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Pharmacology 2 > Exam 2 - high yield > Flashcards

Exam 2 - high yield Flashcards

1
Q

Tx for stable CAD?

A 
A=ASA, ACEI/ARB
B=Beta blocker (Metoprolol)
C=Cholesterol and Cigarettes
D= Diet
E=Exercise
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2
Q

PAD treatments? (Hint: Three)

A
  1. ASA
  2. Clopidogrel if ASA allergy
  3. Cilastazol w/IC
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3
Q

VTE prophylaxis in gen med PT and if trauma patient? Dose? Renal?

A

Gen med:

  1. UHF 5000U SC (good for renal)
  2. Enox 40mg SC or 30mg SC if Cr below 30
  3. Fonda 2.5mg SC or not if Cr less than 30.

Trauma: Enox

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4
Q

Fondapirinux dose for DVT prophylaxis and VTE tx? Renal concerns?

A

DVT Proph: 2.5mg SC daily. If CrCl less than 30 don’t give.

VTE: 5-10mg daily SC between 50kg and 100kg.

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5
Q

Enoxaparin dose for DVT prophylaxis and VTE Tx? Renal concerns?

A

DVT Proph: 40mg SC. CrCl less than 30 then 30mg.

VTE Tx: 1mg/1kg q12h SC -or- 1.5mg/kg q24h

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6
Q

Tx of Acute VTE? If bad kidney? Goal?

A
  1. Enoxaparin 1mg/kg. (Best, CrCl 20 no)
  2. Fondapirinux 5mg to 10mg. (CrCl 20 no)
  3. UFH.
    Bad kidney=UFH.
    Goal=transition to PO Warfarin with INR of 2-3.
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8
Q

Tx for VTE if kidney good? If kidney bad? Duration? INR goal?

A

Good kidney=LMWH daily or q12h (Enox 1mg/kg or Fonda 5-10mg)
Bad kidney= IV UFH x5 days
1st occurrence= Warfarin x3 months
2nd occurrence= Warfarin lifelong

INR=2-3 (2.5 ideal)

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8
Q

In Acute VTE which medication to use if renal impairment is an issue?

A

If CrCl less than 20 do not use LWMH (Enox or Fonda)! Use UFH to reduce bleeding

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10
Q

Tx of choice for Pulmonary Embolism? Shock with low bleed risk? Small PE?

A

Acute PE=5-10mg Fondaparinux or 1mg/kg Enodaparin
or IV UFH
Shock with low bleed risk= Thrombolytic
Small PE= Alteplase

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11
Q

Tx for high-risk PE? Renal impairment? High risk bleeding?

A

IV UFH is agent of choice.
High -risk bleeding=Apixaban (less bleeding)

Renal impairment= Warfarin is gold standard and then Apixiban

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12
Q

AFib/AFlutter stroke prevention? (Hint: three)

A
  1. Warfarin 5mg if healthy, 2.5 older than 75 or hepatic dysfunc
  2. Dabigitran
  3. Oral Xa
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13
Q

Tx for Secondary Stroke Prevention if from cardioembolic stroke (Afib/Aflut)? INR?

A

Warfarin aka Coumadin. INR 2-3.

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14
Q

Tx for NSTEMI? What if going for PCI?

A 
Morphine
Oxygen
Nitrates
ASA
Heparin
Beta-Blocker
PCI=Prasugruel (P2Y12-inhib)
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15
Q

What is reversal agent for Indirect Thrombin Inhibitors (LMWH and UFH/Enox)?

A

Protamine Sulfate IV.
UFH= 1mg:100U
Enox=1mg:1mg 60-70% effective
None for Fonda.

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16
Q

Tx for Acute Ischemic Stroke? When to use what? What are two major exclusion criteria?

A
  1. IV t-PA within 4.5hr
  2. ASA 325mg PO 12-24h after t-PA
    Exclusion: SBP 185 or DBP 100, 80+
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17
Q

Secondary stroke prevention if not from cardioembolic? (Hint: 3)

A
  1. ASA
  2. ASA + Dipyridamole ER
  3. Clopidogrel if cannot tolerate ASA
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18
Q

What are the 4 main anti-platelets? MOAs?

A
  1. ASA (COX-inhib)
  2. Clopidogrel (ADP P2Y12-inhib)
  3. Cilostazol (PDE-inhib)
  4. Dipyridamole (Adenosine + PDE-inhibitor)
    (ACCD)
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19
Q

What are the indications for the 4 main anti-platelets?

A
  1. ASA=PAD, CVA/TIA prevention and treatment
  2. Clopidogrel=PAD
  3. Cilostazol=PAD with intermittent claudication
  4. Dipyridamole=Secondary CVA/TIA prevention
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20
Q

What is intermittent claudication? What is it a sign of?

A

Cramping in legs. Sign of PAD.

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21
Q

What is the class and mechanism of ASA? Side-effects? Contraindications?

A

Class: Antiplatelet
MOA: Irreversibly inhibits prostaglandin cyclooxygenase (COX-1) in platelets. Prevents formation of Thromboxane A2 (TXA2).

SE: GI upset and/or bleeding
Contras: Active bleeding, hemophilia, thrombocytopenia

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22
Q

What is the class and mechanism of Dipyridamole? Side-effects? Contraindications?

A

Class: Antiplatelet
MOA: Inhibits platelet aggregation via adenosine and PDE inhibition.

SE: Angina, HA, dizziness, hypotension, dyspnea
Contras: Active bleeding, CAD (“coronary steal syndrome”)

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23
Q

What is the class and mechanism of Cilostazol? Side-effects? Contraindications?

A

Class: Anti-platelet
MOA: Phosphodiesterase inhibitor; suppresses platelet aggregation; direct artery vasodilator
SE: Fever, infection, tachycardia
Contras: All CHF patients. They’ll die quicker.

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24
Q

What is the class and mechanism of Clopidogrel? Side-effects? Contraindications?

A

Class: Anti-platelet
MOA: Inhibits binding of ADP to analogues to platelet receptor causing irreversible inhibition of platelets

SE: Chest pain, purpura (purple rash spots d/t bleeding)
Contras: Active pathologic bleeding (peptic ulcer, intracranial bleed)

25
Q

What is CHA2DS2-VASc Score assess? Score of 0, 1, and 2 mean for treatment?

A

Assesses stroke risk.
0=don’t give anticoagulant even if have afib.
1=ASA (anti-platelet)
2 or above=Anticoagulant like Warfarin or new novel anticoagulants.

26
Q

What does HAS-BLED calculate? What to consider if score is 3 or higher?

A

Risk of bleeding vs clot from anticoagulant or ischemic stroke.

3 or higher=consider alternative to anticoagulant warfarin. Not valid for other anticoags.

27
Q

What is tx for of AFib/AFlutter if has CHA2DS2-VAS2c of 0, 1, or 2?

A

0=No antithrombotic
1=ASA
2=Warfarin or the “-bans” (oral Direct Xa Inhibitors “ARE”)

28
Q

Two treatments for Acute Ischemic Stroke? Timing?

A
  1. IV t-PA. Within 3h, up to 4.5h.
  2. ASA 325. 24-48h after t-PA.

No anti-thrombitics for 24h after t-PA.

29
Q

What is SBP and DBP exclusion criteria for Acute Ischemic Stroke? Others?

A

SBP over 185
DBP over 110 at time of treatment
Others: Active bleeding, bleeding within 3 weeks, recent anticoagulation, recent surgery.

30
Q

4 treatments for Secondary Stroke Prevention?

A
  1. Statins
  2. BP reduction below 140/90
  3. Stop smoking
  4. Antiplatelet (ASA, Clopidogrel, Dipyridamole). Anticoagulatant if cardioembolic.
31
Q

Warfarin (Coumadin) class and MOA? Use? Monitor test? Adverse effects?

A

Class: Direct Thrombin (Factor II) inhibitor.
MOA: Antagonized VitK to inhibit SNOT/1972 and proteins C, S
Use: DVT/PE, prevent CVA/TIA in AFib with heart valve replacement
Monitor: INR
Adverses: Bleeding, bruising

32
Q

What three tx choices of antiplatelets for Secondary Stroke Prevention? (Hint: one is a combo)

A
  1. ASA
  2. Clopidogrel
  3. ASA + Dipyridamole
33
Q

Fibrinolytics: MOA and indication?

A

Convert plaminogen to plasin to lyse thrombi. In acute ischemic stroke. NOT IN NSTEMI!

33
Q

GP IIb/IIIa, PAR-1, PDE, COX, and ADP P2Y12 inhibitors are all what drug class?

A

Antiplatelet drugs

34
Q

UFH dose for VTE prophylaxis?

A

5000U SC q8-12h, usually TID

35
Q

Warfarin for initiation? Kidney issues? Goal?

A

Init: 5mg if healthy, 2.5mg if older than 75 or hepatic dysfunction.

INR: 2-3

36
Q

What are the three Direct Thrombin Inhibitors? Which are IV and oral? What is the factor and pathway? Reversal agent?

A

DTI=ABD. Inhibitor Factor 2a in common pathway.
Agratroban- IV only
Bivalirudin- IV only (CrCl 30 reduce)
Dabigatran-PO only (AFib 15-30 reduce; AFib 15 no; VTE 30 no)
Reversal: Praxbind/Idarucizumab

37
Q

What are the three Ora Direct Xa Inhibitors? What is the factor and pathway? Reversal agent? Kidney?

A 
"ORAL are A.R.E."
Apixiban
Rivaroxaban (CrCl 50 reduce; 30 dont give)
Edoxaban
Reversal: None!
38
Q

Which are the Indirect Xa inhibitors? Renal issues? Reversal?

A
  1. UFH
  2. LMWH/Enox (Cr 30 reduce, 20 don’t use!)
  3. Fondaparinux (Cr 50 reduce, 30 DON’T USE BLACK BOX)
    Reversal for Heparin and Enox=Protamine. None for Fondaparinux.
39
Q

What severe condition can UFH cause? Around when in treatment? What will notice on labs? Tx?

A

HIT. 5-10 days into treatment. 50% platelet drop. Stop UFH and give IV Direct Thrombin IIa Inhibitors (Agatroban and Bivalirudin).

40
Q

What are 5 general CIs for anticoagulants?

A
  1. Active major bleed
  2. Hemophilia
  3. Severe liver dz
  4. Severe thrombycytopenia
  5. Malignant HTN
41
Q

What three labs to check at baseline before starting anti-coagulants?

A
  1. CBC w/platelets (#1)
  2. SrCr
  3. LFTs
42
Q

What is the length of time for “bridge to Warfarin”.

A

Around 5 days.

43
Q

Which med not used in hepatic dysfunction?

A

Agatroban (Direct 2a Inhib IV)

44
Q

Which meds increase INR while on Warfarin?

A

TEAM Cipro

45
Q

What to check post Heparin infusion?

46
Q

What is Virchow’s Triad?

A

Hypercoagulable state, Stasis, Vessel wall injury. Risk factors for VTE.

47
Q

Which are the three Novel Oral Anticoagulants? What factor? When are they contraindicated?

A

-xabans. Factor Xa=A.R.E.

Contraindicated in renal dysfunction.

48
Q

If PT on Cipro which NOAC can you only use?

A

Edoxaban. Not a CYP3A4 interaction.

49
Q

Clopidogrel has a Drug-Drug Interaction which what class? What to use instead?

A

DDI with PPIs (omerprazole). D/C omerprazole and give ranitidine.

50
Q

Which is the only P2Y12 agent that is reversible?

A

Ticagrelor

51
Q

Which 3 Beta-blockers to use in stable HF?

A
  1. Carvedilol
  2. Metoprolol
  3. Bisoprolol
52
Q

Which Beta-blocker to use in hypertensive emergencies? MOA?

A

Labetelol. Nonselective Beta, selective alpha 1.

53
Q

If PT cannot tolerate BB and need to reduce HR what to use?

A

Non-DI CCBs (verapamil, diltiazem)

54
Q

Which nitrate to use for short acting and long acting?

A

Short=NTG. Develops tolerance. Lasts 20-30min.

Long=Isosorbide Mononitrate. No tolerance.

55
Q

When to never give nitrates? When PT is on ____ or ____.

A

EtOH or PDE-inhibitors like Viagra.

56
Q

Conservative TX for NSTEMI?

A

ASA, Clopidogrel, and Enoxaparin

57
Q

Invasive Tx for NSTEMI?

A

ASA, Clopidogrel, Enoxaparin, and PCI. Can give Pasugrel and GP-inhibitors with PCI.

Pharmacology 2 (17 decks)

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