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DIT Level 2 > CV Meds and treatments > Flashcards

CV Meds and treatments Flashcards

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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
Q

Complications of prolonged norepinephrine as vasopressor

A

ischemia/necrosis of fingers and toes
mesenteric ischemia
renal insufficiency - decreased urine output

26
Q

Best vasopressor for anaphylaxic shock

A

epi

27
Q

best vasopressor for septic shock

A

norepi

28
Q

best vasopressor for cardiogenic shock

A

dobutamine

29
Q

Antiarrhythmic medication classifications

A

“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
Q

Class IA antiarrhythmics

A

sodium channel blocker

Procainamide
quinidine
disopyramide

Use in supra ventricular or ventricular arrhythmias

31
Q

Class IB antiarrhythmics

A

Sodium channel blocker

Lidocaine
Tocainide
mexiletine

Use in ventricular arrhythmias

32
Q

Class IC antiarrhythmics

A

sodium channel blocker

Flecainide, propafenone

use: Afib, PSVT, Ventricular arrhythmias

33
Q

Class II antiarrhythmics

A

betablockers

metoprolol
atenolol
propranolol

Afib, atrial flutter, MAT

Rate control of atrial tachy

34
Q

Class III antiarrhythmics

A

K channel blockers

Amiodarone
sotalol
ibutilide

Rhythm control - afib, atrial flutter

35
Q

Class IV antiarrhythmics

A

calcium channel blocker - NDP

diltiazem
verapamil

afib, atrial flutter

36
Q

Amiodarone s/e

A

pulmonary fibrosis
liver toxicity
thyroid toxicity

Check PFTs, LFTs, TFTs

37
Q

Drugs used in treating stable, asymptomatic vtach

A

amiodarone - first line
procainamide, sotalol

if fail -> synchronized cardioversion - if you shock on T wave -> vfib

38
Q

Treatment for SVT

A

attempt vagal manuevers - valsalva, carotid massage

IV adenosine push - can use 2 rounds

Ventricular rate control:
Nondihydropyridine CCB - diltiazem
Beta-blocker - metoprolol

39
Q

Side effects of adenosine

A

lasts a few seconds
Intense flushing sensation
CP
hypotension

40
Q

ACLS meds for v-fib or unstable (pulseless) vtach

A

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
Q

ACE inhibitors - drugs, mechanism, uses, s/e

A

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
Q

ARBs drugs, mechanism, uses, s/e

A

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
Q

CCBs - dihydropyridines; drugs, mechanism, uses, s/e

A

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
Q

CCBs - nondihydropyridines drugs, mechanism, uses, s/e

A

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
Q

Thiazide diuretico drugs, mechanism, uses, s/e

A

Chlorthalidone
HCTZ

Reduce intravascular volume initially
Vasodilation

HTN
Volume overload - CHF, CKD

S/E:
hypokalemia
hyponatremia
hypercalcemia
sulfa allergy
46
Q

B-blockers drugs, mechanism, uses, s/e

A

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
Q

Alpha blockers drugs, mechanism, uses, s/e

A

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
Q

Arterial vasodilators drugs, mechanism, uses, s/e

A

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
Q

Aliskiren

A

direct renin inhibitor

50
Q

Clonadine

A

alpha 2 receptor agonist -> decreased BP by inhibiting NE release

S/E:
rebound HTN
xerostoma
dizziness
sedation

AVOID

51
Q

JNC8 - initial drugs used in CKD pts

A

ACE-i/ARB - renal protective

52
Q

JNC8 - initial drugs used in blacks without CKD

A

thiazide or CCB

53
Q

JNC8 - initial drugs used in non-blacks without CKD

A

thiazide or CCB

ACE-i/ARB

54
Q

Antihypertensives safe in pregnancy

A

“Hypertensive moms love nifedipine”

Hydralazine
Methyldopa (1st line)
Labetalol (1st line)
Nifedipine, amlodipine, felodipine

55
Q

Antihypertensives unsafe in pregnancy

A

Teratogenic: ACE/ARB, aliskiren

Cause kidney damage

56
Q

Patient has HTN, CHF and/or post MI drugs of choice:

A

ACE/ARB
B-blockers
Aldosterone antagonist - spironolactone, eplerenone

57
Q

BPH + HTN - drugs of choice

A

Alpha blockers - prazosin, doxazosin, terazosin

58
Q

Migraine + HTN drugs of choice

A

b-blocker, CCB

59
Q

HTN + COPD or Asthma drugs to avoid

A

avoid b-blockers

60
Q

HTN + CHF + peripheral edema drugs to avoid

A

avoid CCBs - cause edema

61
Q

HTN + gout drugs to avoid

A

diuretics

DIT Level 2 (49 decks)

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