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Test 2
Pharm
102
Pharmacology
Professional
10/28/2013

Additional Pharmacology Flashcards

 


 

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Term
Nicotine
Definition
Nicotine agonist, (blocker)
metabolized and excreted rapidly

insecticide, cigarettes
Term
Trimethapan
Definition
Nicotine antagonist
not orally active
hypertensive emergencies
controled hypotension during surgery
short duration of action
S: PHT, mydriasis
Term
Mecamylamine
Definition
Nicotine antagonist
active orally
longer acting than trimethapan
S: PHT, mydriasis
Term
Succinylcholine
Definition
depolarizing agonist
Fasiculations
Non reversible
rapid onset, 1-2 min
brief duration 5-10 min due to breakdown by pseudocholinesterase

SE: atypical AchE, malignant hyperthermia, hyperkalemia (in burn/trauma patients 2-3 days later)
Term
What are the two types of neuromuscular blocking agents
Definition
1. Non depolarizing (competitive)
-Tubocurarine (curare)
-Rocuronium, Pancuronium,
cisAtracurium

2. depolarizing (non competitive)
Term
These compete with Ach for binding to the receptor. The muscle can still be stimulated directly by increasing the concentration of Ach. They cause flaccid , relaxed paralysis
Definition
Competitive (non depolarizing ) neuromuscular blocking agents
Term
How are competitive, non depolarizing neuromuscular blocking agents reversed
Definition
cholinesterase inhibitors such as neostigmine
Term
What are the 3 side effects of succinylcholine
Definition
1. Malignant hyperthermia
2. Hyperkalemia (trauma/burn patients due to upregulation of N-receptors)
3. prolonged paralysis due to atypical pseudocholinesterase
Term
Can succinylcholine be reversed?
Definition
No, can only give mechanical breathing support
Term
What breaks down succinylcholine
Definition
pseudocholinesterase
Term
Tubocurarine (curare)
Definition
Not orally transmitted
long onset 4-6 mins, long acting 80-120 min
histamine release (cause bronchospasm)
Term
Pancuronium
Definition
longer lasting and cleaner than tubocurarine
more potent than tubocurarine (x5)
less histamine release!
Term
Rocuronium
Definition
fast onset 1-2 min
short intermediate durationof 30-40 min
good substitute for succinylcholine
Term
cisAtracurium
Definition
Hoffman degradation
organindependent and has less risk in patients with liver or renal disease
Term
What drug is give to those who have atypical pseudocholinesterase or cannot have succinylcholine
Definition
rocuronium
Term
what neuromuscular blocking agent is given to someone who has liver or renal disease
Definition
rocuronium, due to Hoffman degradation
Term
This is the DOC given to prevent malignant hyperthermia due to succinylcholine
Definition
dantrolene
Term
The ganglionic nicotinic receptor is a ______. ___ goes inward while ____ goes outward
Definition
pentamer ion channel
Na+
K+
Term
What happens when nicotine reaches a toxic level
Definition
NMJ paralysis due to depolarizing blockade
hypertension initially followed by hypotension due to depolarizing block, cardiac arrhythmias
convulsions, vomiting, CV
Term
What is the treatment for nictotine toxicity
Definition
treatment is symptom directed
1. muscarinic excess- anticholinergic (atropine)
2. NMJ blockade- mechanical respiration
3. CNS stimulation: anticonvulsant (diazepam)
Term
Toxicity by ganglionic blocking agetns causes
Definition
hypotension, posteral hypotension
give presser agent to counter hypotension actions
Term
What breaks down AcH
Definition
acetylcholinesterase
Term
Can the effects of succinylcholine be overcome?
Definition
No, trying to over come the effects will only make it worst.
Mechanical respiration is the only treatment
Term
True or false: succinylcholine has a shorter duration than Ach
Definition
false
Term
What is the most important factor in regulating BP
Definition
TPR
Term
What are reasons for secondary HT and treatment
Definition
-cortisol overproduction
-aldosterone overproduction
-renal artery stenosis
-pheochromocytoma

**treat the disease, and HT will be treated
Term
What are reasons for primary HT and treatment
Definition
genetics, stress, obesity, smoking, salt intake, age, caffeine, and alcohol.

**Can lower HT with medication and lifestyle changes but HT will not be "cured"
Term
What are the treatment indications for pre hypertension
Definition
lifestyle change
Term
what are the treatment indications for stage 1 hypertenison
Definition
use a single drug and lifestyle change
Term
what are the treatment indications for stage 2 hypertension
Definition
use a drug combination and lifestyle change
Term
What are the four front line drugs for treating HT
Definition
1. Diuretics
2. Renin/A-II system (ACE1, ARBs)
3. Calcium antagonists
4. Beta receptor antagonists
Term
Which hypertension drug is recommended for an uncomplicated case
Definition
diuretics
Term
patients with diabetes who have HT should use which front line hypertension drug
Definition
Renin/ A-II system/ ACE1 ARBs
Term
patients with a history of myocardial infarct should use which front line hypertension drug
Definition
beta receptor antagonists
Term
Where do thiazides take action and how
Definition
early distal tubule, inhibit Na-CL symporter to inhibit water/Na reabsorption. This decreased BP by depleting the body of Na
Term
Hydrochlorothiazide
Definition
thiazide
treats hypertension, HF
decrease Na reabsorbtion in early distal tuble and decreases blood volume

SE: hypokalemia, decreased glucose tolerance, photosensitivity, hearing loss
Term
Metolazone
Definition
thiazide
treats hypertension, HF
decrease Na reabsorbtion in early distal tuble and decreases blood volume

SE: hypokalemia, decreased glucose tolerance, photosensitivity, hearing loss
Term
Chlorthalidone
Definition
thiazide
treats hypertension, HF
decrease Na reabsorbtion in early distal tuble and decreases blood volume

SE: hypokalemia, decreased glucose tolerance, photosensitivity, hearing loss
Term
Indapamide
Definition
thiazide
treats hypertension, HF
decrease Na reabsorbtion in early distal tuble and decreases blood volume

SE: hypokalemia, decreased glucose tolerance, photosensitivity, hearing loss
Term
Spironolactone
Definition
Acts on collecting tube, no K+ loss, blocks aldosterone
Term
Eplerenone
Definition
Acts on collecting tube, no K+ loss, blocks aldosterone
Term
Triamterene
Definition
Acts on collecting tube, no K+ loss, blocks Na channels
Term
Angiotensin converting enzyme inhibitors end in
Definition
-pril
Term
This is a potent vasocontrictor peptide which increases the production of aldosterone
Definition
angeiotensin II
Term
What are the steps in the making of Angiotensin II
Definition
Angiotensinogen converted to angiotensin I by renin. angiotensin I converted to angiotensin II by ACE
Term
What drug blocks the conversion of angitensinogen to angiotensin I
Definition
Aliskiren
Term
Aliskiren
Definition
Treatment of hypertension

direct renin inhibitor
decreases angiotensin I
NO DRY COUGH
hyperkalemia, altered taste (Zn), glossitis, angioedema, dry mouth
Term
Captopril
Definition
treats hyptertension, heart failure
ACE inhibitor
decreasess angiotensin II and aldosterone, which decreases TPR

SE: increases bradykinin which causes a dry cough
other side effects: hyperkalemia, altered taste (Zn), glossitis, angioedema, dry mouth
Term
Lisinopril
Definition
treats hyptertension, heart failure
ACE inhibitor
decreasess angiotensin II and aldosterone, which decreases TPR

SE: increases bradykinin which causes a dry cough
other side effects: hyperkalemia, altered taste (Zn), glossitis, angioedema, dry mouth
Term
Enalapril
Definition
treats emergency hyptertension, heart failure
prodrug with a half life of 6 hours
ACE inhibitor
decreasess angiotensin II and aldosterone, which decreases TPR

SE: increases bradykinin which causes a dry cough
other side effects: hyperkalemia, altered taste (Zn), glossitis, angioedema, dry mouth
Term
All Angiotensin II Type 1 Receptor Blockers (ARBs) end in
Definition
-sartan
Term
What are the two receptors that angiotensin II affect. Which ones do ARBs affect?
Definition
angiotensin II type I receptor
angiotensin II type II receptor

angiotensin II type I receptor
Term
Angiotensin II type I receptors mediate
Definition
production of aldosterone, anti diuretic hormone, increased TPR, increased sympathetic NS
Term
Angiotensin II type II receptors mediate
Definition
vasodilation, decreased TPR, increase NO
Term
Losartan
Definition
Treats Hypertension and heart failure
angiotensin II type I receptor blocker

treats hyptertension, heart failure
ACE inhibitor
decreasess angiotensin II and aldosterone, which decreases TPR

NO DRY COUGH
side effects: hyperkalemia, altered taste (Zn), glossitis, angioedema, dry mouth
Term
Irbesartan and Valsartan
Definition
Treats Hypertension and heart failure
angiotensin II type I receptor blocker

treats hyptertension, heart failure
ACE inhibitor
decreasess angiotensin II and aldosterone, which decreases TPR

NO DRY COUGH
side effects: hyperkalemia, altered taste (Zn), glossitis, angioedema, dry
Term
What are the two classes of calcium channel blockers
Definition
Non dihydropyridines
Dihydropyridines (end in dipine)
Term
What is the effect of calcium channel blockers
Definition
bind to L type calcium channels in cardiace and vascular smooth muscle and causes dilation of vessels
Term
Nifidipine is a _____ and mainly causes ____ vasodilation and has little effect on ____.
Definition
dihydropyridine calcium channel blocker
arteriole
cardiace tissue
commonly causes reflex tachycardia
Term
Verapamil is a ______ and has effect on _______
Definition
non dihydropyridine calcium channel blocker
cardiac tissues
causes brady cardia
Term
Dilitazem is a _____ and has actions on ____ and _____.

Is it more similar to nifidipine or verapamil?
Definition
non dihydropyridine calcium channel blocker
cardiac and vascular beds

verapamil action
Term
Amlodipine
Definition
treats hypertension and mainly acts on arterioles.

causes reflex tachycardia
Term
what are side effects of calcium channel blockers
Definition
constipation (more so w/ non-DHPs)
cardiac depression, brady cardia (non DHPs)
hypotension (DHP)
gingival hyperplasia (esp with nifedipine)
Term
Beta blockers have a ____ hypotensive action.
Definition
delayed
Term
What are the possible mechanisms of action for beta blockers
Definition
CNS effect to decrease sympathetic NS tone
inhibition of renin secretion: beta 1 receptors mediate renin release

block cardiac beta 1 receptors which causes a decrease in HR and cardiac output decreasing the BP
Term
Selective beta blockers have names beginning with ___
Definition
A-N
Term
All beta blockers end in ___
Definition
-olol
Term
Atenolol
Definition
selective B1 blocker
No local anestetic action
Term
Labetalol
Definition
Non selective B blocker with partial alpha blocker activity

local anesthetic action
Term
Metoprolol
Definition
selective B1 blocker
local anesthetic action
Term
Pindolol
Definition
non selective B blocker with local anesthetic action and partial agonist
Term
Propranolol
Definition
non selective B blocker with local anesthetic action
Term
Timolol
Definition
non selective B blocker
Term
What are the 2 mixed alpha and beta recepter blockers that are used for acute and chronice hypertension
Definition
labetalol
carvedilol
Term
What are the 2 mixed alpha and beta recepter blockers that are used for Heart Failure
Definition
carvedilol and metoprolol
Term
What antihypertensive agents cause hypokalemia
Definition
thiazides
Term
what antihypertensive agents cause hyperkalemia
Definition
ACE/ARBs
Term
What antihypertensive agents/CHF drugs are contraindicated for pregnant women?
Definition
ACE/ARBs
Term
Define compensated heart failure
Definition
resting cardiac function is ok
excessive stress or exercise is not ok
Term
Define congestive heart failure (CHF, decompensated)
Definition
resting cardiac function is inadequate for body's oxygen demand
Term
What are some symptoms of CHF
Definition
venous pooling which causes edema especially in the lungs
dyspnea
neurohormonal storm
Term
Describe the neurohumoral storm
Definition
Decreased cardiace function leads to neuro-humoral activation which increases sympathetic NS activity and Renin angiotensin aldosterone system activity. This also leads to tissue remodeling (hypertrophy, decreased CO)
Term
are calcium channel blockers used for CHF?
Definition
No
Term
What is the site of action for cardiac glycosides
Definition
Na+,K+, ATPase
Term
What is the cardiac glycoside that we need to know for this test?
Definition
Digoxin
Term
Digoxin
Definition
cardiac glycoside
has very narrow therapeutic range
contraindicated for women
Term
An increase in potassium concentration causes ________ of the alpha subunit of the Na/K ATPase pump causing cardiac glycosides to bind _______
Definition
dephosphorylation
less effectively
Term
An decrease in potassium concentration causes ________ of the alpha subunit of the Na/K ATPase pump causing cardiac glycosides to bind _______
Definition
phosphorylation
more effectively
Term
Do ACE inhibitors enhance or weaken the effects of cardiac glycosides
Definition
weaken
Term
Do thiazide diuretics enhance or weaken the effects of cardiac glycosides
Definition
enhance
Term
Describe the steps of how digoxin works
Definition
It inhibts the Na/K/ATPase which decreases the exchange of Na/K. the concentrat the Na/Ca exchanger to reverse or to become depolarized and the intracellular concentration of Ca increases, thus increasing the SR stores of Ca and increasing contractile force
Term
cardio glycosides have an ionotropic effect which means
Definition
it increases the influx of Ca stores which increases contraction
Term
How does digoxin affect the frank-starling graph
Definition
it will shift the line up and to the left (increase steepness of the curve)
Term
What effects are seen with cardiac glycoside toxicity
Definition
ventricular tachycardia, delirium, fatigue, weakness, dizziness, nausea, vomiting, vision/light disturbances (halo effect, mainly yellow and green )
Term
what is the treatment for toxicity by cardiac glycoside
Definition
discontinue cardiac glycoside or alter dose
administer K or discontinue K depleting diuretics
Term
What type of drug is used in IV form in acute emergency CHF NOT CHRONIC
Definition
catecholamines
Term
What 3 drugs are catecholamines used for acute emergency CHF
Definition
dobutamine, milrinone, Inamrinone
Term
These catecholamine inhibit phosphodiesterase III. Which increases cAMP levels and causes phosphorylation of Ca channel
Definition
Inamrinone and milrinone
Term
what vasodilator is a combination of isosorbide dinitrate and hydralazine and is good for treating African Americans with CHF
Definition
Bidil
Term
Is propranolol recommended for CHF?
Definition
No
Term
Beta-type natriuretic peptide is also known as ____
Definition
nesirited
Term
Beta-type natriuretic peptide
Definition
Uses NO to Increase cGMP, leading to smooth muscle relaxation and vasodilation. works on both arteries and veins.
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