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NPLEX 2.0 > CV Pharm II > Flashcards

CV Pharm II Flashcards

1
Q

How do Angiotensin II receptor antagonists ARB’s work?

A

Block type I angiotensin II receptors on blood vessels and the heart

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2
Q

What drugs are in the ARB class of anti hypertensives?

A

Valsartan, Irbessartan, Valsartan

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3
Q

When are ARBs indicated?

A

HTN, congestive heart failure

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4
Q

What is the MOA of ARBs?

A

i. Vasodilator
ii. Down regulate sympathetic adrenergic activity
iii. Promote renal excretion of sodium and water
iv. Inhibit cardiac and vascular remodeling

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5
Q

When are ARBs CI?

A

Pregnancy
Bilateral renal artery stenosis

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6
Q

how do ACE inhibitors work?

A

i. Vasodilator
ii. Down regulate sympathetic adrenergic activity
iii. Promote renal excretion of sodium and water
iv. Inhibit cardiac and vascular remodeling

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7
Q

What are ACEI used for?

A

HTN
Edema
CHF

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8
Q

What are some of the AEs of ACE inhibitors?

A

Dry cough
Angioedema
Hyperkalemia
Hypotension

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9
Q

Which drugs are from the class of ACE inhibitors?

A

Lisinopril, Ramipril

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10
Q

When are ACE inhibitors CI?

A

Pregnancy
Bilateral renal artery stenosis

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11
Q

Which drugs are in the Beta Blocker class of anti hypertensives?

A

Atenolol, Metoprolol, Carvedilol, Propranolol

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12
Q

Which beta blocker is B-1 selective?

A

Atenolol, Metoprolol

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13
Q

Which beta blockers affects B1 and B2 receptors?

A

Carvedilol
Propranolol

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14
Q

What drugs act as an alpha and beta adrenergic blocker?

A

Carvedilol

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15
Q

What is the advantage of using atenolol or metoprolol, a beta-1 blocker only?

A

Less bronchoconstriction than agents that bond to B-2 receptors

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16
Q

How do B-1 blockers work?

A

Selective sympatholytic agent
Causes decreased HR and output
Decreases renin release

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17
Q

What are the AEs of beta blockers?

A

May worsen CHF
Bradycardia
Cold extremities
Reduced exerces capacity
Fatigue
Hypotension
Impotence

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18
Q

What are the other uses for propranolol?

A

i. Migraine prophylaxis
ii. Hyperthyroidism
iii. Benign essential tremor

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19
Q

What is one of the SEs of propranolol?

A

Bronchoconstriction so CI in asthma or COPD pts

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20
Q

Which population should you be cautious of prescribing of beta blockers?

A

Diabetics, may mask the tachycardia associated with hypoglycemia

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21
Q

What are the CIs of beta blockers?

A

Sinus bradycardia
Partial AV block

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22
Q

What black box warning is associated with beta blockers?

A

Increased risk of angina pectoris and MI with abrupt discontinuation

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23
Q

Which drugs are Calcium Channel blockers?

A

Dihydropyridine : Amlodipine
Nondihyropyridine : Diltiazem, Verapamil

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24
Q

What is the MOA of CCBs?

A

i. Calcium channel antagonist which reduces calcium influx into cardiac cells
ii. Vascular smooth muscle relaxation : vasodilatioin
iii. Decreased myocardial force generation (negative inotropy)
iv. Decreased HR (negative chronotropy)

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25
Q

What are some of the uses for CCB?

A

HTN
Angina
Arrhythmias

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26
Q

What are some of the AEs of CCBs?

A

Dizziness
Peripheral edema
Hypotension
Nausea
Fatigue

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27
Q

What are CIs for prescribing CCBs?

A

Preexisting bradycardia
Conduction defects or systolic function HF

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28
Q

Which hypertensive drug class should not be given together with CCBs?

A

Beta Blockers

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29
Q

What is the MOA of Clonidine?

A

Centrally acting alpha-2 agonist

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30
Q

What are some of the AEs of Clonidine?

A

Sedation
Dry mouth
Bradycardia
Orthostatic hypotension
Impotence
Edema

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31
Q

What is the prototype anti-angina drug?

A

Nitroglycerine

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32
Q

How does nitroglycerin work?

A

Releases nitrous oxide into smoooth muscle causing relaxation

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33
Q

What situation is nitroglycerin best used in?

A

Acute angina due to its rapid onset

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34
Q

What are the AEs of nitroglycerin?

A

Postural hypotension
HA

35
Q

What is Digoxin used for?

A

Congestive HF

36
Q

How does Digoxin work?

A

Decreased HR
Increases contractility
Makes heart beat more efficiently

37
Q

What are some of the side effects of digoxin?

A

i. Cardiac arrhythmia : atrial tachycardia and AV block
ii. Bradycardia
iii. Fatigue
iv. N/V
v. changes in mood and mental alertness
vi. Vision changes - yellow/green vision

38
Q

What do you need to be careful of when prescribing digoxin?

A

It has a very narrow therapeutic window so levels need to be checked frequently

39
Q

What is the effect of amiodarone on CYP450?

A

Inhibits 2C9, 2D6, and 3A4/5/7 significantly

40
Q

When is amiodarone used?

A

Tacharrhythmias

41
Q

What effect does amiodarone have on digoxin’s pharmacokinetics?

A

Doubles half-life, so cut dose in half

42
Q

What is the interaction of amiodarone with warfarin?

A

Potentiates it, inceases risk of bleeding

43
Q

What are the different types of diuretics?

A

i. Loop diuretics
ii. Thiazide diuretics
iii. Potassium sparing diuretics

44
Q

What is the order of strength for the different diuretics from strongest to weakest?

A

i. Loop diuretics
ii. Thiazide diuretics
iii. Potassium sparing diuretics

45
Q

What is the loop diuretic?

A

Furosemide

46
Q

How do loop diuretics work?

A

They alter sodium transport in the loop of Henle

47
Q

What is furosemide used for?

A

i. HTN
ii. Edema
iii. Pulmonary edema
iv. Ascites
v. CHF

48
Q

What are some of the AEs of furosemide?

A

i. Hypokalemia
ii. Hyperuricemia
iii. Electrolyte imbalances
iv. Ototoxic

49
Q

How do thiazide diuretics work?

A

They act on the distal tubules to increase NaCl excretion
i.e. inhibit sodium and chloride reabsorption

50
Q

What is the prototype of thiazide?

A

Hydrochlorothiazide

51
Q

What are uses for hydrochlorothiazide?

A

i. HTN
ii. Edema
iii. Diuresis

52
Q

What are the AEs of hydrochlorothiazide?

A

i. Hypertriglyceridemia
ii. Electrolyte imbalances
iii. Decreased glucose tolerance

53
Q

What are the CIs of hydrochlorothiazide?

A

i. Cannot be taken with sulfonamide
ii. Cannot be taken with quinidine

54
Q

How do potassium sparing diuretics work?

A

They act as antagonists to aldosterone, therefore stopping aldosterone from retaining sodium

55
Q

What are the potassium sparing diuretics?

A

Spironolactone
Triamterene

56
Q

What are the AEs of potassium sparing diuretics?

A

i. Hyperkalemia
ii. Metabolic acidosis
iii. Impotence
iv. Gynecomastia

57
Q

What is the prototype cholesterol lowering medication?

A

Statin Drugs : Atorvastatin, Simvastatin

58
Q

How do statin medications work?

A

It inhibits the enzyme HMG CoA reductase, which is the enzyme invovled in cholesterol synthesis

59
Q

What is the indication for statin medications?

A

i. Dyslipidemia
ii. Prevention of complications of atherosclerosis

60
Q

What nutrient is depleted by statin medications?

61
Q

Which cholesterol molecule does statin medications have the greatest impact upon?

A

Lowering LDL

62
Q

What are some of the AEs of statins?

A

i. Increase LV enzymes
ii. Nasopharyngitis
iii. Arthralgia
iv. Diarrhea
v. Hyperglycemia and diabetes
vi. Black box warning : Rhabdomyolysis

63
Q

What are the CIs for statins?

A

i. Active LV disease
ii. Pregnancy / lactation

64
Q

Which drugs interact with statins?

A

i. Gemfibrozil, Niacin
ii. CCBs
iii. Azole anti-fungals
iv. Amiodarone
v. Erythromycin
vi. Grapefruit juice

65
Q

What action does Gemfibrizol have on lipids?

A

Lowers VLDL and triglyceride levels

66
Q

What are some of the SEs of Gemfibrizol?

A

Cholelithiasis
Rhabdomyolysis which combined with statins
Nausea

67
Q

What is the MOA of Terazosin?

A

Selective A-1 antagonist that causes vasodilation by blocking the binding of norepinephrine to the smooth muscle receptors.

68
Q

When should Terazosin not be used?

A

Heart failure and angina

69
Q

Terazosin AEs

A

Dizziness
Nasal Congestion
Orthostatic hypotension
HA
Edema

70
Q

What is hydralazine used for?

A

Acute HTN emergencies due to its direct vasodilating effects

71
Q

What are some AEs of hydralazine?

A

HA
Flushing
Tachycardia
Angina
Lupus-like syndrome (rare)

72
Q

What is different about effect of Isosorbidemononitrate?

A

Longer onset and duration of action than nitroglycerin

73
Q

How does carvedilol act?

A

Non specific alpha/beta1 blocker

74
Q

When is carvedilol indicated?

A

Congestive HF

75
Q

What type of Anti-arrhythmic is Flecainide?

A

Sodium Channel Blocker

76
Q

What type of arrhythmia is Flecainide used for?

A

Life threatening supraventricular tachyarrythmias

77
Q

What can Flecainide cause?

A

Increased risk of sudden death in pts with prior MI or sustained ventricular arrthmias

78
Q

What is the action of Colesevelam?

A

Bile acid sequestrant : binds bile acids in intestine to prevent absoprtion

79
Q

What are the common SEs of Colesevelam?

A

Abdominal Pain and constipation

80
Q

What other conditions is Colesevelam used in?

81
Q

What is the action of ezetimibe?

A

Inhibits cholesterol absorption in small intestine

82
Q

SEs of ezetimibe

A

Rhabdomyolysis, diarrhea, pancreatitis, URI symptoms

83
Q

What medications should not be taken with Ezetimibe?

A
  1. Gemfibrozil
  2. Cyclosporine
  3. Fenofibrate in a pt with cholelithiasis
  4. Statin those with severe LV disease
84
Q

CI of Digoxin

A

It is potentiated by potassium loss, therefore CI with diuretics

NPLEX 2.0 (6 decks)

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