Pharmacology Quiz 2

Front 1

Introduction to Narcotics (Opiates):
-what is pain
-what is endorphans

Back 1

pain
- is an unpleasant sensation disturbing patient's comfort, thought sleep or normal daily activity and is symptomatic of an underlying disease process
- is the 5th vital sign

Endorphans are the body's own internal analgesic.
When opiates stimulate the endorphan receptors the perception of pain is blocked.

Front 2

Narcotics (Opiates) Mechanism of Action

Back 2

Endorphans --> blocks perception of pain when stimulated.

people's endorphan varies, some produce more, some less. so pain threshold varies b/w individuals

the more endorphans the less pain

Front 3

therapeutic uses of Narcotics

Back 3

analgesia (moderate to severe)

antitussive - blocks cough reflex

antidiarrheal - side effect of narcotic is constipation. it slows down the GI. not good for Bacterial diarrhea.

Front 4

Pharmacology of Narcotic (Opiates): CNS

Back 4

-analgesia without loss of consciousness (moderate to sever)
-drowsiness
-behavioral changes (euphoria with Heroin IV, and dysphoria)
-depress cough reflex
-nauseant and emetic (esp. injectible ones. makes the patient nauseous so the solution is add another drug) **BUT THIS ONLY WORKS FOR NO MORE THAN 3 DAYS**

Front 5

Pharmacology of Narcotic (Opiates): CNS
-toxicities
-head injury

Back 5

-toxic effects:
respiratory depression and miosis (pupil constriction) this indicates that the pt. od'ed on Narcotics

-head injury:
pts. who had head injury should not be given narcotics because or the already low resp. drive.

Front 6

Pharmacology of Narcotics: Cardio

Back 6

SPECIFIC FOR IV MORPHINE

-orthostatic hypotension -bp goes down when pt. moves

-Morphine effects: IV administration decrease cardiac workload during MI ...good property or bad?


GOOOD!! during heart attack (MI) we want to decrease heart workload to decrease the demand of O2 in the heart

Front 7

Pharmacology of Narcotics: Gastrointestinal

Back 7

-decrease peristalsis = stomach and intestines = decrease diarrhea, increase constipation

-increases biliary pressure. good or bad property of narcotics for pts. with gall stones? -----> BAD! why? because narcotics INCREASES biliary pressure.

Front 8

Pharmacology of Narcotics MISC.

Back 8

Uterus - prolongs labor - do not give high doses ..it can stop labor.

Front 9

Narcotic Analgesics:
-3 drugs and what they do.

Back 9

MORPHINE - intermediate action, but can be given sustained release. decreases cardiac workload (IV). long acting sustained release narcotics for terminal pts.

MEPERIDINE - short acting. used after surgery

FENTANYL - extremely potent. dose in mcg because of resp. depression. patch form is available for terminal pts. --> patch is 72 hours.

Front 10

NARCOTIC ANTAGONIST

Back 10

-Blocks opiate receptor --works IMMEDIATELY -- pulls narcotic and replaces and blocks it.

-Short acting (45 min.) --> pts. who OD on long acting narcotics goes back and OD again.

-precipitates withdrawal. no use for addicts. severe withdrawal immediately

- Naloxone (Narcan)

Front 11

Narcotic Agonist/Antagonist

Back 11

-stimulates or blocks receptors -- no surge to the brain (100% stimulation) only 50% is being stimulated
-not effective in severe pain
-advantages : decrease abuse potential, and decrease addictive potential. less change of causing problems in labor and gall stone pts.
-drawback : not for severe pain

Front 12

Narcotic (Opiates): Antidiarrheal

Back 12

-effective in non-infectious diarrhea
-decreases GI motility to decrease diarrhea - but will retain toxins and bacteria

Front 13

Narcotic (Opiates): Antitussive

Back 13

-why we give antitussive to pt.?
1. so they can sleep, 2. for people with chronic dry unproductive cough.
-decreases cough reflex
-decreases sternal pain to encourage deep breathing

Front 14

Narcotic (Opiates): Pain control concepts

Back 14

-pt controlled analgesia - leads to less use

-chronic terminal pain - addiction is not a concern

-post-operative use is a recommendation - not adequately utilized to promote healing --should not be used more than 3 days (addiction potential)

Front 15

Name 9 Narcotic Analgesics (Sched. II)

Back 15

-Morphine Sulfate (MS Contin)
-Meperidine (Demerol) is very short acting
-Hydromorphone (Dilaudid)
-Codeine -also found in combination (eg. Tylenol/Codeine Sched. III)
-Hydrocodone (Vicodin) in combo with acetaminophen -sched III
-Fentanyl (Sublimaze, Duragesic) inj., patch --use very low dose
-Methadone (Dolophine)
-Oxycodone (Percodan, Percocet, Tylox, Oxycontin)
-Propoxyphene (Darvon) Sched IV

Front 16

Name 3 Narcotic Agonist/Antagonist Analgesics

Back 16

-Pentazocine (Talwin) ---why sched. IV? --> Talwin Nx

-Butorphanol (Stadol) - not sched.

-Nalbuphine (Nubain) - not sched.

Front 17

Name 1 Narcotic Antagonists

Back 17

-Naloxone (Narcan) pure antagonist **CANNOT BE TAKEN ORALLY. only works for IV.

Front 18

Name 2 Narcotic Antidiarrheals

Back 18

-Diphenoxylate with Atropine (Lomotil) Sched. V --> Atropine is an anticholinergic= slow down GI

-Loperamide (Imodium) no abuse potential. OTC

Front 19

Name 4 Narcotic Cough Preparations

Back 19

-Hydromorphone (Dilaudid) Sched II

-Hydrocodone (Hycodan) Sched III

-Codeine (Robitussin AC) Sched V

-Dextromethorphan (Robitussin DM) OTC no abuse potential (only one on this list)

Front 20

Name 5 Non-Narcotic Analgesics (eg. Salicylates)

Back 20

4 SALICYLATES:
-Acetylsalicylic Acid - Aspirin (Bayer, Anacin, Alka Seltzer)
-Enteric Coated Aspirin (Ecotrin)
-Salsalate (Disalcid)
-Choline Salicylate (Arthropan) liquid

-Acetaminophen (Tylenol, Anacin III) -*NOT A SALICYLATE

Front 21

Salicylates Therapeutic Properties - all salicylates have these properties

Back 21

-Analgesia =mild to moderate pain
-Antipyretic =lowers febrile temperature for fever
-Anti-inflammatory =arthritis
-Anti-platelet =**Acetylsalicylate only

Front 22

Salicylate: Antiplatelet properties

Back 22

-acetylsalicylate only
-transient ischemic attacs (TIA)
-post heart attack - lowers possibility of having a second MI
-cardiac valve replacement (CVR)=thrombosis. --aspirin = less clotting **that's the new use of baby aspirin. it's now for adults, it's never used for children. and use only in VERY LOW dose of Aspirin

Front 23

Salicylates: GI Effects

Back 23

-nausea/vomiting

-Ulcerations -enteric coating to bypass stomach

Front 24

Salicylates: Toxicities

Back 24

-tinnitus= early warning- salicylate in the blood is too high

-metabolic acidosis

-dehydration

Front 25

Salicylates: Uricosuric Properties

Back 25

-higher doses =uricosuric
-uric acid is pushed from the blood to the urine = helpful for gout pts.
-retains uric acid at LOW DOSES

Front 26

note to remember about the doses for Salicylates

Back 26

LOW DOSES = retain uric acid

HIGH DOSES = uricosuric

Front 27

Salicylates: Hypersensitivity

Back 27

-higher incidence in women
-higher incidence in asthmatics
-cross sensitivity with some NSAIDs (pts. may also be allergic to Motrin, Aleve)...

Front 28

Salicylates: Doses

Back 28

LOW DOSE for Antiplatelet

HIGH DOSE for Anti-inflammatory

LOW DOSE to retain uric acid

HIGH DOSE for uricosuric

Front 29

Salicylates: Other Uses

Back 29

-topical use
1. keratolytic =dissolve on top layer of skin. treatment of warts
2. counter irritant for muscle pain = sports cream --no lactic acid before pain

Front 30

Salicylates: Products

Back 30

-Acetylsalicylate =possesses antiplatelet properties

-Salsalate =low incidence of GI irritation (remember its side effects? ulcerations)

-Methylsalicylate =extremely TOXIC -your sports creams

-NO liquid form of Aspirin -must use Alka Seltzer -liquid aspirin

Front 31

Acetaminophen (not a Salicylate) Properties

Back 31

-Analgesic
-Antipyretic
-do not have anti inflammatory and platelet properties

-dont exceed more than 4g/day
-why cough adult syrups are not used for toddlers now?

Front 32

Acetaminophen Toxicities

Back 32

-Hepatotoxicities : fatal doses at 25 grams (or 50 strong Tylenol)

-Antidote - must be within 6 hours of OD. --> Acetylcysteine (Mucomyst) have also been used for resp. therapy

Front 33

Rheumatoid Arthritis Intro

Back 33

-Auto-immune disease
-progressive
-destruction and deformities of joints
-juvenile to adult onset
-Step therapy (less toxic to more toxic): --> salicylate, NSAIDs. progressively more toxic

Front 34

NSAIDs Properties (Antiarthritic)

Back 34

-Analgesic, antipyretic, anti-inflammatory

-has a little bit of antiplatelet property but not used for that, like Aspirin, it can make a pt. bleed

Front 35

NSAIDs Side effects (Antiarthritic)

Back 35

-GI effects : nausea, ulcerations

-Na & H2O retention = NSAIDs can increase BP

-Decreased renal function

-Anti-Platelet = must discontinue prior to a procedure

Front 36

NSAIDs : Indomethacin, Ketorolac, Sulindac (Antiarthritic)

Back 36

-Indomethacin =side effects of severe frontal headaches

-Ketorolac =inj. for acute pain, no abuse potential.

-Sulindac =low incidence of decreasing renal function (least used)

Front 37

what is the only inj. analgesic in the market that is NOT controlled substance?

Back 37

KETOROLAC

no more than 5 days of drug therapy = renal damage also used for drug abusers

Front 38

Cox 2 Inhibitors -Cyclooxygenase 2 receptors) Cox 1 and Cox 2 (Antiarthritic)
-Properties

Back 38

**not always prescribed for ulcer pts. because its too expensive only prescribed when 1. severe ulcer 2 no other drug works

PROPERTIES
-decreases inflammation with lesser effects on GI tract
-specifically inhibits cyclo-oxygenase 2 receptors

Front 39

Cox 1 and Cox 2?

Back 39

Cox 1 =production of a muco-protective coating in the intestinal tract (against ulcers) --side effect of pts using this for arthritis?. but less.

Cox 2 =causes inflammation of joints

Front 40

Hydroxychloroquine (Antiarthritic)
-onset of action
-misc.
-side effects

Back 40

-onset of action : 3 months ...add another drug

-also possesses anti-malarial properties (what its originally used for)

-side effects: 1.reversible coreal opacity -like cataract
2. irreversible retinal damage -destroys the nerve of the eye, pt. can lose their vision so they have to go to eye exams when on this drug.

Front 41

Intra-Articular Steroids (Antiarthritic)

Back 41

-useful if only a few joints involved

-biggest risk is infection and antibiotics don't go to joints easily.

-limit on how many joints

Front 42

Systemic Steroids (Antiarthritic)

Back 42

-consequences of prolonged use:
adrenal suppression, cataracts, ulcers, depression

Front 43

Gold Therapy (Antiarthritic)

Back 43

-inj. =1/month. pill= 1/day but with greater risks of adverse reactions

-gold sodium thiomalate and auranofin

-onset of action is 3 moths =add another drug

-may slow progression of Rheumatoid arthritis

-Adverse reactions : renal damage, and bone marrow depression

Front 44

MISC. Disease modifying antirheumatic drugs (DMARD's)

Back 44

-all may slow disease progression
-the following drugs increases the risk of lymphoma and leukemia

-Anakinra (Kineret) =inhibits interleukin1 inflammation
-Etanercept (Enbrel) =inhibits tumor necrosis factor (TNF) inflammation
-Leflunamide (Arava)=inhibits immune modulator inflammation

Front 45

Chemotherapeutic Agents for Rheumatoid Arthritis

Back 45

examples: Azathioprine, Methotrexate, Cyclophosphamide

-inhibits immune response- what we want for RA
-adverse reactions : carcinogenic (can cause cancer), bone marrow depression, low immune response

Front 46

Gouty Arthritis

Back 46

-in-born metabolic error
-over production of urates
-under excretion of urates through kidneys

-extra uric acid cristalizes in the joint where immune system tries to attack it.

-may be secondary to other disease or drug therapy: 1. sickle cell anemia --> (destruction of RBC realease RNA=purines =uric acid) 2. thiazide and loop diuretics can increase uric acid

Front 47

Acute therapy for Gouty Arthritis

Back 47

Colchicine (0.6mg)

-blocks migration of granulocytes to inflamed area, causing less urate deposits
-side effects: (toxicity) severe diarrhea
-dose: is every hour until symptomatic relief or side effects.

Front 48

Prophylactic Therapy for Gouty Arthritis

Back 48

-diet-low purine/high carbs: avoid beans, pease, spinach, mushrooms.... restrict meat, fish, seafood, and alcohol....increase intake of H2O.

-Allopurinol (Zyloprim) =decrease metabolic formation of uric acid for over producers

-Probenecid (Benemid) or Sulfinpyrazone (Anturane) =uricosuric agents where uric acid is pushed to the urine for under excreters

Front 49

Migraine

Back 49

-recurrent headache with N/V
-contraction of intracranial vessels lead to an aura
-serotonin causes a compensatory vasodilations that impinges on nerves
-contributing factors : 1 tension, 2 medications (birth control pills), 3 food (chocolate, milk)

Front 50

Acute therapy for Migraine

Back 50

-medications cause severe vasoconstriction--> not specific for blood vessels in the brain = heart attack

-Ergotamine (Caffergot)= 2dose/24hours

-Triptans= warning is no more than 2 dose/24 hours

Front 51

Prophylactic Therapy for Migraine

Back 51

-Propranol (Inderal) - beta blocker
-everyday use
mechanism is still unknown

Front 52

Name 12 NSAIDs/Antiarthritic/Cox1&2 Inhibitors

Back 52

-Indomethacin (Indocin)
-Ibuprofen (Motrin, Advil, Nuprin)
-Tolmetin (Tolectin)
-Naproxen (Naprosyn, Aleve)
-Diclofenac (Voltaren)
-Ketorolac (Toradol)
-Fenoprofen (Nalfon)
-Sulindac (Clinoril)
-Etodolac (Lodine)
-Piroxicam (Feldene)
-Ketoprofen (Orudis)
-Meclofenamate (Meclomen)

Front 53

Why do pts. in NSAIDs get ulcers?

Back 53

because it blocks Cox 1

Front 54

Name 1 Cox 2 Inhibitor

Back 54

Celocoxib (Celebrex)

-given to pts. with higher risk of ulcers. very expensive

Front 55

Name 7 DMADs

-slows progression of the disease but are MORE toxic

Back 55

-Hydroxychloroquine (Plaquenil)
-Gold Sodium Thiomalate (Myochrisine)
-Auranofin (Ridaura)
-Etanercept (Enbrel)
-Anakinra (Kineret)
-Methotrexate (Rheumatrex) chemo drug
-Leflunomide (Arava)

Front 56

Name 4 Gout Therapy Drugs

Back 56

-Colchicine
-Allopurinol (Zyloprim)
-Probenecid (Benemid)
-Sulfinpyrazone (Anturane)

Front 57

Name 4 Acute Migraine Drugs

Back 57

-Ergotamine (Caffergot)

-Sumatriptan (Imitrex)
-Rizatriptan (Maxalt)
-Zolmitriptan (Zomig)

Front 58

What are the warnings when using Migraine Therapy Agents?

Back 58

make cause heart attack

...drug mechanism = non specific vasoconstriction = increase cardiac workload = heart attack

Front 59

1 Prophylactic Migraine Drug

Back 59

Propranolol (Inderal)

-taken every day
-taken before aura/migraine

Front 60

Autonomic Nervous System Intro
-Purpose/primary function

Back 60

-maintain stable internal environment by coordinating, adjusting, and regulating the body's visceral activity

-examples include: digestion, body temperature, heart reate
-primary function is to maintain homeostasis.

Front 61

ANS Parasympathetic division

Back 61

-cranio-sacral system
-conserve and restore energy

increase GI and sweat
decrease BP

Front 62

ANS Sympathetic Division

Back 62

-Thoraco-lumbar system
-Prepares body for stress and emergency
-also non-stress regulation

increase BP and sweat
decreases GI

Front 63

Neurofiber Anatomy

Back 63

-Pre-ganglionic and post-ganglionic fibers
-neurotransmitter vesicles
-junctional spaces
-receptors

Front 64

Parasympathetic Fiber

Back 64

-post-ganglionic neurotransmitter: Acetylcholine

-receptor site: Muscarinic

-Activity stopped by Acetylcholine esterase

Front 65

Sympathetic Fiber

Back 65

-Post-ganglionic neurotransmitter: Norepinephrine (Catecholamine)

-Receptor Site: alpha, beta1, beta 2

-Activity stopped by: Reuptake (primary mechanism) and Mono amine oxidase (MAO) destroys NE

Front 66

Neurohormonal Transmission: Acetylcholine

Back 66

-released by all pre-ganglionic fibers (stimulates nicotinic receptors)

-post ganglionic parasympathetic fibers (stimulates muscarinic receptors)

Front 67

Neurohormonal Transmission:
Norepinephrine

Back 67

-post ganglionic sympathetic fibers (stimulates alpha, beta 1 and beta 2 receptors)

Front 68

Parasympathetic effects in the Eye

Back 68

-miosis (pupil constriction)
-lacrimation (tear secretion)
-accommodate for near vision (fixed for reading)
-decreased intra-ocular pressure (decrease symptoms of glaucoma)

Front 69

Parasympathetic effects in the Digestion

Back 69

-increase saliva secretion
-increase stomach acid = ulcer
-increase peristalsis = diarrhea

Front 70

Parasympathetic effects: cardio, lungs, and bladder

Back 70

-decrease heart rate

-bronchial constriction (asthmatics) =bad property--> muscarinic receptor stimulates this--> antiasthmatic drugs = blocks muscarinic =anticholinergic = asthma

-Enhances urination: bladder contraction, and sphincter relaxation

Front 71

Parasympathomimetic Agents

Back 71

-Bethanechol =stimulates GI motility and bladder (specific for GI & bladder contraction) - for pts who came out of surgery and to stimulate them

-Pilocarpine =ophthalmic - lowers intra-ocular pressure =gluacoma pts.

Front 72

Parasympathomimetic Agents Contraindications

Back 72

-asthma
-cardiac insufficiency
-peptic ulcer
-eye drps may still be used with precaution (make sure it does not drain and get in the blood stream)

Front 73

Acetylcholine Esterase Inhibitors

Back 73

-blocks acetylcholine esterase enzyme from breaking down acetylcholine

-pharmacology will be similar to parasympathomimetic agents, just mechanism of action differs

Front 74

Edrophonium

Back 74

-Acetylcholine Esterase Inhibitor
-short acting reversible = minutes. only used for diagnosis.
-diagnose myasthenia gravis -muscle weakness. theory is body does not produce enough Ach

Front 75

Intermediate acting reversible agents

Back 75

-Neostigmine and Pyridostigmine:
treatment of myasthenia gravis

-Physostigmine: ophthalmic agent -lower intra-ocular pressure (glaucoma)

-Donepezil, Galantamine, Rivastigmine: temporarily lessen symptoms of Alzheimer's Disease - theory is the body not producing enough Ach.

Front 76

Long Acting Irreversible Agents

Back 76

Echothiophate and Isofluorphate:

-Organophosphate (used in pesticides, bannned in US) toxic agents --powerful treatment for glaucoma but cant go to blood stream
-Must use precaution when administering by placing pressure on the corner of the eye
-only utilized as an ophthalmic agent

Front 77

Anticholinergics

Back 77

-blocks muscarinic receptor so that acetylcholine cannot bind and stimulate

Front 78

Anticholinergic effect on the eye

Back 78

-dry eye
-accommodate for far vision
-mydriasis -dilate pupil
-increase intra-ocular pressure

Front 79

Anticholinergic effect on digestion

Back 79

-decreased saliva production
-decreased acid production = decrease ulcer
-decreased peristalsis =constipation

Front 80

Anticholinergic effect: cardio, pulmonary, and urinary

Back 80

-increased heart rate (good for bradycardia)

-urinary retention especially in BPH (esp. prostatic pts)

-bronchodilation (asthmatics)

Front 81

Anticholinergic order of sensitivity (by dose)

Back 81

-secretory (saliva, sweat, stomach acid)
-eye
-heart
-GI motility (highest dose, but more side effects and secretory, eye, heart, are being affected)

Front 82

Anticholinergic Therapeutic Use

Back 82

1. Natural Alkaloids

-prior to procedure (decrease aspiration) to avoid secretions and infection during procedure
-sinus bradycardia
-motion sickness
-GI cramping to slow down peristalsis

2. Antispasmodic (bladder/GI)
3. Mydriatic (dilates eyes) and Cycloplegic (far vision) -opthalmic exam (eye drops for testing)

Front 83

Anticholinergic Contraindications

Back 83

-Myasthenia gravis b/c body does not make enough Ach so we wanna save s many Ach as possible

-Narrow angle glaucoma : most have wide angle

-unstable cardiovascular system: we don't want to keep stimulating the heart

-intestinal atony: don't have bowel sounds= no peristalsis

Front 84

Sympathetic (Adrenergic)
Alpha, Beta 1, Beta 2 properties

Back 84

Alpha
-vasoconstriction= increase BP = good for shock
-stimulate sweat and salivary gland
-decrease intra-ocular pressure

Beta 1
-increase heart rate and force of contraction= shock pts = increase cardiac output

Beta 2
-bronchodilation, smooth muscle relaxation for asthmatics and for uterus to relax. used for premature labor to slow/delay it.

Front 85

Epinephrine: Alpha, Beta 1, 2

Back 85

Alpha
-decrease IOP
-prolong action of local anesthetics and decrease bleeding (very small amount for its alpha properties)

Beta 1
-increase blood pressure in shock

Beta 2
-relieve bronchospasm
-status asthma -non-stop asthma and anaphelactic shock (ex. "epipen")

Front 86

Advantages of Alpha properties of Epinephrine?

Back 86

1. constricts BV = no bleeding

2. constricts BV =anesthetic stays in that area

Front 87

Levarterenol

Back 87

Alpha
-very strong vasoconstriction --too strong that it can cause heart failure
-reversed by Alpha blocker so no strain on the heart. alpha property of Levarterenol is not wanted so we add another drug to block it.

Beta 1
-increases blood pressure in shock

Front 88

Isoproterenol

Back 88

Beta 1
-increase blood pressure = shock

Beta 2
-bronchodilation =asthma (inhaled or injected)

Front 89

Dopamine

Back 89

Dopamine (outside CNS)
-Renal Artery Dilation for shock pts. =urine output is decreased during shock

Beta 1
-increase blood pressure =shock

Alpha
-very strong vasocontriction (dose rate dependent) =decrease infusion rate of Dopamine so it does not reach alpha level

Front 90

Dobutamine

Back 90

Beta 1
-cardiogenic shock

Front 91

Bronchodilators

Back 91

Beta 2 Stimulation

Beta 1 Spill over can increase heart rate, sweat, solution=inhalation*
-best avoided by giving via inhaled route and utilizing a beta 2 specific agent (ex. Albuterol )

Front 92

Alpha Stimulants

Back 92

Opthalmic Decongestants
-getting congestant out of eye =getting red eye out =Visine
warning*: do not use moe than 3 days--> autonomic rebound effect and eyes will get redder than ever

Nasal Decongestant
-oral products may also increase BP
-topical nasal sprays should not be used for more than 3 days - can cause addiction

Front 93

Alpha blocking agents

Back 93

Pheochromocytoma
-disease/tumor in the adrenal gland
-secretes NE that increases BP

Reverse Alpha properties of Levarterenol
-Phentolamine

Front 94

Beta Blockers

Back 94

-Utilized to block beta 1 receptors
-all will have beta 2 spill over, some more than others (asthmatic will have problem with this -->blocking B2 = bronchoconstriction)

Front 95

Beta Blockers Use

Back 95

-Arrythmia (tachycardia) =B1 blockade slows BP
-Hypertension (decrease renin release) high renin hypertension = block or decrease release of renin
-angina = blocker decrease 02 demand = B1 blocked = decrease HR = decrease O2 demand diminishes
-post MI = beta blocker increases survival (used prophylactically)
-migraine also used prophylactically

Front 96

Beta blocker caution

Back 96

-Asthma =use Beta 1 specific

-insulin dependent diabetic = masks symptoms of hypoglycemia

-peripheral vascular disease = poor blood flow to the lower extremities

Front 97

Hypertension Intro

Back 97

-afflicts over 60 million americans
-diagnosis
-diastolic > 90 systolic > 140
-age, # of readings (best taken in the morning)
-etiology: essential (primary), and secondary (high renin, Cushing's, drugs)

Front 98

Hypertension long term consequences

Back 98

-renal, cardiac, vascular
-non-pharmacologic therapy
-diet = decrease weight, decrease Na, decrease alcohol, decrease fats
-decrease smoking
-increased exercise
-relaxation techniques

Front 99

Hypertension: Pharmacologic Therapy

Back 99

short term benefits versus long term
-VHA Coop Study = benefits demonstrated
-mortality and morbidity consequences

Front 100

Causes of Therapeutic failures : coop study

Back 100

-compliance = drug side effects
-insufficient dose
-non-compliance to diet/exercise
-drug interactions
-acquired resistance

Front 101

step approach : hypertension step 1

Back 101

-diuretic
-beta blocker
-alpha adrenergic blocker
-ace inhibitor
-calcium channel blocker

Front 102

step approach : hypertension step 2

Back 102

-sympatholytic
-beta blocker
-alpha adrenergic blocker
-ace inhibitor
-calcium channel blocker

Front 103

step approach : hypertension step 3

Back 103

-vasodilator

Front 104

step approach : hypertension step 4

Back 104

-sympatholytic --> Guanethidine

Front 105

Diuretics
-Definition
-Use

Back 105

Definition = increases formation of urine

Use =
-management of edema (worse lungs) - CHF, cranial, ascites (fluid build up in the abdominal area)
-hypertension
-maintain urine flow -shock
-protect from nephrotoxic agent
-glaucoma

Front 106

Osmotic Diuretics (1st category)

Back 106

-non -electrolyte
-freely filterable at glomerulus
-pharmacologically inert = no receptors = no side effects
-osmotically pull active particles into blood stream and into uring
-no effect on serum electrolyte balance

Front 107

Osmotic Diuretics
-toxicities
-use

Back 107

toxicities
-increased cardiac work load

use
-maintain urine volume during shock/renal failure
-protect against nephrotoxic agents
-glaucoma -intraocular pressure decreased
-cerebral edema - often trauma

Front 108

Carbonic Anhydrase Inhibitors (2nd category)

Back 108

Pharmacology
-increases loss of bicarbonate in urine and loss of sodium
-diuretic effects works for only 3 days (short term)
-decrease intraocular pressure effects continues indefinitely

if used more than 3 days can cause metabolic acidosis and resp. complications

Front 109

Carbonic Anhydrase Inhibitors
-toxicities
-use

Back 109

toxicities
-drowsiness
-metabolic acidosis

therapeutic use
-short term diuretic
-glaucoma

Front 110

Thiazide Diuretics

Back 110

pharmacology
-blocks reabsorption of Na and H20 in distal tubule of kidney

-Metolazone also blocks reabsorption in the proximal tubule of kidney

-increases secretion of K into urine

Front 111

Thiazide Diuretics other metabolic effects

Back 111

-increases blood uric acid (gout pts), sugar, cholesterol, and triglyceride
-increases blood Ca
-decreases blood K, and Magnesium

Front 112

Thiazide Diuretics
-Use

Back 112

-hypertension
-management of Edema (Metolazone with or without a loop diuretic)
-contraindication: hypercalcemia

Front 113

Loop Diuretics (4th Category)

Back 113

pharmacology
-blocks reabsorption of Na and H2O in ascending loop of henle (more powerful diuretic)
-increases secretion of K into urine

Front 114

Loop Diuretics
-toxicities
-other metabolic effects

Back 114

toxicities
-Ototoxicity, nephrotoxicity

other metabolic effects
-increases blood uric acid, sugar, cholesterol, and triglyceride
-decreases blood Ca *
-decreases blood K and Magnesium

Front 115

Loop Diuretics
-Use

Back 115

-hypertension
-management of Edema
-treatment of hypercalcemia

Front 116

Potassium Sparing Diuretics (5th Category)
-direct acting
-indirect acting

Back 116

direct acting
-Triamterene
-Amiloride
-blocks reabsorption of Na and H2O in collecting duct of nephron

indirect acting
-Spironolactone
-competetive inhibitor of Aldosterone

Front 117

Potassium sparing diuretics
-pharmacology

Back 117

-minimal diuretic effects
-decreases secretion of K into urine

Front 118

Potassium sparing diuretics
-use and therapeutic alternatives

Back 118

therapeutic use
-spare K loss of diuretics
-additional uses of Spironolactone (block aldosterone) =edema with liever failure and congestive heart failure

therapeutic alternatives
-foods high in K
-K supplement - caution with IV administration

Front 119

Potassium sparing diuretics
-toxicities

Back 119

-hyperkalemia = therefore K is not administered concurrently

Front 120

Sympatholytics (6th category)

Back 120

Step 2 therapy

Side effects
-Na and H2O retention
-postural hypotension
-constipation
-dry mouth
-impotency

Front 121

Sympatholytic Agents

Back 121

Clonidine
- rebound hypertension if not compliant
-patch alternative
-may be used for acute high BP

Methyldopa

Reserpine
-noted to cause breast CA

Guanethidine
-4th step due to diarrhea

Front 122

Hypertension : Beta Blockers

Back 122

-blocks renin release

-caution: diabetics (masks hypoglycemia) and asthmatics (effect of Beta 2)

Front 123

Hypertension : Alpha Adrenergic Blockers

Back 123

-Dual mechanism = blocks alpha receptor and directly causes vascular smooth muscle vasodilation

-no rebound tachycardia

-first dose effect = caution for syncope

Front 124

Hypertension : Alpha Adrenergic Blockers

-uses

Back 124

-hypertension
-prostate hyperthropy -shrinks prostate

Front 125

Hypertension : Vasodilator (Step 3)

Back 125

-direct relaxation of vascular smooth muscle
-rebound tachycardia (beta blocker 1)
-Na and H2O retention

Front 126

Hypertension :Vasodilator Agents

Back 126

Hydralazine
-side effect= lupus like syndrome= affects joints and skin. dose related

Minoxidil
-side effect = hair growth

Nitroprusside (used for hypertensive emergency)
-dilates arterioles and venules
-therapy cannot exceed 3 days or leads to thiocyanate poisoning (muscle spasm, stupor)

Diazoxide
-side effect =hyperglycemia
-very poor control of the lowering of blood pressure

Front 127

Hypertension : Angiotensin Converting Enzyme Inhibitor

Back 127

-blocks conversion of angiotensin 1 to angiotensin 2
-side effects = non productive cough
-use = hypertension, congestive heart failure, diabetic renal sparing

Front 128

Hypertension: Angiotensin Receptor Blocker

Back 128

-utilized for pts. that cannot tolerate side effects of ACE inhibitors
-examples: Losartan, Irbesartan

Front 129

Hypertension: Calcium Channel Blocker

Back 129

-blocks entry of Ca into cells
-prevents contraction of vascular smooth muscles

use
-hypertension
-angina
-arrhythmia

Front 130

Name 2 Parasympathomimetic Agents (cholinergic drugs)

Back 130

-Bethanechol (Urecholine) = stimulate GI motility and bladder

-Pilocarpine (Pilocar) = short acting glaucoma drug

Front 131

Name 7 Anticholinesterase agents (Acetylchilinesterase inhibitors)

Back 131

-Edrophonium (Tensilon) = diagnosis for myasthenia gravis
-Neostigmine (Prostigmin) = treatment for myasthenia gravis
-Physostigmine (Eserine)
-Pyridostigmine (Mestinon) =treatment for myasthenia gravis
-Donepezil (Aricept) -treatment for Alzheimer's disease
-Galantamine (Reminyl) -treatment for Alzheimer's disease
-Rivastigmine (Exelon) =treatment for Alzheimer's disease

Front 132

Name 4 Anticholinergic drugs : Natural Alkaloids

Back 132

-Atropine = used before surgery to dry up secretion. found in crash carts for bradycardia

-Belladonna =dilates eyes. intestinal cramping

-Hyoscyamine =for intestinal cramping

-Scopolamine (Hyoscine) =before procedure to dry out secretions. patch form is used for motion sickness

Front 133

Name 3 Synthetic Antispasmodic Drugs (anticholinergic)

Back 133

-Dicyclomine (Bentyl) =specific for intestinal cramping

-Oxybutynin (Ditropan) =specific for bladder contractions/incontinence

-Tolterodine (Detrol) =specific for bladder contractions/incontinence

Front 134

Name 3 Synthetic Anticholinergic drugs

Back 134

-Glycopyrrolate (Robinul) =use before surgery to dry secretions

-Propantheline (Pro-Banthine) =not commonly used because of its too many side effects. but some still used for ulcers

-Ipratropium (Atrovent) =inhaler for asthma

Front 135

Name 5 Mydriatics and Cycloplegics

Back 135

-Atropine =long acting m&c

-Cyclopentolate (Cyclogyl) =short acting m&c

-Homatropine (Homatrocel) =short acting m&c

-Scopolamine (Hyoscine) =short acting m&c

-Tropicamide (Mydriacyl) =mydriasis only

Front 136

Name 5 drugs used in shock (Sympathomimetic/Adrenergic)

Back 136

-Epinephrine (Adrenalin)

-Isoproterenol (Isuprel)

-Levarterenol (Levophed)

-Dopamine (Intropin)

-Dobutamine (Dobutex)

Front 137

Name 5 Adrenergic Bronchodilatros/ Beta 2 bronchodilators

Back 137

-Metaproterenol (Alupent)

-Pirbuterol (Maxair)

-Albuterol (Ventolin, Proventil) = "rescue inhalers" for acute =draw back is it can't be over use = beta 1 spill over =heart attack

-Terbutaline (Brethine, Bricanyl)

-Salmeterol (Serevent) =Prophilactic and sometimes mixed with steroids, Advair. should only be inhaled 2/day

Front 138

Name 3 Nasal Decongestant

Back 138

-Phenylephrine (Neo-Synephrine)

-Oxymetazoline (Afrin)

-Pseudoephedrine (Sudafed) =long term pts. with high BP cannot use this

Front 139

Name 2 Alpha blocking agents

Back 139

-Phenoxybenzamine (Dibenzyline) =Pheochromocytoma disease

-Phentolamine (Regitine) =reverese Alpha properties of Levarterenol

Front 140

Name 5 Beta Blocking Agents (Beta1/2 non selective)

Back 140

-Propranolol (Inderal)

-Nadolol (Corgard)

-Timolol (Blocadren)

-Pindolol (Visken) =also ISA activity

-Labetalol (Normodyne, Trandate) =also alpha blocking activity

Front 141

Name 3 Beta Blocking agents (Primarily Beta 1 activity)

Back 141

-Atenolol (Tenormin)

-Metoprolol (Lopresor)

-Acebutolol (Sectral) =also ISA activity

Front 142

Name 3 Opthalmic (Topical) Sympathetic Blocking Agents

Back 142

-Timolol (Timoptic)

-Betaxolol (Betoptic)

-Levobunolol (Betagan) =primarily beta 1

Front 143

Name 3 Osmotic Diuretics

Back 143

-Mannitol =can be used for glaucoma, shock and nephrotoxic kidneys

-Hetastarch (Hespan) =shock

-Albumin =naturally occurring protein in our blood stream

Front 144

Name 3 Carbonic Anhydrase Inhibitor

Back 144

-Acetazolamide (Diamox)

-Methazolamide (Neptazine)

-Dorzolamide (Trusopt) =ophth drop =less potential for side effects if use for glaucoma

Front 145

Name 4 Thiazide Diuretics

Back 145

-Chlorthiazide (Diuril)

-Hydrochlorthiazide (Hydrodiuril)

-Metolazone (Zaroxolyn) = **works on both proximal/distal tubule making it synergistic with the loop diuretics

Front 146

Name 4 High ceiling loop diuretics

Back 146

-Ethacrynic Acid (Edecrin)

-Furosemide (Lasix)

-Bumetanide (Bumex)

-Torsemide (Demadex)

Front 147

Name 3 Potassium sparing diuretics

Back 147

-Spironolactone (Aldactone)

-Triamterene (Dyrenium)

-Amiloride (Midamor)

Front 148

Name 5 Sympatholitic Antihypertensives

Back 148

-Methyldopa (Aldomet)

-Clonidine (Catapres) -also topical

-Reserpine (Serpasil)

-Guanabenz (Wytensin)

-Guanethidine (Ismelin) =4th step drug

Front 149

Name 8 Beta blocking Antihypertensive Agents

Back 149

-Propranolol (Inderal)
-Metoprolol (Lopresor, Toprol XL)
-Nadolol (Corgard)
-Timolol (Blocadren)
-Atenolol (Tenormin)
-Pindolol (Visken)
-Acebutol (Sectral)
-Labetalol (Normodyne)

Front 150

Name 3 Alpha Adrenergic Blocking Agents

Back 150

-Prazosin (Minipres)

-Terazosin (Hytrin)

-Doxazosin (Cardura)

Front 151

Name 4 Vasodilators

Back 151

-Hydralazine (Apresoline)

-Minoxidil (Loniten)

-Diazoxide (Hyperstat)

-Nitroprusside (Nipride)

Front 152

Name 7 Angiotensin Converting Enzyme Inhibitor

Back 152

-Captopril (Capoten)
-Enalapril (Vasote)
-Lisinopril (Zestril, Prinivil)
-Benazepril (Lotensin)
-Fosinopril (Monopril)
-Quinapril (Accupril)
-Ramipril (Altace)

Front 153

Name 5 Angiotensin receptor blocker

Back 153

-Irbesartan (Avapro)

-Losartan (Cozaar)

-Valsartan (Diovan)

-Candesartan (Atacand)

-Telmisartan (Micardis)

Front 154

Name 9 Calcium Channel Blocking Agents

Back 154

-Diltiazem (Cardizem)
-Diltiazem SR (Cardizem SR)
-Diltiazem Long Acting (Cardizem CD, Dilitrate XR)
-Felodipine (Plendil)
-Nicardipine (Cardene)
-Nifedipine (Procardia, Adalat)
-Nifedipine XL (Procardia XL, Adalat CC)
-Verapamil (Calan, Isoptin)
-Verapamil SR (Calan SR, Isoptin SR)

Front 155

What is the receptor site in a parasympathetic fiber?

Back 155

muscarinic

Front 156

What is the receptor site in a sympathetic fiber?

Back 156

Alpha, beta 1, and beta 2