20 Random Final Questions Flashcards
Which diuretics are preferred in the elderly with HTN?
Thiazides, unless CrCl < 30 (in which case loops are used)
What are the two Thiazides used?
Chlorthalidone. HCTZ
What are the two Loops used?
Bumetanide. Furosemide
What are the disadvantages of ACE-I?
Exaggerated response with diuretic use (be very careful when adding it on). Hypotension in hypovolemic patients. Risk of hyperkalemia and hyponatremia. Potential for decreased renal function
What are the advantages of B-Blockers?
Reduce sympathetic nervous system activation. Reduce risk for MI. Useful in patients with angina or MI history
What are the disadvantages of B-Blockers?
Mimic age-associated CV changes. Reduce exercise tolerance
What are the frequently used B-Blockers?
Metoprolol and Carvedilol
Which B-Blocker should be used with caution?
Atenolol (d/t renal clearance)
When should B-Blockers be avoided?
Insulin-dependent DM. Peripheral vascular disease. Asthma or obstructive airway disease
What are the disadvantages of CCBs?
Some agents reduce MI contractility. May worsen CHF symptoms. Most agents are CYP3A4 substrates
Which CCBs are the main ones to avoid?
Diltiazem and Verapamil
What are the Alpha-Adrenergic blockers that are generally avoided for treating HTN?
Doxazosin, Prazosin, Terazosin
What is the altered presentation of CHF in elderly?
Symptoms of hypoxia (lethargy, restlessness, confusion) rather than dyspnea on exertion
What are some drugs that can precipitate CHF?
Anti-arrhythmics (eg. Quinidine). B-Blockers, CCBs. Anti-hypertensives (eg. Clonidine). Steroids, NSAIDs, Alcohol
What is the normal CHF treatment strategy?
ACE-I or ARB is first choice. B-Blockers (Carvedilol or Bisoprolol), Aldosterone can be added in later stages. Consider holding Diuretics for Stage I, but add it for fluid retention in later stages. Digoxin can be added to Stage III and IV
How does Digoxin work?
Increases force and velocity contractions. Decreases activation of sympathetic nervous system and RAA system. Decreased HR and conduction velocity through the AV node4
Which statins can be used if patient didn’t have a good response with one of them?
Rosuvastatin (Crestor) or Atorvastatin (Lipitor)
What can be used if patient just has elevated TG?
FIbrate (Gemfibrozil or Fenofibrate). All fibrates need renal adjustment
What can be used in patients with Low HDL, High LDL and TG?
Statin + Fibrate. OR. Niacin (but patients don’t like d/t flushing)
What can be used in patients with Elevated LDL or nonresponse?
Ezetimibe (Zetia). OR. Ezetimibe + Simvastatin (Vytorin)
What can insulin resistance lead to?
HTN, Increased TGs and Insulin, Decreased HDL
What are some common ADRs with Metformin?
N/V, abdominal pain. Taste disturbance. Anorexia
When is Metformin contraindicated?
Renal impairment, CHF, h/o acute Lactic Acidosis, Hepatic disease, Hypoxemia, Acute MI, Radiographic contrast (look for iodine allergy)
Which Sulfonylurea is avoided?
Glyburide. It has an active metabolite that is renally cleared. High risk of hypoglycemia
