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DIT Level 2 > CV Meds and treatments > Flashcards

CV Meds and treatments Flashcards

1
Q

Statins

A

Lovastatin, pravastatin, simvastatin, fluvastatin, pitavastatin
High intensity: atorvastatin, rosuvastatin

Inhibit HMG-CoA reductase -> decreased synthesis of cholesterol in liver

Best drugs to lower LDL

Side effects: muscle injury (depletes Coenzyme Q10, check CK level), hepatic dysfunction (check LFTs)

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2
Q

Ezetimibe

A

Impairs dietary and biliary cholesterol absorption at the brush border of the intestine

Lowers LDL - use if can’t tolerate statin

Side effects: myalgias and increased LFTs

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3
Q

Fibrates

A

Gemfibrozil, fenofibrate

Primary effect on TGs, mild increased of HDLs by 5-10%

reduce hepatic secretion of VLDL

Side effects: myositis, LFT elevation (caution mixing with statins)

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4
Q

Bile acid sequestrants

A

Cholestyramine (also used as adjunct for relapsing c. diff infection, binds c. diff toxin)
Colestipol
Colesevelam

Primary effect on LDL 10-20%, some A1c 0.5%

Side effects: GI (N, bloating, cramping, constipation), LFT elevation

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5
Q

Niacin

A

Primary effect on HDL

Side effect: uncomfortable facial flushing - prevent with pretreatment of aspirin or NSAIDs, take at night, better with time

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6
Q

Omega-3 fatty acids

A

Primary effect on TGs

S/E: fishy burp

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7
Q

Treatment of Stable Angina

A

B-blockers - decrease HR, contractility -> decreased O2 demand

CCB (diltiazem, verapamil, amlodipine) promote coronary and peripheral vasodilation, reduce contractility

Nitrates - peripheral venous dilation -> decreased preload, decreased O2 demand
-sublingual - acute sxs

Bb and CCB combined can cause heart block
Long acting nitrates with b-blockers for long term - risk nitrate tolerance

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8
Q

Treatment of acute coronary syndrome (unstable angina, MIs)

A

ABCs

MONA-B (caution Bb in HF, COPD, severe asthma)

Statin (atorvastatin 80 mg) before PCI

Antiplatelet: clopidogrel or ticagrelor

Anticoagulant: unfractionated heparin for PCI, enoxaparin for non-PCI pts

Manage Potassium above 4, magnesium above 2 to decrease risk of arrythmias

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9
Q

Fibrinolysis in MI

A

Only in STEMI, avoid in NSTEMI

Altaplase
Retaplase
Tenecteplase

Give within 12 hours (stroke 3-4 hours)

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10
Q

Aspirin MOA

A

COX -1 and -2 inhibitor

COX -1 inhibition inhibits thromboxane A2 - impairs platelet aggregation

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11
Q

ADP receptor blockers MOA

A

Clopidogrel, ticlopidine, prasugrel, ticagrelor

block P2Y12 receptor preventing platelet aggregation

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12
Q

Glycoprotein IIb/IIIa inhibitors MOA

A

abciximab, eptifibatide, tirofiban

inhibit platelet aggregation

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13
Q

Heparin MOA

A

activates antithrombin - anticoagulant

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14
Q

LMWH MOA

A

enoxaparin

Activates antithrombin - anticoagulant

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15
Q

Warfarin MOA

A

Vit K antagonist - inhibits clotting factors 10, 9, 7, 2, protein C and S “1972 diSCo”

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16
Q

Thrombolytics MOA

A

alteplase, reteplase, tenecteplase

convert plasminogen to plasmin

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17
Q

Long-term management of MI

A

Aspirin and/or clopidogrel (depends on stent)
B-blocker
ACE-i or ARBs
-all above decrease mortality

Potassium sparing diuretic - spironolactone
Statin
Exercise, smoking cessation, dietary modification

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18
Q

Treatment of Prinzmetal Angina

A

Smoking cessation
CCB first line - diltiazem
Nitrates
Avoid nonselective b-blockers (propranolol) and triptans

Aspirin used with caution and at low dose - inhibits prostacyclin

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19
Q

Action and primary use of dobutamine as a vasopressor

A

Action: Beta 1 agonist - increases HR and contractility = increased CO
-reflex vasodilation

Primary use: cardiogenic shock

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20
Q

Action and primary use of Norepi as a vasopressor

A

Action: alpha 1 agonist - vasoconstriction; beta 1 agonist - increased HR and contractility = increased CO

Primary use: septic shock

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21
Q

Action and primary use of epi as a vasopressor

A

Action: alpha 1, alpha 2, beta 1, beta 2 agonist

  • low dose - beta 1 increased CO
  • high dose - alpha 1 vasoconstriction

Primary use: anaphylactic shock; septic shock (2nd line)

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22
Q

Action and primary use of vasopressin (ADH) as a vasopressor

A

Action: weak vasoconstrictor

Primary use: 2nd line for septic shock or anaphylactic shock

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23
Q

Action and primary use of phenylephrine as a vasopressor

A

Action: alpha 1 agonist - vasoconstrictor, minimal effect on heart

  • raises SVR, increases after load w/o increased contractility -> decreased SV and decreased CO
  • risk arrhythmias

Primary use: 2nd link for septic shock

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24
Q

Action and primary use of Dopamine as a vasopressor

A

Action: low dose - Beta 1 agonist; high dose alpha 1 agonist
-renovasodilation - selective

Primary use:2nd line for cardiogenic shock or adjuvant pressor

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25
Complications of prolonged norepinephrine as vasopressor
ischemia/necrosis of fingers and toes mesenteric ischemia renal insufficiency - decreased urine output
26
Best vasopressor for anaphylaxic shock
epi
27
best vasopressor for septic shock
norepi
28
best vasopressor for cardiogenic shock
dobutamine
29
Antiarrhythmic medication classifications
"No bad boy keeps clean" or "some block potassium channels" Na channel blockers: IA, IB, IC Beta blockers - II K channel blockers - III CCB - NDP - IV
30
Class IA antiarrhythmics
sodium channel blocker Procainamide quinidine disopyramide Use in supra ventricular or ventricular arrhythmias
31
Class IB antiarrhythmics
Sodium channel blocker Lidocaine Tocainide mexiletine Use in ventricular arrhythmias
32
Class IC antiarrhythmics
sodium channel blocker Flecainide, propafenone use: Afib, PSVT, Ventricular arrhythmias
33
Class II antiarrhythmics
betablockers metoprolol atenolol propranolol Afib, atrial flutter, MAT Rate control of atrial tachy
34
Class III antiarrhythmics
K channel blockers Amiodarone sotalol ibutilide Rhythm control - afib, atrial flutter
35
Class IV antiarrhythmics
calcium channel blocker - NDP diltiazem verapamil afib, atrial flutter
36
Amiodarone s/e
pulmonary fibrosis liver toxicity thyroid toxicity Check PFTs, LFTs, TFTs
37
Drugs used in treating stable, asymptomatic vtach
amiodarone - first line procainamide, sotalol if fail -> synchronized cardioversion - if you shock on T wave -> vfib
38
Treatment for SVT
attempt vagal manuevers - valsalva, carotid massage IV adenosine push - can use 2 rounds Ventricular rate control: Nondihydropyridine CCB - diltiazem Beta-blocker - metoprolol
39
Side effects of adenosine
lasts a few seconds Intense flushing sensation CP hypotension
40
ACLS meds for v-fib or unstable (pulseless) vtach
Shock/CPR 2 min ``` Repeat point Check rhythm Shock/CPR/epi 1 mg q3-5 min 2min check rhythm shock CPR Amiodarone 300 mg IV bolus (2nd dose 150 mg) Evaluate/tx reversible causes repeat ```
41
ACE inhibitors - drugs, mechanism, uses, s/e
Captopril Enalapril Fosinopril Lisinopril inhibit angiotensin converting enzyme -> less vasoconstriction ``` HTN Post MI CHF CKD DM - renal protective ``` ``` S/E: Cough (increased bradykinin) Angioedema Renal insufficiency - small bump BUN/Cr d/t decreased GFR Hyperkalemia ``` Teratogenic - kidney damage
42
ARBs drugs, mechanism, uses, s/e
Candesartan Losartan Valsartan Inhibit angiotensin receptors ``` HTN Post MI CHF CKD DM - renal protective ``` S/E: Angioedema - less frequent than ACE Renal insufficiency - small bump BUN/Cr d/t decreased GFR Hyperkalemia Teratogenic - kidney damage
43
CCBs - dihydropyridines; drugs, mechanism, uses, s/e
amlodipine felodipine nifedipine blocks Ca2+ channels in vascular smooth muscle -> vasodilation HTN prinzmetal angina esophageal spasm migraine prophylaxis ``` S/E: Peripheral edema HA Constipation GERD ```
44
CCBs - nondihydropyridines drugs, mechanism, uses, s/e
Diltiazem Verapamil Blocks Ca2+ channels in the heart -> reduced CO and HR HTN Afib and SVT Migraine ppx - verapamil ``` S/E: Peripheral edema HA Constipation GERD Bradycardia ```
45
Thiazide diuretico drugs, mechanism, uses, s/e
Chlorthalidone HCTZ Reduce intravascular volume initially Vasodilation HTN Volume overload - CHF, CKD ``` S/E: hypokalemia hyponatremia hypercalcemia sulfa allergy ```
46
B-blockers drugs, mechanism, uses, s/e
Beta 1 - first half of alpha Atenolol bisprolol Metoprolol Nonselective - last 1/2 of alpha Propranolol Alpha1/beta: carvedilol, labetalol Block beta-adrenergic receptors - decrease myocardial contractility, HR, and CO - decreased renin-> vasodilation HTN CHF: reduced mortality - bisprolol, carvedilol, metoprolol ER CAD Propranolol: hyperthyroidism, essential tremor, migraine pax, social anxiety ``` S/E: Bronchoconstriction - nonselective -contra in asthma/COPD reduced HDL Increased TG Mask symptoms of hypoglycemia Slight increased risk of stroke ```
47
Alpha blockers drugs, mechanism, uses, s/e
Doxazosin Prazosin Terazosin Block alpha1-adrenergic receptors -> vasodilation Relax smooth muscle in vessel and urethra HTN BPH S/E: orthostatic htn with first dose rebound htn when stop
48
Arterial vasodilators drugs, mechanism, uses, s/e
Hydralazine minoxidil -> hypertrichosis (hair growth, aka rogaine) relax vascular smooth muscle - arteries, arterioles HTN male pattern baldness S/E: reflex tachycardia Drug induced lupus - anti-histone ab - hydralazine
49
Aliskiren
direct renin inhibitor
50
Clonadine
alpha 2 receptor agonist -> decreased BP by inhibiting NE release ``` S/E: rebound HTN xerostoma dizziness sedation ``` AVOID
51
JNC8 - initial drugs used in CKD pts
ACE-i/ARB - renal protective
52
JNC8 - initial drugs used in blacks without CKD
thiazide or CCB
53
JNC8 - initial drugs used in non-blacks without CKD
thiazide or CCB | ACE-i/ARB
54
Antihypertensives safe in pregnancy
"Hypertensive moms love nifedipine" Hydralazine Methyldopa (1st line) Labetalol (1st line) Nifedipine, amlodipine, felodipine
55
Antihypertensives unsafe in pregnancy
Teratogenic: ACE/ARB, aliskiren | Cause kidney damage
56
Patient has HTN, CHF and/or post MI drugs of choice:
ACE/ARB B-blockers Aldosterone antagonist - spironolactone, eplerenone
57
BPH + HTN - drugs of choice
Alpha blockers - prazosin, doxazosin, terazosin
58
Migraine + HTN drugs of choice
b-blocker, CCB
59
HTN + COPD or Asthma drugs to avoid
avoid b-blockers
60
HTN + CHF + peripheral edema drugs to avoid
avoid CCBs - cause edema
61
HTN + gout drugs to avoid
diuretics

DIT Level 2 (49 decks)

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