Advanced Pharmacology Exam 3 Test With d d d d d d
Verified Answers d
What are the two things that antihypertensive medications usually work on? -
d d d d d d d d d d d d
d d d d d d d d d d d d d 1) decrease cardiac output
d d d
2) decrease peripheral resistance
d d d
Where in the renin-angiotensin-aldosterone system does the ACE inhibitors work on? -
d d d d d d d d d d d d
ACE inhibitors work on inhibiting the angiotensin converting enzyme that would usually
d d d d d d d d d d d d d d d d d d d d d d d d d
convert angiotensin I to angiotensin II
d d d d d
Where in the renin-angiotensin-aldosterone system does the ARBs work on? -
d d d d d d d d d d d
ARBs work on blocking angiotensin II from binding to its receptor that would usually
d d d d d d d d d d d d d d d d d d d d d d d d d d d
produce aldosterone d
What are the indications for ACE inhibitors? What name is well known for ACE inhibitors? What is
d d d d d d d d d d d d d d d d d
the MOA of ACE inhibitors? -
d d d d d d
- indications- hypertension, hypertensive proteinuric diabetes, angina and ischemic heart
d d d d d d d d d d d d d d d d d d d d d d d
disease, post-MI, heart failure d d d
- ACE inhibitors are usually known as "-prils"
d d d d d d d d
- MOA- lower BP by inhibiting the conversion of angiotensin I to angiotensin II, which is a potent
d d d d d d d d d d d d d d d d d d
vasoconstrictor; also inhibits the degradation of bradykinin and increases the synthesis of
d d d d d d d d d d d d
vasodilating prostaglandins d
- decreases oxygen demands, decreases thickening of ventricular walls, and decreases heart
d d d d d d d d d d d d
remodeling after cardiac event (ARBs have same efficacy)
d d d d d d d
- renal protector med; good for patients with both diabetic and HTN- decreases protein in urine and
d d d d d d d d d d d d d d d d
dprotects kidneys d
What is thought to cause the cough in patients who use ACE inhibitors? -
d d d d d d d d d d d d d d
bradykinin- inflammatory mediator; thought to be the cough in ACE inhibitors; bradykinin
d d d d d d d d d d d d d d d d d d d d d d d d d
many cause angioedema
d d
T/F: ACE inhibitors are not very suitable for people of African American and Asian descent due to
d d d d d d d d d d d d d d d d d
more adverse effects; ARBs are considered instead -
d d d d d d d d
1|Page
,d d d d d d d d d d d d d true
What are adverse effects of ACE inhibitors? -
d d d d d d d d
d d d d d d d d d d d d d - dry cough
d d
- hyperkalemia
d
- skin rash
d d
- hypotension
d
- altered taste
d d
- angioedema
d
What are contraindications for ACE inhibitors? -
d d d d d d d
d d d d d d d d d d d d d - avoid in bilateral renal artery stenosis
d d d d d d
- avoid in idiopathic or hereditary angioedema- since prolonged duration of bradykinin can make it
d d d d d d d d d d d d d d d
worse
- avoid in pregnancy and lactation
d d d d d
- avoid concurrent use of ACE-I with ARB or aliskiren
d d d d d d d d d
- caution in renal and hepatic impairment
d d d d d d d
- approved in patients older than 6 y/o
d d d d d d d
What are the indications for ARBs? What name is well known for ARBs? What is the MOA of ARBs?
d d d d d d d d d d d d d d d d d d d
- d
- indications- hypertension, hypertensive proteinuric diabetes, angina and ischemic heart
d d d d d d d d d d d d d d d d d d d d d d d
disease, post-MI, heart failure (EXACT SAME AS ACE INHIBITORS)
d d d d d d d d
- ARBs are usually known as "-sartans"
d d d d d d
- MOA- block the angiotensin II receptors, which is a potent vasoconstrictor; by reducing the levels
d d d d d d d d d d d d d d d d
of angiotensin II effect, there is a reduction in aldosterone secretion, which reduces the retention of
d d d d d d d d d d d d d d d
dsodium and water d d
Why are ARBs better than ACE inhibitors? -
d d d d d d d d
d d d d d d d d d d d d d - no effect on bradykinin- aka no/less effect on cough or angioedema
d d d d d d d d d d d
- suitable for African American or Asian descent patients; due to less adverse effects
d d d d d d d d d d d d d
What are adverse drug effects of ARBs? -
d d d d d d d d
2|Page
,d d d d d d d d d d d d d - dizziness
d
- hypotension
d
- hyperkalemia
d
- fatigue
d
- URI- upper respiratory infection
d d d d
- only similarity with adverse effects of ACE-I are hyperkalemia and hypotension
d d d d d d d d d d d
What are contraindications of ARBs? -
d d d d d d
d d d d d d d d d d d d d - avoid in bilateral renal artery stenosis
d d d d d d
- avoid in pregnancy and lactation
d d d d d
- avoid concurrent use of ACE-I with ARB or aliskiren
d d d d d d d d d
- caution in renal and hepatic impairment
d d d d d d d
- approved in patients older than 6 y/o
d d d d d d d
- SAME CONTRAINDICATIONS AS ACE-I except for contras against angioedema since ARBs are not
d d d d d d d d d d d d d d
known to cause angioedema, but ACE-I are
d d d d d d
What is one exception to concurrent use of ACE-I and ARB? -
d d d d d d d d d d d d
d d d d d d d d d d d d d Entresto- as long as prescribed by cardiologist
d d d d d d
T/F: calcium channel blockers can increase risk of HF s/sx -
d d d d d d d d d d d
d d d d d d d d d d d d d true
What are the two categories of calcium channel blockers? -
d d d d d d d d d d
d d d d d d d d d d d d d 1) dihydropyridines- nifedipine (Procardia) and amlodipine (Norvasc)
d d d d d d
2) non-dihydropyridines- verapamil and diltiazem (Cardizem)
d d d d d
What are indications of dihydropyridines? Which medications are examples of dihydropyridines and
d d d d d d d d d d d d
how are they remembered? What is the MOA of dihydropyridines? -
d d d d d d d d d d d
d d d d d d d d d d d d d - indications- hypertension and angina
d d d d
- examples- nifedipine (Procardia) and amlodipine (Norvasc)
d d d d d d
3|Page
, - remembered by "-dipine"
d d d
- MOA- inhibits calcium ions from crossing the cell membrane, resulting in marked decrease in
d d d d d d d d d d d d d d d
transmembrane calcium context and prolonged vascular smooth muscle relaxation- calcium cannot
d d d d d d d d d d d
enter the muscle cells
d d d
- no negative effect on HR and contractility
d d d d d d d
What are the 3 voltage dependent calcium channels that calcium enters through? Which one does
d d d d d d d d d d d d d d d
most calcium channel blockers work on? -
d d d d d d d
d d d d d d d d d d d d d 1) L type- most Ca2+ channel blockers work on blocking this channel in cardiac and smooth
d d d d d d d d d d d d d d d
d muscles
2) N type
d d
3) T type
d d
What are adverse effects of dihydropyridines? -
d d d d d d d
d d d d d d d d d d d d d - flushing
d
- dizziness
d
- headache
d
- hypotension
d
- peripheral edema
d d
What are contraindications for dihydropyridines? -
d d d d d d
d d d d d d d d d d d d d - avoid in patients with significant peripheral edema
d d d d d d d
- avoid in unstable angina
d d d d
- caution in hepatic impairment
d d d d
- nifedipine may be used in pregnancy and lactation
d d d d d d d d
- approved in those older than 6 y/o
d d d d d d d
Nifedipine vs amlodipine in pregnancy and lactation? -
d d d d d d d d
d d d d d d d d d d d d d - only use nifedipine in pregnancy and lactation
d d d d d d d
- avoid amlodipine in pregnancy and lactation
d d d d d d
T/F: long acting Ca2+ channel blockers are safer than short acting due to decreased post MI patient
d d d d d d d d d d d d d d d d d
mortality and decreased reflex tachycardia and peripheral pooling -
d d d d d d d d d
4|Page
Verified Answers d
What are the two things that antihypertensive medications usually work on? -
d d d d d d d d d d d d
d d d d d d d d d d d d d 1) decrease cardiac output
d d d
2) decrease peripheral resistance
d d d
Where in the renin-angiotensin-aldosterone system does the ACE inhibitors work on? -
d d d d d d d d d d d d
ACE inhibitors work on inhibiting the angiotensin converting enzyme that would usually
d d d d d d d d d d d d d d d d d d d d d d d d d
convert angiotensin I to angiotensin II
d d d d d
Where in the renin-angiotensin-aldosterone system does the ARBs work on? -
d d d d d d d d d d d
ARBs work on blocking angiotensin II from binding to its receptor that would usually
d d d d d d d d d d d d d d d d d d d d d d d d d d d
produce aldosterone d
What are the indications for ACE inhibitors? What name is well known for ACE inhibitors? What is
d d d d d d d d d d d d d d d d d
the MOA of ACE inhibitors? -
d d d d d d
- indications- hypertension, hypertensive proteinuric diabetes, angina and ischemic heart
d d d d d d d d d d d d d d d d d d d d d d d
disease, post-MI, heart failure d d d
- ACE inhibitors are usually known as "-prils"
d d d d d d d d
- MOA- lower BP by inhibiting the conversion of angiotensin I to angiotensin II, which is a potent
d d d d d d d d d d d d d d d d d d
vasoconstrictor; also inhibits the degradation of bradykinin and increases the synthesis of
d d d d d d d d d d d d
vasodilating prostaglandins d
- decreases oxygen demands, decreases thickening of ventricular walls, and decreases heart
d d d d d d d d d d d d
remodeling after cardiac event (ARBs have same efficacy)
d d d d d d d
- renal protector med; good for patients with both diabetic and HTN- decreases protein in urine and
d d d d d d d d d d d d d d d d
dprotects kidneys d
What is thought to cause the cough in patients who use ACE inhibitors? -
d d d d d d d d d d d d d d
bradykinin- inflammatory mediator; thought to be the cough in ACE inhibitors; bradykinin
d d d d d d d d d d d d d d d d d d d d d d d d d
many cause angioedema
d d
T/F: ACE inhibitors are not very suitable for people of African American and Asian descent due to
d d d d d d d d d d d d d d d d d
more adverse effects; ARBs are considered instead -
d d d d d d d d
1|Page
,d d d d d d d d d d d d d true
What are adverse effects of ACE inhibitors? -
d d d d d d d d
d d d d d d d d d d d d d - dry cough
d d
- hyperkalemia
d
- skin rash
d d
- hypotension
d
- altered taste
d d
- angioedema
d
What are contraindications for ACE inhibitors? -
d d d d d d d
d d d d d d d d d d d d d - avoid in bilateral renal artery stenosis
d d d d d d
- avoid in idiopathic or hereditary angioedema- since prolonged duration of bradykinin can make it
d d d d d d d d d d d d d d d
worse
- avoid in pregnancy and lactation
d d d d d
- avoid concurrent use of ACE-I with ARB or aliskiren
d d d d d d d d d
- caution in renal and hepatic impairment
d d d d d d d
- approved in patients older than 6 y/o
d d d d d d d
What are the indications for ARBs? What name is well known for ARBs? What is the MOA of ARBs?
d d d d d d d d d d d d d d d d d d d
- d
- indications- hypertension, hypertensive proteinuric diabetes, angina and ischemic heart
d d d d d d d d d d d d d d d d d d d d d d d
disease, post-MI, heart failure (EXACT SAME AS ACE INHIBITORS)
d d d d d d d d
- ARBs are usually known as "-sartans"
d d d d d d
- MOA- block the angiotensin II receptors, which is a potent vasoconstrictor; by reducing the levels
d d d d d d d d d d d d d d d d
of angiotensin II effect, there is a reduction in aldosterone secretion, which reduces the retention of
d d d d d d d d d d d d d d d
dsodium and water d d
Why are ARBs better than ACE inhibitors? -
d d d d d d d d
d d d d d d d d d d d d d - no effect on bradykinin- aka no/less effect on cough or angioedema
d d d d d d d d d d d
- suitable for African American or Asian descent patients; due to less adverse effects
d d d d d d d d d d d d d
What are adverse drug effects of ARBs? -
d d d d d d d d
2|Page
,d d d d d d d d d d d d d - dizziness
d
- hypotension
d
- hyperkalemia
d
- fatigue
d
- URI- upper respiratory infection
d d d d
- only similarity with adverse effects of ACE-I are hyperkalemia and hypotension
d d d d d d d d d d d
What are contraindications of ARBs? -
d d d d d d
d d d d d d d d d d d d d - avoid in bilateral renal artery stenosis
d d d d d d
- avoid in pregnancy and lactation
d d d d d
- avoid concurrent use of ACE-I with ARB or aliskiren
d d d d d d d d d
- caution in renal and hepatic impairment
d d d d d d d
- approved in patients older than 6 y/o
d d d d d d d
- SAME CONTRAINDICATIONS AS ACE-I except for contras against angioedema since ARBs are not
d d d d d d d d d d d d d d
known to cause angioedema, but ACE-I are
d d d d d d
What is one exception to concurrent use of ACE-I and ARB? -
d d d d d d d d d d d d
d d d d d d d d d d d d d Entresto- as long as prescribed by cardiologist
d d d d d d
T/F: calcium channel blockers can increase risk of HF s/sx -
d d d d d d d d d d d
d d d d d d d d d d d d d true
What are the two categories of calcium channel blockers? -
d d d d d d d d d d
d d d d d d d d d d d d d 1) dihydropyridines- nifedipine (Procardia) and amlodipine (Norvasc)
d d d d d d
2) non-dihydropyridines- verapamil and diltiazem (Cardizem)
d d d d d
What are indications of dihydropyridines? Which medications are examples of dihydropyridines and
d d d d d d d d d d d d
how are they remembered? What is the MOA of dihydropyridines? -
d d d d d d d d d d d
d d d d d d d d d d d d d - indications- hypertension and angina
d d d d
- examples- nifedipine (Procardia) and amlodipine (Norvasc)
d d d d d d
3|Page
, - remembered by "-dipine"
d d d
- MOA- inhibits calcium ions from crossing the cell membrane, resulting in marked decrease in
d d d d d d d d d d d d d d d
transmembrane calcium context and prolonged vascular smooth muscle relaxation- calcium cannot
d d d d d d d d d d d
enter the muscle cells
d d d
- no negative effect on HR and contractility
d d d d d d d
What are the 3 voltage dependent calcium channels that calcium enters through? Which one does
d d d d d d d d d d d d d d d
most calcium channel blockers work on? -
d d d d d d d
d d d d d d d d d d d d d 1) L type- most Ca2+ channel blockers work on blocking this channel in cardiac and smooth
d d d d d d d d d d d d d d d
d muscles
2) N type
d d
3) T type
d d
What are adverse effects of dihydropyridines? -
d d d d d d d
d d d d d d d d d d d d d - flushing
d
- dizziness
d
- headache
d
- hypotension
d
- peripheral edema
d d
What are contraindications for dihydropyridines? -
d d d d d d
d d d d d d d d d d d d d - avoid in patients with significant peripheral edema
d d d d d d d
- avoid in unstable angina
d d d d
- caution in hepatic impairment
d d d d
- nifedipine may be used in pregnancy and lactation
d d d d d d d d
- approved in those older than 6 y/o
d d d d d d d
Nifedipine vs amlodipine in pregnancy and lactation? -
d d d d d d d d
d d d d d d d d d d d d d - only use nifedipine in pregnancy and lactation
d d d d d d d
- avoid amlodipine in pregnancy and lactation
d d d d d d
T/F: long acting Ca2+ channel blockers are safer than short acting due to decreased post MI patient
d d d d d d d d d d d d d d d d d
mortality and decreased reflex tachycardia and peripheral pooling -
d d d d d d d d d
4|Page
