CARDIO: Pharm

Question 1

In a pt with newly dx’d htn and comorbitidy of gout, what medications might you consider for htn control?

Answer 1

For gout, consider Losartan or other ARB or CCB. Avoid diuretics although it pts with no comorbities, first line htn treatment include ARBs, ACEs, CCBs, and thiazide diuretics. Thiazide diuretics increased uric acid levels thus increasing risk of a gout attack so we avoid these in pts with gout.

Question 2

What are our first line treatments for newly dx’d htn with no comorbidities?

Answer 2

ARBs, ACEs, CCBs, and thiazide diuretics.

Question 3

MOA: Dobutamine

Answer 3

β-1 adrenergic receptor agonist

At higher doses, it also has weak agonism at both β-2 and α-1 adrenergic receptors

Dobutamine is used to increase cardiac contractility and cardiac output in patients with cardiogenic shock primarily via its agonistic

Question 4

What drug do we use in the setting of cadiogenic shock to increas HR and contractility?

Answer 4

Dobutamine, β-1 adrenergic receptor agonist

Question 5

In a pt w/ htn and migraine w/aura, what therapy might you prescribe?

Answer 5

B Blockers

Question 6

In pts w/htn and no other comorbidities, what drugs should you consider?

Answer 6

In patients with hypertension and no other comorbidities, thiazide diuretics, ACE inhibitor, calcium channel blockers, and/or angiotensin-receptor blockers should be tried first.

Question 7

Patients with stable chest pain and an intermediate to high PTP of CAD should undergo coronary CT angiography (CCTA) or cardiac stress testing (CST) for further risk stratification and treatment decisions. Patients with stable chest pain and an intermediate to high PTP of CAD should undergo coronary CT angiography (CCTA) or cardiac stress testing (CST) for further risk stratification and treatment decisions. What is a contraindication for using adenosine or dipyridamole?

Answer 7

Reactive airway disease ie asthma

Question 8

Most common adverse effects of ARBs

Answer 8

Angioedema and hyperkalemia

Angiotensin II receptor blockers (e.g., losartan) cause decreased activity of angiotensin II on the AT1 receptor, which leads to decreased systemic vasoconstriction as well as decreased renal reabsorption of water, sodium, and bicarbonate.

Question 9

Common adverse effects of ACE inhibitors

Answer 9

Cough, angioedema, hyperkalemia

ACE inhibitors (e.g., lisinopril) inhibit the conversion of angiotensin I to angiotensin II by ACE, thereby decreasing systemic vasoconstriction and renal reabsorption of water and sodium. While ACE inhibitors are used in the treatment of hypertension, common adverse effects include cough, angioedema, and hyperkalemia.

Question 10

Common adverse effects of spironolactone

Answer 10

Hyperkalemia and antiandrogen effects (ie gynecomastia)

Aldosterone receptor antagonists (e.g., spironolactone) block aldosterone-mediated sodium and water reabsorption in the distal convoluted tubule. While aldosterone receptor antagonists are used in the treatment of hypertension, common adverse effects include hyperkalemia and antiandrogen effects (e.g., gynecomastia).

Question 11

Common adverse effects of thiazide diuretics

Answer 11

Hypokalemia, hyponatremia, hyperglycemia, hyperlipidemia, hyperuricemia, and hypercalcemia

Thiazide diuretics (e.g., hydrochlorothiazide) inhibit the reabsorption of sodium in the distal convoluted tubule (which increases the excretion of sodium, water, potassium, and hydrogen ions). While thiazide diuretics are used in the treatment of hypertension, common adverse effects include hypokalemia, hyponatremia, hyperglycemia, hyperlipidemia, hyperuricemia, and hypercalcemia,

Question 12

Common adverse effects of CCBs

Answer 12

Edema, headaches, dizziness, facial flushing, and reflex tachycardia.

Question 13

Common adverse effects of nonselective b-blockers

Answer 13

Include bradycardia, orthostatic hypotension, bronchoconstriction, and erectile dysfunction.

Question 14

What kind of drug: Losartan

Answer 14

ARB

Question 15

MOA: Losartan

Answer 15

Angiotensin II receptor blockers (e.g., losartan) cause decreased activity of angiotensin II on the AT1 receptor, which leads to decreased systemic vasoconstriction as well as decreased renal reabsorption of water, sodium, and bicarbonate. While ARBs are used in the treatment of hypertension, the most common adverse effects are angioedema and hyperkalemia, not peripheral edema.

Question 16

What kind of drug: Lisinopril

Answer 16

ACE inhibitor

Question 17

MOA: Lisinopril

Answer 17

ACE inhibitors (e.g., lisinopril) inhibit the conversion of angiotensin I to angiotensin II by ACE, thereby decreasing systemic vasoconstriction and renal reabsorption of water and sodium. While ACE inhibitors are used in the treatment of hypertension, common adverse effects include cough, angioedema, and hyperkalemia, but not peripheral edema.

Question 18

What kind of drug: spironolactone

Answer 18

Aldosterone receptor antagonist

Question 19

MOA: spironolactone

Answer 19

Aldosterone receptor antagonists (e.g., spironolactone) block aldosterone-mediated sodium and water reabsorption in the distal convoluted tubule. While aldosterone receptor antagonists are used in the treatment of hypertension, common adverse effects include hyperkalemia and antiandrogen effects (e.g., gynecomastia), but not peripheral edema.

Question 20

What kind of drug: hydrochlorothiazide

Answer 20

Thiazide diuretic

Question 21

MOA: hydrochlorithiazide

Answer 21

Thiazide diuretics (e.g., hydrochlorothiazide) inhibit the reabsorption of sodium in the distal convoluted tubule (which increases the excretion of sodium, water, potassium, and hydrogen ions). While thiazide diuretics are used in the treatment of hypertension, common adverse effects include hypokalemia, hyponatremia, hyperglycemia, hyperlipidemia, hyperuricemia, and hypercalcemia, but not peripheral edema.

Question 22

What kind of drug: Amlodopine

Answer 22

Dihydropyridine calcium channel blocker

Question 23

MOA: amlodipine

Answer 23

Dihydropyridine calcium channel blockers such as amlodipine inhibit voltage-dependent slow calcium channels. Blockage of these channels results in a decrease in the intracellular calcium that is needed for electromechanical coupling and muscle contraction. This causes vascular smooth muscle relaxation, which leads to systemic vasodilation and a decrease in blood pressure. Other common side effects of CCBs include headaches, dizziness, facial flushing, and reflex tachycardia.

Question 24

What kind of drug: propanolol

Answer 24

Nonselective beta blocker

Question 25

MOA: propanolol

Answer 25

Nonselective beta blockers (e.g., propranolol) inhibit both beta-1 receptors and beta-2 receptors. While beta blockers are frequently used in the treatment of hypertension, common adverse effects of nonselective beta blockers include bradycardia, orthostatic hypotension, bronchoconstriction, and erectile dysfunction. Propranolol would be unlikely to cause peripheral edema because it decreases the vasodilatory effect of peripheral beta-2 receptors.

Question 26

________________________ that acts as an arterial vasodialator to decrease mean arterial pressure and is used in the management of htn. A common adverse effect is peripheral edema.

Answer 26

Amlodipine, dihydropyridine calcium channel blocker.

Question 27

A pt w/ lower extremity edema due to dihydropyridine calcium channel blocker would be managed how?

Answer 27

Reducing dose or switching to another antihypertensive medication

Question 28

Why must you take caution w/NSAIDs like Naproxen when a pt is on diuretics or ACE inhibitors?

Answer 28

Naproxen can cause acute kidney injury/nephrotoxicity in pts w/chronic kidney disease, volume depletion, or pts who are taking diuretics or ACE inhibitors.

Question 29

MOA of ezetimibe

Answer 29

inhibits absorption of cholesterol at the intestinal brush border and increases cholesterol clearance.

Question 30

When do pts qualify for ezetimide according to ACC/AHA?

Answer 30

According to ACC/AHA 2018 guidelines, in patients with an LDL level of 190 or higher who do not achieve at least a 50% reduction in LDL on maximally-tolerated statin therapy or individuals with clinical ASCVD who have an LDL level of 70 or higher after maximally tolerated statin therapy, ezetimibe therapy is reasonable.

Question 31

What pharm approach do we use for pts w/ HFrEF?

Answer 31

5 prong approach:
-beta-adrenergic antagonist (metoprolol, propanolol, your lol’s)
-Renin-angiot-aldost system inhibitor (like lisinopril, ace inhibitor)
-diuretic
-minerlocorticoid inhibitor (like an aldosterone antag, spironolactone, eplerenone)
-SGLT2 inhibitor

Question 32

Agent of choice for antibiotic prophylaxis before dental procedure

Answer 32

Amoxicillin

Question 33

Why is it no bueno to pair lisinopril with an NSAID?

Answer 33