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Clin Pharm Exam Two > Cardio Case Wrap Up > Flashcards

Cardio Case Wrap Up Flashcards

1
Q

What is the INR goal for patients with Afib? What about a mechanical valve?

A

2-3, 2.5-3.5

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2
Q

What two things constitute a coumadin failure?

A

thromboembolic (clot) event while on coumadin at a therapeutic level and people who cannot maintain an INR while on coumadin

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3
Q

Should a patient on coumadin stop eating things high in vitamin K?

A

No she should just eat a regular intake and keep it constant over time

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4
Q

What foods have very high levels of vit k?

A

spinach, brussel sprouts, collard greens, turnip, mustard greens, kale

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5
Q

Are these foods high or low in vitamin K?

A

avocado, banana, chickpeas, fruit, oil, peppers, seaweed, tomatoes

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6
Q

Is coumadin or DOACs better for ESRD?

A

Coumadin

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7
Q

In patients with mechanical valves, they should be on _______ instead of _________

A

warfarin instead of DOACs

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8
Q

Do you need INR checks in DOACs?

A

No

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9
Q

There is a higher rate of GI bleeding in coumadin or doacs?

A

doacs

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10
Q

Dabigatran (pradaxa) has what MOA?

A

direct thrombin inhibitor

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11
Q

Rivaroxaban (Xarelto), Apixiban (Eliquis), and Edoxaban (Savaysa) all have what MOA?

A

Direct factor Xa inhibitor

**they all have X in their name and are an Xa inhibitor

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12
Q

What is a good RATE control medication?

A

beta blockers (lopressor, carvedilol, toprol)

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13
Q

What electrolyte abnormalities can HCTZ cause?

A
  • *all HYPO
  • hyponatremia
  • hypokalemia
  • hypomagnesemia
  • can ppt gout attack
  • caution in diabetics
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14
Q

Mucinex D can cause ____

A

HTN

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15
Q

Norvasc (amlodipine) can cause ______

A

peripheral edema

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16
Q

What is the BP goal in DM + HTN? What are ideal meds for HTN?

A

130/80

-diuretics, ACEI/ARB, CCB

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17
Q

What is a life threatening s/e of amlodipine (norvasc)? What is a common s/e?

A

angina/mi and caution in patients with severe aortic stenosis because it can reduce coronary reperfusion

Peripheral edema

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18
Q

What is a life threatening symptom of lisinopril? What is a common s/e?

A

Angioedema not only of the lips but can also effect the gut and african americans are at an increased risk

Hyperkalemia

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19
Q

What is a life threatening symptom of lopressor (metoprolol tartrate)? What are some common s/e?

A

life threatening: AV block, brady

common: hypotension, brady dizziness

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20
Q

What is a life threatening symptom of lopressor (metoprolol succinate)? What are some common s/e?

A

*same as metoprolol tartrate
life threatening: AV block, brady

common: hypotension, brady dizziness

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21
Q

What is a life threatening symptom of labetalol (metoprolol succinate)? What are some common s/e?

A

Life threatening: hypotension

Common: hypotension and orthostatic hypotension

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22
Q

What is a life threatening symptom of HCTZ? What are some common s/e?

A

Life threatening: severe electrolyte disturbances and angle closure glaucoma

Common: hyponatremia, hypokalemia, hypomagnesmia, ppt of gout (electrolyte abnormalities)

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23
Q

What is a life threatening symptom of losartan (cozaar)? What are some common s/e?

A

Life threatening: angioedema, hyperK, hypotension

CommonL cough, hyperkalemia

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24
Q

Should clonidine be used for first line in anything?

A

NO

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25
Q

Clonidine can cause this side effect?

A

xerostomia (dry mouth)

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26
Q

What is a life threatening symptom of diltiazem (cardizem)? What are some common s/e?

A

life threatening: AV block, bradycardia, SJS, hypotension

Common: peripheral edema, HA, brady, dizziness

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27
Q

This medication can cause drug-induced-lupus like syndrome, contraindicated in those with CAD and peripheral neuritis

A

hydralizine

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28
Q

Patients with a CrCl < 30 should use caution when taking what medication?

A

Metformin

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29
Q

What is the difference between primary and secondary prevention of ASCVD?

A

Primary prevention refers to the effort to prevent or delay the onset of ASCVD. Secondary prevention refers to the effort to treat known, clinically significant ASCVD, and to prevent or delay the onset of disease manifestations.

30
Q

In secondary prevention of ASCVD, patients should be on a ________ intensity statin. Name them and the doses.

A

high intensity statin

atorvastatin 40 or 80mg
rosuvastatin 20 or 40mg

31
Q

What is the DOC for lowering LDL?

A

Statin

32
Q

You should obtain baseline _______ 6-12 weeks after initation or any dose increase of a statin then annually

A

LFTs

33
Q

What are two contraindications for statins?

A

liver disease (alcohol abuse) and pregnancy

34
Q

What is a life threatening sxs of statins? What are some common s/e?

A

Rhabdo

common: arthralgias, photosensitivity, GI upset

35
Q

What are drug eluding stents?

A

Drug-eluting stents prevent a coronary artery from narrowing again after angioplasty. They are coated with medicine that prevents scar tissue from growing into the artery.

36
Q

What is DAPT? What meds are involved?

A

dual antiplatelet drug therapy used after a patient gets a stent placed (Clopidogrel (plavix) + ASA)

37
Q

______ should be continued indefinitely in all stented patients

A

ASA

38
Q

this is the MOA of what drug?

Inhibits platelet aggregation

A

ASA

39
Q

The peak plasma concentration of ASA can occur within 30 min of taking a ________ pill and up to ____ hrs if enteric coated

A

non-enteric coated

4 hrs

40
Q

When is a 325mg ASA used??

A

really only used for AMI and acute ischemic stroke. whereas the 81mg is sufficient for daily use

41
Q

ASA interacts with what med? and is contraindicated in patients with what condition?

A

NSAID, GI bleed

42
Q

This is the only anti angina med class that is proven to improve survival and prevent re-infarction in patients who have had MI

A

beta blockers

43
Q

This is the first line therapy for acute angina symptoms?

A

nitrates

44
Q

This med class causes coronary and peripheral vasodilation and reduces contractility

A

CCB

45
Q

What are two cardioselective beta blockers and why are they recommended?

A

metoprolol, atenolol- they don’t interfere with bronchodilation or peripheral vasodilation

46
Q

How do beta blockers work?

A

They reduce HR and contractility (also improve survivial in patients with prior MI and those with HFrEF

47
Q

What are three major contraindications to nitrates?

A

Hypotension, avoid in patients with RV MI (can cause severe hypotension) and patients on PDE-5 inhibitors

48
Q

What nitrate is used for prevention, not acute treatment of angina?

A

isosorbide mononitrate (used in the prevention of anginal episodes)

49
Q

This is the MOA of what medication?

INcreases coronary artery blood flow by vasodilation, reduces myocardial oxygen demand by decreasing preload

A

nitrates

50
Q

This is the MOA of what drug?

A

partial fatty acid oxidation inhibitor- alters myocardial energy metabolism decreasing cardiac workload (different from nitrates but can use as an antianginal to prevent sxs)

51
Q

What is the medication interaction between these two meds?

ASA + plavix

A

increases risk of adverse bleeding events

52
Q

What is the medication interaction between these two meds?

nitro + bb

A

additive hypotension

53
Q

What is the medication interaction between these two meds?

nitro + viagra

A

hypotension

54
Q

What are the ABCDE’s of s/p AMI?

A 
A- ASA and antiplatelets 
B- BB and good BP control 
C- cholesterol lowering agents and reduce smoking 
D- diet 
E- exercise
55
Q 
What NYHA class is this?
No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).
A

I

56
Q 
What NYHA class is this?
Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).
A

II

57
Q 
What NYHA class is this? 
Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.
A

III

58
Q 
What NYHA class is this?
Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.
A

IV

59
Q 
This is the MOA of what class of meds?
Inhibit Na and Cl resorption --> profound diuresis from the excretion of urinary Na, Cl and K
A

loop diuretics

60
Q

What is a big s/e of loop diuretics?

A

hypokalemia

61
Q

In patients in acute fluid overload, what can you do?

A

give them IV loop diuretics

62
Q

Digoxin is a positive inotrope meaning it does what?

A

increases contractility aka makes the heart squeeze harder. It is given for symptom control in patients already on appropriate therapy

63
Q

What is an optimal INR for patients on dig?

A

0.7 to 1.2

64
Q

In this med, you should watch for cardiac arrythmias, visual disturbances (blurred or yellow vision)

A

dig

65
Q

dig levels can be increased by what med?

A

amioderone

66
Q

__________ decreases morbidity and mortality in CHF patients

A

spironolactone

67
Q

what is a s/e of spironolactone?

A

hyperK

68
Q

What are four meds that adversely affect CHF?

A

NSAIDs, antiarrythmics, CCB, thiazolidinediones

69
Q

These three meds together can cause what interaction?

lisinopril + KCl + spironolactone

A

hyperkalemia

70
Q

These three meds together can cause what interaction?

Lisinopril + BB + lasix

A

hypotension

71
Q

These two meds together can cause what interaction?

ASA + plavix

A

increased bleeding risk

72
Q

What are some medications that IMPROVE mortality in patients with CHF?

A
  • ACEI
  • ARB
  • Apironolactone
  • Hydralizine + nitrates
  • BB

Clin Pharm Exam Two (6 decks)

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