Toxicology - Exam 2

Front 1

Equation for Blood Pressure

Back 1

BP=COxTPR

Front 2

Equation for Cardiac Output

Back 2

CO=HRxSV

Front 3

What is the average cardiac output?

Back 3

5 liters

Front 4

What is TPR?

Back 4

total peripheral resistance

condition of vascularity

Front 5

Define Hypertension

Back 5

Defined in an adult as a systolic pressure of 140mmHg or higher and/or a diastolic pressure of 90mmHg or higher.

Front 6

Normal BP

Back 6

less than 120
---------------------
less than 80

Front 7

Prehypertension

Back 7

120-139
------------
80-89

Front 8

High blood pressure directly increases the risk of what?

Back 8

coronary heart disease

Front 9

Coronary heart disease leads to what?

Back 9

Heart attack and stroke

Front 10

High blood pressure is prevalent in what types of people?

Back 10

-African Americans
-middle-aged and elderly
-obese
-heavy drinkers
-people w/ diabetes mellitus, gout or kidney disease

Front 11

What is considered as the silent killer?

Back 11

high blood pressure

Front 12

What 3 things should people with high blood pressure do?

Back 12

1)follow their healthcare provider's instructions
2)stay on their medication
3)make lifestyle changes

Front 13

Name a diuretic

Back 13

HCTZ = Hydrochlorothiozide

Front 14

Diuretics may cause what in 1/2 the population?

Back 14

Impotence

Front 15

Name a Beta Blocker

Back 15

propranolol

Front 16

Impotence may occur with what condition?

Back 16

hypertension

Front 17

What do beta blockers do?

Back 17

block beta receptors on the heart so the heart doesn't do too much work

-decreases CO
-decreases BP

Front 18

Name 2 ACE inhibitors

Back 18

1)Lisinopril
2)Captopril

Front 19

What do ACE inhibitors do?

Back 19

prevent conversion of Angiotensin I to Angiotensin II (occurs in the lungs)

Front 20

What enzyme converts angiotensin I to angiotensin II?

Back 20

ACE = angiotensin converting enzyme

Front 21

What is the most common side effect of ACE inhibitors?

Back 21

dry cough (lungs are irritated)

Front 22

What drug is more expensive than ACE inhibitors?

Back 22

ARBs = Angiotensin II Receptor Blocker

Front 23

Name an ARB

Back 23

Valsartan

Front 24

Where would you find angiotensin II receptors?

Back 24

endothelial cells lining blood vessels

Front 25

Stage 1 Hypertension

Back 25

140-159 systolic
or
90-99 diastolic

Front 26

Stage 2 hypertension

Back 26

160 or higher systolic
or
100 or higher diastolic

Front 27

What BP reading require Emergency Care?

Back 27

higher than 180 systolic
or
higher than 110 diastolic

Front 28

Name a Calcium Channel Blocker

Back 28

Verapamil

Front 29

Why would an individual taking a calcium channel blocker have swollen ankles as a possible side effect?

Back 29

Calcium channel blockers dilate blood vessels and there is fluid loss in capillaries.

Front 30

Name an Alpha blocker

Back 30

Prazosin

Front 31

Name a side effect when taking alpha blockers

Back 31

tachycardia

Front 32

What is the state of dilation or constriction in peripheral vessels called?

Back 32

total peripheral resistance (TPR)

Front 33

What are now considered first-choice treatment and are the cornerstone of heart failure drug therapy?

Back 33

ACE inhibitors

Front 34

In a study, ____________ has been proven to slow the progression of heart failure.

Back 34

ACE inhibitors

Front 35

ACE inhibitors are a type of _________.

Back 35

vasodilator

Front 36

What is a substance in the blood that causes vessels to tighten and raises blood pressure?

Back 36

angiotensin

Front 37

What are drugs called that should not be taken during pregnancy?

Back 37

Tetragens

Front 38

What two types of drugs can effect K+ levels in the blood?

Back 38

1) Diuretics (hypokalemia)
2) ACE inhibitors (hyperkalemia)

Front 39

A possible side effect when taking an ACE inhibitor is feeling weak and dizzy when first taking the drug. What causes this?

Back 39

Due to lowering of blood pressure.

Front 40

When should the first doses an ACE inhibitor be taken?

Back 40

Just before bedtime

Front 41

What is prescribed for almost all patients who have fluid buildup in the body and swelling in the tissues?

Back 41

Diuretics

Front 42

A diuretic causes the kidneys to remove more __________ and __________ from the bloodstream than usual and convert it to urine.

Back 42

water and sodium

Front 43

Name four main side effects when taking diuretics.

Back 43

1) poor kidney function
2) dizziness
3) low blood pressure
4) hypokalemia

Front 44

Function of vasodilators

Back 44

release nitric oxide from endothelial cells of blood vessels which generate cGMP and cause vasodilation

Front 45

Name a vasodilator

Back 45

nitrates/nitroglycerine

Front 46

What is a major contraindication when taking nitrates/nitroglycerine?

Back 46

Don't take Viagra
-can lead to dangerously low blood pressure

Front 47

People who can't tolerate __________ are often prescribed other types of vasodilators to relieve symptoms and improve their tolerance for exercise.

Back 47

ACE inhibitors

Front 48

What is a type of vasodilator prescribed to ease chest pain?

Back 48

nitroglycerine

Front 49

What are the special instructions for taking nitroglycerine?

Back 49

-take one tablet, wait 5 minutes
-take another one if chest pain still there
-if pain persists for another 5 minutes, take a 3rd
-if chest pain doesn't go away after this, call ambulance right away

Front 50

How can vasodilators cause postural hypotension and palpitations?

Back 50

TPR decreases so much, CO can't increase enough to compensate so heart rate is increased causing palpitations.

Front 51

Name 2 Digitalis drugs

Back 51

1) digoxin
2) digitoxin

Front 52

What does digoxin do?

Back 52

Inceases the force of the heart's contraction, which can be beneficial in heart failure.

Front 53

What drug is given to patients who aren't responding to ACE inhibitors or diuretics?

Back 53

Digitalis

Front 54

When used by someone who has atrial fibrillation, digoxin prevents what?

Back 54

Prevents the ventricles from beating too rapidly.

Front 55

What drug effects the conduction system of the heart?

Back 55

Digitalis

Front 56

Levels of digitalis that are too high can cause?

Back 56

-loss of appetite
-nausea
-vomiting
-headaches

Front 57

Which drug can occasionally interfere with the normal heartbeat, causing irregular heartbeats or skipped beats?

Back 57

Digitalis

Front 58

Name beta blockers

Back 58

1) atenolol
2) propranolol

Front 59

How does a failing heart try to compensate for its weakened pumping action?

Back 59

It beats faster = more strain on the heart

Front 60

Function of beta blockers

Back 60

reduce the heart's tendancy to beat faster by reducing the effects of chemical messengers that increase heart rate.

allows the heart to maintain a slower heart rate & lowers BP

Front 61

Name 2 Digitalis drugs

Back 61

1) digoxin
2) digitoxin

Front 62

What does digoxin do?

Back 62

Inceases the force of the heart's contraction, which can be beneficial in heart failure.

Front 63

What drug is given to patients who aren't responding to ACE inhibitors or diuretics?

Back 63

Digitalis

Front 64

When used by someone who has atrial fibrillation, digoxin prevents what?

Back 64

Prevents the ventricles from beating too rapidly.

Front 65

What drug effects the conduction system of the heart?

Back 65

Digitalis

Front 66

What drugs are used for mild to moderate heart failure?

Back 66

Beta blockers

Front 67

Which drug can decrease the amount of oxygen that circulates thru the body as a side effect?

Back 67

beta blockers

Front 68

How do beta blockers decrease the workload of the heart?

Back 68

decrease HR---->decrease BP----->decrease workload

Front 69

How do beta blockers cause dizziness and fainting?

Back 69

decrease BP---->decrease CO----->decrease O2 to tissues---->dizziness and fainting

Front 70

Name a blood thinner

Back 70

-warfarin (Coumadin)

Front 71

Who are at risk of developing blood clots, usually in the BVs of the legs, lungs, and heart?

Back 71

People with heart failure

Front 72

blood clots in BVs of the heart can occur in cases of a condition called?

Back 72

atrial fibrillation

-atria contract rapidly w/out coordination causing the blood to pool in the atria where it can form a clot

Front 73

Blood clots can be carried into the blood vessels that supply the brain. What can result?

Back 73

Blood flow to the brain is cut off and a stroke results.

Front 74

Blood thinners are prescribed to individuals who have a history of what?

Back 74

1) clots in the lungs or legs
2) atrial fibrillation
3) stroke

Front 75

Blood thinners are ___________.

Back 75

anti-coagulants

Front 76

What do INR tests measure?

Back 76

Measures how quickly blood clots.

Normal is b/t 2 and 4 minutes.

Front 77

Why is it difficult to get the correct dose of blood thinners?

Back 77

10% of population don't respond appropriately to warfarin due to a genetic predisposition.

Front 78

Name some side effects caused by blood thinners.

Back 78

-nosebleeds
-bleeding in the gums
-bleeding while shaving
-easy bruising

Front 79

Name an Angiotensin II Receptor Blockers (ARBs)

Back 79

Valsartan

Front 80

What is considered the cornerstone of heart failure drug therapy?

Back 80

ACE inhibitors

Front 81

Function of ARBs

Back 81

Prevent angiotensin II from having any effects on the heart and blood vessels. It keeps blood pressure from rising.

Front 82

Side effects of ARBS

Back 82

-nausea
-dizziness
-headaches
-low BP

Front 83

Name a calcium channel blocker

Back 83

Amlodipine

Front 84

Function of Ca2+ channel blockers

Back 84

Block calcium channels preventing smooth muscle in blood vessels from contracting, causing vasodilation. This causes decrease workload on heart.

It also blocks calcium channels on heart muscles, decreasing the force of contraction.

Front 85

Functions of Potassium

Back 85

1) helps control heart rhythm
2) essential for normal work of NS and muscles

Front 86

How is the level of potassium regulated in the bloodstream?

Back 86

Kidneys control amount of K+ in the bloodstream and eliminate any excess thru the urine.

Front 87

What drugs cause the body to retain potassium?

Back 87

ACE inhibitors

Front 88

What do patients need to do if their potassium levels are effected by certain drugs?

Back 88

Need to monitor K+ levels when they take these drugs and they should recceive regular checks for kidney function.

-decrease amphetamine
-increase K+ intake

Front 89

Functioni of analgesics

Back 89

decrease in sensation of pain

Front 90

Functions of Potassium

Back 90

1) helps control heart rhythm
2) essential for normal work of NS and muscles

Front 91

How is the level of potassium regulated in the bloodstream?

Back 91

Kidneys control amount of K+ in the bloodstream and eliminate any excess thru the urine.

Front 92

What drugs cause the body to retain potassium?

Back 92

ACE inhibitors

Front 93

What do patients need to do if their potassium levels are effected by certain drugs?

Back 93

Need to monitor K+ levels when they take these drugs and they should recceive regular checks for kidney function.

-decrease amphetamine
-increase K+ intake

Front 94

Functioni of analgesics

Back 94

decrease in sensation of pain

Front 95

Morphine acts on ______ receptors.

Back 95

Mu

Front 96

What is the generic reference to morphine-like drugs/actions?

Back 96

opioids

Front 97

Where are opioids derived from?

Back 97

opiate derivatives of opium

Front 98

Who is the god of dreams?

Back 98

Morpheus

Front 99

Mu is what kind of receptor?

Back 99

an endorphin receptor

Front 100

What is the prototype of opioids?

Back 100

morphine

Front 101

Name an opioid agonist

Back 101

morphine

Front 102

What can occur with opioid toxicity?

Back 102

Respiratory depression=stop breathing

Front 103

Actions of opioid receptors

Back 103

1) analgesia
2) respiratory depression
3) sedation
4) euphoria
5) physical dependence

Front 104

What drug is used to wheen people off heroin?

Back 104

naloxone

Front 105

Name 2 pure agonists of opioids.

Back 105

1) morphine
2) codeine

Front 106

Main effect of opioids

Back 106

analgesia

Front 107

General actions of opioids

Back 107

1) analgesia
2) respiratory depression
3) cough suppression

Front 108

Name an NSAID similar to aspirin

Back 108

acetaminophen (Tylenol)

Front 109

What is the difference b/t the effects of aspirin and acetaminophen?

Back 109

Acetaminophen only inhibits synthesis of CNS prostaglandins, does not have peripheral side effects ASA.

Front 110

What organ can be affected if too much acetaminophen in taken?

Back 110

Liver

-you can only take about 500mg/day

Front 111

Peripheral side effects of ASA (aspirin)

Back 111

1) gastric ulceration
2) decrease platelet aggregation
3) decrease renal flow
4) decrease uterine contractions

Front 112

Function of prostaglandins

Back 112

promote pain

Front 113

Function of anesthetics

Back 113

-Loss of all sensation
usually w/ loss of consciousness

-decrease propagation of neural impulses

Front 114

Name a gasous general anesthetic

Back 114

nitrous oxide (nitronox)

Front 115

Name an IV general anesthetic

Back 115

Pentothal, a barbituate

Front 116

Function of local anesthetics

Back 116

-blocks sodium channels
-affect on area around injection

Front 117

Local anesthetics are usually accompanied by what?

Back 117

epinephrine

Front 118

Name a local anesthetic

Back 118

lidocaine

Front 119

What are the classes of anti-anxiety and sedative-hypnotic drugs?

Back 119

1) Barbiturates
2) Benzodiazepines
3) Alcohol

Front 120

Function of sedation

Back 120

decrease anxiety and inhibitions

Front 121

Function of hypnoses

Back 121

instigation of sleep

Front 122

What are anti-anxiety and sedative-hypnotic drugs used for?

Back 122

1) sedation
2) hypnosis
3) insomnia

Front 123

Which drugs have a higher potency? Barbiturates or Benzodiazepines?

Back 123

Barbiturates

Front 124

Function of benzodiazepines

Back 124

-promote the effectiveness of GABA receptors in the CNS

Front 125

Function of Barbiturates

Back 125

-promote and at high doses stimulate GABA receptors in the CNS

Front 126

Name the chief CNS inhibitory neurotransmittor.

Back 126

GABA

Front 127

Function of GABA

Back 127

promotes hyperpolarization via increase of chloride influx

inhibits neuron by hyperpolarizing it and bringing it further away from threshold

Front 128

Which is more safe? Barbiturates or benzodiazepines?

Back 128

Benzodiazepines

Front 129

Which has an antagonist available? Benzodiazopines or barbiturates?

Back 129

Benzodiazepines

Front 130

Name a benzodiazepine

Back 130

diazepam (Valium)

Front 131

What is the typical indication for secobarbital (Seconal)?

Back 131

Used for insomnia

Front 132

Name a short acting barbiturate prototype.

Back 132

secobarbital (Seconal)

Front 133

Seizures are caused by?

Back 133

hyperactive brain areas

Front 134

Function of anti-seizure medications

Back 134

-decrease propagation of action potentials

Front 135

Function of anti-seizure medications

Back 135

Decrease propagation of action potentials

Front 136

How do anti-seizure meds decrease propagation of action potentials?

Back 136

1) decease Na+, Ca2+ influx (delay depolarization/prolong repolarization)

2) increase Cl- influx (hyperpolarize membrane)

Front 137

Name 2 types of anti-seizure meds?

Back 137

1) benzodiazepines
-diazepam (Valium)
-lorazepam (Ativan)

2) Barbiturates
-phenobarbital (Luminal)

Front 138

What are the 2 general mechanisms of SNS stimulants?

Back 138

1) increase excitatory neurotransmitter release
-usually norepinephrine

2) decrease inhibitory neurotransmitter release
-usually GABA or Glycine

Front 139

3 classes of SNS Stimulants

Back 139

1) amphetamines
2) methylphendidate
3) methylxanthines

Front 140

Caffiene is a type of what?

Back 140

methylxanthine=SNS stimulant

Front 141

Function of MAO

Back 141

promote release of norepinephrine and dopamine

Front 142

Name an indication for amphetamines

Back 142

diet suppressioni

Front 143

Side effects of amphetamines

Back 143

1) tachycardia
2) hypertension
3) convulsion
4) insomnia
5) psychosis

Front 144

What will happen if you block MAO?

Back 144

Can't breakdown norepinephrine---->more norepinephrine around

Front 145

Mechanism of action of Methylxanthines

Back 145

reversible blockade of adenosine receptors

Front 146

Where are there lots of adenosine receptors?

Back 146

1) Nervous system
2) Cardiovascular system

Front 147

AKA for anti-psychotic drugs

Back 147

Neuroleptics

Front 148

Treatment of Schizophrenia aimed at what?

Back 148

Decreasing dopamine activity

-blocks dopamine receptors

Front 149

Name an anti-psychotic drug

Back 149

phenothiazines

=chlorpromazine (Thorazine)

Front 150

Uses for anti-psychotics

Back 150

1) Schizophrenia
2) Bipolar depression
3) Tourette's Syndrome
4) prevention of emesis
5) Dementia (OBS)
6) temporary psychoses from other illness

Front 151

Function of Barbiturates

Back 151

-promote and at high doses stimulate GABA receptors in the CNS

Front 152

Name the chief CNS inhibitory neurotransmittor.

Back 152

GABA

Front 153

Function of GABA

Back 153

promotes hyperpolarization via increase of chloride influx

inhibits neuron by hyperpolarizing it and bringing it further away from threshold

Front 154

Which is more safe? Barbiturates or benzodiazepines?

Back 154

Benzodiazepines

Front 155

Which has an antagonist available? Benzodiazopines or barbiturates?

Back 155

Benzodiazepines