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Advanced Pharm Exam 2 > Cardiac/Renal > Flashcards

Cardiac/Renal Flashcards

1
Q

nitrates MOA

A

vasodilator

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2
Q

nitroglycerin preparation and onset

A

sublingual q5 minutes

onset 1-3 minutes

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3
Q

nitrates examples

A

nitroglycerin

isosorbide mononitrate

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4
Q

isosorbide mononitrate onset

A

30-60 mins

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5
Q

nitrate precautions

A

tolerance

avoid with PDE5 inhibitors for erectile dysfunction

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6
Q

ranolazine MOA

A

antianginal inhibits sodium

does not cause hypotension

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7
Q

ranolazine vs. nitrates

A

ranolazine does not lower HR or BP

ranolazine is more expensive ($400/mo)

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8
Q

aspirin MOA

A

inhibits cyclooxygenase-1

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9
Q

aspirin dosing for acute MI

A

162-325 mg

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10
Q

aspirin use

A

decrease mortality and acute MI by 50%

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11
Q

platelet aggregation inhibitors MOA

A

bind to ADP which decreases platelet aggregation

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12
Q

platelet aggregation inhibitors examples

A

clopidogrel

prasugrel

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13
Q

which enzyme is responsible for clot lysis?

A

plasmin

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14
Q

fibrinolytics MOA

A

convert plasminogen to plasmin

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15
Q

indications for tPA

A

stroke and MI

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16
Q

calcium channel blocker MOA

A

coronary vasodilator in peripheral blood vessels

increase o2 supply to heart

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17
Q

which CCBs decrease O2 demand? how?

A

verapamil and diltiazem

decrease HR and contractiity

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18
Q

when should CCBs be avoided?

A

heart block
post MI
bradycardia

HF or pulm edema - but CAN use amlodipine and felodipine

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19
Q

CCBs are first line in what type of angina?

A

prizmental’s

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20
Q

ACE inhibitors MOA

A

reduces aldosterone secretion to decrease sodium and water retention in kidneys
reduce preload and afterload

arterial dilation

used for hypertension and CHF

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21
Q

indications for ACE inhibitors

A

DM
HF
renal insufficiency

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22
Q

contraindications to ACEI

A

pregnancy

angioedema

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23
Q

ACE inhibitors examples

A

lisinopril (Privinil)

fosinopril (Monopril)

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24
Q

commonly used ARB

A

valsartan (diovan)

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25
Q

angiotensin II receptor blockers MOA

A

reduces secretion of aldosterone, reducing sodium and water retention

vasodilation

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26
Q

which has a worse cough? ACE or ARB?

A

ACE inhibitors

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27
Q

lab monitoring for ACE/ARBs

A

potassium
creatinine (within 2 weeks of starting)

hypotension
cough

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28
Q

contraindication to ARB

A

pregnancy

do not use with ACEI!!! can cause renal dysfunction

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29
Q

direct renin inhibitor MOA

A

binds to binding pocket of renin, inactivating renin

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30
Q

loop diuretics MOA

A

inhibit NaK2Cl cotransporter in the loop of henle

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31
Q

loop diuretics AEs

A

lowers K, Na, Mg

increases uric acid

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32
Q

loop diuretics examples

A

furosemide (lasix), torsemide (demadex)

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33
Q

thiazide diuretics MOA

A

inhibit NaCl co-transporter in the distal tubule

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34
Q

thiazide diuretics examples

A

chlorthalidone (hydone)

metolazone (zaroxolyn)

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35
Q

preferred diuretics for CHF

A

loop diuretics, metolazone

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36
Q

spironolactone AEs

A

gynecomastia and sexual dysfunction in men and women

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37
Q

alternative for spironolactone

A

eplerenone (Inspra) does not have sexual side effects

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38
Q

potassium sparing diuretics MOA

A

inhibit epithelial sodium channel in the collecting duct

spironolactone & eplerenone are aldosterone antagonists

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39
Q

spironolactone MOA

A

lowers aldosterone

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40
Q

potassium sparing diuretics examples

A

spironolactone
eplerenone
triamterene

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41
Q

dyazine (HCTZ/triamterene) MOA

A

HCTZ - thiazide diuretic
triamterene - potassium sparring diuretic

used for K regulation

42
Q

commonly used statins

A

rosuvastatin (Crestor)
atorvastatin (Lipitor)
simvastatin (Zocor)
pravastatin (Prevacol)

43
Q

which statins can be taken at any time of day?

A

rosuvastatin

atorvastatin

44
Q

which statins need to be taken at bedtime?

A

simvastatin

pravastatin

45
Q

rosuvastatin dosing

46
Q

atorvastatin dosing

47
Q

precautions for atorvastatin?

A

many drug interactions and grapefruit

48
Q

precautions for simvastatin

A

many drug interactions and grapefruit

49
Q

statins MOA

A

inhibition of HMG-CoA

50
Q

benefit of prevastatin

A

low incidence of muscle pain

51
Q

statins AEs

A

muscle pain (rhabdomyolysis) can lead to kidney damage - stop if CK >10x normal

elevated LFTs - stop if >3x normal AST

52
Q

lab work for statins

A

baseline LFTs

baseline CK & with muscle problems

53
Q

supplement option for muscle pain with statins

A

CoQ-10 or vitamin D

54
Q

PCSK9 inhibitors MOA and use

A

inhibit PCSK9 which increase number of LDL receptors in liver to decrease LDL

second line after statins

55
Q

examples of PCSK9 inhibitor and dosing

A

alirocumbab (praluent) SQ every 2 weeks

evolocumab (Repatha) SQ every 2 weeks

56
Q

ezetimibe (zetia) MOA and use

A

cholesterol absorption inhibitor in small intestine

3rd line add on to statins for high cholesterol

57
Q

bile acid sequesterants examples

A

colestipol (colestid)

colesevalem (welchol)

58
Q

bile acid sequestrants MOA and use

A

bind to bile acid to decrease LDL

59
Q

bile acid sequesterants AEs

A

constipation, drug interactions - dont take with other meds

can lead to deficiency of fat soluble vitamins

60
Q

Niacin MOA and use

A

inhibits triglycerides and decreases secretion of VLDL and LDL particles

add on therapy for high LDL

61
Q

niaspan MOA and AEs

A

niacin

can cause liver dysfunction and failure

62
Q

fibric acids MOA and use

A

induces clearance of triglyceride-rich particles

lowers triglyceridades

63
Q

fibric acids examples

A

gemfibrozil (lopid)

fenofibrate (tricor)

64
Q

omega 3 fatty acids use and examples

A

treat triglycerids >500

lovaza
vascepa

OTC fish oils - cheaper

65
Q

treatment for homozygous familial hypercholesterolemia & precautions

A

MTP inhibitor - lomitapide (Juxtapid)
antisense oligonucleotide inhibitor - mipomersen (kynamro)

both have BBW for hepatotoxicity!

66
Q

routine treatment of stage B HFrEF

A

ACEI & beta blocker

67
Q

routine treatment of stage C HFrEF

A

ACEI/Entresto + Beta blocker + loop diuretic

68
Q

commonly used ARB

A

valsartan (diovan)

69
Q

Entresto (sacubitril/valsartan) MOA and use

A

valsartan - ARB, sacubitril- neprilysin inhibitor

preferred agent for HF but expensive

70
Q

precaution before starting Entresto

A

stop ACEI or ARB 2 days before starting Entresto…. can cause angioedema

71
Q

indication for hydralazine + nitrate

A

CHF in african americans

72
Q

hydralazine MOA

A

direct vasodilator

73
Q

digoxin MOA

A

inhibits Na-K-ATPase pump

74
Q

digoxin indication

A

used to improve fatigue in patients with CHF

75
Q

s/s of dig toxicity

A

nausea, yellow halos

76
Q

AE of digoxin

A

dig toxicity

bradycardia

77
Q

ivabradine (Corlanor) MOA and use

A

HCN (funny) - channel blocker

used in place of beta blocker in CHF

78
Q

are calcium channel blockers used for CHF?

A

no

ESPECIALLY not verapimil/diltiazem

79
Q

which medications should be avoided in CHF?

A

NSAIDS

antihyperglycemics - pioglitazone, saxagliptin, alogliptin

sudafed

amiodarone

80
Q

treatment for acute HF warm and wet

A

loop diuretics

IV nitro

81
Q

treatment for acute HF cold and dry

A

dobutamine

82
Q

treatment for acute HF cold and wet

A

dobutamine
milrinone

then start diuretics

83
Q

diuretics dosing for acute HF

A

1-2x home dose up to 4 times a day

84
Q

nesiritide MOA and precautions

A

vasodilates, decreases aldosterone secretion

may cause hypotension

85
Q

milrinone (primacor) MOA

A

phosphodiesterase inhibitor

increases contractility

86
Q

indication for milrinone

A

useful in patients taking beta blockers with acute HF

can be used alone or w dobutamine

87
Q

dobutamine MOA and precautions

A

increases contractility - B1 agonist

may worsten ischemia

88
Q

dopamine indication

A

increase renal perfusion, positive inotrope/chronotrope, vasoconstriction

depends on dose

89
Q

class I antiarrhythmics

A

Na channel blockers

IB - lidocaine, mexiletine
IC - flecainide

90
Q

class II antiarrhythmics

A

B blockers

91
Q

class III antiarrhythmics

A

K channel blockers

amiodarone

92
Q

class IV antiarrhythmics

A

CCBs - verapamil, diltiazem

93
Q

class V antiarrhythmics

A

adenosine, digoxin

94
Q

amiodarone precautions/AE

A

very long half life! days

pulmonary interstitial pneumonitis, hepatotoxicity, hypothyroid

95
Q

sinus tachycardia treatment

A

beta blockers

96
Q

a fib treatment

A

oral anticoagulants

rate control - amiodarone or digoxin, beta blocker

cardiovert + amio for symptomatic

97
Q

stable v tach treatment

A

adenosine, amiodarone, ICD

98
Q

stable torsades treatment

A

cardiovert, epi, amio

99
Q

dronedarone AEs

A

worsten HF

100
Q

flecainide AE

A

worsten HF

101
Q

mexiletine AE

A

hepatotoxicity

102
Q

procainamide AE

A

neutropenia

Advanced Pharm Exam 2 (3 decks)

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