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Pharm III FINAL (ASL πŸ‘΅πŸ»πŸˆπŸŒ­) > Cardiovascular (Lauren🌭) > Flashcards

Cardiovascular (Lauren🌭) Flashcards

1
Q

What effects does the Sympathetic Nervous system have on the cardiovascular system?

A

Increased HR (chronotropy)

Increased contractility (Inotropy)

Coronary vasodilation

Increased renin release

Blood vessels: α constricts (skin, splanchnic) and ß dilates (skeletal muslce)

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2
Q

What kinds of physical exam findings would you expect from someone with CHF who stopped taking their diuretic?

A

Unable to complete full sentences

+JVD

Crackles in lung bases

3+ pitting edema

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3
Q

What is the BEST class of drug for someone who is completely fluid overloaded that will get all the fluid off really fast

A

Loop diuretics

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4
Q

What are the 4 loop diuretics?

A

Furosemide (Lasix)

Torsemide (Demadex)

Bumetanide (Bumex)

Ethacrynic Acid (Edecrin)

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5
Q

What is the contraindication to 3 of the loop diuretics

A

Sulfa allergy

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6
Q

Which loop diuretic is OK for someone with a sulfa allergy

A

Ethacrynic acid

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7
Q

What is the big risk of ethacrynic acid

A

Ototoxicity πŸ‘‚πŸ»

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8
Q

What are the main side effects of all loop diuretics?

A

Hypokalemia

Hyponatremia

Hypocalcemia

Hyperuricemia (may precipitate gout at HIGH doses)

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9
Q

What kind of supplement might you want to give your patient who is on a loop diuretic?

A

Potassium

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10
Q

Is it ok to give Loop Diuretics or Thiazides to patients who are anuric (Don’t make pee)

A

NO you dumbass

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11
Q

What are the 3 thiazide diuretics?

A

HCTZ (Microzide)

Chlorothiazide (Diuril)

Metolazone (thiazide related)

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12
Q

What is the contraindication to HCTZ and Chlorothiazide?

A

Sulfa allergy

Metolazone, the thiazide-related diuretic just has a ~caution~ for sulfa allergy

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13
Q

What are the side effects of thiazide diuretics?

A

Hypokalemia

Hyponatremia

Hyperuricemia (may precipitate gout at HIGH doses)

Hypercholesterolemia

Hyperglycemia

Erectile dysfunction

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14
Q

What are the 2 drugs that are aldosterone antagonists?

A

Spironolactone (Aldactone)

Eplerenone (Inspra)

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15
Q

What are the 2 drugs that are K+ sparing diuretics?

A

Triamterene (Dyrenium)

Amiloride

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16
Q

What is the MOA of Triamterene (Dyrenium) and Amiloride?

A

Direct inhibitors of Na+ flux

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17
Q

Which one of these diuretics can you use by itself:

Spironolactone (Aldactone)

Eplerenone (Inspra)

Triamterene (Dyrenium)

Amiloride

A

NONE of them.

They’re all weak diuretics and are used in combination with other diuretics. (May eliminate the need for K+ supplementation)

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18
Q

What are the common contraindications oF all these:

Spironolactone (Aldactone)

Eplerenone (Inspra)

Triamterene (Dyrenium)

Amiloride

A

Hyperkalemia

Anuria

Severe kidney problems

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19
Q

What is the side effect of all of these:

Spironolactone (Aldactone)

Eplerenone (Inspra)

Triamterene (Dyrenium)

Amiloride

A

Hyperkalemia

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20
Q

What is a ~relative~ contraindication to these:
Spironolactone (Aldactone)

Eplerenone (Inspra)

Triamterene (Dyrenium)

Amiloride

A

If they are also on an ACE or ARB

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21
Q

What 2 classes of drugs will reduce mortality and improve symptoms in someone with HF?

A

ACE inhibitors

ß blockers

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22
Q

What are the absolute contraindications of ACE inhibitors

A

Angioedema

Pregnancy

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23
Q

What is the MOA of ACE inhibitors?

A

Block ACE and stop the formation of angiotensin II

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24
Q

ACE inhibitors decrease (preload/afterload/both)

A

Both

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25
Q

What conditions are treated with ACE inhibitors/

A

HFrEF

HTN

STEMI

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26
Q

What are the side effects of ACE inhibitors?

A

Dry cough

Orthostatic hypotension

Hyperkalemia

Angioedema

Rash

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27
Q

Which two drug classes are considered first line for patients with diabetes, CKD, and HFrEF?

A

ACE inhibitors and ARBs
*********

(Had a blue star on it)

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28
Q

What are the contraindications to ß-blockers?

A

Severe bradycardia

2nd or 3rdΒΊ AV block

Uncompensated HF

Systolic BP under 100

Cardiogenic shock

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29
Q

What would happen if your patient who takes a ß-blocker goes on vacation and forgets to bring their medicine?

A

They’ll die

Abrupt withdrawal can cause acute coronary events and severe increases in BP

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30
Q

What are the Non-Selective ß-blockers?

A

Propranolol (Inderal)

Nadolol (Corgard)

Timolol

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31
Q

What are the cardioselective ß-blockers?

A

Acebutolol (Sectral)

Atenolol (Tenormin)

Metoprolol (Lopressor)

Nebivolol (Bystolic)

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32
Q

Which two ß-blockers have Intrinsic Sympathetic Activity?

A

Acebutolol (Sectral)

Pindolol

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33
Q

What is the difference between Non-selective and cardioselective ß-blockers?

A

The non-selective ones are more likely to cause bronchospasm.

34
Q

What are the side effects of ß-blockers?

A

Bronchospasm

Fatigue

Worsen CHF (when it’s decompensated)

Raise lipids

Impaired glucose tolerance

Decreased libido/impotence

Depression

35
Q

If someone develops a bothersome cough on an ACE inhibitor, what could you give them instead?

A

ARB

36
Q

What are the contraindications to ARBs

A

Angioedema

Pregnancy

37
Q

What drugs are ARBs?

A

Valsartan

Other ones that end in -sartan

38
Q

What are the side effects of ARBs?

A

Orthostatic hypotension

Hyperkalemia

39
Q

What effects does digoxin have on the heart?

A

Increased contractility (inotropy)

Decreased HR (Chronotropy)

Increased cardiac output

40
Q

We all know that digoxin has a narrow margin of safety, but which patients are at a particular risk of toxicity?

A

Reduced renal clearance

Hypokalemia

41
Q

What labs/tests do you need to keep an eye on if you put a patient on digoxin?

A

ECG

Electrolytes

Renal function

Serum digoxin concentrations

42
Q

What is normal BP?

A

Less than 120/80

Both systolic AND diastolic need to be below 120/80

43
Q

What is considered Prehypertension?

A

Systolic: 120-139

Diastolic: 80-89

44
Q

What BP is considered Stage 1 hypertension?

A

Systolic: 140-159

Diastolic: 90-99

45
Q

What BP is considered stage 2 hypertension?

A

Systolic: 160+

Diastolic: 100+

46
Q

What are the 4 first line drugs for HTN?

A

HCTZ

ACE

ARB

CCB

47
Q

Which of the big 4 HTN meds are better for black patient?

A

HCTZ

CCB

48
Q

Which HTN meds are better for non-black patients?

A

ACE

ß-blocker

49
Q

Which of the big 4 HTN meds is best for patients with kidney disease?

A

ACE or ARBs

50
Q

At what BP do we start HTN meds for someone who is 60+ and does not have diabetes or kidney disease

A

150/90

51
Q

At what BP do we start HTN meds for anyone who is less than 60 or who has DM or CKD?

A

140/90

52
Q

A 74 year old lady takes lisinopril (an ACE) for her HTN.
She does not have DM or CKD.
Her BP today is 148/90.

What do we need to do to her meds?

A

Nothing!!

She is over 60 without DM or CKD, so her goal BP is less than 150/90.

53
Q

What are the rules for using more than one HTN meds?

A

There really aren’t any you can do whatever you want.

Maximize 1st med before adding 2nd

OR

Add second med before reaching max dose of first

OR

Start with 2 separate classes

54
Q

What class of HTN meds can actually CAUSE peripheral edema?

A

Short acting CCBs ex: amlodipine

55
Q

What are the 2 types of CCBs?

A

Dihydropyridines

Non-dihydropyridines

56
Q

Which drugs are dihydropyridine CCBs?

A

Nifedipine

Amlodipine

Other ones that end in -dipine

57
Q

Which drugs are non-dihydripyridine CCBs?

A

Verapamil (Calan)

DIltiazem (Cardizem)

58
Q

Which one has a bigger effect on the HEART vs the vasculature:

Dihydropyridines or Non-dihydropyridines

A

Heart: Non-dihydropyridines (verapamil and diltiazem)

Vasculature: dihydropyridines

59
Q

What is the caution for using dihydropyridine CCBs?

A

HF

60
Q

What are the cautions for using non dihydropyridine CCBs

A

ß-blockers

SA or AV node abnormalities

61
Q

What drugs are the Ξ±1-blockers?

A

Selective:
Prazosin (Minipress)

Doxazosin (Cardura)

Terazosin

Non-selective:
Phenoxybenzamine (Dibenzyline)- pretty much only used for pheochromocytoma

62
Q

What is the BIG side effect of Ξ±-blockers

A

Orthostatic hypotension

63
Q

Which class of drugs is associated with the β€œfirst dose phenomenon?”

A

Ξ±-blockers

64
Q

What is the first dose phenomenon?

A

First time you take an Ξ±-blocker it knocks you on your ass due to the orthostatic hypotension

65
Q

Other than HTN, what other condition can Ξ±-blockers help with?

A

BPH 🌰

66
Q

What class of drugs can help a guy with BPH go pee pee

A

Ξ± blockers

67
Q

Which drugs are Central Ξ±-agonists?

A

Clonidine (Catapres)

Methyldopa

68
Q

What are the side effects of central Ξ±-agonists?

A

Orthostatic hypotension

Sedation

Xerostomia

69
Q

If you are taking Clonidine or Methyldopa and you take a trip to Mexico without your meds, what’s gonna happen

A

You die due to a hypertensive crisis

70
Q

Which classes of drugs in this lecture should NOT be stopped abruptly?

A

ß-blockers

Central Ξ±-agonists

71
Q

Which 2 HTN drugs are CLASSICALLY associated with being used during preganncy

A

Methyldopa

Labetalol

72
Q

What labs do you have to monitor if someone is on Methyldopa?

A

CBC

Liver enzymes

Coombs test

RISK OF HEMOLYTIC ANEMIAπŸ”ͺ

73
Q

What is the most appropriotate drug to give someone who is diagnosed with stable angina?

A

Sublingual nitro PRN

74
Q

What are the side effects of sublingual nitro?

A

Throbbing headache

Hypotension

Tachycardai

75
Q

What are the instructions you need to give your patient for taking their sublingual nitro?

A

One dose every 5 min for up to 3 doses.

If chest pain doesnt go away, call 911

If after 1 dose it doesn’t get even little better, call 911

76
Q

Nitroglycerin decreases (preload/afterload/both)

A

Both

77
Q

What are the contraindications to nitroglycerin?

A

Within 24 hours of taking viagra

Hypertrophic Cardiomyopathy (HCM)

RV infarction

78
Q

What is the difference between Nitroglycerin and Isosorbide dinitrate/mononitrate

A

Nitroglycerin= rapid acting

Isosorbide dinitrate/mononitrate= long acting (oral or topical)

79
Q

What would you use long acting nitrates (isosorbide dinitrate/mononitrate) for?

A

Long term management of chronic stable angina

80
Q

Is it easy to develop a tolerance to long acting nitrates (Isosorbide dinitrate/mononitrate)?

A

Yes, tolerance delvelops quickly

81
Q

Can ß-blockers and CCBs be used as long term management of chronic angina?

A

Yes

82
Q

What is the best class of drug for Vasospastic (Prinzmetals) angina?

A

CCBs

Pharm III FINAL (ASL πŸ‘΅πŸ»πŸˆπŸŒ­) (2 decks)

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