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Pharmacology > Cardio > Flashcards

Cardio Flashcards

1
Q

Drugs that can increase BP

A 
Oral contraceptives
Nicotine
Steroids
Appetite suppressants
Tricyclic antidepressants 
Effexor
Cyclosporine
NSAIDs
Some nasal decongestants
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2
Q

Herbal products that can increase BP

A 
Capsicum
Goldenseal
Licorice root
Ephedra
Scotch broom
Witch hazel
Yohimbine
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3
Q

HTN is defined as..

A

150/90+ in adults >60

140/90+ in adults <60

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4
Q

Diagnostic testing to do routinely with HTN

A

EKG, BG, HGB, HCT, UA, CMP, LFTs, HgbA1C, fasting lipids

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5
Q

Value for tx of HTN in patients with HTN and DM

A

140/90+ regardless of age

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6
Q

Value for HTN tx in non diabetic patients with CKD with normal to mild albuminuria

A

140/90+

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7
Q

Value for HTN tx in non diabetic patients with CKD with severe albuminuria

A

130/80+

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8
Q

5 classes of diuretics

A 
Loop
Thiazide
KCL sparing
Thiazide-like
Carbonic anhydrous inhibitors (not used for HTN)
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9
Q

Patients at highest risk for hypokalemia and hypomagnesia (can lead to cardiac arrhythmias) with diuretic therapy

A

Receiving digitalis
Left ventricular hypertrophy
Ischemic heart disease

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10
Q

Mech of action of thiazide diuretics

A

Increase urinary excretion of sodium and chloride in equal amounts by inhibiting reabsorption in the loop of henle and early distal tubules

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11
Q

How long does it take thiazide diuretics to take effect and how should they be dosed

A

Requires several days to produce effects

Requires a single daily dose

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12
Q

Thiazide diuretics decrease excretion of what

A

Calcium

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13
Q

What else do Thiazide diuretics increase excretion of

A

Potassium

Bicarb

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14
Q

Adverse effect of thiazide diuretics

A

Increased retention or uric acid. Not for use with gout

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15
Q

Contraindications to thiazide diuretics

A

Creat clearance <30
Renal compensation
Allergic to thiazide or sulfonamides

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16
Q

When are loop diuretics indicated

A

CHF, hepatic cirrhosis, renal disease

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17
Q

Mech of action of loop diuretics

A

Furosemide and ethacrynic acid inhibit reabsorption of sodium and chloride in the proximal/distal tubules and loop of henle

Bumetanide is more chloruretic than natriuretic and may have additional action in the proximal tubule

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18
Q

Loop diuretic contraindications

A

Anuria
Allergic to loops or sulfonylureas
Hepatic coma or states of severe electrolyte depletion

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19
Q

Which loop diuretic is contraindicated in infanta

A

Ethacrynic acid

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20
Q

Loop diuretics should be reserved for what

A

People with renal dysfunction

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21
Q

Mech of action of KCL-sparing diuretics

A

Interfere with sodium reabsorption qt the distal tubule decreasing potassium excretion

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22
Q

Diuretic ideal for CHF

A

Potassium sparing diuretics

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23
Q

Patients at higher risk for hyperkalemia with potassium sparing diuretics

A

Renal insufficiency
DM
Receiving ACEI, NSAIDs, or KCL supplements

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24
Q

Potassium level to avoid potassium sparing diuretics and aldosterone

A

> 5

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25
Q

SE of potassium sparing diuretics

A

Gynecomastia
Hirsutism
Menstrual irregularities

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26
Q

Beta blocker mech of action

A

Block central and peripheral beta receptors decreasing cardiac output and sympathetic outflow

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27
Q

Cardioselective beta blockers

A 
Mostly bind to beta1 receptors and are safer than nonselective beta blockers for patients with asthma, COPD, PVD
Metoprolol tartrate (lopressor)
Metoprolol succinate (toprol)
Atenolol
Nebivolol
Bisoprolol
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28
Q

Beta blockers and CHF

A

Used only in stable HF and temp DC’d with acute exacerbations

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29
Q

Why should patients be told not to abruptly stop beta blockers

A

Can cause unstable angina, MI, and death

Must be weaned over 14 days

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30
Q

Beta blocker contraindications

A

Sinus bradycardia
Asthma/COPD
2nd or 3rd degree heart block
Overt cardiac failure

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31
Q

NonISA beta blockers are the preferred agents to tx what

A

HTN with coexisting CAD, especially post-MI

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32
Q

Serious SEs of beta blockers

A

Bradycardia
AV conduction abnormalities
Development of CHF

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33
Q

Beta blockers in diabetic patients

A

Can mask all the symptoms of hypoglycemia except sweating

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34
Q

ACEI mech of action

A

Inhibits ACE enzyme from converting angiotensin 1 to angiotensin 2 (vasoconstrictor)

Inhibits degradation of bradykinin and increases synthesis of vasodilating prostaglandins

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35
Q

ACEI contraindications

A

Bilat renal artery stenosis (risk acute renal fx)
Previous angioedema
Pregnancy

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36
Q

SE of ACEI

A 
Chronic dry cough
Rashes
Dizziness
Angioedema
Laryngeal edema
37
Q

ARB mech of action

A

Blocks angiotensin2 from binding to its receptor found in many tissues

38
Q

ARBs are recommended for who?

A

HTN, diabetic neuropathy, HF

39
Q

Contraindications for ARBs

A

Caution with renal/hepatic function impairment
Pregnancy
Angioedema

40
Q

Renin inhibitor mech of action

A

Blocks conversion of angiotensin to angiotensin 1 which decreases formation of angiotensin 2

41
Q

Contraindications for renin inhibitors

A

Use of ACEI or ARB

Pregnancy

42
Q

SE or renin inhibitors

A

Diarrhea and angioedema

43
Q

Calcium channel blocker mech of action

A

Ability to inhibit movement of calcium irons across the cell membrane which results in muscle relaxation and dilation

44
Q

Indications for using CCBs

A

Black patients
HTN assoc with ischemic heart disease
Prinzmetal angina

45
Q

Contraindications for CCBs

A 
Accelerate progression of CHF
AV node dysfunction
Left ventricular (systolic) dysfunction with ejection fraction <45%
46
Q

Extra contraindications for nifedipine

A

Essential HTN

Hypertensive emergencies

47
Q

Peripheral alpha receptor blockers mech of action

A

Dilating both arteries and veins relaxing smooth muscle

48
Q

Alpha1 receptor blockers are effective for what?

A

BPH and not usually solely for HTN
Doxazosin (cardura)
Prazosin (minipress)
Terazosin (hytrin)

49
Q

Contraindications to alpha1 receptor blockers

A

Cardiovascular disease

Viagra/Cialis/etc (washout window of 4-6h)

50
Q

Adverse events with alpha1 receptor blockers

A

First dose phenomenon (dizziness or faintness, palpitations or syncope)
Fluid/Na retention (use with diuretics)

51
Q

Alpha1 receptor agonists mech of action

A

Stim alpha2 receptors in the brain resulting in decreased sympathetic outflow, cardiac output, and peripheral resistance

52
Q

SE of alpha2 receptor agonist

A

Fluid retention (use with diuretic)
Sedation
Dry mouth
First dose effect

53
Q

Contraindications for alpha2 receptor agonists

A 
Severe coronary insufficiency
Conduction disturbances
Recent MI
Cerebrovascular disease
Renal failure
54
Q

Mech of action of direct vasodilators

A

Directly cause arterial smooth muscle relaxation

55
Q

Use for direct vasodilators

A

Essential or severe HTN

56
Q

Direct vasodilators (drugs)

A

Hydralazine

Minoxidil

57
Q

Admin of direct vasodilators

A

Can cause fluid retention and reflexive tachycardia so it can be used with a diuretic and/or beta blocker (or other agent) to slow HR

58
Q

Contraindications for hydralazine

A

CAD

Mitral valvular rheumatic heart disease

59
Q

Minoxidil contraindications

A

Pheochromocytoma
Acute MI
Dissecting aortic aneurysm

60
Q

Adverse events with direct vasodilators

A

Hydralazine - lupus like syndrome at doses >300mg

Minoxidil- causes hair growth

61
Q

Adrenergic antagonists mech of action

A

Depletes norepinephrine in the CNS inhibiting the sympathetic nervous system and decreasing peripheral vascular resistance and lowering BP

62
Q

SE of adrenergic antagonists

A

Depression

63
Q

Adrenergic antagonists (drugs)

A

Reserpine (serpasil)
Guanethidine (ismelin)
Guanadrel (hylorel)

64
Q

HTN med during pregnancy

A

Methyldopa

65
Q

Tx of HTN emergency

A

Lower bp in a controlled manner to preserve end organ function

66
Q

Lab monitoring with HTN therapy

A

Creat and KCL

67
Q

Alcohol intake and cholesterol

A

Excessive can elevate triglycerides. Moderation may improve HDL levels and decrease ASCV risk

68
Q

Statin benefit group >21

A

Have clinical signs of ASCVD

do not have ASCVD but have LDL >190

69
Q

Statin benefit group 40-75

A

DM and LDLC values of 70-189

LDL values 70-189 and 10y risk of ASCVD >7.5%

70
Q

Statin mech of action

A

Blocks production of cholesterol in the liver leading to increased LDL receptors in the liver which increases reuptake of LDL by the liver resulting in decreased serum levels

71
Q

Freq of statin dosage adjustments

A

No more than q4wks

72
Q

Statin contraindications

A

Pregnancy/breast feeding
Active or Hx of liver disease
Unexplained elevated aminotransferase
Large amounts of alcohol

73
Q

Exceptions to taking stations at night

A

Lovastatin increased bioavailability with food

Atorvastatin and rosuvastatin can be taken whenever due to long half lives

74
Q

Cholesterol absorption inhibitor available

A

Ezetimibe (zetia)

75
Q

Zetia mech of action

A

Acts at the brush border of the small intestines to inhibit absorption of cholesterol which decreases the delivery of intestinal cholesterol to the liver

76
Q

Dosage of zetia

A

10mg daily

2h before or 4h after a bike acid resin if used concomitantly

77
Q

Bike acid resin mech of action

A

Binds bike acids in the intestine to form insoluble complex excreted in feces decreasing return of cholesterol to the liver which increases LDL receptors in the liver leading to more reuptake of LDL cholesterol by the liver.

78
Q

Bike acid resins contraindications

A

Biliary obstruction
Chronic constipation
Fasting triglycerides >300

79
Q

Admin of bike acid resins

A

Take with food

80
Q

Bile acid resins (drugs)

A

Cholestyramine

Colesevelam

81
Q

Niacin dosage

A

50-100mg bid or tid

Can increase q1-2wks until max dose of 1-1.5g qd

82
Q

Contraindications of niacin

A 
Hepatic dysfunction
Severe hypotension 
Persistent hyperglycemia 
Acute gout
New afib
Active peptic ulcers
83
Q

How to decrease severity of niacin flush

A

325mg ASA 30min prior

84
Q

Fibric acid derivatives (drugs)

A

Gemfibrozil and fenofibrate

85
Q

Indication for fibric acid derivatives

A

Severely elevated triglyceride levels that have not responded to dietary therapy

86
Q

Gemfibrozil dosage

A

600mg bid with breakfast and dinner

87
Q

Fenofibrate dosage

A

43-67mg daily with max 200mg

88
Q

Contraindications of fibric acid derivatives

A

Hx of gallstones

Severe hepatic or renal dysfunction

89
Q

Drug interactions fibric acid derivatives

A

Gemfibrozil is contraindicated with simvastatin

Fenofibrate can increase anticoagulant effects

Pharmacology (11 decks)

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