Pharmacology Overview – Lecture by Jerry Soukal, BSN

150 Question-and-Answer style flashcards covering the mechanisms, indications, side effects, and key facts for NSAIDs, muscle relaxants, opioids, benzodiazepines, antidepressants, cardiovascular drugs, respiratory agents, and additional pharmacologic topics from the lecture notes.

What is the primary mechanism by which NSAIDs reduce inflammation?

They block cyclo-oxygenase (COX) enzymes, lowering prostaglandin production.

How do NSAIDs provide analgesic (pain-relieving) effects?

By decreasing pain-inducing prostaglandins in peripheral tissues and the CNS.

Name three commonly used NSAIDs mentioned in the lecture.

Etodolac, Ketorolac (Toradol), and Ibuprofen (Advil).

What gastrointestinal complication is a well-known risk of chronic NSAID use?

Development of stomach ulcers and GI bleeding.

Which organ’s function can be reduced by prolonged NSAID therapy?

Kidney (renal) function can be impaired.

Which cardiovascular events may be increased by certain NSAIDs?

Risk of heart attack and stroke.

List two minor but possible neurologic side effects of NSAIDs.

Dizziness and headache.

Why should NSAIDs be used cautiously in patients with renal insufficiency?

They decrease renal blood flow, potentially worsening kidney injury.

For what primary purpose is cyclobenzaprine prescribed?

To relieve acute muscle spasms (e.g., back or neck pain).

Methocarbamol is classified as what type of medication?

A centrally acting skeletal muscle relaxant.

What is the most common central nervous system side effect of muscle relaxants?

Drowsiness (sedation).

Name two anticholinergic-type side effects that some muscle relaxants can produce.

Dry mouth and blurred vision (or constipation).

Are skeletal muscle relaxants recommended for long-term daily use?

No—short-term use only due to tolerance and side-effect risk.

Why should patients avoid driving after taking a new dose of a muscle relaxant?

Because dizziness and sedation can impair motor skills and reaction time.

Opioid agonists exert their effects by binding to which receptors?

Mu (μ), kappa (κ), and delta (δ) opioid receptors in the CNS and peripheral tissues.

List three principal clinical effects produced by opioid agonists.

Analgesia (pain relief), sedation, and euphoria.

Morphine is classified as what type of opioid?

A full opioid agonist (natural opiate).

Which schedule II opioid is available in immediate- and controlled-release tablets for severe pain?

Oxycodone.

What life-threatening respiratory effect can high doses of opioids cause?

Respiratory depression (suppressed breathing drive).

Which very common gastrointestinal side effect occurs with nearly all opioid use?

Constipation due to reduced GI motility.

What medication should be available to reverse life-threatening opioid overdose?

Naloxone (Narcan), an opioid antagonist.

Why must opioid prescriptions be monitored closely by clinicians?

Because of risks for dependence, tolerance, and addiction.

Benzodiazepines enhance the activity of which inhibitory neurotransmitter?

Gamma-aminobutyric acid (GABA).

What psychiatric condition is the most common indication for benzodiazepines?

Acute anxiety or panic disorder.

For which sleep-related complaint are short-acting benzodiazepines often prescribed?

Insomnia or difficulty falling asleep.

Diazepam is marketed under what brand name?

Valium.

Alprazolam is more commonly known by what trade name?

Xanax.

What serious risk increases with prolonged benzodiazepine use?

Physical dependence and withdrawal symptoms on discontinuation.

Which two central nervous system effects make benzodiazepines dangerous when combined with alcohol?

Additive sedation and respiratory depression.

Which class of antidepressants works by blocking serotonin reuptake into presynaptic neurons?

Selective Serotonin Reuptake Inhibitors (SSRIs).

What is the primary psychiatric indication for SSRIs?

Major depressive disorder.

Fluoxetine is sold under what brand name?

Prozac.

Sertraline’s trade name is _.

Zoloft.

Which SSRI is the S-enantiomer of citalopram?

Escitalopram (Lexapro).

Compared with tricyclic antidepressants, why are SSRIs considered safer?

They have fewer anticholinergic effects and are less lethal in overdose.

What enzyme do MAOIs inhibit to increase monoamine levels?

Monoamine oxidase (MAO).

Which three neurotransmitters rise in the brain when MAO is inhibited?

Serotonin, dopamine, and norepinephrine.

Why must patients on MAOIs avoid foods high in tyramine?

Tyramine can trigger hypertensive crisis due to excess catecholamines.

Phenelzine is marketed under which brand name?

Nardil.

Eating aged cheese while on an MAOI may precipitate what dangerous event?

A severe hypertensive crisis.

MAOIs are less commonly used today primarily because of what two factors?

Stringent dietary restrictions and numerous drug interactions.

How do tricyclic antidepressants (TCAs) increase synaptic monoamines?

By blocking reuptake of serotonin and norepinephrine.

List two classic anticholinergic side effects of TCAs.

Dry mouth and constipation.

Why are TCAs considered more dangerous in overdose than SSRIs?

They can cause fatal arrhythmias and severe hypotension.

Amitriptyline belongs to which antidepressant class?

Tricyclic antidepressants (TCAs).

Nortriptyline is a metabolite of what parent TCA?

Amitriptyline.

What visual disturbance can occur from TCA anticholinergic effects?

Blurred vision (mydriasis).

ACE inhibitors block the conversion of which two substances?

Angiotensin I to angiotensin II.

How does lowering angiotensin II affect blood vessels?

It causes vasodilation and reduces blood pressure.

Name two cardiovascular disorders commonly treated with ACE inhibitors.

Hypertension and heart failure (or post-MI remodeling).

Lisinopril is marketed under what two common brand names?

Prinivil and Zestril.

Enalapril’s trade name is _.

Vasotec.

A persistent dry cough in ACE inhibitor therapy results from increased levels of what peptide?

Bradykinin.

What renal complication can ACE inhibitors precipitate in susceptible patients?

Acute kidney injury (particularly in bilateral renal artery stenosis).

Which electrolyte should be monitored because ACE inhibitors may raise its serum level?

Potassium (risk of hyperkalemia).

Why are ACE inhibitors contraindicated during pregnancy?

They can cause fetal renal damage and malformations.

How can ACE inhibitors protect the kidneys of diabetic patients?

By reducing intraglomerular pressure and slowing diabetic nephropathy.

How do angiotensin II receptor blockers (ARBs) lower blood pressure?

They block angiotensin II from binding to its AT1 receptors on vessels and adrenal cortex.

Which class is preferred when patients develop ACE-induced cough?

ARBs.

Losartan is sold commercially as _.

Cozaar.

Valsartan’s brand name is _.

Diovan.

Irbesartan is marketed under what trade name?

Avapro.

Can ARBs also increase serum potassium?

Yes—hyperkalemia remains a possible adverse effect.

Why, like ACE inhibitors, are ARBs avoided during pregnancy?

They are teratogenic and can harm fetal kidneys.

Beta-blockers exert their action by blocking which catecholamines?

Epinephrine (adrenaline) and norepinephrine.

What cardiovascular condition is the most common indication for beta-blockers?

Hypertension.

How do beta-blockers help relieve exertional angina?

By lowering heart rate and myocardial oxygen demand.

What overall effect do beta-blockers have on heart rate?

They decrease (slow) heart rate.

Metoprolol belongs to which drug class?

Selective beta-1 adrenergic blocker.

Why should non-selective beta-blockers be avoided in uncontrolled asthma?

They can trigger bronchoconstriction by blocking pulmonary beta-2 receptors.

What common tolerability complaint do some patients report on beta-blockers?

Fatigue or exercise intolerance.

What mechanism allows calcium channel blockers to lower blood pressure?

They block L-type calcium channels, reducing calcium entry into vascular smooth muscle.

Vascular smooth-muscle relaxation by CCBs produces what hemodynamic effect?

Peripheral vasodilation and decreased systemic vascular resistance.

Amlodipine is marketed under what brand name?

Norvasc.

Diltiazem’s brand names include _.

Cardizem and Tiazac.

Name a non-dihydropyridine CCB that can slow AV nodal conduction.

Verapamil (Calan, Isoptin).

What common peripheral side effect occurs with dihydropyridine CCBs?

Ankle or peripheral edema.

What is the principal therapeutic purpose of all diuretics?

To promote excretion of excess fluid and sodium.

List the four major classes of diuretics discussed.

Loop, thiazide, potassium-sparing, and osmotic diuretics.

What daily assessment helps gauge effectiveness of diuretic therapy?

Monitoring body weight and edema status.

What volume-related adverse effect can diuretics cause?

Dehydration or hypovolemia.

Which electrolyte requires the most frequent monitoring with many diuretics?

Serum potassium.

Why are diuretics usually given in the morning?

To minimize nocturia and sleep disruption.

Where in the nephron do loop diuretics act?

The thick ascending limb of the loop of Henle.

What is the brand name of the prototype loop diuretic furosemide?

Lasix.

Loop diuretics may lower which two key serum electrolytes?

Sodium and potassium.

High IV doses of furosemide can cause what potentially irreversible adverse effect?

Ototoxicity (hearing damage).

Thiazide diuretics primarily inhibit sodium/chloride reabsorption in which nephron segment?

Distal convoluted tubule.

Hydrochlorothiazide is commonly abbreviated as _.

HCTZ.

Which serum electrolyte may rise slightly with thiazide use, unlike loop diuretics?

Calcium (risk of hypercalcemia).

How do potassium-sparing diuretics such as spironolactone work?

They antagonize aldosterone or block sodium channels in the distal nephron.

Spironolactone belongs to which diuretic subclass?

Potassium-sparing (aldosterone antagonist).

Why is spironolactone contraindicated in severe renal failure?

Because already high potassium cannot be excreted, worsening hyperkalemia.

What potentially lethal electrolyte imbalance must be monitored with potassium-sparing diuretics?

Hyperkalemia (elevated serum potassium).

How do platelet inhibitors such as aspirin prevent arterial thrombosis?

By irreversibly inhibiting platelet aggregation.

Low-dose aspirin is frequently used for primary prevention of what two events?

Myocardial infarction and ischemic stroke.

Clopidogrel is marketed under what brand name?

Plavix.

In what type of vessels are antiplatelet drugs especially protective?

High-pressure arteries (coronary, cerebral).

What is the main safety concern when a patient takes antiplatelet drugs?

Increased risk of bleeding (e.g., GI or intracranial).

How do anticoagulants differ mechanistically from antiplatelet drugs?

They slow or block the coagulation cascade rather than platelet plug formation.