Pharm Exam 4

What is fludrocortisone?

Mineralocorticoid replacement (aldosterone)

What is fludrocortisone used for?

Primary renal insufficiency, orthostatic hypotension

What are the adverse effects of fludrocortisone?

Hypertension, hypokalemia, edema, metabolic alkalosis, weight gain

What is the MOA of Aliskiren?

Direct renin inhibitor, blocks conversion of angiotensinogen to angiotensin I.

What is Aliskerin used for?

HTN

Contraindications for Aliskerin?

Pregnancy, ACE, ARBs

What are the adverse effects of Aliskiren?

hyperkalemia, hypotension, renal impairment, teratogenesis

What are ACE inhibitors?

angiotensin converting enzyme inhibitors

What are the contraindications of ACE inhibitors?

pregnancy, bilateral renal artery stenosis

What are ACE inhibitors used for?

Hypertension, heart failure, post-MI

What are ARBs?

Angiotensin Receptor Blockers

What are the contraindications of ARBs?

pregnancy, bilateral renal artery stenosis

What are ARBs used for?

Hypertension, heart failure, and for patients who do not tolerate ACE inhibitors.

What are the adverse effects of ARBs?

angioedema, fetal harm, renal failure

What are calcium channel blockers?

Drugs that prevent calcium ions from entering cells

What are calcium channel blockers used for?

hypertension, vasospastic angina, arrhythmias

What are the adverse effects of calcium channel blockers?

constipation, bradycardia

What are verapamil and diltiazem used for?

HTN, angina, dysrhythmias

What are the contraindications of Verapamil and Diltiazem?

Bradycardia, AV block, Sick sinus syndrome,cardiogenic shock

What is the MOA of nitroglycerin?

Low doses: venous vasodilator

High doses: arterial vasodilator

What is the MOA of sodium nitroprusside?

direct arteriolar and venous dilator

When to use nitroglycerin?

Acute angina, stable exertional angina

What are the side effects of nitroglycerin?

headache and hypotension, tolerance

What are the adverse effects of sodium nitroprusside?

reflex tachcardia

When to use sodium nitroprusside?

HTN emergencies, acute heart failure

What are the contraindications of nitroglycerin?

PDE5 usage, severe HTN, brady or tachycardia

What are contraindications of sodium nitroprusside?

conditions with compensatory HTN, Pts with risk of cyanide toxicity

What do PDE-5 inhibitors treat?

erectile dysfunction, pulmonary arterial HTN

What are the contraindications of PDE-5 inhibitors?

Use of Nitrates can cause dangerous hypotension

What do PDE inhibitors do?

prevent degradation of cGMP (NO causes intracellular increase of cGMP and this causes smooth muscle relaxation and vasodilation)

What is a special side effect of Sildenafil?

Visual disturbances including blue-green color hinge

What does cilostazol do?

PDE-3 inhibitor reduces degradation of cAMP

What is cilostazol used for?

intermittent vascular claudication

What are the adverse effects of cilostazol?

headache, hypotension

What is milrinone used for?

decompensated heart failure

What are the adverse effects of milrinone?

allergic reaction, irregular heartbeat

What is minoxidil?

K channel opener

What is minoxidil used for?

severe hypertension

What are the adverse effects of minoxidil?

reflex tachycardia, sodium and water retention, hypertrichosis, pericardial effusion

What is yohimbine?

alpha 2 antagonist

What is yohimbine used for?

erectile dysfunction

What does acetazolamide do?

inhibits carbonic anhydrase

inhibits reabsorption of bicarbonate

What is Acetazolamide used for?

It can treat glaucoma, epilepsy, mountain sickness, and fluid retention (edema).

What are Acetazolamide adverse effects?

hypokalemia

What is furosemide?

loop diuretic

What is furosemide used for?

Edema, HF

What are the adverse effects of furosemide?

Ototoxicity, Hypokalemia, Metabolic Alkalosis, Dehydration, sulfa drug allergy, Hyperuricemia (increase urate reabsorption)

What is hydrochlorothiazide?

thiazide diuretic- wastes potassium

treats HTN and edema from heart failure

What are the adverse effects of hydrochlorothiazide?

electrolyte disturbances, hypokalemia, hypercalcemia, hyperuricemia

What is Amiloride?

K+ sparing diuretic

blocks ENaC therefore inhibits sodium reabsorption in DCT, collecting ducts and reduces K+ excretion.

What is amiloride used for?

reduces lithium induced polyuria

What are the adverse effects of amiloride?

hyperkalemia, metabolic acidosis

What are the drug interactions of Amiloride?

Additive effects with other K sparing drugs

What is spironolactone used for?

HTN, edema, HF

What is spironolactone?

potassium-sparing diuretic; aldosterone antagonist

What are the adverse effects of spironolactone?

hyperkalemia, gynecomastia

What is mannitol used for?

Decreases intraocular and intracranial pressure

What does mannitol do?

Osmotic diuretic acts as membrane stabilizer

Wha is Tolvaptan?

AVP antagonist- aquaretic

When to use Tolvaptan?

Euvolemic and hypervolemic hyponatremia

What is black box warning for Tolvaptan?

hepatotoxicity

What are class 1a sodium channel blockers?

Quinidine

Procainamide

Disopyramide

What is the Class 1B sodium channel blocker?

Lidocaine

What are class 1A sodium channel blockers used for?

A fib, Ventricular tachycardia, AVRT

What are the adverse effects of class 1A sodium blockers?

Drug induced lupus, Torsades de pointes

What do class 1B sodium channel blockers do?

weak Na blockade, short repolarization

What are Class 1B Sodium Channel Blockers used for?

Acute ventricular rhythms

What are the adverse effects of class 1B Na channel blockers?

CNS depression, hepatic impairment, toxicity

What do class 1C sodium channel blockers do?

Strong Na channel blockade, minimal effect on action potential or repolarization

What are Class 1C Sodium Channel Blockers Used for?

SVT

What are the class 1c Na channel blockers?

Moricizine

Flecainide

Propafenone

What is contradiction for class 1C Na channel blockers?

Ischemic or structural heart disease

What are the class 2 beta blockers?

Atenolol, propanolol

When to not use B blockers in heart rythym issues?

with CCB (VD)

What are the Contraindications for using B-blockers?

2 or 3 degree heart block, COPD, Asthma, Decompensated heart failure

What are the class 3 potassium channel blockers?

Amiodarone, Ibutilide, Sotalol (combo class 2 and 3)

What are class III K channel blockers used for?

Atrial and ventricular arrhythmias, atrial conversion

What does amiodarone do?

Prolongs the action potential and refractory period,

Slows the sinus rate, and

Increases PR and QT intervals.

What are the adverse effects of amiodarone?

1. Pulmonary fibrosis!

2. Hepatotoxicity!

3. Hypo/hyperthyroidsm!

4. Corneal deposits,skin deposits

5. Neuro effects, GI and CV effects

What is ibutilide used for?

1st line for cardioversion of A-fib

What does sotalol do?

Slows HR, Decreases AV nodal conduction, increases AV node refractoriness

What are the adverse effects of sotalol?

1. Torsades

2. Excessive Beta block

What is sotalol used for?

Ventricular arrhythmias, atrial fibrillation

What is the minimum inhibitory concentration (MIC)?

lowest concentration of antibiotic that inhibits bacterial growth

What is the minimum bactericidal concentration (MBC)?

lowest concentration of antibiotic that kills 99% of bacteria

What is bacteriostatic?

arrests growth and replication of bacteria

What is bactericidal?

kills bacteria

When to initiate empiric therapy?

after specimens for lab analysis are obtained but before results are back

Gram positive color

Purple

gram negative

structurally more complex and contains less peptidoglycan

What is prophylaxis?

use of a drug to prevent imminent infection of a person at risk

What is definitive therapy?

administration of antibiotics based on known results of a c&s

What is an organism's susceptability?

achievable concentration inhibits organism

What is an intermediate succebtibility?

clinical efficacy in body sites where the drugs are concentrated or when higher than normal dosage can be used

What is a concentration dependent abx?

achieve increasing bacterial kill with increase the dose of drug

What is a time dependent abx?

efficacy of the abx is correlated with the length of time above the MIC

Which antibiotics are time dependent?

Beta-lactams

Vancomycin

most macrolides

Tetracyclines

What antibiotics are concentration dependent?

Aminoglycosides

Fluoroquinolones

What is post-antibiotic effect (PAE)?

bacterial growth inhibited even after concentration drops below MIC

Aminoglycosides and Post antibiotic effect

pulse dose due to drug toxicity