CV Flashcards
Nitroglycerin
Nitrates
Isosorbide mononitrate
Nitrates
Nitrates MOA
work directly on vascular smooth muscle
Nitrates AE
reflex tachycardia, dizziness, OH, weakness
Nitrates Common Routes
IV, sublingual, topical
Nitrates Other drug care
“limit light exposure
short shelf life
tingling sensation as drug dissolves
1st dose 1-2 min, 2nd dose 5mins, 3rd in 15mins”
Aspirin
NSAID that works as a Antiplatelet
Clopidogrel (Plavix)
Antiplatelet
Antiplatelet MOA
ADP receptor inhibitor which decreases platelet aggregation (will last 7-10 days)
Antiplatelet AE
BLEED
Aspirin MOA
inhibs COX 1 and COX 2 -> Inhib platelet aggregation (low doses COX 1 specific)
Aspirin AE
GI, kidney, Heart?
Antiplatelet Other
“CYP2C19 to activate (metabolism)
decreased efficacy in some genetic variations (asain and african american)”
Rivaroxaban (Xarelto)
Anticoagulant (factor Xa)
Apixaban (Eliquis)
Anticoagulant (factor Xa)
anticoagulant (Factor Xa) MOA
SELECTIVELY and REVERSIBLY binds to FXa –> stops further coagulation cascade
Rivaroxaban AE
More GI BLEED (beers list)
Apixaban AE
Lowest Bleed risk
Rivaroxaban Other
MUST BE TAKEN WITH FOOD (HIGH FAT)
Factor Xa reversal agent
reversal agent andexanet alfa,
Enoxaparin (Lovenox)
LMWH Anticoagulant
Warfarin
Anticoagulant
Haparin
ANticoagulant
Heparin MOA
potentiates action of antithrombin which prevents fibrinogen to fibrin
Heparin AE
Heparin induced thrombocytopenia (HIT)
Heparin reversal agent
reversal agent: protamine sulfate
Lovenox MOA
Like heparin, potentiates action of antithrombin but has a greater effect on inhib FXa (prefered over heparin)
Lovenox reversal agent
reversal angent: Andexanet alfa (andexxa)
Antithrombotics types
Antiplatelet
Anticoagulant
Fibrinolytics
Antithrombotics
PT concerns
"FALLS Contradicted PT treatment Haparin - LAB VALUES (aPTT) Warfarin - LAB VALUES (INR) LMWH dont need to"
Warfarin MOA
converts inactive vit K to active vit K, depletes vit k stores, inhibts synth of factors VII, IX, X, and II (REVERSAL AGENT VIT K)
Warfarin AE
Intercranial bleed, DDIs
Warfarin other
FOOD INTERACTIONS, “3 to 5 days to take effect
NTI requires frequent monitoring of INR
Metabolized by CYP2C9
Atorvastatin (lipitor)
HMG CoA Reductase inhibs (statins)
Rosuvastatin (crestor)
HMG CoA Reductase inhibs (statins)
less likely myalgia
simvastatin
HMG CoA Reductase inhibs (statins)
pravastatin
HMG CoA Reductase inhibs (statins)
less likely Myalgia
HMG CoA Reductase inhibs MOA
block HMG-CoA Reductase= blocks cholesterol synthesis
HMG CoA Reductase inhibs AE
“MYALGIA (less likely with pravastatin and rosuvastatin)
myopathy, rhabdo
dyspepsia, headache, increased liver enzyme function, tendinopothy”
HMG CoA Reductase inhibs PT
“Mytositis and myalgia
persistent muscle effects
Rhabdo”
HMG CoA Reductase inhibs Other
“increased myopathy with fibrates (DDI)
1ST line for atherosclerosis then go to ezetimibe”
Grapefruit Juice
Amiodarona used for
Used for ventricular arrhythmias
Amiodarona MOA
prolong duration of the action potential by blocking K, Na, and Ca channels
Amiodarona AE
pulmonary fibrosis, GI problems, Thyroid dysfuction, blurred vision, ataxia, dizziness, liver tox, neuropathy, CV (bradycardia, heart block), bluish discoloration on exposed areas
Amiodarona Other
Long half life 50 days
Sacubitril/valsartan (Entrsto)
ARNI
Digoxin
ARNI
Sacubitril/valsartan (Entresto) MOA
“Valsartan MOA: previously discussed to↓ VASOCONSTR aldosterone release, also ↓ CATECHOLAMINE RELEASE
Sacubitril MOA: inhibits neprilysin enzyme (which typically breaks down peptides) = ↑natriuretic peptides = ↑ vasodilation, diuresis, natriuresis, GFR
“
ARNI AE
SAME AS THE ARBs BUT HIGHER RISK OF ANGIODEMA
ARNI Other
reduces mortality even more than ACEi (only ernesto)
Digoxin MOA
inhib Na/K ATPase in myocardial cells = increases Na = increase Ca = Increased contractility