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456 Cards in this Set
- Front
- Back
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Name 4 types of microbes
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Bacteria, parasites, viruses, fungi
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Name 4 types of nutrients for bacteria
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Carbon source (sugars) for energy, nitrogen, sulfur, phosphorus
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Other than nutrients, what do bacteria require in order to grow?
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The proper pH, the proper temperature, the proper oxygen concentration
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What are 4 ways bacteria are classified?
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Shape, colour, genes and oxygenation
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What does it mean if a bacteria is an aerobe?
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It needs oxygen and can grow in air
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What does it mean if a bacteria is an anaerobe?
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It is a bacteria that cannot grow in the presence of oxygen
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What is the term for the type of bacteria that can grow in either aerobic or anaerobic conditions?
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Facultative organisms
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What is the term that means a drug can be highly toxic to microbes but it is harmless to the host?
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Selective toxicity
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Sulfonamides block an _______ necessary to make folic acid.
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Enzyme
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Define bactericidal
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Kills bacteria
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Define bacteriostatic
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Slows bacterial growth or reproduction
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What Is the lab test done when bacterial resistance is likely?
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Sensitivity
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What type of antibiotic would a patient be placed on INITIALLY when bacterial resistance is likely?
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Sensitivity
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A common side-effect of antibiotic therapy is a secondary infection. This is also called a __________
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Superinfection
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What is the term for an infection that occurs when microorganisms normally present in the body are destroyed?
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Superinfection
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How can nurses decrease the incidence of nosocomial infections?
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Remove invasive devices ASAP, encourage pts to get vaccinations, break the chain of infection transmission
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What was the first mass-produced antibiotic?
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Penicillin
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What type of antibiotic is also referred to as a beta-lactam antibiotic?
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Penicillin
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What method of action does Penicillin use to stop bacteria?
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Kills bacteria by disrupting their cell walls
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What is the most common adverse effect of PCN?
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Allergy
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Should PCN be given with food or on an empty stomach?
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EMPTY stomach - 1 or 2 hrs before a meal
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Name 2 narrow spectrum/penicillinase sensitive Penicillins
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Penicillin G and Penicillin B
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Name 3 narrow spectrum penicillinase resistant penicillins
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Methicillin, Nafcillin, Dicloxacillin
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Name 2 Broad Spectrum Penicillins
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Ampicillin, amoxicillin
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Name 2 Extended-spectrum penicillins
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Piperacillin, ticarcillin
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What class of drug is clavulanic acid?
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Beta-Lactamase Inhibitor
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What class of dug is tazobactam?
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Beta-Lactamase Inhibitor
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What is the enzyme that bacteria use to combat penicillins?
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Beta-lactamase
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What are the 4 drugs that include a beta-lactamase inhibitor?
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Unasyn, Augmentin, Timentin and zosyn
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What type of drug classes are included in the following drugs: Unasyn, Augmentin, Timentin, and Zosyn
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Beta-Lactamase inhibitor combined with a penicillinase-sensitive penicillin
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What are the S/S of anaphylaxis?
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Hives, Tachy, SOB, Wheezes
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What is the treatment for anaphylaxis? (6)
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Epinephrine IM/SQ, Aminophyilline, Vasopressors, Corticosteroids, hydration, Benadryl PO/IM
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Penicillin G and Penicillin V are what type of penicillin?
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Narrow Spectrum/penicillinase sensitive
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Piperacillin and ticarcillin are what type of penicillin?
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Extended-spectrum penicillins
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Ampicillin and amoxicillin are what type of penicillin?
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Broad Spectrum Penicillins
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Methicillin, Nafcillin, and Dicloxacillin are what type of penicillin?
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Narrow Spectrum Penicilinase resistant penicillins
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What class of antibiotics is the largest class with over 20 types of medications?
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Cephalosporins
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Do Cephalosporins contain a beta-lactam ring?
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YES
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Are cephalosporins bactericidal or bacteriostatic?
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Bactericidal
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How do cephalosporins prevent bacteria from spreading?
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They attach to PCN binding protein to inhibit cell wall synthesis - Bactericidal
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Each generation of cephalosporins gets better at 3 things. What are they?
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Increasing activity against gram neg. bacteria, increasing resistance to beta-lactamases, increasing ability to reach the CSF
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How many generations of cephalosporins are there?
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4
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What is the most common adverse reaction to cephalosporins?
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Hypersensitivity reactions
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Do you take cephalosporins with food or on an empty stomach?
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WITH FOOD
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Other than hypersensitivity what are 2 other common adverse effects to cephalosporins?
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Rash and bleeding
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If a patient has had anaphylaxis with penicillins is it safe to give them a cephalosporin?
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NO! Cross reactivity to Penicillin - similar in structure (Incidence is low 5-10% of PCN allergic patients)
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T or F Fourth generation cephalosporinshave more activity against gram negative organisms than First generation
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T
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T or F First generation cephalosporins are more active against anaerobes than fourth generation
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F
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T or F First generation cephalosporins have increased resistance to beta-lactamases
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False *fourth generation!
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T or F Fourth generation cephalosporins are more able to reach the CSF than First generation?
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True
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T or F First generation agents are more vulnerable to destruction by beta-lactamases than fourth generation
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True
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Are carbapenem antimicrobial narrow spectrum or broad spectrum?
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Very broad spectrum
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How many drugs are there in the carbapenem class of antimicrobials?
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3
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What are the 3 carabapenem antimicrobials?
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Imipenem-cilastatin sodium, merpenem, and ertapenem
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Imipenem-silastatin sodium, merpenem and ertapenem belong to what class of antimicrobials?
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Carbapenems
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What is the enzyme located in the kidneys that degrades imipenem?
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Dehydropeptidase
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What is the inhibitor of dehydropeptidase that is used in combination with imipenem so that is will increase urinary concentration of the drug?
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Cilastatin
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What are carbapenems used to treat?
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Staphylococcus aureus and gram negative bacteria
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How are carbapenems administered? PO, IM, SQ, IV?
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ALL IV
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T or F Carbapenems may have cross-sensitivity with other beta-lactam antibiotics?
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TRUE
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What is another name for Primaxin? (side effect!)
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Primaxin
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What are the side effects of carbapenems?
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Primarily GI, hypersensiticity and superinfections
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What is the name of the drug that has a beta-lactam ring but is not fused with a second ring?
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Azactam
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Is Azactam a broad spectrum or narrow spectrum antibiotic? What class of antimicrobials does it belong to?
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Narrow spectrum - gran negative only. Monobactam
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Is Azactam a good choice of medication for a patient with Beta-lactam anaphylaxis?
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Yes - cross sensitivity is rare
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What is the term for the amount of blood pumped from the ventricle per minute?
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Cardiac output
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What is the equation for cardiac output?
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Stroke Volume X Heart Rate = Cardiac Output
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The heart rate is increased by ________ receptors
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Beta1 andrenergic receptors
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The heart rate is decreased by the ________ system via the ______ nerve
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Parasympathetic / vagus
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Stroke volume is determined mostly by what three factors?
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Myocardial contractility, afterload and preload
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What is the term for the stretch applied to the heart muscle prior to contraction? (The greater the filling pressure the greater the contraction)
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Preload
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What is the term for the load against which the myocardium must eject against?
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Afterload
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End-systolic wall stress or resistance is preload/afterload?
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Afterload
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Arterial pressure is regulated by the ______ nervous system
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Autonomic
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How long does it take for blood pressure to respond to the autonomic nervous system?
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Seconds
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How long does it take for blood pressure to respond to the renin-angiotensin-aldosterone system?
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Slower response - hours to days
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Which is responsible for long term control of blood pressure the autonomic nervous system or the kidneys?
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Kidneys
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What Is the protective measure for the cardiovascular system during volume overload?
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Natriuretic peptides
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What are the 3 Natriuretic peptides?
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ANP - atrial natriuretic peptide, BNP - brain natriuretic peptide,and CNP - C-natriuretic peptide
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When are natriuretic peptides released?
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When hypervolemia persists or there is volume excess
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What is the function of natriuretic peptides?
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They reduce blood volume and increase venous capacity to reduce cardiac preload.
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Which 2 natriuretic peptides have an effect on the renin-angiotensin-aldosterone system?
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ANP, BNP
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What do natriuretic peptides do to arteries and veins?
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They promote dilation
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Natriuretic peptides inhibit the proliferation of ________
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Myocytes
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What is the system that aids in regulating blood pressure, blood volume, and fluid and electrolyte balance?
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Renin-angiotensin-aldosterone system
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What are the actions of angiotensin II?
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Vasoconstriction, release of aldosterone. Angiotensin can cause hypertrophy and remodeling
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What is the purpose of aldosterone?
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It regulates blood volume and BP
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How does aldosterone regulate blood volume and BP?
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Causes sodium retention and excretion of potassium and hydrogen
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When is renin released?
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Secondary to a decrease in BP, blood volume, plasma sodium, or renal perfusion pressure
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Aldosterone causes retention of _____ and excretion of ____ and ___
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NA+/K+/H+
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What is the name of the enzyme that catalyzes the conversion of angiotensin I into angiotensin II?
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Angiotensin converting enzyme (ACE)
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Where is angiotensin converting enzyme found?
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Located on the luminal surface of all blood vessels, in the vasculature of the lungs
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What is the enzyme found on the luminal surface of all blood vessels, in the vasculature of the lungs and is involved in BP and blood volume control?
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Angiotensin-converting enzyme (ACE)
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How long does the conversion of angiotensin I to II take? Why?
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Almost immediate. Angiotensin converting enzyme (ACE) is abundant in the body
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What conditions are treated with ACE inhibitors?
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HTN, heart failure, diabetic nephropathy, and myocardial infarction
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What do ACE inhibitors to?
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Reduce levels of angiotensin II, increase levels of bradykinin, dilates blood vessels, reduces blood volume, prevents or reverses pathologic changes in the heart
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What heart medication can prevent or reverse pathologic changes in the heart and blood vessels that are mediated by angiotensin II and aldosterone?
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ACE Inhibitors
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Do ACE inhibitors interfere with the cardiovascular reflexes?
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NO
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Can a person still exercise safely while using ACE inhibitors?
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YES
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Can ACE inhibitors be used in patients with asthma?
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YES
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Do ACE inhibitors cause orthostatic hypotension?
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Minimal but yes
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Do ACE inhibitors produce hypokalemia?
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NO
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Do ACE inhibitors produce hyperuricemia?
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NO
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Do ACE inhibitors cause hyperglycemia?
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NO
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Do Ace inhibitors cause lethargy or weakness?
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NO
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Can ACE inhibitors be a cause of sexual dysfunction?
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NO
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Do ACE inhibitors reduce the risk of cardiovascular mortality caused by HTN?
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YES
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How do ACE inhibitors treat heart failure?
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They lower the tone of the arteries, improve blood flow, reduce cardiac afterload, increase cardiac output, reduce pulm. Congestion & peripheral edema & increases renal blood flow for excretion of Na & H2O
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What is the drug name ending used for ACE inhibitors?
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Pril
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Name 6 ACE inhibitors used for Heart Failure
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Captopril, Enalapril, Fosinopril, Lisinopril, Quinapril and Ramipril
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How long should treatment with ACE inhibitors last in a patient with MI?
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At least 6 weeks, if symptoms of HTN persist, then tx should be longer
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What are 3 ACE inhibitors approved for MI therapy?
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Captopril, Lisinopril and Trandolapril
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How do Ace Inhibitors benefit patients with diabetic neuropathy?
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Slow the progression of renal disease, delay onset of nephropathy by decreasing glomerular filtration pressure.
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What is the one ACE inhibitor that is approved for Diabetic and Non-diabetic Nephropathy?
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Captopril
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What is the one ACE inhibitor approved for use in the prevention of MI, Stroke, and death in pts with high cardiovascular risk?
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Ramipril
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What conditions are necessary in order for a pt to be considered high risk for MI, Stroke or Death?
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Hx of stroke, CAD, peripheral vascular disease, or diabetes COMBINED WITH one other risk factor - high HDL, low LDL and smoking
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High Cardiovascular Risk patients taking an ACE inhibitor have a __% reduction in risk.
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22%
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What is the initial adverse effect of ACE inhibitors?
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Hypotension
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What should be done to prevent hypotension for a pt starting an ACE inhibitor?
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Dose should start low and work up
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What is the side effect of ACE inhibitors caused by the accumulation of bradykinin that occurs in 5-10% of patients and is the most common reason for stopping the drug?
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COUGH
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What is the side effect of ACE inhibitors that is due to the inhibition of aldosterone that causes a retention of a specific substance in the blood?
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Hyperkalemia
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ACE Inhibitors are contraindicated under 2 conditions - what are they?
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renal artery stenosis (can cause renal failure) and pregnancy (can cause fetal injury)
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What is the one ACE inhibitor that can be given IV?
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Vasotec
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There are 2 ACE inhibitors that should not be taken with food - what are they?
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Captopril and moexipril
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All ACE inhibitors have prolonged half lives and can be administered just once or twice a day except ________
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Cptopril
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__________ block the production of angiotensin II. _______ block the ACTION of angiotensin II.
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ACE inhibitors/ARBs (angiotensin II Receptor Blockers
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ACE inhibitors can cause cough and hyperkalemia. Do ARB's have these side effects?
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NO
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What type of drug is considered to be a good replacement for ACE inhibitors because they have similar effects?
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ARB's
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What is the one ARB approved for heart failure and MI?
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Diovan
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There are 2 ARB's approved for diabetic nephropathy - what are they?
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Cozaar and Avapro
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What is the one ARB medication approved for stroke prevention?
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Cozaar
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What is the cause of the side effect of a cough in patients taking an ACE inhibitor?
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Accumulation of bradykinin
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What are the 3 adverse effects of ARB's?
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Angioedema, Fetal Harm and Renal failure
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What is the function of aldosterone antagonists?
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They block the receptors for aldosterone
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What are the 2 aldosterone antagonist medications?
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Spironolactone and eplerenone.
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What are aldosterone antagonist medications used to treat?
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Hypertension and heart failure
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What happens when aldosterone receptors are blocked by aldosterone antagonists?
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Produces retention of potassium and loss of Na+ and H2O
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How long does it take for aldosterone antagonist medications to reach optimal results for hypertension?
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Up to 4 weeks
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Why would calcium channel blockers be used to treat heart conditions?
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Calcium plays a critical role in the function of the vascular smooth muscle and heart - regulates contractions in vascular smooth muscle
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If calcium channels are blocked what is the result in the blood vessels?
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Contraction is prevented - vasodilation results
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Calcium channel blockers act selectively on what vessels?
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Peripheral arterioles and arteries and arterioles of the heart
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Do calcium channel blockers have any action on veins?
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No - or very little
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Calcium channel blockers help regulate the function of 3 things within the heart- what are they?
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Myocardium, SA node and AV node
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How do calcium channel blockers affect the myocardium?
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They decrease the force of the contractions
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How do calcium channel blockers affect the SA node?
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Pacemaker activity is regulated by Ca influx - results in decreased heart rate
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How do calcium channel blockers affect the AV node?
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Decrease the velocity of the conduction through the AVE node
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Name one calcium channel blocker
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Verapamil
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What are the hemodynamic effects of Verapamil?
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Vasodilation (reduced arterial pressure), increased coronary perfusion, reduced heart rate, decreased force of contraction
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Verapamil can be given via what route(s)?
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IV and PO
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Other than hypertension, what is verapamil prescribed to treat?
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Cardiac dysrhythmias - atrial flutter, fibrillation and tachycardia and angina pectoris,
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What are some of the side effects of verapamil?
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Bradycardia, constipation, dizziness, facial flushing, HA and edema of hands and feet, gingival hyperplasia
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What is the class of calcium channel blockers that causes blockage of ca channels in blood vessels and minimal blockage in the heart?
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Dihydropyridines
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What is the name of a dihydropyridine?
|
Nifedipine
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What is the indirect effect of dihydropyridine calcium channel blockers such as Nifedipine?
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Increases HR and contractile force! (Activates the baroreceptor reflex and causes sympathetic stimulation of the heart.)
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Why are Dihydropyridine calcium channel blockers not being used as much anymore?
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Reflex tachycardia
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What are 3 things that dihydropyridine calcium channel blockers are prescribed to treat?
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Angina pectoris, HTN, cerebral blood vessel vasodilation - prevention of stroke
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What is the one dihydropyridine calcium channel blocker that is used to block calcium channels in the cerebral blood vessels?
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Nimodipine
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If a drug dilates arterioles if will decrease _______
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Cardiac afterload
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If a drug dilates veins it will reduce ____ filling which decreases _______
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Ventricular/ cardiac preload
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What are 5 main things that vasodilators are used to treat?
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HTN, angina, heart failure, MI, PVD
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Is hydralazine (a vasodilator) often used on it's own to treat essential HTN?
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Rarely
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What is the vasodilator usually used in combination with isosorbide dinitrate on a short term basis as an afterload reducer for Heart Failure treatment?
|
Hydralazine
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Does hydralazine have any effect on veins?
|
NO
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What are the 3 main side effects of Hydralazine?
|
Reflex tachy, increased blood volume due to sodium and H2O retention, Systemic Lupus Erythematosus-like Syndrome - rare when dose less than 200mg/day
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How long does Systemic Lupus-Erythematosus-like Syndrome caused by taking Hydralazine take to resolve?
|
May take 6 mos
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What are the symptoms of systemic Lupus Erythematosus-like Syndrome caused by Hydralazine?
|
Muscle and joint pain, fever, nephritis
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What is the fastest acting hypertensive agent - the drug of choice for hypertensive emergencies?
|
Sodium Nitroprusside
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Does Sodium Nitroprusside have any effect on the veins?
|
YES - causes both venous and arterial dilation
|
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Does Sodium Nitroprusside cause reflex tachycardia?
|
Does not cause significant reflex tachycardia
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How is Sodium Nitroprusside given? IV, IM, SQ, PO?
|
IV infusion in ICU
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How long does it take to see the effects of Sodium Nitroprusside?
|
IMMEDIATE
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What are the adverse effects of Sodium Nitroprusside?
|
Hypotension - rapid drop in BP, Cyanide poisoning (RARE - but contains 5 cyanide groups),
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What are the symptoms of hypotension to watch for when a patient has been given sodium nitoprusside for a hypertensive emergency?
|
HA, palpitations, nausea, vomiting and sweating
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How should sodium nitoprusside be monitored when given to a patient for hypertensive emergency?
|
CLOSELY - preferably with an arterial line
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What does the term cor pulmonale mean?
|
Right sided heart failure
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What are two terms you should always think of when considering afterload?
|
Resistance and constriction
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What are two terms you should always think of when considering preload?
|
Stretch and volume
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What are the two greatest indicators of cardiac output?
|
Blood pressure and urine output
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Do diuretics have an effect on preload or afterload?
|
Preload
|
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Does decreased blood volume have an effect on preload or afterload?
|
Preload
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What is the normal oxygen saturation of blood in the right ventricle?
|
75%
|
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If a patient has aortic stenosis where is the afterload problem? What symptoms would be present?
|
Aorta/ Left Ventricular hypertrophy
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Is end diastolic volume preload or afterload?
|
Preload
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Is hypertension a preload or afterload problem?
|
Afterload
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When the baroreceptor reflex is activated, what happens?
|
Heart rate increases
|
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What do baroreceptors sense?
|
Decreased blood volume
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What is the first sign of decreased blood volume?
|
Increased heart rate
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Increased blood volume over time due to bad contractility of the heart leads to poor kidney perfusion which causes a(n) increase/decrease in the RAA system.
|
Increase
|
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Natriuretic peptides inhibit what hormone?
|
Aldosterone
|
|
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Do natriuretic peptides affect preload or afterload?
|
Preload
|
|
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Why would we want naturietic peptides to help inhibit the proliferation of myocytes?
|
Decrease cardiac hypertrophy
|
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Doe the RAA system affect preload or afterload?
|
BOTH
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Does angiotensin II affect preload or afterload?
|
Afterload
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What is the main job of angiotensin II?
|
VASOCONSTRICTION!
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Does aldosterone affect preload or afterload?
|
Preload
|
|
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How does angiotensin II cause remodeling of the heart?
|
Increased afterload causes hypertrophy (left ventricle)
|
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Why would a physician prescribe ARB's if a patient cannot tolerate ACE inhibitors due to an ACE cough?
|
No bradykinin accumulation - no cough associated with ARB's
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Why would a physician prescribe ARB's if a patient cannot tolerate ACE inhibitors due to hyperkalemia?
|
ARB's do not cause hyperkalemia
|
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What condition is a contraindication for ARB's?
|
Renal stenosis
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What is the condition that is possible if a patient is taking ARB's and has renal impairment? How do you check for this condition?
|
Neutropenia/ CBC w/diff
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What are 4 types of drugs that have interactions with ACE inhibitors?
|
Diuretics (increase 1st dose Hypotension), antihypertensives (cause hypotension), Lithium (increase lithium levels), NSAIDS (decrease antihypertensive effects)
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What drug would you choose for a gram + infection such as MRSA?
|
Vancomycin (tricyclic glycopeptide)
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ACE inhibitors and ARB's have very similar results. What are the two benefits of ARB's as opposed to ACE inhibitors?
|
No bradykinin accumulation and no hyperkalemia
|
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When would an aldosterone antagonist be prescribed?
|
When other antihypertensive drugs are not working on their own.
|
|
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What does calcium do for the heart?
|
Increases contractility, increases heart rate and increases blood vessel constriction
|
|
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What is an inotropic effect?
|
Increases contractile force
|
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What effect do calcium channel blockers have in the inotropic effect?
|
Decreases inotropic effecct (which is increased contractile force)
|
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Would you use a calcium channel blocker in a patient with heart failiure?
|
NO it decreases contractility
|
|
|
Do all calcium channel blockers work on AV node conduction?
|
NO Verapamil and Diltiazem only
|
|
|
Would verapamil be considered as a first choice for antihypertensive treatment?
|
NO
|
|
|
What does paroxysmal mean?
|
Sudden onset
|
|
|
Why is good oral care important in a pt taking verapamil?
|
Possibility of gingival hyperplasia as a side effect
|
|
|
When would you hold a calcium channel blocker?
|
Decreased blood pressure (less than 90 systolic) or decreased heart rate (less than 60 BPM)
|
|
|
How do dihydropyridine calcium channel blockers decrease hypertension and angina?
|
They promote vasodilation
|
|
|
Why do vasodilators cause reflex tachycardia?
|
Vasodilation causes a decrease in blood pressure which causes the heart rate to increase
|
|
|
What drug would you give to reduce cerebral vasospasm, brain aneurysm or brain trauma?
|
NIMODIPINE! (A dihydropyridine calcium channel blocker)
|
|
|
What is the most powerful vasodilator available?
|
Sodium nitroprusside
|
|
|
What is hypotension? (systolic # etc..)
|
Systolic less than 90 or mean arteriole pressure less than 65
|
|
|
What is pheochromocytoma?
|
Tumor on adrenal glands that causes increased epi and norepi
|
|
|
What type of drug would be used in a patient with pheochromocytoma?
|
Vasodilator such as hydralazine
|
|
|
Do most vasoldilators affect preload or afterload?
|
Afterload
|
|
|
For what conditions might you use an IV infusion of sodium nitroprusside?
|
Intracranial bleed or aneurysm - must keep bp low!
|
|
|
Does sodium nitroprusside have a short or prolonged half life?
|
SHORT
|
|
|
What is included in sodium nitroprusside that causes a very rare side effect?
|
Thiocyanate (cyanide poisoning!)
|
|
|
|
|
|
|
What symptoms would you look for in a patient who has been taking sodium nitrprusside for several days to keep BP down?
|
Delerium and disorientation signs of cyanide poisoning
|
|
|
What 5 drug classes have effects on vasodilation?
|
ACE inhibitors, ARB's, Calcium Channel Blockers, Organic Nitrates, Sympatholytics
|
|
|
What are 2 ACE inhibitors that should not be taken with food?
|
Captopril and moexipril
|
|
|
When analyzing cardiac output what are the 2 best indicators?
|
Blood pressure and urine output
|
|
|
What radiology test can be done to tell you ejection fraction?
|
Echocardiogram
|
|
|
What is the formula for figuring mean arterial pressure?
|
Systolic minus diastolic divided by 3 + diastolic 100/50 = (100-50)/3+50 = 66.6667
|
|
|
What are the two terms that define "afterload"
|
Resistance and constriction
|
|
|
What are the two terms that define "preload"
|
Stretch and volume
|
|
|
Do diuretics have an effect on afterload or preload?
|
Preload
|
|
|
What is the oxygen saturation in the right ventricle?
|
75%
|
|
|
What is the term that means right-sided heart failure?
|
Cor pulmonale
|
|
|
If a patient has aortic stenosis where is the afterload problem?
|
Aorta
|
|
|
Is HTN an afterload or preload problem?
|
Afterload
|
|
|
Is end diastolic volume afterload or preload?
|
Preload
|
|
|
What symptoms would be present in a patient with aortic stenosis?
|
Left ventricular hypertrophy
|
|
|
When the baroreceptor reflex is activated what happens?
|
Arterioles dilate, venous return decreases, heart rate increases, peripheral resistance decreases
|
|
|
What do baroreceptors sense?
|
Decreases blood volume
|
|
|
What is the first sign of decreased blood volume?
|
Increased heart rate
|
|
|
Increased blood volume overtime due to bad contractility of the heart has what effect on the kidney?
|
Decreased perfusion to the kidney which causes an increase in the RAA system
|
|
|
What do natriuretic peptideds affect? Preload/afterload
|
Preload
|
|
|
When are natriuretic peptides released?
|
They compensate for increased blood volume by inhibiting aldosterone
|
|
|
Why would we want natriuretic peptides to inhibit myocytes?
|
To decrease cardiac hypertrophy!
|
|
|
Does the RAA system affect preload or aftterload?
|
BOTH
|
|
|
Does angiotensin II affect preload or afterload?
|
Afterload
|
|
|
Does aldosterone affect preload or afterload?
|
Preload
|
|
|
How does angiotensin II cause remodeling of the heart?
|
Increased afterload causes hypertrophy
|
|
|
Why would a patient be prescribed an ARB?
|
No bradykinin accumulation and no hyperkalemia issues
|
|
|
What are the biggest side effects of an ACE inhibitor?
|
ACE cough and kyperkalemia
|
|
|
When are ACE inhibitors contraindicated?
|
Renal stenosis
|
|
|
ACE inhibitors have drug reactions with diuretics, antihypertensives, lithium and NSAIDS - what are the effects?
|
Diuretics - can increase 1st dose hypeotension, antihypertensives - can cause hypotensives, lithium - ACE can increase levels, NSAIDS - decrease anti-hypertensive effects
|
|
|
What drug would you choose for a gram + infection?
|
Vancomycin - tricyclic glycopeptide
|
|
|
If a patient is taking an ACE inhibitor and has renal impairment what labs should you be watching?
|
Neutropenia is possible - check CBC w/differential
|
|
|
When would an aldosterone antagonist be prescribed?
|
When other drugs aren't working well on their own
|
|
|
What does calcium do for the heart?
|
Increases contractility, increases heart rate, increases blood vessel constriction
|
|
|
What does the term inotropic mean?
|
Increased contractile force of the heart
|
|
|
What does the term chronotropic mean?
|
Increased heart rate
|
|
|
Would you use a calcium channel blocker in a patient with heart failure? Why?
|
NO - it decreases contractility
|
|
|
What effect do calcium channel blockers have on the inotropic effect?
|
Decreases inotropic effect
|
|
|
Do all calium channel blockers work on AV node conduction?
|
Verapamil and Diltiazem are the only 2
|
|
|
Would verapamil be considered first as an antihypertensive?
|
NO
|
|
|
What does paroxysmal mean?
|
Sudden onset
|
|
|
Why is good oral care important in a patient taking verapamil
|
Possibility of gingival hyperplasia as a side effect
|
|
|
When would you lokd a calcium channel blocker? (What 2 things would you check before giving it?)
|
Decreased heart rate and decreased blood pressure - less than 100 systolic, less than 60 HR
|
|
|
How do dihydropyridine calcium channel blockers decrease hypertension and angina?
|
Promote vasodilation
|
|
|
Why do vasodilators cause reflex tachycardia?
|
Vasodilation causes decreased blood pressure which causes heart rate to increase
|
|
|
What drug would you give to reduce cerebral vasospasm?
|
Nimodipine - dihydropyridine calcium channel blocker
|
|
|
What is hypotension?
|
Systolic less than 90 or mean arterial pressure less than 65
|
|
|
What is pheochromocytoma?
|
Tumor on the adrenal glands that causes increase in epi and norepi
|
|
|
What type of drug would be used in a pt with pheochromocytoms?
|
A vasodilator - hydralazine
|
|
|
Most vasodilators affect afterload/preload?
|
Afterload
|
|
|
What is the most powerful vasodilator available?
|
Sodium nitroprusside
|
|
|
What condition might you use sodium nitroprusside?
|
Intracranial bleed/aneurysm - keep blood pressure LOW - ICU only
|
|
|
Does sodium nitroprusside have a short or long half life?
|
SHORT
|
|
|
What is included in sodium nitroprussidde that causes a very rare side effect?
|
Thiocyanate - cyanide poisoning
|
|
|
What symptoms would you look for in a patient who has been taking sodium nitroprusside for several days?
|
Delerium and ______ signs of cyanide poisoning
|
|
|
What 5 drug classes have effect on vasodilation?
|
ACE inhibitors, ARB's, Organic nitrates, Ca Ch Blockers, Sympatholytics
|
|
|
Where are baroreceptors located?
|
In carotid sinus and aortic arch
|
|
|
What 4 drug classes have an effect on the RAA system and thus treat HTN?
|
Beta blockers, ACE inhibitors, Aldosterone receptor blocker, ARB's
|
|
|
What do Beta 1 receptor blockers do?
|
Prevent sympathetic stimulation of the heart
|
|
|
What do Alpha 1 receptor blockers do?
|
Dilation of arteries and veins
|
|
|
What are some adverse effects of diuretics?
|
Hypokalemia, dehydration, hyperglycemia, hyperuricemia
|
|
|
Why would a potassium sparing diuretic not be used with an ACE inhibitor or an ARB?
|
Both drug classes cause hyperkalemia
|
|
|
Name a potassium sparing diuretic
|
Spironolactone
|
|
|
What are 2 major side effects of a loop diuretic?
|
Hypokalemia and ototoxicity
|
|
|
What drug would drug would be prescribed to a patient with asthma that needs a beta blocker?
|
Metoprolol
|
|
|
Why would you not prescribe beta blockers to a diabetic?
|
Mask the effects of hypoglycemia
|
|
|
What do sympatholytics do?
|
Suppress N.S. effectson the heart, blood vessels and other structures
|
|
|
Name the 5 drug classes that have a sympatholytic effect
|
Beta blockers, alpha 1 blockers, alpha/beta blockers, alpha 2 agonists, and adrenergic neuron blockers
|
|
|
Doxazosin is a drug in what drug class?
|
Alpha 1 blockers
|
|
|
Terazosin is a drug in what drug class?
|
Alpha 1 blockers
|
|
|
What is the effect of doxazosin?
|
Blocks alpha 1 on arteries and veins - blocks vasoconstriction
|
|
|
Name a loop diuretic
|
Lasix
|
|
|
Carvediol is included in what drug class?
|
Alpha/beta blockers
|
|
|
Labetolol is included in what drug class?
|
Alpha/beta blockers
|
|
|
Coreg is in what drug class?
|
Alpha/beta blockers
|
|
|
What do alpha/beta blockers do/
|
Decrease heart rate and contractility and promote dilation
|
|
|
What are the 2 effects of a beta blocker?
|
Decrease heart rate and contractility
|
|
|
What is the effect of an alpha 1 blocker?
|
Promote dilation
|
|
|
Clonidine is in what drug class?
|
Centrally acting alpha 2 agonists
|
|
|
Methyldopa is in what drug class?
|
Centrally acting alpha 2 agonists
|
|
|
What are the effects of a centrally acting alpha 2 agonist?
|
Decrease symplathetic outflow to heart and vessels - decrease cardiac output and increase vasodilation
|
|
|
What are the side effects of centrally acting alpha 2 agonists?
|
Dry mouth, sedation, rebound hypertension -if stopped abruptly
|
|
|
What are the names of 2 centrally acting alpha 2 agonists?
|
Clonidine and methyldopa
|
|
|
What are the names of 3 alpha/beta blockers?
|
Coreg, Carvediol, Labetolol
|
|
|
Name 2 alpha 1 blockers
|
Doxazosin and Terazosin
|
|
|
Name 3 adrenergic neuron blockers
|
Guanethidine, guanadrel, raserpine
|
|
|
What do adrenergic neuron blockers do?
|
Inhibit release of epi and norepi to decrease sympathetic nervous system stimulation
|
|
|
Name 2 direct vasodilators
|
Hydralazine and minxidil (rogaine!)
|
|
|
What is the action of vasodilators?
|
Dilation of arterioles
|
|
|
Hydralazine is in what drug class?
|
Direct vasodilators
|
|
|
Minoxidil (Rogaine) is in what drug class?
|
Direct vasoldilators
|
|
|
What are some side effects of direct vasodilators?
|
Reflex tachycardia, release of renin - fluid retention, and SLE-like reaction
|
|
|
How can you counteract the side effects of direct vasodilators?
|
Beta-blocker to counteract reflex tachy and diuretic to counteract fluid retention
|
|
|
What is the newest class of anti hypertensive medication?
|
Renin inhibitor
|
|
|
Name one renin inhibitor
|
Tekturna
|
|
|
What does a renin inhibitor do?
|
Inhibits the conversion of angiotensinogen to angiotensin I - dirupts RAAS feedback loop
|
|
|
What 5 drug classes are used to treat heart failure? In order of prescribing priority
|
Diuretics, ACE inhibitors, Aldosterone antagonists, beta blockers, inotropic agents
|
|
|
What is a side effect of aldosterone antagonists that might make it a bad choice for men?
|
Gynecomastia
|
|
|
What are two inotropic medications?
|
Dopamine and dobutamine
|
|
|
What effect do inotropic medications have on the heart?
|
Increase contractility
|
|
|
What effect do phophodiesterase inhibitors have on the heart?
|
Increase contractility
|
|
|
What conditions would be treated with digoxin?
|
Heart failure and dysrhythmia
|
|
|
What is a major side effect of digoxin and what should be checked prior to administering?
|
Heart rate! Bradycardia
|
|
|
Is there a cure for hypertension?
|
NO
|
|
|
If a patient has an aneurysm what # is considered to be hypertension?
|
130 systolic
|
|
|
After weight loss what is the most important thing you can do to reduce BP?
|
Exercise - brings down 10mmHg
|
|
|
Does decreased sodium intake affect preload or afterload?
|
Preload
|
|
|
Adrenergic nerves release what???
|
Norepinephrine
|
|
|
Adrenergic nerves release a catecholamine - how does this catecholamine effect the heart?
|
Heart rate and contractility
|
|
|
What is the most important vital sign to check prior to giving a diuretic?
|
BP
|
|
|
Why should you not combine potassium sparing diuretics with ACE inhibitors or ARBs?
|
They both cause hyperkalemia
|
|
|
What is the typical dose of lasix?
|
20-40 mg
|
|
|
What 2 conditions should be monitored closely while taking beta blockers?
|
Asthma and diabetes
|
|
|
What 2 Ca Ch Blockers would you used for AV node conduction?
|
Verapamil and cardiazem
|
|
|
What 2 Ca Ch blockers are used for vasodilation?
|
Nifedipine and nimodipine
|
|
|
What Ca Ch Blocker would you use in a pt who needs vasodilation of cerebral arteries?
|
Nimodipine
|
|
|
Why would you use an ACE inhibitor for vasodilation?
|
Blocks angiotensin II (which is a powerful vasoconstrictor)
|
|
|
Where does vasopressin come from?
|
Pituitary
|
|
|
What does vasopressin do?
|
It is a diuretic - in increased doses it is a vasodilator
|
|
|
Statins should not be combined with what drug class?
|
Fibrates
|
|
|
What do natriuretic peptides do?
|
Sense increased blood volume
|
|
|
Why do patients taking an ACE inhibitor sometimes get a cough?
|
Accumulation of bradykinins
|
|
|
What medication would you take for tx of H.F. if you get an ACE cough?
|
ARB
|
|
|
Adverse effects of aldosterone antagonists?
|
Gynecomastia, hyperkalemia
|
|
|
What 2 beta blockers are approved for heart failure to decrease workload of the heart?
|
Coreg and toprol
|
|
|
Why would an inotropic agent be used in heart failure?
|
To increase the performance of the failing heart
|
|
|
Dopamine has different effects when given at different doses - what does it do at a low dose?
|
1-5mcg/kg/min - renal vasodilation - increased perfusion
|
|
|
Dopamine has different effects when given at different doses - what does it do at a medium dose?
|
5-10 mcg/kg/min - inotropic activity
|
|
|
Dopamine has different effects when given at different doses - what does it do at a large dose?
|
10-20 mcg/kg/min - alpha 1 stimulation - vasoconstriction (given for hypotension)
|
|
|
What is the best inotropic drug for heart failure?
|
Dobutamine (acts on Beta1)
|
|
|
What is the action of phophodiesterase inhibitors?
|
Inotropic effect on beta 1
|
|
|
Name a cardiac glycoside?
|
Digoxin
|
|
|
What is the problem with digoxin?
|
Narrow therapeutic index - can be highly toxic
|
|
|
What are the S/S of digoxin overdose?
|
Bradycardia, N/V, greenish-yellow halo lights
|
|
|
What effect does digoxin have on heart rate?
|
Decrease
|
|
|
What effect does digoxin have on urine output?
|
Increase
|
|
|
What should be checked prior to administering digoxin?
|
Heart rate and potassium levels, digoxin level (therapeutic range)
|
|
|
What is the drug that is the antidote for digoxin?
|
Digibind
|
|
|
What is the normal rate for urine production based on weight?
|
.5mL/kg/hr
|
|
|
What patient population has trouble with triglycerides?
|
Diabetics
|
|
|
What drug class is the drug of choice for decreasing cholesterol?
|
Statins
|
|
|
What is the action of sulfonylureas?
|
They promote insulin release
|
|
|
What is the action of meglinitides?
|
They promote insulin release
|
|
|
What is the action of biguanides?
|
They decrease gluconeogenesis and increase the uptake of glucose in muscle
|
|
|
What is the action of thiazolidinediones?
|
They decrease insulin resistance
|
|
|
What is the action of alpha glucosidase inhibitors?
|
They slow the absorption of carbs
|
|
|
What is the action of amylin mimetics?
|
They decrease gastric emptying and increase satiety
|
|
|
What is the action of incretin mimetics?
|
They decrease gastric emptying, increase the release of insulin and decrease appetite
|
|
|
What is the action of DPP-4 Inhibitors?
|
Enhances the body's ability to release insulin
|
|
|
Name 5 sulfonylureas
|
Orinase, glucotrol, micronase, diabeta, amaryl
|
|
|
Name 2 meglitinides
|
Prandin and starlix
|
|
|
Name a biguianide
|
Metformin
|
|
|
Name 2 thiazolidinediones
|
Actos and avandia
|
|
|
Name an alpha glucosidase inhibitor
|
Acarbos
|
|
|
Name an amylin mimetic
|
Symlin
|
|
|
Name an incretin mimetic
|
Byetta
|
|
|
Name a DPP-4 inhibitor
|
Januvia
|
|
|
What are the side effects of sulfonyureas?
|
Hypoglycemia
|
|
|
What are the side effects of Diabeta or Amaryl?
|
Hypoglycemia
|
|
|
What are the side effects of prandin or starlix?
|
Hypoglycemia
|
|
|
What are the side effects of meglitinides?
|
Hypoglycemia
|
|
|
What are the side effects of biguanides?
|
Nausea, diarrhea, decreased appetite and lactic acidosis
|
|
|
What are the side effects of metformin?
|
Nausea, diarrhea, decreased appetitie and lactic acidosis
|
|
|
What are the side effects of thiazolidinediones?
|
Fluid retention and increased plasma lipid levels
|
|
|
What are the side effects of actos and avandia?
|
Fluid retention and increased plasma lipid levels
|
|
|
What are the side effects of alpha glucosidase inhibitors?
|
Flatulence, diarrhea, abdominal distention
|
|
|
What drug is contraindicated when taking an alpha glucosidase inhibitor?
|
Metformin
|
|
|
What drug is contraindicated when taking actose or avandia?
|
Metformin
|
|
|
What drug is contraindicated when taking prandin or starlix?
|
NSAIDS
|
|
|
What drug is contraindicated when taking melitinides?
|
NSAIDS
|
|
|
What are the side effects of amylin mimetics?
|
Hypoglycemia
|
|
|
What are the side effects of simlyn?
|
Hypoglycemia
|
|
|
What are the side effects of incretin mimetics?
|
N/V/D, hypoglycemia with sulfonylureas but not with Metformin!
|
|
|
What are the side effects of Byetta?
|
N/V/D, hypoglycemia with sulfonylureas but not with Metformin!
|
|
|
What other oral hypoglycemic drug should not be given with Byetta? Why?
|
Sulfonylureas - hypoglycemia
|
|
|
What are the side effects of DPP-4 Inhibitors?
|
N/D, stuffy nose and sore throat
|
|
|
What are the side effects of Januvia?
|
N/D, stuffy nose and sore throat
|
|
|
Name a drug with a narrow therapeutic index
|
Digoxin
|
|
|
Digoxin is in what drug class?
|
Cardiac glycosides
|
|
|
What is the main effect of cardiac glycosides?
|
Inotropic
|
|
|
What part of the heart do beta blockers help?
|
Left ventricular function
|
|
|
What are the 3 main drugs used to treat heart failure?
|
Diuretics, ace inhibitors, beta blockers
|
|
|
What drug class is contraindicated for use in heart failure?
|
Calcium channel blockers
|
|
|
When would you need to d/c a beta blocker in a pt w/ heart failure?
|
Edema, or other symptoms of heart failure
|
|
|
What drug class is used to lower cholesterol?
|
Statins
|
|
|
What do statins lower specifically?
|
LDL's
|
|
|
What is the main side effect to consider when taking statins?
|
Hepatotoxicity
|
|
|
What labs should be monitored in a patient taking statins?
|
ALT/AST - liver function
|
|
|
What 4 classes contain a beta-lactam ring?
|
Carbapenems, penicillins, monobactams, and cephalosporins
|
|
|
Why shouldn't pregnant women or children take tetracycline?
|
Stains teeth
|
|
|
Why isn't tetracycline a 1st line antimicrobial?
|
Resistance!
|
|
|
If a patient has been having diarrhea for more than 2-3 days while taking an antibiotic such as clindamycin what is the recommendation?
|
Discontinue!
|
|
|
Angioedema is a side effect of what medications?
|
ACE and ARB's
|
|
|
Name some macrolydes?
|
Erythromycin, zithromax
|
|
|
What is the main side effect of erythromycin?
|
Diarrhea - GI upset
|
|
|
Would a patient who has diarrhea while taking erythromycin be able to switch to another macrolide such as azithromycin?
|
YES - doesn't cause nearly the GI upset that erythromycin does - not an allergy just a side effect.
|
|
|
Valsartan is part of what drug class?
|
ARB - ends in "tan"
|
|
|
Staph and strep are gram-/gram+ organisms
|
Gram+
|
|
|
E.Coli is a gram+/gram- organism
|
Gram-
|
|
|
What medications might be prescribed for a gram + infection?
|
PCN, cephalosporins 1st & 2nd gen
|
|
|
What medications might be prescribed for a gram - infection?
|
Cephalosporins 3rd & 4th gen, aminoglycosides
|
|
|
Would you prescribe PCN for an E.Coli infection?
|
NO - PCN fights gram + E. Coli is gram -
|
|
|
Would you prescribe PCN for a staph infection?
|
YES
|
|
|
What is the drug with the main side effect of flushing?
|
Niacin
|
|
|
What does niacin do?
|
Decreases LDL, decreases triglycerides, MAY increase HDL's
|
|
|
Name a common normal flora on the skin?
|
Staphylococcus aureus
|
|
|
How do you know if a patient is experiencing ketoacidosis?
|
DEHYDRATION, ketones in urine, increased blood glucose
|
|
|
How do you treat ketoacidosis?
|
IV fluids, regular insulin, watch potassium
|
|
|
When would you hold verapamil or cardiazem?
|
BP less than 90 systolic, HR less than 60
|
|
|
Which calcium channel blockers work on vascular smooth muscle?
|
Dihydropyridines - nimodipine and nifedipine
|
|
|
What Is the onset for a rapid acting insulin?
|
10-15 min
|
|
|
Metformin does what 3 things?
|
Increases glucose uptake in muscles, decreases gluconeogenesis in liver, increases insulin sensitivity
|
|
|
Cephalosporins get better at what 3 things with each generation?
|
Betalactamase resistance, covering gram neg bacteria, permeating the CSF
|
|
|
Name some superinfections
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Yeast - monilial infection, candida, pseudomembranous colitis
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What labs do you watch with pseudomembranous colitis?
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Electrolytes
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Can you use a bottle of Lispro that is cloudy?
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NO - throw it out
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Can you use a bottle of NPH that is cloudy?
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YES - it should be cloudy
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What is important to remember about diet in a patient taking linezolid?
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Tyramine containing foods are contraindicated - wine, aged cheeses etc…
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What are some side effects of vasodilators such as hydralazine?
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Reflex tachy, SLE-like symptoms, orthostatic hypotension
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Name a betalactamase inhibitor
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Clavulanic acid, sulbactam, and tazobactam
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What does a betalactamase inhibitor do when combined with another antibiotic?
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Broadens the spectrum of the antibiotic
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Name a fibrate
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Gemfibrozil
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What is a side effect of gemfibrozil (a fibrate)
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Myopathy - rhabdomyolysis
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How is Red Man syndrome caused?
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Rapid infusion of vancomycin - causes rapid release of histamine
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What are the names of the drugs with betalactamase inhibitors included?
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Unasyn, Augmentin, Zosyn, and Timentin
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What are the 2 drugs included in Unasyn and what is it used for?
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Ampicillin and sulbactam - betalactamase inhibitor and penicillinase sensitive PCN- broad spectrum antibiotic
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What are the 2 drugs included in the drug Augmentin and what is it used for?
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Amoxicillin and clavulanic acid - betalactamase inhibitor and penicillinase sensitive PCN- broad spectrum antibiotic
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What are the 2 drugs included in the drug Timentin and what is it used for?
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Ticarcillin/clavulanic acid - a betalactamase inhibitor and penicillinase sensitive PCN- broad spectrum antibiotic
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What are the 2 drugs included in the drug Zosyn and what is it used for?
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Piperacillin and tazobactam - betalactamase inhibitor and penicillinase sensitive PCN - broad spectrum antibiotic
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