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Therapeutics > Final > Flashcards

Final Flashcards

1
Q

A consistent care process is important for the pharmacist’s process of care and practice because it promotes

A

Consistent outcomes for the care delivered

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2
Q

A question to assess the effectiveness of someone who wants to establish care would be:

A

How well do you feel this medication is working for your disease? Need to address outcome or therapy goals.

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3
Q

If a patient comes in with two medications with the same indication. (e.g. aspirin and naproxen and ibuprofen, lisinopril, benazapril) What is this indication called?

A

Duplicate therapy

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4
Q

IESA (Indication, Effectiveness, Safety, Adherence) is part of what?

A

The pharmacists patient care process (PPCP) and specifically part of ASSESS

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5
Q

What is the correct order of indication, effectiveness, safety, and adherence?

A

Indication effectiveness, safety, and adherence

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6
Q

If a patient walks into your pharmacy and says that she had Td 10 or more years ago, this is likely an

A

Indication issue and needs additional therapy

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7
Q

If you were to assess for safety of the medication a patient is using, you would probably ask if you have ever

A

Had dark tarry stools since you are taking ibuprofen and naproxen

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8
Q

When a patient tells you what kind of medications they are taking, is this subjective or objective.

A

Subjective Information

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9
Q

Ideal Pharmacist-Patient Relationship Fundamental DOES NOT include what?

A

Knowledge of a pharmacist

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10
Q

Where would allergies go in a medical chart

A

Past medical history

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11
Q

If a patient has a family history of an allergy (e.g. asthma, excema, fever) , then the patien’t family members would be expected

A

to have the same (e.g. asthma, fever, etc.)

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12
Q

Family history should include

A

parents, three generations, deceased siblings, etc. in the patient chart

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13
Q

What is a common error in lab setting

A

Faulty reagents

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14
Q

Results reported in conventional units or SI units are ____ not/are factors that affect normal values

A

They are NOT factors that affect normal values

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15
Q

For complete blood count, hematocrit is

A

the percentage of red blood cells to blood volume

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16
Q

INR is a test used to monitor

A

Warfarin

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17
Q

A small volume of distribution makes a drug

A

amenable to enhanced elimination

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18
Q

NPI (Narrow Therapeutic Index) is

A

Adverse effects are expected at close to the therapeutic dose

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19
Q

______ are involved in a majority of poison control exposure

A

Pharmaceuticals

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20
Q

Idiosyncratic adverse reactions occur regardless of ____

A

The Drug Dose

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21
Q

At a therapeutic dose this drug can cause tiredness, but at doses above the therapeutic dose it can cause life threatening arrhythmias. This is called?

A

Off-target effect

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22
Q

Activated charcoal does not bind to

A

Iron, Polar molecules, alcohols, electrolytes, metals

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23
Q

______ is the leading cause of preventable injury according to the poinson control center

A

Poisoning

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24
Q

There is a small/large amount of substances that have antidotes compared to the number of drugs available

A

There is a small amount of substances that have antitodes

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25
Q

Enternal syringes measure what?

A

Liquid enternal meds

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26
Q

Patient is 11kg, 82 cm. Mycophenolate oral dosing is 600/mg/m2/dose every 12 hours. Whats the dose

A

300mg every 12 hours

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27
Q

Patient is 20kg. Prednisone dose = 1-2mg/kg/day in doses. Solution is 15mg/5ml. Whats the proper dose

A

21mg bid

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28
Q

A patient is 12 years old. What should the care provider consider without ANY additional context

A

Pediatric -to-adult care transition readiness should occur

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29
Q

Why should we write dose as 2.5 mL TID for liquid preperations for a new kid patient

A

For clarity

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30
Q

A baby born 3 hours ago has a BP of 75/40, resp of 50, HR 190, weight 3kg. Is this baby “healthy”

A

Yes, babies are bad at everything

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31
Q

What is the most appropriate source to search to see if meds are good for kids

A

KIDS LIST

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32
Q

INCREASED GASTRIC PH, DECREASED BILE ACID SECRETION, AND INTESTINAL TRANSIT TIME ALL AFFECT WHAT?

A

The absorption of a drug

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33
Q

A hydrophilic drug has bigger _____ in neonates

A

vD

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34
Q

What is the formular for glomerular filtration rate?

A

(0.413*height)/Scr

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35
Q

What is the formula to calculate maintenance flud rate in mL/hr if the patient is 40kg.

A

Segar formula (4/2/1 rule - 4x10,2x10,1x20, 40+20+20 =

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36
Q

A patient weights 25kg, what is the correct maintenance fluid rate

A

65mL/hr

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37
Q

For diaper rash, the patient should

A

Apply the cream first, then cover with a barrier

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38
Q

If MRSA isn’t common, the _____ is the proper treatment

A

Cephalexin

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39
Q

If a patient only has a couple flares of asthma per year and doesn’t show symptoms any other time then the likelihood of having asthma is

A

Low

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40
Q

T/F - Doses of asthma meds are not well known

A

False and meds and doses are not exploratory

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41
Q

Alpha 1 _____ the internal sphincter muscle of the bladder while _____ relaxes it.

A

Contracts, Muscarinic

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42
Q

What would be the acetylcholeine and beta 1 receptor response during rapid and pounding heartbeat

A

Increased acetylcholine release, increased beta 1 receptor stimulation

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43
Q

Dopamine can be use for management of

A

Hypertensive crisis

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44
Q

Primary MOA of doxazosin

A

Alpha -1 Antagonist

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45
Q

2 examples of prn treatments of acute bronchospasm

A

albuterolor levalbuterol

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46
Q

Orthostatic hypotension treated with _____

A

midodrine

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47
Q

In sepsis, a patient should receive ______ for hypotension

A

Norepinephrine

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48
Q

Atenolol is a

A

Beta-1 Selective ANTAGONIST

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49
Q

Local anesthetic with alpha-1 antagonists ______ time in recovery of sensation after a mouth procedure

A

Decrease

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50
Q

AE of terazosin can be

A

hypotension

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51
Q

With urinary retention, you should used a ___________ like ________

A

non-selective muscarinic agnost, bethanechol

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52
Q

______ is an NTM at nicotinic receptors in the skeletal muscle

A

Acetylcholine

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53
Q

With alzheimers, you would use a treatment geared to inhibit _________

A

Acetylcholinesterase

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54
Q

Cholinomimetic drugs should not be used if the patient has _________

A

asthma

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55
Q

Oxybutinin is used in the treatment of

A

overactive bladder

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56
Q

For excessive drooling the patient should recieve

A

Glycopyrrolate

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57
Q

Sympathomimetic toxidrome will present with symptoms like

A

Agitation, delirium, hallucination, and paranoia, along with HTN, fever, dilated pupils, sweaty skin, normal bowles (adderall OD)

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58
Q

Treatment of antimuscarinic toxidrome is usually

A

physostigmine

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59
Q

AE of scopolamine is

A

dry outh

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60
Q

When the intraocular pressure of the eye is increased, the muscarinic receptors _______ the outflow of ________

A

increased, aqueous humor

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61
Q

When timilol is administered after epi, the BP is ______ but the HR is _______. (Increased/Decreased)

A

BP increased.
HR Decreased

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62
Q

Allergic reaction? Give

A

Epinepherine

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63
Q

phentolamine can be used preoperatively to prevent

A

severe hypertension during surgery

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64
Q

cevimeline is more tolerated for those with

A

dry mouth

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65
Q

succinylchole has a therapeutic agonist effect through the ______ receptors

A

nicotinic

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66
Q

When exposed to insecticides, muscle weakness can/cannot be reversed with amlodipine

A

Cannot be reveresed

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67
Q

Benztropine is used when antipsychotic medications cause _______ _____

A

Dystonic Reactions

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68
Q

Diphenhydroamine is an antimuscarinic, so it can also cause what

A

Antimuscarnic toxidrome

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69
Q

When a patient is exposed to insecticide, the endpoint of therapy with atropine is to

A

Dry respiratory secretions

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70
Q

Sympatholytic toxidrome are known to cause

A

Unresponsiveness, Bradycardia, and Hypotension

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71
Q

Metoprolol is known to _____ mortality and ______ in patients with HF

A

mortality
hospitalizations

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72
Q

Mirabegron is used in the management of

A

Urinary Incontinence (overactive bladder)

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73
Q

Sympathetic postganglionic neurons synthesize and release ________, making them andregenic

A

Norepinepherine

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74
Q

Dobutamine has chronotropic effects on the ______

A

Heart

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75
Q

T/F - Airway constriction is not an AE of dopamine

A

FALSE. DOPAMINE AE ARE HYPERTENSION, LOCAL ISCHEMIC NECROSIS, AND TACHYARRHYTHMIAS

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76
Q

Formoterol should be used as maintenance therapy for patients with _______

A

COPD

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77
Q

If someone injects an epi-pen wrong (dumbass) what do you do to reverse effects

A

Phentolamine reversal

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78
Q

Clonidine decreases bp due to its decreased release of NE from

A

Sympathetic nerve terminals

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79
Q

NE/Alpha 1 is the main determinant of

A

vascular tone

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80
Q

varenicline is a partial agonsist of neuronal ______ receptors

A

nicotinic

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81
Q

With patients with COPD, inhaled tiotropium should be given to reduce

A

brasoconstriction

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82
Q

When someone is diagnosed with myasthenia gravis, you should do an IV admin of ______

A

edrophonium

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83
Q

Rocuronium is used to induce _______ during tracheal intubation

A

paralysis

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84
Q

AE of oxybutynin could include

A

dry mouth
constipation
drowsiness

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85
Q

When a patient is presenting with sympathomimetic toxidrome, it is best to use ________ to control agitation

A

benzodiazepines

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86
Q

Patient presents with agitation, delirium, hallucinations, paranoia, HTN, dialated pupils, sweaty skin, DIMINISHED BOWELS(IMPORTANT) they OD’d on

A

Diphenydramine (antimuscarinic toxidrome

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87
Q

Patient presenting with sympatholytic toxidrome, they should be given

A

catecholamines

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88
Q

The MOST Na+ reabsorption occurs in the ___________

A

Proximal Convoluted tubule

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89
Q

Loop diuretics inhibit the ___, ____, _____, cotransporter in the thick ascending limb

A

Na+, K+, 2Cl-

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90
Q

The primary MOA for ACE inhibitors is blocking conversion of

A

Ang I to Ang II

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91
Q

Common side effect of loop diuretics is

A

hypokalemia

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92
Q

Hyperkalemia is a risk with amiloride because it inhibits sodium channels in the distal nephron, reducing _______ excretinon

A

potassium

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93
Q

A common side effect of thiazide diuretics is ______

A

hypokalemia

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94
Q

The primary site of action of spironolactone is the _________

A

collecting duct

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95
Q

the actinos of SGLT2s in the kidney block glucose and sodium reabsorption in the _____________

A

proximal convoluted tubule

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96
Q

The most common argument for using the cockcroft-gault over GFR for drug dosing is that most drug dosing recommendations are based on

A

creatine clearance cut offs

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97
Q

_______ is the recommended initial approach for diagnosing kidney disease in adults

A

CKD-EPI eGFRer

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98
Q

What are teh variables in CKD-EPI eGFRcr

A

SCr, Age, Sex

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99
Q

When using CKD-EPI eGFRcr equation for drug dosing the units should be converted to __/___ in large and small patients

A

mL/min

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100
Q

The most accurate method to determine a patien’s kidney function for a 67 year old woman with longstanding malnutrition bilateral below the knee amputatinos, and stable SCr of 2.1 mg/dL is the

A

CKD-EPI eGFRcr-cys

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101
Q

The most appropriate method to determine drug dosing for a 69 year old male, stable SCr of 1.21mg/dL, 77kg, 175cm, BMI 25 with no known medical problems, exercises regularly, eats a healthy omnivorous diet is the

A

estimated creatinine clearance using the cockcroft-gault equation

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102
Q

In resolving AKI WITH A DOWNWARD TRENT IN scR FROM 4.31 YESTERDAY TO 2.71 TODAY. IF THE TREND CONTINUES THE COCKCROFT-GAULT AND CKD-EPI EQUATIONS WOULD

A

UNDERESTIMATE THIS PATIENTS CURRENT KIDNEY FUNCTION

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103
Q

ACEi’s and ARB’s can cause a drop in

A

glomular filtration rate through vasodilation of efferent arterioles

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104
Q

A patient that is deydrated is most likely to experience AKI when an _____ is initiated

A

ACEi

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105
Q

if a patient has an smz induced acute interstitial nephritis the most important treatment step is to

A

stop the smz

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106
Q

maintaining a serum trough of <2mg/L are associated with lower risk of ATN and may reduce the nephrotoxicity of

A

aminoglycosides (ex gentamicin)

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107
Q

iodinated contrast can cause

A

acute tubular necrosis

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108
Q

continuous renal replacement therapy is primarly used in teh ICU in acute dialysis patients who wouldn’t tolerate removal of large amounts of flud over

A

short periods of time

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109
Q

acute indications for dialysis included

A

electroyte disorders, overload of fluid, and uremic symptoms

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110
Q

______ is the internation organizatino that publishes guidelines for managing kidney disease

A

KDIGO

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111
Q

Screening for CKD is recommended annually for all patients with T2DM. So the most important patient is a

A

71 yera old with T2DM

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112
Q

GFR 45-60 IS WHICH G STAGE

A

G3A

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113
Q

ALBUMINURIA IS WHICH A CLASS

A

A2

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114
Q

within the first 4 weeks of starting ACEI OR ARB in CKD, the most important to monitor is

A

potassium and serum createnine

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115
Q

Pt has CKD, due to HTN, G3A, A3, PGM, HTN, CKD, ALLERGIES. The most important medicaiton to slow CKD Progression is

A

dapagliflozin (SGLT2 best for non diabetic CKD + on ACEi or ARB

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116
Q

34 YEAR OLD MALE
T1DM
CKD
GFR = 48
ALB 550
A1C = 6.9
BP 130/80
The most important med to use for CKD progression is

A

Lisinopril (don’t use SGLT2 because of ketoacidosis risk with T1DM

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117
Q

48 YEAR OLD
CKD DUE TO T2DM
G3B
A2
BP = 140/80
Most important plan to reduce CV events is to

A

target systolic BP <120

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118
Q

CKD due to T2DM
lisinopril
empagliflozin
metformin
eGFR = 32
ALB = 650
What drug and why

A

Finerenone is recommended for CKD with T2DM, A2-3 proteinuria, eGFR>25, on ACE-I or ARB.

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119
Q

________ is the primary cause of anemia in CKD

A

decreased erythropoietin production

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120
Q

derangements of concentrations of calcium, phosphorus, parathyroid hormone and vitamin D cause the onset of

A

CKD - MBD

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121
Q

Anemia is a complication of CKD in males if

A

HGB <13

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122
Q

CKD-MBD is a complication in a patient with recent hip fracture and iPTH >

A

2-9x upper limit of normal

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123
Q

If a patient is taking calcium carbonate 1000mg TID and has CKD what should you do, explain

A

check corrected calcium
corrected calcium = calcium value + 0.8*(4-albumin level)

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124
Q

Ca normal limits

A

8.5 - 10.2

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125
Q

If pt is on calcium carbonate and corrected ca is above 10.2, what should you do

A

d/c calcium carbonate and start sevelamer carbonate

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126
Q

HGB RANGE 9-11
DARBEPOETIN ALPHA WITH HGB 11.7
FERRITIN = 750
TSAT = 45
BEST TREATMENT?

A

DECREASE DARBEPOETIN ALPHA

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127
Q

Taking darbepoetin alpha
hgb - 9.7
ferritin - 75
tsat - 10%
What is indicated here and why

A

When ferritin <100 and tsat <10% INDICATION OF IRON DEFICIENCY WHICH IS BEST TREATED WITH IV IRON

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128
Q

sodium bicarbonate is most important to initiate if patient has co2 levels

A

below 22

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129
Q

It is important to counsel a patient starting oral iron on adverse effects including

A

consitpation and it may turn stool dark

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130
Q

_______ and anaphylaxis are rare adverse effects of IV iron

A

hypotension

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131
Q

In-center hemodialysis is done _____ days per week for __ - ___ hour sessions via fistula, graft, or catherter

A

3 days per week
3-5 hour session

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132
Q

An advantage of peritoneal dialysis is

A

better blood pressure control compared to in-center hemodialysis

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133
Q

the treatment for hemodialysis complication of hypotension is

A

midodrine

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134
Q

_______ is the most common complication of peritoneal dialysis

A

Peritonitis

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135
Q

Patients with CKD NOT on dialysis should avoid what class of medication

A

NSAIDS (I.E NAPROXEN)

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136
Q

Patients with CKD on dialysis should avoid _______ enemas

A

phosphate

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137
Q

for mild - moderate dehydration in an 8 year old, recommend

A

2-4 L of ORT over 3 hours and replace fluid losses

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138
Q

A 5 month old with 10 diarrhea (ah man) in 24 hours, unresponsive (not ideal), dry, and sunekn fontanelle is considered _______ dehydration

A

severe

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139
Q

ph > 7.4 = _______
PaCO2 >40 and HCO3 >38 = _______
urine chloride <10 = ________

A
  1. alkalosis
  2. primary metabolic cause
  3. chloride responsive METABOLIC ALKALOSIS
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140
Q

Uremia is most likely to result in

A

anion gap metabolic acidosis

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141
Q

COPD is the most likely to result in _______ acidosis

A

respiratory acidosis

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142
Q

PH <7.35 = ______
______ = same direction with decrease in pH
pCO2, HCO3, anion gap = ______

A
  1. acidosis,
  2. metabolic
  3. na- cl +HCO3 if over 12 considered anion gap
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143
Q

After trauma and head injury if labs are drawn with pH <7.35 and PaCO2 and HCO3 risking = ____ _______ acidosis

A

acute respiratory acidosis

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144
Q

5% albumin is an example of a

A

colloid

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145
Q

An example of a crystalloid is lactated ringers. To calculate maintenance rate (4 - 2 -1 rule) 4 * 10 kg = 40, 2 * 10 kg = 20, 1 * additional kg = x, so 40 + 20 + x = mL/hr
So for a 104 kg patient what is the maintenance rate

A

For a 104 kg pt, 40 + 20 + 84 = 144 mL/hr

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146
Q

For severe hyponatremia and altered mental status with intermittent seizures, treat with

A

150 mL bolus of 3% NaCl

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147
Q

Sodium > 145 = hypernatremia, edema and fluid overload =

A

hypervolemia

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148
Q

to calculate tonicity (Na * 2) + (Glucose / 18) + (BUN / 2.8)

So if Na = 152, glucose = 110, BUN = 18, tonicity =

A

316

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149
Q

Hyperkalemia >5, treat with IV _____ and dextrose.

A

Insulin 5-10 units

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150
Q

to stabalize cardiac myocardium treat with

A

calcium gluconate

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151
Q

hypomagnesemia <1.6 treat with

A

magnesium sulfate

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152
Q

You cannot treat hyponatremia with more than 12mEq/L in 24 hours otherwise it can lead to what

A

osmotic demylination syndrome (ODS) (vegtebelized patient dangit)

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153
Q

hyperphosphatemia < 1.5 treat with

A

potassium phosphate

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154
Q

Correct order of the cardiovascular continum: Risk factors, CAD, MI, heart failure, death

A

Risk factors, CAD, MI, heart failure, death

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155
Q

What stage did cigarette smoking, reduced physical activity, and increased meat consumption play a major role in deaths from CV disease

A

stage 3

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156
Q

beat to beat electrical signal in the heart originates from

A

sinoatrial node (sa node)

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157
Q

leakage of mitral valve cause blood to flow back from

A

Left ventricle to left atrium

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158
Q

isovolumetric ventricular contraction phase includes all valves being closed LV volume ______ and pressure in the LV being ______

A

LV volume unchanged
LV pressure increased

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159
Q

Frank starling relationship

A

effect of the ventricular end diastolic volume on the force generated during systol

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160
Q

small arteries and arteiole of the vasculature contain more layers of smooth muscle compared to

A

veins

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161
Q

contraction in the vascular smooth muscle is regulated by ______, not troponin

A

enzymes

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162
Q

arterial blood pressure equation

A

BP = CO X PVR

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163
Q

SBP increases with ______

A

age (after 40)

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164
Q

patient vitals
46 years
154/102
what stage HTN

A

STAGE 2

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165
Q

PATIENT HAS 3 RISK FACTORS
10 year ASCVD risk is 24.3%
framingham risk score of 24.1%
considered ______ risk

A

HIGH RISK

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166
Q

Average of 154/102 mmHg through three readings. Tests to order

A

BMP
12-LEAD ECG
CBC
LIPID PANEL
URINALYSIS

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167
Q

clinical CAD with angina on exertion (bp 150/102) BP GOAL = ?

A

<130 MMHG SBP

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168
Q

active guy
drinks
doesn’t diet
used to smoke (aka nick)
needs to continue with outdoor activities
incorporate ______ diet with eating less ______

A

DASH DIET
less SALT

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169
Q

WHITE DUDE
61 yo
framingham score 17.5%
BP 146/100
HR 50
STARTED HCTZ
we recommend
- continue lifestyle changes
- HCTZ
- Add _______

A

lisinopril

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170
Q

72 AA female with lot of shit wrong
>55 yo
family members not alived due to bp
high bp
low hdl-c

A

this case is probably not on the test
but answer is
4 risk factors
3 affected organs

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171
Q

72 AA female with lot of shit wrong
>55 yo
family members not alived due to bp
high bp
low hdl-c
4 risk factors
3 affected organs
added diltiazem 120mg/day
still high bp
needs second drug? which one?

A

HCTZ 12.5MG QD

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172
Q

doxazosin monitoring paramater does not match

A

seated BP

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173
Q

58 latino dude treated with ______ bc he is chunky, DMT2, depression (real), and HTN

A

LISINOPRIL

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174
Q

lisniopril causes _______ due to inhibiting bradykinin breakdown

A

cough

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175
Q

ACEi lowers BP by inhibiting formation of ______

A

angiontenisin II

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176
Q

beta blockers decrease _____ concentrations
________ generated by cardiac myocytes and decrease HR

A

bb’s decrease
cAMP concentrations
peak forces generated by cardiac myocytes
decrease HR of course

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177
Q

pedal edema from dihydropyridines from incrased outward capillary hydrostatic pressure gradient, moving fluid ______ (in relation to the capillary)

A

out of the capillary

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178
Q

Verapamil should be used with caution in patients with:

A

HF
reduced cardiac contractility
and on a B-Receptor antagonist

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179
Q

Amlodipine binds to the outer surface of the _ - Type calcium channel toward the Lipid molecules

A

L-type calcium channel

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180
Q

CKD = ACE/ARB
DM = ACE/ARB
ELDERLY + ONE =

A

MINERALOCORTICOID

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181
Q

felodipine (amlodipine cousin) has what affect on
HR
preload
afterload
contractility

A

^HR
no effect on preload,
decreases afterload
no effect on contractility.

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182
Q

37 yo
white male
HTN
asthma
impotence

what are we putting bro on

A

amlodipine

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183
Q

Uncontrolled BP dx can be given under what circumstances

A

on at least 3 drugs of DIFFERENT CLASSES at max tolerated doses

including a diuretic

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184
Q

Amlodipine is monitored by these paramaters (3)

A

Orthostatic BP
PERIPHERAL EDEMA
FATIGUE

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185
Q

Chylomicrons have the highest _______ content

A

triglyceride

186
Q

ApoA-1 serves a critical role in ___

A

HDL

187
Q

______ does all of the following

transfer cholesterol to chylomicrons in the exogenous pathway

acts primarily on ApoB containing lipoproteins in the exogenous pathway

raree loss of function mutations in MTP can cause abetalipoprotenemia

A

MTP

188
Q

A principal part of the exogenous lipid pathway is that triglycerides arising from dietary lipids are metabolized by lipoprotein lipase to deliver

A

FATTY ACIDS to peripheral tissues

189
Q

________ (drug) activates PPAR-alpha which promotes HDL synthesis and reverse cholesterol transport

A

fenofibrate

190
Q

Which of the following are associated with fatty streak formation:

deposition of LDL particles in the intima

oxidation of LDL particles in the intima

inflammation and immune cell recruitment to the intima.

A

all of them

deposition of LDL particles in the intima

oxidation of LDL particles in the intima

inflammation and immune cell recruitment to the intima.

191
Q

T/F - Catalyzing the conversion of cholesterol to cholesterol esters not a major role for apoproteins.

A

True

192
Q

Bile acid resins should be used in caution in combinatino with other therapeutic agents because they affect the

A

absorption of other compounds

193
Q

NPC1L1 is a key protein that facilitates uptake of _________ into enterocytes of lipid metabolism

A

cholesterol

194
Q

The primary MOA of PCSK9 inhibitors is to prevent ____-____ receptor degredation in endosomes

A

LDL-LDL receptor degredation

195
Q

T/F - Contractility is not a factor contributing to myocardial oxygen supply

A

TRUE

196
Q

A key factor underlying the transition of atherosclerotic plaques from fatty to fibrous is

A

smooth muscle cells migrating from the turnica media to the tunica intima

197
Q

Is HTN considered ASCVD

A

NO

198
Q

A key difference between PREVENT and ASCVD risk score is that ASCVD calculator OVERESTIMATES a patient’s CV risk compared to the PREVENT score where risk estimates showed to be overall _______

A

Lower

199
Q

Patients should come in how long after statin initiation for a repeat lipid panel draw

A

4-12 weeks after statin initiation

200
Q

48 yo old obese male
no PMH
No meds
excercises regularly
watches diet
ASCVD 3.4%
no risk factors
(LDL 113, TG 158, TC 198, HDL 45)
Today you should emphasize ________. Should you start a statin?

A

Emphasize lifestyle changes
no itiation of statin therapy
doesn’t fall into four statin benefit groups

201
Q

61 year old female, PMH: HTN, depression, T2DM, and ASCVD risk score is 15.4%. (LDL 217, HDL 32, TG 328). She is at high risk and needs

A

high intensity statin
atorvastatin 40mg

primary prevention first and second statin benefit group
age 40-75 yo
t2dm
requires high intensity statin

202
Q

67 year old AA male, PMH: T2DM, hyperlipidemia, CAD s/p CABG in 2004 with stable angina and HTN. ASCVD: 30%, dad died from MI at 43. Started gemfibrozil six months ago and lipid panels worsened. He is at high risk: start _______.
Should this pt stop med(s)
follow up?

A

Start high intensity statin
Stop gemfibrozil
Clinical ASCVD (secondary prevention)
hasn’t tried statin

203
Q

60 year old female starting atorvastatin 80mg due to CAD with multiple stents. LDL 165. She experienced mild muscle pain and discontinued atorvastatin. Now you recommend ________

A

TRIAL rosuvastatin 40mg

secondary prevention statin has benefit due to:
intolerance
switch to moderate intensity statin

204
Q

53 year old male, PMH: CAD, 2 ACS events, diabetes, HTN, active smoker. LDL 100, was 150 6 months ago. Taking rosuvastatin 40mg and ezetimibe 10mg. He is working on changing his diet, lifestyle and decreasing cigarettes. You recommend

A

Evolucumab (Repatha) 140mg SQ every 2 weeks.

High Risk ASCVD
Statin + Ezetemibe
not at target LDL

start PSCK9. (repatha)

205
Q

The four potential secondary causes of hypertriglyceridemia are

A

underlying disease

diet/lifestyle

drugs

metabolic disorders

206
Q

The REDUCE IT (NEJM 2019) showed cardiovascular benefit with which drug/medication

A

Icosapent ethyl (vascepa)

207
Q

A false misconception about rx fish oils is that

A

OTC fish oil is a good replacement because they have the same potency and contents

208
Q

54 year old female, PMH: uncontrolled T2DM, HTN, and current smoker. Mostly eats carbs, one beer/night, meds: HCTZ 25mg and NPH insulin 10 units BID. TG 300. Which of the following can be modified to reduce Sally’s TG level:

change HCTZ to alternative BP med

eliminate alcohol

reduce carbohydrate consumption

improve control of diabetes.

A

All of the above

change HCTZ to alternative BP med,

eliminate alcohol

reduce carbohydrate consumption

and improve control of diabetes.

209
Q

Ther therapeutic effects of verapamil are that

A. slows heart rate
b. reduces afterload
c. relaxes vasospastic coronary vessels
d. all of the above

A

D is correct, all of the above

A. slows heart rate
b. reduces afterload
c. relaxes vasospastic coronary vessels
d. all of the above

210
Q

T/F - Metoprolol is NOT the first line in treatment of vasospastic angina

A

True

211
Q

The MOA of ranolazine is it inhibits late ______ currents in cardiomyocytes

A

inhibits late SODIUM currents in cardiomyocytes

212
Q

ranolazine is used as an anti-anginal agent because it decreases _______ consumptions during _______

A

decreases oxygen consumption during diastole

213
Q

Why can drugs that slow heart rate be used to treat stable angina.

A
  • The heart is more efficient, oxygen consumption is reduced
  • myocardial blood flow is improved due to the increased time the heart spends in diastole during slower heart rates.
214
Q

Glyceryl trinitrate (nitroglycerin prevents angina by decreasing ______

A

preload

215
Q

combining a beta blocker and non-dhp for angina is not advised due to what?

A

Both cause bradycardia

216
Q

PDE5 inhibitors can potentiate the action of which class of drug and cause profound HYPOtension

A

nitrovasodilators (ex. nitroglycerin)

217
Q

Typical SIHD: chest pressure with exercise/housework, substernal, doesn’t radiate, lasts 5 minutes. PMH: T2DM, weight 245lbs, height 5’6”.

What should this patient be on.

When should they follow up

A

Start SL NTG
clopidogrel 75mg

empagliflozin (jardiance) 10mg,

semaglutide (ozempic) 0.25mg,

return in 2 weeks.

218
Q

If blood pressure and heart rate are low, which of the following can you use for SIHD.

a Beta blocker

b Long acting nitrate

c non-dhp ccb

d. all of the above

e. a and b

f. none of the above

A

f. none of the above.

219
Q

If a patient has SIHD, and is already on metoprolol, with low BP and low HR, which drug would you add if pt is still symptomatic

A

ranolazine (ranexa) 500mg

220
Q

When a patient is diagnosed with sihd what should be discussed immediately?

A

prognosis

Treatment

Physical Activity

221
Q

what is contraindicated to starting a nonselective beta blocker for SIHD

asthma with daily beta adrenergic agonist inhaler use, active peripheral artery disease, and HR < 60 bpm.

A

ALL OF THEM ARE CONTRAINDICATED

222
Q

82 year old hispanic female, PMH: HTN, active PVD, hyperlipidemia, presents with SIHD daily and must stop daily chores. ASCVD = 10.5%.

WHAT MEDS ARE WE PUTTING THIS PATIENT ON

A

Start SL NTG 0.4mg, Aspirin 81mg, Colchicine 0.5mg, Lisinopril 5mg, Rosuvastatin 10mg, Carvedilol 25mg.

Clinical HTN = lisinopril, hyperlipidemia = rosuvastatin, and SIHD = NTG, Aspirin, inflammatory PVD = Colchicine, carvedilol, ASCVD = mod statin

223
Q

BETA ADRENERGIC BLOCKERS ARE PRESCRIBED IN SIHD TO BALANCE WHAT?

A

myocardial oxygen supply and demand

224
Q

________ BP measurements is a monitoring paramater for SIHD

A

ORTHOSTATIC BP

225
Q

Which of these can cause harm to a patient with SIHD

sympathomimetic weight loss drugs chronic use of opioids
PDE5 inhibitors

A

all of them
sympathomimetic weight loss drugs, chronic use of opioids, and PDE5 inhibitors.

226
Q

A patient experiencing MI from small clots at the ruptured plaque site without concomitant necrosis.

What is this patient likely experiencing

A

Chest Pain

227
Q

A rupture of a thin fibrous cap on a stenotic lipid-rich plaque can lead to….

A

a thrombus forming on an atheromatous plaque

228
Q

The accumulation of ADP, thromboxane, and thrombin in areas of disturbed blood flow lead to…..

A

activation and accumulation of platelets

229
Q

the interaction of platelets with damaged endothelial surfaces is most affected in which disease

A

von willebrands disease

230
Q

ADP activating P2Y12 on platelets results in a conformational change in GPIIb/IIIa receptors that triggers ________

A

aggregation

231
Q

Platelet aggregation blocking drugs least to worst.

Options, aspirin, clopidogrel, abciximab

A

aspirin<clopidogrel< abciximab

232
Q

Prasugrel is better than clopidogrel in the sense that the _______ and _______ of prasugrel is higher

A
  1. absorption
  2. bioactivation
233
Q

MOA of vorapaxar

A

block PAR-1 receptors on platelets

234
Q

decreased antithrombin activity can lead to _______ formation

A

thrombus

235
Q

intrinsic x-ase complex (FIXa/FVIIIa/FX) is on the surface of what

A

phosphatidylserine-positive activated platelets

236
Q

the initiation of clot formation is most affected by

A

inactivated tissue factor

237
Q

the function of activated protein C is to _____________ at the site of injury

A

limit coagulation

238
Q

homeostasis example

A

cutting yourself shaving then bleeding stops 10 minutes later

239
Q

patients at high risk of bleeding should avoid anticoagulation therapy and should do what instead

A

sequential compression devices instead of anticoag tx

240
Q

for hemodynamically stable patient, oral _______ is the best therapy and does NOT require injection

A

DOAC

241
Q

T/F- DOACs should NOT be taken when breastfeeding

A

TRUE- no DOAC when breastfeeding

242
Q

If switching from injection tx to warfarin for anticoag, typically in pregnant patients, what do you need to do

A

overlap for 5 days

243
Q

______-_____ or ______ is contraindicated in alteplase

A

recent surgery or trauma

244
Q

Alteplase binds fibrin clots with high affinity which helps localize what to the clot

A

plasmin formation

245
Q

What is the best anticoag treatment for factor V Leiden while pregnant

A

enoxaparin

246
Q

Fondaparinux MOA for inhibiting coagulation is by

A

increasing the binding of antithrombin to factor Xa

247
Q

Idarucizumab can rapidly reverse the effects of ________

A

dabigatran

248
Q

Warfarin should be monitored by prothrombin time (PT) displayed as _____

A

INR

249
Q

Warfarin affects which important clotting factor(s)

A

factor X and factor II

250
Q

Warfarin should be overlapped during with treatment with another UHF or LMWH. Stops activation of __________ dependent clotting factor and crosses the __________

A
  1. vitamin k
  2. placenta
251
Q

Anticoag therapy should be initiated until the VTE has been objectively confirmed so patient should obtain a __________ ultrasound

A

compression ultrasound

252
Q

__________ helps form coagulation complexes on phospholipid surfaces during fibrin formation

A

calcium

253
Q

A fractured ankle with plaster cast would cause _______ formation as part of Virchow’s triad

A

thrombus

254
Q
A
255
Q

Fibrin is most likely to be formed during the ________ phase

A

propagation

255
Q

Which of the following are contraindications to receiving a fibrinolytic:

A

all of the above

severe uncontrolled HTN, significant closed head trauma within the last 3 months, and active bleeding

255
Q

SECONDARY prevention of atherosclerotic ischemic stroke is _______

A

aspirin

255
Q

PREIMARY prevention of CARDIOEMBOLIC ischemic stroke is

A

apixaban

255
Q

best plan to reverse warfarin with an active bleed is

A

vitamin k 5mg IV

256
Q

patients with suspected acute ischemic stroke can be eligible for fibrinolysis if they present

A

within 4.5 hours asn does not have an acute bleed

256
Q

Suspected NSTE-ACS at PCI capable, getting cath lab in 24 hours, pt takes atorvastatin 20, metformin 500 BID, and amlodipine 5. Treatment plan:

A

Treatment plan: ASA 325 CHEW, hold P2Y12 until table, hold BB, heparin, increase atorvastatin to 40mg, SL NTG prn, continue lisinopril, hold metformin

256
Q

t/f- NSAIDs should not be given in CVD patients

A

true

256
Q

It is appropriate to give a fibrinolytic in a STEMI with symptoms within _____ hours and unable to get PCI capable within ______ minutes of presenting

A
  1. 12 hours
  2. 120 minutes
256
Q

Ticagrelor should not be given with more than 100mg of ______

A

aspirin

256
Q

CVD patient + headache, what OTC do we recommend

A

acetaminophen

256
Q

Avoid prasugrel in patients

A

> 75 years

hx of stroke

weight <60 kg

256
Q

Ticagrelor is an _________ medication should be avoided in an _________ patient post STEMI-ACS with DES

A
  1. expensive
  2. uninsured
257
Q

Post STEMI-ACS regimen for patient on with DES placed and taking lisinopril 10:

A

aspirin 81, prasugrel 10, atorvastatin 80, metoprolol 25, continue lisinopril

257
Q

Dual antiplatelet therapy should be continued for ____ months post-ACS with a DES

A

12 months

257
Q

Which of the following are reasons to avoid IV beta-blockers for acute ACS:

signs of cardiogenic shock, active wheezing, and 2nd degree heart block without a pacemaker

A

All of the above

signs of cardiogenic shock, active wheezing, and 2nd degree heart block without a pacemaker

257
Q

which study showed lower rates of death & no difference in bleeding risk between prasugrel and ticagrelor

A

ISAR-REACT 5 (2019) showed lower rates of death & no difference in bleeding risk between prasugrel and ticagrelor

257
Q

which study compared clopidogrel + ASA 81 is better than ASA alone

A

CURE (2001) compared clopidogrel + ASA 81 is better than ASA alone

258
Q

which study showed that long-term beta blockers may not have strong benefit for ACS with normal EF

A

REDUCE-AMI (2024) showed that long-term beta blockers may not have strong benefit for ACS with normal EF

258
Q

which study showed low-dose colchicine may reduce risk of ischemic events in patients post-ACS

A

COLCOT (NEJM 2019) showed low-dose colchicine may reduce risk of ischemic events in patients post-ACS

259
Q

which of the following contribute to the progression of HFrEF: neuroendocrine stimulation, increased myocyte energy expenditure, and enhanced myocyte apoptosis

A

All of the following contribute to the progression of HFrEF: neuroendocrine stimulation, increased myocyte energy expenditure, and enhanced myocyte apoptosis

260
Q

Accumulation and inflammation of adipose tissue contributes to the progression of _______. (HF)

A

Accumulation and inflammation of adipose tissue contributes to the progression of HFpEF

261
Q

WHICH of the following neurohormones are matched with their pathophysiological effects progressing HFrEF: increased norepi + B1 adrenergic down regulation, ang II + enhanced cardiac myocyte hypertrophy, vasopressin + retention of free water

A

All of the following neurohormones are matched with their pathophysiological effects progressing HFrEF:

increased norepi + B1 adrenergic down regulation, ang II + enhanced cardiac myocyte hypertrophy, vasopressin + retention of free water

262
Q

The range for HFmrEF is __-__%

A

The range for HFmrEF is 40-49%

263
Q
A
264
Q

_______ P-V loop is shifted to the right (larger EDV and ESV) compared to the normal and HFpEF P-V loops

A

HFrEF’s P-V loop is shifted to the right (larger EDV and ESV) compared to the normal and HFpEF P-V loops

265
Q

In heart failure, Endothelin I causes potent ____________ in paracrine signaling

A

In heart failure, Endothelin I causes potent vasoconstriction in paracrine signaling

266
Q

To slow progression of HFrEF, treatments rely on roles of _______ and ________

A

To slow progression of HFrEF, treatments rely on roles of ang II and norepi

267
Q

WHICH DRUG inhibits PDE3 which increases cardiac contractility and relaxes vascular smooth muscle

A

Milrinone inhibits PDE3 which increases cardiac contractility and relaxes vascular smooth muscle

268
Q

Which drug is beneficial because it increases plasma concentrations of natriuretic peptides and block ang II receptors

A

Entresto is beneficial because it increases plasma concentrations of natriuretic peptides and block ang II receptors

269
Q

IV _____ should be administered for severe hypotension and in states of cardiogenic shock

A

IV dopamine should be administered for severe hypotension and in states of cardiogenic shock

270
Q

Adding carvedilol after an MI is to do what

A

Adding carvedilol after an MI is to slow the progression of heart failure

271
Q

The Frank Starling curve shows what two metrics

A

The Frank Starling curve shows EDV (preload) vs systole (cardiac output)

272
Q
A
273
Q

An example of an SGLT2 inhibitor is

A

Dapagliflozin (Farxiga)

274
Q

In the EMPEROR trial showed what

A

In the EMPEROR trial, Empagliflozin (Jardiance) showed to reduce CV death or hospitalization for heart failure in HFpEF

275
Q
A
276
Q

Give adenosine for what

A

paroxysmal supraventricular tachycardia

277
Q

If there is a delay at the AV node, you will have an elongated ____ _______ (look at ECG)

A

If there is a delay at the AV node, you will have an elongated PR segment (look at ECG)

278
Q

If you have HFrEF, you will have what 3 primary symptoms

A

If you have HFrEF, you will have fatigue, dyspnea, and edema

279
Q

T/F - Aflutter does not have multiple or unstable ectopic pacemakers

A

TRUE

Aflutter does not have multiple or unstable ectopic pacemakers

280
Q

WHICH TYPE OF arrhythmias require fast current, slow current, and island of UNexcitable tissue

A

Re-entrant arrhythmias require fast current, slow current, and island of UNexcitable tissue

281
Q

TZDs are pretty chill to use in HF

A

no TZD will kill your patient.
SAY NO TO TZD IN HF

282
Q

WPW involves an accessory pathway between the a______ and the _________

A

WPW involves an accessory pathway between the atrium and the ventricle

283
Q

If pt has severe symptoms of irregularly irregular ventricular rhythm arrhythmia and faints, they need rhythm control → give them _________

A

If pt has severe symptoms of irregularly irregular ventricular rhythm arrhythmia and faints, they need rhythm control → give them dofetilide (Dronedarone NOT for permanent AFIB or HF)

284
Q

Magnesium sulfate treats _____

A

Magnesium sulfate treats TdP

285
Q

T/F - A patient with mild symptoms of afib for last few days does need rhythm control

A

FALSE

A patient with mild symptoms of afib for last few days does NOT need rhythm control

286
Q

Decreasing PCWP = (INCREASING OR DECREASING) mortality rate

A

Decreasing PCWP = decreased mortality rate

287
Q

If a patient has a mechanical heart valve but has Vfib, send them home on long term ________

A

If a patient has a mechanical heart valve but has Vfib, send them home on long term warfarin

288
Q

If a patient has a mechanical heart valve and Vfib but needs to be DCC, use _______ first

A

If a patient has a mechanical heart valve and Vfib but needs to be DCC, use UFH first

289
Q

Use amiodarone for WHAT TYPE OF arrhythmias

A

Use amiodarone for refractory ventricular arrhythmias

290
Q

When using nesiritide, monitor for what?

A

When using nesiritide, monitor for low blood pressure

291
Q

Amiodarone can lead to which of the following:

pulmonary fibrosis
corneal microdeposits
hepatotoxicity

A

all of the above

Amiodarone can lead to pulmonary fibrosis, corneal microdeposits, and hepatotoxicity

292
Q
A
293
Q

Early ___________ can contribute to various forms of arrhythmias. EAD: a sufficient number of ion channels are in the closed state and can be activated by a sufficient depolarizing stimulus thus triggering an AP

A

Early Afterdepolarizations can contribute to various forms of arrhythmias. EAD: a sufficient number of ion channels are in the closed state and can be activated by a sufficient depolarizing stimulus thus triggering an AP

294
Q

Proarrhythmic means what

A

Proarrhythmic= when drugs cause arrhythmias

295
Q

If you are NYHA stage 3, your number one priority is what

A

If you are NYHA stage 3, your number one priority is exercise tolerance

296
Q

Before starting spironolactone (aldosterone antagonist) check which labs

A

Before starting spironolactone (aldosterone antagonist) check labs: SCr and K

297
Q

If a HF patient wants non-pharm measures, make sure they get which of the following:

vaccines needed
exercise
diet

A

All of the above

If a HF patient wants non-pharm measures, make sure they get vaccines needed, exercise, and diet (all)

298
Q
A
299
Q

If you’re going to DCC someone, give them _________ first

A

If you’re going to DCC someone, give them Midazolam first

300
Q

If a patient has renal diuretic resistance, first try what before adding anything else on

A

If a patient has renal diuretic resistance, first try increasing their diuretic dose before adding anything else on

301
Q

if a patient is WARM and WET

A

deal with that

302
Q

If a patient is on ⅘ of the pillars and doesn’t want to start a new med…..

A

If a patient is on ⅘ of the pillars and doesn’t want to start a new med, that’s too damn bad cause they’re getting empagliflozin (also if they’re ok with it cause this was a dual ?)

303
Q

Propranolol can cause ______ in OD

A

Propranolol can cause seizures in OD

304
Q

Superwarfarins have what kind of half life compared to warfarin

A

Superwarfarins have a longer half-life than warfarin

305
Q

If a patient has HF, ibuprofen and diltiazem CCBs can do what

A

If a patient has HF, ibuprofen and diltiazem CCBs can worsen it

306
Q

High BUN (>43)
High SCr(>2.75)
low SBP (<115)

What does this mean for a hospitalized patient

A

High BUN (>43), High SCr(>2.75), and low SBP (<115)= BAD for in hospital mortality

307
Q

If you eat rat poison and your INR is ok 2 days later, what should you do

A

If you eat rat poison and your INR is ok 2 days later, check it again in a day

308
Q

Most common AE when giving IV glucagon for BB OD is _______

A

Most common AE when giving IV glucagon for BB OD is vomiting

309
Q

MOA of high dose insulin on cardiac myocytes in ccb or bb od=

A

MOA of high dose insulin on cardiac myocytes in ccb or bb od= increased glucose utilization

310
Q

___________ is an indicator of NDHP CCB overdose

A

Hyperglycemia is an indicator of NDHP CCB overdose

311
Q

Give digoxin immune fab (Digifab) in acute digoxin toxicity if potassium of what level

A

Give digoxin immune fab (Digifab) in acute digoxin toxicity if potassium of 6.5mEq/L (hyperkalemia >5)

312
Q

If patient has tachycardia and irregular pulse and presents to ED in 4h, give them _______ IV bolus then q6hx2, if O2 sat is low (<90), give them _________, __________ bolus (if fluid overloaded), and TEE now

A

If patient has tachycardia and irregular pulse and presents to ED in 4h, give them digoxin IV bolus then q6hx2, if O2 sat is low (<90), give them O, furosemide bolus (if fluid overloaded), and TEE now

313
Q

If person has new palpitations over last couple of days and is newly diagnosed with Afib and no thrombus found, give them ____________ for rate control immediately

A

If person has new palpitations over last couple of days and is newly diagnosed with Afib and no thrombus found, give them METOPROLOL for rate control immediately

314
Q

If a patient passes out from Vfib, they should get IV _________ to terminate it

A

If a patient passes out from Vfib, they should get IV amiodarone to terminate it

315
Q

Digoxin increases _____ _____ in Afib

A

Digoxin increases vagal tone in Afib

316
Q

________ is responsible for the rapid depolarization of the SA node

A

Calcium is responsible for the rapid depolarization of the SA node

317
Q

t/f- VFib is the most immediately life threatening arrhythmia

A

TRUE

VFib is the most immediately life threatening arrhythmia

318
Q

If a patient with HFrEF is on an ace or an arb, monitor for which of the following:

A. orthostatic bp
B. angioedema
C. BMP
D. ALL OF THE ABOVE

A

ALL OF THE ABOVE (DUH)
If a patient with HFrEF is on an ace or an arb, monitor for orthostatic bp, angioedema, and BMP

319
Q

T/F- Ivabridine is not shown to decrease morbidity and mortality

A

TRUE

Ivabridine is not shown to decrease morbidity and mortality

319
Q

If patient has HFrEF & is not on spironolactone…….

A

If patient has HFrEF & is not on spironolactone, start them on it

320
Q

The age of degenerative and civilization associated disease is related to________ and reduced _________ ________

A

The age of degenerative and civilization associated disease is related to smoking and reduced physical activity

321
Q

PUT THESE IN ORDER

CV continuum order: HF, Death, risk factor, CAD, MI,

A

CV continuum order: risk factor, CAD, MI, HF, Death

322
Q

If patient not on all pillars, put them on ___________ if they’re not on it

A

If patient not on all pillars, put them on empagliflozin if they’re not on it

323
Q

Lidocaine preferentially inhibits what

A

Lidocaine preferentially inhibits RAPIDLY depolarizing ventricular myocytes

324
Q

​​Use dependence of Na channel blocker will (speed up or slow down) conduction of depolarization in Cardiac myocyte

A

​​Use dependence of Na channel blocker will SLOW conduction of depolarization in Cardiac myocyte

325
Q

is DOAC tx for MG with palpitations over last 3 days recommended

A

Yes DOAC tx for MG with palpitations over last 3 days

326
Q

TdP is from what

A

TdP from prolonged QT

327
Q

___________ is the preferred treatment for hypothyroidism because its tolerated and has a long ½ life

A

Levothyroxine is the preferred treatment for hypothyroidism because its tolerated and has a long ½ life

328
Q

Overproduction of Thyroxine (T4) is associated with exophthalmos in which disease

A

Overproduction of Thyroxine (T4) is associated with exophthalmos in graves disease

329
Q

_________ is preferred in hyperthyroidism because it has a longer ½ life and fewer adverse effects compared to PTU

A

Methimazole is preferred in hyperthyroidism because it has a longer ½ life and fewer adverse effects compared to PTU

330
Q

Type __ diabetes is associated with Diabetic Ketoacidosis

A

Type 1 diabetes is associated with Diabetic Ketoacidosis

331
Q

Central diabetes insipidus is treated with _________

A

Central diabetes insipidus is treated with desmopressin

332
Q

Phenytoin could potentially decrease or increase? the efficacy of levothyroxine by enhancing its metabolism (P450 enzymes)

A

Phenytoin could potentially DECREASE the efficacy of levothyroxine by enhancing its metabolism (P450 enzymes)

333
Q

HbA1c of ___ or higher is diagnostic criteria indicative of diabetes mellitus

A

HbA1c of 6.5% or higher is diagnostic criteria indicative of diabetes mellitus

334
Q

A complete lack of insulin characterizes Type __ diabetes

A

A complete lack of insulin characterizes Type 1 diabetes

335
Q

______ facilitates glucose uptake into muscle and adipose tissues in response to insulin during glucose metabolism

A

GLUT4 facilitates glucose uptake into muscle and adipose tissues in response to insulin during glucose metabolism

336
Q

Activation of GLUT4 translocation to the cell membrane is the mechanism by which insulin promotes the uptake of _____ into skeletal and cardiac muscle post-prandial

A

Activation of GLUT4 translocation to the cell membrane is the mechanism by which insulin promotes the uptake of glucose into skeletal and cardiac muscle post-prandial

337
Q

Glucagon is released from alpha cells and primarily acts as a catabolic counterpart to _______

A

Glucagon is released from alpha cells and primarily acts as a catabolic counterpart to insulin

338
Q

Microvascular complications is a consequence of prolonged _________ in diabetes

A

Microvascular complications is a consequence of prolonged hyperglycemia in diabetes

339
Q

Enhanced insulin secretion and reduced postprandial hyperglycemia would be seen if a drug increased the release of incretin hormones in a patient with WHAT TYPE OF DIABETES

A

Enhanced insulin secretion and reduced postprandial hyperglycemia would be seen if a drug increased the release of incretin hormones in a patient with T2DM

340
Q

I GUESS THIS IS A STATEMENT SOMEONE WROTE DOWN, I don’t know WHAT THIS IS ABOUT

Injection site, dose, and physical activity can affect the onset and duration of its action

A

Injection site, dose, and physical activity can affect the onset and duration of its action

341
Q

Enhanced ketogenic and elevated blood ketone levels is the effect if _________ secretion is absent

A

Enhanced ketogenic and elevated blood ketone levels is the effect if insulin secretion is absent

342
Q

Higher fasting glucose levels due to impaired insulin release is the most direct effect of ______ cell loss in T2DM

A

Higher fasting glucose levels due to impaired insulin release is the most direct effect of Beta cell loss in T2DM

343
Q

If a patient was just diagnosed with T1DM, insulin glargine __ units at bed and insulin aspart _ units TID with meals is appropriate.

→ Patient’s weight is 62 kg– 0.5 units/kg/day, divided between basal and bolus with bolus at every meal

A

If a patient was just diagnosed with T1DM, insulin glargine 15 units at bed and insulin aspart 5 units TID with meals is appropriate. → Patient’s weight is 62 kg– 0.5 units/kg/day, divided between basal and bolus with bolus at every meal

344
Q

Increase dinner dose of novolog mix 70/30 if his glucose level is at 191 mg/dL 2 hrs after dinner→ postprandial insulin should be <______

A

Increase dinner dose of novolog mix 70/30 if his glucose level is at 191 mg/dL 2 hrs after dinner→ postprandial insulin should be <180

345
Q
A
346
Q

_________ breakfast dose of insulin lispro if pre lunch glucose level is 156 mg/dL

→ preprandial should be 80-130

A

Increase breakfast dose of insulin lispro if pre lunch glucose level is 156 mg/dL→ preprandial should be 80-130

347
Q

_________ evening insulin dose if fasting glucose levels are 64 mg/dL → 80-130 is normal range

A

Decrease evening insulin dose if fasting glucose levels are 64 mg/dL → 80-130 is normal range

348
Q

or a flexpen, admin it ____ mins before a meal but it can be given up to ___ mins after meal

A

or a flexpen, admin it 15 mins before a meal but it can be given up to 20 mins after meal

349
Q

weight is 83 kg if A1C increased WHAT SHOULD WE DO

this question did not have very much context for whoever took notes on it

A

Add glargine 16 units at bedtime if A1C increased→ 10 units per day increase or 0.1-0.2 units/kg/day…weight is 83 kg

350
Q

low context notes

Add aspart 4 units if A1C decreased but post prandial is 190-200 mg/dL

→ 4 units or 0.1 units/kg or 10% of daily dose

A

Add aspart 4 units if A1C decreased but post prandial is 190-200 mg/dL → 4 units or 0.1 units/kg or 10% of daily dose

351
Q

low context notes on this

Lispro before meal if pre lunch 210 mg/dL, Insulin to Carb Ratio 1:15 and correction factor 30→ mealtime dose=grams of carbs in meal/ICR→ 60g/15=4 units. Correction dose= BG before-BG after/CF (210-120)/30=3, 4+3=7

A

Lispro before meal if pre lunch 210 mg/dL, Insulin to Carb Ratio 1:15 and correction factor 30→ mealtime dose=grams of carbs in meal/ICR→ 60g/15=4 units. Correction dose= BG before-BG after/CF (210-120)/30=3, 4+3=7

352
Q

MOA of metformin =

A

MOA of metformin = activate AMPK, reduce gluconeogenesis in the liver

353
Q

GLP1 cardiovasc effect=

A

GLP1 cardiovasc effect= increased NO production and decreased ROS

354
Q

Metformin should be used in caution with ________ impaired patients

A

Metformin should be used in quation with renally impaired patients

355
Q

GLP1 agonists promote ______ and _______ gastric emptying

A

GLP1 agonists promote satiety and slows gastric emptying

356
Q

Metformin __________ TGs, VLDL, and LDL, increases HDL

A

Metformin decreases TGs, VLDL, and LDL, increases HDL

357
Q

Tirxepatide is a (what class)

A

Tirxepatide is a GLP1+GIP

358
Q

DPP4 inhibitor inhibits DPP4 to prolong action if _________ (Question of the Year!)

A

DPP4 inhibitor inhibits DPP4 to prolong action if incretins (Question of the Year!)

359
Q

T/F- Glyburide cannot be combod with bolus insulin

A

TRUE

Glyburide cannot be combod with bolus insulin

360
Q

If a patient has recurrent UTI, T2DM, CKD obesity, on metformin, glimepiride and has high A1C, give her __________

A

If a patient has recurrent UTI, T2DM, CKD obesity, on metformin, glimepiride and has high A1C, give her semaglutide

361
Q

Pt has gained 5 lbs in 6mo. ____________ (drug) IS contributing to his weight gain

A

Pt has gained 5 lbs in 6mo. Pioglitazone contributing to his weight gain

362
Q

Pt with t2dm and ckd and on metformin 1000 BID -> eGFR decreased so now what

A

Pt with t2dm and ckd and on metformin 1000 BID -> eGFR decreased so reduce metformin to 500mg BID

363
Q

if picking up liraglutide for first time, teach him what

A

if picking up liraglutide for first time, teach him proper self-injection technique, including site rotation and needle disposal

364
Q

· The glucose lowering effects of SGLT2i are less pronounced at lower _______ levels

A

· The glucose lowering effects of SGLT2i are less pronounced at lower eGFR levels

365
Q

Metformin should be started at _______mg QD then slowly titrated up to a max dose of ________mg QD

A
  1. 500mg qd
  2. 2000mg qd
366
Q

Pt wants to lose weight and does not want to inject any meds -> give him

A

Pt wants to lose weight and does not want to inject any meds -> give him sitagliptin (januvia)

367
Q

hx of t2dm and MI 3 years ago and Is currently on ASA 81, metformin 2000, Olmesartan, and rosuvastatin 40. Add ____________ to his treatment to reduce risk of CV events MACE

A

hx of t2dm and MI 3 years ago and Is currently on ASA 81, metformin 2000, Olmesartan, and rosuvastatin 40. Add empagliflozin to his treatment to reduce risk of CV events MACE

368
Q

· Patient develops ulcer on foot and already on a bunch of meds so he needs ________

A

· Patient develops ulcer on foot and already on a bunch of meds so he needs insulin

369
Q

· Patient with hx of pancreatitis (no glp1 and no dpp4) wants to avoid meds that cause weight gain= what med

A

· Patient with hx of pancreatitis (no glp1 and no dpp4) wants to avoid meds that cause weight gain= canagliflozin

370
Q

· If diabetes patient loses their insurance and is on metformin, you can give them _______ , they don’t need insulin unless >10

A

· If diabetes patient loses their insurance and is on metformin, you can give them glipizide (sur are cost effective ), they don’t need insulin unless >10

371
Q

· Don’t use _____ in hf, if on glp1 don’t use _______, and if pt has HF get them on _________ if they have good insurance coverage

A

· Don’t use tzd in hf, if on glp1 don’t use dpp4, and if pt has HF get them on empagliflozin if they have good insurance coverage

372
Q

· A patient centered approach should be utilized to select diabetes pharmacotherapy according to ______

A

· A patient centered approach should be utilized to select diabetes pharmacotherapy according to_____

373
Q

· If patient has t2dm, HTN, PVD and an A1c of 7.6, already on metformin 2000, lisinopril 20, amlodipine 10, add ____________ bc ascvd benefit

A

· If patient has t2dm, HTN, PVD and an A1c of 7.6, already on metformin 2000, lisinopril 20, amlodipine 10, add dalaglutide (Trulicity) bc ascvd benefit

374
Q

· DCCT and UKPDS 33 trials looked at what

A

· DCCT and UKPDS 33 trials looked at preventing microvascular complications with early intensive glycemic control

375
Q

· Comprehensive foot exams should be performed at least annually starting when with T2DM

A

· Comprehensive foot exams should be performed at least annually starting at the time of diagnosis with T2DM

376
Q

· To prevent macrovascular complications in a tobacco dependent diabetic patient, initiate a ______ and repeat lipid panel in 4-12 weeks

A

· To prevent macrovascular complications in a tobacco dependent diabetic patient, initiate a statin and repeat lipid panel in 4-12 weeks

377
Q

· Gastroparesis is a neuropathic complication of ________

A

· Gastroparesis is a neuropathic complication of _______

378
Q

· According to ADA, patients should incorporate more _____________________ into meals and snacks

A

· According to ADA, patients should incorporate more non starchy vegetables into meals and snacks

379
Q

T/F- · Core component of comprehensive care plan for patients with diabetes does not include counting carbs

A

· TRUE

Core component of comprehensive care plan for patients with diabetes does not include counting carbs

380
Q

______ _________ occurs in patients when they are frustrated with their treatment

A

· Diabetes distress occurs in patients when they are frustrated with their treatment

381
Q

T/F- Depending on intensity of exercise, diabetic patients can experience hypo or hyperglycemia

A

TRUE

Depending on intensity of exercise, diabetic patients can experience hypo or hyperglycemia

382
Q

T/F- IV dextrose for DKA used when hyperglycemia is NOT resoled and ketoacidosis is not yet resolved

A

FALSE

IV dextrose for DKA used when hyperglycemia is resolving but ketoacidosis is not yet resolved

383
Q

· If patient is admitted with DKA, initial treatment should be

A

· If patient is admitted with DKA, initial treatment should be IV fluid, K, IV regular insulin

384
Q

T/F- Infection can cause DKA

A

TRUE

Infection can cause DKA

385
Q

· If patient is going NPO at midnight
-and bg ok (range 140-180 in hosp ok)-> d/c insulin aspart 8U TID after dinner, change insulin aspart sliding scale to

A

· If patient is going NPO at midnight
-and bg ok (range 140-180 in hosp ok)-> d/c insulin aspart 8U TID after dinner, change insulin aspart sliding scale to q4h after dinner tonight

386
Q

· Corticosteroids can ________ blood glucose

A

· Corticosteroids can increase blood glucose

387
Q

_______ insulin glargine by 20-25% for NPO

A

decrease insulin glargine by 20-25% for NPO

388
Q

______ metformin in hospital (AKI), reduce glargine dose to 5 u and start aspart sliding scale

A

Hold metformin in hospital (AKI), reduce glargine dose to 5 u and start aspart sliding scale

389
Q

· Dose of levothyroxine calculation = ____ - _____ mcg/kg IBW/day

A

· Dose of levothyroxine calculation = 1.6-1.8 mcg/kg IBW/day

390
Q

Bg goal in hospital is

A

Bg goal in hospital is 140-180

391
Q

· Following dose adj of levothyroxine, recheck TSH in

A

· Following dose adj of levothyroxine, recheck TSH in 4-8 weeks

392
Q

· If TSH is too low and showing signs of hyperthyroidism, decrease levothyroxine by

A

· If TSH is too low and showing signs of hyperthyroidism, decrease levothyroxine by 12.5-25mcg

393
Q

· Methimazole for _______ disease hyperT

A

· Methimazole for graves disease hyperT

394
Q

· If patient develops recurrent hypoglycemia despite glucose tx following SUR OD , administer _________

A

· If patient develops recurrent hypoglycemia despite glucose tx following SUR OD , administer octreotide

395
Q

· Levothyroxine OD most like ____________ toxidrome

A

· Levothyroxine OD most like sympathomimetic toxidrome

396
Q

· Check ______ ______ for metformin OD

A

· Check serum lactate for metformin OD

397
Q

· SUR have highest risk of ______glycemia

A

· SUR have highest risk of hypoglycemia

398
Q

· Oral contraceptive might be less effective after _______ surger

A

· Oral contraceptive might be less effective after bariatric surger

399
Q

· Obesity classes: BMI=

A

· Obesity classes: BMI=weight (kg)/ height in m^2

400
Q

· First line tx for obesity management is _________ modifications

A

· First line tx for obesity management is behavioral modifications

401
Q

· Best recommendation for weight management when patient has been trying to lose weight with diet exercise fro 6mo= ________ (medication)

A

· Best recommendation for weight management when patient has been trying to lose weight with diet exercise fro 6mo=tirzepatide

402
Q

· Stop phentermine/ topiramate due to lack of full response to treatment if don’t lose _% of weight in _ mo

A

· Stop phentermine/ topiramate due to lack of full response to treatment if don’t lose 5% of weight in 3 mo

403
Q

which weight loss med is Inappropriate med if HTN/ hx of ascvd

A

· Inappropriate med if HTN/ hx of ascvd = phentermine

404
Q

· Tirzepetide should be started at low dose and titrated to max dose to avoid ____

A

· Tirzepetide should be started at low dose and titrated to max dose to avoid AE

405
Q

We expect pts to regain portion of weight back after stopping ___________ (weight loss med)

A

We expect pts to regain portion of weight back after stopping semaglutide

406
Q

________have the smallest energetic contribution to drug binding

A

Van der Waals have the smallest energetic contribution to drug binding

407
Q

____________ doesn’t violate lipinski’s rule of 5

A

Acetaminophen doesn’t violate lipinski’s rule of 5

408
Q

Which statement(s) are true

Drugs bind to multiple biological targets
GPCRs are targets
binding is mediated by molecular interactions

A

all of the above!

Drugs bind to multiple biological targets, GPCRs are targets, and binding is mediated by molecular interactions

409
Q

which statement(s) are true

Stereochemistry determines pharmacokinetics

Stereochemistry determines pharmacodynamics

Biomolecules are chiral

A

all of the above are true

Stereochemistry determines pharmacokinetics and pharmacodynamics. Biomolecules are chiral

410
Q

Added _____ groups on structures can cause phenolic oxygens to bind tighter and be more basic and less stable

A

Added methyl groups on structures can cause phenolic oxygens to bind tighter and be more basic and less stable

411
Q

Halogens can make structures more acidic and more stable

A

Halogens can make structures ____ acidic and _____ stable

412
Q

Lipinski’s rule of 5
are ?

A

Lipinski’s rule of 5
5 hydrogen donors
10 hydrogen acceptors
MW of 500 or less
LogP that does not exceed 5 (prime spot 1.4-1.8)

413
Q

_-thalidomide causes birth defects because it’s active but _-thalidomide is not active

A

D-thalidomide causes birth defects because it’s active but L-thalidomide is not active

414
Q

Carboxyl groups have ______ like tetrazoles, sulfonamide

A

Carboxyl groups have isosteres like tetrazoles, sulfonamide

415
Q

Phase __ metabolism contains hydroxylation, demethylation, hydrolysis, and epoxidation

A

Phase 1 metabolism contains hydroxylation, demethylation, hydrolysis, and epoxidation

416
Q

Phase _ metabolism contains sulfation, acetylation, and glucuronidation

A

Phase 2 metabolism contains sulfation, acetylation, and glucuronidation

417
Q

Phase _ metabolism occur in the gut microbiome

A

Phase 3 metabolism occur in the gut microbiome

418
Q

___________ can be triggered by ANG 2 which is 2HN-Asp-Arg-Val-Tyr-Ile-His-Pro-Phe-COOH

A

Vasoconstriction can be triggered by ANG 2 which is 2HN-Asp-Arg-Val-Tyr-Ile-His-Pro-Phe-COOH

419
Q

ACEi accumulate bradykinin which causes ______

A

ACEi accumulate bradykinin which causes cough

420
Q

LMWH is obtained from ______________. They do not have the same half-lives

A

LMWH is obtained from unfractionated heparin (UFH). They do not have the same half-lives

421
Q

T/F- heparin activates inactivate vit k reductase

A

FALSE

heparin DOES NOT inactivate vit k reductase

422
Q

Warfarin mimic_____ and affects recycling

A

Warfarin mimic vitAMIN k and affects recycling

423
Q

Heparin functions as an ______________ (class)

A

Heparin functions as an anticoagulant

424
Q

P2Y12 inhibitor that requires CYP activation (clopidogrel) - know this structure

A

P2Y12 inhibitor that requires CYP activation (clopidogrel) - know this structure

425
Q

know what captopril looks like

A

know captopril structure

426
Q

identify a pro-drug

A

identify pro-drug structure

427
Q

Aspirin inhibits COX enzymes in the ________

A

Aspirin inhibits COX enzymes in the platelet

428
Q

Ticagrelor inhibits platelet activation, it mimics adenosine and a ribose ring

A

Ticagrelor inhibits platelet activation, it mimics _________ and a ribose ring

429
Q

know structure The Antiplatelet agent (Tirofiban)

A

know structure The Antiplatelet agent (Tirofiban)

430
Q

know structure - Angiotensin Receptor Blocker (biphenyl ring, carboxylic acid, and an isostere)

A

know structure - Angiotensin Receptor Blocker (biphenyl ring, carboxylic acid, and an isostere)

431
Q

SGLT2 inhibitors have a ______ like functional group

A

SGLT2 inhibitors have a glucose like functional group

432
Q

know ccb structure

A

know ccb structure

433
Q

know antianginal agent structure

A

know antianginal agent structure

434
Q

Cholesterol lowering agents mimic HMG-CoA or can have a cyclic lactone that acts as a prodrug aspect that gets activated to mimic _____-___

A

Cholesterol lowering agents mimic HMG-CoA or can have a cyclic lactone that acts as a prodrug aspect that gets activated to mimic HMG-CoA

435
Q

know structure lipid lowering agent that targets PPAR receptor

A

know structure lipid lowering agent that targets PPAR receptor

436
Q

KNOW COXi structure

A

COXi structure

437
Q

know mixed beta blocker (carvedilol) structure

A

know mixed beta blocker (carvedilol) structure

438
Q

_______ channel blockers include procainamide, procaine, verapamil, and lidocaine

A

Sodium channel blockers include procainamide, procaine, verapamil, and lidocaine

439
Q

know structure arrhythmia drug

A

.

440
Q

know structure for anticoag that mimics vit k

A

..

441
Q

Bioisosteres can replace functional groups to improve bioavailability and reduce side effects and off-target effects. Some commercial drugs can be racemic. Amidoxime is used instead of amidine because it’s _______ ______

A

Bioisosteres can replace functional groups to improve bioavailability and reduce side effects and off-target effects. Some commercial drugs can be racemic. Amidoxime is used instead of amidine because it’s less basic

442
Q

cGMP mediated vasodilation is regulated by nitric oxide which is released from organic ______

A

cGMP mediated vasodilation is regulated by nitric oxide which is released from organic nitrates

443
Q
A

Therapeutics (7 decks)

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