Zana Pharmacology – Flashcards
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4 major diuretics
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Carbonic anhydrase inhibitors, loop diuretics, thiazides diuretics, potassium sparing diuretics
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example of carbonic anhydrase inhibitor
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Acetazolamide
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Actions of Acetazolamide
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Prevents reabsorption of bicarbonate, prevents H+ secretion and decreases absorption of sodium and water
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Use of Acetazolamide (diuretic)
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Glaucoma, altitude sickness & alkalize urine
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Side effects of acetazolamide
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Metabolic acidosis, hypokalemia, tingling of extremities
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example of a Loop diuretic
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Furosemide (Lasix)
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Use of furosemide
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Used as renal function declines
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MOA of furosemide
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Inhibit reabsorption of sodium, chloride, and potassium from loop of henle
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Side effects of furosemide
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Hypokalemia, hyponatremia, hypochloremia, ototoxocity, hyperglycemia, metabolic alkalosis, hyperuricemia, dehydration
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Drug interaction of furosemide
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Digoxin (dysrhthmias)
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example of Thiazide diuretic
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Hydrochlorothiazide
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MOA of thiazide
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Inhibit reabsorption of sodium in distal convoluted tubule by blocking chloride pump
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Thiazide increases...
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Calcium excretion
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Side effects of thiazide
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Hypocalcemia, hypokalemia, hypochloremia, hyperuricemia
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Thiazide contraindicated with...
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Allergies to sulfonamides
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example of Potassium sparing diuretic
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Spironolactone (aldactone)
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Spironolactone is what type of antagonist
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Aldosterone antagonist
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Spironolactone is what type of channel blocker
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Sodium channel blocker
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Side effects of Spironolactone
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Hyperkalemia and gynecomastia
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First line anti hypersensitive agent
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Beta blocker/ diuretic
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Diabetic agent
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Ace inhibitor
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Second line anti hypersensitive agent
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Substitute or add (diuretic + blocker)
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Third line anti hypersensitive agent
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Central a2 agonists, hydralazine, minoxidil
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What is common when used with ace inhibitors?
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Hyperkalemia
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Hypertension
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140/90
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Prehypertension
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120-139/80-89
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Primary hypertension
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Has no specific cause
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Secondary hypertension
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Pinpoint an exact cause
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Drugs which block rns
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Ace inhibitors & A2 receptor antagonist
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Drugs that interfere with SNS
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beta blockers, alpha blockers, a2 receptor agonists
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4 anatomical sites for blood pressure
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arterioles, venules, SNS, heart
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Ace inhibitors
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captopril (capoten) & enalapril (vasotec)
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MOA of ace inhibitors
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block production of A2 & prevent degradation of bradykinin
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Ace inhibitors decreases...
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aldosterone secretion and PVR
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Side effects of enalapril
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skin rash, dry cough, hypotension, hyperkalemia, acute renal failure, angioedema, protenuria
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ace inhibitors contraindicated in...
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pregnancy
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Drug interactions with ace inhibitors
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N-SAIDS, K-sparing diuretics
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A2
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vasoconstricter, stimulate secretion of aldosterone, increase SNS
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A2 receptor antagonist
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Losartan (cozaar)
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MOA of Losartan
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blocks effects of a2 on its receptor
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Lasartan is useful for patient who...
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cannot tolerate ace inhibitors
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Losartan has no effect on
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bradykinin
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Side effects of Losartan
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dry skin, dry mouth, tooth pain, alopecia, hypotension, rash
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Renin Inhibitor
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Aliskiren (tektura)
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Aliskiren contraindicated in...
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pregnancy
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Side effects of Aliskiren
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diarrhea, angioedema, cough, seizures
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action of Beta 1 receptor
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increase heart rate, renin release, cardiac contractility
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action of Beta 2 receptor
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bronchodilation, vasoconstriction
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action of Beta Blocker
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decrease heart rate, cardiac output an sympathetic outflow
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example of a beta blocker
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Metoprolol (lopressor)
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side effects of metoprolol
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bradycardia, abnormal AV conduction, heart failure, bronchospasms, cold extremities, prolonged hypoglycemia
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abrupt withdrawal of metoprolol may produce
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unstable angina and heart attack
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example of an Alpha blocker
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Doxazosin (cardura)
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doxazosin decreases...
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PVR
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Doxazosin not used for what?
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first line defense except benign prostatic hyperplasia
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Side effects of doxazosin
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orthostatic hypotension, nasal congestion, dizziness
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A2-agonists
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Clonidine (catapres) & methyldopa (aldomet)
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A2-Agonists found on what?
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presynaptic membranes of postganglionic neurons
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A2-Agonists reduce what?
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NE release
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A2-Agonists used as...
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last line of defense
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Side effects of A2-Agonists...
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orthostatic hypotension, sedation, decreased libido, incompetence, dry mouth
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example of calcium channel blockers
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Verapamil (isoptin) & Nifedipine (Nimotop)
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MOA of Calcium channel blocker
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block voltage dependent L-type calcium channels
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Verapamil has major effects on what?
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the Heart
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Nifedipine has major effects on what?
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Smooth muscle
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Side effects of calcium channel blockers
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constipation, flushing, cardiac depression
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verapamil produces less___ and is used as___
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hypotension ; antiarrhythmics
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Nifedipine useful for___
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AV conduction abnormalities
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vasodilators
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hydralazine, minoxidill, calcium channel blockers
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Hydralazine (apresoline) dilates what?
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arterial smooth muscle
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Hydralazine is reserved for...
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severe hypertension
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Side effects of hydralazine...
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reflex tachycardia, lupus like syndrome, sodium/water retention
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Angina pectoris
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severe chest pain that occurs when coronary blood flow is inadequate to supply the oxygen required by the heart
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2 major types of angina
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Classic & variant/vasospastic
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Classic angina
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At rest you're okay, but increase in exercise/activity brings pain
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most common cause of classic angina
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atherosclerosis
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Vasospastic angina
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Angina at rest
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cause of vasospastic angina
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caused by vasospasms (coronary arteries constrict for no reason)
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drug therapy of angina is aimed at what 2 things...
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increasing myocardial oxygen supply and decreasing oxygen demand
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myocardial oxygen demand depends on...
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heart rate, contractility, wall tension
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3 classes of drugs used to treat angina
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nitrates, beta blockers, calcium channel blockers
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Example of a Nitrate
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Nitroglycerine (nitrostat)
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MOA of Nitroglycerine
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relaxes all smooth muscle
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nitroglycerine effect on oxygen...
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reduces oxygen consumption and increases oxygen supply
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Side effects of Nitrates
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orthostatic hypotension, increased intracranial pressure, tolerance, flushing, persperation
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use of nitrates
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variant and effort angina, congestive heart failure
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Route of administration or Nitrates
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Sublingual, oral, IV, transdermal
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How to decrease nitrate tolerance
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Use the transdermal patch, 12 hr on 12 hr off
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How beta blockers work with angina
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decrease heart rate, contractility, oxygen demand
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Be careful with betablockers on a patient who has what type of angina
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Vasospastic because it can cause further constriction of blood vessels
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How calcium channel blockers work with angina
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decrease heart rate, contractility, oxygen demand
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nifedipine can be used for what type of angina
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variant angina
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Congestive heart failure
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inadequate cardiac output to provide the oxygen needed by the body
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signs/symptoms of congestive heart failure
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pulmonary edema, shortness of breath, decreased exercise tolerance with rapid muscle fatigue, peripheral edema, tachycardia, cardiac hypertrophy
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Compensatory mechanisms for heart failure
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increase activation of SNS: increase heart rate & PVR Activate renin angiotensin system: increase aldosterone cardiac hypertrophy: increase size of muscle cells in heart
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What do you use as drug therapy for heart failure
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ionotropic and non-ionotropic agents
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MOA of ionotropic agent: Digitalis Glycosides
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increase contractility of the heart muscles
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MOA of non-ionotropic agent: hydralazine
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vasodilators
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digitalis glycosides divided into 2 parts...
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digoxin & digitoxin
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therapeutic range of Digoxin 1/2 life...
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0.8-2.0 ng/mL >2.0=toxic 36 hours
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therapeutic range of Digitoxin 1/2 life...
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20-35 ng/mL >35=toxic 7 days
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Pharmacology effects of digitalis glycosides
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-increase cardiac contractility -conduction velocity through AV node and increase refractory period of AV node -decrease hearts oxygen consumption
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toxic effects of digitalis gylcosides
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Visual disturbances, bradycardia, premature ventriculare contractions, A-fib, ventriculaar tachycardia, ventricular fibrillation
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treatment of digitalis gylcosides
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*Potassium supplement lidocaine=antiarrhythmic, FAB fragment= digoxin antibody
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clinical uses of digitalis glycosides
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chronic heart failure and to treat supraventricular arrhythmias
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Drug interactions of glycosides
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DIURETICS: decrease serum potassium and enhance efects of the cardiac glycoside
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Precaution of glycosides: derease...
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...decrease with age
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phosphodiesterase inhibitor
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milrinone (primacor)
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Milrinone used in patients getting what?
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digoxin and diuretics
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MOA of milrinone
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block enzyme phosphodiesterase which increases cAMP and calcium in the cell
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Milrinone associated with fatal...
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ventricular arrythmias
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Side effects of milrinone
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anorexia, thrombocytopenia, chest pain, hypotension
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3 major hormones of the adrenal glands
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glucocorticoids, mineralocorticoids, sex hormones
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example of a glucocorticoid
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hydrocortisone
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example of a mineralocorticoid
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desoxycorticosterone
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adrenal hormones suppress what?
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the immune response by inhibiting antibody production
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adrenal hormones produce
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gastric acid and are anti-inflammatory
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adrenal hormones increase...
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liver glycogen storage, gluconeogenesis and lipolysis
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A glucocorticoid without mineralocorticoid activity is called...
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Prednisone (meticorten)
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Side effects of hormones for adrenal glands
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susception to infection, peptic ulcers, osteoperosis, myopathy, hyerglycemia, cushings syndrome, weight gain
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clinical use of adrenal gland hormones
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-manage rheumatoid arthritis -severe allergic reactions -bronchial asthma -ocular disorder involving inflammation -ulcerative colits
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why should adrenal gland hormones should be given with meals?
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to minimize gastric irritation
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FSH
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helps follicle grow which secretes estradiol
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action of progesterone and estrogen
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prepare the body for pregnancy
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progesterone regulates what?
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the uterus
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5 types of estrogen
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estradiol, estrone, estriol, synthetic steroidal estrogens, non-steroidal compounds
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estradiol
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main estrogen produced; most potent; produced in the ovary
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Estrone and Estriol formed where?
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The liver
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ex. of steroidal estrogen
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ethinyl estradiol
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ex. of non-steroidal compounds
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diethylstilbestrol
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What does estrogen do to the body?
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mature sex organs, mature ovaries, stimulate growth of endometrial lining, increase blood cooagulation, treat acne, increase HDL's & decrease LDL's
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Side effects of estrogen
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thromboembolism, revirsable hypertension, vaginal/breast cancer, irregular vaginal bleeding, weight gain & tender breasts
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Contraindications of estrogen (shouldnt be used with people who have...)
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vascular disease, vascular thromboembolism, pregnancy, breast cancer
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estrogen is eliminated by the...
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liver
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Drug interactions with estrogen
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antibiotics: make estrogen go away nicotine: risk of thrombi and emboli grapefruit juice: allows estrogen to stay longer corticosteroids: increase toxicity
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Clinical uses of estrogen
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menopause, oral contraceptives, cancer therapy, amenorrhea (absence of menstrual cycle)
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selective estrogen receptor modulator
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Toremifene (foreston)
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Use of Toremifine
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treats breast cancer in post-menopausal women with ER tumors and can induce ovulation
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side effects of toremifene
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hot flashes, uterine cancer, thromboembolic events
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estrogen + medroxyprogesterone (prempro)
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decrease LDL in cholesterol and Increase bone density -interferes with re clover disease
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side effects or prempro
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fluid retention, breast tenderness, cramps
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what cancer does estrogen increase
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Uterine cancer
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what cancer does estrogen + progestin increase
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breast cancer
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example of progesterone drug
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norethindrone (norlutin)
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actions of norethindrone
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decrease bloating, prepare uterus for implantation, increase thickness of cervical secretions, breast development, increase body temp
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progesterone is a weak...
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aldosterone antagonist
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clinical use of progesterones
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replacement therapy, long term ovarian suppression, oral contraceptives
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side effects of progesterone
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thromboembolytic, increase blood pressure, abdominal pain, breast enlargement, break through bleeding
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oral contraceptives are a combination pill with what 2 components
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estrogen (ethnyl estradiol) & progesterone (norethindrone)
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Oral contraceptive MOA
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suppression of ovulation
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types of combination pills
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monophasic, diphasic, triphasic
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monophasic
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provide 1 estrogen and 1 progesterone
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diphasic
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provide 1 estrogen and 2 progesterone
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triphasic
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provide 1 estrogen and varies progesterone dose 3 times
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triphasic is a way to minimize what...
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minimize breakthrough bleeding
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example of monophasic pill
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brevicon, ovcon, ovral loestril
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example of diphasic pill
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ortho-novum 10/11
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example of triphasic pill
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ortho-novum 7/7/7 & triphasil
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progestin is good for what type of women?
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breastfeeding women
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Minipill (microno, ovrette)
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thickens cervical mucous and has low dose progesterone
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Implanon (etonogestrel)
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subcutaneous and lasts 3 years
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Levonogestrel (Mirena)
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intrauterine system
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Depo Provera (medroxyprogesterone)
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injected every 3 months
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Ortho Evra
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transdermal patch; good for 1 week -risk of heart attack and stroke
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Nuva Ring
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vaginal ring containing 1 estrogen and 1 progestin
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beneficial effects of minipill
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ovarian cysts, ovarian/endometrial cancer, pelvic inflammatory disease, ectopic pregnancy, PMS & dysmenorrhea, endometriosis, iron deficiency, duodenal ulcer, rheumatoid arthritis
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Drug interactions with minipill
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Antimicrobials: they reduce the efficacy of oral ontraceptives
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emergency contraception prevents...
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ovulation or implantatioin (take within 72 hours)
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Plan B
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0.75 mg of levonogestrel in 2 doses
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Preven
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combine ethinyl estradiol & levonogestrel in 2 doses
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Diethylstilbestrol is used for whom?
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Women who have risk of misscarriage -SE: vaginal cancer
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MOA of (clopidogrel) Plavix
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Decrease responsiveness of platelet stimuli to stick
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Heparin and pregnancy
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Safe during pregnancy (does not cross placental barrier)
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Cure for heparin overdose
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Protamine sulfate
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Cure for warfarin overdose
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Vitamin k (potassium)
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Functions of thyroid hormone
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Temperature regulator, cardiovascular stimulation, growth/development of all tissues
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Symptoms of hypothyroidism
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Cold dry skin, hypothermia, fatigue, brittle nails, drowsiness
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Hashimoto thyroiditis
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Inflammation of thyroid; body attacks the thyroid gland as if foreign tissues
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Cretinism
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Deficiency of thyroid hormone in CHILDREN
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Myxedema
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Under-activity of the thyroid gland in ADULTS
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Side effects of myxedema
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Puffy eyes, hands, face & mental sluggishness
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Warfarin and pregnancy
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Not safe during pregnancy (cross placental barrier)
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Symptoms of hyperthyroidism
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Increased heart rate, moist skin, intolerance to heat, increase motor activity
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Graves disease
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Swelling of neck from enlarged thyroid gland
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Goiter
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Protrusion of the eyes from overactive thyroid gland
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Propylghiouracil treats ...
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Treat children, young adults, & pregnant women with hyperthyroidism
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Radioactive iodine is useful for who?
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Elderly patient with heart disease and those who can't have surgery
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iodine (Lugol's solution) is used...
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preop to control hyperthyroidism
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MOA of iodine (Lugol's solution)
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inhibits the release of hormone (blocks thyroid function)
