Questions and Answers
What is the primary mechanism of action for nitroglycerin?
Which beta-blocker is considered cardio-selective?
What is a common adverse drug reaction (ADR) associated with calcium channel blockers?
Which drug is an effective treatment option for arrhythmias and is associated with corneal deposits?
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What is a key difference between ACE inhibitors and ARBs?
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Which medication is classified as a direct vasodilator that dilates veins?
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What is one of the main actions of sodium channel blockers?
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Which adverse effect is specifically associated with ranolazine?
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What is the primary therapeutic use of digoxin?
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Which adrenergic blocker is contraindicated in pregnancy?
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Which diuretic is primarily used for massive fluid removal and can cause ototoxicity?
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Which diuretic is contraindicated in pregnancy due to its effects on aldosterone receptors?
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Which opioid is considered a moderate to severe pain reliever and has a risk of respiratory depression?
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Which classification of opioids has a lower potential for abuse due to its mu antagonist and kappa agonist properties?
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Which medication can be used to reverse opioid overdose and is classified as a narcotic antagonist?
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Which thiazide diuretic blocks sodium reabsorption in the distal convoluted tubule (DCT) and is often used to treat hypertension?
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What condition is characterized by the need for a larger dose of an opioid to achieve the same effect?
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Which drug class is used primarily to treat ulcers and is known to potentially cause vitamin B12 deficiency?
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Which medication is a potassium-sparing diuretic that can cause hyperkalemia and has hormone-related side effects?
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Which of the following opioids is characterized by being 100 times more potent than morphine?
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Which diuretic is known to create diuresis by osmotic force and is also used to decrease intracranial pressure (ICP)?
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Which of the following medications is a full agonist at both mu and kappa receptors?
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What symptom occurs during opioid withdrawal and peaks with arthralgia and cramps?
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What is a common adverse drug reaction (ADR) of using iodides?
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Which glucocorticoid is characterized as short-acting?
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Which class of oral diabetic agents primarily reduces insulin resistance?
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What is a potential consequence of chronic glucocorticoid therapy?
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What is the mechanism of action (MOA) of sodium glucose cotransporter 2 inhibitors (SGLT)?
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Which glucocorticoid is considered long-acting?
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What describes the use of pramlintide in diabetic therapy?
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Which of the following are known short duration insulins used in therapy?
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What is a contraindication for the use of radioactive iodide therapy?
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What potential ADR is associated with biguanides?
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What is the primary effect of acetaminophen?
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Which of the following insulins provides baseline glycemic control?
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What distinguishes the action of celecoxib from non-selective NSAIDs?
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What is the appropriate treatment for hypoglycemia in a patient with impaired consciousness?
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Study Notes
Cardiovascular Medications
Nitroglycerin
- Organic nitrate used as an anti-anginal medication.
- Mechanism of Action (MOA): Promotes vascular dilation, reducing preload.
- Sublingual formulation is considered the gold standard for acute anginal attacks.
- Adverse Drug Reactions (ADRs): Development of tolerance and vasodilation effects.
Beta-Blockers
- Primarily used for prevention of angina.
- Effects include decreased heart rate (HR), contractility, and renin release.
- Common ADRs: Bradycardia, bronchoconstriction, atrioventricular (AV) block, central nervous system (CNS) effects, cold extremities.
Propranolol
- First-generation non-selective beta-adrenergic blocker for anti-anginal, anti-hypertensive, and anti-arrhythmia use.
Metoprolol
- Second-generation cardio-selective beta-adrenergic blocker, effective as an anti-anginal and anti-hypertensive.
Carvedilol
- Third-generation mixed receptor block (A1, B1, B2) used primarily as an anti-hypertensive and to reduce heart failure (HF) mortality.
Calcium Channel Blockers
- MOA involves peripheral relaxation and coronary vasodilation.
- Common ADRs: Edema, flushing, headache, dizziness, reflex tachycardia.
Verapamil & Diltiazem
- Both classified as calcium channel blockers, used for anti-anginal, anti-hypertensive, and anti-arrhythmia purposes with significant cardiac and vascular effects.
- Common ADRs: Bradycardia, HF, edema, hypotension, constipation.
Nifedipine & Amlodipine
- Target vascular smooth muscle only; used primarily for anti-hypertensive effects.
Ranolazine
- Sodium channel blocker with MOA that reduces Na+ entry into the heart.
- Used for angina prevention with ADRs: Long QT syndrome, constipation, nausea/vomiting, headaches.
Sodium Channel Blockers
- MOA includes slowing impulse conduction; potential ADRs: Cardiotoxicity and torsade de pointes.
Quinidine & Lidocaine
- Quinidine: Maintenance medication, delays repolarization, limited use for arrhythmias.
- Lidocaine: Emergency medication, similar action but not used for long-term arrhythmias.
Amiodarone
- Potassium channel blocker, delays repolarization with broad application across all arrhythmia types.
- Notable ADRs include corneal deposits, skin changes, and pulmonary fibrosis.
Antihypertensive Medications
ACE Inhibitors
- Prevent the formation of angiotensin II; common ADRs: First-dose hypotension, bradykinin cough, angioedema, hyperkalemia; contraindicated in pregnancy.
Captopril & Enalapril
- MOA: Inhibits conversion of angiotensin I to II, with both used for primary anti-hypertension and HF mortality reduction.
Angiotensin Receptor Blockers (ARBs)
- Block effects of angiotensin II; common ADRs: First-dose hypotension, hyperkalemia; no bradykinin cough; contraindicated in pregnancy.
Losartan & Valsartan
- Both are used to reduce HF death and manage hypertension without bradykinin effects.
Alpha Adrenergic Blockers
- Terazosin blocks vascular A1 receptors, used to manage hypertension with ADRs including postural hypotension and fatigue.
Alpha 2 Adrenergic Agonists
- Decrease sympathetic nervous system input, with potential ADRs: Sedation and dry mouth.
Clonidine & Methyldopa
- Clonidine acts centrally for hypertension and pain relief; methyldopa is safe for pregnancy.
Direct Vasodilators
Hydralazine & Isosorbide Dinitrate
- Hydralazine dilates arteries to reduce afterload; can cause orthostatic hypotension and lupus-like syndrome.
- Isosorbide dinitrate dilates veins to reduce preload, associated with similar ADRs.
- Both used in combination to manage heart failure.
Diuretics
Hydrochlorothiazide
- Thiazide diuretic that blocks sodium reabsorption in the distal convoluted tubule (DCT); used primarily for hypertension and HF symptoms.
Furosemide
- Loop diuretic that blocks sodium reabsorption in the loop of Henle; indicated for massive fluid removal with risks of hypokalemia and ototoxicity.
Spironolactone
- Potassium-sparing diuretic; reduces HF symptoms and treats edema while causing hyperkalemia and hormonal effects.
Mannitol
- Osmotic diuretic used to maintain urine output, lessen intracranial pressure (ICP), with concerns about fluid imbalance.
Neurological and Pain Management
Opioids
- Both natural and synthetic varieties for pain management, e.g., morphine and fentanyl.
- Main ADRs: Respiratory depression, sedation, and biliary colic.
Tolerance & Dependence
- Opioid tolerance requires higher doses for the same effect; cross-tolerance occurs among different opioids.
- Dependence develops with withdrawal symptoms occurring after cessation.
Naloxone
- Opioid antagonist effective in reversing overdose symptoms like coma and respiratory depression.
Endocrine Medications
Thyroid Hormones
- Levothyroxine (T4) and Liothyronine (T3) treat hypothyroidism; caution in cardiovascular diseases.
- Methimazole and Propylthiouracil for hyperthyroidism; potential for agranulocytosis.
Inflammatory and Pain Relief
NSAIDs
- Anti-inflammatory and pain-relieving medications such as ibuprofen, naproxen, and selective COX-2 inhibitors like celecoxib.
- Common ADR: GI bleeding and ulcers.
Acetaminophen
- Non-NSAID pain reliever with a max dose of 4 g/day for adults; liver toxicity risks with overdose.
Multimodal Analgesia
- Strategy incorporating multiple analgesic agents for enhanced efficacy and reduced side effects.
Antidiabetic Medications
Biguanides & Sulfonylureas
- Biguanides (e.g., Metformin) reduce hepatic glucose production; sulfonylureas stimulate insulin release.
- Risk of lactic acidosis with biguanides; hypoglycemia and weight gain with sulfonylureas.
GLP-1 Agonists
- Semaglutide and Tirzepatide stimulate insulin release while promoting weight loss; associated with GI issues and pancreatitis.
Insulin
Types of Insulin
- Rapid-acting insulins (e.g., lispro) for meal coverage; long-acting insulins (e.g., glargine) for basal control.
Insulin Administration
- Insulin pens for ease of use; pumps for continuous subcutaneous infusion, mimicking natural insulin release.
Caution and Monitoring
- Regular monitoring of patients on medications for cardiovascular, endocrine, and pain conditions for potential ADRs and therapeutic effectiveness.
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Description
This quiz covers the pharmacological aspects of nitroglycerin and beta-blockers, focusing on their mechanisms of action, usage, and side effects. Emphasis is placed on nitroglycerin as an anti-anginal treatment and the role of beta-blockers in heart rate management and hypertension. Test your knowledge on these critical cardiovascular medications.
