Cardiac Flashcards
HTN Drugs: Improved __________ can be achieved with once-daily drug dosing, rather than multiple dosing, and with ________ ________ rather than individual drugs; when necessary.
adherence
combination therapies
_______ can cause an elevation of blood pressure, particularly when combined with ACEs & ARBs.
NSAIDs
________ can also worsen heart failure and should be avoided.
NSAIDs
Clients with ________ should be counseled not to use devil’s claw, ginseng, goldenseal, black licorice, ma huang, squill, or Yohimbe.
HTN
Anti-hypertensives can cause _________ _________. This is even a bigger concern in the elderly.
orthostatic hypotension
As a group, anti-hypertensives can cause _________ __________. Counsel your patients accordingly. BBLs, thiazides, and Spironolactone seem to have the greatest risk of causing it.
(erectile dysfunction) ED
These classes of drugs do what??
Sympathomimetic agents such as pseudoephedrine and methylphenidate (decongestants)
NSAIDs & COX-2 inhibitors
Corticosteroids
CNS stimulants such as caffeine
Estrogens and progestins
SNRIs such as venlafaxine & sibutramine
Immunosuppressants such as cyclosporine and tacrolimus
Atypical antipsychotics (e.g., clozapine, olanzapine)
Alcohol
Herbal supplements (e.g., Ma Hung (epheda), St. John Wort (with MAO inhibitors))
Recreational drugs (e.g., bath salts (MDPV), cocaine, methamphetamine))
Increase BP
Begin screening for HTN at age ____ and check annually (more frequently for those with obesity, renal disease, DM, aortic arch obstruction or coarctation, or if the patient is on certain meds that can raise the BP).
3
At the time of HTN diagnosis, provide advice on the _____ diet and the need for vigorous physical activity (at least ____ days per week for ______ minutes).
DASH
3-5 days/week for 30-60 min
In _________ and _________ that have failed lifestyle interventions and whom pharmacological treatment is warranted, initiate an ACE, ARB, long-acting CCB, or thiazide diuretic.
children and adolescents
In African American children, the response to an______ might not be as robust, so a higher initial dose may be used.
ACE Inhibitor
__________ are not first-line choices for HTN in children due to adverse risk profile
Beta-blockers
Adolescents of child-bearing potential must be informed of the risk of _____ and ____ for HTN. Consider alternatives when appropriate (e.g., CCBs, BBLs).
ACEIs and ARBs
If the pediatric patient has HTN and CKD, or DM, an ____ or _____ is recommended as the initial agent, unless otherwise contraindicated.
ACEI or ARB
When choosing an agent, think about ______ of _______ (as once daily will likely increase adherence), cost, and potential for side effects (e.g., _______ can lead to electrolyte disturbances and dehydration and may not be optimal in certain athletes).
frequency of dosing
thiazides
In chidlren, if the maximum dosage is reached and goal BP is not, add another medication with a different _____.
F/U every _____ weeks until BP is stable.
MOA
4-6 weeks
___statin carries the lowest risk of myopathy; followed by _____statin due to lower drug-drug interactions.
Fluvastatin; Pravastatin
____statin is metabolized differently, so it might be tolerable in those patients intolerable to other agents.
Pravastatin
class of drugs that irreversibly bind to bile acids in the intestines, forming an insoluble complex that is excreted in the feces. This decreases the return of cholesterol to the liver. This causes the body to respond by making more LDL receptors on the liver, allowing greater LDL binding from the bloodstream and as a result, lowering serum LDL cholesterol levels. The downside here though is that this also triggers the increased production of VLDL particles, leading to a rise in triglycerides. So, although these drugs can lower serum LDL levels by 15% to 30% and increase HDL levels by ~3%, they can also raise triglyceride levels by 15%. In the past, these were the primary agents for lipid management, but now, this class is for adjunct therapy.
Bile Acid Sequestrants/Resins
Contraindications for ________:
History of bowel obstruction
Serum TG concentrations of more than 500 mg/dL
History of hypertriglyceridemia-induced pancreatitis.
Bile Acid Sequestrants/Resins
Cautions for ________:
Gastrointestinal disease: Use is not recommended in patients with gastroparesis, other severe GI motility disorders, a history of major GI tract surgery, or patients at risk for bowel obstruction.
Hypertriglyceridemia
Bile Acid Sequestrants/Resins
SE of ________:
Relatively safe
flatulence, bloating, heartburn, and constipation can occur
Bile Acid Sequestrants/Resins
These drugs are not effective LDL lowering agents
Primarily lower triglycerides by stimulating enzyme that breaks down VLDL & IDL, so indicated for those with severely elevated triglyceride levels
Can lower triglycerides by 60% and increase HDL by 30%
Do not give in a patient with a history of gallstones, severe renal or hepatic dysfunction
Myopathy and rhabdo can occur
Fibric Acid Derivatives
Drug that acts at the brush border of the small intestine to inhibit the absorption of cholesterol. This results in reduced hepatic cholesterol stores and increased blood clearance.
Works really well-lowering LDL levels when added to a statin (up to 50% in LDL reduction). However, CV events did not lessen.
It can be used as a single agent too.
Cholesterol absorption Inhibitors (Ezetimibe)
This is a naturally occurring B vitamin that can improve cholesterol levels when given at doses 100-300 times the RDA.
Its MOA is uncertain.
Lowers LDL & triglycerides, and raises HDL
It can be effective if the “flush” can be tolerated.
The dose should “start low, go slow”, until reaching 1-1.5 g daily (takes 4-5 weeks to reach this dosage). Increase every 1-2 weeks to achieve this daily dose. For maximal effect, may need 3 grams daily.
Niacin
Adverse effects of ________ may be attenuated by: gradual increase in dose
administering with food
avoidance of concurrent ingestion of ethanol, hot or spicy foods/liquids
by taking aspirin 30 minutes before dosing. May also use other NSAIDs according to the manufacturer.
Flushing associated with extended-release preparation is significantly reduced
For immediate-release preparations, may administer in 2 to 3 divided doses to reduce the frequency and severity of flushing/pruritus.
Consider discontinuation if persistent severe cutaneous symptoms occur during therapy.
Niacin
Flushing and pruritus are common adverse effects of:
Niacin
Things to lower ______:
Statins
Vit C
Exercise, a healthy diet, management of stress
CRP
Universal Screening should take place between the ages of _____ years of age and again somewhere between ____ years of age. If the reading is elevated, take again in a few weeks and take an average of the two.
9-11
17-21
When to screen children for _______:
DM
HTN
BMI greater or equal to the 95 percentile
smokes
early family history of heart disease
parent has dyslipidemia with TC equal or more than 240 mg/dl
high-risk medical condition (e.g., ESRD, HIV, etc.) **screening parameters change.
Dyslipidemia
DASH diet reduces _____ and ____.
LDL and HDL
______ have been studied in children and are regarded to be safe, effective, and well-tolerated
Statins
these can be used in some children with certain forms of dyslipidemia. However, these agents appear to raise triglycerides, while depleting folate, carotenoid, and Vit D levels. They are also not very palatable.
Bile Acid-Binding Resins
there is only off-label use for this drug as there is limited safety and efficacy information in children.
Niacin
_________ are used to treat intrahepatic cholestasis of pregnancy (ICP)
Bile acid sequestrants
Treatment of Hyperlipidemia is based upon _____! _____ assessment is everything.
RISK; Risk
\_\_\_\_\_\_\_ is responsible for production of: Estrogen/Progesterone Cortisol Cell Membranes Vit. D Bile Salts
Cholesterol
3 Major Categories of Antithrombotic Drugs
Anticoagulants
Antiplatelets
Thrombolytics
__________ are in 3 pharmacological classes:
Vitamin K antagonists
Direct factor Xa inhibitors
Direct thrombin inhibitors
Anticoagulants
Drugs that activate antithrombin
All share the same MOA.
Greatly enhance the activity of antithrombin, causing a reduction in fibrin and ultimately clotting.
Heparin and Deriviatives
Oral anticoagulants that inhibit factor Xa; thus inhibiting thrombus formation.
Adverse Effects: Bleeding, but this risk is less when compared to warfarin.
Direct Factor Xa Inhibitors: Rivaroxaban (Xarelto), Apixaban (ELiquis), & Edoxaban (Savaysa)
a coagulation factor Xa (recombinant), that can reverse the effects of anticoagulation due to the Xa inhibitors Apixaban (Eliquis) and Xarelto (Rivaroxaban)
Prior to this, if an agent needed to be reversed, dialysis was required.
Indication: for patients treated with rivaroxaban and apixaban, when reversal of anticoagulation is needed due to life-threatening or uncontrolled bleeding
Andexxa
Suppresses platelet aggregation. Prevents thrombosis in the arteries/ There are 4 major groups: ASA P2Y12 ADP Receptor Blockers PAR1-antagonists GPIIb/IIa Receptor antagonists Increased risk of bleeding: In patients with chronic kidney disease, antiplatelet therapy may increase the risk for bleeding and may not reduce myocardial infarction, stroke, or mortality
Antiplatelets
Added to ASA after acute coronary syndromes.
Prevents stenosis of coronary stents.
Platelet Inhibitors
Clopidogrel (Plavix), ticagrelor (Brilinta), and prasugrel (Effient)
\_\_\_\_\_\_\_\_\_ resulting from ACEI/ARB Therapy may include: abdominal pain SOB dizziness and fainting
Angioedema
Things that lower \_\_\_\_\_\_: Vit C Statin Lower stress Exercise Healthy Diet
HsCRP
HsCRP increases risk for
inflammation
plaque
Heart Dx
