-
The most prominent actions of angiotensin II are
vasoconstriction and
stimulation of aldosterone release
-
What effect does aldosterone have on the kidneys?
Retention of sodium and excretion of potassium and hydrogen
-
The vasculature of which organ is especially rich in angiotensin-converting enzyme (ACE)?
The Lungs
-
The most prominent adverse effects of ACE inhibitors include
first-dose hypertension, cough, hyperkalemia .
-
Which ACE inhibitor is given intravenously?
enalaprilat
-
The principal protective mechanism of the ACE inhibitors for diabetic and nondiabetic nephropathy is
reduction of glomerular filtration pressure
-
Angiotensin II receptor blockers exert their therapeutic effect by
blocking angiotensin II actions
-
Eplerenone (Inspra) is the
first representative of a new class of drugs, selective aldosterone receptor blockers.
-
Calcium channel blockers are widely used to treat
hypertension, angina pectoris, cardiac dysrhythmias.
-
At therapeutic doses, calcium channel blockers act selectively on the
peripheral arterioles, arteries and arterioles of the heart
No effect on the Veins
-
A positive inotropic effect produces
an increased force of cardiac contraction
-
Calcium channel blockers and _______ have identical effects on the heart
Beta Blockers
-
The overall cardiovascular effect of verapamil is
simply vasodilation accompanied by reduced arterial pressure and increased coronary perfusion
-
The most common cause of complaints from patients taking verapamil is
Constipation
-
The overall hemodynamic response to nifedipine is
increased heart rate, lowered blood pressure, increased contractile force of the heart.
-
Concurrent use of a beta blocker with verapamil or diltiazem can cause
Bradycardia
-
Vasodilators are used for
hypertension, angina pectoris, heart failure.
-
Hydralazine produce
selective dilation of arterioles
-
nitroglycerin produce
selective dilation of veins
-
prazosin
dilate arterioles and veins
-
Blood volume is increased by two mechanisms. They include
Secretion of Aldosterone which acts on the kidney to promote retention of sodium and water, thereby increasing blood volume, and by involvement of the kidney.
- By reducing arterial pressure, vasodilators decrease
- renal blood flow and glomerular filtration, causing the kidney to reabsorb an increased fraction of filtered sodium and water, which causes blood volume to expand.
-
Patients often receive concurrent therapy with a ______ to prevent the kidney from neutralizing the beneficial effects of vasodilation.
Diuretic
-
Hydralazine is inactivated by a metabolic process known as
acetylation.
-
Because it is both very effective and very dangerous_____ is reserved for patients with severe hypertension that has been refractory to safer drugs.
minoxidil
-
Excessive growth of hair is known as
hypertrichosis
-
hypertrichosis and is associated with use of which vasodilator?
Minoxidil _
-
Sympathomimetic drugs promote vasodilation by
preventing the sympathetic nervous system from causing vasoconstriction
-
Prolonged infusion of nitroprusside can result in toxic accumulations of
cyanide, thiocyanate
-
Reserpine is an example of a(n)
adrenergic neuron-blocking agen
-
Reflex tachycardia is undesirable for two reasons. They are that
tachycardia can put an unacceptable burden on the heart;
if the vasodilator is given to reduce blood pressure, tachycardia would raise pressure and thereby counteract beneficial effects.
-
Left untreated, chronically elevated blood pressure can lead to
- left ventricular hypertrophy,
- myocardial infarction,
- angina pectoris,
- kidney disease,
- blindness,
- stroke.
-
Lifestyle modifications that are components of the management of essential hypertension include
- weight loss,
- sodium restriction,
- alcohol restriction,
- exercise,
- smoking cessation,
- maintenance of potassium and calcium intake
-
Cardiac output is influenced by
heart rate, myocardial contractility, blood volume, venous return of blood to the heart
-
How do antihypertensive drugs act in the brainstem
They suppress sympathetic outflow to the heart and blood vessels, resulting in a decreased heart rate, decreased myocardial contractility, and vasodilation.
-
Angiotensin-converting enzyme (ACE) inhibitors act to
to suppress the formation of angiotensin II
-
Angiotensin-converting enzyme (ACE) inhibitors act to suppress the formation of angiotensin II; resulting in
peripheral vasodilation, renal vasodilation, and suppression of aldosterone-mediated volume expansion
-
In patients with uncomplicated hypertension and no comorbid conditions, initial therapy with a
diuretic or beta blocker is recommended
-
Which antihypertensive works best in the treatment of hypertension in patients who have nephrosclerosis?
angiotensin-converting enzyme (ACE) inhibitors
-
Sodium nitroprusside
the drug of choice for hypertensive crisis
-
Fenoldopam
an intravenous (IV) drug indicated for short-term management of hypertensive emergencies
-
Fenoldopam benefits are
as great as those of nitroprusside
-
Fenoldopam differs from other antihypertensives in that it
helps to maintain (or improve) renal function.
-
When drug therapy is initiated during pregnancy
methyldopa is the traditional agent of choice.
-
The principal drugs used to treat allergic rhinitis include
- oral antihistamines,
- intranasal glucocorticoids,
- intranasal cromolyn,
- sympathomimetics
-
What is the role of antihistamines in the treatment of the common cold?
Antihistamines are of no value against the common cold because they do not reduce nasal congestion
-
What is the role of antihistamines in the treatment of allergic rhinitis?
They can relieve sneezing, rhinorrhea, and nasal itching.
-
Antihistamines are more effective when taken
prophylactically
-
Antihistamines are less helpful when taken
after symptoms have appeared
-
Antihistamines should be administered
on a regular basis throughout the allergy season, even when symptoms are absent.
-
What is the only antihistamine available for intranasal use?
azelastine
-
How does cromolyn work?
Cromolyn reduces symptoms by suppressing the release of histamine and other inflammatory mediators from mast cells
-
What drug is a monoclonal antibody that is directed against immunoglobulin E (IgE)?
omalizumab
-
The two most frequently drugs used for cough suppression are
-
Dextromethorphan
is the most effective nonopioid cough suppressant available.
-
The underlying cause of the symptoms and signs of asthma is
immune-mediated airway inflammation
-
The two major pharmacologic classes of drugs used to treat asthma are
- anti-inflammatory drugs,
- bronchodilators
-
Beta2 agonists function by promoting
bronchodilation
-
Glucocorticoids are indicated for the treatment of which type of asthma?
Chronic
-
Potential adverse effects of oral glucocorticoids include
- adrenal suppression,
- osteoporosis,
- hyperglycemia,
- peptic ulcer disease,
- growth suppression in young patients
-
Cromolyn works by
- stabilizing the cytoplasmic membrane of mast cells, thereby preventing release of histamine and other
- mediators
-
The newest class of drugs for the treatment of asthma is the
leukotriene modifiers
-
The drug of choice for the treatment of exercise-induced bronchospasm is
cromolyn sodium
-
Opioid
a general term defined asany drug, natural or synthetic, that has actions similar to those of morphine
-
Narcotic
- has been used to mean an analgesic, central nervous
- system depressant and any drug capable of causing physical dependence.
-
Responses to the activation of mu receptors
include analgesia, respiratory depression, euphoria, sedation, and the development of physical dependence.
-
Morphine
is the prototype of the strong opioid analgesic and remains the standard by which newer opioids are measured.
-
The most serious adverse effect of the opioids is
Respiratory Depression
-
however, when administered at usual therapeutic doses, they _____ significant respiratory depression.
Rarely Cause
-
The adverse effect on the gastrointestinal system related to opioid use is
Constipation
-
How does the use of morphine elevate intracranial pressure
By suppressing respiration, morphine increases the carbon dioxide (CO2) content of the blood, which dilates the cerebral vasculature, causing intracranial pressure (ICP) to rise
-
Opioid overdose causes
coma, respiratory depression, pinpoint pupils
-
Use of meperidine is on the decline because
the drug has a short half-life, it interacts adversely with a number of drugs, there is a risk of harm owing to accumulation of a toxic metabolite
-
The most effective dosing schedule for morphine is
A Fixed Schedule
-
To minimize physical dependence and abuse, opioid analgesics should be administered in
the lowest effective dosages for the shortest time needed
-
Analgesia refers specifically to
refers specifically to loss of sensibility to pain, and
-
Anesthesia refers to the
refers to the loss not only of pain, but also of all other sensations
-
The agents used most commonly to obtain a state of balanced anesthesia are
- short-acting barbiturates for the induction of
- anesthesia, neuromuscular blocking agents for muscle relaxation, opioids and nitrous oxide for analgesia
-
In which stage of anesthesia are respirations typically irregular and vomiting and urinary or
fecal incontinence and reflex muscle activity most likely to occur?
Stage II
-
The most recent data suggest that inhalation anesthetics work primarily by
- activating receptors for gamma-aminobutyric acid
- (GABA), the principal inhibitory transmitter in the CNS
-
The risk of malignant hyperthermia is greatest when an inhalation anesthetic is used in combination
with
succinylcholine
-
Preanesthetic medications are administered to
- reduce anxiety,
- produce perioperative amnesia,
- relieve preoperative and postoperative pain
-
Anticholinergic drugs are given with general anesthesia to
decrease the risk of bradycardia during surgery
-
Isoflurane
is the most widely used inhalation anesthetic.
-
Midazolam
may be used for the induction of anesthesia and to produce conscious sedation.
-
Why does propofol carry a high risk of bacterial infection?
Because the drug is supplied in a mixture of soybean oil, glycerol, and egg lecithin, all of which are excellent media for the growth of bacteria.
-
The great advantage of local anesthesia, compared with inhalation anesthesia, is that
- pain can be suppressed without causing generalized
- depression of the entire nervous system
-
How do local anesthetics work?
Local anesthetics stop axonal conduction by blocking sodium channels in the axonal membrane, thereby bringing conduction to a halt.
-
What is the order in which sensation is lost when local anesthesia is used?
- Perception of pain is lost first, followed in order
- by perception of cold, warmth, touch, and deep pressure.
-
Local anesthetics are frequently administered in combination with a vasoconstrictor, usually
epinephrine
-
The benefits of the vasoconstrictor (epinephrine) include
prolonged anesthesia, reduced risk of toxicity
-
If necessary, excessive excitation during the excitation phase of local anesthetic administration can be treated with
intravenous (IV) benzodiazepine,
IV thiopental
-
Epidural
anesthesia is achieved by injecting a local anesthetic within the spinal column, but outside the dura mater
-
Lidocaine and bupivacaine
are popular drugs used for this type of anesthesia.
by injecting a local anesthetic within the spinal column, but outside the dura mater
-
The most significant adverse effect of spinal anesthesia is
Hypotension
-
How can spinal headaches be relieved?
By having the patient assume a supine position
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