CARDIO: Pharm Flashcards
In a pt with newly dx’d htn and comorbitidy of gout, what medications might you consider for htn control?
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.
What are our first line treatments for newly dx’d htn with no comorbidities?
ARBs, ACEs, CCBs, and thiazide diuretics.
MOA: Dobutamine
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
What drug do we use in the setting of cadiogenic shock to increas HR and contractility?
Dobutamine, β-1 adrenergic receptor agonist
In a pt w/ htn and migraine w/aura, what therapy might you prescribe?
B Blockers
In pts w/htn and no other comorbidities, what drugs should you consider?
In patients with hypertension and no other comorbidities, thiazide diuretics, ACE inhibitor, calcium channel blockers, and/or angiotensin-receptor blockers should be tried first.
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?
Reactive airway disease ie asthma
Most common adverse effects of ARBs
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.
Common adverse effects of ACE inhibitors
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.
Common adverse effects of spironolactone
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).
Common adverse effects of thiazide diuretics
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,
Common adverse effects of CCBs
Edema, headaches, dizziness, facial flushing, and reflex tachycardia.
Common adverse effects of nonselective b-blockers
Include bradycardia, orthostatic hypotension, bronchoconstriction, and erectile dysfunction.
What kind of drug: Losartan
ARB
MOA: Losartan
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.
What kind of drug: Lisinopril
ACE inhibitor
MOA: Lisinopril
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.
What kind of drug: spironolactone
Aldosterone receptor antagonist
MOA: spironolactone
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.
What kind of drug: hydrochlorothiazide
Thiazide diuretic
MOA: hydrochlorithiazide
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.
What kind of drug: Amlodopine
Dihydropyridine calcium channel blocker
MOA: amlodipine
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.
What kind of drug: propanolol
Nonselective beta blocker
MOA: propanolol
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.
________________________ 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.
Amlodipine, dihydropyridine calcium channel blocker.
A pt w/ lower extremity edema due to dihydropyridine calcium channel blocker would be managed how?
Reducing dose or switching to another antihypertensive medication
Why must you take caution w/NSAIDs like Naproxen when a pt is on diuretics or ACE inhibitors?
Naproxen can cause acute kidney injury/nephrotoxicity in pts w/chronic kidney disease, volume depletion, or pts who are taking diuretics or ACE inhibitors.
MOA of ezetimibe
inhibits absorption of cholesterol at the intestinal brush border and increases cholesterol clearance.
When do pts qualify for ezetimide according to ACC/AHA?
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.
What pharm approach do we use for pts w/ HFrEF?
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
Agent of choice for antibiotic prophylaxis before dental procedure
Amoxicillin
Why is it no bueno to pair lisinopril with an NSAID?
