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pharm week 1 > Cardio Week 1 > Flashcards

Cardio Week 1 Flashcards

1
Q

Examples of acute coronary syndrome?

A

Unstable angina

MI

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2
Q

Usual cause of coronary heart disease?

A

Atherosclerosis

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3
Q

Two other terms for coronary heart disease?

A

Coronary artery disease

Ischemic heart disease

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4
Q

Types of cardiovascular disease (7)?

A

Coronary heart disease

Cerebrovascular disease

Peripheral artery disease

Rheumatic heart disease

Congenital heart disease

DVT

PE

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5
Q

All-cause Mortality refers to?

A

Whether statin therapy Increases the risk of death from non-coronary causes more than it reduces coronary heart disease (CHD) death.

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6
Q

Major coronary events include?

A

Non-fatal MI

CHD

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7
Q

Secondary prevention using Statin therapy is most applicable to which patient population?

A

Those with acute coronary syndrome. History of unstable angina or MI.

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8
Q

Thiazide diuretics work here?

A

Distal convoluted tubule

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9
Q

Thiazide diuretics do this?

A

Inhibit tubular reabsorption of Na, Cl, K ions

Dilate the arterioles via direct relaxation

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10
Q

First line tx for hypertension? Dose?

A

HCTZ 12.5 mg OD

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11
Q

Dose that HCTZ reaches 80% of it’s effectiveness?

A

25mg OD

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12
Q

HCTZ treats this? (6)

A

Heart failure

Edema related to:
Heart failure
Renal dysfunction
Cirrhosis
Steroid therapy
Estrogen therapy
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13
Q

Don’t use HCTZ for? (4)

A

Drug allergy
Anuria
Severe renal failure
Breastfeeding mothers

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14
Q

ADE of HCTZ?

A 
dehydration
electrolyte imbalances
hyperuricemia
insulin dose may need adjusting
photosensitivity
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15
Q

Pts on HCTZ may need?

A

K supplementation
Serum electrolyte assessments
Insulin adjustments

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16
Q

Why is Chlorthalidone a pain in the butt?

A

Only comes in 5omg tabs
starting dose= 12.5mg (most effective SBP lowering)
25mg = most effective DBP lowering

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17
Q

Spironolactone is… (4)

A

Aldactone
a aldosterone receptor antagonist
a steroid
analogue (comparable to) aldosterone

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18
Q

Spironolactone works by:

A

inhibits aldosterone in collecting ducts
= loss of bicarbonate and calcium, conserves potassium and hydrogen (K sparing!)
Decreases Na reabsorption (water flows out of blood into tubules - follows Na)
Decreases K excretion (K sparing)

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19
Q

Spironolactone is…

A

A weak diurectic
A weak antihypertensive (compared to other diurectics)

Increases survival in HF
Potassium sparing

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20
Q

Drugs that can reach toxic levels if taken with diuretics ?

A

Digoxin

Lithium

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21
Q

This can lead to additive hypokalemia in pts taking thiazides diuretics?

A

Black licorice

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22
Q

Compound found in licorices root that causes increased Na and decreased K?

A

Glycyrrhetic acid

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23
Q

What do the adrenal glands secrete?

A

Aldosterone

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24
Q

Where does aldosterone exert its effect ?

A

Kidneys
Heart
Arteries

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25
Q

What does aldosterone do?

A

Increases BP by:

Increasing systemic vascular resistance (artery constriction)

Retains Na in the kidneys

Increased heart contractility, HR, BP

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26
Q

Ace inhibitors are the …?

A

“prils ”

Ramipril
Captopril
Lisinopril
Enalapril

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27
Q

ACEi lower BP by:

A

Reducing systemic vascular resistance

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28
Q

First line agents for BP tx?

A

Thiazide diurectics

ACE inhibitors

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29
Q

Captopril starting dose?

A

25mg daily

Capoten

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30
Q

Enalapril starting dose?

A

5mg daily

vasotec

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31
Q

Lisinopril starting dose?

A

10mg daily

Prinvil, Zestril

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32
Q

Ramipril starting dose?

A

2.5 mg daily

altace

33
Q

Ace inhibitors such as ramipril reduce BP by what amount?

A 
SBP = 8
DBP= 5
34
Q

ACE inhibitors treat? (6)

A

First line for HTN

First line for heart failure (stopping aldosterone = decreased systemic resistance, decreased HR, decreased BP = lets the heart rest)

Cardio protection post MI

Renal protective in DM

Reduce GFR pressure

Reduce proteinuria = reduced diabetic nephropathy

35
Q

BP meds not advised as 1st line in patients of African decent?

A

ACEi

ARBs

36
Q

Who should not be given Vitamin K?

A

< 9 INR with no risk of bleeding

37
Q

INR goal range and target for non-valvular atrial fib?

A

2.0- 3.0

Target= 2.5

38
Q

Drugs associated with increased risk of bleeding for patients taking warfarin?

A

NSAIDS
antiplatelet agents
some antimicrobials
Some foods, herbal products

39
Q

Recommended way of preventing drug/herbal interactions with warfarin?

A

check 2 drug resources

40
Q

Antimicrobials that may interact with anticoagulants?

A
  • amoxi-clav
  • fluoroquinolones
  • trimethoprim-sulfamethoxazale
  • macrolides
  • metronidazole
  • azole antifungals
  • tetracyclines
  • rifampin
41
Q

Cardiovascular medications that may react with anticoagulants?

A 
amiodarone
fenofibrate
propafenone
propranolol
simvastatin
41
Q

Cardiovascular medications that may react with anticoagulants?

A 
amiodarone
fenofibrate
propafenone
propranolol
simvastatin
42
Q

What CNS meds potentially react with anticoagulants?

A

Carbamazepine
SSRI
Tramadol

43
Q

Risk factors for anticoagulant associated bleeding? (9)

A

Hx of GI bleed, thrombocytopenia, platelet dysfunction, active peptic ulcers

Uncontrolled hypertension

Renal or hepatic dysfunction

CV disease

Increased age

Labile or supratherapeutic INRs

Concomitant meds (NSAIDS, antiplatelets)

Excessive alcohol consumption

Malignancy

44
Q

3 fold risk of bleeding when you take these 2 meds with warfarin?

A

ASA

Clopidogrel

45
Q

Special circumstances where anticoagulants and antiplatelets are warrented?

A

1- intracoronary stent placement

2- acute coronary syndrome

46
Q

What is a prescribing cascade?

A

A prescribing cascade occurs when a drug-related adverse event leads to the addition of a subsequent medication to treat
the adverse event

47
Q

dihydropyridine Calcium channel blocker that studies show causes a 3-11% of peripheral edema?

A

Amlodipine

48
Q

What is important to monitor for new oral anticoagulants?

A

Renal function
hepatic function
compliance

49
Q

When to consider Warfarin? (9)

A
  • Prosthetic heart valves or hemodynamically-significant valvular disease
  • currently well managed on warfarin
  • Stable coronary heart disease, placement of an intracoronary stent or acute coronary syndrome
  • CYP- P450 3A4 and P‐glycoprotein drug interactions
  • History of GI bleed
  • Reversal needed
  • Cost concerns
  • Poor compliance
  • Consider travel insurance
50
Q

Transient Lifestyle changes that can affect INR levels?

A

Gastrointestinal illness

Missed or extra dose

Antibiotics

Recent increase of alcohol

51
Q

Permanent changes that can cause fluctuations in INR?

A

Lifestyle change

Change in chronic medication

52
Q

When should you not adjust warfarin doses?

A

previously stable INR for the last three months with a single INR that is within + or Minus 0.5 of therapeutic range

Recheck INR within 1 to 2 weeks

53
Q

INR > 9.0

A

Urgently assess

Temporarily stop warfarin

Consider a vitamin K 2.5 mg orally, repeat in 24 hours if INR remains > 9

Once I know it is in therapeutic range of 2 to 3

Decrease weekly dose by 20%

54
Q

INR < 1.5

A

Give one extra dose (equivalent to 20% of weekly dose).

Increase weekly dose by 10 to 20%

55
Q

INR 1.5-1.9

A

Increase weekly dogs by 5 to 10%

56
Q

INR 3.1- 3.5

A

Consider decreasing weekly dose by 5 to 10%

57
Q

INR 3.6 to 4.9 (without bleeding)

A

Hold one dose

Decrease weekly dose by 10-20%

58
Q

INR 5.0 - 9.0

A

Hold 2 doses

Decrease weekly dose by 10 to 20%

59
Q

Which meds are dual action alpha and beta blockers?

A

Labetalol

Carvedilol

60
Q

What does the alpha 1 receptor blockade cause?

A

Vasodilation

61
Q

What does the beta 1 receptor blockade cause?

A

Decreased HR

62
Q

2 drugs used for epilepsy, pain and anxiety that are calcium antagonists?

A

Pregabalin

Gabapentin

63
Q

Cardiac drugs that are Ca antagonist?

A

Diltiazem

Verapamil

Nifedipine (dihydropyridines)

64
Q

What does ASA do?

A

Tx suspected:
MI
TIA
Embolic stroke

Prevention of MI and STROKE in prosthetic heart valve

65
Q

ASA is a 1st line :

A

Anti platelet option for secondary prevention in ischemic stroke

66
Q

Clopidogrel dosing?

A

300 mg initial dose

Then 75mg daily

67
Q

What drug may decrease effectiveness of clopidogrel?

A

Omeprazole

68
Q

What class of enzyme might increase clopidogrel metabolites and increase bleeding risk?

A

CYP2C19 inducers

69
Q

Normal aPTT?

A

Normal: 25-35 seconds

Therapeutic: 55-80 seconds

70
Q

How long to stop plavix ahead of surgery?

A

5-7 days

71
Q

How long to stop heparin prior to surgery?

A

24-48 hrs (pt dependent)

90 min half life.

72
Q

Advantage of heparin over warfarin ?

A

Can be used in pregnancy. Warfarin cannot.

Used as bridging therapy for oral anticoagulants

73
Q

What to monitor on patient on heparin?

A

Platelet count

aPTT

signs of bleeding

drug interactions

74
Q

Tx and dose for PE, DVT, ACS?

A

Enoxaparin 1mg/kg BID

75
Q

LMWH is sometimes preferred over heparin because: (6)

A
  • Greater affinity for factor Xa than heparin
  • Longer ½ life than heparin
  • Higher bioavailability
  • Predictable dose response
  • Less risk of thrombocytopenia
  • Preferred in pregnancy r/t less HIT and osteoporosis risk
76
Q

Whats the antidote for heparin and LMWH?

A

Protamine Sulphate

77
Q

Negative inotropic effect?

A

Weaken the force of the heartbeat

treat high blood pressure, chronic heart failure, arrhythmias, and angina

78
Q

Positive inotropic effect?

A

Strengthen the force of the heart beat

Tx: congestive heart failure or cardiomyopathy

pharm week 1 (8 decks)

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