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Module 5: Mali: Cardio > CV1-PharmChart > Flashcards

CV1-PharmChart Flashcards

1
Q

what are the 2 drugs that are vasodilator: Nitrates

A

Isosorbide Dinitrate

Nitroglycerin

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2
Q

MOA of Isosorbide Dinitrate

A

Smooth muscle dilation of arteries and veins

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3
Q

Class of Isosorbide Dinitrate

A

Vasodilator: Nitrates

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4
Q

Indication of Isosorbide Dinitrate

A

frequent stable angina

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5
Q

SE with Isosorbide Dinitrate

A

Headache, hypotension, tachycardia, re-bound HTN

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6
Q

Common Dx-Dx interaction of ALL vasodilators: Nitrates

A

PDE-5 inhibitors

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7
Q

What is important to remember time wise about Isosorbide Dinitrate

A

want a 6-12 hour of nitrate free interval DAILY!

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8
Q

Drug class of Nitroglycerin

A

Vasodilator: Nitrates

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9
Q

MOA of Nitroglycerin

A

Smooth muscle dilation of the arteries and veins

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10
Q

Indications of Nitroglycerin

A

Angina, CHF

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11
Q

What forms does Nitroglycerin come in

and what are the two most important SE:

A

SL spray
SL or buccal tablet
topical
IV

SE: headache, dizzyness

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12
Q

What is it important to remember about storage of Nitroglycerin (2 things)

A

kept in a glass bottle to help minimize moisture

kept in dark container because sensitive to sunlight!

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13
Q

What are the four Vasodilator: Calcium Channel Blockers?

A
  1. Dihydropyridine: Amlodipine
  2. Dihydropyridine: Nifedipine
  3. NonDihydropyridine: Dilitiazem
  4. NonDihydropyridine: Verapam
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14
Q

Is Amlodipine a nonDihydropyridine or Dihydropyridine?

A

Dihydropyridine

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15
Q

MOA of Amlodipine

A

Vasodilation due to blocking calcium channels in vascular smooth muscle and myocardium

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16
Q

Indications of Amlodipine

A

Angina

HTN

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17
Q

Common SE of Amlodipine (2)

A

Peripheral edema

ELDERLY HYPOTENSION

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18
Q

Dx-Dx interactions of Amlodipine and Nifedipine

A

Grapefruit juice

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19
Q

what can Amlodipine be used instead of

A

Beta Blockers

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20
Q

Is Nifedipine a Dihydropyridine or nonDihydropyridine

A

Dihydropyridine

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21
Q

MOA of Nifedipine

A

Vasodilation due to blocking calcium channels in vascular smooth muscle and myocardium

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22
Q

Indications of Nifedipine

A

Angina
HTN

sound familiar?

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23
Q

Common SE of Nifedipine (3)

A

Palpitations
peripheral edema
ELDERLY HYPOTENSION

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24
Q

what is Nifedipine most likely to do?

A

Most likely to produce hypotension

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25
Q

is Diltiazem a Dihydropyridine or nonDihydropyridine

A

nonDihydropyridine

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26
Q

MOA of Diltiazem

A

Dilate coronary arteries and decrease myocardial oxygen demands

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27
Q

indications of Diltiazem (5)

A

1) Angina
2) HTN
3) A FIB
4) A FLUTTER
5) PSVT

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28
Q

SE of Diltiazem

A

Edema

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29
Q

what has the contraindications of both Bradycardia and SSS if no pacer

A

Nondihydropyridine’s

Diltiazem and Verapamil

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30
Q

What can you not use in combo with Diltiazem

A

Not for combo use with Beta blockers

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31
Q

What increased the half life of Diltiazem

A

half life increased in cirrhosis

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32
Q

is Verapamil a nondihydropyridine or dihydropyridine

A

nondihydropyridine

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33
Q

MOA of Verapamil

A

Dilate coronary arteries and decrease myocardial oxygen demands

sound familiar?

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34
Q

indications of Verapamil (3)

A

PSVT
A fib
A flutter

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35
Q

SE of Verapamil (1)

A

Gingival hyperplasia

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36
Q

Dx-Dx interactions with Verapamil

A

Grapefruit juice

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37
Q

What can you not use Verapamil in combo with

A

Beta Blockers

it will decrease nodal conduction!

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38
Q

What are the selective (B1) beta blockers

A
  1. Metoprolol Tartrate/ Metoprolol succinate

2. Atenolol

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39
Q

MOA of Metoprolol Tartrate/ Metoprolol succinate

A

Selective B1 adrenergic receptor inhibitor

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40
Q

Indications of selective (B1) beta blockers

A

Angina
HTN
hemodynamically stable MI

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41
Q

SE of selective (B1) beta blockers (6)

A
  1. fatigue
  2. sleep disturbance
  3. depression
  4. bradycardia
  5. rebound angina/hypertension
  6. hypotension
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42
Q

Contraindications for selective (B1) beta blockers (4)

A
  1. bradycardia
  2. heart block
  3. uncompensated heart failure
  4. severe depression
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43
Q

What can high doses cause in selective (B1) beta blockers

A

High doses can lose B1 selectivity

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44
Q

what do you do Post MI or in compensated HF with selective (B1) beta blockers… what about when stopping?

A

up titrate slowly

when stopping? down titrate slowly

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45
Q

which Beta blocker drug has an increase absorption with food?

A

Metoprolol Tartrate/ Metoprolol succinate

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46
Q

MOA of Atenolol

A

Selective B1 adrenergic receptor inhibitor

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47
Q

when do you adjust the dose of Atenolol

A

Adjust dose in CKD (50% renally excreted unmetab)

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48
Q

Non-selective (B1 and B2) : Beta blockers

A

Propranolol

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49
Q

MOA of Propranolol

A

Adrenergic B1 and B2 receptor inhibitor

Reduction in myocardial oxygen demand

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50
Q

indications of Propranolol

A

Tachyarrhythmia
Essential Tremor
migraine Px
anxiety

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51
Q

the 3 SE of Propranolol

A

fatigue
sleep disturbance
depression

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52
Q

contraindications of Nonselective Beta blockers (6)

A
  1. Hypersensitivity
  2. Bradycardia
  3. Heart Block
  4. Uncompensated heart failure
  5. Severe depression
  6. Bronchospasm
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53
Q

what may increase or decrease concentration of Propranolol

A

Ethanol aka alcohol

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54
Q

what may Propranolol mask

A

may mask hypoglycemia

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55
Q

what do we have to know about HR relate to Propranolol

what about when stopping

A

titrate to HR 50-60 bpm or increase HR 20 bpm with exercise

when stopping: down titrate

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56
Q

when does the bioavailability increase in Propranolol and by how much

A

Bioavail increases x2 in elderly

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57
Q

drug class of Carvediliol

A

Beta blocker: Non selective (B1 , B2, Alpha 1)

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58
Q

MOA of Carvediliol

A

Mixed alpha beta receptor inhibition

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59
Q

indications of Carvediliol

A

angina (off label)
HTN
Stable HF
Stable Post MI

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60
Q

SE of Carvediliol (hint … youve seen this before)

A
  1. fatigue
  2. sleep disturbance
  3. depression
  4. bradycardia
  5. rebound angina/hypertension
  6. hypotension
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61
Q

when do you titrate slowly in Carvediliol

A

Post MI or Compensated HF

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62
Q

Anti-anginal Agent: Miscellaneous

A

Ranolazine

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63
Q

MOA of Ranolazine

A

Inhibits inward sodium channel in ischemic cardiac myocytes during repolarization thereby reducing Na+/Ca++ exchange which relaxes cardiac muscle and reduces myocyte oxygen consumption (proposed mechanism)

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64
Q

Indication of Ranolazine

A

CHRONIC ANGINA

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65
Q

SE of Ranolazine

A

HYPERHYDROSIS

also: constipation, HA, bradycardia, hypotension etc

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66
Q

Contraindications of Ranolazine (2)

A
  1. any degree of hepatic cirrhosis

2. concurrent strong CYP3A4 inhibitors or inducers

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67
Q

Common dx-dx interactions with Ranolazine

A
  1. CYP3A4 inhibitors (diltiazem, eythromycin, verapamil etc)
  2. P-glycoprotein inhibitors (cyclosporine)
  3. simcastatin (max dose is 20mg/day)
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68
Q

what do you NOT do with Ranolazine

A

SO NO CRUSH OR CHEW

69
Q

what is Ranolazine not for?

A

not for acute episodes of angina

70
Q

do not use Ranolazine with

A

grapefruit juice or st johns wort

71
Q

how much is Ranolazine

A

AWP at full dose is $476.51

72
Q

how do you dose Nitroglycerin?

A

Sublingually… if chest pain 1 tab every 5 min due to chest pain
3 pills max in 15 min.

you can also use it prophylactically

73
Q

what is the drug class for asprin?

A

anti-platelet aggregation drug COX 1 inhibitor

74
Q

what is the MOA of aspirin?

A

Irreversible inactivation (via acetylation) of cyclo-oxygenase (COX1)- inhibits synthesis of thromboxane A2 – prevents platelet aggregation & vasoconstriction by thromboxane A2

75
Q

what is the indication for aspirin?

A

secondary prophylaxsis

especially with MI, CVA

76
Q

what person of people experience gastritis with aspirin?

A

30%!!

77
Q

what are the two contraindications for asprin?

A

nasal polyps

bronchospasm

78
Q

what should you not take ASA with (2)

A

NSAIDS

other anticoagulants

79
Q

what is one thing you want to monitor for a pt taking ASA?

A

melena

80
Q

what do higher doses of ASA more than 325 mg do?

A

inhibit PGI2 (inhibits platelet aggreagation in vivo

81
Q

what is the drug class for clopidigrel?

A

platelet ADP inhibitor

82
Q

what is the indication for clopidigrel? (4)

A

secondary prevention
AMI
CVA
PAD

83
Q

what is the MOA of clopidigrel?

A

irreversibly blocks ADP receptor on platelets preventing platelet/fibrinogen binding and platelet aggregation

84
Q

what are the 3 negative effects experienced by those who take clopidigrel?

A

27% experience gastritis
abdominal pain
thrombocytopenia

85
Q

what are the 4 drug interactions that interact with clopidigrel?

A
  1. antiplatelet/anticoagulant (increase)
  2. atorvastatin (decrease)
  3. macrolides abx (decrease)
  4. ginko biloba (increase)
86
Q

Is clopidigrel used for ASA allergy?

A

why yes, yes it is

87
Q

what is the dosing for clopidigrel?

A

300 mg loading, 75 maitenance

88
Q

what are the three drugs in the Diuretics: Loop diuretics

A
  1. Furosemide
  2. Torsemide
  3. Ethacrynic Acid
89
Q

MOA of Furosemide

A

Inhibits NA+, K+, Cl2, symporter in TAL of loop and distal tubule

90
Q

Indications of Furosemide

A

Edema 2nd to CHF, kidney, liver failure

HTN

91
Q

SE of Furosemide and Ethacrynic Acid (6)

A
  1. hypotension
  2. dehydration
  3. hyperglycemia
  4. increased then decreased uric acid
  5. electrolyte abnormalities
  6. jaundice
92
Q

Contraindications of Furosemide

A

Hypersensitive to sulfa

93
Q

DX-DX interactions of Furosemide

A
  1. Increases impact of anti-HTN meds and lithium

2. corticosteroids increase furosemide impact

94
Q

what is the outpatient target with Furosemide

A

outpatient target 2lbs body weight loss/day to get to dry weight, then down titrate

95
Q

MOA of Torsemide

A

Inhibits NA+, K+, Cl2, symporter in TAL of loop and distal tubule

96
Q

Indications of Torsemide

A

Edema of cardia, renal and hepatic failure

HTN

97
Q

SE of Torsemide

A
  1. Constipation

2. diarrhea

98
Q

Contraindications of Torsemide

A

anuria

sulfa sensitivity

99
Q

Dx-Dx interactions of Torsemide

A

Other K+ wasting drugs

100
Q

2 things to monitor with Torsemide

A

k+

eGFR

101
Q

how much Torsemide is equal to Furosemide

A

10-20mg Torsemide about equal to Furosemide 40mg

102
Q

MOA of Ethacrynic Acid

A

Inhibits NA+, K+, Cl2, symporter in TAL of loop and distal tubule

103
Q

indications of Ethacrynic Acid

A

Edema 2nd to CHF, kidney, liver failure

104
Q

contraindications of Ethacrynic Acid and Dx-Dx interactions (2)

A

Contraindications: H/o of severe watery diarrhea with ethacrynic acid

Dx-Dx:

  1. Increase anti-HTN impact
  2. corticosteroids increase diuretic impact
105
Q

what about outpatient target

A

outpatient target 2lbs body weight loss/day to get to dry weight, then down titrate

106
Q

what are the 2 Diuretics: aldosterone Antagonists

A
  1. Spironolactone

2. Eplerenone

107
Q

MOA of Spironolactone

A

Inhibit Na reabsorption by distributing the aldosterone-dependent NA+/K+ pump

108
Q

Indications of Spironolactone

A
  1. Excessive aldosterone excretion or HF
  2. HTN
  3. hypokalema
  4. liver cirrhosis with edema or ascites
109
Q

SE of Spironolactone

A

SJS
gynecomastia
amenorrhea

110
Q

contraindications of Spironolactone

A

Addisons dx
K+>5.5
eGRF

111
Q

monitoring Spironolactone

A

K+

112
Q

what does K+ need to be below for Spironolactone

A

K+ needs to be below 5.5 in order to initiate

113
Q

MOA of Eplerenone

A
  • -> more specific aldosterone receptor antagonist in kidney, heart, blood vessels, brain
  • -> reduces vascular and cardiac fibrosis
114
Q

Indications of Eplerenone

A
  1. excessive aldosterone excretion
  2. heart failure
  3. HTN
  4. hypokalema
  5. liver cirrhosis with edema or ascites
115
Q

Dx-Dx of Eplerenone

A
  1. K+ >5.5 (K must be below 5.5 to start)

2. eGFR

116
Q

monitor with Eplerenone

A

K+

117
Q

referring to Eplerenone

  1. what is it less likely to cause
  2. when do you reduce dose
  3. what to be cautious with?
A

less likely to cause gynecomastia

reduce dose for renal, hepatic insufficiency

caution in DM (hyperkalemia risk)

118
Q

3 Vasodilators: ACE inhibitors

A
  1. Captopril
  2. Lisinopril
  3. Fosinopril

ok- so these are all the same so the next cards are for all three together

119
Q

MOA of Vasodilators: ACE inhibitors

A

Competitive inhibitor of ACE preventing angiotensin I conversion to angiotensin II decreasing vasoconstriction by angiotensin II and decreases aldosterone secretion

120
Q

Indications of Vasodilators: ACE inhibitors (4)

A
  1. HTN
  2. HF
  3. left ventricular dysfunction after MI
  4. DM neuropathy
121
Q

SE of Vasodilators: ACE inhibitors (3)

A

cough

hyperkalmia

angioedema

122
Q

Contraindications of Vasodilators: ACE inhibitors (3)

A
  1. Hx angioedema
  2. concurrent use of Aliskerin in DM patients
  3. bilat renal artery stenosis
123
Q

Dx-Dx of Vasodilators: ACE inhibitors

A

don’t use with ARB’s, aliskerin

124
Q

Pregnancy category of Vasodilators: ACE inhibitors

A

PG. D
TERTOGEN
AHHHH!

125
Q

what do you watch for during first time dose of Vasodilators: ACE inhibitors

A

watch for first dose hypotension

126
Q

Drug class of Losartan

A

Vasodilators:
Angiotensin 2 Receptor Blockers
ARB

127
Q

MOA of Losartan

A

Selectively and competitively blocks AT1 and AT2 receptors

128
Q

indication of Losartan

A
  1. HTN
  2. DM neuropathy
  3. stroke
  4. LVH
129
Q

SE of Losartan

A
  1. hyperkalemia
  2. especially in people with T2DM:
    - ->chest pain
    - ->fatigue
    - ->hypogycema
    - ->diarrhea
    - ->UTI
130
Q

dx-dx interactions of Losartan

A

Aliskerin

ACEI

131
Q

what increases with Losartan

A

incr excretion of uric acid

132
Q

which drug is a Direct-Acting Vasodilators

A

Hydralazine
+
Isosorbide Dinitrate

133
Q

MOA of
Hydralazine
+
Isosorbide Dinitrate

A

Direct-acting arteriolar vasodilators

134
Q

Indication of
Hydralazine
+
Isosorbide Dinitrate

A

adjunct in HF esp. afro-americans

135
Q

SE of
Hydralazine
+
Isosorbide Dinitrate

A
  1. Angina
  2. orthostatic htn
  3. SLE-like syndrome
136
Q

contraindications of
Hydralazine
+
Isosorbide Dinitrate

A

Mitral valve rheumatic heart disease

137
Q

Which drug is a
Positive Inotropic Agents:
Cardiac Glycoside

A

Digoxin

138
Q

MOA of Digoxin

A
  1. Inhibits Na/K ATPase pump in myocardial cells promoting influx Ca++ leading to increased contractility
  2. direct suppressor of AV node decr ventricular rate
139
Q

indications of Digoxin

A

Afib rate control

140
Q

SE of Digoxin

A
  1. incomplete heart block may proceed to complete block
  2. digoxin toxicity
  3. SSS
141
Q

Contraindications of Digoxin

A
  • -> V-fib
  • -> co-existing thyroid d/o
  • -> recent MI
142
Q

what is a list to remember in Digioxin and what kinda of effect is important to remember

A

BEERS list: cautious use in elderly

proarryhthmic effect

143
Q

What drug is under the drug class
Positive Inotropic Agents:
B-agonists

A

Dobutamine

144
Q

MOA of Dobutamine

A

Stimulates B1 adrenergic receptors increasing cardiac contractility and HR

little impact on B2 or alpha receptors

145
Q

Indications of Dobutamine

A

Short-term management of cardiac decompensation

146
Q

SE of Dobutamine

A

incr HR

paradoxical hypotension

exacerbation of ventricular ectopy

147
Q

contraindications of Dobutamine

A
  1. allergy to sulfites

2. recent MAOI

148
Q

Which drug is under the class
Positive Inotropic Agents:
Phosphosdiesterase
Inhibitors

A

Milrinone

149
Q

MOA of Milrinone

A

Selective PDE inhibitor in cardiac and vascular tissue producing vasodilation and inotropic effects with little chronotropic activity

150
Q

indications of Milrinone

A

Short-term IV therapy of acutely

151
Q

contraindications of Milrinone

A
  • -> AMI

- -> severe obstructive or pulmonic valvular disease

152
Q

Drug class of Nesiritide

A

Miscellaneous:

Recombinant BNP

153
Q

MOA of Nesiritide

A

Increases intracellular GMP in vascular smooth muscle cells and endothelium resulting in smooth muscle relaxation reducing pulmonary capillary wedge pressure (PCWP) and systemic arterial pressure

154
Q

indication of Nesiritide

A

acutely decompensated HF with dyspnea at rest or with minimal activity

155
Q

SE of Nesiritide

A
  • -> Increase creatinine

- -> arryhthmias

156
Q

contraindications of Nesiritide

A

cardiogenic shock

hypotension (SBP

157
Q

drug class of Aliskiren

A

Miscellaneous:

Direct Renin Inhibitor

158
Q

MOA of Aliskiren

A

Direct renin inhibitor preventing conversion of angiotensinogen to angiotensin I which reduces conversion to angiotensin II producing arteriolar vasodilation

159
Q

indication of Aliskiren

A

HTN

160
Q

Contraindications of Aliskiren

A

itraconazole

161
Q

Dx-Dx interactions of Aliskiren (2)

A
  1. decr effect of furosemide

2. NSAIDs decr effect of Aliskerin

162
Q

what do you not take with Aliskiren!!!!!

A

Not with grapefruit juice!

163
Q

which drug just has the drug class Miscellaneous

A

Ivabradine

164
Q

MOA of Ivabradine

A

Selective and specific inhibition of If SA node and prolonging diastolic depolarization and reducing HR

165
Q

indications of Ivabradine

A

Stable HF with EF70 and who are on max tolerated doses of B-blocker or unable to take B-blocker

166
Q

indications of Ivabradine (3)

A
  1. afib
  2. heart block
  3. phosphene
167
Q

SE of Ivabradine

A
  • SSS

- BP

168
Q

“other category” Ivabradine

and what to avoid

A

Retinal Ih (similar to If) channel partial inhibition may account for phosphene

avoid grapefruit juice

Module 5: Mali: Cardio (4 decks)

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