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Pharm III Final > CV > Flashcards

CV Flashcards

1
Q

Which diuretics are highly efficient at moving large volumes of fluids (ie in HF)?

A

Loop diuretics

Furosemide
Torsemide
Bumetanide
Ethacrynic acid

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2
Q

How are loop diuretics usually used?

A

To treat edema

SYMPTOMATIC relief of HF, not first line antihypertensive)

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3
Q

Side effects of loop diuretics

A

HYPOkalemia - my require K+ supplementation
HYPOnatremia
HYPOcalcemia
HYPERuricemia

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4
Q

Which loop diuretics are contraindicated in patients with sulfa allergies?

A

Furosemide
Torsemide
Bumetanide

Ethacrynic Acid is OK (not a sulfa)

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5
Q

Which loop diuretic has the highest risk of ototoxicity

A

Ethacrynic acid

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6
Q

How are thiazides used?

A

To treat HTN, or to enhance antihypertensive actions of other drugs

Can be used for edema/MILD fluid retention in HF, but they are better as antihypertensives than they are at diuresis

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7
Q

What are the three thiazide diuretics?

A

HCTZ (Microzide)
Chlorothiazide (Diuril)
Metolazone (thiazide-related)

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8
Q

HCTZ and Chlorothiazide are contraindicated in patients with…

A

Sulfa allergy

Anuria

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9
Q

Anuria is a contraindication for…

A

Loop and thiazide diuretics

They’re gonna make you pee a lot, and if you CAN’T pee, you’re gonna be in trouble

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10
Q

Is metolazone contraindicated in patient’s with sulfa allergies?

A

Not contraindicated but use with CAUTION

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11
Q

Side effects of thiazide diurectics

A 
HYPOkalemia
HYPOnatremia
HYPERuricemia
Hypercholesterolemia 
Hyperglycemia
ED
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12
Q

What should you monitor in patients on thiazides?

A

BP/orthostatic
Electrolytes
Renal function

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13
Q

Loops and thiazides may precipitate _____ at high doses

A

Gout

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14
Q

How are aldosterone antagonists and potassium sparing diuretics used?

A

Overall weak diuretic effect, used in combo with other diuretics to eliminate need for K+ supplementation)

Used to treat edema, HF (not first line for HTN)

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15
Q

What are the contraindications for aldosterone antagonists and potassium sparing diuretics?

A

HYPERKALEMIA
Anuria
Severe, progressive kidney disease/dysfunction

Use with caution with ACE-Is/ARBs

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16
Q

Which drugs are aldosterone antagonists?

A

Spironolactone (Aldactone)

Eplerenone (Inspra)

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17
Q

Which drugs are direct inhibitors of Na+ flux (used as potassium sparing diuretics)?

A

Triamterene (Dyrenium)

Amiloride

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18
Q

Major side effect of potassium sparing diuretics and aldosterone antagonists

A

Hyperkalemia (DUH)

Monitor potassium, BP, and renal function in these patients

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19
Q

Which HTN drugs are best for reducing mortality AND improving Sx of HF?

A

ACEIs (ie Lisinopril)

BBs (ie Metoprolol)

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20
Q

Which drugs are good at improving Sx of HF but do not reduce overalls mortality?

A

Loop diuretics

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21
Q

Contraindications for ACEIs and ARBs

A

Angioedema

Pregnancy

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22
Q

MOA for ACEIs

A

Block angiotensin converting enzyme and stop formation of angiotensin II

—> lower preload and afterload

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23
Q

Which drug is considered first-line in all patients with diabetes, CKD, and HFrEF?

A

ACEIs and ARBs

Can be used to treat HFrEF, HTN, STEMI

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24
Q

SE of ACEIs

A 
DRY COUGH
Orthostatic hypotension
Hyperkalemia
Angioedema
Rash

Monitor: electrolytes, renal function, BP

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25
Q

MOA for beta blockers

A

ß-adrenergic antagonists —> negative chronotropy, negative inotropy, and reduced CO

Decrease mortality rate s/p MI, stable class II and III HF

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26
Q

How are beta blockers used?

A

To treat angina, HFrEF, and HTN (not first line but useful)

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27
Q

When are beta blockers contraindicated?

A

Severe bradycardia

2nd/3rd degree AV block

Uncompensated HF

SBP <100

Cardiogenic shock

28
Q

Which beta blockers are non-selective?

A

Propranolol
Nadolol
Timolol

29
Q

SE of NON-selective BBs

A 
BRONCHOSPASM
WORSEN CHF
Raise lipids
Impaired glucose tolerance
FATIGUE
Decreased libido/impotence
Depression
Insomnia
30
Q

Which beta blockers are cardioselective?

A

Acebutolol
Atenolol
Metoprolol
Nebivolol

31
Q

What happens to side effects when you used cardioselective BBs instead of non-selective?

A

They are reduced but not eliminated

Can raise lipids

32
Q

Which beta blockers have intrinsic sympathomimetic activity?

A

Acebutolol

Pindolol

33
Q

What is the biggest caution when using beta blockers?

A

Avoid abrupt withdrawal - can precipitate acute coronary events and severe increases in BP

34
Q

What drug should you consider if you put your patient on an ACE and they can’t handle the cough?

A

Angiotensin Receptor Blocker (ARB) - the “sartans”

35
Q

MOA for ARBs

A

Block angiotensin II from binding to AT1 receptors —> reduced preload and afterload

36
Q

How are ARBs used?

A

To treat HFrEF, HTN, STEMI

Considered first-line in all patients with diabetes CKD, HFrEF

37
Q

Effects of Digoxin

A

(+) Inotropy, (-) Chronotropy, increased CO

38
Q

How is Digoxin used?

A

To treat mild to moderate HFrEF, a fib

39
Q

Side effects of Digoxin

A

Arrhythmias
HA
Fatigue
Drowsiness

40
Q

Digoxin has a narrow margin of safety, especially in patients with…

A

Reduced renal clearance and hypokalemia

Monitor ECG, electrolytes, renal function, and serum digoxin concentrations

41
Q

What is considered to be “pre-hypertension”?

A

120-139 SBP or 80-89 DBP

42
Q

What is considered to be stage 1 hypertension?

A

140-159 SBP or 90-99 DBP

43
Q

What is considered to be Stage 2 hypertension?

A

≥160 SBP or ≥100 DBP

44
Q

Lifestyle mods recommended to patients with HTN

A 
Smoking cessation
Salt restriction
DASH Diet
Exercise/physical activity
Weight management
45
Q

What are considered to be the four first line meds for HTN?

A

HCTZ, ACEIs, ARBs, CCBs

46
Q

Which first line HTN meds are more effective in black patients?

A

HCTZ, CCB

47
Q

Which HTN meds are more effective in non-black patients?

A

ACE-I, BBs

48
Q

Which HTN meds are first line for patients with CKD?

A

ACE/ARBs

49
Q

MOA for CCBs and how are they used?

A

(-) inotropy, relax smooth muscles (esp vascular)

Used to treat HTN, vasospastic angina

50
Q

When are CCBs contraindicated?

A

SA or AV node abnormalities

BB

HF

51
Q

Which type of CCBs are more potent vasodilators?

A

Dihydropyridines - ex: Nifedipine and other dipines

Cause arterial smooth muscle relaxation and decrease in PVR

52
Q

SE of dihydropyridines

A

Short acting CCBs - may cause mild to moderate reflex tachycardia, may see SA, flushing, or PERIPHERAL EDEMA

Long-acting CCBs - usually only cause EDEMA

53
Q

Which drugs are non-dihydropyridines?

A

Verapamil and Diltiazem

Less vasodilation effect, (-) inotropy, (-) chronotropy

54
Q

SE of non-dihydropyridines

A

Constipation
Bradycardia
SA dysfunction
Heart block

Monitor BP, HR, edema

55
Q

How do alpha blockers work?

A

Decrease vasoconstriction and reduce peripheral vascular resistance

Used to treat HTN in patients with BPH

56
Q

Which drugs are alpha blockers?

A

Prazosin
Doxazosin
Terazosin

Non-selective: Phenoxybenzamine

57
Q

Major side effect of alpha blockers

A

Orthostatic hypotension (first dose phenomenon)

Others: fatigue, weakness, nasal congestion, and HA

58
Q

MOA for central alpha agonists?

A

Reduce sympathetic vasoconstriction and total peripheral vascular resistance

Used to treat refractory HTN (not first line)

59
Q

What drugs are central alpha agonists?

A 
Clonidine
Methyldopa (recommended for use in pregnancy)
60
Q

SE of central alpha agonists

A

Sedation/drowsiness
Xerostomia
Orthostatic hypotension

61
Q

What should you warn patients about when taking central alpha agonists

A

Avoid abrupt withdrawal - can precipitate hypertensive crisis

62
Q

What patient ed should you provide with sublingual nitro?

A

SE: orthostatic hypotension, THROBBING HA, tachycardia

Take one dose every 5 min for up to 3 doses —> call EMS if not improved after first dose

63
Q

What drug is preferred for treatment of vasospastic (Prinzmetal) angina?

A

CCBs

64
Q

When is nitro contraindicated?

A

Within 24 hours of Sildenafil

HCM

RV infarction

65
Q

What are the different antianginal options?

A

Rapid-acting nitrates (ie Nitroglycerin) for acute angina or prophylaxis

Long-acting nitrates (ie Isosorbide dinitrate) for long term management of chronic stable angina

BBs/CCBs for long term management of chronic stable angina, sometimes unstable angina

Pharm III Final (8 decks)

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