Kaplan Section 3 Drugs Review
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| What are the two drugs used for pheochromocytoma | Phentolamine and Phenoxybenzamine
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| What is cinchonism and what drugs is it associated with? | flushed skin, ringing of the ears (tinnitus), blurred vision, confusion, lichenoid photosensitivity, vertigo, dizziness, dysphoria (feeling uneasy), nausea and vomiting, and diarrhea. Quinidine (class 1A antiarrhythmic) and quinine (anti-malarial)
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| When should you use quinidine? | afib, post MI prophylaxis against cardiac arrhythmias
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| Which of the following actions is characteristic of amiloride? A. Alkalosis, B. Block of Na reabsorption in proximal conv tubule, C. hyperK, D. inc tubular reabsorption of Ca, E. Bicarbonaturia | C. hyperK
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| The most common manifestation of lidocaine toxicity is…. | CNS dysfunction
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| Why is the use of propranolol especially good for hyperthyroid patients with cardiac arrhythmia? | In addition to its decreased SANS effects on the heart, it also inhibits 5' deiodinase --> prevents conversion of T4 to T3
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| Metropolol | B1 selective inhibitor
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| 75 yo with CHF ingests toxic dose of digoxin. Clinical consequences to the toxic fx of digoxin LEAST likely to include: A. bigeminy, B. hypoK, C. nausea, vomiting, D. premature ventricular beats, E. visual disturbances | B. hypoK -- hypoK makes facilitates digoxin's effects and therefore increases its toxicity
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| Digoxin | cardiac glycoside --> inhibit Na/K ATPas --> increase contractility
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| In a pt weighing 70 kg, the Vd of lidocaine is 80L and clearance is 28 L/h. Elimination half life of lidocaine in this pt is…. | t1/2 = (0.7 x Vd)/(Cl) = 2 hrs
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| High dose dopamine effects felt where? | D1 - vasodilation of mesenteric and renal vascular beds
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| What is the one drug FDA-approved for usage in subarachnoid hemorrhage? Why? | Nimodipine - CaCB --> vasodilation selective for cerebral vascular beds --> prevent post-hemorrhagic vasospasm
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| Which is LEAST likely to occur after treatment with cholestyramine? A. inc elim of bile salts, B. dec circulating cholesterol, C. enhanced receptor-mediated endocytosis of LDL, D. dec plasma HDL, E. inc plasma TG's | Bile acid sequestration. D. Increases, not decreases, HDL.
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| What drug am I describing? Increases urine volume, dec urinary Ca, increases body pH, decreases serum K. | Thiazide diuretics, blocks NaCl cotransporter in DCT
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| Which drugs block K channels? | Class IA and Class III (inc APD and ERP --> torsades)
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| What is niacin? What is it used for? | nicotinic acid; treatment of hyperlipidemic pts
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| Treatment with niacin results in what? A. inc VLDL, B. dec plasma chol and TG's, C. inhib of HMG-CoA reductase, D. dec HDL, E. no change in total chol in plasma | B - decreases plasma cholesterol and TG's
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| What happens with the abrupt discontinuation of clonidine? | Clonidine is a2 agonist --> dec NE. Abrupt discontinuation will cause rebound HTN and tachycardia.
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| What is a common reason a pt suffering from HTN would discontinue their meds? | HTN meds can cause sexual dysfunction.
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| What would discontinuation of a thiazide result in? | fluid retention and weight gain
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| What is the general effect of EtOH? | Vasodilator, decreases BP
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| Which of the following drugs is most likely to cause severe depression in treatment of HTN pts? Captopril, hydrochlorothiazide, prazosin, nifedipine, reserpine? | reserpine --> block packaging of NE --> dec NE. Also cause dose-dependent depletion of brain amines (NE and serotonin) --> serious depression leading to suicide.
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| Name the three actions of ACEi's | 1. inhibit ANG I conversion to ANG II --> dec aldosterone --> dec volume retention --> dec BP. 2. block ANGII action at AT-1 receptors on vessels --> vasodilation, 3. inhibit metabolism of bradykinin (BK) --> BK not broken down --> BK causes vasodilation
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| What should you give a pt in ER if he develops ventricular tachycardia post-MI? | lidocaine
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| For post-MI pt suffering from pulm edema, what effect would amrinone, digoxin, and med/high dose dopamine have in common if given separately? | Amrinone - bipyridine (inc contractility and vasodilation); digoxin - cardiac glycoside, block Na/K ATPase --> inc contractility; high dose dopamine --> B1 activator --> inc contractility and CO. In common: increased ventricular contractility --> improve
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| Which of the following is most appropriate? A. captopril (60yo w diabetic nephrop), B. nitroprusside (50yo man w BP140/95), C. Losartan (29yo pregnant woman), D. Propranolol (40yo w perpiph vasc dz), E. reserpine (37yo w pheochromocytoma) | A. ACEi's slow progression of diabetic nephropathy and treats HTN.
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| Would you prescribe nitroprusside to 50 yo male pt with BP 140/95? | no because Nitroprusside is for severe HTN - not mild to mod HTN
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| Would you prescribe losartan to 29 yo pregnant woman? | AT-1 antag and ACEi's are teratogens
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| Would you prescribe propranolol for 40 yo pt with peripheral vascular disease? | No because nonselective B blockers not good for periph vasc dz, diabetes, or asthma patients.
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| Would you prescribe reserpine to patient with pheochromocytoma? | No because reserpine causes release of amines (i.e. NE) from tumor, making pheochromocytoma worse.
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| True or false - loop diuretics cause hyperurecimia, which can lead to syncope (fainting) | False. Loops can cause hyperuricemia, but no connection of hyperuricemia to fainting.
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| True or false - Spironolactone is proven to increase survival when used to treat HTN. | False. Spironolactone + ACEi's for CHF pts shown to improve survival. Nothing to do with HTN patients.
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| Which of these drugs increase AV node transmission/conduction? Adenosine, digoxin, esmolol, quinidine, verapamil. | Quinidine (class IA) also blocks M receptors in heart --> only one in list to increase AV conduction. Digoxin and verapamil decrease AV conduction. Adenosine and esmolol decrease AV conduction, but IV and short-acting.
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