Pharmacology Ch 28, 29, 22

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Pharmacology Ch 28, 29, 22 - Quiz

Medication for Heart and kidneys


Questions and Answers
  • 1. 

    Common side effects of niacin includes:

    • A.

      Headache and hypertension

    • B.

      Nausea, diarrhea and flatulence

    • C.

      Flushing, itching and headache

    • D.

      Constipation

    Correct Answer
    C. Flushing, itching and headache
    Explanation
    The correct answer is "Flushing, itching and headache". Niacin, also known as vitamin B3, is commonly used to treat high cholesterol. One of the most common side effects of niacin is flushing, which is characterized by redness and warmth in the face and neck. Itching and headache are also common side effects. These side effects are usually temporary and can be managed by taking niacin with food or using a slow-release form of the medication.

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  • 2. 

    Thiazide Diuretics may cause:

    • A.

      Nephrotoxicity

    • B.

      Ototoxicity

    • C.

      Hyperuricemia

    • D.

      Hypertension

    Correct Answer
    C. Hyperuricemia
    Explanation
    Thiazide diuretics are known to cause hyperuricemia, which is an increased level of uric acid in the blood. This occurs because thiazide diuretics inhibit the excretion of uric acid, leading to its accumulation in the body. Hyperuricemia can increase the risk of developing gout, a type of arthritis caused by the deposition of uric acid crystals in the joints. Therefore, patients taking thiazide diuretics should be monitored for elevated uric acid levels and managed accordingly.

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  • 3. 

    Ace Inhibitors:

    • A.

      Reduce blood pressure (afterload)

    • B.

      Decrease renal flow

    • C.

      Increase peripheral vascular resistance

    • D.

      Increase peripheral vascular resistance

    Correct Answer
    A. Reduce blood pressure (afterload)
    Explanation
    Ace inhibitors are a class of medications commonly used to treat high blood pressure. They work by blocking the action of an enzyme called angiotensin-converting enzyme (ACE), which is involved in the production of a hormone called angiotensin II. Angiotensin II causes blood vessels to constrict and also stimulates the release of another hormone called aldosterone, which increases fluid retention. By inhibiting ACE, these medications reduce the production of angiotensin II, leading to relaxation and dilation of blood vessels, which in turn lowers blood pressure. Therefore, the correct answer is "Reduce blood pressure (afterload)".

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  • 4. 

    Fibric Acids are used to lower:

    • A.

      Triglycerides

    • B.

      Cholesterol

    • C.

      Fatty acids

    • D.

      Insulin resistance

    Correct Answer
    A. Triglycerides
    Explanation
    Fibric acids are a class of medications used to lower triglyceride levels in the body. Triglycerides are a type of fat found in the blood, and high levels can increase the risk of heart disease. Fibric acids work by reducing the production of triglycerides in the liver and increasing the breakdown of triglycerides already present in the blood. This helps to lower triglyceride levels and improve overall cardiovascular health.

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  • 5. 

    Digitalis toxicity symptoms are:

    • A.

      Increased renal output

    • B.

      Anorexia, nausea, vomiting, blurred vision

    • C.

      Increased potassium level

    • D.

      Peripheral edema, pulse deficit, nocturnal leg cramps

    Correct Answer
    B. Anorexia, nausea, vomiting, blurred vision
    Explanation
    Digitalis toxicity can cause various symptoms, including anorexia, nausea, vomiting, and blurred vision. These symptoms occur due to the toxic effects of digitalis on the gastrointestinal system and the visual system. Digitalis can irritate the stomach lining, leading to decreased appetite, nausea, and vomiting. It can also affect the nerves responsible for vision, causing blurred vision. Therefore, experiencing anorexia, nausea, vomiting, and blurred vision can be indicative of digitalis toxicity. The other symptoms listed, such as increased renal output, increased potassium level, peripheral edema, pulse deficit, and nocturnal leg cramps, may be associated with other conditions or medications, but they are not specific to digitalis toxicity.

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  • 6. 

     Potassium supplements and salt substitutes should not be given with the following class of diuretic:

    • A.

      Thiazide

    • B.

      Loop

    • C.

      Potassium sparing

    • D.

      Carbonic anhydrase inhibitors

    Correct Answer
    C. Potassium sparing
    Explanation
    Potassium sparing diuretics, such as spironolactone and amiloride, work by blocking the action of aldosterone, a hormone that promotes the reabsorption of sodium and the excretion of potassium in the kidneys. These diuretics help to retain potassium in the body and prevent its excretion. Therefore, giving potassium supplements or salt substitutes along with potassium sparing diuretics can lead to excessive levels of potassium in the body, which can be dangerous and cause hyperkalemia. Thiazide, loop, and carbonic anhydrase inhibitors do not have the same effect on potassium levels and can be given with potassium supplements or salt substitutes.

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  • 7. 

     HMG-CoA reductase drugs are also known as:

    • A.

      Nicotinic acid

    • B.

      Statins

    • C.

      Hypoglycemics

    • D.

      Cholesterol potentiators

    Correct Answer
    B. Statins
    Explanation
    HMG-CoA reductase drugs are commonly referred to as statins. Statins are a class of medications used to lower cholesterol levels in the body by inhibiting the enzyme HMG-CoA reductase, which plays a key role in cholesterol production. These drugs are widely prescribed to reduce the risk of cardiovascular diseases and are known for their effectiveness in managing high cholesterol levels.

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  • 8. 

     Which of the following are ways to assess for hydration? Select all that apply

    • A.

      Skin turgor

    • B.

      Oral mucous membrane

    • C.

      Vital signs

    • D.

      Labatory changes

    • E.

      All of the above

    Correct Answer
    E. All of the above
    Explanation
    All of the above options are ways to assess for hydration. Skin turgor refers to the elasticity of the skin, which is reduced in dehydration. Oral mucous membrane can become dry and sticky in dehydration. Vital signs, such as blood pressure, heart rate, and temperature, can provide indications of hydration status. Laboratory changes, such as increased blood urea nitrogen (BUN) and creatinine levels, can also be seen in dehydration. Therefore, all of these options can be used to assess for hydration.

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  • 9. 

     Omega-3 fatty acids are often referred to as:

    • A.

      Fish Oil

    • B.

      Statins

    • C.

      Water soluable vitamins

    • D.

      Bile acid resins

    Correct Answer
    A. Fish Oil
    Explanation
    Omega-3 fatty acids are often referred to as fish oil because they are commonly found in fatty fish such as salmon, mackerel, and sardines. Fish oil is a rich source of omega-3 fatty acids, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which have been shown to have numerous health benefits. These fatty acids are known to support heart health, reduce inflammation, improve brain function, and promote healthy skin. Therefore, fish oil is a commonly used supplement to increase the intake of omega-3 fatty acids in the diet.

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  • 10. 

    Why are diuretics usually not administered after midafternoon?

    • A.

      They are irritating to the GI lining

    • B.

      They cause orthostatic hypotension

    • C.

      To prevent nocturia

    • D.

      To prevent polyuria

    Correct Answer
    C. To prevent nocturia
    Explanation
    Diuretics are medications that increase urine production, and they are usually not administered after midafternoon to prevent nocturia, which is the need to wake up during the night to urinate. By avoiding diuretics in the late afternoon or evening, it helps to minimize the amount of urine produced at night, allowing individuals to sleep without interruption. This is especially important for individuals who already have difficulty sleeping or who may be at risk for falls during nighttime trips to the bathroom.

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  • 11. 

     Which of the following statements is/are true about Omacor? Select all that apply.

    • A.

      Omacor is used to decrease very elevated triglyceride level

    • B.

      Omacor is often used with statins to further lower cholesterol levels

    • C.

      Omacor may cause myositis or rhabdomylosis

    • D.

      Omacor should be used with caution in patients with allergies to fish

    Correct Answer(s)
    A. Omacor is used to decrease very elevated triglyceride level
    B. Omacor is often used with statins to further lower cholesterol levels
    D. Omacor should be used with caution in patients with allergies to fish
    Explanation
    Omacor is used to decrease very elevated triglyceride levels. It is often used with statins to further lower cholesterol levels. It should be used with caution in patients with allergies to fish.

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  • 12. 

    This is when the ventricles contract as they stretch. How much the heart fibers stretch before contraction for systole (ventricles)

    • A.

      Preload

    • B.

      After load

    Correct Answer
    A. Preload
    Explanation
    Preload refers to the amount of blood that fills the ventricles of the heart just before contraction. It is determined by the volume and pressure of blood in the ventricles during diastole (relaxation phase). When the ventricles stretch due to the increased blood volume, it allows for a greater force of contraction during systole (contraction phase). Therefore, preload affects the amount of stretch in the heart fibers before contraction for systole. Afterload, on the other hand, refers to the resistance that the heart must overcome to eject blood into the circulation.

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  • 13. 

    This is the pressure in the aorta that must be overcome for blood to be ejected from the L side of the heart

    • A.

      Preload

    • B.

      Afterload

    Correct Answer
    B. Afterload
    Explanation
    Afterload refers to the pressure that the heart must overcome in order to eject blood from the left side of the heart into the aorta. It is the resistance that the heart encounters when pumping blood out. This resistance is determined by factors such as the size and elasticity of the arteries, as well as the amount of blood in the circulatory system. Therefore, afterload is the correct answer as it accurately describes the pressure in the aorta that needs to be overcome for blood ejection.

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  • 14. 

    Another name for muscle weakness is:

    • A.

      Mytosis

    • B.

      Hypertrophy

    • C.

      Rhabdimyosis

    Correct Answer
    B. Hypertrophy
    Explanation
    Muscle weakness refers to a decrease in the strength and power of muscles. Hypertrophy, on the other hand, is the increase in the size and mass of muscle cells. These two terms are opposite in meaning, as muscle weakness implies a decrease in muscle function, while hypertrophy suggests an increase in muscle size and strength. Therefore, hypertrophy is not another name for muscle weakness.

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  • 15. 

    True or false:Diastolic Dysfunction is the most common type of heart failure

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    ALSO KNOWN AS CONTRACTING DYSFUNCTION
    The heart usually pumps at a rate to support the body’s need for blood flow and oxygen- to the organs and muscles- systolic dysfunction occurs when the heart doesn’t pump with enough force to pump all of the blood (decreased cardiac output) and this leads to decreased tissue perfusion
    Early symptoms are decreased exercise tolerance and poor perfusion to peripheral tissues (what symptoms would you expect to see?)
    As the condition progresses the left ventricle enlarges (LVH) and an increase in the blood volume is required to fill the ventricle to maintain cardiac output.
    So what causes systolic dysfunction? Damage to the heart- coronary artery disease that leads to MI is the most common cause. Other causes include dysrhythmias, congenital defects, and cardiomyopathies
    Usually the left side fails first but as the disease progresses the right side of the heart begins to enlarge because of increased pulmonary resistance and then eventually the right side fails too

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  • 16. 

    Common signs and symptoms of diastolic dysfunction includes:

    • A.

      Pulmonary edema and CHF

    • B.

      Pulmonary congestion and peripheral edema

    • C.

      Respiratory distress

    Correct Answer
    B. Pulmonary congestion and peripheral edema
    Explanation
    Diastolic dysfunction refers to abnormalities in the filling of the heart during the relaxation phase. Pulmonary congestion and peripheral edema are common signs and symptoms of diastolic dysfunction. Pulmonary congestion occurs when there is an accumulation of fluid in the lungs, leading to symptoms such as shortness of breath and coughing. Peripheral edema refers to swelling in the extremities, such as the legs and ankles, due to fluid retention. These symptoms occur because the impaired filling of the heart causes increased pressure in the blood vessels, leading to fluid leakage into the lungs and tissues.

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  • 17. 

    Identify which side of the heart is affected:  n ventricle unable to compensate and blood “backs up” into the lungs nSymptoms SOB and cough (esp. when lying down) AKA Congestive Heart Failure

    • A.

      Left side heart failure

    • B.

      Right side heart failure

    Correct Answer
    A. Left side heart failure
    Explanation
    Left side heart failure is the correct answer because when the left ventricle is unable to compensate and blood "backs up" into the lungs, it leads to symptoms such as shortness of breath (SOB) and cough, especially when lying down. This condition is also known as Congestive Heart Failure.

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  • 18. 

    Identify which side of the heart is affected:  nIf this side becomes weak the blood “backs up” into the peripheral veins nPeripheral edema (feet and ankles) and engorgement of organs such as the liver occurs

    • A.

      Left side HF

    • B.

      Right side HF

    Correct Answer
    B. Right side HF
    Explanation
    Right side heart failure occurs when the right side of the heart is unable to effectively pump blood. This can cause a backup of blood into the peripheral veins, leading to peripheral edema (swelling) in areas such as the feet and ankles. It can also result in engorgement of organs like the liver. Therefore, the correct answer is Right side HF.

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  • 19. 

    Cardiac glycosides are:

    • A.

      The class that increases the strength of contraction

    • B.

      The class that decreases the strength of contraction

    Correct Answer
    A. The class that increases the strength of contraction
    Explanation
    Cardiac glycosides are a class of medications that increase the strength of contraction of the heart muscles. They work by inhibiting the sodium-potassium pump in cardiac cells, leading to an increase in intracellular calcium levels. This increase in calcium enhances the force of contraction, thereby improving the heart's pumping ability. Cardiac glycosides are commonly used in the treatment of heart failure and certain arrhythmias.

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  • 20. 

    How do we treat heart failure?

    • A.

      Negetive inotrpics and Cholinergics

    • B.

      We use vasoconstrictor, inotropic and diuretic therapy.

    • C.

      We use vasodilators, inotropic and diuretic therapy.

    Correct Answer
    C. We use vasodilators, inotropic and diuretic therapy.
    Explanation
    We use vasodilators, inotropic and diuretic therapy.
    Vasodilators are used to reduce the strain on the L ventricle by reducing systemic vascular resistance (afterload) this increases tissue perfusion to vital organs and muscles. They also reduce preload so the high volume of blood returning to the heart is decreased. The decrease in preload reduces pulmonary congestion and helps the pt to breathe more easily.
    Inotropic agents stimulate the heart to increase the force of contractions which increases cardiac output. This also helps with pulmonary congestion and improves tissue perfusion. With the increase of blood flow to the kidneys (renal perfusion) potent diuretics are administered to enhance sodium and water excretion. This also reduces the workload of the heart and symptomatic relief.

    If the pt is on IV therapy they are frequently in the ICU

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  • 21. 

    To treat heart failure the A is:

    • A.

      ARBs (Angiotensin Receptor Blockers)

    • B.

      ACE Inhibitors (Angiotensin Converting Enzyme Inhibitors)

    • C.

      Alpha blockers

    Correct Answer
    B. ACE Inhibitors (Angiotensin Converting Enzyme Inhibitors)
    Explanation
    ACE inhibitors are the preferred treatment for heart failure because they help to relax and widen blood vessels, reducing the workload on the heart. They also help to lower blood pressure and prevent the progression of heart failure. ARBs (Angiotensin Receptor Blockers) are also effective in treating heart failure, but ACE inhibitors are generally the first line of treatment. Alpha blockers are not typically used for heart failure and are more commonly used to treat conditions like high blood pressure or urinary problems.

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  • 22. 

    This enzyme:  nLower blood pressure and decrease volume nThis decreases arterial blood pressure and increases cardiac output nAlso dilates veins that return blood to the heart- this decreases preload and decreases peripheral edema

    • A.

      ARB

    • B.

      ACE

    • C.

      Alpha blockers

    • D.

      Beta Blockers

    Correct Answer
    B. ACE
    Explanation
    Increases excretion of Na and water
    ACE inhibitors reduce morbidity and mortality associated with heart failure. They reduce afterload (by reducing BP) and preload (by reducing circulating volume)
    ACEs are the drug of choice over digoxin (in a few slides) for mild to moderate systolic dysfunction heart failure

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  • 23. 

    ACE Inhibitors can cause:

    • A.

      Hypokalemia

    • B.

      Hyperkalemia

    • C.

      Hypertension

    • D.

      Hypotension

    Correct Answer
    B. Hyperkalemia
    Explanation
    ACE inhibitors can cause hyperkalemia, which is an elevated level of potassium in the blood. This occurs because ACE inhibitors inhibit the production of angiotensin II, a hormone that constricts blood vessels and stimulates the release of aldosterone. Aldosterone helps regulate potassium levels by promoting its excretion in the urine. Therefore, when ACE inhibitors block the production of aldosterone, potassium may accumulate in the body, leading to hyperkalemia. This can be a potential side effect of ACE inhibitor therapy and needs to be monitored in patients taking these medications.

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  • 24. 

    With regards to HF the B is for:

    • A.

      Bronchospasms

    • B.

      Bronchodialators

    • C.

      Beta Blockers

    Correct Answer
    C. Beta Blockers
    Explanation
    Beta blockers are medications that are commonly used to treat various cardiovascular conditions such as high blood pressure, angina, and heart failure. They work by blocking the effects of adrenaline on the heart and blood vessels, thereby reducing heart rate and blood pressure. In the context of heart failure (HF), beta blockers are used to improve symptoms, reduce hospitalizations, and increase survival rates. They help to decrease the workload on the heart and improve its efficiency. Therefore, in the given options, the letter "B" stands for beta blockers, which are an important component of the treatment for HF.

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  • 25. 

    These enzymes:  nDecrease HR, cardiac output, BP nCommonly used with ACE inhibitors

    • A.

      Bronchodialtors

    • B.

      Beta-adrenergic Blockers

    Correct Answer
    B. Beta-adrenergic Blockers
    Explanation
    Beta-adrenergic blockers are a class of drugs that are commonly used with ACE inhibitors. They work by blocking the action of adrenaline and other stress hormones on beta receptors in the body. By doing so, they decrease heart rate, cardiac output, and blood pressure. This makes them effective in treating conditions such as hypertension and heart failure. Additionally, beta-adrenergic blockers can also be used as bronchodilators, helping to relax and open up the airways in conditions like asthma and chronic obstructive pulmonary disease (COPD).

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  • 26. 

    With regards to HF the D is for:

    • A.

      Dygloside Digitalis

    • B.

      Cardiac/ Digitalis glycosides

    Correct Answer
    B. Cardiac/ Digitalis glycosides
    Explanation
    The correct answer is "Cardiac/ Digitalis glycosides." This is because the letter "D" in HF stands for Digitalis, which refers to a group of medications known as cardiac glycosides. These medications, such as Digoxin, are commonly used in the treatment of heart failure (HF) to strengthen the heart's contractions and regulate its rhythm. Therefore, the correct answer indicates that the letter "D" in HF represents the use of cardiac or Digitalis glycosides in the management of heart failure.

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  • 27. 

    True or false:Digoxin is not used to treat diastolic heart failure

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    This has been around since 1785.
    Increase the force of myocardial contraction (positive inotropic effect)- increases cardiac output

    Also slows electrical activity in the heart which decreases HR (negative chronotrophy)
    It also reduces the conduction velocity and prolongs the refractory period at the AV node
    The result of this is the heart is able to fill and empty more completely which improves circulation- which reduces the systemic and pulmonary congestion and peripheral edema because of the improved perfusion to the kidneys

    Used to treat mild to severe systolic heart failure that doesn’t respond to other meds (diuretics, beta blockers and ace) also used for a-fib, a-flutter, and paroxysmal tachycardia.
    Digoxin is NOT used to treat diastolic heart failure- it may worsen diastolic heart failure
    Too many side effects

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  • 28. 

    What route is Digoxin immune fab (ovine) given?

    • A.

      PO

    • B.

      IV

    • C.

      IM

    • D.

      Sub q

    Correct Answer
    B. IV
    Explanation
    Digoxin immune fab (Ovine) is given IV

    It binds to the digoxin and stops it from reaching the tissues

    Rapid onset- less than 1 minute after infusion is started

    Digoxin immune fab (Digibind) is given IV to reverse toxic levels of digoxin

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  • 29. 

    What year were Natriuretic approved for heart failure?

    • A.

      2001

    • B.

      1998

    • C.

      2002

    • D.

      2005

    Correct Answer
    A. 2001
    Explanation
    In 2001, Natriuretic was approved for heart failure treatment.

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  • 30. 

    These are a small peptide hormone that is produced through recombinant DNA technology and is structurally identical to a hormone secreted by the heart

    • A.

      Novian

    • B.

      Nitrates

    • C.

      Nesiritide (Natrecor)

    Correct Answer
    C. Nesiritide (Natrecor)
    Explanation
    Nesiritide (Natrecor) is the correct answer because it is a small peptide hormone that is produced through recombinant DNA technology and is structurally identical to a hormone secreted by the heart. Nitrates and Novian are not small peptide hormones produced through recombinant DNA technology, and they are not structurally identical to a hormone secreted by the heart.

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  • 31. 

    What is BNP (hbnp). Select all that applies.

    • A.

      It is a hormone known as beta-type natriuretic peptide

    • B.

      It is a hormone known ascholinergic-type natriuretic peptide

    • C.

      It is made by the ventricles when HF occurs in response to increased stretch of ventricular walls

    • D.

      It is made by the ateries when HF occurs in response to increased stretch of ventricular walls

    Correct Answer(s)
    A. It is a hormone known as beta-type natriuretic peptide
    C. It is made by the ventricles when HF occurs in response to increased stretch of ventricular walls
    Explanation
    BNP acts on the kidney to increase excretion of sodium and water which decreases BP

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  • 32. 

    These are  nUsed for short term control of acute heart failurenThese drugs have a short half life

    • A.

      Nitrates

    • B.

      Phosphodiesterase Inhibitors

    • C.

      Nateuric Peptides

    • D.

      Nesiritide (Natrecor)

    Correct Answer
    B. Phosphodiesterase Inhibitors
    Explanation
    These are also inotropic agents to increase the force and velocity of myocardial contractions by inhibiting cyclic adenosine monophosphate (cAMP) phosphodiesterase activity and increases cellular levels of cAMP in heart muscle. It is also a smoot muscle relaxant that causes vasodilation which reduces preload and afterload

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  • 33. 

    Select all that applies.Phosphodiesterase Inhibitors :

    • A.

      This increases the amount of K+ (potassium) available for myocardial contraction

    • B.

      This increases the amount of Ca+ (calcium) available for myocardial contraction

    • C.

      Causes a positive inotropic response and vasodilation

    • D.

      Causes a negetive inotropic response and vasodilation

    • E.

      They block the enzyme phosphodiesterase in cardiac and smooth muscles

    Correct Answer(s)
    B. This increases the amount of Ca+ (calcium) available for myocardial contraction
    C. Causes a positive inotropic response and vasodilation
    E. They block the enzyme phosphodiesterase in cardiac and smooth muscles
    Explanation
    Positive inotropic effect is an increased force of contraction

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  • 34. 

    Select all thqt applies:Name the medication made for Phosphodiases Inhibitors.

    • A.

      Inamrinone

    • B.

      Profilax

    • C.

      Milrinone

    • D.

      Mirinax

    Correct Answer(s)
    A. Inamrinone
    C. Milrinone
    Explanation
    The correct answer is Inamrinone and Milrinone. These medications are both phosphodiesterase inhibitors, which means they work by blocking the enzyme phosphodiesterase, leading to increased levels of cyclic adenosine monophosphate (cAMP) in cells. This helps to relax smooth muscles and increase the force of contraction in the heart, making them useful in the treatment of heart failure. Profilax and Mirinax are not medications made for phosphodiesterase inhibitors.

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  • 35. 

    The most common side effects for Phosphodiases Inhibitors

    • A.

      Dysrhythmia

    • B.

      Tachycardia

    • C.

      Bradycardia

    • D.

      Respiratory failure

    Correct Answer
    A. Dysrhythmia
    Explanation
    Dysrhythmia is a correct answer because it refers to an abnormal heart rhythm, which is a common side effect of Phosphodiases Inhibitors. These medications can affect the electrical signals in the heart, leading to irregular or fast heartbeats (tachycardia) or slow heartbeats (bradycardia). Respiratory failure, on the other hand, is not directly related to the use of Phosphodiases Inhibitors and is not mentioned in the given options.

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  • 36. 

    Excess fluid balance includes:

    • A.

      Bradycardia

    • B.

      HTN

    • C.

      Nausea

    • D.

      Dehydration

    Correct Answer
    B. HTN
    Explanation
    Regulate fluid balance

    Regulate electrolyte composition

    Regulate the acid-base balance of body fluids

    Secrete renin and erythropoieten

    Produces calcitriol

    Excess fluid volume can lead to HTN or CHF and depletion leads to dehydration
    Specific amts of electrolytes must be maintained. Imbalances can be fatal
    Excessive acids or bases can change the body fluid pH and rapidly result in death if untreated
    Renin helps to regulate blood pressure (Renin is an enzyme)
    Erythropoieten stimulates RBC production (it is a hormone)
    Calcitriol is the active form of vitamin D and is essential for calcium absorption

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  • 37. 

    Select all that applies.What substances are reabsorbed by the kidney that cannot be filtered?

    • A.

      Pottassium

    • B.

      Glucose

    • C.

      Albumins

    • D.

      Sodium

    • E.

      Chloirde

    Correct Answer(s)
    B. Glucose
    C. Albumins
    D. Sodium
    E. Chloirde
    Explanation
    Blood proteins such as albumin because they are too large to pass through the filter
    Water is reabsorbed at a high rate if 180 liters pass through then 178.5 liters is reabsorbed this leaves only 1.5 liters for urine
    In addition to water, glucose, amino acids, sodium, chloirde, calcium and bicarb are reabsorbed.

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  • 38. 

    Select all that applies.Some substance that are filtered by the kidneys

    • A.

      Aluminum

    • B.

      Phosphate

    • C.

      Pottassium

    • D.

      Hydrogen

    • E.

      Calcium

    Correct Answer(s)
    B. Phosphate
    C. Pottassium
    D. Hydrogen
    Explanation
    The ions and large molecules pass from the blood to the filtrate by the process of secretion.
    Potassium, phosphate, hydrogen, and ammonium ions and many organic acids enter the filtrate through secretion
    Secretion is the process of transporting solutes into the renal tubule so that they can be excreted in the urine. Secretion allows substances such as hydrogen ions to be eliminated at a rate that exceeds glomerular filtration. Both reaborption and secretion are controlled by the selective permeability of different areas of the renal tubule to water, sodium, and urea (a by-product of protein metabolism) and the response of the distal collecting tubules in the kidney to hormones such as aldosterone, antidiuretic hormone (ADH), and parathyroid hormone (PTH).

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  • 39. 

    PCN-G enters the urine by:

    • A.

      Secretion

    • B.

      Diffusion

    • C.

      Excretion

    • D.

      None of the above

    Correct Answer
    A. Secretion
    Explanation
    PCN-G enters the urine through secretion (about 90% of the dose)

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  • 40. 

    What is the normal creatine level for males?

    • A.

      0.7-1.5

    • B.

      0.8-1.9

    • C.

      7.0-10.5

    • D.

      8.0-9.1

    Correct Answer
    A. 0.7-1.5
    Explanation
    When the kidneys fail the doses of many drugs needs to be adjusted

    If excretion is limited the drugs will accumulate to high concentrations in the blood and tissues and may result in toxicity

    Most drugs are excreted by the kidneys

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  • 41. 

    What is the most common cause of Renal Failure?

    • A.

      Liver failure

    • B.

      Drug accumilation

    • C.

      Most common cause is lack of sufficient blood flow through the kidney

    Correct Answer
    C. Most common cause is lack of sufficient blood flow through the kidney
    Explanation
    Most common cause is lack of sufficient blood flow through the kidney

    Requires immediate treatment

    The cause needs to be quickly identified and treated

    CVVH (Continuous veno-venous hemofiltration) or CVVHD (Continuous veno-venous hemo-diafiltration) is used
    Some of the potential causes for ARF include heart failure, dysrhythmias, hemorrhage, dehydration, multi-system organ failure
    CVVH is similar to dialysis but the treatment is continuous not 3 times per week. Survival rate of ARF requiring CVVH is only about 30%

    Treatment is required to remove the buildup of waste products from the blood stream- creat, BUN, lytes

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  • 42. 

    Most common cause of Chronic Renal Failure is:

    • A.

      Respiratory Disease

    • B.

      Diabetes Mellitus

    • C.

      Bladder infection

    • D.

      Urinary tract infection

    Correct Answer
    B. Diabetes Mellitus
    Explanation
    Occurs over months or years

    Most common causes of CRF are HTN and DM

    Treatment for ESRD includes hemodialysis, peritoneal dialysis (PD) or transplant

    ESRD end stage renal disease
    HTN- 25% of all new cases and DM 30-40% of all new cases
    Without dialysis or transplant pts will die
    The third and fourth causes of ESRD are glomerulonephritis (inflammatory disease of the kidney) and polycystic kidney disease

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  • 43. 

      nEpoetin alfa (Procrit, Epogen) nDarbepoetin alfa (Aranesp)These are considered:

    • A.

      Snthetic plasma

    • B.

      Synthetic erythropoietin

    • C.

      Synthetic leukocytes

    • D.

      Syntehtic enzymes

    Correct Answer
    B. Synthetic erythropoietin
    Explanation
    The kidney secretes erythropoietin

    This hormone causes an increase in RBC production

    Synthetic erythropoietin
    Epoetin alfa (Procrit, Epogen)
    Darbepoetin alfa (Aranesp)
    These will be covered in depth in pharm 2- oncology
    Epogen is given 3 times a week- usually SQ unless pt is in ESRD then given through dialysis access for hemodiaysis pts 3 times per week

    Aranesp is given every 2 weeks to every month SQ
    Your book says it is given until an increase in RBCs is achieved but the dose is usually adjusted to maintain a target hgb of approx 10-11 (still anemic) in renal pts. Need to pay attention to the rate of rise in hgb because of the potential for cardiovascular complications (stroke and HTN crisis) with rate of rise > 1 gm in 2 weeks
    Also need for the pt to have adequate iron stores to build the RBCs. Without iron it isn’t possible to build the cells

    More info on this is covered with antineoplastic meds (chapter 24)

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  • 44. 

    Most work by blocking sodium reabsorption in the neprhon which sends more sodium into the urine

    • A.

      Loop diurectics

    • B.

      Diurectics

    • C.

      Potassium sparing

    • D.

      Thizide potassium

    Correct Answer
    B. Diurectics
    Explanation
    Drugs that increase urine output

    Most work by blocking sodium reabsorption in the neprhon which sends more sodium into the urine

    Water likes to go where sodium goes so this increases diuresis
    Many uses for diuretics- HTN, heart failure (these are the 2 biggest uses for them), renal failure, pulmonary edema, liver failure
    JNC 7 recommends after lifestyle modification that diuretics are used (often with other meds) as primary agents to treat HTN because they have been shown to reduce cardiovascular morbidity and mortality associated with HTN

    Remember where salt goes water follows
    The different classes of diuretics work in different places in the kidney- loop of henle, glomerular filtration, tubular reabsorption, etc

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  • 45. 

    These:  nAKA high ceiling diuretics nThese are the most effective diuretics nWork on the Loop of Henle

    • A.

      Potassium sparing diurectics

    • B.

      Thiazide diurectics

    • C.

      Loop diurectics

    • D.

      Carbonic anhydrase inhibitor diuretics

    Correct Answer
    C. Loop diurectics
    Explanation
    They block sodium and chloride re-absorption
    In the loop of henle there is a large amount of sodium so they are very effective at producing a large amount diuresis

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  • 46. 

    Loop Diuretics inhibit the body’s ability to reabsorb sodium at the ascending Loop of Henle which leads to increased water in the urine. Potassium is also "lost" into the urine. Can cause

    • A.

      Hypercalcemia

    • B.

      Low sodium

    • C.

      Hypokalemia

    • D.

      Hyperkalemia

    Correct Answer
    C. Hypokalemia
    Explanation
    Loop diuretics inhibit the reabsorption of sodium at the ascending loop of Henle, which leads to increased water excretion in the urine. Along with sodium, potassium is also "lost" into the urine. This excessive loss of potassium can result in hypokalemia, which is a condition characterized by low levels of potassium in the blood. Therefore, the given correct answer of "Hypokalemia" is the most appropriate choice based on the information provided.

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  • 47. 

      nFurosemide (Lasix) nTorsemide (Demadex) nBumetanide (Bumex) are considered:

    • A.

      Loop diurectics

    • B.

      Thiazide directics

    • C.

      Heart medication

    • D.

      Respiratory meds

    Correct Answer
    A. Loop diurectics
    Explanation
    Furosemide can increase urine output even when blood flow to the kidneys is diminished
    Torsemide has a longer half life and can be dosed once a day
    Bumex is 40 times more potent than furosemide but has a shorter duration of action
    There are other loop diuretics too. There is a lot to watch for with your pts on loops

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  • 48. 

    Side effects of Loop diurectics includs.  Select all that applies:

    • A.

      Hypotension

    • B.

      Emesis

    • C.

      Dehydration Thirst, dry mouth, HA, weight loss

    • D.

      Ototoxicity

    • E.

      Nausea

    Correct Answer(s)
    A. Hypotension
    C. Dehydration Thirst, dry mouth, HA, weight loss
    D. Ototoxicity
    Explanation
    Hypokalemia can result in dysrhythmias- leg cramps is usually first sign of low K
    Lytes include potassium, sodium and chloride
    Orthostatic hypotension
    Furosemide can inhibit the excretion of uric acid which leads to a build up which causes gout
    Ototoxicity is most often associated with IV lasix- rapid push- shouldn’t be done.

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  • 49. 

    These drug:  nMost commonly prescribed class of diuretics nAct on the distal tubule to block sodium reabsorption and increase water excretion nLess effective than loop diuretics and are INEFFECTIVE in pts with severe renal disease

    • A.

      Potassium sparing diurectics

    • B.

      Loop diurectics

    • C.

      Thiazide Diurectics

    Correct Answer
    C. Thiazide Diurectics
    Explanation
    Not as
    Thiazide diuretics act on the distal tubule and inhibit the sodium chloride symporter which leads to the retention of water in the urine. Also causes potassium to be "lost" in the urine.
    effective in pts with severe renal disease because of the decreased blood flow to the kidneys

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  • 50. 

    Common thiazides includes:Select all that applies  

    • A.

      Hydrochlorothiazide (HCTZ)

    • B.

      Inamrinone (Inocor)

    • C.

      Chlorthalidone (Hygroton)

    • D.

      Milrinone (Primacor)

    Correct Answer(s)
    A. Hydrochlorothiazide (HCTZ)
    C. Chlorthalidone (Hygroton)
    Explanation
    HCTZ is a thiazide!!!

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