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Pharm > Exam II > Flashcards

Exam II Flashcards

1
Q

What are the types of anemia?

A
  1. Macrocytic (megaloblastic and non-meg)
  2. Iron Deficiency Anemia
  3. Anemia of Chronic Disease
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2
Q

What is the treatment for iron deficiency anemia?

A

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).

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3
Q

What drugs interact with folic acid synthesis?

A

hydroxurea, triamtrene (K sparing diuretic)

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4
Q

What are the IV drugs for low iron?

A

Ferumoxytol- CKD
Na3Fe2 Gluconate- hemodialysis and esa (in)
Fe dextran- avoid d/t anaphylaxis
Fe sucrose- hemodialysis and epoetin alfa (out)

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5
Q

What are reasons for IV therapy?

A

malabsorption, no transfusion, CKD, hemodialysis and cancer pts

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6
Q

What is the dose for B12?

A

1,000 mcg of cyanocobalamin for 1 week, daily 1 mg

symptoms include: parasthesia, neuro

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7
Q

What is the dose for folic acid?

A
  1. 4 mg for pregnancy to prevent spinal bifida, 1 mg/day o/w (up to 5mg)
    * synthetic has good absorption
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8
Q

Which drugs can cause megaloblastic anemia?

A

metformin B12 and hydroxurea

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9
Q

What is the treatment for sickle cell anemia?

A
  • 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
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10
Q

What are the two IV drugs for DVT/PE?

A

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
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11
Q

What are two contraindications for lovenox?

A

creatinine clearance less than 30 ml/min and obesity

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12
Q

How do you treat a hypercoaguability disorder found incidentally?

A

Do nothing.

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13
Q

What do loop diuretics do? What are the side effects? Which drug do you avoid?

A

fuorosemide/lasix (40:1): bumetanide/bumex, ethacrynic acid

  • inhibits Na, K, Cl symporter so increase Na, K, Ca excretion.
  • ototoxic, gout, hyperglycemia
  • NSAIDs
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14
Q

What do thiazide diuretics do? What drug interaction do they have? What is the caveat with thiazides?

A

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
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15
Q

What are the K sparing diuretics?

A

triamterene (dyrenium) and amiloride (midamor)

-inhibit renal epithelial Na channels so increase Na, Cl excretion

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16
Q

What are the aldosterone antagonists? What is the side effect? Contraindicated?

A

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)

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17
Q

What are the ACE-inhibitors? What do they improve? What should you avoid? Side effects?

A

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

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18
Q

What do beta blockers do? When do you not give them?

A

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

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19
Q

If someone is non-black hypertensive?

A

ACE or ARB or thiazide or CCB or combo

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20
Q

If someone is black hypertensive?

A

thiazide or CCB or combo

ACE+thiazide

21
Q

If someone has CKD with or w/o diabetes?

A

ACE or ARB alone or in combo with another class

22
Q

HTN drugs: LV issues? Post-MI? DM or CKD? Recurrent CVA?

A

ACE+BB+ diuretic
ACE+ BB
ACE
ACE+diuretic

23
Q

What are the goals for under 60 years or CKD or diabetes? For over 60 years?

A

<150/90

24
Q

When time of day do you give diuretics? What do you give with pregnancy?

A 
Morning
Methyldopa (or low dose thiazide)
25
Q

If TG and LDL are high, which do you treat first?

A

TG

26
Q

What are the TLCs?

A

sat fat <200 mg, increase physical activity, decrease weight,
eat plant sterols (2g) and soluble fiber (10-25g)

27
Q

What are statins? Target? Side Effects? Contraindications? Intensities? Reasons to stop therapy?

A 
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*
28
Q

What are bile acid sequestrators? Targets? Side Effects? Contraindications?

A

Cholestyramine, colestipol, colesevelam. LDL.
GI distress
dysbetalipoproteinemia, TG >400

29
Q

What is nicotinic acid? Target? Side Effects? Contraindications?

A

niacin. HDL.
flushing (take aspirin 30 min prior), hyperglycemia/uremia, GI distress, hepatotoxicity
liver dz, gout, peptic ulcer, use of statins

30
Q

What is fibric acid? Target? Side Effects? Contraindications?

A 
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)
31
Q

What are the 4 benefit groups?

A
  1. clinical ASCVD- age 7.5% high
  2. LDL >190-high
  3. Risk >7.5% mod to high
    Risk 5-<7.5% mod
    o/w ATP III
32
Q

What do you use for Stage A HF?

A

ACE (if AA then diuretic and ACE)

*if intolerant, try ARB or hydralzaine with oral nitrate

33
Q

What do you use for Stage B?

A

(ACE or ARB) + BB

34
Q

What do you use for Stage C?

A
  • 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%
35
Q

Which drugs precipitate HF?

A

anti-arrhythmics, BB, CCB, NSAIDs, COX2 inhibitors

36
Q

What are the Ca channel blockers?

A 
Non-dihydro= verapimil and diltiazem= HR
Dihydro= nifedipine and amlodipine (extended release)= Vasodilate
37
Q

Which drugs for Stage D?

A

none- surgery or palliative care

38
Q

What are digoxin drug interactions?

A

antacids and bile acid seq decrease availability of dig

diuretics= dig toxicity (nausea, vomitting, abd pain, vision changes, AV block)

39
Q

How do you monitor acute decompensating HF?

A

weight–> loop
want CI >2
positive ionotrops- NE

40
Q

What drugs for class I recommendation for chronic angina?

A
  • aspirin if prior MI
  • BB in prior MI
  • statin if LDL >130 if CAD
  • ACE with CAD + DM or LVSD
41
Q

What drugs for class IIa chronic angina?

A
  • 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
42
Q

Why use BB and nitrates together?

A

nitrates cause venodilation and hypotension so HR increases–> BB keep HR normal

43
Q

What are the types of nitrates?

A

isosorbide dinitrate (dose free 14 hr), isosorbide monotrate (7 hr interval), long-acting transdermal (on 12-14, off 10-12 hr), nitroglycerin sl

44
Q

What does ranolazine do?

A

reduce arrhythmias but doesn’t drop BP or HR

don’t use with statins or liver cirrhosis

45
Q

For subset II (warm-perfuse and wet-congested) what is the treatment?

A

need to monitor bp before starting diuretics (don’t start if SBP

  1. start IV bolus loop and/or vasodilator
  2. increase dose of loop
  3. switch to continuous infusion
  4. add different type, like thiazide
  5. IV inotrope(milrinone or dobutamine) + PAC to guide therapy
46
Q

What is the class I recommendation for acute angina?

A

-Nitrates

47
Q

What do you do if BB don’t work or are contraindicated in chronic angina Class I?

A
  1. Don’t work:
    Add CCB non-dihydro or long-acting nitrates
  2. Contraindicated:
    CCB non-dihyrdo and/or long-acting nitrates
48
Q

What are some benefits of using nitrates?

A

antithrombotic and antiplatelet effects

49
Q

Which drugs affect iron absorption?

A 
Al, Mg, Ca
antacids
tetracycline/docxycycline
histamine
proton pump inhibitors
cholestyramine
methyldopa
fluoroquinolones

Pharm (8 decks)

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