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Therapeutics P2 Winter Semester > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Treatment goal for dyslipidemia

A

Greater than or equal to 50% reduction in LDL

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2
Q

Preferred treatment for dyslipidemia

A

-Lifestyle modifications
-Low (<7%) saturated fat; Low (<200 mg/dL) C
-Moderate-High intensity statin

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3
Q

Treatment goal for HTN

A

BP < 130/80 mmHg

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4
Q

Preferred treatment for HTN

A

-Lifestyle modification
-Therapy based on compelling indications with BB, ACEi, ARBs + others as needed

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5
Q

Treatment goal for DM

A

HbA1c < 7%

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6
Q

Treatment preferred for DM

A

-Individualize to reach goal
-T2DM with ASCVD: SGLT2 or GLP-1

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6
Q

Treatment goal for smoking

A

Complete smoking cessation/exposure

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6
Q

Preferred treatment for smoking

A

Systematic strategy, pharmacotherapy

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7
Q

Treatment goal for weight management

A

-BMI: 18.5-24.9
-Waist circumference: 40 for men and 35 for women
-Wt loss 5-10% initially

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8
Q

Preferred treatment for weight management

A

Diet/lifestyle counseling; printed educational materials and encourage

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9
Q

Treatment goal for physical activity

A

~30-60 min mod intensity activity 5-7 days/wk
~cardiac rehab/supervised

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10
Q

Preferred treatment for physical activity

A

Brisk walking, swimming, cycling; increased daily activities

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11
Q

Why is it not recommended to give low-dose ASA in patients who have no risk of CAD?

A

Greater risk of developing hemorrhagic stroke (risk outweighs potential benefit)

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12
Q

Which P2Y12 inhibitor is indicated following ACS

A

Cangrelor or Prasugrel

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13
Q

Which P2Y12 inhibitor is indicated following ACS or prior MI

A

Ticagrelor

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14
Q

What is the purpose of enteric coated ASA?

A

Protect gastritis/stomach ulcer irritation

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15
Q

For a patient having an MI, take ____ in addition to NGL

A

1 ASA tablet (can chew and swallow to help it be absorbed faster)

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16
Q

____-dose ASA reduces risk of future ____ substantially

A

Low; MACE

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17
Q

Which P2Y12 inhibitors are pro-drugs

A

Clopidogrel and Prasugrel

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18
Q

What is the time to peak inhibition for clopidogrel

A

4-5 h (300 mg); 2-3 h (600 mg)

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19
Q

What is the time to peak inhibition of prasugrel

A

2-4 h

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20
Q

What is the time to peak inhibition of ticagrelor

A

2-4 h

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21
Q

What is the time required for effect dissipation for clopidogrel?

A

5 d

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22
Q

What is the time required for effect dissipation for prasugrel?

A

7 d

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23
Q

What is the time required for effect dissipation for ticagrelor?

A

5 d

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24
Q

Can 2 antiplatelets be used together? Why or why not?

A

Yes; they have different MOA

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25
Q

P2Y12 agents add additional benefit to ASA in specific situations, but also significantly increase ____

A

Bleeding risk

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26
Q

Why must an antiplatelet be given after stent placement?

A

If there was a mistake, blood may bind to the area thinking it is damaged and we do not want blood to accumulate there.

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27
Q

ASA dose MUST be ___ 100 mg with _____

A

Less than or equal to; ticagrelor

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28
Q

Do RAS inhibitors improve symptomatic ischemia?

A

NO! They decrease cardiovascular events

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29
Q

ACEi/ARB should be considered for ___

A

All patients with CCD (especially those with LVEF < 40%, HTN, DM, and CKD)

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30
Q

Which ACEi were studied for people with CCD?

A

Ramipril 10 mg/d
Perindopril 8 mg/d

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31
Q

Which ARB was studied for people intolerant to ACEi with CCD?

A

Telmisartan 80 mg/d

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32
Q

When should a statin be used?

A

When LDL > 100

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33
Q

Do nitrates have an effect on the natural history of a disease?

A

NO! They treat symptoms, but do not keep people alive

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34
Q

What is a challenge with nitrates?

A

Poor dexterity: grabbing small tablet or pushing down on spray

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35
Q

Efficacy of nitrates

A

They are all the same!

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36
Q

Advantage of NTG spray

A

Longest shelf life

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37
Q

Storage of NTG

A

Must keep in original container

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38
Q

Instructions for NTG

A
  1. Sit down
  2. Place 1 tablet under the tongue (don’t swallow; no H2O)
  3. If still experiencing chest pain after 5 min, call 911 and take another tablet
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39
Q

What should and should not be used for a HA while a patient is taking NTG?

A

Should take: Tylenol
Should NOT take: ASA or anti-inflammatory meds

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40
Q

What medication class must be used with extreme caution with nitrates?

A

PDEi due to hypotension and may lead to death

Explain risk of combined agents

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41
Q

What should a patient do if they took a PDE-i and experience chest pain, but they are still in the time frame that NTG should be avoided?

A

Stop action and hope the pain resolves

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42
Q

How long should you wait after taking Avanafil to take NTG?

A

12 h

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43
Q

How long should you wait after taking Sildenafil or Vardenafil to take NTG?

A

24 h

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44
Q

How long should you wait after taking Tadalafil to take NTG?

A

48 h

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45
Q

Which beta blockers are lipid soluble?

A

Propranolol
Carvedilol

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46
Q

Which beta blockers are water soluble?

A

Atenolol
Bisoprolol

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47
Q

Adverse cardiac effects with beta blockers

A

Sinus bradycardia
Sinus arrest
AV block

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48
Q

Goal HR while on BB

A

50-60 bpm at rest
<100 bpm when exercising

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49
Q

Which CCB are DHP?

A

Amlodipine

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50
Q

Which CCB are non-DHP?

A

Diltiazem and verapamil
**Act like BB

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51
Q

What are the examples of short-acting DHPs? Can short-acting DHP’s be used for CAD? Why?

A

Nicardipine and Nifedipine
NO; they cause substantial tachycardia

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52
Q

Which CCB are C/I in HF?

A

Verapamil and Diltiazem

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53
Q

Monitoring for DHPs

A

BP and edema

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54
Q

Monitoring for non-DHPs

A

Constipation
HR (goal: 50-60 at rest and <100 during exercise)

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55
Q

Do you get nitrate protection overnight?

A

Nope; that’s the nitrate-free period

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56
Q

NTG patch dosing

A

On @ 7 AM and take off 7-9 PM (put on in AM and take off in PM)

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57
Q

ISDN tablet dosing

A

10 mg TID (8,12,4 or 7,12,5)

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58
Q

ISMN tablet dosing

A

20 mg BID (8,3 or 8,4)

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59
Q

ISMN SR tablet dosing

A

30 mg QD in AM (8)

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60
Q

When should Ranolazine monotherapy be utilized?

A

When BP/HR are too low with other first-line agents

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61
Q

Which drug classes can be used for stable angina?

A

BB, CCB, nitrates

62
Q

Should BB and non-DHP CCB be used together in stable angina?

A

No–b/c of HR lowering effect and negative conduction abnormalities

63
Q

First line options if NSAIDs are to be used with ASA

A

Ibuprofen or naproxen

64
Q

Which NSAID should be avoided with ASA use?

A

Diclofenac

65
Q

Prinzmetal’s angina/vasospastic angina usually occurs (during exercise/at rest)?

A

At rest

66
Q

Vasospastic angina is associated with ECG __-segment (elevation/depression)?

A

ST; elevation

67
Q

When do ischemic episodes occur most frequently in vasospastic angina?

A

Early morning hours

68
Q

Treatment options for vasospastic angina

A

CCB (1st line)
Nitrates
Combo tx (CCB + nitrate)

69
Q

Define unstable angina

A

A little bit of an occlusion

70
Q

Define NSTEMI

A

Some blood flowing through

71
Q

Define STEMI

A

Full occlusion; no blood passing through

72
Q

Type 1 acute coronary syndrome

A

Spontaneous MI; atherosclerotic plaque ruptures

73
Q

Type 2 acute coronary syndrome

A

MI secondary to ischemic imbalance (oxygen supply and demand mismatch to heart)

74
Q

Diagnosing ACS: All patients should receive an ECG within __ minutes of arriving to the ED facility

A

10

75
Q

What condition is described: persistent ECG ST elevation; Q wave changes

A

STEMI

76
Q

What condition is described: ST depression or new T wave inversion; Q wave changes are unlikely

A

NSTEMI

77
Q

Units of high sensitivity troponin

A

ng/L

78
Q

Units of conventional troponin

A

ng/mL

79
Q

Levels of high sensitivity troponin that detect myocardial injury

A

Greater than 14 ng/L

80
Q

Levels of conventional troponin that detect myocardial injury

A

Greater than 0.05 ng/mL

81
Q

Which part of the heart is the strongest and pumps blood out to the rest of the body?

A

Left ventricle

82
Q

If initial ECG is not diagnostic, but symptoms persist, how often should serial ECG’s be performed?

A

q15-30min for the first hour

83
Q

Why should NSAIDs be avoided during hospitalization for UA, NSTEMI, or STEMI?

A

Lead to sodium and water retention which increases risk of MACE

84
Q

When is supplemental oxygen needed?

A

When O2 sat is less than 90%

85
Q

What are the names of the fibrinolytics learned in class? Which disease state are they used for? Which ones are weight based?

A

Names: tenecteplase, Reteplase, Alteplase
Disease: STEMI
Weight based: Tenecteplase and Alteplase

86
Q

Which STEMI patients should get reperfused? Which type of reperfusion is preferred?

A

ALL patients whose symptoms began in previous 12h; PCI is preferred over fibrinolytic

87
Q

Door-to-needle time (Fibrinolytics)

A

within 30 minutes of hospital arrival

88
Q

Door-to-balloon time (PCI/stent)

A

within 90 minutes of hospital arrival

89
Q

How long is DAPT recommended for UA/NSTEMI/STEMI patients?

A

12 months

90
Q

The loading dose of clopidogrel is 300-600 mg. Most of the time 600 mg is used. In which situation would 300 mg be used?

A

If pt is on a fibrinolytic

91
Q

What is prasugrel not recommended for?

A

ischemia guided strategy, pt 75+ years old, less than 60 kg, or at high bleed risk

92
Q

What is a contraindication for prasugrel?

A

Patient has a hx of stroke/TIA

93
Q

In the acute/early phase of switching from one P2Y12 inhibitor to another, is washout needed? Is loading dose needed?

A

Washout of 24h is NOT needed, but a loading dose is needed

94
Q

In the late phase of switching from one P2Y12 inhibitor to another, is washout needed? Is loading dose needed?

A

24h washout is needed, but a loading dose is not needed.

95
Q

Which P2Y12i is preferred for ischemia guided tx?

A

Clopidogrel or ticagrelor

96
Q

Which P2Y12i is preferred with a fibrinolytic?

A

Clopidogrel

97
Q

Which P2Y12i is preferred for PCI?

A

Ticagrelor or prasugrel

98
Q

Adverse event with ticagrelor

A

SOB

99
Q

Major s/sx of bleeding

A

Blood in urine/stool; coughing up blood; cut that won’t stop bleeding after pressure is applied for ~10 min

100
Q

Does ASA need to be held before a CABG?

A

NO

101
Q

How long do the P2Y12i need to be held before elective CABG?

A

Ticagrelor: 3d
Clopidogrel: 5d
Prasugrel: 7d

102
Q

GPIIb/IIIa inhibitors include

A

Abciximab, eptifibatide, and tirofiban
**Given in addition to ASA and P2Y12 inhibitor if needed

103
Q

Which drug class can be used as “bail out”?
*Used during PCI if thrombus develops or low blood after stenting

A

GPIIb/IIIa

104
Q

What are the names of the two screening tests available for HIT?

A

Enzyme-linked immunosorbent assay (ELISA) and Serotonin release assay (SRA)

105
Q

What should you do if a patient tests positive for ELISA test?

A

STOP heparin and send off SRA to lab to verify the positive reading

106
Q

What is UFH dosing based on?

A

aPTT (activated partial thromboplastin time) or ACT (activated clotting time)

107
Q

What drug class does enoxaparin belong to? What should be checked before giving a pt enoxaparin?

A

LMWH; CrCl

108
Q

What drug class does bivalirudin belong to?

A

Direct thrombin inhibitor

109
Q

Can bivalirudin be used with GPIIb/IIIa inhibitors?

A

NO–except when used for “bail out”

110
Q

What drug class does fondaparinux belong to?

A

Factor Xa inhibitor

111
Q

When is fondaparinux mainly used?

A

If pt has a hx of HIT

112
Q

Is fondaparinux the DOC if planning on a PCI?

A

NO–need to give UFH or bivalirudin also

113
Q

When is fondaparinux C/I?

A

When CrCl < 30 ml/min

114
Q

When should a BB be utilized in ACS?

A

Within 24h

115
Q

Which BB should be used for pts with HFrEF?

A

Metoprolol succinate, carvedilol, or bisoprolol

116
Q

What should you do if a patient is using cocaine and needs a BB?

A

Use a non-selective BB, such as carvedilol for alpha blockade as well

117
Q

Is it okay to start or increase a BB in a patient with acute HF exacerbation?

A

No

118
Q

Is it okay to continue giving a patient their BB during acute HF exacerbation?

A

Yes

119
Q

Which sign of hypoglycemia do BB not mask?

A

Cold sweats

120
Q

Blood pressure and heart rate that are too low for BB

A

BP< 90/60 mmHg
HR<50-60 bpm

121
Q

If a patient has recurrent ischemia and they are contraindicated to BB, what should be used next?

A

Non-DHP CCB (diltiazem or verapamil)

122
Q

Which patients should be on a statin?

A

ALL! **High-intensity

123
Q

Which patients should be on an ACE inhibitor?

A

ALL–especially those with HFrEF, DM, or CKD

124
Q

When should an ACE inhibitor be added to regimen?

A

Use cautiously in first 24h of MI because it may result in hypotension/renal dysfunction

125
Q

Which ACE inhibitors are indicated for ACS?

A

captopril, enalapril, lisinopril, ramipril, and trandopril

126
Q

Monitoring parameters for ACE-i

A

BP (decreases)
K+ (increases)
SCr (increases)
Angioedema (swelling of face and lips)

127
Q

Counseling point if patient experiences angioedema

A

STOP taking med and seek medical attention

128
Q

How many sprays does it take to prime nitrolingual?

A

5

129
Q

How many sprays does it take to prime Nitromist?

A

10

130
Q

Which patients should get nitroglycerin?

A

ALL; they should get 0.3-0.4 mg for under the tongue 15min for chest pain….max 3 doses

131
Q

Which type of ischemia (supply or demand) is Printzmetal’s?

A

Supply

132
Q

Which type of ischemia (supply or demand) is fixed stenosis?

A

Demand

133
Q

Which type of ischemia (supply or demand) is unstable angina?

A

Supply

134
Q

Cause of stable angina ischemia

A

Fixed obstruction in epicardial artery

135
Q

Cause of stable angina pectoris

A

Myocardial ischemia and associated disturbances in myocardial function WITHOUT myocardial necrosis

136
Q

What is the definitive test of coronary anatomy?

A

Cardiac catherization and coronary angiography

137
Q

Do nitrates impact supply or demand?

A

decrease preload=decrease demand

138
Q

Do beta blockers impact supply or demand?

A

decrease demand

139
Q

Do CCB impact supply or demand?

A

decrease demand

140
Q

Side effects of BB

A

Sinus bradycardia
Sinus arrest
AV block

141
Q

Monitoring of DHPs

A

Edema and BP

142
Q

Monitoring of non-DHPs

A

Constipation and HR

143
Q

MOA of nitrates

A

ALDH2 inactivation in mitochondria

144
Q

Adverse events of nitrates

A

BP reduction; reflex tachycardia

145
Q

MOA of ranolazine

A

Inhibit late sodium channel to prevent an increase in intracellular sodium and calcium increase

146
Q

Which drug class should ranolazine NOT be used with?

A

CYP3A inhibitors and inducers

147
Q

With moderate CYP3A inhibitors (diltiazem and verapamil), ranolazine should be dosed at ____.

A

500 mg BID

148
Q

What is a contraindication for DHP and non-DHP CCB?

A

HFrEF

149
Q

What should be used in combination with nitrates to blunt nitrate induced increase in HR?

A

Non-DHP CCB or BB

150
Q

When do MIs occur most of the time?

A

At rest

151
Q

Atypical s/sx of MI

A

Indigestion, epigastric pain, increasing dyspnea in absence of CP

152
Q

If a patient has elevated troponin, is it conclusive that they have a STEMI/NSTEMI?

A

NO–other conditions can cause elevated troponin. Check ECG as well!

153
Q
A

Therapeutics P2 Winter Semester (29 decks)

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