Exam 2 - Pharm Blessings! :) Flashcards
*flash cards no longer under construction*
Your encounter begins now.
What are the “Stage 2” requirements for HTN for sytolic and diastolic pressures?
systolic pressure greater than 20ml
diastolic pressure greater than 10ml
so 160/100
what is the DOC for Stage 1 HTN?
Chlorthalidone (hygroton) or lisinopril (zestril)
Could you do dual therapy and prescribe both a thiazide drug like chlorthalidone [hygotron] and an ACE-I like lisinopril [zestril]?
YES!
When would dual therapy NOT be needed?
if lifestyle modifications are taken very seriously
In an african american, what is the DOC for stage 1 HTN?
HCTZ (microzide) or CCB
Whats the DOC in a person with stage 2 HTN?
ACE-I - lisinopril [zestril]
What can you add to stage 2 htn treatment if the person isn’t responding well?
CCB
What do you add to HTN treatment for a person with angina?
add beta blocker
What do you add to HTN treatment if a person is at high risk for a cardiac event?
ASA and/or statin
How does your treatment change for a patient in heart failure with HTN?
you’ll want to use a loop diuretic
Which disease is usually always correlated with HTN?
HF
Could you do dual therapy and prescribe both a thiazide diuretic like chlorthalidone [hygotron] and an ACE-I like lisinopril [zestril]?
YES!
Which drug classes work directly on the RAA axis?
ACE-I
ARBs
Direct Renin Inhibitors
What is the main mechanism for all ACE-I?
decrease peripheral resistance
reduce Na and H2O retention
what are the new guidelines for treating htn for patients 50+ regardless of comorbidities?
140/90 or less
What do ACE-I have an added effect of treating in diabetics?
diabetic neuropahty
What can happen as a s/e with the first dose of an ACE-I?
hypotension
When should a patient take an ACE-I for the first time?
in bed at night when already lying down
If you have a patient with diabetes, what drug in this section should they NOT be prescribed and why?
Beta blocker
Masks symptoms of hypoglycemia
What did one EKG machine say to the other EKG machine?
“you’re tachy”
(get ready for some killer jokes)
If a person is started on an anti-hypertensive med, what should they be monitoring, even at home?
BP
Why are ACE-I good in diabetics?
Diabetics get plaque buildup in kidney vessels so it helps to protect against this
What do you always give for treatment of a diabetic with HTN?
diuretic and ACE-I
dual therapy
What is the best thiazide diuretic?
chlorthalidone [hygroton]
Which common OTC drug can cause HTN?
Ibuprofen
what body chemical does Ibuprofen cut down on?
what does that chemical do?
prostaglandins
prostaglandins vasodilate
Which drug can cause decreased peripheral vascular resistance, leading to postural hypotension?
apha1 blockers -
prazosin [minipress]
can a pregnant woman be on an ACE-I?
neggnog
can a pregnant woman be on losartan [cozaar]?
kinda sorta yes! it’s a category B!
Your patient on Lisinopril [zestril] now has a cough. Why?
ACE-I cause couging from inc bradykinin
What do you do if your pt on an ACE-I can’t stand their cough?
tell him to suck it up
(in every deck there’s literally always one person who just needs to suck it up)
But you should actually be kind, rewind, and switch to an ARB like losartan [cozaar]
Can methyldopa be used in PG for HTN?
Yeah that’s what it’s indicated for but it’s literally never used
What are C/I of ACE-I?
bilat renal artery stenosis
angioedema
30y/o black man with HTN. What shall you give him?
HCTZ [microzide]
Is HCTZ cheap or expensive?
Cheap!
4 dollar make ya hollerrrrrrrrrr
Why is it that ACE-I don’t work well for blacks?
(related to MOA)
ACE-I work on the RAA system. Blacks don’t have high levels of renin, so it doesn’t really work.
Why does HCTZ work in the black population?
it works directly in the kidneys at the distal convoluted tubule (DCT) to inhibit NaCl reabsorption
How long does the diuretic effect work in HCTZ?
The NaCl thing is its MOA for 2 weeks, but then it becomes a vasodilator.
Hey baby, are you my carotid artery?
Because I can’t live without you for more than 7 seconds.
So back to this black man who has HTN and is put on HCTZ [microzide]. What drug class is the 2nd line or can be used in combo with this?
CCBs
What can you look to in the serum that indicates that someone is taking an nsaid?
elevated serum Na
What is the max dose of lisinopril [zestril]?
40mg daily
Your patient has a history of HTN, angina, and is in stage 3 kidney failure. No history of HF. What will you prescribe for his HTN?
ACE-I (adjust dose) and CCB (will also work with angina).
Which beta blocker is stronger than the others?
What are s/e?
propanolol [inderal]
s/e = sedation, fatigue
What is propanolol used for, mostly?
migraine prophylaxis
(lower dose, at night)
are CCBs cheap or expensive?
$$$$$$$$$$$$$$$$$$$$$$$$
What’s the rule of 6?
ITZ ALL ABOUT STATINZ
Every time you double a dose, you get a 6% decrease in LDL
so itz not worth it lolz
How does HTN usually present?
asx
What calculation do you make prior to starting someone on a statin?
10 year CVD risk
( >7.5%)
What time of day should a patient take his/her statin?
at night
What are you really looking for with s/e of a statin?
muscle pain or weakness
If on a statin, what might muscle pain/weakness be indicative of?
myopathies or rhabidomylitis
(I know I probably didn’t spell that right but a girl can’t be awesome at <em>everything</em>)
what do statins block?
it blocks the HMG-COA reductase enzyme
thus it blocks the synthesis of new cholesterol (“de novo synthesis”)
what do statins decrease?
LDL and trigs
What should you get as baseline tests when you put a patient on a statin?
CK
LFTs
When should your patient follow up when you put them on a statin?
4-6 weeks
(when max effect happens)
what kind of a pulse is indicative of afib?
irreg irreg
Why did the female blood vessel not want to date the male blood vessel?
because he was a little vain
(slash vein, i really struggled with which spelling to put here so here’s both)
which type of CCB helps with rate control?
nondihydropyridines
are beta blockers good BP drugs?
no
What drug do you want to use for a patient who has cirrhosis and hyperlipidemia? Why that drug?
Pravastatin [pravachol] because it is not metabolized by the liver
What conditions put a patient in a high risk category for CVD, where lipid therapy should be considered?
afib and hx of angina
what lipid drug would you consider for someone in the CVD high risk category?
atorvastatin [lipitor]
Aren’t Paige’s jokes just hilarious?
Choose your own adventure:
if Yes - press 5 and never see this card again
if No - press 1 and see this card until you vote 5
which herb decreases the effect of atorvastatin [lipitor]?
St. John’s Wort
Yah or nah: pravastatin [pravachol] is metabolized by the CYP450 enzyme system
NAHHHHHH bro
(ps this is literally saying the same thing as ‘not metabolized in the liver’)
What does niacin [niaspan] do?
reduces trigs
reduces LDL
increases HDL
What are s/e of niacin?
flushing toilets +/- pruritis
(jk it’s not flushing toilets, it’s just regular flushing)
How can a patient prevent himself from flushing toilets?
(again, if anyone is confused, we’re actually just talking about regular flushing)
take an ASA or ibuprofen 30 minutes before taking niacin [niaspan]
What do you do if your patient develops muscle symptoms on a statin?
d/c until sx go away, then try again at a lower dose
(because it’s most likely dose related)
What if a person can’t tolerate 10mg of atorvastatin [lipitor]?
could switch to fibric acid
OR could just push lifestyle modifications
What are the 2 fibric acids on our table?
Gemfibrazil [lopid]
Fenofibrate [fibricor]
which LDL lowering drug lowers mortality?
STATINZ
(also to avoid any further confusion, there’s not actually a “z” at the end of statins)
what substance causes flushing?
prostaglandin!
(causes vasodilation)
When you rx statins and fibrates as dual therapy, what does it put the patient at an inc risk for?
myopathies
If you need to stop dual therapy with the statin and fibric acid, which one do you discontinue?
the fibrate
but would still lower the statin
fibric acids are c/i in what disease?
biliary disease
How should you instruct a patient to take their fibric acid in conjunction with other meds?
take fibric acid 1 hour before or 4 hours after other prescriptions
Why was there a police officer at the heart’s house?
for a cardiac arrest
(ba-dn chhhh)
What does Exetimibe [Zetia] do to cholesterol?
decreases LDL
What is the MOA of Exetimibe [Zetia]?
cholesterol absorption inhibitor
decreases absorption of cholesterol in the GI tract
what can happen to your pancreas if you have severe hypertriglyceridemia?
pancreatitis
Between a statin and a fibric acid, which drug is most liley to reduce trigs?
fibric acid
Fenofibrate [fibricor] and Warfarin [coumadin] have a drug-drug interaction. What happens?
increases INR
can increase gallstones
What do you give for strep A 1st line?
penicillin
What is 2nd line for Strep A?
cephalosporins
What do you give for Strep A if someone has a penicillin allergy?
Macrolides (azithro)
What is the problem with giving macrolides (other than resistance)?
can cause QT prolongation
what populations are at an increased risk for drug-induced QT prolongation?
CAD
afib
other arrhythmias
So what’s your 4th line choice for Strep A?
Clindamycin
Can statins + azithromycin cause qt prolongation?
maybe! ongoing study
(I added this because I don’t read the articles but this sounded like a potential article topic)
Your patient with non-valvular afib is on metoprolol [lopressor]. what should you add to the treatment regimen?
Dabigatran [pradaxa]
Your patient on valvular afib is on metoprolol [lopressor]. What should you add to the treatment regimen?
Warfarin (coumadin)
Do statins interact with dabigatran?
Yes
statin can dec [dabigatran] in serum
When putting a patient on Warfarin [coumadin], when should that pt follow up?
1 week to check INR
What is ALWAYS a component of afib treatment (not a drug, but a goal)?
rate control
Let’s suppose that your patient is ALREADY on a max dose of a beta blocker for afib, but their rate is not controlled. What 3 options do you have to add to the treatment?
digoxin
verapamil
diltiazem
What are negatives about digoxin?
Very low therapeutic index
lots of s/e
Your 75y/o patient with COPD has developed afib. Treat with?
NDHP CCB like diltiazem [cardizem]
(technically you could also use a <strong>selective</strong> BB here too)
+ anticoag
(One class chose warfarin [coumadin], one class chose dabigatran [pradaxa]. Your move.)
if a patient presents to you in the ER with super bad afib or PSVT, how will you treat her?
probably cardioversion
What if you’re worried that your afib patient might have a blood clot?
get an echo and make sure there’s no clot
What drug treatment is indicated for a patient presenting with unstable, new onset afib, often used post-MI or post-grafting?
amiodarone [cordarone]
in what setting are you most likely to see a patient on amiodarone [cordarone]?
in the ICU
Your patient has intermittent episodes of lightheadedness and fatigue. Heart is RRR. What does he have?
paroxysmal afib
Assuming, being the great PA-S that you are, you have already given him a holter monitor to confirm that he has paroxysmal afib, how would you treat him?
selective, long-acting beta blocker soooo metoprolol [lopressor]
and anticoag soooo dabigatran [pradaxa]
Your patient presents with a sudden onset of fluttering in her chest. Her boyfriend broke up with her and she hasn’t slept in 3 days. Pulse too rapid to count. What does she have?
PSVT
How do you treat PSVT?
It’s adenosine [adenocard] but that doesn’t give you an accurate description of real life so if you wanna know what really happens..
- push 6cc adenosine IV rapidly*
- immediately flush with 10 cc saline*
- wait 2 minutes, if not better then*
- push 12cc adenosine rapidly*
- immediately flush with 10 cc saline*
(way cooler, right?)
What if you give someone adenosine for PSVT treatment, but they actually have afib?
You’re still a hero
it won’t treat the afib, but it will slow the rate enough so that you can dx the afib
What do you prescribe for PA students who have just spent an entire month learning about cardio?
caffeine PRN P.O. or IV until monday
and happy pills too
so keep calm…
and just remember that you have to get some PAC’s before you can become a PA-C.
…don’t worry, my terrible puns are all over.
love you all <3<3<3<3<3<3<3<3<3
GOOOOD LUCKKKK!
