Pharm Exam 3
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| 25-30% of the American population have? | Hypertension
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| emphasizes lifestyle changes and recommends: thiazide diuretics beta-blockers ACE Inhibitors as the first-line drugs in treatment of hypertension | Joint National Committee
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| suggests that thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension | JNC-7
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| Thiazide diuretics Beta-blockers ACE Inhibitors | First-line drugs for treating hypertension
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| a drug that acts on the kidney to increase urine formation primarily inhibit the reabsorption of SODIUM from the kidney tubules | Diuretic
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| A moderate diuretic increase the sodium chloride content and water in the tubular flitrate in the distal tubule (thiazides work here) | Thiazide [Hydrochlorothiazide]
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| MOA of thiazide in the treatment of hypertension? | Unknown/Unclear
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| Mild edema Drug induced edema treats hypertension often combined with other hypertensive drugs | ThiazideDiuretics
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| potassium losing diuretics that cause: hypokalemia hyperuricemia hyperglycemia (monitor blood glucose) | Thiazide Diuretics
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| well absorbed from the GI Tract eliminated by the kidney filtered through tubules (reabsorption of sodium) | Thiazide Diuretics
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| this drug does not work in pt with poor renal function? | Thiazide Diuretics
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| this drug works in pt with poor renal function? | Loop Diuretics
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| increase the risk of lithium toxicity? (Pharmacokinetic Reaction) | Thiazides [Hydrochlorothiazide]
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| NSAIDs may diminish the antihypertensive effect of? | Thiazide Diuretics but more so LOOP Diuretics
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| potassium loss increases the risk of digoxin toxicity? (the lower the serum potassium level the greater the risk of digoxin arrythmias)Pharmacodynamic | Thiazide Diuretics
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| Diuretics that work in the Loop of Henle | High Ceiling (LOOP) Diuretics
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| main LOOP Diuretic? | LASIX
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| also potassium-losing diuretics? | High Ceiling (Loop) diuretic
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| treatment of resistant edema acute pulmonary edema edema associated with CHF treatment of hypertension, high blood pressure MOST EFFICACIOUS of the diuretics!!!!!! | LASIX/Loop Diuretics
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| hypokalemia hyperurecimia hyperglycemia hypocalcemia (pt with calcium issues) | LOOP Diuretics
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| lowers serum potassium (digoxin toxicity) increase lithim levels(lithium toxicity) given by injection and tend to cause DEAFNESS! | Interactions of Loop Diuretics
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| _______________ are better in treating hypertension than Loop Diuretics! Use Lasix if pt has poor renal function! | Thiazide Diuretics
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| Aminoglycoside antibiotics [Gentomicin] prescribed with Lasix given by injection causes additive deafness! | Loop Diuretics
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| NSAIDs interfere with their diuretics and antihypertensive effectiveness | Loop Diuretics
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| there are 2 types of Potassium-Sparing Diuretics | Triamterene and Spironolactone
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| get inside of the tubule and intereferes with sodium retention and potassium loss. The outside is activated by Aldosterone | TRAIMTERENE
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| competitively blocks the affect of aldosterone | Spironolactone
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| part of the renin-angotensin-aldosterone system, stimulates the Na/K pump in the distaltubule to promote reabsorption of sodium in exchange for potassium | Aldosterone
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| combinations of Triamterenes with Hydrochlorothiazide | Dyazide
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| can be used to treat/prevent hypokalemia | Potassium-sparing Diuretics
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| main side effect of ________is: gynecomastia | Aldosterone-Spironolactone
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| main contraindication in ______? Hyperkalemia-Excessive potassium retention Treats CHF steroid-like structure with hormonal effect | Aldosterone-Spironolactone
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| Lousy diuretic that only works for a couple of days! Carbonic Anahydrase Inhibitor! Decreases intraocular pressure in pt with GLACOMA! | Diamox-CAIs
not used as a diuretic
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| treats mountain sickness? | DIAMOX (Carbonic Anahydrase Inhibitor) Diuretic
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| Osmotic Diuretic Sugar (Disaccharide) most commomn OD physical process of osmotic pressure in kidney quickly filtered by glomelular filtration | Mannitol Diuretic
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| when given IV it is NOT metab by the body used as a diuretic used during surgery or post-surgery the kidney will continue to function properly, to preserve water in kidney | Mannitol Diuretic
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| pt on thiazides or loop diuretics are told to take what? | Potassium supplements
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| centrally acting Alpha-2 agonist | Clonidine [Catapres]
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| prototype drug of Sympatholytics | Methyldopa
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| most freq prescribed Sympatholytic | CLONIDINE
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| is not to be stopped abruptly because rebound hypertension happens! | CLONODINE
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| Clonodine MAO | Centrally acting Alpha-2 agonist
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| drugs act on central inhib neurons on an Alpha-2 recep shuts off symphathetci center in back of brain decr heart rate vasodilation lower BP | CLONODINE [Catapres]
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| nonselective and cardioselective | Beta-Blockers
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| selectively Block Beta-1 [Metoprlol] | Cardioselective Beta-Blockers
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| Block Beta-1 and Beta-2 [inderal]Propranolol | Nonselective Beta-Blockers
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| used to treat hypertension | Beta-Blockers
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| beta blocker most frequently prescribed | Atenolol
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| main side effect of giving a beta-blocker? | Bradycardia
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| I have asthma and High BP...will I get a Beta Blocker? Diabetes? | NOOOOOOO!! NO again bc it increases blood sugar...
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| which of the following antihypertensive drugs is MOST likely to cause hypoglycemia and mask the symptoms of hypoglycemia? | Beta Blockers
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| Name an Alpha-1 blocker...(In the beginning there was SIN) | Cardura [Doxazosin]
Minipress[Prazosin]
Hytrin [Terazosin]
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| cause vasodilation BP Falls treats hypertension cause sodium and water retention edema | Alpha-1 blocker
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| the main warning...first dose effect! Give the first dose at bedtime bc it may cause syncopy! | Alpha-1 blocker
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| step 3 drugs...JNC-7 step process | vasodilators
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| 2 main vasodilator drugs given for hypertension? | [Apresoline]
Minoxidil
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| these drugs act directly on blood vessels to cause vasodialtion! Direct acting vasodilators... | [Apresoline}
Minoxodile
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| Step 3 drugs decrease BP: you have to use a drug that blocks tachycardia first before you use these drugs. | Vasodilator Drugs
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| MAIN adverse effect of VASODILATORS Peripheral Edema | TACHYCARDIA
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| Vasodilation and decr BP decr blood flow to the kidney that sets off Renal-Angotensin-Aldosterone System act on distal tubule wo cause reab of sodium and water...cause of periph edema | Vasodilators
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| 1st: Use Diuretic (Periph edema prevention) 2nd: Use Sympatholytic or Beta-blocker (block Tachy) 3rd: Use Vasodilator | STEP 3 drugs
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| vasodilator for hypertensive emergencies! causes mixed arterial & venous dliation | Nitroprusside [Nipride] IV
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| issue: breaks down fast in light first metab to Cyanide then slower metab to Phiosinate give the drug too fast(overdose) you can cause cyanide toxicity | [Nipride] craefully controlled rate
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| Viagra Cialis Levitra | Vasodilators for Erectile Dysfunction (Penis)
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| act specifically on an ezyme system causing vasodilation in penis no problems in vison | Vasodilators for Erectile (ED) Dysfunction in penis
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| main warning about this drug... can cause hypotension pt on nitrates or nitroglycerin | Erectile Dysfunction drugs
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| What meds are used to treat Benign Prostatic Hypertrophy and High BP? | Hytrin and Cardura
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| what treats tachyarrythmia? (a Calcium Channel blocker that slows the heart) | Verapamil
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| vasodilation on blood vessels decreased strength of heart beat(inotropic) block smooth muscle | Calcium Channel Blocker
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| cause dilation of vessels by interfering w/the availability of Calcium | Calcium Channel blockers
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| decrease smooth muscle contraction because Calcium is blocked | Calcium Channel blockers
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| 2 types of Calcium Channel blockers: | Dihydropyridine (Nifedipine)
Nonhydropyridine (Verapamil)
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| Verapamil Nifedipine | [Prototypes] Calcium Channel Blockers
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| slows the heart decreases contractility by blocking Ca Channels in heart moderate effect on blood vessels | Verapamil (Ca Channel Blocker)
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| Dihydropyridine. NO effect on heart DOES NOT SLOW THE HEART MAJOR effect on blood vessel dilation lowers BP reflex Tachycardia may cause preipheral edema Contraind in Anginal pt: You don't want to speed up my heart! | Nifedipine (Ca Channel Blocker)
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| sits in the middle combination of Verapimil and Nifedipine doesn't cause many problems doctors like to use this drug! | Diltiazem
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| when using _____push on pt ankles to check for pitting edema? | Procardia XL [Nifedipine]
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| what could I have if I am in the hospital receiving Verapamil? | Hypertension (All CCB)
Angina (ALL CCB)
Tacharrythmias*****
DOES NOT TREAT HF!!!!!!!!!!!!!!!!!!!!!
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| Verapamil and Diltiazem are enzyme inhibitors increased blood levels of cyclosporine V&D raise serum digoxin blood levels | Interactions of Ca Channel blockers (CCB)
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| ______is actively secreted in kidneys by P-glycoprotein | Digoxin
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| MAINLY...slows the heart notorius for causing CONSTIPATION | SE of Verapamil CCB
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| PRIMARILY causes...reflex tachycardia periph edema sodium and water retention | SE of Nifedipine CCB
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| problem with grapefruit juice...you destroy enzymes in gut [Nicardopine] has a low bioavailability can cause a severe hypotensive rxn | SE of NicardoPINE CCB
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| new antiarrythmic drug! grapefruit juice is contraindicated in this drug | AmiodarONE [Cordarone] NOT A CCB
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| most commonly prescribed Calcium Channel Blocker | AmlodiPINE [Norvasc] CCB
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| Angiotensin Converting Enzyme Inhibitors | ACE Inhibitors
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| prototype ACE inhibitor rarely used destroyed by food given several times a day | Catopril [Capotem]
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| most potent vasoconstrictor we have acts on the adrenal gland to release aldosterone which acts on distal tubule to cause sodium retention and throw away potassium | Angiotensin II
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| the second most prescribed drug in the US in 2008! | Lisinopril
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| From Angiotensinogen....Angiotensin I is converted by an enzyme into Angiotensin II! | Angiotensin converting enzyme
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| INHIBIT angiotensin converting enzyme PREVENT the formation of Angiotensin II They are VASO-DILATORS! Prevent ALDOSTERONE release...mild hyperkalemic effect mild effect in salvaging potassium | ACE Inhibitors
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| treatment in HYPERTENSION #1 according to JNC-7 Drug of choice in treating CHpartic in diabetics w/Hypertension Drug of CHOICE in treating/Preventing DIABETIC nephropathy | ACE Inhibitors
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| Hytrin and Cardura are used for what? (Alpha-1 blockers) | Hypertension and BPH
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| formed in the body which has a vasodilating effect stim pain & stretch recep in lungs and tend to cause a COUGH Kinase is the same enzyme as Angiotension Converting Enzyme | Bradykinin (vasodilator)
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| tend to cause a COUGH...because of their action on bradykinin | ACE Inhibitors
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| Catopril is well absobed in the GI Tract although food decreases the amount of drug absorbed | Ace Inhibitor Kinetics
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| produce arteriolar vasodilation and venodilation | ACE Inhibitors
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| skin rash (accomp by pain/joint discomfort) change/loss in taste or dyspgeusia a cough | SE/Adverse effects of ACE INHIB
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| Pregnancy Category D in the 2nd and 3rd trimesters studies show they cause fetal anomalies | Warnings of ACE Inhib
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| pt. with hyperkalemia (if the pt is taking a potassium supplement, pt taking potassium-sparing diuretic, or pt with impaired renal function) | Contraindications of ACE INHIB
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| Prototype: Locartan[COZAAR] they all do the exact same thing there are 6 block the angiotensin receptor similar to ACE Inhib | ARBs
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| used for hypertension!It is an ARB! | COZAAR
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| COZAAR are similar to ACE INHIBITORS BUT they do not cause COUGH | COZAAR
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| your heart telling you you are NOT getting enough blood | Angina Pectoris
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| the main reason why people have _____the work load is greater than the artery supply due to artherscolorosis! fatty coronary vessels. Blood flow to the heart is decreased. | Angina
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| Angina that results with progression of the disease where signs and symptoms occur even at rest You have less than 5 years to live! | (Preinfarctional) Unstable Angina
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| the most common type of angina | Chronic Stable Angina
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| Chest pain when walking up the stairs | Exersional Angina
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| in young women with no artherosclorosis has chest pain that radiates down her arm she becomes very anxious | Coronary vasospasm, Variant Angina, Vasospastic Angina,Prinzmetal's Angina
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| Clinical studies suggest early treatment with aspirin reduces mortality and reinfarction rates in patients with | Unstable angina and acute myocardial infarction
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| primarily vasodilators dilate the venous blood vessels decrease the return load of blood to the heart ventricle decrease the heart's demand for oxygen | Nitrates
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| work primarily by relaxing blood vessel smooth muscle causing vasodilation decreasing return of blood to the heart | Nitrates
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| Large first pass effect the liver LOVES it | Nitrates
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| large first pass effect if given sublingual tablets... goes right into the blood vessels under the tongue it bypasses the first pass effect | Nitroglycerin
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| causes a headache our body builds up a tolerance quickly 10-12 hour Nitrate free period every day (to overcome tolerance) | Nitroglycerin
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| Volatile comes in a small brown bottle It must be refilled every 6 months it will disappear when exposed to air | Nitroglycerin
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| may cause tachycardia may cause hypotension may cause headache | Nitroglycerin
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| hypotension tachycardia tolerance | Adverse/side effects of Nitroglycerin
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| Failure to respond to 3 tablets given 5 min apart suggests a myocardial infarction After taking one tab if their is no improvement call 911! | Nitroglycerin
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| How do you think Beta-Blockers work in Angina? | Causes vasoconstriction
slows the heart
decre contractility
decroxygen demand in heart
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| most common method of admin_SL-under tongue SL it lasts for an hour and the onset is 2-3 minutes SL admin treats acute attacks | Nitroglycerin
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| by blocking beta-1 receptors in the heart,the beta-blockers reduce heart rate and contractility of the myocardium...thus reducing myocardial oxygen demand | Beta-Adrenergic Antagonist
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| causes vasoconstriction | beta-blockers
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| Abrupt discontinuation of _______ result in myocardial infarction | beta-blockers
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| which of the calcium channel blockers acts to slow the heart and decrease contraction | Verapamil
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| often used during the nitrate-free period | Calcium Channel Blockers (CCB)
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| nay cause narrowing of the coronary arteries,these agents are not recommended for vasospatic angina! | Beta Blockade
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| which of the calcium channels blockers act on blood vessels to cause vasodilation and return blood to the heart? | Nifedipine
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| initial drug of choice in the treatment of heart failure? | ACE Inhibitors
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| By vasodilation,they reduce both preload and afterload and heart size and increase cardiac output. improved regional blood flow increase cardiac outpit reduced pulmonary congestion reduced periph edema | ACE Inhib
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| increase survival in pt with CHF, digoxin has NOT | ACE Inhib
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| drugs which increase the force of muscle contraction Digoxin Dobutamine Inamrinone | Positive inotropic effect
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| Increase water and sodium EXCRETION | Diuretics
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| Decrease the affect of renin-angiotensin system cause sodium & water loss decrease preload | ACE Inhib
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| Reduce afterload | VD
Hydralazine
ACE
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| SLOWS THE HEART (negative Chronotropic effect) | Beta blockade
DIGOXIN
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| Decrease the effect of released NE | Beta-blockers
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| defined as the inability of the heart to pump enough oxygen and nutrient containing blood to satisfy the needs of vital organs. this may be ACUTE but more often progresses slowly in response to long-standing hypertension or renal disease. | Heart Failure
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| most common form of heart failure is _______. Low cardiac output! | CHF or Congestive Heart Failure
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| ofthe digitalis glycosides only _____ is used to any extent its action in the failing heart is complex | Digoxin[Lanoxin]
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| a drug with a narrow therapeutic index aka digitalis commonly used adverse drug effects | Digoxin
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| believed to bind to and inhibit the sodium-potassium ATPase ion transport system | Digoxin
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| hypokalemia decreases the effectiveness of this pump inhibits the sodium potassium ATPase pump and prevents sodium from pumping out of the cell increase of sodium inside of the cell | Digoxin
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| of you increase calcium and actin and myosin contract to cause muscle contraction increase strength of heart contraction incr calcium coming into heart | Digoxin
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| Main action of digitalis [DIGOXIN] on the failing heart? |
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| slows conduction of the AV Node | Digoxin
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