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Pharmacology > Cardio > Flashcards

Cardio Flashcards

1
Q

ACEs (-prils) Uses & MOA

A

Uses: HTN, angina, prevent/tx HF, prevent MI
MOA: block conversion of angiotensin 1 to 2; breaks down bradykinins

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2
Q

ACE (-prils) Side/Adverse effects

A

ANGIOEDEMA
orthostatic hypotension
dry, hacking cough (SWITCH TO ARB)

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3
Q

ACE (-prils) Contraindications/Precautions

A

bilateral renal artery stenosis
angioedema
pregnancy
hyperkalemia
impaired renal function
hypovolemia/hyponatremia
hepatic impairment

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4
Q

ACE (-prils) Interactions

A

CYP450 inhibitors
additive hypotensive effects (diuretics, BP agents, phenothiazines, alcohol)
K+ supplements = hyperkalemia
K+ sparing diuretics = hyperkalemia
NSAIDs/ASA = DEC effect

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5
Q

ACE (-prils) Monitoring/Patient education

A

monitor: obtain baseline, dosage changes, periodically; BP, weight, pulse; renal function DEC dose if serum >2.5; potassium

education: take med same time each day, do NOT double dose, CONTACT PCP BEFORE USING OTC MEDS; avoid salt substitutes

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6
Q

ARBs USES & MOA

A

Uses: HTN, prevent diabetic nephropathy, angina, post MI, HF

MOA: blocks angiotensin 2 at receptor

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7
Q

ARB side/adverse effects

A

orthostatic hypotension (fall risk)

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8
Q

ARB contraindications/precautions

A

bilateral renal artery stenosis
angioedema
pregnancy
hyperkalemia
impaired renal function
hypovolemia/hyponatremia
hepatic impairment

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9
Q

ARB interactions

A

CYP450 inhibitors
additive hypotensive effects (diuretics, BP agents, phenothiazines, alcohol)
K+ supplements = hyperkalemia
K+ sparing diuretics = hyperkalemia
NSAIDs/ASA = DEC effect

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10
Q

ARB Monitoring/patient education

A

Monitoring: obtain baseline, dosage changes, periodically; BP, pulse, weight; renal function DEC dose if serum >2.5; potassium; CHECK LFTs

education: no reflex tachycardia, no effect on bradykinin pathway, take same time each day, do NOT double doses, CONTACT PCP BEFORE TAKING OTC MED; avoid salt substitutes

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11
Q

DRIs USES/MOA

A

Uses: HTN, angina, post MI, HF
MOA: block renin

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12
Q

DRI side/adverse effects

A

ANGIOEDEMA
orthostatic hypotension

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13
Q

DRI contraindications/precautions

A

NO renal function <60 mL/min
bilateral renal artery stenosis
angioedema
pregnancy
hyperkalemia
impaired renal function
hypovolemia/hyponatremia
hepatic impairment

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14
Q

DRI interactions

A

CYP450 inhibitors
additive hypotensive agents: diuretics, BP agents, phenothiazines, alcohol
K+ supplements = hyperkalemia
K+ sparing diuretics = hyperkalemia
NSAIDs/ASA = DEC effects

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15
Q

DRI monitoring/patient education

A

monitoring: obtain baseline, dosage changes, periodically; BP, pulse, weight; renal function DEC dose if serum Cr >2.5; potassium

education: take same time each day, do NOT double doses, CONTACT PCP BEFORE USING OTC MEDS, avoid salt substitutes

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16
Q

CCBs Uses/MOA

Medications: Type 1 (verapamil, diltiazem), Type 2 (dihydropyridines - nifedipine)

A

Receptors: Type 1 (heart, heart contractility/HR control), Type 2 (peripheral/vascular smooth muscle, BP control)

Uses: HTN, SVT/Afib, unstable angina (only if vasospasm present, verapamil used)

MOA: bind to L-type channels in depolarized membranes to DEC channel opening
DEC calcium = INC muscle relaxation

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17
Q

CCB side/adverse effects

A

orthostatic sx
N/V, reflux
peripheral edema
reflex tachycardia

LESS COMMON W/ SR FORM

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18
Q

CCB Contraindications/precautions

A

STRONG INOTROPIC EFFECT & BRADYCARDIA (DEC PRELOAD, AFTERLOAD, HR)
AVOID IN HF
immediate post MI
ventricular arrhythmias
DIHYDROPYRIDINES - AVOID w/ peripheral edema and unstable angina
hepatic impairment
pregnancy

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19
Q

CCB interactions

A

additive HTN effects
DEC BP w/ NSAIDs
additive bradycardia w/ BBs and digoxin
verapamil alter Li levels
grapefruit juice
VERAPAMIL AND DILTIAZEM INC RISK MYALGIA W/ STATINS

20
Q

CCB monitoring/patient education

A

monitoring: verapamil monitor Li levels, LIVER FUNCTION AT BASELINE & PERIODICALLY, monitor for HF

education: take same time each day (best in AM), gradual withdrawal to prevent MI, careful if pharmacy switches brands or old vs new med, HF sx, constipation relief

21
Q

Cardiac Glycosides (CGs) (Digoxin) Uses/MOA

A

Uses: Afib, PVST (DEC HR = help convert rhythm); HF (add after ACE/ARB + diuretic in place)

MOA: inhibits Na-K-ATPase pump = keep Na in/push K out = strong ventricular contraction + INC cardiac output

22
Q

CGs (Digoxin) side/adverse effects

A

GI- from CNS reactions and stimulus of CTZ
fatigue, disorientation, hallucinations
yellow vision or green halos
gynecomastia = rare

23
Q

CG (Digoxin) contraindications/precautions

A

AV block
uncontrolled ventricular arrhythmias
IHSS
Cor pulmonale
severe renal impairment
ELECTROLYTE ABNORMALITIES
DEC albumin states
pregnancy
babies sensitive to dig

24
Q

CG (Digoxin) Interactions

A

NARROW THERAPEUTIC INDEX
drugs that cause: hypokalemia, hypercalcemia, hypomagnesemia
K+ and CGs antagonize each other
hypercalcemia = INC risk arrhythmia, as does hypomagnesemia

25
Q

CG (digoxin) monitoring/education

A

monitoring: digitalis effect (EKG changes- scooped ST, lengthened PR, T wave blunting); serum dig levels

education: monitor for TOXICITY (serum level >2 mg/mL); toxicity sx: INC HR, CNS/visual disturbances; HOLD med, K+, lidocaine (vent arrhythmias), digibind

take same time each day, pill container, do NOT alter forms, MONITOR HR: CONTACT PCP IF <60 OR >100

26
Q

Antiarrhythmics (C1: procainamide, lidocaine, flecanide); (C2: propranolol, atenolol); (C3: amiodarone, sotalol); (C4: verapamil)

USES/MOA

A

Uses: atrial arrhythmias, ventricular arrhythmias
MOA: DEC ectopic pacemakers or alter abnormal impulse conduction by…
Na channel blockade, blockade of SNS, prolongation of effective refractory period, calcium channel blockade

27
Q

Antiarrhythmics monitoring/primary care responsibilities

A

monitoring: labs (K+, renal & hepatic function, drug levels (draw 4-6 hours after last dose)), EKG, EPS

primary care responsibilities: understand beneficial effects, know adverse effects, any required monitoring, patient education, cardiology should initiate therapy

28
Q

Nitrates Uses/MOA

A

Uses: angina - INC MOS by facilitating movement of O2 across arterial-myocardial cells

MOA: vasodilation DEC afterload (resistance) and preload (venous pooling)

29
Q

Nitrates Side/adverse effects

A

orthostatic hypotension
tachycardia
throbbing HA: tylenol
ischemia, arrhythmias, rebound HTN
rash w/ flushing (transdermal)
ED, N/V, incontinence, urinary frequency

30
Q

Nitrates contraindication/precautions

A

vasodilation INC ICP
vasodilation cause postural hypotension
volume DEC & anemia
INC IOP (glaucoma)
hypersensitivity
pregnancy

31
Q

Nitrates interactions

A

additive hypotensive effects
anticholinergic DEC absorption of SL or buccal
ASA INC concentration
Nitrates DEC heparin

32
Q

Nitrates starting therapy/patient education

A

starting therapy: start LOW and SLOW, advance dose Q1-2 wks, guidelines to INC (DEC or absent angina w/ usual activity, resting HR INC <15 bpm, No orthostatic hypotension)

Education: tolerance: nitrate free interval 10-12 hrs/day, use BB or CCB during nitrate free interval, AVOID SR products

**DOSE FOR ACUTE: 0.4-0.6MG Q 5MIN X3. 3RD DOSE CALL 911.

33
Q

Peripheral vasodilators (minoxidil, hydralazine) Uses/MOA

A

Add-on therapy, NOT first line

Uses: resistant HTN, PVD often used w/ nitrates for HF
MOA: direct relaxation of arteriolar smooth muscle to DEC peripheral vascular resistance

34
Q

Vasodilators side/adverse effects

A

may trigger compensatory SNS and RAAS stimulation:
prevent orthostatic hypotension and ED
precipitate tachycardia, INC contractility, INC output, Na/water retention, HA, tachyphylaxis

35
Q

vasodilator contraindications/precautions

A

use caution in CVD patients
pregnancy
hydralazine OK for lactation
minoxidil NOT recommended in lactation

36
Q

vasodilator interactions

A

additive antihypertensive effects
NSAIDs DEC effectiveness
BBs & LOOPS MAY PREVENT ADVERSE EFFECTS OF PADs

37
Q

vasodilator medication administration

A

INC absorption w/ food
hydralazine may induce lupus-like syndrome w/ dose >50 mg

38
Q

Diuretics (loop, thiazide, potassium sparing) Uses/MOA

A

FIRST LINE THERAPY: HF, HTN
USES: HTN, Edema

MOA:
loop - block Na/water absorption, K+ wasting, POWERFUL
thiazide - block Na/water absorption distal tubule, longer acting
potassium sparing - block aldosterone from receptor = K+ in circulation, Na excreted; WEAK diuretic

39
Q

Diuretic side/adverse effects

A

ELECTROLYTE IMBALANCES
glucose intolerance + DEC K+ levels = thiazide loops
hypotension/fluid volume deficit
gynecomastia = spironolactone
photosensitivity long after d/c thiazides
hyperlipidemia = thiazides

40
Q

Diuretics contraindications/precautions

A

electrolyte disorders
POTASSIUM SPARING W/ SEVERELY IMPAIRED RENAL FUNCTION = RISK FOR HYPERKALEMIA
hepatic dysfunction
gout/renal calculi
DM
older adults - INC risk hypotension, falls, tinnitus, hearing loss
DEC placental perfusion

41
Q

Diuretics Interactions

A

additive hypotensive effects
synergistic hypokalemia
additive hyperkalemia w/ PCNs, amphotericin B, glucocorticoids
K+ sparing + ACE/ARB = hyperkalemia
warfarin
NSAIDs/Salicylates DEC diuretic effect

42
Q

ARNI (sacubitril/valsartan) Entresto USES/MOA

A

Class II-III HF, Add-on or switch, NOT first line
Prodrug

Uses: Class II-III HF
MOA: inhibits the enzyme from degrading atrial and BNP; more BNP available

43
Q

ARNI side/adverse effects

A

hypotension
hyperkalemia
impaired renal function
angioedema

44
Q

ARNI contraindications/precautions

A

HX ANGIOEDEMA (inc BRADYKININ PRODUCTION)
do NOT use within 36 hours of ACE = bradykinin INC w/ ARNI + ACE
do NOT use w/ DRI

45
Q

Sinus node inhibitor (Ivabradine) Uses/MOA

A

Uses: to reduce HF hospitalization in patients w/ symptomatic class II-III HF w/ LVEF <35%

MOA: blocks a gated channel responsible for the cardiac pacemaker
DEC HR w/o DEC contractility

46
Q

SNI med administration/patient education

A

med admin: must be in NSR w/ HR >70 bpm, management must include BB at maximum tolerated dose

patient education: does NOT reduce risk of cardiac death or MI

Pharmacology (12 decks)

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