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Paige: CARDIO > Exam 1 - Pharm Blessings > Flashcards

Exam 1 - Pharm Blessings Flashcards

1
Q

What is the first-line drug for angina?

A

nitroglycerin [nitrostat] PRN

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2
Q

What is the MOA of nitroglycerin [nitrostat]

A

vasodilator:

dilates the smooth muscle of arteries and veins

decreases the cardiac preload

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3
Q

What drug class will eliminate the S/E of tachycardia with nitroglycerin, and how?

A

beta blockers

by decreasing cardiac contractility and HR, thus decreasing workload of heart

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4
Q

What are the MC side effects of nitro? (think of MOA)

A

tachycardia, orthostatic hypotension, HA

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5
Q

What drug class has been shown to decrease mortality after MIs?

A

beta blockers

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6
Q

What else would you prescribe for stable angina?

A

an aspirin a day keeps the MI away

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7
Q

What is an alternative for a person who is allergic to aspirin?

A

clopidogrel [plavix]

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8
Q

Your patient has HTN, and his ECG shows LVH. What does this indicate has happened, and what should you look for on PE?

A

indicates end-organ involvement

do a fundascopic exam to look for A-V nicking and sclerosing of vessels

Look for JVP, peripheral edema

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9
Q

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]

A

Give nitroglycerin [nitrostat] for angina

Give aspirin for angina

Give metoprolol [lopressor] for HTN and angina

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10
Q

Is it okay to have a person on HCTZ and metoprolol at the same time?

A

Yeah looks like it

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11
Q

When a person is having chest pain and takes nitro, after how long should they call 911?

A

If the chest pain has lasted longer than 5 minnies

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12
Q

Where are beta 1 receptors located?

A

myocardium of the heart around the SA and AV nodes

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13
Q

Where are beta 2 receptors located?

A

lungs and skeletal muscles

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14
Q

If a person has asthma (or any lung disease) and angina, what type of drug should you use?

A

a selective agent (b1 blocker) like metoprolol [lopressor]

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15
Q

if a person has CAD, what is the diagnostic gold standard test?

A

cardiac catheterization and angiography

(there’s some random blessington input for you)

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16
Q

What type of drug class are erectile dysfunction pills?

A

PDE5 inhibitors

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17
Q

What are the rules with prescribing nitro and PDE5 inhibitors (like erectile dysfunction pills) together?

A

CANNOT use nitro if you have taken PDE5 inhibitors within 24 hours prior

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18
Q

What disease is absolutely contraindicated with nitroglycerin?

A

head trauma/stroke (risk of brain bleed)

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19
Q

What is a S/E of amlodipine [norvasc] and other dihydropyridines to be aware of?

A

peripheral edema

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20
Q

What is another extremely common SE of amlodipine?

A

HA

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21
Q

What are some options if your patient is on amlodipine for heart disease, but is developing peripheral edema from it?

A

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

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22
Q

Why do beta blockers cause orthostatic hypotension?

A

When we stand, the HR normally increases.

On a beta blocker, that adrenergic reaction is blocked to maintain a low HR.

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23
Q

If a person has orthostatic hypotension, and is also prescribed nitro, what instructions should you give them for taking their nitro?

A

sit dat ass down when taking the nitro!

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24
Q

Your person with once stable angina is now getting symptoms more often. What should you do for them?

A

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

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25
Q

Your patient is on salmeterol diskus for her COPD and is developing unstable angina. Why is the salmeterol diskus dangerous?

A

Salmeterol is a b2 agonist, and will affect her heart. Switch to LAA.

She shoulda been on that in the first place anyway.

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26
Q

What is the diuretic class of choice for patients who have peripheral edema and CKD?

A

loop diuretics

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27
Q

All diuretics inhibit sodium reabsorption in the kidneys, so why are loop diuretics the choice drug in patients with CKD?

A

they work at the loop of henle so they work better

get it… <strong>loop</strong> diruetics… :)

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28
Q

How often per day should you be “nitrate free?”

What happens if you don’t do this?

A

Should be nitrate free for 8-12 hours per day

otherwise, the efficacy of nitro goes down

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29
Q

What forms does nitro come in?

A

sunlingual spray

sublingual/buccal tablet

topical

IV

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30
Q

What drug comes in a dark glass bottle?

A

nitroglycerin

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31
Q

What is the effective time frame of furosemide [lasix]?

A

6 hours

(so take 1 in AM, take 1 in afternoon)

32
Q

Should a person take furosemide [lasix] before bed?

A

not unless they wanna be peein’ all night

33
Q

if a patient gains ___ lbs in 24 hours, they should take a dose of furosemide [lasix]

A

3

(pretty sure I gain 3 lbs over the course of a meal)

34
Q

If a person is taking furosemide [lasix] twice daily, and they finally get down to their water weight, should they continue taking furosemide [lasix]?

A

Yep, they can take it PRN instead though!

35
Q

What if a person is on Salmeterol diskus for COPD, and is also on a loop diuretic?

A

No bueno.

Salmeterol decreases the effect of the loop diuretic

Change to tiotroprium

36
Q

What heart failure drug class does tiotroprium interact with?

A

ACE inhibitors

37
Q

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?

A

often have to up the dose from 20mg to 40mg to get an impact

38
Q

What are some side effects of furosemide [lasix]?

A

Dehydration leading to hypotension

hypokalemia (AKA potassium depletion)

decreases other electrolytes

39
Q

For a person on furosemide [lasix], how many pounds is the patient aiming to lose daily?

A

2 lbs

40
Q

Is furosemide [lasix] indicated for a person with renal disease?

A

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)

41
Q

What stages of CKD is furosemide [lasix] best for?

A

stage 3 and 4

42
Q

Pt. has a sulfa allergy, and has water retention from CKD. What drug can’t you give him?

A

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

43
Q

So that doesn’t change the fact that your pt has a sulfa allergy and water retention from CKD. What do you give him?

A

ethacrynic acid [edecrin]

44
Q

How do you feel about the BP 110/70 for a 70y/o?

A

doesn’t matter how you feel

it’s low

old people should develop higher blood pressure

45
Q

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??

A

Ace inhibitors

46
Q

When should you take ethacrynic acid [edecrin]?

A

morning and afternoon, not before bed

(again, the whole peeing thing)

47
Q

Your patient needing a diuretic also has low potassium. What should you prescribe her?

A

spironolactone (aldactone) or eplerenone (inspra)

these spare potassium

48
Q

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]?

A

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

49
Q

Are thiazide diuretics useful in patients with renal disease?

A

Nosiree

you want da loopz

50
Q

So what exactly do the loop diuretics do, in the kidneys and in the heart?

A

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

51
Q

ACE inhibitors are for HTN, but what other disease are they good in?

A

renal disease, esp in diabetics

52
Q

Hey Professor White, should I know about using ACE inhibitors for HTN for exam 1?

A

“No.” - Tommy W

So don’t bother! :)

But DO know about ACE inhibitors for HF.

53
Q

What are the S/E of ace inhibitors?

A

hyperkalemia, coughing

54
Q

What causes the cough with ACE inhibitors?

A

production of bradykinin

55
Q

What are C/I of ACE inhibitors?

A

angioedema*** (won’t respond to drugs)

bilat renal artery stenosis

56
Q

What is the PG category of ace inhibitors?

A

D

teratogenic

57
Q

Which diuretic is equally effective IV or orally at the same dosage?

A

torsemide [demadex]

58
Q

Which diuretics can be used IV?

A

furosemide [lasix]

torsemide [demadex]

59
Q

What are the 3 major diseases that often coexist in patients?

A

CKD

COPD

HF

hard to tell which is causing what symptoms

60
Q

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?

A

Tell him to get his shit together

And put him on Furosemide [lasix] 40mg twice daily until he gets his shit together

61
Q

This is a break card

A

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!

62
Q

What is the MOA of spironolactone [aldactone]?

A

this diuretic competitively inhibits aldosterone in the kidney

63
Q

What would every single one of these patients benefit from once they are at their dry weight?

A

cardiac rehab program

64
Q

Pt on metoprolol [lopressor] for afib is in sinus bradycardia. what will you do?

A

titrate down the dosage of his metoprolol

he could also be switched to an anticoag for his afib

65
Q

What do African Americans not produce as much of?

A

Angiotensin I

66
Q

What is the potential dx-dx interaction between lisinopril and furosemide [lasix]?

A

hypotension

67
Q

Rx-ing Lisinopril vs. Captopril. GO!

A

Lisinopril is on the $4 list. Once daily. MC prescribed.

Captopril is more expensive and must be taken 2x daily.

Both are good drugs.

68
Q

Who is a candidate for hydralazine + isosorbide dinitrate [BiDil]?

A

a person who has failed on other HF treatment, especially African Americans

69
Q

What is the MOA of hydralazine (one of the combos in BiDil)?

A

decreases total peripheral resistance by relaxing smooth muscle in arterioles

thus decreases afterload

thus decreases blood pressure

70
Q

More commonly in white patients, what can hydralazine + isosorbide dinitrate [BiDil] cause?

A

Lupus

71
Q

Dobutamine is a heavy hitter drug that we will not rx. But what’s the drug class? What are indications?

A

inotropic agent

afib, mild-mod HF

72
Q

Diuretics decrease ______ while hydralazine + isoborbide dinitrate [BiDil] decreases ______

A

diuretics: decrease preload
bidil: decreases afterload

73
Q

What do nitrates decrease, preload or afterload?

A

preload

74
Q

do diuretics dilate more veins or arteries?

A

veins

75
Q

YAY CONGRATS YOU MADE IT THRU THE BLESSINGS

A

h;raeng;rnse;igohaeo;gnalwhg[02hgsjk.erzdmvzk.n

losing my mind

getting food

bye

<3

Paige: CARDIO (11 decks)

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