Pharmacology Test 3 Flashcards
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Questions and Answers

What is the main side effect of ACE inhibitors?

dry hacking cough

What tests are used to monitor ACE inhibitors? (Select all that apply)

  • Potassium (correct)
  • Serum creatinine (correct)
  • Blood pressure (correct)
  • Liver function tests

    • Which 3 beta blockers are shown to improve survival in patients with heart failure?

    carvedilol (Coreg), metoprolol succinate (Toprol XL), bisoprolol (Zebeta)

    What is the mechanism of action of loop diuretics?

    <p>They work on the ascending loop of Henle and induce a prostaglandin-mediated increase in renal blood flow.</p> Signup and view all the answers

    Are thiazide diuretics recommended as first line?

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

    BP = ___ x ____

    <p>CO X PR</p> Signup and view all the answers

    What is the most common primary diagnosis in the US?

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

    What are 8 risk factors for HTN?

    <p>Age (males &gt;55, females &gt;65), diabetes, increased LDL, decreased HDL, GFR, supraventricular arrhythmias.</p> Signup and view all the answers

    Indication for class Ic antiarrhythmics?

    <p>Supraventricular and ventricular arrhythmias (limited use due to risk of proarrhythmias).</p> Signup and view all the answers

    What are possible ADR's of quinidine?

    <p>Nausea, vomiting, diarrhea, cinchonism, tinnitus.</p> Signup and view all the answers

    What are drug interactions of quinidine?

    <p>They increase the effect of warfarin.</p> Signup and view all the answers

    Quinidine should be avoided in a-fib cardioversion due to what?

    <p>GI effects</p> Signup and view all the answers

    Procainamide is indicated for?

    <p>Premature atrial contractions, paroxysmal atrial tachycardia, a-fib of recent onset, maintaining NSR after conversion from atrial flutter or fibrillation.</p> Signup and view all the answers

    What are ADR's of procainamide?

    <p>Hypotension, AV block, ventricular arrhythmias, complete heart block, agranulocytosis, seizures.</p> Signup and view all the answers

    Contraindications for procainamide?

    <p>Hypersensitivity, AV block, myasthenia gravis, hypersensitivity to tartrazine dye (FD &amp; C yellow no. 5).</p> Signup and view all the answers

    What 3 drugs increase the effects of procainamide?

    <p>Ranitidine, quinidine, trimethoprim.</p> Signup and view all the answers

    Which IV vasodilator would you use in a patient with severe renal disease?

    <p>Nitroprusside - it prevents thiocyanate accumulation.</p> Signup and view all the answers

    Which classes of antiarrhythmic drugs cause increased mortality in HF patients?

    <p>Class I - Na, Class III - K.</p> Signup and view all the answers

    Which antiarrhythmics have neutral effects on mortality in HF?

    <p>Amiodarone and dofetilide.</p> Signup and view all the answers

    What is the only calcium channel blocker that may be considered to treat HTN or ischemic heart disease in HF patients?

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

    Least likely to cause cardiac failure: propranolol, pindolol, or metoprolol?

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

    Major adverse effects of verapamil (Isoptin, Calan) or diltiazem (Cardiazem) IV administration: (Select one)

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

    Same antiarrhythmic classification: disopyramide (Norpace) and?

    <p>Procainamide (Procan SR, Pronestyl-SR)</p> Signup and view all the answers

    Most likely effective in treating supraventricular tachyarrhythmias: (Select one)

    <p>Esmolol (Brevibloc)</p> Signup and view all the answers

    A reversible lupus erythematous-like syndrome is most likely associated with this antiarrhythmic drug?

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

    What test should be ordered before starting amiodarone?

    <p>Thyroid function</p> Signup and view all the answers

    Antiarrhythmic drug most likely to cause seizures (at high concentrations) by direct CNS actions?

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

    Antiarrhythmic drug acting at potassium channels: (Select one)

    <p>Sotalol (Betapace)</p> Signup and view all the answers

    Cinchonism: adverse effect associated with this antiarrhythmic drug?

    <p>Quinidine gluconate (Quinaglute)</p> Signup and view all the answers

    Study Notes

    ACE Inhibitors

    • Main side effect: dry hacking cough.
    • Monitoring tests: serum creatinine, potassium levels, and blood pressure.

    Beta Blockers

    • Three beta blockers improving survival in heart failure: carvedilol (Coreg), metoprolol succinate (Toprol XL), bisoprolol (Zebeta).

    Diuretics

    • Loop diuretics target the ascending loop of Henle, increasing renal blood flow via prostaglandin mediation.
    • Thiazide diuretics are not recommended as first-line due to limited effectiveness.

    Blood Pressure Equation

    • Blood Pressure (BP) is calculated as Cardiac Output (CO) x Peripheral Resistance (PR).

    Hypertension (HTN)

    • Most common primary diagnosis in the U.S.
    • Risk factors: age (men >55, women >65), diabetes, high LDL, low HDL, reduced Glomerular Filtration Rate (GFR), supraventricular arrhythmias.

    Antiarrhythmic Medications

    • Class Ic antiarrhythmics used for supraventricular and ventricular arrhythmias, with limited use due to proarrhythmic risks.
    • Possible adverse drug reactions (ADRs) of quinidine include nausea, vomiting, diarrhea, cinchonism, and tinnitus. Interacts with warfarin, increasing its effect.
    • Avoid quinidine in a fib cardioversion due to gastrointestinal effects.

    Procainamide

    • Indications: premature atrial contractions, paroxysmal atrial tachycardia, recent onset atrial fibrillation, and maintaining normal sinus rhythm post-conversion.
    • ADRs include hypotension, AV block, ventricular arrhythmias, complete heart block, agranulocytosis, and seizures.
    • Contraindications: hypersensitivity, AV block, myasthenia gravis, and hypersensitivity to tartrazine dye.
    • Drug interactions that increase effects: ranitidine, quinidine, and trimethoprim.

    Vasodilators & Heart Failure

    • Nitroprusside is preferred for patients with severe renal disease due to preventing thiocyanate accumulation.
    • Class I (Na channel blockers) and Class III (K channel blockers) antiarrhythmics are associated with increased mortality in heart failure patients.
    • Amiodarone and dofetilide have neutral mortality effects in heart failure.

    Calcium Channel Blockers

    • Amlodipine is the only calcium channel blocker recommended for treating hypertension or ischemic heart disease in heart failure patients.

    Cardiac Failure

    • Pindolol is least likely to cause cardiac failure among beta blockers.
    • Major adverse effect of IV verapamil or diltiazem is hypotension.

    Antiarrhythmic Classifications

    • Disopyramide (Norpace) and procainamide (Procan SR, Pronestyl-SR) belong to the same antiarrhythmic classification.
    • Esmolol is most effective for treating supraventricular tachyarrhythmias.

    Additional Antiarrhythmic Information

    • Procainamide is associated with a reversible lupus erythematous-like syndrome.
    • Thyroid function tests should be conducted before starting amiodarone.
    • Lidocaine may cause seizures at high concentrations due to direct CNS effects.
    • Sotalol acts on potassium channels, while quinidine is linked with the adverse effect of cinchonism.

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    Description

    Test your knowledge with these flashcards covering key topics in pharmacology, specifically focusing on ACE inhibitors and beta blockers. Each card provides definitions and crucial information to enhance your understanding of these medications. Perfect for quick revision before exams or to solidify your learning.

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