1. An ACE inhibitor which produces an adverse effect of a dry, persistent cough. 2. An aldosterone receptor blocker which works by decreasing vasoconstriction and blocking aldosterone production. 3. A drug used for lowering serum cholesterol levels in conjunction with a low-fat diet. Elevated liver function tests (LFTs) are an adverse effect. 4. A cardiac glycoside with positive inotropic, negative chronotropic, and negative dromotropic properties. 5. The prototype of the class 1B antidysrhythmics. 6. A diuretic which is a first-line drug for HTN. 7. A relatively selective beta 1 blocker which causes rebound tachycardia when discontinued abruptly. 8. A potassium-sparing diuretic that works by blocking aldosterone. 9. A diuretic that works by increasing osmotic pressure. 10. An IV drug that mimics the activity of BNP. 11. An IV-only direct vasodilator which metabolizes to thiocyanate. 12. A beta blocker which blocks alpha-1 receptors in addition to beta 1 and beta 2 receptors. 13. A diuretic which works in the ascending loop of Henle. 14. A calcium channel blocker used for atrial dysrhythmias. 15. An alpha-1 blocker which causes orthostatic hypotension as an adverse effect. _____ furosemide (Lasix) _____ digoxin (Lanoxin) _____ hydrochlorothiazide (HCTZ) (Microzide) _____ prazosin (Minipress) _____ nitroprusside (Nipride) _____ lisinopril (Prinivil) _____ losartan (Cozaar) _____ carvedilol (Coreg) _____ lovastatin (Mevacor) _____ mannitol _____ metoprolol (Lopressor) _____ nesiritide (Natrecor) _____ spironolactone (Aldactone) _____ diltiazem (Cardizem) _____ lidocaine
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1. What are the major risk factors for developing cardiovascular disease in all patients? And what type of target organ damage can develop over time when hypertension is not appropriately managed? (0.5 points) 2. What major risk factors does SJ have? (0.5 points) 3. List and prioritize medical and pharmacy-related problems for this patient. How would you classify SJ's hypertension (controlled or uncontrolled)? (1 point) 4. The physician tapered off and discontinued metoprolol, initiated lisinopril and HCTZ. SJ was counseled on smoking cessation and starting low-sodium diet. Two months later, SJ comes in for a follow-up visit, his labs including potassium were WNL, however SJ complains of new onset of persistent dry cough. The physician decides to discontinue lisinopril and initiate amlodipine. Current Medications Amlodipine 5 mg PO once daily Hydrochlorothiazide 25 mg PO once daily Atorvastatin 40 mg PO once daily Metformin 500 mg PO BID a. Compare and contrast metoprolol, lisinopril, HCTZ, losartan, amlodipine in terms of MOA, pertinent PK parameters, adverse effects, and drug-drug interactions (2 point) b. Which medication likely caused SJ's cough? Explain the mechanism by which this occurs. Why are ARBs, such as losartan, a good alternative in patients who develop cough? Explain (3 points) c. Adverse effects associated with lisinopril and amlodipine are hyperkalemia and peripheral edema, respectively. Explain the mechanism by which these adverse effects occur for each medication. (3 points) i. lisinopril-induced hyperkalemia ii. amlodipine-induced edema
Sri K.
Later Monday Afternoon Detective Sam Garrison returned to police headquarters and, after reading the medical examiner’s complete report, began the process of writing his own explanation of what happened to the Underhills. As he wrote, he thought about all that had happened and began to wonder about the physiology associated with the couple’s death. From the lung autopsy analysis, it was clear the Underhills were still breathing and alive when they went under water. This suggests that they became unconscious in the hot tub and subsequently drowned. The level of alcohol found by the medical examiner was high but was not necessarily sufficient to cause their death, but was it a contributing factor? Sam knew that nitroglycerin could cause low blood pressure and that both alcohol and heat would reduce blood pressure, but he was unsure of the mechanism. He also wondered whether the furosemide found on the night table was involved in this hot tub mystery. Question 8 (10 points) If the paramedics had found the Underhills still alive despite their low blood pressure, which of the following medication could have been used to save them and why? Pilocarpine, a muscarinic agonist, which would activate muscarinic receptors on arterioles and therefore dilate arterioles. Epipen, which delivers epinephrine, would stimulate beta-adrenergic receptors on the heart and therefore increase cardiac output. Viagra® (sildenafil citrate), which would increase the local production of nitric oxide and therefore decrease total peripheral resistance. Acebutolol, a beta-blocker, which would antagonize beta-adrenergic receptors on arterioles and therefore constrict arterioles. Hydrochlorothiazide, a diuretic (or “water pill”), which would increase urine output and therefore restore blood volume to normal.
Keemin L.
About a year later, Mr. Smith suddenly began to experience increasing muscle weakness, cramping and tingling, palpitations, generalized fatigue and recurrent headaches. One day he felt very uneasy and asked his coworkers to take him to the emergency room. On physical examination the only significant findings were a documented blood pressure of 210/120 mmHg, a heart rate of 110 bpm and moderate peripheral edema. The rest of his evaluation at the ER revealed the following: Additional routine tests which included a complete blood count (CBC), a chest X-ray and a 12 lead EKG were all unremarkable. An arterial blood gas (ABG) analysis was consistent with a mild metabolic alkalosis with some degree of compensation. An abdominal ultrasound study revealed a suspicious small mass at the level of the right adrenal cortex. Further imaging evaluation with high-resolution CT scan confirmed an adrenal adenoma of the right adrenal cortex. Based on the CT scan results Mr. Smith underwent surgery for removal of the adrenal tumor. Post-operatively, Mr. Smith recovered well without complications and with significant improvement of all his symptoms. His blood pressure began to normalize gradually and after just a few weeks, his doctor was able to completely discontinue all blood pressure medications with no further complaints.
Shaiju T.
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