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2022 Adv Pharm Faculty Landing Page > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Calcium Channel Blockers Mechanism of Action

A

Prevent calcium moving into cardiac and smooth muscle cells resulting in decreased cardiac muscle contraction and conduction, and vasodilation of the coronary arteries and peripheral arterioles

  • Decreases cardiac output
  • Decreases HR
  • Decreased coronary artery spasm
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2
Q

Which CCB decrease heart rate significantly?

A

Verapamil

Diltiazem

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3
Q

Which CCB cause significant vasodilation?

A

Dihydropyridines (nifedipine, amlodipine)

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4
Q

Calcium channel blockers Dihydropyridines clinical use

A

HTN

angina

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5
Q

Calcium channel blockers Non-dihydropyridines–clinical use

A

HTN

angina

atrial fibrillation/flutter

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6
Q

Calcium channel blockers non dihydropyridine–toxicity

A

cardiac depression

AV block

hyperprolactinemia

constipation

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7
Q

Calcium channel blockers dihydropyridine–toxicity

A

peripheral edema

flushing

dizziness

gingival hyperplasia

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8
Q

RAAS pathway

A
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9
Q

ACE inhibitors mechanism of action

A

Prevent angiotensin converting enzyme from converting angiotensin I to angiotensin II (vasodilator). Also stops breakdown of bradykinin (vasodilator).

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10
Q

Angiotensin Receptor Blocker mechanism of action

A

Prevent Angiotensin II from binding to receptor.

No impact on bradykinin.

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11
Q

ACE Inhibitor/ARB indications

A
  • HTN
  • CHF
  • Acute/post MI
  • Diabetic nephropathy
  • Proteinuria
  • Acute MI/post
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12
Q

ACE inhibitor/ARB Side Effects

A

Dizziness, hyperkalemia, elevated renal tests, angioedema

Dry cough in ACE inhibitors

Monitor renal function and electrolytes.

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13
Q

Thiazide diuretic indications

A

1st line therapy for hypertension (decreases risk for MI and CVA in HTN)

Edema

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14
Q

Thiazide diuretic adverse effects

A
  • Hypokalemia
  • Dehydration
  • Hyperglycemia
  • Hyperuricemia
  • Hyperlipidemia
  • Impotence
  • Hyponatremia
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15
Q

Loop diuretic mechanism of action

A

Inhibit Na/K/Cl cotransporter in the Loop of Henle which inhibits reabsorption of sodium and chloride leading to increased water excretion

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16
Q

Loop diuretic adverse effects

A
  • Risk of hypokalemia, hypocalcemia, hypomagnesemia, hyponatremia
  • Hyperuricemia
  • Hyperglycemia
  • Ototoxicity
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17
Q

Loop diuretic indications

A

Edema/fluid overload, CHF, cirrhosis, renal disease – most common use

Hypertension- less effective than thiazides at lowering BP

18
Q

Potassium sparing diuretics mechanism of action

A

Blocks Na+ movement in, and also prevents K+ movement out of cells

19
Q

Potassium sparing diuretics contraindications/caution

A

Use caution with other meds that may increase K (i.e. ACEI/ARB)

Caution in renal impairment

20
Q

Beta Blocker Mechanism of Action

A
  • Decreases heart rate (chronoropy)
  • Decreases strength of myocardial contraction (inotropy)
  • Block epinephrine and norepinphrine leading to decreased vasoconstriction
21
Q

Common Beta Blocker side effects

A
  • impotence
  • exacerbation of COPD and asthma
  • cardiovascular effects (bradycardia, AV block, HF)
  • CNS effects (sedation, sleep alterations)
  • may mask signs of hypoglycemia
22
Q

Cardioselective Beta Blockers

A
  • atenolol
  • esmolol
  • metoprolol
  • bisoprolol
  • nebivolol
23
Q

Alpha blocker mechanism of action and indications

A

Block the alpha 1 adrenergic receptor on vascular (arteriole and venule) smooth muscle and decrease vascular resistance

Used for HTN (not a first line agent) and BPH

24
Q

Alpha bockers adverse effects

A
  • First dose phenomenon hypotension
  • Reflex tachycardia
  • Dizziness
  • Palpitations
  • Headache
  • Orthostatic hypotension
25
Q

High intensity statins

A
  • Atorvastatin 40-80mg
  • Rosuvastatin 20-40mg
26
Q

Statin mechanism of action

A
  • HMG CoA inhibitors prevent the production of mevalonate – the building block of cholesterol
  • Reduced intrahepatic cholesterol synthesis
  • Upregulates expression of LDL receptor gene = more LDL receptors on the liver = lower LDL/triglycerides and higher HDL
27
Q

Statin Adverse Effects and Education

A
  • Myalgia (can be dose dependent)
  • Myopathy (can lead to rhabdo)
  • Headache
  • GI symptoms
  • Elevated LFTs (<1% of patients)
  • Increased risk for DM/hyperglycemia
  • ? Cognitive decline
  • Brain fog

Take at night

28
Q

Ezetimibe (Zetia) Contraindication

A

Contraindicated in patients with liver disease also on statins

29
Q

Bile Acid Sequesterants Mechanism of Action and Examples

A

Liver increases production of bile acids using cholesterol which is then secreted in the GI tract

Cholestyramine, colestipol, colesevelam

30
Q

Bile Acid Sequesterants Adverse Effects

A
  • GI upset
  • Decreased absorption of other medications
31
Q

PCSK9 Inhibitors Mechanism of Action

A
  • PCSK9 is an enzyme that degrades LDL receptors on the liver
  • Inhibitors bind to PCSK9 resulting in inhibition of receptor degredation leading to more LDL receptors lowering serum LDL

Not generally prescribed in PCP setting

32
Q

Fibrates Mechanism of Action and Indication

A

Increase lipoprotein lipase activity causing more rapid degredation of triglycerides and LDL

Mostly used for hypertriglyceridemia

33
Q

Which fibrate should be avoided with statin?

A

gemfibrozil

34
Q

Nitrate mechanism of action and indications

A
  1. Vasodilation of the peripheral arteries and veins which decreases volume of blood returning to heart (preload) which decrease workload.
  2. Vasodilation of coronary arteries causes increased blood flow and oxygen to heart.

Indications include acute and chronic angina, anal fissure, CHF and MI, peri/intraoperative BP management

35
Q

Short Acting Nitrate Education

A

Adminstration is buccal or sublingual to avoid first pass effect

Can be repeated after 5 minutes up to 3 administrations, still need to call 911

Needs to be refilled at least 1x a year (make sure unexpired)

Take while seated

36
Q

Long Acting Nitrate Education

A

Need a 10-12 hour nitrate free period per day to avoid tolerance

37
Q

Nitrate Adverse Effects and Contraindications

A
  • Headaches
  • Flushing
  • Dizziness
  • Hypotension
  • Syncope
  • Reflex tachycardia

Contraindicated with PDE-5 Inhibitors (Viagra/Cialis)

38
Q

Digoxin Mechanism of Action

A

Cardiac glycoside: Inhibits Na/K ATPase resulting in increased cardiac contractility and decreased AVE conduction/heart rate

39
Q

Digoxin indications

A
  • Afib
  • Treatment resistant heart failure
  • SVT
40
Q

Digoxin toxicity and treatment

A

Manifestations include N/V, diarrhea, blurry vision with yellow tint/halos, disorientation, weakness

Can lead to hyperkalemia and fatal arrhythmias

Treatment is digibind

2022 Adv Pharm Faculty Landing Page (22 decks)

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