Cardiology Flashcards
contraindications of statins
pregnancy, breastfeeding
liver disease
CYP3A4 inhibitors - simvastatin and lovastatin
Vascepa generic name
icosapent ethyl
Zetia generic name
ezetimibe
Lovaza generic name
omega-3
Possible side effects of Lovaza include:
a. burping
b. arthralgias
c. dyspepsia
d. taste perversions
e. rhabdomyolysis
a, c, d
Which of the following can cause LDL to increase?
a. Tacrolimus
b. Niaspan
c. Lovaza
d. Dexamethasone
e. Welchol
F. Risperidone
a, c, d, f
Which of the following should be avoided with lovastatin?
a. Lopid
b. Voriconazole
c. Theophylline
d. Plavix
e. Biaxin
a, b, e
What are the max doses per day of simvastatin and lovastatin when used in combination with non-DHP CCBs?
simvastatin 10 mg
lovastatin 20 mg
Which statin is the least potent?
fluvastatin
For cholestyramine or colestipol, take all other meds at least ______ hours before or _______ hours after.
1-4; 4-6
Elevated TGs are most likely to cause what?
pancreatitis
Which statin should be taken with an evening meal?
lovastatin IR
Which of the following will help to lower TG?
a. Lovaza
b. Trilipix
c. TriCor
d. Vascepa
e. Welchol
a, b, c, d
What is a key counseling point for ER niacin administration?
Take at bedtime after a low fat snack
Select the correct MOA of cholestyramine.
a. Reduces cholesterol absorption at the brush-border
b. Peroxisome proliferator receptor alpha activator
c. Increases HDL synthesis
d. Inhibits the enzyme HMG-CoA reductase
e. Bind to bile acids in the gut
e
What drugs increase TG only?
IV lipid emulsions, propofol, bile acid sequestrants
When combined with simvastatin, which of the following increases the risk of myalgias?
a. Niacin 1 g daily
b. Colesevelam
c. Red yeast rice
d. Fenofibrate
e. Rifampin
a, c, d
T/F: Formulations of niacin (IR vs ER) are interchangeable.
F
What other names is niacin known by?
vitamin B3, nicotinic acid
Welchol is approved for use in which of the following conditions?
a. RA
b. Diabetes
c. Gout
d. Hypertriglyceridemia
e. Crohn’s disease
b
What cholesterol meds increase bleeding risk?
fish oil
Which of the following effects do statins have on cholesterol values?
a. Raises HDL
b. Lowers HDL
c. Raises TG
d. Lowers LDL
e. Lowers TG
a, d, e
What is the MOA of ezetimibe?
inhibits the absorption of cholesterol in the small intestine
Which statins can be given at any time of the day? (5)
Crestor, Lipitor, Livalo, Lescol XL, Pravachol
What condition is a contraindication to using lomitapide?
active liver disease
What is the therapeutic range for digoxin when used to treat HF?
0.5-0.9
Which potassium chloride formulation can be opened and sprinkled on food?
a. Micro-K
b. Klor-Con 10
c. Khlor-Con M10
d. K-Tab
e. Khlor-Con M15
a
Which of the following natural products may have a beneficial effect on HF? SELECT ALL THAT APPLY
a. Ginkgo
b. Fish oils
c. Hawthorn
d. Ma huang
e. Coenzyme Q10
b, c, e
GW was brought to the ER for difficulty breathing and notable swelling of the face, lips, and tongue. His medical hx is significant for diabetes and HFrEF. He currently takes rosuvastatin, metformin, spironolactone, carvedilol, fosinopril, bumetanide, and digoxin. Which medication should be discontinued and why?
Fosinopril - ACEs and ARBs can cause angioedema that presents as face swelling
What are the target doses of carvedilol IR for < 85 kg and > 85 kg?
25 mg BID and 50 mg BID
Which of the following meds could worsen HF? SELECT ALL THAT APPLY.
a. Itraconazole
b. Alogliptin
c. Ramipril
d. Procainamide
e. Carbamazepine
f. Acarbose
g. Daunorubicin
a, b, d, g
Which of the following regarding the dosing and administration of Toprol XL are true? SELECT ALL THAT APPLY.
a. The tablet should be swallowed whole and cannot be cut.
b. It should be taken with or immediately after meals.
c. It should be started at a dose of 200 mg daily for HF.
d. It can be converted to IV form using a 1:1 ratio.
e. The tablet can be cut in half at the score line if needed.
b, e
Which beta blockers reduce mortality in systolic HF?
metoprolol succinate, bisoprolol, carvedilol
Non-selective beta blocker that also blocks alpha 1
carvedilol
Which of the following physical exam findings are consistent with symptomatic HF? SELECT ALL THAT APPLY.
a. Asterixis
b. Dyspnea
c. Jugular venous distension
d. Peripheral edema
e. Rales
b, c, d, e
Ivabradine is indicated in HF patients with:
a. Afib
b. Bradycardia
c. Resting HR >/= 70 bpm
d. HTN
e. QT prolongation
c
Which of the following best describes safe dosing practices for the use of digoxin in treating HF?
a. Start at 0.5 mg daily; no renal adjustments required
b. Start 125 mg daily; reduce dose when CrCl < 50
c. Start at 0.25 mg daily; no renal adjustments needed
d. Start at 250 mg daily; reduce dose when CrCl < 30
e. Start at 0.25 mg daily; reduce dose when CrCl < 50
e
Which of the following is most appropriate to decrease fluid volume in a patient with a sulfa allergy?
a. Ethacrynic acid
b. Torsemide
c. Bumex
d. Lanoxin
e. Furosemide
a
What are the main pathways activated in HF?
RAAS system, sympathetic nervous system, vasopressin
Activation of the sympathetic nervous system in HF causes what physiologic effects?
increase in HR, contractility, and vasoconstriction
In HF, what are the initial medications for all patients without contraindications?
ACEs, ARBs, ARNI
Beta blockers
Loop diuretics
ACEs, ARBs, and loop diuretics can decrease renal clearance and increase the toxicity of what medication?
lithium
The combination of hydralazine and isosorbide dinitrate is a suitable alternative to which medications in a patient with HF and bilateral renal artery stenosis?
ACEs and ARBs
Which of the following is a common side effect of BiDil?
a. Rash
b. Headache
c. Hair growth
d. Sore, painful joints
e. Increased appetite
b
Which of the following is the correct MOA of ACE inhibitors?
a. Blocks aldosterone receptors in the distal convoluted tubule
b. Prevents the conversion of angiotensin I to angiotensin II
c. Blocks angiotensin II by binding directly to the AT1 receptor
b
EK has systolic HF and is taking quinapril, carvedilol, torsemide, spironolactone, and BiDil. He presents to the clinic with a mild fever, sore finger and arm joints, and muscle aches. He reports being more tired than usual and feels miserable. What adverse drug effect is EK likely experiencing?
drug-induced lupus erythematous
What drug causes DILE?
BiDil
Which of the following meds require monitoring of serum potassium?
a. Candesartan
b. Carvedilol
c. Lanoxin
d. Vasotec
e. Hydralazine
f. Entresto
g. Eplerenone
a, c, d, f, g
A patient experiencing a hypertensive emergency should have BP lowered according to which criteria?
a. 5-10% within the first 4-6 hours
b. </= 25% within the first hour
c. 25-30% in the next 10 min
d. </= 40% within the first hour
e. As fast as possible to reach a goal of < 130/80
b
Choose the correct statements concerning clevidipine:
a. It’s a milky white color
b. It’s contraindicated in patients with a soy or egg allergy
c. It’s a non-DHP CCB
d. It can be prepared for administration using a non-sterile technique
e. This lipid emulsion provides 2 kcal/mL
a, b, e
Which of the following meds are classified as direct vasodilators?
a. Labetalol
b. Hydralazine
c. Minoxidil
d. Methyldopa
e. Doxazosin
b, c
The hospital receives the following order for a 74 y/o M admitted to the ER with hypertensive urgency: “Nifedipine IR 60 mg TID x 24 hours”
The pharmacist doesn’t process the order because the patient would be at risk for which of the following?
a. DILE
b. Severe angioedema
c. Hemolytic anemia
d. Gynecomastia
e. Profound hypotension
e
Choose the correct statement regarding carvedilol to carvedilol CR dosing:
a. Carvedilol 25 mg BID is equivalent to Coreg CR 40 mg daily
b. Carvedilol 6.25 mg BID is equivalent to Coreg CR 20 mg daily
c. Carvedilol 12.5 mg BID is equivalent to Coreg CR 30 mg daily
d. Carvedilol 3.125 mg BID is equivalent to Coreg CR 5 mg daily
e. Carvedilol 25 mg BID is equivalent to Coreg CR 20 mg daily
b
Which of the following should not be taken with grapefruit juice?
a. Lopressor
b. Accupril
c. Avapro
d. Dyazide
e. Procardia XL
e
Which of the following statements are true regarding enalapril?
a. It can retain potassium; potassium levels must be monitored
b. It shouldn’t be used in patients with bilateral renal artery stenosis
c. It comes in an oral and patch formulation
d. It can cause a dry, hacking cough
e. It has been shown to be beneficial in slowing progression of diabetic kidney disease
a, b, d, e
A patient with diabetes, HTN, and peptic ulcer disease is on aspirin, glyburide, enalapril, metoprolol, chlorthalidone, and famotidine. Which of the patient’s meds may block signs and symptoms of hypoglycemia?
metoprolol
JB has a PMH significant for systolic HF and HTN. He’s being seen in the clinic for routine follow-up. He is on quinapril 20 mg BID, Toprol XL 200 mg QD, furosemide 20 mg BID, spironolactone 25 mg QD. His BP has been been averaging 154/94 mmHg and his HR is averaging 65 bpm. Which medication can be safely added to provide better control of his BP?
a. Amlodipine
b. Diltiazem
c. Losartan
d. Eplerenone
e. Carvedilol
a
Amlodipine has been shown to have a neutral effect on outcomes in patients with systolic HF. It’s considered the safest if a CCB must be used to lower BP in HFrEF.
Which of the following ACE inhibitors has the shortest half-life?
a. Enalapril
b. Monopril
c. Captopril
d. Lisinopril
e. Accupril
c
JG is a white male who presents with high BP on several visits. Which classes of meds are appropriate initial therapy for JG?
a. Potassium-sparing diuretics
b. ACE inhibitors
c. ARBs
d. CCBs
e. Thiazide-type diuretics
b, c, d, e
Which of the following are possible side effects of felodipine?
a. Peripheral edema
b. Flushing
c. Hypokalemia
d. Gingival hyperplasia
e. Hyperuricemia
a, b, d
JF is a 62 y/o AAM. His potassium level is 4.2, Na 141, BUN 24, and SCr 1.2. JF’s current meds include atenolol and citalopram. The physician is considering starting fosinopril. JF has a risk factor for developing angioedema. Which risk factor for angioedema is present in this patient?
a. Age
b. Gender
c. Race
d. Concurrent meds
e. Electrolyte profile
c
There is a higher incidence of angioedema in black patients.
Which of the following meds should be taken with food?
a. Carvedilol IR
b. Metoprolol succinate
c. Metoprolol tartrate
d. Carvedilol CR
e. Bisoprolol
a, b, c, d
JB has been taking ticagrelor 90 mg BID for 3 months. Which of the following new orders should not be filled by the pharmacist and why?
a. Enoxaparin 1 mg/kg every 12 hours
b. Warfarin 2 mg daily
c. Metoprolol XL 50 mg daily
d. Morphine 1 mg IV every 2-4 hours PRN pain
e. Aspirin 325 mg daily
e
Maintenance doses of aspirin > 100 mg reduce the effectiveness of ticagrelor
RS is a 57 y/o man, presenting for his annual cardiology appointment. He is currently being treated for OA, GERD, HTN, and MI 5 years ago. His current med list includes acetaminophen, aspirin, atorvastatin, benazepril, famotidine, HCTZ, metoprolol, and NTG spray. Which of the following meds must RS continue indefinitely following the MI?
a. Aspirin
b. Atorvastatin
c. Benazepril
d. HCTZ
e. NTG
a, b, c, e
Which of the following meds work by blocking the binding of fibrinogen, von Willebrand factor, and other ligands at the glycoprotein IIb/IIIa receptor?
a. Eptifibatide
b. Fondaparinux
c. Bivalirudin
d. Ticagrelor
e. Vorapaxar
a
Which of the following are likely signs/symptoms of a heart attack?
a. Chest pain or pressure that lasts more than a few minutes
b. Shortness of breath
c. Incontinence
d. Sweating
e. Seizure
f. Radiating pain
a, b, d, f
can present with ECG changes such as ST depression or prominent T wave inversion
Unstable angina and NSTEMI
A pharmacist covering the ED receives an order for tissue plasminogen activator (tPA) 15 mg IV bolus, 50 mg over 30 min, then 35 mg over 1 hour. Total dose = 100 mg. What drug is being ordered?
a. Abciximab
b. Alteplase
c. Epitifibatide
d. Tenecteplase
e. Tirofiban
b
Which of the following are contraindications to fibrinolysis for STEMI?
a. Active internal bleeding
b. Hypersensitivity to soy products
c. Recent ischemic stroke
d. Recent minor surgery
e. Severe uncontrolled hypertension
a, c, e
Which of the following NSAIDs would be considered the safest in patients who have had an MI?
a. Celecoxib
b. Naproxen
c. Diclofenac
d. Meloxicam
e. Etodolac
b
Which of the following is an advantage of using NTG in a patient with chest pain?
a. Increases BP
b. Increases preload
c. Dilates coronary arteries
d. Reduces anxiety
e. Helps with fibrinolysis
c
If the nearest facility capable of performing PCI is ~2 hours away, within how many minutes of arrival at the rural hospital should a fibrinolytic be administered?
a. 30 min
b. 60 min
c. 120 min
d. 270 min
e. STEMI patients are not candidates for fibrinolytic therapy
a
A patient at the hospital is receiving morphine for chest pain. What are the advantages of using morphine in a patient with chest pain?
a. Provides analgesia
b. Reduces preload
c. Reduces myocardial oxygen demand
d. Reduces respiratory rate
e. Increases BP
f. Decreases myocardial oxygen supply
g. Increases ejection fraction
a, b, c
Which of the following are risk factors for an acute coronary syndrome?
a. Atrial fibrillation
b. Dyslipidemia
c. Diabetes
d. Excessive exercise
e. Hypertension
f. Hypothyroidism
g. Smoking
h. Age > 40 y/o
b, c, e, g
What drugs should be avoided when using clopidogrel?
omeprazole and esomeprazole
Which of the following meds can cause thrombotic thrombocytopenic purpura?
a. Clopidogrel
b. Effient
c. Eptifibatide
d. Tenecteplase
e. Vorapaxar
a, b
What is the primary reason for using aspirin in a patient with chest pain?
a. Inhibit platelet aggregation
b. Provide moderate degree of analgesia
c. Increase mortality in patients with STEMI
d. Prevent flushing
e. Break down the clot
a
What is the MOA of tenecteplase?
a. Binds to fibrin and converts plasmin to plasminogen
b. Binds to antithrombin and converts thrombin to fibrin
c. Binds to thrombin and converts fibrinogen to fibrin
d. Binds to thrombin and converts fibrin to fibrinogen
e. Binds to fibrin and converts plasminogen to plasmin
e
What is the half-life of amiodarone?
a. 4 hours
b. 24 hours
c. 3 days
d. 60 days
e. 1 year
d
Which of the following meds has the lowest risk of QT prolongation?
a. Quinidine
b. Procainamide
c. Dofetillide
d. Diltiazem
e. Amiodarone
d
What classes of antiarrhythmics can increase or prolong the QT interval?
Ia, Ic, III
What is the function of a Holter moniter?
a. To detect intermittent arrhythmias in an ambulatory setting
b. To provide rate control in atrial fibrillation
c. To identify electrolyte disorders impacting cardiac function
d. To disrupt abnormal electrical signals to restore sinus rhythm
e. To provide rhythm control in atrial fibrillation
a
A man comes into the ED complaining of dizziness and poor balance since yesterday. His wife states that he has been lethargic and confused since waking up today. He loses consciousness shortly after arrival at the hospital. His ECG showed QTc 600 milliseconds and Torsade de Pointes. His home meds are amitriptyline, quetiapine, amlodipine, losartan, acetaminophen, and methadone.
Which of his home meds could have contributed to the arrhythmia?
Amitriptyline, methadone, quetiapine
A pharmacist on internal medicine rounds overhears the cardiologist saying that a “rate control strategy with stroke prophylaxis” will be used for a patient. Which group of meds is most appropriate?
a. Dofetilide + aspirin
b. Digoxin + flecainide
c. Diltiazem + clopidogrel
d. Propafenone + warfarin
e. Metoprolol + apixaban
e
Which drug is correctly matched with its Vaughan Williams class?
a. Flecainide: Class III
b. Amiodarone: Class Ia
c. Lopressor: Class III
d. Cardizem: Class IV
e. Lidocaine: Class II
d
Which of the following are symptoms of digoxin toxicity?
a. Constipation
b. Bradycardia
c. Greenish-yellow halos around lights
d. Loss of appetite
e. Respiratory depression
b, c, d
What is the therapeutic range for digoxin when used for atrial fibrillation?
a. < 0.5 ng/mL
b. 0.5-0.9 ng/mL
c. 0.8-2 ng/mL
d. 2.5-3.5 ng/mL
e. 5-10 ng/mL
c
MJ is a 52 y/o M with paroxysmal atrial fibrillation, HTN, and dyslipidemia. He presents to the pharmacy complaining of ringing in the ears, blurred vision, and confusion. Which antiarrhythmic is most likely causing his symptoms?
a. Quinidine
b. Amiodarone
c. Diltiazem
d. Digoxin
e. Procainamide
a
What do you do when you need to convert someone’s PO digoxin to IV digoxin?
decrease PO digoxin dose by 20-25%
CF is a 60 y/o M admitted to the hospital after a MVA. He takes digoxin 0.125 mg PO daily at home for rate control of atrial fibrillation. On admission, his serum digoxin level is therapeutic. He will be NPO for numerous surgeries over the next several days. What equivalent dose of IV digoxin should be recommended?
a. Digoxin 0.025 mg IV daily
b. Digoxin 0.1 mg IV daily
c. Digoxin 0.125 mg IV daily
d. Digoxin 0.16 mg IV daily
e. Digoxin 0.25 mg IV daily
b
Slow acetylation of procainamide increases which of the following risks?
a. Drug accumulation
b. Lower serum concentration
c. Decreased efficacy
d. Increased toxicity
e. Falsely elevated serum concentrations
a, d
A patient presents with SVT. The rhythm is terminated with adenosine. Which of the following correctly describes the pharmacology of adenosine?
a. Beta 1 receptor agonist
b. Calcium channel antagonist
c. Potassium channel agonist
d. Sodium channel antagonist
e. Adenosine receptor agonist
e
Which of the following drugs is used to control ventricular rate in a patient presenting in atrial fibrillation with a rapid ventricular response?
a. Quinidine
b. Digoxin
c. Lidocaine
d. Procainamide
e. Mexiletine
b
What lab abnormalities increase the risk for digoxin toxicity?
hypokalemia, hypomagnesemia, hypercalcemia
Dofetilide must be started in the inpatient setting in order to facilitate required monitoring of which of the following?
a. Thyroid function tests
b. Hemoglobin and hematocrit
c. ECG
d. Liver function
e. Renal function
c, e
A patient’s ECG indicates a tachyarrhythmia. Which of the following may have precipitated his arrhythmia?
a. Gout
b. Electrolyte abnormality
c. Illicit drug use
d. Infection
e. Hypothyroidism
b, c, d
A patient who works in the fields of a farm is seen by his PCP for a blue-grey skin discoloration of the face and forearms. The patient states that he normally wears a hat, a short-sleeved shirt, and pants when working. Which antiarrhythmic is the patient likely receiving?
a. Procainamide
b. Lidocaine
c. Ibutilide
d. Sotalol
e. Amiodarone
e
Put the following steps of normal electrical cardiac conduction in the correct order.
a. Purkinje fibers
b. Right and left bundle branches
c. AV node
d. SA node
e. Bundle of His
d, c, e, b, a
Adenosine is used to treat what type of arrhythmia?
a. Atrial fibrillation
b. Ventricular arrhythmias
c. Torsade de Pointes
d. Paroxysmal supraventricular tachycardia
e. Pulseless ventricular tachycardia
d
Which meds are used only IV for treating arrhythmias?
a. Quinidine and sotalol
b. Digoxin and disopyramide
c. Propafenone and procainamide
d. Dofetilide and flecainide
e. Ibutilide and lidocaine
e
What is the most common dose of nitroglycerin in short-acting products?
0.4 mg or 400 mcg
The pharmacist receives a new prescription for isosorbide mononitrate IR BID. When should the patient take the medication?
take at 8 am and 3 pm
HJ uses a NTG transdermal patch 0.6 mg/hr for stable ischemic heart disease. Which of the following is true?
a. Short-acting NTG is not needed for acute chest pain episodes
b. The preferred site of application is the chest
c. Apply the patch in the morning; wear for 20-24 hours, then remove
d. A heating pad should be applied over the patch to improve response
e. Use the measuring applicator to cut the patch to the correct size
b
What drugs are contraindicated when a patient is on a nitrate?
PDE-5 inhibitors
SR is a 48 y/o female who presents to the ER and is diagnosed with an ischemic stroke. She weighs 250 lbs and her CrCl is 60 mL/min. The pharmacist receives an order for alteplase 0.9 mg/kg x 1. Which of the following represents the most appropriate course of action for the pharmacist?
a. Verify this order as written and dispense 100 mg of alteplase
b. Reject this order; alteplase should only be given to patients who weigh < 200 lbs
c. Verify this order as written and dispense 90 mg of alteplase
d. Institute a therapeutic interchange to enoxaparin and dispense
e. Recommend heparin instead because of the patient’s creatinine clearance
c
What is an appropriate route of administration for nimodipine?
oral
JL had a stroke and has been given a prescription for aspirin + ER dipyridamole. JL might experience which of the following side effects?
a. Bleeding
b. Headache
c. Dyspepsia
d. Heartburn
e. Hypertension
f. TTP
a, b, c, d
If a patient is taking amiodarone, what are the max doses of simvastatin and lovastatin that they can take?
simvastatin 20 mg/day
lovastatin 40 mg/day
LDL formula
LDL = TC - HDL - (TG/5)
A patient is currently on hydrochlorothiazide, ambien, levothyroxine, and a prenatal MVI. Which of the following meds could contribute to her lipid panel abnormalities?
hydrochlorothiazide
What is the target dose for Valsartan in HF?
160 mg BID
A patient is currently taking furosemide PO 40 mg BID. What is the equivalent dose of furosemide in IV form?
20 mg BID
BP >/= 180/120 and there is no evidence of acute target organ damage
hypertensive urgency
BP >/= 180/120 and patient has acute target organ damage that may be life-threatening (e.g., encephalopathy, stroke, AKI, acute coronary syndrome)
hypertensive emergency
Which electrolyte abnormalities can occur with the use of chlorthalidone?
a. Hyperkalemia
b. Hyponatremia
c. Hypokalemia
d. Hypercalcemia
e. Hypomagnesemia
b, c, d, e
Chlorthalidone can cause which side effect?
a. Peripheral edema
b. Hypermagnesemia
c. Increased uric acid
d. Decreased LDL cholesterol
e. Increased cough
c
Treating HTN will reduce the risk of which of the following?
a. Stroke
b. Kidney disease
c. Heart disease
d. Cancer
e. Thyroid disorders
a, b, c
A pharmacist has received a new prescription for oral amiodarone for a patient. The pharmacist should counsel the patient on risks to which organs with amiodarone therapy?
a. Eyes
b. Liver
c. Lungs
d. Pancreas
e. Thyroid
a, b, c, e
How should the patient be counseled if they are on NitroMist?
a. Do not shake
b. Call 911 if chest pain is not relieved after the 1st dose
c. Inhale the medication with a quick, deep breath
d. Use twice daily at 7 am and 3 pm to provide a nitrate-free interval
e. This medication can cause a headache, flushing, or a drop in BP
a, b, e
What counseling point should a pharmacist provide on NitroStat?
a. Place 1 tablet under the tongue and swallow with a full glass of water
b. Take 1 tablet at the first sign of chest pain. Continue to take 1 tablet every 15 min until chest pain resolves
c. Store tablets in the original amber bottle at room temp
d. You will know it’s working when you feel a slight burning sensation
e. Take 1 tablet TID (at 8 am, 12 pm, and 4 pm) for a nitrate-free interval
c
What beta blockers have intrinsic sympathomimetic activity, and who are they not recommended in?
Acebutolol, pindolol, penbutolol
Post-MI patients
