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Résidence - Pharmacology > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Nomme des exemples : inhibiteurs de l’enzyme de conversion de l’angiotensine (IECA) (ACE inhibitor)

A

-PRIL
* Lisinopril
* Enalapril
* Captopril
* Ramipril

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2
Q

Décrire mécanisme : inhibiteurs de l’enzyme de conversion de l’angiotensine (IECA) (ACE inhibitor) (4)

A
  1. Inhibit angiotensin-converting enzyme
  2. Prevent conversion of angiotensin 1 to angiotensin 2
  3. Lower levels of angiotensin 2 = reduced aldosterone
  4. Lower blood pressure
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3
Q

Nommez les indications : inhibiteurs de l’enzyme de conversion de l’angiotensine (IECA) (ACE inhibitor) (4)

A
  • HTA
  • Chronic heart failure
  • Post MI
  • CKD progression prevention
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4
Q

Name advese effects : inhibiteurs de l’enzyme de conversion de l’angiotensine (IECA) (ACE inhibitor) (5)

A
  • Dry cough (Consider changing to ARA - sartan)
  • Acute kidney injury
  • Muscle cramps
  • Dizziness
  • HyperK+
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5
Q

Describe monitoring : inhibiteurs de l’enzyme de conversion de l’angiotensine (IECA) (ACE inhibitor) (2)

A
  • Blood pressure
  • K+ level
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6
Q

Name C-I : inhibiteurs de l’enzyme de conversion de l’angiotensine (IECA) (ACE inhibitor) (1)

A

Pregnancy (cause injury and death to the developping fetus)

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7
Q

Name patient advice : inhibiteurs de l’enzyme de conversion de l’angiotensine (IECA) (ACE inhibitor) (1)

A

Advise the first dose before bedtime (first-dose phenomenon)

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8
Q

Name exemples : Les antagonistes des récepteurs de l’angiotensine (ARA)

A

-SARTAN
* Losartan
* Telmisartan
* Valsartan

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9
Q

Describe mechanism of action : Les antagonistes des récepteurs de l’angiotensine (ARA) (3)

A
  1. Block angiotensin 2 receptor
  2. Blocking vasoconstriction effect and aldosterone scretion
  3. Lower blood pressure
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10
Q

Name indications : Les antagonistes des récepteurs de l’angiotensine (ARA) (4)

A
  • HTA
  • Chronic heart failure
  • Post MI
  • CKD progression prevention
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11
Q

Name adverse effects : Les antagonistes des récepteurs de l’angiotensine (ARA) (5)

A
  • HyperK+
  • Acute kidney injury
  • Muscle cramps
  • Dizziness

WON’T cause dry caugh

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12
Q

Describe monitoring : Les antagonistes des récepteurs de l’angiotensine (ARA) (2)

A
  • Blood pressure
  • K+ level
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13
Q

Name C-I : Les antagonistes des récepteurs de l’angiotensine (ARA) (1)

A

Pregnancy
Cause injury and death to the developping fetus

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14
Q

Name patient advice : Les antagonistes des récepteurs de l’angiotensine (ARA) (1)

A

Advise the first dose before bedtime (first-dose phenomenon)

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15
Q

Name class members of BETABLOCKERS

A

-LOL
* Metoprolol
* Atenolol
* Propanolol
* Labetalol
* Carvedilol
* Bisoprolol

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16
Q

Describe mechanism : Beta-blockers (4)

A
  1. Bloquer les récepteurs bêta dans le cœur et les vaisseaux
  2. Réduire FC, la contractilité et la pression artérielle
  3. ⬇️ travail ventriculaire gauche et des besoins en oxygène
  4. Résultat final: Réduire la pression artérielle, aider à lutter contre l’angine
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17
Q

Name indications : Beta-blockers (3)

A
  • Angina
  • MI prevention
  • CHF (only some BB can treat CHF)
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18
Q

Name BBlockers that can treat CHF (3)

A
  • Metoprolol XR
  • Carvedilol
  • Bisoprolol
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19
Q

Name adverse effects : Betablockers (4)

A
  • Bronchospasme
  • Dyspnée
  • Bradycardie et hypotension
  • Heart block
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20
Q

Name cautions : Betablockers (1)

A

In diabetic patients, it may mask signs of hypoglycemia

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21
Q

Name C-I : Betablockers (4)

A
  • Heart block
  • Severe hypotension
  • Uncontrolled HF
  • Poorly controlled airway disease
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22
Q

Describe monitoring : Betablockers (1)

A

Monitor blood pressure for efficacy

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23
Q

Describe mechanism : Hydralazine (3)

A
  1. Direct vasodilation of arterioles
  2. Reduces blood pressure

Exact MOA is still unknown

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24
Q

Name indications : Hydralazine (3)

A
  • Severe HTN
  • CHF
  • Hypertensive emergency in pregnancy (off-label)
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25
Q

Name adverse effects : Hydralazine (4)

A
  • Lupus-like syndrome
  • Reflex tachycardia
  • Flushing
  • GI upset
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26
Q

Describe : Drug-induced lupus syndrome (3)

A
  • Up to 10% of patients with hydralazine (at dose of > or = 200 mg, for 3 or more months)
  • Reversible upon discutinuation
  • Exact mechanism is unknown : may occur via IL-10 suppression at higher doses of hydralazine
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27
Q

Name class members : Bloqueur des canaux calciques (BCC) (4)

A

Dihydropyridine (DHP)
* Nifedipine
* Amlodipine

Non-Dihydropyridine (non-DHP)
* Diltiazem
* Verapamil

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28
Q

Describe mechanism : Bloqueur des canaux calciques (BCC) (4)

A
  1. Empêche le Ca de pénétrer dans le canal lent du muscle lisse vasculaire
  2. = vasodilatation coronarienne
  3. Augmenter l’apport d’oxygène au myocarde chez les patients souffrant d’angine
  4. Pour -dipine, agit également sur les muscles lisses vasculaires pour produire une vasodilatation artérielle périphérique et réduire la TA
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29
Q

Name indications : Bloqueur des canaux calciques (BCC) (3)

A
  • Hypertension
  • Prevention of angina
  • Supra-ventricular tachycardia (Verapamil)
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30
Q

Name adverse effects : Bloqueur des canaux calciques (BCC) (4)

A
  • Peripheral edema
  • Flushing
  • Palpitation
  • Dizziness
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31
Q

Describe caution : Bloqueur des canaux calciques (BCC) (2)

A
  • In practice, mainly dihydropyridines are used for hypertension
  • If induced edema occurs, cessation of treatment (but not adding diuretics)
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32
Q

Describe monitoring : Bloqueur des canaux calciques (BCC) (1)

A

Monitor blood pressure for efficacy

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33
Q

Describe mechanism : Nitrate (6)

A
  • Fournir une source exogène d’oxyde nitrique
  • Détente des muscles lisses
  • Provoquer une vasodilatation
  • Réduire le travail cardiaque et la congestion pulmonaire
  • Diminuer les besoins en oxygène du cœur.
  • Résultat final : Aide en cas d’insuffisance cardiaque et d’angine de poitrine.
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34
Q

Name class members : Nitrate (3)

A
  • Isosorbide mononitrate
  • Isosorbide dinitrate
  • Glycery trinitrate (GTN)
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35
Q

Name indications : Nitrate (2)

A
  • Angina : GTN for acute relief, mononitrate/dinitrate for prevention
  • CHF
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36
Q

Describe caution : Nitrate

A

Nitrate-free interval : need 10-12 hours each day

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37
Q

Name C-I : Nitrate (1)

A

Inhibiteurs de la phosphodiestérase-5 (PDE-5) (ex.:viagra) within 24h

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38
Q

What are the 5 types of diuretics?

A
  • diurétiques thiazidiques
  • diurétiques de l’anse
  • épargneurs de potassium
  • diurétiques osmotiques
  • inhibiteurs de l’anhydrase carbonique.
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39
Q

Décrire méchanisme : Diurétiques de l’anse (5)

A
  • Inhibe la réabsorption de Na et Ca
  • Agissant principalement sur le site : Anse ascendante de Henlé, tubules proximaux et tubules rénaux distaux
  • Effet natriurétique
  • Résultat final : Effet diurétique très puissant
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40
Q

Nommez exemples : Diurétiques de l’anse (2)

A
  • Furosemide
  • Bumetanide
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41
Q

Name indications : Diurétiques de l’anse (2)

A
  • Edema due to CHF
  • Ascites due to cirrhosis (Usually use with spironolactone)
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42
Q

Name adverse effects : Diurétiques de l’anse (6)

A
  • Acute kidney injury (due to fluid loss)
  • Electrolyte loss
  • Ototoxicity
  • Angioedema
  • Urticaria
  • Gout (hyperuricemia)
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43
Q

Describe monitoring : Diurétiques de l’anse (5)

A
  • Electrolyte impact : Hypo - K, Na, Mg
  • Monitor : K, Na, Mg, weight, fluid in/out
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44
Q

Describe caution : Diurétiques de l’anse (1)

A

Aggravation of hyperuricemia (gout)

45
Q

Describe patietn advice : Diurétiques de l’anse (2)

A
  • There will be increased urine output
  • 2nd dose before 6PM for toilet time before sleep
46
Q

Décrire mécanisme : Diurétique Thiazide (4)

A
  • Inhibe la réabsorption de Na
  • Agissant principalement sur le côté : Tubules distaux
  • Augmenter l’excrétion de Na, K et d’eau
  • Résultat final : effet diurétique modéré
47
Q

Name class member : Diurétique Thiazide (1)

A

Hydrochlorothiazide

48
Q

Name class member : Diurétique Thiazide (4)

A
  • Hypertension
  • Calcium nephrolithiasis
  • Nephrogenic diabetes insipidus
  • Refractory edema
49
Q

Name adverse effects : Diurétique Thiazide (4)

A
  • Electrolyte disturbances
  • Gout (hyperuricemia)
  • Skin photosensitivity (risk on repeated use)
  • Myopia and acute angle-closure glaucoma (reversible)
50
Q

Describe monitoring : Diurétique Thiazide (4)

A
  • Hypo : K, Na, Mg
  • Hyper : Ca
51
Q

Describe caution : Diurétique Thiazide (1)

A

Beware of sulfa allergy (cross reactivity)

52
Q

Décire mécanisme : Diurétiques épargneurs de potassium (3)

A
  • Inhiber le récepteur minéralocorticoïde
  • Agissant principalement sur le site : Tubules rénaux distaux
  • Augmentation de l’excrétion de Na et d’eau, tout en préservant le niveau de K
53
Q

Name indications : Diurétiques épargneurs de potassium (2)

A
  • Aldosteronism
  • Usually used with other diuretics to preserve K level (loop and thiazide both cause hypo-K)
54
Q

Name adverse effects : Diurétiques épargneurs de potassium (4)

A
  • Gynecomastia
  • HyperK+
  • Menstrual irregularities
  • Metabolic acidosis
55
Q

Describe monitoring : Diurétiques épargneurs de potassium (4)

A
  • Hypo : Na, Ca, Mg
  • Hyper : K
56
Q

Describe C-I : Diurétiques épargneurs de potassium

A

Hyper K+
Risk increased when used with ACEI/ARB

57
Q

Describe mechanism : Clopidogrel (3)

A
  • Activer le bloc métabolite P2Y12 du récepteur ADP (irréversiblement)
  • Empêche l’activation du complexe récepteur GPIIb/IIIa
  • Résultat final: réduire l’agrégation plaquettaire
58
Q

Name indications : Clopidorel (3)

A
  • Post-syndrome coro aigu (peut être utilisé avec de l’aspirine ensemble comme bithérapie antiplaquettaire)
  • 2ème prévention des accidents vasculaires cérébraux, AIT et cardiopathie ischémique
  • Intolérance à l’aspirine
59
Q

Name adverse effects : Clopidogrel (3)

A
  • Saignement
  • Purpura thrombotique thrombotique
  • Troubles gastro-intestinaux
60
Q

Describe caution with surgeries : Clopidogrel

A

Stop 5 days

61
Q

Compare clopidogrel and aspirin (4)

A

Compare to aspirin :
* Moins d’événements hémorragiques majeurs composites
* Diminution du risque d’AVC ischémique aigu récurrent
* Risque moindre d’événements cardiovasculaires composites
* Diminution du risque d’hémorragie intracrânienne

62
Q

Describe mechanism : Aspirin (3)

A
  • Inhibe les enzymes COX-1 et 2 (de manière irréversible)
  • Diminution de la synthèse de TXA2 par les plaquettes
  • Résultat final : Réduire l’agrégation plaquettaire
63
Q

Name indications : Aspirin (4)

A
  • Acute MI
  • Unstable angina
  • 2nd prevention of stroke, TIA and IHD
  • Use as NSAID (in high dose)
64
Q

Name adverse effects : Aspirin (5)

A
  • GI ulcer (decreased prostaglandin)
  • Risk of bleeding
  • Decreased RFT
  • Dyspepsia
  • Abdominal pain
65
Q

Name cautions for allergy : Aspirin

A

Allergy check : NSAID, salicylate

66
Q

Name cautions for surgery : Aspirin

A

Stop 7-14 days

67
Q

When to take aspirin?

A

Take with or after food

68
Q

Name class members : Statin

A

-statin
* Simvastatin
* Atorvastatin
* Rosuvastatin

69
Q

Describe mechanism : Statin (6)

A
  • Inhibit HMG-CoA reductase
  • Block the rate-limited step of cholesterol biosynthesis
  • Reduce intrahepatic cholesterol
  • Increase expression of LDL receptors
  • Stimulate of LDL catabolism
  • End result : Decrease LDL and
70
Q

Name indications : Statin (2)

A
  • 1st-line drug for hyperlipidemia (esp. for high LDL)
  • Prevention of artherosclerotic CV disease
71
Q

Name adverse effects : Statin (4)

A
  • Muscle-related effect (myopathy, rhabdomyolysis)
  • Hepatotoxycity (Increased AST-ALT)
  • GI upset
  • Proteinuria
72
Q

Describe monitoring : Statin (2)

A
  • Baseline monitorin : liver function test, Renal Function Test
  • If muscle ADR occurs : CK
73
Q

Name C-I : Statin

A

Pregnancy

74
Q

Name interaction : Statin (1)

A

Interaction with CYP3A4 inhibitox

75
Q
A
76
Q

Name patient advise : Statin (2)

A
  • Take in evenin
  • Counsel on signs of muscle ADR
77
Q

Name indications : Warfarin (2)

A
  • 1st, 2nd prevention of stroke, ACS and VTE
  • Prevention of TE with prosthetic heart valves
78
Q

Name adverse effect : Warfarin (6)

A
  • Bleeding risk
  • Nephropathy
  • Vascular calficiation
  • Skin necrosis
  • Purple-toe syndrome
  • Abdominal pain
79
Q

Describe mechanism : Warfarin (4)

A
  • Inhibe la vitamine K époxyde réductase
  • Diminuer la conversion “active” de la vitamine K
  • Diminution de la formation de facteurs fonctionnels de coagulation 2,7,9,10, protéine C et protéine S
  • Résultat final: plus difficile à former un caillot sanguin
80
Q

Describe monitoring : Warfarin (3)

A
  • Narrow therapeutic index : monitor INR for efficacy
  • Target INR : usually 2-3
  • Target 2.5 - 3.5 for mechanical aortic valve
81
Q

Describe caution : Warfarin (4)

A
  • Pregnancy
  • CYP2C9 inhibitor
  • Alcoholism interaction
  • Vit K food (advise stable intake)
82
Q

Describe patient advice : Warfarin (2)

A
  • Signes of bleeding ADR
  • Onset usually around 2-3 days
83
Q

Name class members : Anticoagulants oraux directs (4)

A

Inhibiteur direct de la thrombine
* Dabigatran

Inhibiteur direct de Xa
* Apixaban
* Edoxaban
* Rivaroxaban

84
Q

Name indication : Anticoagulants oraux directs

A

2nd prevention of stroke or systemic embolism in AF

85
Q

Name indication : Anticoagulants oraux directsName adverse effects (5)

A
  • Bleeding risk
  • GI upset
  • Anaemia
  • Renal clearance
  • Deranged FLT and bilirubin
86
Q

Describe mechanism : Inhibiteur direct de la thrombine (Anticoagulants oraux directs) (4)

A
  • Inhibit both free and fibrin-bound thrombin
  • Prevent conversion of fibrinogen to fibrin
  • Prevent platelet aggregation
  • End result : Harder to form blood clot
87
Q

Describe mechanism : Inhibiteur direct de Xa
(Anticoagulants oraux directs) (3)

A
  • Selectively inhibitt factor Xa
  • Block thrombin production
  • End reuslt : Harder to form blood clot
88
Q

Name antidote for Dabigatran

A

Idarucizumab

89
Q

Comparez Anticoagulants oraux directs et Warfarin (4)

A
  • No need to monitor INR
  • No food interaction
  • Lower bleeding risk
  • Fixed-dose
90
Q

Name patient advise : Anticoagulants oraux directs (2)

A
  • Dabigatran : Swallow the whole capsule, do not open
  • Take with meal, may help with GI upset
91
Q

Name class members : Heparin (2)

A
  • Unfractionated Heparin
  • Enoxaparin
92
Q

Name indications : Heparin (3)

A
  • Prevention and tx of VTE
  • Prvention of ACS
  • Used for bridging between warfarin
93
Q

Name adverse effects : Heparin (4)

A
  • Heparin-induced thrombocytopenia
  • Risk of bleeding
  • Rversible alopecia
  • Osteoporosis
94
Q

Describe mechanism : Heparin (4)

A
  • Bind to anti-thrombin
  • Inactive factors IIa, IXa, Xa, XIa, XIIa and plasmin
  • Prevents conversion of fibrinogen to fibrin
  • End result : Result the formation of fibrin
95
Q

Describe monitoring : Heparin (2)

A
  • Renal function
  • aPTT (Activated Partial Thromboplastin Time)
96
Q

Describe patient advise : Heparin (1)

A

Can be used for bridging warfarin gap in surgery in high risk patients

97
Q

Name antidote : Heparin (1)

A

Protamine sulfate

98
Q

Name indications : Amiodarone (2)

A
  • Ventricular arythmia
  • Used as rate-control agent
99
Q

Name adverse effects : Amiodarone (8)

A
  • **Pulmonary toxicity **
  • Thyroid effects (either hyper or hypo)
  • Corneal microdeposits
  • Bradycardia
  • Hypotension
  • Hepatotoxicity
  • Photosensitivity
  • Proarrhytmic effect
100
Q

Describe mechanism : Amiodarone (4)

A
  • Inhibits adrenergic stimulation
  • Block Na, Ca, K chennels
  • Prolong the action potential and refractory period in myocardial tissue
  • End result : Decreases AV conduction and sinus node function
101
Q

Name C-I : Amiodarone (1)

A

Iodine

102
Q

Describe monitoring : Amiodarone (5)

A
  • Thyroid function test
  • Liver function test
  • Chest X-ray
  • Eye examination
  • Pulmonary function
102
Q
A
103
Q

Name indications : Digoxin (4)

A
  • Heart failure (HFrEF)
  • Atrial fibrillation
  • Atrial flutter
  • Supraventricular tachyarrhythmia
104
Q

Name adverse effect : Digoxin (5)

A
  • Digoxin toxicity (visual disturbances halos, n-vo, lethargy, arrythmias)
  • Anorexia
  • Nightmares
  • Agitation
  • GI upset
105
Q

Describe caution : Digoxin

A

TDM
Draw serum level 12-24hours after a dose

106
Q

Describe monitoring : Digoxin (4)

A
  • Renal function test
  • Serum drug concentration (TDM)
  • K level (predispose digoxin toxicity)
  • Pulse rate (withhold if < 60 beats/min)
107
Q
A

Résidence - Pharmacology (4 decks)

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