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Pharm 323 : exam 1 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What class of drug is typically given for first line monotherapy to tx HTN?

A

diuretics

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2
Q

Why would diuretics be taken with other anti-hypertensive medications?

A

they will have enhanced effects

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3
Q

Diuretics work by decreasing what 2 things?

A
  • blood volume

- arterial resistance

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4
Q

What type of beta blocker is best for diabetics? Why?

A
  • B1 - cardioselective is preferred : s/s of hypoglycemia are masked but does not induce hypoglycemia
  • non selective beta blockers can cause hypoglycemia in DM pts and the s/s are masked
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5
Q

Which type of CCB works on the heart?

What is the prototype?

A
  • dipines : work on blood vessels only

- nifedipine

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6
Q

Why might a diabetic patient who does not have hypertension be prescribed an ACE inhibitor?

A
  • it helps protect the kidney from diabetic nephropathy
  • by dec angiotensin 2 the efferent arterioles are able to vasodilate –> lowering the pressure in the glomerulus –> slows the progression of kidney disease / problems
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7
Q

What is angioedema?
What do we give to treat it?
What causes it?

A
  • a potentially life threatening hypersensitivity reaction
  • give epi
  • an increase in bradykinins from ACE inhibitors or ARBs can cause this –> it can happen at any point in drug therapy
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8
Q

What are the goals of anti angina drugs? (2)

A
  • dec O2 demand of the heart : dec HR, contractility, preload or after load
  • inc O2 delivery to heart : relax / dilate coronary arteries
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9
Q

When do the coronary arteries receive blood?

A
  • during diastole / filling
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10
Q

Stable Angina

  • triggered by :
  • ___ is the underlying cause
  • tx :
A
  • triggered by : activity
  • CAD (coronary artery disease)
  • tx : dec O2 demand of the heart
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11
Q

Variant Angina

  • What is it?
  • triggers/timing?
  • tx :
A
  • coronary artery vasospasm
  • occurs at anytime : rest or activity
  • tx : inc O2 supply with relaxation and dilation of coronary arteries
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12
Q

Unstable Angina :

  • emergency?
  • tx ?
A
  • yes : medical emergency

- tx as MI until proven otherwise

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13
Q

Why is PO short acting nitro not prescribed?

A
  • completely metabolized by the liver and will have no effect on the heart : we do give long acting : isosorbide mononitrate or dinitrate
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14
Q

What edu should be given about storing SL nitro at home?

A
  • dark container
  • not in bathroom or humid area
  • do not dump out into hand and pour back into bottle (dump into cap)
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15
Q

What edu should be given about nitro administration via patch?

  • pt
  • nurse / administrator who is not the pt
A

Pt
- remove patch at night to have drug free pd so tolerance does not develop
- rotate sites
Nurse
- wear gloves so your skin does to absorb the medication
- wipe off area before applying defib patches –> can cause burns

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16
Q

How is acute chest pain treated in the ED? (6)

A
  • SL nitro x3 then IV
  • IV BB (CCB is 2nd choice)
  • supplemental O2
  • IV morphine –> dec preload and after load
  • ACE inhibitor : dec mortality in pts with Left vent dysfunction / HF
  • anti platelet and anticoagulation therapy
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17
Q

What are underlying cxs of HF? (7)

A
  • chronic HTN
  • MI
  • Valvular heart disease
  • coronary artery disease
  • congenital heart disease
  • dysrhythmias
  • aging
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18
Q

Right ventricular hypertrophy causes a back up of pressure into the ___ ___. Which causes __ (3 different things).

A
  • back of up pressure into the peripheral veins

- cx : vein distention, edema in LE, ascites

19
Q

Left ventricular hypertrophy causes a back up of pressure into the ___ ___. Which causes __ (3 different things).

A
  • pressure backs up into the lungs

- cx : pulmonary HTN, pulmonary edema, wet lungs

20
Q

The goal of HF tx is to inc force of ___ and dec ___ to reduce O2 consumption.

A
  • need to increase the force of contraction

- need to dec HR

21
Q

HF pts who take a diuretic may alter their daily doses using a ___ ___ that is based on ___ ___.

A
  • sliding scale

- daily weight

22
Q

When should diuretics be administered? (time of day)

A
  • early so you aren’t peeing all night –> fall risk
23
Q

Blocking angiotensin does what 3 things?

A
  • cx vasodilation
  • prevent Na and H2O retention
  • prevents cardiac remodeling
24
Q

Blocking aldosterone does what 2 things?

A
  • inhibit Na and H2O retention

- prevent cardiac remodeling

25
Q

What is the function of VLDL?

A
  • deliver triglycerides from the liver to the adipose tissue and muscle
26
Q

What is the function of LDL?

What does it contribute to?

A
  • deliver cholesterol to non-hepatic (peripheral) tissue

- cx atherosclerosis

27
Q

What is the function of HDL?

A
  • deliver cholesterol from the peripheral tissue to the liver to be removed
  • prevent atherosclerosis
28
Q

Anticoagulants work in which bv group?

A
  • veins : prevent clot formation
29
Q

Antiplatelets work in which bv group?

A

arteries : prevent platelet aggregation

30
Q

aPTT

  • normal range
  • therapeutic range
A
  • norm : 40

- therapeutic : 1.5-2x baseline = 60-80

31
Q

PT

  • normal :
  • therapeutic range :
A
  • norm : 12

- therapeutic : 1-2 x baseline = 12-24

32
Q

INR

  • therapeutic range :
  • mechanical heart valve:
A
  • therapeutic range : 2-3

- mechanical heart valve : higher

33
Q

What pt edu is specific to warfarin? (8)

A
  • take at same time each day
  • frequent lab monitoring
  • soft tooth brush
  • electric razor
  • stop 1 week before procedure w/ approval from dr
  • medical alert bracelet
  • no NSAIDS / ASA
  • garlic and ginger will inc bleeding
34
Q

What 4 situations are a thrombolytic agent used?

A
  • Acute MI
  • Acute ischemic stroke
  • Acute PE
  • clearing a blocked central venous catheter
35
Q

What is the best strategy for drug therapy for pts who have lipid disorders?

A
  • decrease LDLs
36
Q

What things are considered in the tx approach for a pt with a lipid disorder? (5)

A
  • risk of atherosclerotic cv event : framingham risk reduction score
  • therapeutic lifestyle changes : diet, exercise, weight control, stop smoking
  • diabetes
  • metabolic syndrome
  • lifelong tx
37
Q

Why might a diabetic pt who does not have a lipid disorder be prescribed a statin drug?

A
  • reduce the risk of a cv event : dec inflammation, slower progression of coronary artery calcification. improve endothelial function in bv, improve bv dilation, reduce risk of afib, reduce risk of clots
38
Q

How often are labs for aPTT drawn?

Why?

A
  • Q6H

- the 1/2 life of heparin is 90 min –> it takes 4 1/2 lives to reach the therapeutic range –> 4 90 min 1/2 lives = 6 H

39
Q

What is heparin induced thrombocytopenia?

A
  • if platelets are reduced by 50% or are <100,000 –> stop heparin
  • usually occurs after 4 days –> body makes AB against the heparin platelet protein complex –> cause the platelet to drop
  • if this is suspected draw blood for a titer
40
Q

How do you know if you pt is bleeding?

A
  • look for blood coming out of every orpheus
  • brusing
  • discolored urine
  • lumbar pain : peritoneal bleeding
41
Q

Why is heparin and lovanox contraindicated in pts who are receiving an epidural?

A
  • can cause a hematoma that leads to paralysis
42
Q

Describe the transition from IV heparin to warfarin

A
  • typically 2-3 days with simultaneous administration
  • takes several days for warfarin to have effect
  • warfarin does not effect the clotting factors that are already made
  • monitor heparin and warfarin labs during this time
43
Q

Describe the transition from IV harpoon to rivaroxaban

A
  • stop heparin and immediately give PO dose

- may have double doses for a couple days then switch to maintenance dose

Pharm 323 : exam 1 (4 decks)

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