Exam 1 - Pharm Blessings Flashcards
What is the first-line drug for angina?
nitroglycerin [nitrostat] PRN
What is the MOA of nitroglycerin [nitrostat]
vasodilator:
dilates the smooth muscle of arteries and veins
decreases the cardiac preload
What drug class will eliminate the S/E of tachycardia with nitroglycerin, and how?
beta blockers
by decreasing cardiac contractility and HR, thus decreasing workload of heart
What are the MC side effects of nitro? (think of MOA)
tachycardia, orthostatic hypotension, HA
What drug class has been shown to decrease mortality after MIs?
beta blockers
What else would you prescribe for stable angina?
an aspirin a day keeps the MI away
What is an alternative for a person who is allergic to aspirin?
clopidogrel [plavix]
Your patient has HTN, and his ECG shows LVH. What does this indicate has happened, and what should you look for on PE?
indicates end-organ involvement
do a fundascopic exam to look for A-V nicking and sclerosing of vessels
Look for JVP, peripheral edema
This same patient with HTN and LVH is having stable angina. What will you prescribe for him?
[more things: he is on HCTZ for HTN, but his BP is 140/90]
Give nitroglycerin [nitrostat] for angina
Give aspirin for angina
Give metoprolol [lopressor] for HTN and angina
Is it okay to have a person on HCTZ and metoprolol at the same time?
Yeah looks like it
When a person is having chest pain and takes nitro, after how long should they call 911?
If the chest pain has lasted longer than 5 minnies
Where are beta 1 receptors located?
myocardium of the heart around the SA and AV nodes
Where are beta 2 receptors located?
lungs and skeletal muscles
If a person has asthma (or any lung disease) and angina, what type of drug should you use?
a selective agent (b1 blocker) like metoprolol [lopressor]
if a person has CAD, what is the diagnostic gold standard test?
cardiac catheterization and angiography
(there’s some random blessington input for you)
What type of drug class are erectile dysfunction pills?
PDE5 inhibitors
What are the rules with prescribing nitro and PDE5 inhibitors (like erectile dysfunction pills) together?
CANNOT use nitro if you have taken PDE5 inhibitors within 24 hours prior
What disease is absolutely contraindicated with nitroglycerin?
head trauma/stroke (risk of brain bleed)
What is a S/E of amlodipine [norvasc] and other dihydropyridines to be aware of?
peripheral edema
What is another extremely common SE of amlodipine?
HA
What are some options if your patient is on amlodipine for heart disease, but is developing peripheral edema from it?
Could decrease dose of amlodipine
Could switch to another class of calcium channel blockers: the nondihydropyridines
Could close your eyes and just point to something on the drug table and hope that it doesn’t kill them
Why do beta blockers cause orthostatic hypotension?
When we stand, the HR normally increases.
On a beta blocker, that adrenergic reaction is blocked to maintain a low HR.
If a person has orthostatic hypotension, and is also prescribed nitro, what instructions should you give them for taking their nitro?
sit dat ass down when taking the nitro!
Your person with once stable angina is now getting symptoms more often. What should you do for them?
Add a calcium channel blocker like amlodipine
if pt has HTN (which, let’s be real, I bet they do) it will also help with the HTN
Your patient is on salmeterol diskus for her COPD and is developing unstable angina. Why is the salmeterol diskus dangerous?
Salmeterol is a b2 agonist, and will affect her heart. Switch to LAA.
She shoulda been on that in the first place anyway.
What is the diuretic class of choice for patients who have peripheral edema and CKD?
loop diuretics
All diuretics inhibit sodium reabsorption in the kidneys, so why are loop diuretics the choice drug in patients with CKD?
they work at the loop of henle so they work better
get it… <strong>loop</strong> diruetics… :)
How often per day should you be “nitrate free?”
What happens if you don’t do this?
Should be nitrate free for 8-12 hours per day
otherwise, the efficacy of nitro goes down
What forms does nitro come in?
sunlingual spray
sublingual/buccal tablet
topical
IV
What drug comes in a dark glass bottle?
nitroglycerin
What is the effective time frame of furosemide [lasix]?
6 hours
(so take 1 in AM, take 1 in afternoon)
Should a person take furosemide [lasix] before bed?
not unless they wanna be peein’ all night
if a patient gains ___ lbs in 24 hours, they should take a dose of furosemide [lasix]
3
(pretty sure I gain 3 lbs over the course of a meal)
If a person is taking furosemide [lasix] twice daily, and they finally get down to their water weight, should they continue taking furosemide [lasix]?
Yep, they can take it PRN instead though!
What if a person is on Salmeterol diskus for COPD, and is also on a loop diuretic?
No bueno.
Salmeterol decreases the effect of the loop diuretic
Change to tiotroprium
What heart failure drug class does tiotroprium interact with?
ACE inhibitors
What do you have to do with a person’s furosemide [lasix] if they have been on it for a long time/have used it very often?
often have to up the dose from 20mg to 40mg to get an impact
What are some side effects of furosemide [lasix]?
Dehydration leading to hypotension
hypokalemia (AKA potassium depletion)
decreases other electrolytes
For a person on furosemide [lasix], how many pounds is the patient aiming to lose daily?
2 lbs
Is furosemide [lasix] indicated for a person with renal disease?
YAAASSSSS it’s like, only for renal failure
(fun fact: that’s not actually true, it’s also for liver failure and edema from CHF)
What stages of CKD is furosemide [lasix] best for?
stage 3 and 4
Pt. has a sulfa allergy, and has water retention from CKD. What drug can’t you give him?
CAN’T give furosemide [lasix]
it won’t technically cause an “allergic rxn” but there’s a warning about it. so you could get sued.
Can’t give torsemide [demadex] either
So that doesn’t change the fact that your pt has a sulfa allergy and water retention from CKD. What do you give him?
ethacrynic acid [edecrin]
How do you feel about the BP 110/70 for a 70y/o?
doesn’t matter how you feel
it’s low
old people should develop higher blood pressure
So if your patient is on metoprolol [lopressin] and she has a BP of 110/70, what drug class might she benefit from more than a beta blocker??
Ace inhibitors
When should you take ethacrynic acid [edecrin]?
morning and afternoon, not before bed
(again, the whole peeing thing)
Your patient needing a diuretic also has low potassium. What should you prescribe her?
spironolactone (aldactone) or eplerenone (inspra)
these spare potassium
Your patient in need of a diuretic with low potassium is a MALE. You will Rx him Eplerenone [inspra]. Why won’t you Rx him spironolactone [aldactone]?
spironolactone [aldactone] can give him man boobies
(for anyone more mature than me that is interested, the proper term for this is gynecomastia)
Hint: think lactone = lactate
Are thiazide diuretics useful in patients with renal disease?
Nosiree
you want da loopz
So what exactly do the loop diuretics do, in the kidneys and in the heart?
In kidneys: inhibit reabsorption of Na and Cl in the body, so these get excreted and H2O follows (and K+ tags along too)
In heart: Decrease preload
ACE inhibitors are for HTN, but what other disease are they good in?
renal disease, esp in diabetics
Hey Professor White, should I know about using ACE inhibitors for HTN for exam 1?
“No.” - Tommy W
So don’t bother! :)
But DO know about ACE inhibitors for HF.
What are the S/E of ace inhibitors?
hyperkalemia, coughing
What causes the cough with ACE inhibitors?
production of bradykinin
What are C/I of ACE inhibitors?
angioedema*** (won’t respond to drugs)
bilat renal artery stenosis
What is the PG category of ace inhibitors?
D
teratogenic
Which diuretic is equally effective IV or orally at the same dosage?
torsemide [demadex]
Which diuretics can be used IV?
furosemide [lasix]
torsemide [demadex]
What are the 3 major diseases that often coexist in patients?
CKD
COPD
HF
hard to tell which is causing what symptoms
Your pt is on Furosemide [lasix] PRN, but he’s been eating super salty food and has gained 7# and has orthopnea. What can you do for him?
Tell him to get his shit together
And put him on Furosemide [lasix] 40mg twice daily until he gets his shit together
This is a break card
You are on card #61. Go get some water or take a lap or pet your animal or your friend, then grab some snacks/sanity and then come back. It’s a big deck, you’re killing it!
What is the MOA of spironolactone [aldactone]?
this diuretic competitively inhibits aldosterone in the kidney
What would every single one of these patients benefit from once they are at their dry weight?
cardiac rehab program
Pt on metoprolol [lopressor] for afib is in sinus bradycardia. what will you do?
titrate down the dosage of his metoprolol
he could also be switched to an anticoag for his afib
What do African Americans not produce as much of?
Angiotensin I
What is the potential dx-dx interaction between lisinopril and furosemide [lasix]?
hypotension
Rx-ing Lisinopril vs. Captopril. GO!
Lisinopril is on the $4 list. Once daily. MC prescribed.
Captopril is more expensive and must be taken 2x daily.
Both are good drugs.
Who is a candidate for hydralazine + isosorbide dinitrate [BiDil]?
a person who has failed on other HF treatment, especially African Americans
What is the MOA of hydralazine (one of the combos in BiDil)?
decreases total peripheral resistance by relaxing smooth muscle in arterioles
thus decreases afterload
thus decreases blood pressure
More commonly in white patients, what can hydralazine + isosorbide dinitrate [BiDil] cause?
Lupus
Dobutamine is a heavy hitter drug that we will not rx. But what’s the drug class? What are indications?
inotropic agent
afib, mild-mod HF
Diuretics decrease ______ while hydralazine + isoborbide dinitrate [BiDil] decreases ______
diuretics: decrease preload
bidil: decreases afterload
What do nitrates decrease, preload or afterload?
preload
do diuretics dilate more veins or arteries?
veins
YAY CONGRATS YOU MADE IT THRU THE BLESSINGS
h;raeng;rnse;igohaeo;gnalwhg[02hgsjk.erzdmvzk.n
losing my mind
getting food
bye
<3
