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SP 2016 > 6. Cardiovascular drugs > Flashcards

6. Cardiovascular drugs Flashcards

1
Q

2 reading 2 min apart at 2 appointments

A

> 140/90

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2
Q

BP we want most patients

A
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3
Q

Stage II BP

A

160/100

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4
Q

evidence of end organ damage

A
  1. confusion
  2. chest pain
  3. renal failure
  4. visual changes
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5
Q

BP we want most patients

A
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6
Q

Stage II BP

A

160/100

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7
Q

Urgency BP

A

180/110

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8
Q

evidence of end organ damage

A
  1. confusion
  2. chest pain
  3. renal failure
  4. visual changes
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9
Q

Azide side effects

A
  1. hypokalemia
  2. hyperurecemia
  3. xerostomia
  4. anorexia
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10
Q

Loop diuretics act on

A
  • ascending loop of Henle

- inhibits re-absorption of Na with concurrent loss of H2O

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11
Q

5 types of antihypertensives

A
  1. diuretics
  2. adrenergic effects
  3. CCB
  4. ACEI
  5. ARB
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12
Q

Azides act on

A

distal convoluted tubule

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13
Q

azide side effects

A
  1. hypokalemia
  2. hyperurecemia
  3. xerostomia
  4. anorexia
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14
Q

Loop diuretics act on

A
  • ascending loop of Henle

- inhibits re-absorption of Na with concurrent loss of H2O

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15
Q

Loop diuretics side effects

A
  1. hypokalemia

2. hyperurecemia

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16
Q

A2 agonist

A
  • CGF
    1. chlonidine
    2. guanabenz
    3. fadolmadine
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17
Q

Groups of K+ sparing diuretics

A
  • SEAT
    1. Spironolactone/eplereone - competitive antagonist with aldosterone
    2. amiloride/triamterene - block Na+ channels in distal end of distal tubules
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18
Q

K+ sparing side effects

A
  1. hyperkalemia

2. arrythmia

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19
Q

A2 agonist side effects

A
  1. drowsiness

2. sedation (esp chlonidine)

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20
Q

A2 agonist

A
  • CGF
    1. chlonidine
    2. guanabenz
    3. fadolmadine
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21
Q

B1 blocker good for patients with

A
  1. MI

2. ischemic heart disease

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22
Q

Calcium channel blockers

A
  • DVD
    1. diltiazem, verapamil
    2. dipines - class diphydropyridines
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23
Q

nonselective B blocker side effect

A
  • reactive airway disease
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24
Q

B1 blocker side effect

A
  • possible hypotension and bradycardia
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25
Q

CCB adverse reactions

A
  1. gingival overgrowth
  2. excessive hypotension (syncope, dizziness)
  3. nausea and vomiting
  4. bradycardia
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26
Q

Calcium channel blockers

A
  1. diltiazem, verapamil

2. dipines - class diphydropyridines

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27
Q

CCB treat

A
  • arrythmia and angina
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28
Q

CCB produce

A
  1. vasodilation

2. reduce afterload

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29
Q

CCB adverse reactions

A
  1. gingival overgrowth
  2. excessive hypotension (syncope, dizziness)
  3. nausea and vomiting
  4. bradycardia
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30
Q

ACE drugs

A
  • pril
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31
Q

ACE side effects

A
  1. hypotension (syncope, dizziness)
  2. URI - dry cough
  3. nausea and vomiting
  4. lichenoid oral reaction
  5. avoid NSAID
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32
Q

What should ACE avoid?

A

NSAID

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33
Q

ARB drugs

A
  • artan
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34
Q

ARB side effects

A
  1. dizziness, fatigue, insomnia, headache
  2. upper respiratory tract infection
  3. diarrhea
  4. muscle cramps in leg and back
  5. angioedema
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35
Q

common medications for the treatment of HTN

A
  1. HCTZ
  2. ace inhibitor
  3. beta blocker
  4. CCB
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36
Q

emergency hypertension drugs

A
  • NNNHELP
  • nitroprusside
  • nitroglycerine
  • nicardipine
  • hydralazine
  • esmolol
  • propranolol
  • labetolol
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37
Q

nitroprusside action

A
  • arteriole and venous dilator

- works for 10min or less

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38
Q

nitroglycerine action

A
  • mostly venous dilator
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39
Q

nicardipine action

A
  • CCB
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40
Q

hydralazine action

A
  • arteriole dilator

- IV bolus

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41
Q

esmolol action

A
  • B1 blocker

- rapid onset, short duration

42
Q

esmolol good choice for

A
  1. tachycardia

2. asthmatics

43
Q

labetolol action

A
  • A and B blocker, with carvedilol
44
Q

3 cardiovascular meds after MI and stent placement

A
  1. plavix
  2. plendil
  3. nitrostat
45
Q

Plavix inhibits ____ from binding and allowing adhesion of platelets

A

fibrinogen

46
Q

Normal platelet turn around

A

5-9 days

47
Q

Pendil (felodipine) action

A
  1. relaxation of cardiac smooth muscle and vasodilation

2. increase myocardial oxygen delivery

48
Q

Nitrostat action (nitroglycerine)

A
  1. peripheral vasodilator

2. decreases workload

49
Q

Post stent prophylaxis?

A
  • No, only during first 4-12 of stent mucosalization
50
Q

Purpose of drug eluting stent

A
  1. inhibit cell proliferation

2. stop re-stenosis

51
Q

Two main anti-platelet drugs after stent

A
  1. aspirin

2. clopidogrel

52
Q

Aspirins anti platelet effect

A
  • reduces thromboxane
53
Q

BMS anti platelet protocal

A
  • dual-platelet therapy for at least 1 month

- recommended one year

54
Q

DES anti platelet protocal

A
  • dual-platelet therapy for at least 6 months

- recommended one year

55
Q

Two other names for stent placement

A
  • percutaneous coronary intervention (PCI)

- angioplasty

56
Q

How long to defer all treatment after MI with stenting?

A
  • at least 6 weeks
57
Q

How long to defer high risk treatment after BMS?

A
  • at least 6 weeks
58
Q

How long to defer high risk treatment after DES?

A
  • at least 1 year
59
Q

Why consider nitrous for MI/PCI patient?

A
  1. anxiolytic
  2. decrease endogenous catecholamine
  3. increase oxygen delivery
60
Q

How to relieve angina?

A
  1. oxygen
  2. rest
  3. vasodilator
61
Q

What SBP to place patient upright during angina?

A
62
Q

How to treat angina with nitroglycerin?

A
  • 0.4mg nitroglycerin
  • only if diastolic above 90
  • relieve pain 3-5 min
  • can do twice in 5 min intervals
63
Q

Other medications for angina episode

A
  • morphine for anxiolytic and pain relief
  • ASA for platelet
  • 100% oxygen
64
Q

3 main types of drugs to treat angina

A
  1. nitroglycerin
  2. CCB
  3. B blocker
65
Q

NTG activates _____ and increases ____, producing which effect on the heart

A
  1. guanly cyclase
  2. cGMP
  3. relaxation of vascular smooth muscle
66
Q

Two forms of NTG

A
  1. nitrostat tab

2. nitrolingual spray

67
Q

NTG side effects

A
  1. headache
  2. flushing, hypotension, syncope, light headed
  3. sublingual burning and tingling
68
Q

MI occurs when

A
  • ischemia leads to death of cardiac tissue
69
Q

Types of MI dysrhythmias

A
  1. premature ventricular contraction
  2. ventricular tachycardia
  3. ventricular fibrillation
  4. asystole
70
Q

How to treat MI?

A 
• Morphine
• Oxygen
• Nitrates
• ASA
• Beta blockers
• ECG
• CXR
• Sedaton
• Final treatment:
- antithrombolytics 
- angioplasty
71
Q

How to confirm MI?

A
  1. 12-lead ECG

2. cardiac enzymes (CK, CK-MB, troponins)

72
Q

Cause of CHF?

A
  1. ischemic heart disease
  2. valvular heart disease
  3. hypertension
73
Q

Left side failure is ____, right side is ______

A
  1. pulmonary

2. systemic

74
Q

of NY heart classifications

A
  • 4, IV - symptomatic at rest
75
Q

3 medications for CHF

A
  1. digoxin
  2. diuretic
  3. ACEI (1st line)
76
Q

Action of digoxin

A
  • increases force of contraction of myocardium

- CO increases without using more O

77
Q

Adverse effects of digoxin

A

Narrow therapeutic window

  1. arrhythmia
  2. visual changes
  3. nausea and vomiting
  4. headaches
78
Q

Overdose SE of digoxin

A
  1. nausea
  2. vision change
  3. excess salivation
79
Q

Which types of drugs increase digoxin levels by 10%?

A
  • tetracycline and erythromycin
80
Q

Other drugs to treat CHF

A
  • ACEIs:now first-­‐line therapy for CHF
  • ARBs: for patients who cannot tolerate ACEIs
  • β-­‐Adrenergic blockers
  • Vasodilators: hydralazine and nitroglycerin
  • Diuretics: to relieve edema
81
Q

Signs of poor management of CHF

A
  1. shortness of breath
  2. peripheral edema
  3. fluctuations in body weight
82
Q

Afib patients are at ___ times risk for CVA

A
  • 7
83
Q

Treatment of acute/urgent Afib

A
  • cardiovert
84
Q

Within how many hour do you need to cardiovert?

A
  • 48 hrs. give 3 weeks of anticoagulant, then cardiovert
85
Q

How to treat stable/chronic Afib?

A
  • CCB and B blockers to control rate

- anticoagulant

86
Q

Classes of anti-arrhythmia medication

A 
I - Na channel blockers 
    - a-c (medium, fast, slow)
II - B blockers 
III - K+ channel blockers 
IV - CCB
87
Q

Class IA anti-arrhythmia

A
  • Na channel blocker (medium)
    1. quinidine
    2. procainamide
88
Q

Class IB anti-arrhythmia

A
  • Na channel blocker (fast)

1. lidocaine

89
Q

Class IC anti-arrythmia

A
  • Na channel blocker (slow)

1. flecainide

90
Q

Class II anti-arrythmia

A
  • B blocker
    1. esmolol
    2. propranolol
91
Q

Class III anti-arrythmia

A
  • K+ blocker

1. bretylium

92
Q

Class IV anti-arrythmia

A
  • CCB
    1. diltiazem
    2. verapamil
93
Q

Adverse rxn to anti-arrythmia

A
  • narrow therapeutic window
94
Q

4 antihyperlipidemia agents

A
  1. HMG CoA reductase inhibitor
  2. ezetimibe
  3. gemfibrozil
  4. niacin
95
Q

Lower cholesterol by inhibiting HMG-CoA reductase

A
  • statins
96
Q

Adverse rxn to HMG-CoA reductase

A
  1. GI complaints
  2. muscle pain
  3. skin rash
  4. increase anticoagulant warfarin
97
Q

Inhibits cholesterol absorption in intestine

A
  • ezetimibe
98
Q

Adverse rxn to ezetimibe

A
  1. fatigue
  2. abdominal pain
  3. diarrhea
99
Q

Medications that can induce tachycardia

A
  1. ketamine
  2. glycopyrrolate
  3. atropine
100
Q

Mechanical valve

A
  • lasts 20-30 years

- long term anticoagulant

101
Q

Biologic valve

A
  • lasts 10-15 years

- long term anticoagulant not needed

102
Q

What can reset de-fib?

A
  • monopolar cautery

SP 2016 (2 decks)

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