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Cardio Meds I Flashcards

1
Q

What are the Vasodilators?

A

Nitrates

Calcium Channel Blockers

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2
Q

What are the Nitrates

A

Nitroglycerin

Isosorbide Dinitrate

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3
Q

Tell me what the Ca++ Channel Blockers are

A

Amlodipine
Nifedipine
Diltiazem
Verapamil

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4
Q

The Calcium Channel blockers are broken into two types of drugs. What are they?

A

Dihydropyridines (Amlodipine and Nifedipine)

Non-dihydropyridines (Verapamil and Diltiazem)

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5
Q

Explain what the Nondihydropyridines do. Why are the different from the dihydropyridines?

A
  • Cause less vasodilation and more cardiac depression
  • Negative effects at the SA/AV nodes, causing reductio in heart rate and contractility
  • They are used for supra ventricular tachycardias and non-obstructive cardiomyopathies
  • Used for A-fib and A-flutter
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6
Q

Explain the dihydropyridines and what they do in the heart

A
  • have more vascular selectivity with fewer cardiac effects

- Do not suppress the AV node conduction of SA node automaticity

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7
Q

Explain to me what the MOA of the vasodilators is

A

They cause smooth muscle dilation of arteries and veins

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8
Q

Why do you use nitrates?

A

For angina and CHF

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9
Q

BUT, there is a difference between Isosorbide Dinitrate and Nitro. Why would you use one over the other?

A

You use Isosorbide Dinitrate for FREQUENT STABLE angina (and nitro for just plain old angina)

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10
Q

What are the common S/E of both Nitrates?

A

HA
Hypotension
Tachycardia

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11
Q

What is a common S/E in just Isosorbide Dinitrate?

A

Re-bound HTN

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12
Q

The common drug interactions of the nitrates are…?

A

PDE-5 inhibitors (Cialis and Viagra)

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13
Q

What is important to remember about Isosorbide Dinitrate when it comes to how much should be given?

A

Everyone needs to have 8-12 hours of nitrate-free time daily. Taken in the morning, when the risk of having angina is the highest, and it is out of the system for the night time. This reduces the chance of developing tolerance to nitrates

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14
Q

How do the dihydropyridine CCBs work? (MOA)

A

they cause vasodilation due to blocking calcium channels in vascular smooth muscle and myocardium

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15
Q

What are their indications?

A

Angina (chronic, stable, vasospastic)

HTN

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16
Q

Common S/E of the dihydropyradines are…?

A

Nausea
Palpitation
Peripheral Edema
Elderly hypotension

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17
Q

What is the main drug interaction with the dihydropyridines?

A

Grapefruit juice

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18
Q

Between the two dihydropyridines, which is more likely to cause hypotension?

A

Nifedipine

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19
Q

Remind me again what the dihydropyridines are?

A

Amlodipine and Nifedipine

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20
Q

The non-dihydropyridines do what?

A

They dilate coronary arteries and decreased myocardial O2 demands

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21
Q

What are the non-dihydropyridines used to treat?

A 
Angina
HTN
Afib
Aflutter
PSVT (paroxysmal supraventricular tachycardia)
22
Q

Name a few contraindications of the non-dihydropyridines

A

Bradycardia

SSS if no pacer

23
Q

A few common side effects of Diltiazem are?

A

HA
Edema
Dyspepsia

24
Q

A few common s/e for verapamil are?

A

HA
Gingival hyperplasia
Constipation
Fatigue

25
What do you need to make sure you don't use at the same time as the non-dihydropyridines?
Don't use in combo with B blocker! This decreases nodal conduction Don't use in CHF
26
What is another thing you should not take the non-dihydropyridines with?
Grapefruit juice | - They are CYP3A4 inhibitors, which will increase the drugs concentration
27
Again, tell me what the non-dihydropyridines are
Verapamil and Diltiazem
28
What is an anti-anginal agent?
Ranolazine
29
How does Ranolazine work?
It inhibits inward sodium channel in ischemic cardiac myocytes during repolarization thereby reducing Na+/Ca++ exchange which relaxes cardiac muscle and reduces myocyte oxygen consumption
30
What is Ranolazine used for?
Chronic angina
31
What are the contraindications for Ranolazine?
- hepatic cirrhosis | - Concurrent strong CYP3A4 inhibitors/inducers
32
What is a drug that you shouldn't use with Ranolazine?
Simvastatin CYP3A4 inhibitors (diltiazem, erythromycin, verapamil) p-glycoprotein inhibitors (cyclosporine)
33
What are some important cardiac changes that you must consider?
Prolonged QT interval | Not used for ACUTE angina
34
What are the drugs used particularly for management of cardiac arrhythmia, protecting the heart from a second attack after the first MI? These can also be used for HTN
Beta blockers
35
What are the nonselective B blockers?
Propanolol and Carvedilol
36
What is the MOA for the selective B blockers?
Adrenergic B1 and B2 receptor inhibitor Reduction in myocardial O2 demand (Carvedilol has alpha 1 receptor inhibition as well)
37
What is the indication for Propranolol?
``` Angina HTN Tachyarrhythmia Essential Tremor Migraine prophylaxis Anxiety ```
38
What are the indications for Carvedilol
Off label Angina HTN Stable HF Stable Post-MI
39
What are contraindications of Beta Blockers?
``` Bradycardia Heart Block Uncompensated heart failure Severe depression Bronchospasm (in non-selective B Blockers) ```
40
What is important to remember when you are starting or stopping use of beta blockers?
Up-titrate slowly | Down-titrate slowly
41
What is something that might be masked in patients who take Propranolol?
Hypoglycemia
42
Selective Beta Blockers include what meds?
Metoprolol - Tartate an Succinate | Atenolol
43
What is the MOA of Selective Beta Blockers?
Selective B1 adrenergic receptor agonists
44
The indications for the selective beta blockers are?
Angina HTN Hemodynamically stable MI
45
Why is it important to up-titrate slowly with Beta Blockers, especially selective beta blockers?
They lose their B1 selectivity at >100mg/day, so in patients with COPD or asthma, bronchospasm can be triggered
46
HMG-CoA reductase inhibitors include which drugs?
``` Atorvastatin (lipitor) Lovastatin Pravastatin Rosuvastatin (crestor) Simvastatin (zocor) Fluvastatin ```
47
What is the indication for using HMG-CoA reductase inhibitors?
Hyperlipidemia
48
Explain what the MOA is of HMG-CoA reductase inhibitors
They inhibit cholesterol synthesis
49
The Common S/E of HMG-CoA reductase inhibitors include what?
D/N Arthralgia Myopathy Rhabdomyolysis
50
Contraindications to HMG-CoA reductase inhibitors are what?
Liver disease | CYP 450 metabolism
51
What are the drug drug interactions of HMG-CoA reductase inhibitors?
Decrease [Dabigatran] | Sta johns wart is decreases [Atorvastatin]
52
What is important to know about Atorvastatin (Lipitor)
It is the Best combo LDL/Trig reduction of the Statins | Rule of 6

Pharm (12 decks)

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