Advanced Pharm Test 3
PDE5 inhibitors end in
"-anafil" "enafil" sildenafil, tadalafil, vardenafil, and avanafil "fill up the penis!"
Bile acid sequestrants start with the word
'Cole' or "Chole"
ACEIs end in
-pril
You start a patient on a new anti hypertensive med. How much time do you give them to see a therapeutic effect? A. two weeks B. 1 month C. 3 months D. 6 months
1 month. If not to goal in one month, gotta up the dose or add a drug (depending on which strategy you are gonna use).
Define prehypertension
120-139/80-89
What's the goal BP for everyone else?
<140/90
What are we going to give a black, diabetic with chronic kidney disease for hypertension?
ACEI or ARB. Kidney trumps race trumps diabetes. ACEI and ARB do better do preserve kidney function.
RAAS exerts effects through ______ and ________.
Angiotensin 2 & aldosterone
_______ are NOT the drug of choice for MI.
Any of the CCBs.
What causes cinchonism?
Anything with a "quin". Ex. Cardioquine, Cin-Quin, Duraquin, Quinidex, Quinora, Quinact- an antiarrythmic
What is a better predictor for CV risk/ end organ damage than one time office readings?
At home blood pressure measurements --> HBPM
What is possibly happening when you have a falsely low BP reading in older adults?
Ausculatory gap: you either don't pump it up high enough or you hear a click once (at a super high number like 180) then no noise (or a gap) and then it picks back up in the 140's-130's.
A patient is diagnosed with infertility related to hyperprolactinemia. Which medication would the nurse anticipate being prescribed for this patient? A. Choriogonadotropin alpha [Ovidrel] B. Cabergoline [Dostinex] C. Leuprolide [Lupron Depot] D. Cetrorelix [Cetrotide]
B
Which anti-hypertensives are the drug of choice for treating vasospastic angina? Includes Prinzmetals angina- variant angina- vasospasmodic
CCBs non DHPs --> verapamil and nitrates
What are the risk factors for utilizing hormone therapy in the post-menopausal woman? (2)
Cancer & CV stuff
What drugs are most commonly used to treat ventricular tachycardia?
Cardioversion first, if it is ineffective. Then IV Amiodarone. Lidocaine and procainamide are alternatives. Long term: sotalol, amiodarone
Why might an alternative dosing schedule be a good idea for some patients?
Continuous (skipping placebo pills) might help with iron deficient anemia
The nurse teaches a patient about Camila. Which statement by the patient requires an intervention by the nurse? A. "I might have irregular bleeding while taking this pill." B. "These pills do not usually cause blood clots." C. "I should take this pill at the same time every day." D. "This pill works primarily by preventing ovulation."
D. Camila is progestin only so it doesn't work by preventing ovulation.
What's the difference in DHP CCBs and Non DHP CCBs?
DHP = doesn't hurt the pulse Non DHP = does affect the heart rate by slowing it down
________ is most effective at lowering triglycerides
Gemfibrozil, fibric acid deriviative
What should now be a ROUTINE COMPONENT in diagnosis and management of HTN?
HBPM
What drug class are the statins
HMG CoA reductase inhibitors
Which diuretic can be used to decrease preload and pulmonary congestion in an HF patient?
Loop Diuretics: (furosemide) produce profound diuresis
If you are starting a women on HRT, what annual screening should be recommended? A. Pap smear B. mammogram C. uterine sonograms D. colonoscopy
Mammograms- they need to have a clear one before you start the HRT and then annually after initiation of therapy
DTR: NSAIDs and ACEIs or ARBs
NSAIDS reduce the antihypertensive therapeutic effect of these drugs. Just warn 'em.
Which type of drug would you use to raise HDL?
Niacin
What is the usual treatment for Prinzmetals angina?
Nitrates or CCB
What is the usual treatment for chronic stable angina? (3)
Nitrates, CCB, BB
Hi. I'm 55 and have a history of DVT. I would like to start some hormone replacement therapy for my osteoporosis and my atrophic vaginitis.
No mam. Estrogen increases further risk for cardiovascular events.
ACEIs and ARB & Pregnancy?
No mam. Prego category D. If you prescribe a ACEI or ARB they need to be on a reliable form of birth control and also tell the patient- don't get pregnant on this drug.
For which conditions should patients using Amiodarone be monitored? (5)
P. 547 1. pulmonary toxicity 2. cardiactoxcity 3. liver toxicity 4. thyroid toxicity 5. dermatologic toxicity PCDLT
Diagnose me: I am women with irregular periods, anovulation, infertility, acne, and hirsutism.
PCOS
First line treatment for ED
PDE5 inhibitors
Camila, Errin, Heather, Jolivette, Ortho Micronor, Nor-QD, and Nora-BE are examples of what?
Progestin only oral contraceptives
Tamoxifen is an example of what kind of drug
SERM: selective estrogen receptor modulator
For which dysrhythmia might Digoxin be used as treatment?
Supraventricular Dysrhythmia ONLY. p 551
For black people, which med are we gonna try first to manage their HTN?
THIAZIDES or CCB
Describe the additional pharmcologic effects of bile acid sequestrates.
These meds can form complexes with other drugs. They cannot be absorbed if this binding occurs so they have a reduced therapeutic effects.
What are we going to give for a black, diabetic, chronic hypertensive?
Thiazide. Race trumps diabetes.
Which anti-hypertensive medications would be the most likely one prescribed for a patient who had a recent MI (myocardial infarction)?
Three ACEIs 1. captopril 2. lisinopril 3. trandolapril
T/F: 1 in 3 adults have hypertension.
True
T/F. Rifampin can decrease effectiveness of combo oral contraceptives.
True. All antibiotics can (lecture)
T/F. Estrogen has a positive effect on bone mass.
True. Which is why we give it for osteoporosis in menopause.
We know CCBs block calcium influx into the cell thereby reducing excitability. Name the 2 types of receptors these drugs act on.
Type 1. nondihydropyridine based = NON DHP Type 2. dihydropyridine- based = DHP
When do you start HTN meds in uncomplicated elderly adults?
When their BP is over 150/90
What is the pregnancy category of statins?
X
Dinoprostone [Prepidil, Cervidil) is what kind of drug
a synthetic prostaglandin used to ripen the cervix for labor
Silodosin, Tamsulosin & Alfuzosin, Doxazosin, Terazosin are examples of
alpha 1- selective and nonselective blockers used for BPH
Most common complaint of menopause
atrophic vaginitis (lecture)
Goal for LDLs
below 100. high risk patient? below 70
Terbutaline aka brethine is what kind of drug
beta 2 adrenergic agonist used to relax the uterus
What is NOT the treatment for variant angina?
beta blockers like propanolol
Colesevelam is a
bile acid sequenstrant
Ezetimibe is a
cholesterol med
What are Beyaz, Safyral, Natazia?
combo oral contraceptives with unique properties (like Yaz is great for acne)
Biggest problem with oral contraceptives
compliance.
What is unstable angina?
new onset, increasing in frequency, getting worse, less exertion needed to induce...
Viagra should not be taken by men taking
nitrates
How do nitrates reduce hypertension?
nitroglycerin provides more nitric oxide to the endothelium resulting in arterial smooth muscle relaxation and vasodilation all over the vascular system (not just heart related)
Tranexamic acid is used for
painful periods
Side effect of Tamoxifen
produces hot flashes, instead of helps them...
Which med are we NOT GOING TO GIVE to a HF patient
verapamil
How do you treat a patient older than age 75 with CKD for hypertension?
** No evidence to support ACEI or ARB for first line. Start on thiazide or CCB.
5-alpha-reductase inhibitors end in
-ASTERIDE Dutasteride, Finasteride
What do the DHP CCBs end in?
-pine ex. amiodipine, nifedipine, felodipine
ARBs end in
-sartan
What are the signs of digoxin toxicity, beginning with early signs? (3)
1) GI disturbances (anorexia, nausea, vomit, abdominal discomfort) 2) CNS responses (fatigue, visual disturbances) 3) Cardiotoxicity (dysrhythmias) *risk is increased by hypokalemia. *The GI and CNS responses usually precede dysrhythmias and therefore can provide advance warning of serious toxicity.
Disadvantages of depo provera (2)
1. 15 pound weight gain in a year! 2. irregular bleeding
Two types of BPH meds
1. 5-alpha-reductase inhibitors 2. and alpha1-adrenergic antagonist
4 favorite meds for HTN. What's missing?
1. ACEI 2. ARB 3. CCB 4. thiazide NOT beta blockers... alpha blocers, vasodilators.. loop..
What can be done to decrease the facial flushing suffered by users of niacin? (2)
1. Aspirin 325mg before each dose of Niacin 2. Switching to extended release Niaspan (over Niacor)
Absolute contraindications for use of ACEIs and ARBs (3)
1. Bilateral renal artery stenosis 2. Angioedema 3. Pregnancy
Two major/ most serious adverse effects of estrogen replacement
1. Cardiovascular event (clots) 2. cancer (uterine, ovarian, breast)
ATP III Guidelines (9)
1. Determine lipoprotein levels 2. Assess CHD risk (carotid, periph art disease, AAA) 3. Assess for other major risk factors (HTN, smoking, fam) 4. Assess 10 yr risk if 2+ present with Framingham tables 5. Determine risk category & goal LDL 6. Initiate lifestyle changes 7. Initiate drug therapy 8. Identify metabolic syndrome if results unchanged after lifestyle choices 9. Treat triglycerides
Benefits of progestin only mini pills (3)
1. Doesn't cause thromboembolic problems! 2. Good for breastfeeding moms 3. slightly safer
What side effect of niacin might cause a risk for some patients? (3)
1. Hepatotoxicity (LFT always tested before and periodically) 2. hyperuricemia (gout people) 3. hyperglycemia
What are the risk factors for cardiovascular disease? (11)
1. Hypertension 2. High Cholesterol ( high LDL) 3. Diabetes Mellitus 4. Unhealthy diet 5. Physical inactivity 6. Obesity 7. Excessive Alcohol 8. Tobacco 9. Genetics and Fam history 10. Older age 11. Race
Case Study from lecture: 56yo AA female, presents for eval for HTN. PMH: type 2 diabetes, CKD Stage 2, metabolic syndrome, and GERD. No alcohol, tobacco, alcohol drug use. Homemaker for 2 grand kids. VS: 166/100, 62, 16, afebrile. BMI = 38.7. Physical exam unremarkable except for new onset peripheral edema in her lower extremities. Meds: metformin 1000mg BID, glipizide 5mg naily, nebivolol 2.5 mg, omeprazole 20mg, levocarnitine 330 mg. What are we thinking about? (4)
1. Is she well controlled? or meets goals? No. Her goals is <140/90 2. Race! Needs a thiazide or CCB first. 3. CKD.... BUT Stage 2 ISN'T THAT BAD YET. 4. lifestyle: she's obese, needs to lose weight.
What are the basic principles to consider when prescribing contraceptives in primary care? (5)
1. Need to assess for CV risk for thromboembolic problems. 2. Assess ability to be compliant 3. Oral contraceptive pills can cause weight gain and irregular bleeding. 4. Assess the need for combo or progestin only 5. Antibiotics, antiepileptic drugs, St. John's Wort interact with the oral contraceptives
71yo white male prsents with evaluation of HF. PMH: CAD, status post MI 3 years ago, chronic HF, last LVEF 35%. PSH: CABG 3 years ago, status post ICD 1 year ago. SH: retired with kids and grandkids and wife. VS: 160/94, 68, afebrile. Physical exam: unremarkable NYHA Class 2- only slightly limited with fatigue or dyspnea. Labs: K = 4, BUN = 14, creatinine = 1.6, GFR <60, glucose 90, NA 135. EKG: sinus 68/minute, left axis deviation, LVH, old q waves in the inferior leads (consistent with old MI and hypertrophy). Allergies: ACE-I Meds: HCTZ 25 mg, Irbesartan 150 mg daily, Metoprolol XL 100mg daily 1. Is he in goal? 2. What's in our problem list? (3) 3. How are we going to change his regimen? (3)
1. No. His goal is <150/90 2. Heart Failure, reduced kidney function, HTN 3. A)Discontinue HCTZ bc of his creatinine >1.5 & start lasix; B) Keep ARB for his HF; C) Titrate up Beta blocker for his HTN & HF
What's the difference between Paragard and Mirena
1. Paragard is in for 10 years. Mirena = 5 years 2. Mirena helps with cramping & bleeding. Paragard does not. 3. Mirena has hormones. Paragard does not (copper)
What comorbidities would influence your choice for each antihypertensive class? (3)
1. Race 2. CKD 3. DM
For which drugs used to control hyperlipidemia should a base line liver function test be obtained? (3)
1. Statins 2. Niacin 3. Fibric acid derivatives (gemfibrozil)
What are the Non DHP CCBs called? (2)
1. Verapamil 2. Dilitiazem
What factors/health conditions may contribute to ED in men? (4)
1. age 2. diabetes 3. depression 4. hypertension
3 ways a female can be infertile
1. anovulation or failure of follicular maturation 2. unfavorable cervical mucus 3. hyperprolactinemia 4. endometriosis
When should you prescribe a ACEI (3)
1. anybody with kidney disease (chronic, diabetic, non diabetic) 2. heart failure (it can actually prevent further cardiac damage) 3. following an MI (to prevent a person from going into heart failure)
Three ACEIs approved for MI
1. captopril, 2. lisinopril, 3. trandolapril Remember- captopril, we don't see much bc it requires multi doses a day.
Clinical use for CCBs (4)
1. chronic stable or vasospastic angina 2. HTN 3. SVT 4. Afib
2 main categories of oral contraceptives
1. combo estrogen and progesterone 2. progestin only "mini pills"
Adverse effects of ACEI (8)
1. cough 2. hypotension 3. tachycardia with cont therapy 4. angioedema 5. hyperkalemia 6. serious fetal harm 7. Renal failure 8. neutropenia
Name the 2 hormones associated with female maturation
1. estrogen 2. progestin (progesterone)
Elements of Framingham tables (5)
1. gender 2. age 3. total cholesterol 4. HDL 5. BP Points add up for 10 year risk %. If your LDLs are bad + Framingham score is 10-20%, you're probably getting on drugs.
Name our 2 favorite thiazide diuretics
1. hydrochlorothiazide 2. chlorthiadone
Common side effects of angina treatment options (3)
1. hypotension (nitrates, ccbs, bb,) 2. reflex tachycardia with CCB 3. Nitrates- headache
What is the most common cause of dysrhythmias?
1. hypoxia, 2. electrolyte imbalance, 3. cardiac surgery, 4. reduced coronary blood flow, 5. myocardial infarction 6. antidysrhythmic drugs.
Dysrhythmias occur because of a problem with (2)
1. impulse formation (automacity) 2. impulse conduction
Three approaches to BPH
1. invasive treatments, 2. drug therapy, and 3. "watchful waiting.
When would an NP consider an ACE inhibitor in the treatment of Hypertension? (3)
1. kidney patient 2. heart failure patient 3. post MI (to prevent HF)
Consider these 2 forms of birth control for teenage girls
1. nexplanon 2. depo provera
What is the treatment for unstable angina? (5)
1. oxygen 2. hospitalization 3. anti ischemic: nitro, bb, morphine, acei 4. anti platelet: aspirin 5. anticoag: lovenox, heparin
What are the causes of resistant hypertension? (3)
1. poor adherence 2. sleep apnea 3. wrong regimen
Benefits of IUD (3)
1. reversible effects (take it out, get pregnant) 2. long lasting 5-10 years 3. super reliable and effective
Through which two body systems is heart failure compensated?
1. sympathetic nervous system 2. RAAS
Which drugs bind with acid-binding bile resins and, potentially, are poorly absorbed as a result? (4)
1. thiazide diuretics 2. digoxin 3. warfarin 4. some antibx
Symptoms of cinchonism (4)
1. tinnitus and slight deafness 2. photophobia and other visual disturbances 3. mental: dullness, depression, confusion, headache 4. nausea Think: ears, eyes, head, mouth
What labs are we going to be monitoring baseline and after initiation of treatment with ACEIs and ARBs?
1. urine protein 2. LFTs 3. WBC
Principal adverse effects of androgens
1. virilization 2. hepatotoxicity
What do you tell your patient if she calls freaking out because she missed 1-2 of her birth control pills? (3)
1.Take a dose ASAP, 2. continue with the pack. 3. May want to use a 2nd form of birth control for 7 days
What is the goal blood pressure for the general population adults over the age of 60?
150/90
We know ACEIs are great for kidney disease, but a lower dose should be considered when a creatinine is greater than ______
2.5 mg/dl
What is the target potassium level for heart failure patients?
3.5-5 normal
What's the "point difference" between in office and out of office BP readings?
5 points.. 135/85 equates to 140/90 in office..
High (good) HDLs are considered to be Low (bad) HDls are considered to be
>60 <40
A patient has been prescribed dinoprostone for cervical ripening. Which statement about dinoprostone does the nurse identify as being true? A. Dinoprostone is the most widely used agent for cervical ripening. B. The drug is a synthetic estrogen. C. Dinoprostone is administered subcutaneously. D. The drug increases the duration of labor.
A
The nurse identifies which as an approved condition for induction of labor? A. Preeclampsia or eclampsia B. Transverse fetal position C. Previous cesarean delivery D. Placenta previa
A
The nurse instructs a patient about the therapeutic effect of clomiphene [Clomid]. Which statement, made by the patient, indicates that teaching was effective? A. "The drug causes the follicle to mature." B. "The drug prevents premature ovulation." C. "The drug increases estrogen in the blood." D. "The drug acts directly on the ovary."
A
The nurse identifies which female patient as the least at risk for developing complications when hormone therapy is prescribed? A. A 45-year-old patient who takes estrogen after a hysterectomy B. A 55-year-old patient who takes estrogen combined with progestin C. A 58-year-old patient with osteopenia who takes hormone therapy D. A 60-year-old patient with a family history of breast cancer
A- she's the youngest on the list so she's probably not even post menopausal yet.
The nurse instructs a patient in the use of combination oral contraceptives for birth control. The nurse determines that teaching is successful if the patient makes which statement? A. "I'll avoid herbal products such as St. John's wort." B. "Birth control pills don't have serious side effects." C. "I can continue taking birth control before elective surgeries." D. "I should take the pill with food to prevent an upset stomach."
A.
What side effects can happen with the rapid discontinuation of a beta blocker?
Abrupt withdrawal of propranolol can cause rebound excitation of the heart, resulting in tachycardia and ventricular dysrhythmias. This is especially dangerous for patients with preexisting cardiac ischemia. Propranolol should be withdrawn slowly over 1-2 weeks. P.163
What is the advantage of using an alpha 2 agonist instead alpha 1 agonist to treat HTN?
Alpha 2 agonist have less incidence of side effects such as orthostatic hypotension. This is especially important in the elderly population due to increased risk for falls
Important teaching point about potential adverse effects of ACEIs
Angioedema can happen r/t build up of bradykinin. Happens more frequently in African Americans... not a contraindication, but just need emphasize that if they have sudden swelling of the tongue or lips, stop taking the medication and go to the ED.
The nurse teaches a group of postmenopausal women about hormone therapy (HT). Which information should the nurse include in the teaching plan? A. The most frequent adverse effect of HT is headache. B. HT increases the risk of stroke and venous thromboembolism. C. Blood levels of estrogen are more consistent with oral HT. D. HT may cause a harmless yellow discoloration of the skin
B.
A patient contacts a clinic nurse to determine the proper action after she forgot to take her oral contraceptive [Ortho Tri-Cyclen] for the past 2 days during the first week of a 28-day regimen. Which response by the nurse is most appropriate? A. "Take the omitted 2 doses together with the next dose." B. "Take two doses per day on the following 2 days." C. "Stop taking the oral contraceptive until menstruation occurs." D. "Take a dose now and continue with the scheduled doses."
B. is her answer in the slides. BUT ALSO. SLIDE 14 SAYS VERBATIM: 1 or more pills missed first week: Take one pill as soon as possible (ASAP) and continue with the pack; use an additional form of contraception for 7 days which makes the answer D.................
So why aren't ARBs the first choice for HTN over ACEIs?
Because ACEI's have those remodeling properties AND improve renal blood flow. ARBs are second choice after ACEIs
Why is lasix the preferred diuretic for heart failure?
Because of its ability to mobilize large volume of fluid
What's the preferred strategy for initial anti hypertension therapy for a patient whose BP is >160/100.
Begin with 2 drugs at the same time. Not working? Add a third
What drug actions of statins help prevent atherosclerosis?
By lowering cholesterol content, it actually makes the plaques more stable and reduces inflammation at the site... results in better endothelium function and ability of blood vessels to dilate
A patient who is scheduled to receive human chorionic gonadotropin (hCG) complains of abdominal bloating and severe pain. Which action should the nurse take first? A. Administer a narcotic analgesic for the pain B. Tell the patient that the symptoms are expected C. Hold the hCG injection and contact the prescriber D. Assess the patient for injection site pain
C
The nurse cares for a patient who is scheduled to receive menotropin [Repronex]. What should the nurse plan to teach this patient? A. Estrogen will be given to stimulate ovulation. B. The medication will be given intravenously. C. Frequent ultrasounds will be performed. D. Multiple births are relatively uncommon.
C
Which patient would be at greatest risk of developing a venous thromboembolism (VTE) if a combination oral contraceptive were prescribed? A. A 25-year-old patient who drinks 3 to 4 alcoholic drinks a day B. A 45-year-old patient who has a family history of stroke C. A 22-year-old patient who smokes 2 packs of cigarettes a day D. A 29-year-old patient who has used birth control pills for 9 years
C. smoking is way worse than all those other factors, including age.
A patient is taking estrogen daily. Which instruction by the nurse should be included to reduce the risk of a cardiovascular event, such as stroke or myocardial infarction? A. Reduce aerobic activities. B. Increase dietary intake of trans fat. C. Stop smoking. D. Take the medication with food.
C. stop smoking
Know that CCB's can exacerbate compensated HF & why?
CCBs reduce excitability of the cardiac tissue, essentially depressing cardiac function, which is good for HTN, but bad for HF. Bc of their ability to reduce the heart rate, it can really decrease contractility and ultimately CO.
One rule of thumb about prescribing multiple anti hypertensives for one patient.
Do NOT use dual RAAS blockade agents: don't use a ACEI AND a ARB. or ACEI AND direct renin inhibitor
You are caring for a post menopausal women who needs to be started on HRT. What's the first question you ask them?
Do you still have a uterus?
When would an alpha 1 antagonist be used (ie. What drug action are you looking for with the use of an alpha1 antagonist to control HTN?)
Drug action: Alpha 1 antagonists lower BP by causing vasodilation by blocking alpha 1 receptors on arteries and veins. Dilation of arteries reduces BP directly.
Ergonovine and methylergonovine are what kind of drugs
Ergot alkaloids that are used for postpartum hemorrhage
DTR: alcohol and ACEIs and ARBs
Excessive amounts of alcohol may potentiate the hypotensive effects of these drugs. Just.. ease up, k?
T/F. Raloxifene is an unopposed estrogen used to treat post menopausal symptoms.
FALSE. It is a SERM.
T/F. The goal BP for CKD patient is higher than the gen pop.
FALSE. The goal for everyone udner the age of 60 is <140/90
T/F. Antiseizure meds increase the efficacy of combo oral contraceptives.
False. Like antibiotics, antiepileptic meds can reduce effects of combo oral contraceptives
T/F. Some drugs can fix sterility but not fertility.
False. Sterility is the complete absence of the ability to reproduce. Fertility can be enhanced with drugs.
You have a 55yo diabetic CKD patient who's BP is persistently 139/87. T/F. You need to get this patient's BP in better control and increase the BP med dose.
False. The goal is <140/90. No evidence suggesting that going lower will actually improve outcomes.
With which co-morbid conditions might the NP choose to prescribe an ARB (angiotensin-II receptor blocker)?
Heart Failure, HTN, MI, diabetic nephropathy, stroke prevention.. any CV prevention.. .... These are the same answers for ACEI. But ACEI is preferred over ARB first.
What percentage of patients on digoxin will die from toxicity?
Leene pg 524 35%
You have high triglycerides. What should we try first?
Lifestyle modifications.. diet and exercise.
The thing about statins is :
Not ok in viral or alcholic hepatitis.... but they are ok for fatty liver bc they can decrease inflammation
Describe statin therapy including risk associated with treatment
Side effects are uncommon, and serious adverse effects-hepatotoxicity and myopathy, are relatively rare. Hepatotoxicity: statins can injure the liver, but jaundice and other clinical signs are rare. LFT should be monitored before treatment and clinically indicated thereafter. Myopathy: statins can cause muscle injury. If statins are not withdrawn, injury may progress to severe myositis or potentially fatal rhabdomyolysis. Inform pts of the risk of myopathy, and instruct them to notify the prescriber if unexplained muscle pain or tenderness develops.
Which type of drug would you use to lower LDLs?
Statin
How do the different types of HF present?
Systolic (LV)- ventricular dysfunction, reduced cardiac output, insufficient tissue perfusion, and signs of fluid retention (edema, SOB, ect.) Diastolic- preserved ejection fraction
___________ is best known for treatment of breast cancer.
Tamoxifen
Which drug might be good for a migraine?
Verapamil (a non DHP CCB)
_______ should be avoided in CHF and why?
Verapamil.... the non DHP CCB, because it has a strong negative inotropic effect. In other words, it can depress cardiac activity too much.
Because of the risks associated with HRT, how should we adjust our management?
We want our patients on HRT for the shortest time necessary.
Besides increasing blood volume and blood pressure, what other negative effect does Angiotensin 2 have? (Hint: cardiac)
angiotensin 2 causes hypertrophy and remodeling of the cardiac tissue and blood vessels causing fibrosis and artherosclerosis
So why don't ARBs cause a cough like ACEIs?
angiotensin receptor blockers don't affect the angiotensin converting enzyme. Remember the ACE is what breaks down the bradykinin, so ARB users don't have a build up of bradykinin to cause inflammation to cause a cough.
Leuprolide [Lupron Depot, Eligard] is used for
endometriosis as a synthetic analog of gonadotropin-releasing hormone to suppress ovarian hormone production
What is the main estrogen called
estradiol
_________ is an adverse event with Niacin.
hepatotoxicity
When does HBPM not appropriate?
if the patient has some weird heart thing like cardiac dysthrymias that will make the automated BP machine freak out and not be reliable
Menotropins are used
in conjunction with HCG to promote follicular maturation and ovulation to improve female fertility
Treatment for atrophic vaginitis
intra vaginal preparation of estrogen = creams!
5-alpha-reductase inhibs are the most appropriate for men with
large prostates
first line diuretic for heart failure
lasix or bumex
Total cholesterol levels should be
less than 200
Mifepristone (RU 486) is a drug used for
medical abortion
____________ is given for ectopic pregnancy
methotrexate + cytotec
What is cinchonism?
poisoning due to excessive ingestion of cinchona alkaloids --> quinine
A patient is started on an oxytocin infusion to promote uterine contractions during labor. The patient's intrauterine pressure is 25 mm Hg. Which nursing action is appropriate? A. Prepare for immediate cesarean section. B. Assess the fetal heart tones for 2 minutes. C. Stop the infusion immediately. D. Continue to monitor the patient.
power point says C. But that's just not correct.... 25mmHg is not high/ effective contractions.
How does Viagara work?
prevents conversion of cGMP to GMP in smooth muscle in corpus cavernosum to maintain an erection
Colesevelam, the bile acid sequestrant, is used for:
reduce LDLs. Best used in combo with lifestyle changes and or combo statin.
Major advantage for ACEIs (1)
reduces the risk of cardiovascular mortality caused by hypertension
Most common reason a patient would be in a tocolytic
relax the uterus = to prevent preterm labor
What is a SERM? How do they work?
selective estrogen receptor modulator... they block estrogen in some tissue and activate in other tissues
alpha blockers are preferred for men with
smaller prostates
Explain why ACEIs cause a cough.
the angiotensin converting enzyme also breaks down bradykinin which plays a role in inflammation. When you give a ACE INHIBITOR, you prevent the breakdown of that bradykinin, increasing levels of inflammation, causing a cough.
Which calcium channel blockers can be used to treat cardiac dysrhythmias in addition to angina and hypertension? The wrong answer is:
the non- DHPs like verapamil and dilitiazem Wrong answer: the DHPs, the -pines
Ortho Evra is an example of
the transdermal contraceptive patch.
First line diuretic for hypertension
thiazide
Absolute contraindication for combo oral contraceptives
thromboembolic disorders
Cabergoline and bromocriptine are used
to correct amenorrhea and infertility by activating dopamine receptors to improve female fertility in hyperprolactinemia
Clomiphene is used
to promote follicular maturation and ovulation to improve female fertility by blocking receptors for estrogen
If you are a post menopausal women who still has her uterus, you cannot be treated with __________. Why? Instead, she must have _________.
unopposed estrogen because it causes endometrial hyperplasia. She must have progesterone and estrogen together.
