Pharmacology Quiz on Ranolazine and Digoxin
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Questions and Answers

Which of the following is a potential adverse effect of ranolazine?

  • Increased heart rate
  • Arrhythmias
  • Increased blood pressure
  • Dizziness (correct)

    • What is the primary action of calcium channel blockers?

  • Block muscle contraction in smooth muscle (correct)
  • Enhance calcium entry into cells
  • Increase heart rate
  • Increase myocardial oxygen demand

    • Which mechanism does ranolazine use to manage angina?

  • Slows heart rate
  • Increases blood pressure
  • Decreases myocardial workload (correct)
  • Enhances coronary artery dilation

    • What is a contraindication for using ranolazine?

    <p>Chronic kidney disease</p> Signup and view all the answers

    What effect do cardiac glycosides have on renal blood flow?

    <p>Increase renal blood flow</p> Signup and view all the answers

    What effect does digoxin have on the myocardial contraction?

    <p>Increases force of myocardial contraction</p> Signup and view all the answers

    Which of the following conditions is digoxin contraindicated in?

    <p>Ventricular tachycardia</p> Signup and view all the answers

    What is a common adverse effect associated with digoxin use?

    <p>Headache and vision changes</p> Signup and view all the answers

    What is a key pharmacokinetic property of digoxin?

    <p>Rapid onset of action and absorption</p> Signup and view all the answers

    Which statement best describes the chronotropic effect of digoxin?

    <p>It slows down the heart rate</p> Signup and view all the answers

    What is a primary route of excretion for digoxin?

    <p>Urine</p> Signup and view all the answers

    What potential issue can arise from digoxin usage in patients with renal impairment?

    <p>Accumulation and potential toxicity</p> Signup and view all the answers

    Which of these effects results from digoxin's increase in renal perfusion?

    <p>Increased diuretic effect</p> Signup and view all the answers

    What is the primary action of ACE inhibitors?

    <p>Prevent conversion of angiotensin I to angiotensin II</p> Signup and view all the answers

    What may occur if ACE inhibitors are taken with nonsteroidal anti-inflammatory drugs?

    <p>Decreased antihypertensive effects</p> Signup and view all the answers

    Which group of patients should use caution when taking ACE inhibitors?

    <p>Patients with heart failure</p> Signup and view all the answers

    Which adverse effect is commonly associated with ACE inhibitors?

    <p>Dry cough</p> Signup and view all the answers

    Which of the following groups of patients should avoid using ARBs?

    <p>Pregnant or lactating women</p> Signup and view all the answers

    How are ACE inhibitors primarily administered?

    <p>Orally</p> Signup and view all the answers

    Which of the following is a contraindication for using ACE inhibitors?

    <p>Impaired renal function</p> Signup and view all the answers

    What is a common adverse effect of calcium channel blockers?

    <p>Headache</p> Signup and view all the answers

    In what condition should caution be exercised when prescribing ARBs?

    <p>Hypovolemia</p> Signup and view all the answers

    What is the role of ARBs in the treatment of patients with hypertension?

    <p>Block vasoconstriction and aldosterone release</p> Signup and view all the answers

    Which of the following is a contraindication for calcium channel blockers?

    <p>Heart block</p> Signup and view all the answers

    What is a common method of excretion for both ACE inhibitors and ARBs?

    <p>Urine and feces</p> Signup and view all the answers

    What effect do vasodilators have on blood pressure?

    <p>Cause vasodilation and decrease blood pressure</p> Signup and view all the answers

    Which of the following is NOT an adverse effect associated with calcium channel blockers?

    <p>Dry mouth</p> Signup and view all the answers

    What is a common GI complaint linked to ARBs?

    <p>Abdominal pain</p> Signup and view all the answers

    What do calcium channel blockers primarily alter in muscle cells?

    <p>Calcium ion movement</p> Signup and view all the answers

    What is a common adverse effect of anticoagulants?

    <p>Increased bruising</p> Signup and view all the answers

    Which anticoagulant directly inhibits thrombin?

    <p>Dabigatran</p> Signup and view all the answers

    Why should caution be taken when using anticoagulants in patients with closed head injuries?

    <p>Risk of excessive bleeding</p> Signup and view all the answers

    What is the mechanism of action of Warfarin?

    <p>Decreases production of vitamin K-dependent factors</p> Signup and view all the answers

    What common gastrointestinal issue may occur due to the use of anticoagulants?

    <p>Nausea</p> Signup and view all the answers

    How is Rivaroxaban primarily eliminated from the body?

    <p>Urine and feces</p> Signup and view all the answers

    In an acute situation, which anticoagulant is often started before switching to oral medication?

    <p>Heparin</p> Signup and view all the answers

    What is the typical onset of action time for Warfarin?

    <p>3 days</p> Signup and view all the answers

    What effect does digoxin have on heart rate and conduction?

    <p>It slows calcium exit from the cell, prolonging action potential.</p> Signup and view all the answers

    Which of the following statements is correct regarding dronedarone?

    <p>It should not be taken with grapefruit juice.</p> Signup and view all the answers

    What is a common adverse effect associated with dronedarone?

    <p>Nausea</p> Signup and view all the answers

    What type of drug is used to reduce the risk of hospitalization in patients with atrial fibrillation?

    <p>Dronedarone</p> Signup and view all the answers

    Which class of drugs interferes with the clotting cascade?

    <p>Anticoagulants</p> Signup and view all the answers

    How do antiplatelet agents function in the clotting process?

    <p>They block receptor sites on the platelet membrane.</p> Signup and view all the answers

    Which of the following antiplatelet agents is administered intravenously?

    <p>Abciximab</p> Signup and view all the answers

    What is a contraindication for the use of dronedarone?

    <p>Use during pregnancy</p> Signup and view all the answers

    Study Notes

    Chapter 5: Cardiovascular System

    • Cardiovascular system is a large topic, involving multiple drugs to manage hypertension, angina, and other conditions.

    Antihypertensive Drugs

    • Angiotensin-Converting Enzyme (ACE) Inhibitors:

      • Act in the lungs to prevent ACE from converting Angiotensin I to Angiotensin II.
      • Angiotensin II is a powerful vasoconstrictor and stimulates aldosterone release.
      • Lower blood pressure and aldosterone secretion.
      • Result in a slight increase in serum potassium and a loss of serum sodium and fluid.

    • Antihypertensive Drug Approvals (Table of drugs and their indications)

      • Different drugs are approved for treating different aspects of hypertension, Including heart failure, and myocardial infarction

    • Pharmacokinetics

      • All ACE inhibitors are given orally; Enalapril has parenteral use (enalaprilat).
      • Well absorbed, widely distributed, metabolized in the liver, and excreted in urine and feces.
      • Risk of decreased antihypertensive effects if taken with nonsteroidal anti-inflammatory drugs; monitoring is necessary.
      • Should be taken on an empty stomach 1 hour before or 2 hours after meals for better absorption.

    • Contraindications and Cautions:

      • Contraindicated in patients with impaired renal function, pregnancy, and lactation.
      • Caution should be used with patients with heart failure.

    • Adverse Effects:

      • Reflex tachycardia, chest pain, angina, heart failure, cardiac arrhythmias
      • Gastrointestinal irritation, dry cough, ulcers, constipation, liver injury
      • Renal insufficiency, renal failure, proteinuria, and Hyperkalemia, rash, alopecia, dermatitis, and photosensitivity.

    Angiotensin II Receptor Blockers (ARBs)

    • ARBs selectively bind with Angiotensin II receptors in vascular smooth muscle and adrenal cortex.
    • Block the effect of vasoconstriction and aldosterone release.
    • Lower blood pressure.
    • Used alone or in combination therapy for the treatment of hypertension and heart failure.
    • Slow progression of renal disease in patients with hypertension and type 2 diabetes.
    • Usual Indications (Table of drugs and their indications for use in hypertension)

    Calcium Channel Blockers

    • Block calcium ion movement in myocardial and arterial muscle cells.
    • Alter action potentials and block muscle cell contraction.
    • Depresses myocardial contractility.
    • Slows cardiac impulse formation and relaxes/dilates arteries.
    • Decreases blood pressure and venous return.
    • Usual Indications (Table of drugs and their indications)
    • Pharmacokinetics (oral/IV adminstration, absorption, metabolism, excretion)
    • Contraindications and cautions (mention heart block and sick sinus syndrome, impaired renal function, pregnancy)
    • Adverse Effects (CNS effects, GI effects, CV effects)

    Vasodilators

    • Primarily for severe hypertension or hypertensive emergencies.
    • Act directly on vascular smooth muscle, causing muscle relaxation.
    • Lead to vasodilation and lower blood pressure. Do not block the reflex tachycardia that occurs when blood pressure drops.
    • Usual Indications (Table of drugs and their indications)

    Diuretic Agents

    • Increase the excretion of sodium and water, affecting blood sodium levels and volume.
    • Important for treating hypertension, often first-line for mild hypertension.
    • May cause electrolyte and acid-base imbalances.
    • Types of diuretics (Examples of thiazide-like, thiazide, potassium sparing diuretics)

    Renin Inhibitors

    • Directly inhibit renin,
    • Decreases plasma renin activity,
    • Inhibits Angiotensinogen to angiotensin 1
    • Results in lower blood pressure, decreased aldosterone release,
    • Decreased sodium reabsorption.
    • Pharmacokinetics (GI absorption, peak levels, metabolism, excretion)
    • Contraindications and cautions (mentions pregnancy, lactation, and risks associated with renal and hepatic dysfunction)

    Sympathetic Nervous System Blockers

    • Beta-blockers: Block vasoconstriction, decrease heart rate, decrease cardiac muscle contraction, increase blood flow to kidneys.
    • Decrease renin release. These drugs have many adverse effects and are not recommended for everyone.
    • Used as a monotherapy in step 2 treatment in some patients.
    • Alpha- and beta-blockers: Block all receptors in the sympathetic system.
    • Side effects may include fatigue, loss of libido, inability to sleep, and GI/genitourinary problems.

    Alpha-adrenergic Blockers

    • Inhibits postsynaptic alpha-adrenergic receptors,
    • Decreases sympathetic tone in the vasculature,
    • Causes vasodilation, and lowering of blood pressure.
    • Associated with reflex tachycardia
    • Limited usefulness in essential hypertension due to adverse effects.

    Alpha2-agonists

    • Stimulates alpha2-receptors in the CNS,
    • Inhibits the cardiovascular centers,
    • Lowers sympathetic outflow and blood pressure.
    • Associated with adverse CNS and GI effects and cardiac dysrhythmias

    Antianginal Agents

    • Improve blood delivery to heart muscle (1) by increasing oxygen supply (dilating vessels) or (2) by decreasing oxygen demand (decreasing heart workload).
    • Classes of antianginals: Nitrates, beta-adrenergic blockers, calcium channel blockers, piperazineacetamides
    • Angina and Myocardial Infarction (MI) mechanisms.
    • Nitrates: Relax veins, arteries, and capillaries. Decrease preload and afterload.
    • Usual Indications (Table of drugs and their indications for angina.)
    • Pharmacokinetics (oral/sublingual, administration routes, absorption, metabolism, excretion)
    • Contraindications and precautions (pregnancy, lactation)
    • Adverse Effects

    Cardiotonic Agents

    • Affect intracellular calcium levels in the heart, leading to increased contractility.
    • Increases cardiac output and renal blood flow.
    • Increased urine production.
    • Decreases blood volume.

    Cardiac Glycosides

    • Derived from foxglove or digitalis plants.
    • Increases intracellular calcium, leading to a positive inotropic effect (increased force of contraction).
    • Increased cardiac output and renal perfusion, causing a diuretic effect.
    • Slows heart rate (negative chronotropic).
    • Slows AV node conduction.
    • Uses (Heart failure, atrial flutter, atrial fibrillation, and paroxysmal atrial tachycardia)
    • Therapeutic Dose close to toxic dose (requires extreme care).

    Antiarrhythmic Agents

    • Arrhythmias or Dysrhythmias: disruptions in the normal rate or rhythm of the heart.
    • Automaticity: ability of cardiac cells to generate action potentials internally.
    • Factors that trigger Arrhythmias. (Electrolyte disturbances, oxygen delivery to cells, structural damage to conduction pathways, drug effects, acidosis, or waste accumulation.)
    • Class I Antiarrhythmics: Block sodium channels, effect the action potential. Subtypes include Ia, Ib, and Ic.
    • Class II Antiarrhythmics: Beta-adrenergic blockers, block beta-receptors
    • Class III Antiarrhythmics: Block potassium channels, slowing outward movement of potassium.
    • Class IV Antiarrhythmics: Block calcium ion movement. Slows automaticity and conduction.
    • Other Antiarrhythmics: Adenosine, Digoxin, Dronedarone (specific uses, important considerations).

    Drugs Affecting Clot Formation

    • Antiplatelet agents: Decrease responsiveness of platelets, inhibit platelet adhesion and aggregation.
    • Anticoagulants: Interfere with normal coagulation cascade and thrombin formation.
    • Thrombolytic agents: Stimulate plasmin system; break down clots (thrombi).
    • Low-Molecular-Weight Heparins: Used in prevention of clots and emboli formation (specifying common drugs).

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    Antihypertensive Drugs PDF

    Description

    Test your knowledge on ranolazine and digoxin with this quiz, covering their actions, effects, and contraindications. Explore the mechanisms of these medications and their impact on the cardiovascular system, particularly in managing angina and heart failure.

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