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pharmacology
Exam 2/Chapter 5-7
| Term | Definition |
|---|---|
| This drug category inhibits aggregation or clumping to prevent clot formation | antiplatelet agents |
| Certain antihypertensive medications can effectively treat heart failure because they | lower blood volume |
| A medication that increases the stretch of myocardial fibers in order to increase the force of contractions is demonstrating | the Frank-Starling Law |
| All of these tend to increase blood pressure EXCEPT | increasing diuresis |
| Which of the following drug classes is indicated for immediate treatment of patients admitted with symptoms of blood clot (such as myocardial infarction, stroke or pulmonary embolism)? | thrombolytics (such as streptokinase) |
| Indicated to prevent future clots in patients with a history of clotting abnormalities, such as patients with previous myocardial infarction | anticoagulants (such as heparin and warfarin) |
| These medications are considered the drugs of choice (i.e., first-line treatment option) for treatment of moderate to severe hypertension because they have relatively few side effects: | calcium channel blockers (such as nifedipine, amlodipine, diltiazem and verapamil) |
| Low molecular weight heparin (LMWH) exhibits higher bioavailability and longer-lasting effects than standard heparin. T/F | True |
| Which of the following are most directly involved in the coagulation process? | the liver and Vitamin K |
| Which of the following treats heart failure by reducing hert rate and increasing the force of myocardial contractions (i.e., exerts both a negative chronotropic effect and a positive inotropic effect)? | cardiac glycosides (such as digoxin) |
| Describe the role of Vitamin K and the liver in coagulation disorders | The liver uses Vitamin K to produce several clotting factors as a result hepatic disease, hepatic injury, or Vitamin K deficiency can also cause coagulation disorders |
| Name the two types of heparin and state the advantages of LMWH regarding bioavailability | -standard which is animal extract derived from pork -lovenox is a LMWH has a higher bioavailability over standard |
| Name the two types of heparin and state the advantages of LMWH regarding duration of effect | -LMWH has a shortened molecule and it has a longer lasting effect |
| Define, and describe the role they play in hypertension: a. stroke volume | is the volume of blood ejected from ventricles with each beat (stroke) of the heart -increase in SV is and increase in BP -volume of blood pumped per minute |
| Define, and describe the role they play in hypertension: b. peripheral resistance | is the friction in arteries as blood flows through the vessels -the pressure exerted -increase in PR will have an increase in BP |
| Define, and describe the role they play in hypertension: c. blood volume | is the total amount of blood in vascular system -increase BV will have an increase in BP |
| Chronotropic effect in heart failure | -anything that causes a change in HR -a positive chronotropic effect increases the HR -a negative chronotropic effect decreases the HR Ex: atropine, dopamine, epi, theophylline |
| Inotropic effect in heart failure | -anything that causes a change in strength or contractility of the a heart -a positive inotropic effect increases contractility -a negative inotropic effect decreases contractility Ex:digoxin, calcium, Eicosanoids |
| Preload in heart failure | the degree of stretch of cardiac muscle fibers just before they contract |
| afterload in heart failure | the pressure in the aorta that must be overcome for blood to be ejected from the left side of the heart |
| Frank-Starling Law in heart failure | -the principle that states that the greater the degree of stretch of the myocardial fibers, the greater the forces of contract -same principle behind shooting a rubber band |
| Name the class of drugs that reduces heart failure by reducing heart rate and increasing the force of myocardial contractions (i.e., exerts a negative chronotropic effect and a positive inotropic effect) | cardiac glycosides ex: digoxin and digitoxin |
| Discuss non-pharmaceutical methods to control blood pressure and treat heart failure. | -regular aerobic exercise -weight management -limit sodium intake -reduce stress -avoid tobacco products |
| Explain why certain antihypertensives can effectively treat heart failure. | it decreases cardiac workload, preload, and afterload. -ex: ACE inhibitors, directacting vasodilators, and certain diuretics |
| State the benefit and potential adverse reaction of natriuretic peptides. | benefit is they increase cardiac efficiency in moving fluids by increasing excretion and vasodilation adverse is they can cause life threatening hypotension |
| How does adrenergic blockers lower bp | block or inhibit the sympathetic nervous system |
| How does calcium channel blockers lower bp | contraction of muscle is regulated by the amount of calcium ion inside the muscle cell |
| How does ACE inhibitors lower bp | prevent angiotensin converting enzyme from producing angiotensin II and stimulates aldosterone production |
| How does angiotension-receptor blockers lower bp | block an action of angiotensin II after it is formed causing vasodilation, reduces restriction, and reduces BV |
| How does diuretics lower bp | Decreases fluid volume by increasing urinary excretion of water and electrolytes, block reabsorption of Na and Cl |
| Identify the drug category that is currently the drug category of choice for treatment of heart failure, and explain the reason. | ACE inhibitors because it reduces cardiac workload by lowering BV, increasing CO and causing venous dilation with minimal adverse effects |
| Identify the drug category that is considered a first-line option for treatment of moderate-to-severe hypertension, and explain the reason | Calcium channel blockers because it blocks calcium from entering the cells. It decreases vessel tone, HR, and force of contractions |
| Name the common dosing measurement for heparin | administered in units- a measurement of the amount required to keep blood suspended in a liquid solution) |
| Explain the difference between using heparin for treatment of coagulation disorders and administering it to keep an IV line open | treatment is administered in units while IV line is a heparin push which is a large dose pushed intravenously to keep IV site open |
| Anticoagulants | MECHANISM OF ACTION: prevent clot formation by inhibiting specific clotting factors INDICATIONS: atrial fibrillation, coronary artery disease EX: heparin and warfarin |
| Antiplatelets | MECHANISM OF ACTION: prevent clotting by inhibiting platelet aggregation INDICATIONS: arterial thrombosis, MI stroke EX: aspirin, adenosine diphosphate (ADP) |
| Thrombolytics | MECHANISM OF ACTION: dissolve existing clots INDICATIONS: pulmonary embolism, deep vein thrombosis EX: streptokinase |
| Antifibrinolytics (hemostatics) | MECHANISM OF ACTION: promote clotting time by inhibiting fibrin destruction, slow blood flow INDICATIONS: excessive bleeding from surgical sites EX: aminocaproic acid |
| adrenergic blockers | INDICATIONS: due to multiple adverse effects and only used for patients who have not responded to other antihypertensives EX: metopranolol and propranolol |
| cardiac glycosides | INDICATIONS: chronic cardiac insufficiency, arrhythmia absoluta EX: digitoxin |
| Select the four conditions for which calcium channel blockers are indicated | hypertension dysrhythmias angina pectoris myocardial infarction |
| Which of the following is a vasoconstrictor? | epinephrine |
| This category of medications converts to nitric oxide in the body, resulting in vasodilation of coronary arteries. They are often administered sublingually | organic nitrates, such as nitroglycerin |
| Caduet, Vytorin and Advicor are ... | combination drugs for treatment of hyperlipidemia |
| High levels of low-densipity lipoproteins (LDLs) are desirable. T/F | False |
| HMG-CoA Reductase inhibitors (statins) reduce lipid levels by: | slowing production of cholesterol by the liver |
| Which of the following is appropriate immediate treatment for hemorrhagic cerebrovascular accident (i.e., hemorrhagic stroke or hemorrhagic brain attack)? | hemostatics |
| Auto-injectors (such as Epi-Pen) are used to administer epinephrine to treat for | anaphylaxis |
| The main difference between the Class 1-A, 1-B and 1-C antidysrhythmics is | length of onset and duration of effects |
| The reason for administering vasoconstrictors when treating for shock is to: | prevent hypotension by increasing vessel tone |
| Describe the main differences between Class IA, IB and IC Sodium channel blockers in the treatment of dysrhythmias. | Class IA- drugs work quickly and are eliminated quickly, slow conduction velocity in the atria Class IB- are short acting and reserved for ventricular dysrhyth. Class IC- stay in the body for a longer period of time, reserved for life threatening |
| State the general mechanism of action of each of the following in the treatment of dysrhythmias: a. Class I / sodium channel blockers | these medications slow impulse conduction by blocking the sodium ion channels |
| State the general mechanism of action of each of the following in the treatment of dysrhythmias: b. Class II / beta blockers | slow heart rate, decrease conduction velocity and decrease ventricular function |
| State the general mechanism of action of each of the following in the treatment of dysrhythmias: c. Class III / potassium channel blockers | block the potassium channels, reducing the ability of the heart to respond to rapid tachycardias |
| State the general mechanism of action of each of the following in the treatment of dysrhythmias: d. Class IV / calcium channel blockers | drugs depress conduction velocity in dysrhythmias that must travel through the atriventricular node, calcium dependent |
| Identify the classes of meds appropriately used for the treatment of : myocardial infarction | organic nitrates beta blockers calcium channel blockers antidysrhythmics aspirin analgesics anxiolytics |
| Identify the classes of meds appropriately used for the treatment of: angina pectoris | Organic nitrates- SL or transdermal Beta blockers- that have negative chronotropic(reduce HR) + inotropic effects(reduce force of contractions) Calcium channel blockers-lower HR + force of contractions -also dec vascular tone and inc vasodilation |
| State the general mechanism of action for each of the following in the treatment of angina pectoris and/or myocardial infarction: a. organic nitrates | it converts to nitric oxide in the body, which causes vasodilation of the coronary arteries, dec the preload, afterload, and demand for O2 by myocardial cells |
| State the general mechanism of action for each of the following in the treatment of angina pectoris and/or myocardial infarction: b. beta blockers | drugs that reduce HR and reduces force of contractions and decrease the heart's demand for oxygen |
| State the general mechanism of action for each of the following in the treatment of angina pectoris and/or myocardial infarction: c. calcium channel blockers | lowers HR and force of contractions, decreases vascular tone and increase vasodilation, which reduces myocardial demand for O2 |
| When treating for shock, explain the purpose of administering: a. fluids b. vasoconstrictors c. positive inotropic medications | a. fluids-IV, electrolytes, blood products to rehydrate the body b. vasoconstrictors-like epi to stabilize BP + prevent hypotension c. positive inotropic medications-dopamine/digoxin to increase the force of myocardial contractions |
| When treating for ischemic stroke, explain the purpose of administering: a. thrombolytics b. tissue plasminogen activator c. anticoagulants | a. thrombolytics- to dissolve existing clots b. tissue plasminogen activator-to open occluded arteries/plasmin-enzyme that degrades plasma proteins c. anticoagulants-to prevent future clot formation |
| When treating for hemorrhagic stroke, explain the purpose of administering: a. hemostatics b. hyperosmotics | a. hemostatics-to stop bleeding by increasing clotting activity b. hyperosmotics- to help decrease swelling of brain tissue |
| Name the categories of drugs that would appropriately be administered to counter each of the following when treating patients for either ischemic or hemorrhagic stroke: a. anxiety | anxiolytics |
| Name the categories of drugs that would appropriately be administered to counter each of the following when treating patients for either ischemic or hemorrhagic stroke: b. hypertension | antihypertensive agents |
| Name the categories of drugs that would appropriately be administered to counter each of the following when treating patients for either ischemic or hemorrhagic stroke: c. pain | analgesics |
| When treating for anaphylaxis, explain the purpose of administering: a. vasoconstrictors | like epi to increase BP and reverse vasodilation |
| When treating for anaphylaxis, explain the purpose of administering: b. antihistamines | to stop the histamine release |
| When treating for anaphylaxis, explain the purpose of administering: c. bronchodilators | to combat bronchoconstriction- constriction of the airways in the lungs due to the tightening of surrounding smooth muscle |
| When treating for anaphylaxis, explain the purpose of administering: d. corticosteroids | to decrease the inflammatory response |
| When treating for anaphylaxis, explain the purpose of administering: e. oxygen | to help with breathing |
| When treating for anaphylaxis, explain the purpose of administering: f. fluids, electrolytes, blood products | to help increase BP to increase Mass arterial pressure |
| Explain why low levels of LDL are desirable while high levels of HDL are desirable | HDL are good cholesterol, which return cholesterol to the liver, where it can be synthesized and removed and LDL are bad cholesterol which carries cholesterol to the arteries |
| Describe the advantage of each of these combination medications in the treatment of hyperlipidemia: a. Caduet | it contains an antihyperlipidemic (atorvastatin) with an antihypertensive agent (amlodipine) |
| Describe the advantage of each of these combination medications in the treatment of hyperlipidemia: b. Vytorin | it contains ezetimibe (inhibits cholesterol absorption) and simbastin (slows production of cholesterol in the liver) |
| Describe the advantage of each of these combination medications in the treatment of hyperlipidemia: c. Advicor | it contains lovastatin (slows production of cholesterol in the liver) and niacin (decreases liver triglycerol synthesis) |
| Identify the drug category that is considered the drug of choice for treating hyperlipidemia, and describe its mechanism of action. | combination therapy in which 2 antihyperlipidemics with different mechanisms of action are combined is to attack the cholesterol from 2 different angles, inhibiting cholesterol and slowing production of cholesterol |
| antidysrhythmics | INDICATIONS: tachycardia, serious ventricular fibrillation |
| antihyperlipidemics | INDICATIONS: high cholesterol or high LDL EXAMPLES: atorvastatin |
| sodium channel blockers (Class I antidysrhythmics) | INDICATIONS: atrial fibrillation, superventricular and ventricular tachyarrhythmias EXAMPLES: quinidine, lidocaine |
| beta blockers (Class II antidysrhythmics) | INDICATIONS: angina pectoris, atrial fibrillation, cardiac arrhythmia, and congestive heart failure EXAMPLES: propranolol |
| potassium channel blockers (Class III antidysrhythmics) | INDICATIONS: atrial fibrillation, life threatening ventricular tachycardia EXAMPLES: amiodarone |
| calcium channel blockers (Class IV antidysrhythmics) | INDICATIONS: high BP, CAD, angina EXAMPLES: diltiazem, verapamil |
| epinephrine / auto-injectors | INDICATIONS: acute hypersensitivity, acute asthmatic attacks EXAMPLES: EpiPen |
| organic nitrates | INDICATIONS: acute angina pectoris, chronic angina pectoris, pain associated with anal fissures EXAMPLES: nitroglycerin |
| nitroglycerin | DRUG CLASS: Nitrates |
| Caduet, Vytorin, Advicor | DRUG CLASS: antihyperlipidemics |
| epinephrine | DRUG CLASS: Vasoconstrictors |
| Some antibacterials inhibit protein synthesis, which in turn inhibits bacterial reproduction. This represents: | a bacteriostatic agent |
| Cephalosporins are grouped into subcategories called "generations" with each higher generation representing | a broader spectrum of effectiveness |
| These drugs act by blocking the replication cycle of human immunodeficiency virus (HIV): | antiretrovirals |
| Which of the following are common adverse effects of aminoglycosides and some other antibacterials? | ototoxicity and nephrotoxicity |
| MRSA ("Mersa") is a resistant strain of | bacteria |
| Which drug category would be indicated for a gram-positive infection in patients who are allergic to penicillin? | macrolides |
| Which of the following contributes to acquired resistance of bacteria to antibacterials? | - not completing all of the medication as prescribed -mutations -hospital-acquired infections |
| Broad spectrum refers to | antibacterial agents which are effective against a wide variety of gram-positive and gram-negative bacteria |
| Appropriate medication category for a patient diagnosed with pinworms (a species of roundworm) is | antihelminthics |
| Patients being treated for tuberculosis must take antibacterials for a very long time. Which of the following will most likely prevent resistance? | Administer several different antibacterials concurrently |
| Differentiate between a bacteriocidal agent and a bacteriostatic agent | bacteriocidal agent- that is capable of killing bacteria bacteriostatic agent- is one that inhibits (stops) the bacteria’s ability to reproduce (-static means to limit increase) |
| Explain the role of the beta-lactam ring and B-L ring enzyme (beta-lactamase) in antibiotic choice and bacterial resistance | beta-lactam ring- ring coat around penicillin cell B-L ring enzyme (beta-lactamase)-which can break down the beta-lactam ring, rendering the penicillin ineffective |
| Explain how culture and sensitivity studies should be used in determining appropriate antibiotic therapy | culture-Specimen is collected, Specimen is grown in culture medium, and if growth indicates infection, sensitivity is determined sensitivity-Gram staining and other tests are conducted to determine which antibiotics will likely kill the organism |
| Describe four factors that contribute to the development of acquired resistance to antibacterial agents | 1-mutations-allowing bacteria to be resistant to antibiotic 2-Nosocomial infections-HAI 3-Inappropriate antibiotic usage- stop of antibiotic before time 4-over prescribing-antibiotics completely ineffective |
| Explain why tuberculosis requires a concurrent multi-antibacterial regimen | tubercles make it difficult for antibiotics to reach the organisms and allow the organisms an extended time in which to develop resistance |
| Explain why antibiotics (antibacterials) are ineffective against viruses | have no cell wall that can be breached, do not reproduce in the same way that bacteria do, and they are not dependent on folic acid |
| Identify the most serious side effect(s) associated with each of the following: penicillins | (headache; gastrointestinal upset, rash) or very serious adverse effects such as anaphylactic reactions |
| Identify the most serious side effect(s) associated with each of the following: cephalosporins | kidney damage, (headache; gastrointestinal upset, rash) or very serious adverse effects such as anaphylactic reactions |
| Identify the most serious side effect(s) associated with each of the following: levofloxacin (a fluoroquinolone) | seizures, hallucinations, nightmares, depression, confusion, GI infections, and peripheral neuropathy |
| Describe, in general, the difference between cephalosporin generations | 1st gen- beta lactam ring/many are resistant to them 2nd gen- broader spectrum w/ beta lactamase 3rd gen-even more resistant to beta-lactamase 4th gen-very effective against many gram-positive and gram-negative organisms |
| Describe the effect that repeated or prolonged tetracycline use can have on the teeth | stains teeth |
| For aminoglycosides: describe their primary use and their commonly-associated adverse effects | -primary use for serious gram neg. infections in hospitalized patients -common adverse effects ototoxicity and nephrotoxicity |
| bacterial resistance | or antibiotic resistance occurs when an antibiotic has lost its ability to effectively control or kill bacterial growth |
| broad spectrum antibacterial agents (antibiotics) | are agents that are effective against a wide variety of grampositive and gram-negative bacteria |
| chemoprophylaxis | is the administration of antibiotics to prevent an infection |
| extended spectrum antibacterial agents | these combine an antibiotic with a drug that inhibits bacterial production of beta-lactamase |
| MRSA (also known as “Mersa”) | Methicillin-resistant Staphylococcus aureus bacterial mutations occur which create genes resistant to the antibiotic. The resultant genes are then passed on to subsequent generations of bacteria |
| narrow spectrum antibacterial agents | are effective against very specific types of bacteria |
| nephrotoxicity | capable of causing kidney damage |
| nosocomial infection | nosocomial means “hospital acquired” but the term applies to infections acquired in any type of health care facility, such as hospitals, long term care facilities, clinics and doctors’ offices |
| ototoxicity | capable of causing hearing loss |
| pathogenicity | is the ability of a pathogenic agent to produce a disease in any given species. In other words, it refers to the ability of the bacteria to harm the host |
| superinfection | – Infections occurring postanti-infective therapy – May or may not be caused by resistant strains – Etiology: disruption of normal host flora – Can result in uncontrolled growth of microorganisms that are not affected by the antibacterial in use |
| virulence | pertains to the power of any given strain to produce disease. Higher virulence means the pathogen can produce disease when present in very small numbers |
| Identify the advantage of combination antibacterials such as Augmentin and Timentin | Combination drugs that combine an antibacterial with a drug that inhibits the bacterium’s ability to produce penicillinase |
| Explain why Vancomycin should be reserved for only the most severe bacterial infections | It is an extremely potent antibiotic and adverse effects are very serious |
| Name the side effects associated with Vancomycin, and explain the precautions that should be taken in patients receiving this drug | nephrotoxicity, ototoxicity and anaphylaxis -patients taking the drug must undergo blood and urine tests two to three times daily to monitor for signs of adverse reactions |
| bacteriocidal antibacterials (such as penicillin) | MECHANISM OF ACTION;they kill bacteria by breaking up the cell wall. Fluids then enter the breached bacterial cell, causing it to swell and disintegrate INDICATIONS: bacterial infections |
| bacteriostatic antibacterials (such as macrolides, tetracyclines) | MECHANISM OF ACTION; Interfere w/ protein synthesis (bacteriostatic) + are resistant to penicillins Tetracyclines IND:rocky mountain spotted fever, chlamydia, lyme disease, anthrax, cholera Macrolides IND:Legionnaire's disease, STDs, UTI, Pertussis |
| antifungals | MECHANISM OF ACTION; bind to fungal membranes, cause change in cell permeability, causes destruction INDICATIONS: superficial mycoses and candidiasis |
| antiretrovirals | MECHANISM OF ACTION;block replication cycle of the virus INDICATIONS: HIV |
| antivirals | MECHANISM OF ACTION; block or prevent the virus from attaching to human cells, interfere w/ viral activity, impair viral synthesis INDICATIONS: herpes, influenza |
| antituberculars | INDICATIONS; latent TB infection |
| cephalosporins | INDICATIONS; bacterial infections, Resp tract infections, skin infections, UTI |
| aminoglycosides | INDICATIONS;to deadly gram-negative nosocomial infections such as Klebsiella and Pseudomonas |
| fluoroquinolones | INDICATIONS; anthrax exposure or for prophylactic (preventive) treatment when possible exposure has occurred. It is also one of the drugs that is often prescribed for treatment of tuberculosis |
| Vancomycin | INDICATIONS;against many gram-positive bacterial infections, including Staphylococcal and Streptococcal infections |
| sulfonamides | INDICATIONS; treatment of susceptible urinary tract infections |
| antihelminthics | INDICATIONS; used to treat infections with parasitic worms |
| antimalarials | INDICATIONS; prevent or treatment of malaria, lupus |
| antiprotozoans | INDICATIONS;infections of the GI tract |
| amebicides | INDICATIONS; acute and chronic intestinal amebiasis, hepatic coma |
| Functions of the liver | -uses vit K to make the clotting factors -plasminogen is produced -secrete bile -detoxification -breakdown of erythrocytes and hemoglobin |
| What can cause coagulation disorders? | -conditions in which the patient's blood clots when it shouldn't -conditions in which the clotting mechanism is impaired, resulting in chronic blood loss or hemorrhage |
| What are the three main factors contributing to hypertension | medications allergic reactions illnesses |
| What are the MOA of drugs to treat hypertension? | -decrease fluid volume -block absorption of calcium into the cells -lower blood volume/receptor blockers block the action of angiotensin II, block aldosterone production -block sympathetic NS |
| What are the five main categories of drugs to treat hypertension? | -diuretics -ace inhibitors -adrenergic blockers -Ca channel blockers -angiotension receptor blockers |
| There are two forms of stroke – name each and describe treatment | ischemic stroke due to thrombus -thrombolytics /TPA /antihypertensive /Anticoagulent /analgesics /anxiolytics Hemorrhagic stroke is a ruptured blood vessel in the brain -Hemostatics /Hyperosmotic/ antihypertensives/analgesics/ Anxiolytics |
| Lipids are insoluble compounds stored in muscles and organ cells, name the types | Triglycerides Steroids (one of which is cholesterol) Phospholipids |
| How do viruses respond to antibiotics and what is the treatment for viruses | -ineffective because have no cell that can be breached, don't reproduce like bacteria, and not dependent on folic acid -treatment must block the replication cycle or prevent attachment to host cells or impair viral protein synthesis |
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