channel Blockers
Dihydropyridines

Back 10

mainly on vascular smooth muscles (nifedipine). Causes lower blood pressure, increased contractile force, and increase heart rate (due to reflex tachycardia). Side Effects: HB, Constipation, dizziness, headache, facial flushing, ginvival hyperplasia. Interactions=Beta Blockers, Digi.

Front 11

Benzothiazepine-CCB

Back 11

dilitazem (heart and the arterioles) causes vasodilation

Front 12

Digoxin

Back 12

Pharm: positive inotropic action on the heart, increase force of ventricular contractions, myocardial contractitily. By increasing cardiac output you will have decreased sympathetic tone, urine production, and less renin relase. This drug also suppresses the renin release, and increase cardiac barorecetpors sensitivity. Increase firing rates of vagal fibers, and responsiveness of the SA node toacetylcholine.
Side effects: n/v/fatigue.
Interactions: diuretics, ARB, ACE,
WATCH POTASSIUM LEVLES WITH THIS DRUG

Front 13

Inotrope drugs

Back 13

Dopamine
Pharm: activates beta 1 adrenergic receptors in the hear, kidney, and blood vessesls. Net effect: increase hear rate, dilates renal blood vessels,
Dobutamine
Pharm: synthetic catecholamine. Selective activation of beta1 adrenergic receptors. Net effect: increase cardiac output
Phosphodiesterase inhibitors
Inamrinone-iodilator
Milrinone (Primacor)

Front 14

• Class I-Sodium Channel Blockers
o Class IA-Quinidine

Back 14

 Blocks sodium channels, slows impulse conduction, delays repolarization, blocks vagal input to the heart
 Widens QRS complex and prolongs the QT interval
 Useagainst supraventricular and ventricular dysrhythmias
 Can cause hypotension (due to alpha-blocking), diarrhea, cinchonism

Front 15

o Class IB- Lidocaine/Phenytoin, Mexilentine

Back 15

 Blocks cardiac sodium channels thereby slows conduction in the atria, ventricles, and His-Purkinje system
 Accelerates repolarization
 Side effects of drowsiness, confusino

Front 16

o Class IC-Flecainide and Prpafenone

Back 16

 Delay ventricular repolarization

Front 17

• Class II- Beta Blockers

Back 17

o Propranolol (Inderal)
o Effects on the heart and ECG is decreased automaticity of the SA node. Decreased velocity of the conduction through the AV node. Decreased myocardial contractiiltiy
o Use in Supraventricular tachydysrhythmias
o Side effects of heart block, heart failure, AV block, hypotension

Front 18

• Class III- Potassium channel blockers

Back 18

o Retylium
 QT interval prolonged, delay repolarization of fast potentials
 Use in ventricular fibrillation and ventricular tachycardia
o Amiodarone (cordarone, Pacerone)
 Reduces automaticity in the SA node, reduced contractility, conduction velocity, QRS widening, Prolongation of the pr and QT intervals
 Interactions: Warfarin, Diliazem, Diogoxin,

Front 19

• Class IV- Calcium Channel Blockers

Back 19

o Verapamil and Dilitzem
 Reduces SA nodal automaticity, Delays AV nodal conduction , Reduces Myocardial contractiility
 Use in SVT, slow ventricular rate
 Hypotension, AV block, Heart block, heart failure

Front 20

Centrally Acting Alpha 2 Agonisit

Back 20

Pharm: acts within the brainsteam. Causes vasodilation and reduced cardiac output.
Side effects: Dry mouth, sedation, rebound hypertension

Front 21

Sodium Nitroprusside (Nitropress)

Back 21

Pharm: diret acting vasodilator. Acts fast but doesn’t last long.

Front 22

Fenoldopam (corlopam)

Back 22

Pharm: diret activing vasodilator. Lower blood pressure by acting on the dopamine 1 receptors on arterioles

Front 23

Labetalol (Trandate, Normodyne

Back 23

-blocks alpha and beta adrenergic receptors
-blood pressure is reduced by arteriolar dilation secondary to alpha blockade

Front 24

Diazoxide (Hyperstat IV)

Back 24

-causes selective dilation of arterioles
-acts within minutes but last hours
-can cause reflex tachycardia. And hyperglycemia in diabetic patients.

Front 25

Guidelines and Treatment for High Cholesterol

Back 25

Every 5 years for adults over 20
HDL <40 bad
LDL <100 good (higher bad)

Front 26

LDL levels

Back 26

<100=optimal
100-129=near or above optimal
130-159-borderline to high
160-180- High
>190= Very High

Front 27

Low Density goals

Back 27

IF Coronary heart disease geta LDL less than 100
With many risk factors get LDL less than 130
Fewer than two risk factors less than 160
Risk factors: male older than 45, female older than 55, Premature HD, Current Smoking, BP 140/90 or higher or any htn meds, HDL m40, and DM of any kind

Front 28

HMG-COA Reductase Inhibotrs (Stains)

Back 28

Pharm: works in the liver to inhibit the enzyme that catalyese the rate liming tep in cholesterol syntehesis.
Examples: Atorvastatin, Simvastatin (Zocor)
Effects: Most effective at reducing LDL, raise HDL, increase bone formation
Adverse effects: headache, rash, GI problems, Muscle pain.
Interactions: fibrates, ezetimibe, Warfarin,e caffeiene, etc

Front 29

Niacin

Back 29

pharm
Effect: reduces LDL, TG, but raisese HDL better than anything
Adverse effects: flushing, gastro, gouty arthritis

Front 30

Bile Acid-binding Resins
Cholestyramine (Questran), and Colestipol (Colestid)

Back 30

Pharm: bind bile acids in the intestinal lumen, increasing clearance of cholesterol from the blood by forcing the body to replace the lost bile acids
Effect: lower LDL, increase HDL, and lower plasma triglyceride
Side effects: bloating, constipation, and bloating

Front 31

Fibric Acid Derivatives (Fibrates)

Back 31

Pharm: unknown
Effect: decreased Tri levels, rais HDL, and lower levels of VLDL
Side effect: Gallstones, rashes, GI, Liver problems

Front 32

Ezetimibe (Zetia)

Back 32

Pharm: Mechanism of ation and impact on plasma lipds
Effect: rduced Total Cholesterol, and LDL
Side effects: Pancreatititis, Myopathy

Front 33

Loop Diuretics (high ceiling)

Back 33

Pharm: acts on the ascending loop of henle
Examples: Lasix and bumpex

Front 34

Potassium-sparing

Back 34

Pharm: blocks aldosterone in the distal nephron causing retention of potassium
Examples: spironololactone (aldactone)

Front 35

Triamterene (dyernium)

Back 35

Pharm: acts on the sodum-potassium exchange in the distal nephron, direct inhibitor of the exchange mechanism, decrase dosium reuptake
Side effets: can cause hyperkalemia, leg cramps, n/v

Front 36

Amiloride (Midamor)

Back 36

Pharm: acts to block sodium-potassium exchange in the dista nephrone
Intetactions: with ace inhibitor

Front 37

Osmotic Diuretic

Back 37

Examples: Mannitol (osmitrol), urea, glycerin, isosorbide
Pharm: diuresis in lumen of the nephron
Use: prophylaxis of renal failure, reduced in ICP, and Intraocular pressure
Side effects: edema, headache

Front 38

Thiazide (-zide)

Back 38

(Don’t work after GR is less than 30 ml/min)
(avoid with gout)
Pharm: acts on the distal renal tuble to inhibit sodium reabsorption
Side effects: hypokalemia, hyponatremia, hypomagesemia

Front 39

Carbonic Anhydrase Inhibitors

Back 39

Example: Acetozomide
Pharm: this drug interefere with the reabsorption of Hc03 causing metabolic acidosis that increase NA and K excretion.
Use: for open-angel glaucoma/ocular HTN

Front 40

Pradaxa

Back 40

Pharm: direct thrombin inhibitor
Use: reduce risk of stroke and systemic embolism in patients with a.fib
Dosing: if CrCL >30 ml/min 150mg BID
CrCL 15-30 ml 75 mg BID

When to stop for surgery
1 to 2 day (crCL <50) or 3 to 5 days ( CrCL <50)
Interactions:
Rifampin interacts and rudeces the exposure (effects) of this drug
DO not crush or break up (increases bioavailability)