Exam II Flashcards
What are the types of anemia?
- Macrocytic (megaloblastic and non-meg)
- Iron Deficiency Anemia
- Anemia of Chronic Disease
What is the treatment for iron deficiency anemia?
Ferrous salts: take with OJ (vitC) and divided doses if side effects (constipation, heartburn, nausea). Avoid taking with milk, tea, antacids and multivitamins (space 4 hours).
What drugs interact with folic acid synthesis?
hydroxurea, triamtrene (K sparing diuretic)
What are the IV drugs for low iron?
Ferumoxytol- CKD
Na3Fe2 Gluconate- hemodialysis and esa (in)
Fe dextran- avoid d/t anaphylaxis
Fe sucrose- hemodialysis and epoetin alfa (out)
What are reasons for IV therapy?
malabsorption, no transfusion, CKD, hemodialysis and cancer pts
What is the dose for B12?
1,000 mcg of cyanocobalamin for 1 week, daily 1 mg
symptoms include: parasthesia, neuro
What is the dose for folic acid?
- 4 mg for pregnancy to prevent spinal bifida, 1 mg/day o/w (up to 5mg)
* synthetic has good absorption
Which drugs can cause megaloblastic anemia?
metformin B12 and hydroxurea
What is the treatment for sickle cell anemia?
- hydration, analgesic (opoid), hydroxurea to increase HbF)steriods decrease stay but may increase readmit
- prophylactic- PCN (erythromycin if allergic) until age 5, pneumococcal vaccine
- folic acid- 1 mg/day in adults
What are the two IV drugs for DVT/PE?
heparin or fondaparinux with coumadin
- start together and keep heparin on for 5 days until INR >2 for 24 hours (if supratherapeutic before that, then discontinue heparin)
- tPA, alteplase, reteplase= fibrinolytic agent
What are two contraindications for lovenox?
creatinine clearance less than 30 ml/min and obesity
How do you treat a hypercoaguability disorder found incidentally?
Do nothing.
What do loop diuretics do? What are the side effects? Which drug do you avoid?
fuorosemide/lasix (40:1): bumetanide/bumex, ethacrynic acid
- inhibits Na, K, Cl symporter so increase Na, K, Ca excretion.
- ototoxic, gout, hyperglycemia
- NSAIDs
What do thiazide diuretics do? What drug interaction do they have? What is the caveat with thiazides?
cholorothiazide (diuril)
- inhibit Na/Cl transporter so increase Na, K excretion.
- quinidine- pronlonged QT, hyperglycemia
- can only use if creatinine is greater than 30 ml/min *metalozone is the only caveat
What are the K sparing diuretics?
triamterene (dyrenium) and amiloride (midamor)
-inhibit renal epithelial Na channels so increase Na, Cl excretion
What are the aldosterone antagonists? What is the side effect? Contraindicated?
spironolactone (aldactone), eplerenone
-increase Na excretion (spare K and H)
-spirolactone causes gyenclomastia and menstrual irregularities
-renal function, hyperkalemia
*try to avoid combining with ACE or ARB high dose
(only supplement if K <4mmol/L)
What are the ACE-inhibitors? What do they improve? What should you avoid? Side effects?
lisinopril (prinvivil) and enalapril (vasotec)
-decrease intraglomerular pressure by dilating the efferent arteriole
-decrease risk of stroke and kidney protective
-Avoid pregnancy, NSAIDs
-watch for dry cough (switch to ARBs)
angioedema (switch to diff. anti-HTN), and hyperkalemia
What do beta blockers do? When do you not give them?
Decrease HR and contractility
-non-selective are propranolol, nadolo, pindolol
B1 selective are metoprolol (lopressor)
B/a labetolol (hypertensive crisis) and carvedilol (HF pts)
-avoid in pts with HR <55 and COPD
If someone is non-black hypertensive?
ACE or ARB or thiazide or CCB or combo
If someone is black hypertensive?
thiazide or CCB or combo
ACE+thiazide
If someone has CKD with or w/o diabetes?
ACE or ARB alone or in combo with another class
HTN drugs: LV issues? Post-MI? DM or CKD? Recurrent CVA?
ACE+BB+ diuretic
ACE+ BB
ACE
ACE+diuretic
What are the goals for under 60 years or CKD or diabetes? For over 60 years?
<150/90
When time of day do you give diuretics? What do you give with pregnancy?
Morning Methyldopa (or low dose thiazide)
If TG and LDL are high, which do you treat first?
TG
What are the TLCs?
sat fat <200 mg, increase physical activity, decrease weight,
eat plant sterols (2g) and soluble fiber (10-25g)
What are statins? Target? Side Effects? Contraindications? Intensities? Reasons to stop therapy?
HMG CoA reductase inhibitors. LDL. Myopathy and elevated liver enzymes. Liver dz. migraines (use lov or prav) Rosuvastatin high= 20 mg, mod=5-10mg Atorvastatin high=40-80 mg, mod= 10-20mg Simvastatin mod=20-40mg-->no amlodipine or amiodarone Pravastatin mod=40 mg Lovastatin- mod=40 mg *if myopathy on high dose, try low dose on higher intensity but STOP if rhabdomyolysis*
What are bile acid sequestrators? Targets? Side Effects? Contraindications?
Cholestyramine, colestipol, colesevelam. LDL.
GI distress
dysbetalipoproteinemia, TG >400
What is nicotinic acid? Target? Side Effects? Contraindications?
niacin. HDL.
flushing (take aspirin 30 min prior), hyperglycemia/uremia, GI distress, hepatotoxicity
liver dz, gout, peptic ulcer, use of statins
What is fibric acid? Target? Side Effects? Contraindications?
Gemfibrozil, Fenofibrate, Clofibrate. TG Dyspepsia, gallstones, myopathy. Severe renal or hepatic dz. *dont use Gem w/ statins *Feno w/ low or mod statin if appropriate (keep eye on renal fx)
What are the 4 benefit groups?
- clinical ASCVD- age 7.5% high
- LDL >190-high
- Risk >7.5% mod to high
Risk 5-<7.5% mod
o/w ATP III
What do you use for Stage A HF?
ACE (if AA then diuretic and ACE)
*if intolerant, try ARB or hydralzaine with oral nitrate
What do you use for Stage B?
(ACE or ARB) + BB
What do you use for Stage C?
- ACE + BB
- fluid? loop
- sxs still? ARA or ARB or digoxin or hydralizine/ISDN
- HTN? ARA or ARB or hydralizine/ISDN or CCB dihydro
- Angina? nitrates, CCB dihydro
- aldosterone antag shown to improve mortality esp if EF<40%
Which drugs precipitate HF?
anti-arrhythmics, BB, CCB, NSAIDs, COX2 inhibitors
What are the Ca channel blockers?
Non-dihydro= verapimil and diltiazem= HR Dihydro= nifedipine and amlodipine (extended release)= Vasodilate
Which drugs for Stage D?
none- surgery or palliative care
What are digoxin drug interactions?
antacids and bile acid seq decrease availability of dig
diuretics= dig toxicity (nausea, vomitting, abd pain, vision changes, AV block)
How do you monitor acute decompensating HF?
weight–> loop
want CI >2
positive ionotrops- NE
What drugs for class I recommendation for chronic angina?
- aspirin if prior MI
- BB in prior MI
- statin if LDL >130 if CAD
- ACE with CAD + DM or LVSD
What drugs for class IIa chronic angina?
- aspirin if no prior MI
- BB if no prior MI
- Statins w/ CAD LDL 100-129
- ACE with CAD or vascular dz
- if suspect CAD and LDL 100-129=TLC, fibric or nicotinic acid
- nitrates but have free period if taking continuously
Why use BB and nitrates together?
nitrates cause venodilation and hypotension so HR increases–> BB keep HR normal
What are the types of nitrates?
isosorbide dinitrate (dose free 14 hr), isosorbide monotrate (7 hr interval), long-acting transdermal (on 12-14, off 10-12 hr), nitroglycerin sl
What does ranolazine do?
reduce arrhythmias but doesn’t drop BP or HR
don’t use with statins or liver cirrhosis
For subset II (warm-perfuse and wet-congested) what is the treatment?
need to monitor bp before starting diuretics (don’t start if SBP
- start IV bolus loop and/or vasodilator
- increase dose of loop
- switch to continuous infusion
- add different type, like thiazide
- IV inotrope(milrinone or dobutamine) + PAC to guide therapy
What is the class I recommendation for acute angina?
-Nitrates
What do you do if BB don’t work or are contraindicated in chronic angina Class I?
- Don’t work:
Add CCB non-dihydro or long-acting nitrates - Contraindicated:
CCB non-dihyrdo and/or long-acting nitrates
What are some benefits of using nitrates?
antithrombotic and antiplatelet effects
Which drugs affect iron absorption?
Al, Mg, Ca antacids tetracycline/docxycycline histamine proton pump inhibitors cholestyramine methyldopa fluoroquinolones
