Final Flashcards
A consistent care process is important for the pharmacist’s process of care and practice because it promotes
Consistent outcomes for the care delivered
A question to assess the effectiveness of someone who wants to establish care would be:
How well do you feel this medication is working for your disease? Need to address outcome or therapy goals.
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?
Duplicate therapy
IESA (Indication, Effectiveness, Safety, Adherence) is part of what?
The pharmacists patient care process (PPCP) and specifically part of ASSESS
What is the correct order of indication, effectiveness, safety, and adherence?
Indication effectiveness, safety, and adherence
If a patient walks into your pharmacy and says that she had Td 10 or more years ago, this is likely an
Indication issue and needs additional therapy
If you were to assess for safety of the medication a patient is using, you would probably ask if you have ever
Had dark tarry stools since you are taking ibuprofen and naproxen
When a patient tells you what kind of medications they are taking, is this subjective or objective.
Subjective Information
Ideal Pharmacist-Patient Relationship Fundamental DOES NOT include what?
Knowledge of a pharmacist
Where would allergies go in a medical chart
Past medical history
If a patient has a family history of an allergy (e.g. asthma, excema, fever) , then the patien’t family members would be expected
to have the same (e.g. asthma, fever, etc.)
Family history should include
parents, three generations, deceased siblings, etc. in the patient chart
What is a common error in lab setting
Faulty reagents
Results reported in conventional units or SI units are ____ not/are factors that affect normal values
They are NOT factors that affect normal values
For complete blood count, hematocrit is
the percentage of red blood cells to blood volume
INR is a test used to monitor
Warfarin
A small volume of distribution makes a drug
amenable to enhanced elimination
NPI (Narrow Therapeutic Index) is
Adverse effects are expected at close to the therapeutic dose
______ are involved in a majority of poison control exposure
Pharmaceuticals
Idiosyncratic adverse reactions occur regardless of ____
The Drug Dose
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?
Off-target effect
Activated charcoal does not bind to
Iron, Polar molecules, alcohols, electrolytes, metals
______ is the leading cause of preventable injury according to the poinson control center
Poisoning
There is a small/large amount of substances that have antidotes compared to the number of drugs available
There is a small amount of substances that have antitodes
Enternal syringes measure what?
Liquid enternal meds
Patient is 11kg, 82 cm. Mycophenolate oral dosing is 600/mg/m2/dose every 12 hours. Whats the dose
300mg every 12 hours
Patient is 20kg. Prednisone dose = 1-2mg/kg/day in doses. Solution is 15mg/5ml. Whats the proper dose
21mg bid
A patient is 12 years old. What should the care provider consider without ANY additional context
Pediatric -to-adult care transition readiness should occur
Why should we write dose as 2.5 mL TID for liquid preperations for a new kid patient
For clarity
A baby born 3 hours ago has a BP of 75/40, resp of 50, HR 190, weight 3kg. Is this baby “healthy”
Yes, babies are bad at everything
What is the most appropriate source to search to see if meds are good for kids
KIDS LIST
INCREASED GASTRIC PH, DECREASED BILE ACID SECRETION, AND INTESTINAL TRANSIT TIME ALL AFFECT WHAT?
The absorption of a drug
A hydrophilic drug has bigger _____ in neonates
vD
What is the formular for glomerular filtration rate?
(0.413*height)/Scr
What is the formula to calculate maintenance flud rate in mL/hr if the patient is 40kg.
Segar formula (4/2/1 rule - 4x10,2x10,1x20, 40+20+20 =
A patient weights 25kg, what is the correct maintenance fluid rate
65mL/hr
For diaper rash, the patient should
Apply the cream first, then cover with a barrier
If MRSA isn’t common, the _____ is the proper treatment
Cephalexin
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
Low
T/F - Doses of asthma meds are not well known
False and meds and doses are not exploratory
Alpha 1 _____ the internal sphincter muscle of the bladder while _____ relaxes it.
Contracts, Muscarinic
What would be the acetylcholeine and beta 1 receptor response during rapid and pounding heartbeat
Increased acetylcholine release, increased beta 1 receptor stimulation
Dopamine can be use for management of
Hypertensive crisis
Primary MOA of doxazosin
Alpha -1 Antagonist
2 examples of prn treatments of acute bronchospasm
albuterolor levalbuterol
Orthostatic hypotension treated with _____
midodrine
In sepsis, a patient should receive ______ for hypotension
Norepinephrine
Atenolol is a
Beta-1 Selective ANTAGONIST
Local anesthetic with alpha-1 antagonists ______ time in recovery of sensation after a mouth procedure
Decrease
AE of terazosin can be
hypotension
With urinary retention, you should used a ___________ like ________
non-selective muscarinic agnost, bethanechol
______ is an NTM at nicotinic receptors in the skeletal muscle
Acetylcholine
With alzheimers, you would use a treatment geared to inhibit _________
Acetylcholinesterase
Cholinomimetic drugs should not be used if the patient has _________
asthma
Oxybutinin is used in the treatment of
overactive bladder
For excessive drooling the patient should recieve
Glycopyrrolate
Sympathomimetic toxidrome will present with symptoms like
Agitation, delirium, hallucination, and paranoia, along with HTN, fever, dilated pupils, sweaty skin, normal bowles (adderall OD)
Treatment of antimuscarinic toxidrome is usually
physostigmine
AE of scopolamine is
dry outh
When the intraocular pressure of the eye is increased, the muscarinic receptors _______ the outflow of ________
increased, aqueous humor
When timilol is administered after epi, the BP is ______ but the HR is _______. (Increased/Decreased)
BP increased.
HR Decreased
Allergic reaction? Give
Epinepherine
phentolamine can be used preoperatively to prevent
severe hypertension during surgery
cevimeline is more tolerated for those with
dry mouth
succinylchole has a therapeutic agonist effect through the ______ receptors
nicotinic
When exposed to insecticides, muscle weakness can/cannot be reversed with amlodipine
Cannot be reveresed
Benztropine is used when antipsychotic medications cause _______ _____
Dystonic Reactions
Diphenhydroamine is an antimuscarinic, so it can also cause what
Antimuscarnic toxidrome
When a patient is exposed to insecticide, the endpoint of therapy with atropine is to
Dry respiratory secretions
Sympatholytic toxidrome are known to cause
Unresponsiveness, Bradycardia, and Hypotension
Metoprolol is known to _____ mortality and ______ in patients with HF
mortality
hospitalizations
Mirabegron is used in the management of
Urinary Incontinence (overactive bladder)
Sympathetic postganglionic neurons synthesize and release ________, making them andregenic
Norepinepherine
Dobutamine has chronotropic effects on the ______
Heart
T/F - Airway constriction is not an AE of dopamine
FALSE. DOPAMINE AE ARE HYPERTENSION, LOCAL ISCHEMIC NECROSIS, AND TACHYARRHYTHMIAS
Formoterol should be used as maintenance therapy for patients with _______
COPD
If someone injects an epi-pen wrong (dumbass) what do you do to reverse effects
Phentolamine reversal
Clonidine decreases bp due to its decreased release of NE from
Sympathetic nerve terminals
NE/Alpha 1 is the main determinant of
vascular tone
varenicline is a partial agonsist of neuronal ______ receptors
nicotinic
With patients with COPD, inhaled tiotropium should be given to reduce
brasoconstriction
When someone is diagnosed with myasthenia gravis, you should do an IV admin of ______
edrophonium
Rocuronium is used to induce _______ during tracheal intubation
paralysis
AE of oxybutynin could include
dry mouth
constipation
drowsiness
When a patient is presenting with sympathomimetic toxidrome, it is best to use ________ to control agitation
benzodiazepines
Patient presents with agitation, delirium, hallucinations, paranoia, HTN, dialated pupils, sweaty skin, DIMINISHED BOWELS(IMPORTANT) they OD’d on
Diphenydramine (antimuscarinic toxidrome
Patient presenting with sympatholytic toxidrome, they should be given
catecholamines
The MOST Na+ reabsorption occurs in the ___________
Proximal Convoluted tubule
Loop diuretics inhibit the ___, ____, _____, cotransporter in the thick ascending limb
Na+, K+, 2Cl-
The primary MOA for ACE inhibitors is blocking conversion of
Ang I to Ang II
Common side effect of loop diuretics is
hypokalemia
Hyperkalemia is a risk with amiloride because it inhibits sodium channels in the distal nephron, reducing _______ excretinon
potassium
A common side effect of thiazide diuretics is ______
hypokalemia
The primary site of action of spironolactone is the _________
collecting duct
the actinos of SGLT2s in the kidney block glucose and sodium reabsorption in the _____________
proximal convoluted tubule
The most common argument for using the cockcroft-gault over GFR for drug dosing is that most drug dosing recommendations are based on
creatine clearance cut offs
_______ is the recommended initial approach for diagnosing kidney disease in adults
CKD-EPI eGFRer
What are teh variables in CKD-EPI eGFRcr
SCr, Age, Sex
When using CKD-EPI eGFRcr equation for drug dosing the units should be converted to __/___ in large and small patients
mL/min
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
CKD-EPI eGFRcr-cys
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
estimated creatinine clearance using the cockcroft-gault equation
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
UNDERESTIMATE THIS PATIENTS CURRENT KIDNEY FUNCTION
ACEi’s and ARB’s can cause a drop in
glomular filtration rate through vasodilation of efferent arterioles
A patient that is deydrated is most likely to experience AKI when an _____ is initiated
ACEi
if a patient has an smz induced acute interstitial nephritis the most important treatment step is to
stop the smz
maintaining a serum trough of <2mg/L are associated with lower risk of ATN and may reduce the nephrotoxicity of
aminoglycosides (ex gentamicin)
iodinated contrast can cause
acute tubular necrosis
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
short periods of time
acute indications for dialysis included
electroyte disorders, overload of fluid, and uremic symptoms
______ is the internation organizatino that publishes guidelines for managing kidney disease
KDIGO
Screening for CKD is recommended annually for all patients with T2DM. So the most important patient is a
71 yera old with T2DM
GFR 45-60 IS WHICH G STAGE
G3A
ALBUMINURIA IS WHICH A CLASS
A2
within the first 4 weeks of starting ACEI OR ARB in CKD, the most important to monitor is
potassium and serum createnine
Pt has CKD, due to HTN, G3A, A3, PGM, HTN, CKD, ALLERGIES. The most important medicaiton to slow CKD Progression is
dapagliflozin (SGLT2 best for non diabetic CKD + on ACEi or ARB
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
Lisinopril (don’t use SGLT2 because of ketoacidosis risk with T1DM
48 YEAR OLD
CKD DUE TO T2DM
G3B
A2
BP = 140/80
Most important plan to reduce CV events is to
target systolic BP <120
CKD due to T2DM
lisinopril
empagliflozin
metformin
eGFR = 32
ALB = 650
What drug and why
Finerenone is recommended for CKD with T2DM, A2-3 proteinuria, eGFR>25, on ACE-I or ARB.
________ is the primary cause of anemia in CKD
decreased erythropoietin production
derangements of concentrations of calcium, phosphorus, parathyroid hormone and vitamin D cause the onset of
CKD - MBD
Anemia is a complication of CKD in males if
HGB <13
CKD-MBD is a complication in a patient with recent hip fracture and iPTH >
2-9x upper limit of normal
If a patient is taking calcium carbonate 1000mg TID and has CKD what should you do, explain
check corrected calcium
corrected calcium = calcium value + 0.8*(4-albumin level)
Ca normal limits
8.5 - 10.2
If pt is on calcium carbonate and corrected ca is above 10.2, what should you do
d/c calcium carbonate and start sevelamer carbonate
HGB RANGE 9-11
DARBEPOETIN ALPHA WITH HGB 11.7
FERRITIN = 750
TSAT = 45
BEST TREATMENT?
DECREASE DARBEPOETIN ALPHA
Taking darbepoetin alpha
hgb - 9.7
ferritin - 75
tsat - 10%
What is indicated here and why
When ferritin <100 and tsat <10% INDICATION OF IRON DEFICIENCY WHICH IS BEST TREATED WITH IV IRON
sodium bicarbonate is most important to initiate if patient has co2 levels
below 22
It is important to counsel a patient starting oral iron on adverse effects including
consitpation and it may turn stool dark
_______ and anaphylaxis are rare adverse effects of IV iron
hypotension
In-center hemodialysis is done _____ days per week for __ - ___ hour sessions via fistula, graft, or catherter
3 days per week
3-5 hour session
An advantage of peritoneal dialysis is
better blood pressure control compared to in-center hemodialysis
the treatment for hemodialysis complication of hypotension is
midodrine
_______ is the most common complication of peritoneal dialysis
Peritonitis
Patients with CKD NOT on dialysis should avoid what class of medication
NSAIDS (I.E NAPROXEN)
Patients with CKD on dialysis should avoid _______ enemas
phosphate
for mild - moderate dehydration in an 8 year old, recommend
2-4 L of ORT over 3 hours and replace fluid losses
A 5 month old with 10 diarrhea (ah man) in 24 hours, unresponsive (not ideal), dry, and sunekn fontanelle is considered _______ dehydration
severe
ph > 7.4 = _______
PaCO2 >40 and HCO3 >38 = _______
urine chloride <10 = ________
- alkalosis
- primary metabolic cause
- chloride responsive METABOLIC ALKALOSIS
Uremia is most likely to result in
anion gap metabolic acidosis
COPD is the most likely to result in _______ acidosis
respiratory acidosis
PH <7.35 = ______
______ = same direction with decrease in pH
pCO2, HCO3, anion gap = ______
- acidosis,
- metabolic
- na- cl +HCO3 if over 12 considered anion gap
After trauma and head injury if labs are drawn with pH <7.35 and PaCO2 and HCO3 risking = ____ _______ acidosis
acute respiratory acidosis
5% albumin is an example of a
colloid
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
For a 104 kg pt, 40 + 20 + 84 = 144 mL/hr
For severe hyponatremia and altered mental status with intermittent seizures, treat with
150 mL bolus of 3% NaCl
Sodium > 145 = hypernatremia, edema and fluid overload =
hypervolemia
to calculate tonicity (Na * 2) + (Glucose / 18) + (BUN / 2.8)
So if Na = 152, glucose = 110, BUN = 18, tonicity =
316
Hyperkalemia >5, treat with IV _____ and dextrose.
Insulin 5-10 units
to stabalize cardiac myocardium treat with
calcium gluconate
hypomagnesemia <1.6 treat with
magnesium sulfate
You cannot treat hyponatremia with more than 12mEq/L in 24 hours otherwise it can lead to what
osmotic demylination syndrome (ODS) (vegtebelized patient dangit)
hyperphosphatemia < 1.5 treat with
potassium phosphate
Correct order of the cardiovascular continum: Risk factors, CAD, MI, heart failure, death
Risk factors, CAD, MI, heart failure, death
What stage did cigarette smoking, reduced physical activity, and increased meat consumption play a major role in deaths from CV disease
stage 3
beat to beat electrical signal in the heart originates from
sinoatrial node (sa node)
leakage of mitral valve cause blood to flow back from
Left ventricle to left atrium
isovolumetric ventricular contraction phase includes all valves being closed LV volume ______ and pressure in the LV being ______
LV volume unchanged
LV pressure increased
Frank starling relationship
effect of the ventricular end diastolic volume on the force generated during systol
small arteries and arteiole of the vasculature contain more layers of smooth muscle compared to
veins
contraction in the vascular smooth muscle is regulated by ______, not troponin
enzymes
arterial blood pressure equation
BP = CO X PVR
SBP increases with ______
age (after 40)
patient vitals
46 years
154/102
what stage HTN
STAGE 2
PATIENT HAS 3 RISK FACTORS
10 year ASCVD risk is 24.3%
framingham risk score of 24.1%
considered ______ risk
HIGH RISK
Average of 154/102 mmHg through three readings. Tests to order
BMP
12-LEAD ECG
CBC
LIPID PANEL
URINALYSIS
clinical CAD with angina on exertion (bp 150/102) BP GOAL = ?
<130 MMHG SBP
active guy
drinks
doesn’t diet
used to smoke (aka nick)
needs to continue with outdoor activities
incorporate ______ diet with eating less ______
DASH DIET
less SALT
WHITE DUDE
61 yo
framingham score 17.5%
BP 146/100
HR 50
STARTED HCTZ
we recommend
- continue lifestyle changes
- HCTZ
- Add _______
lisinopril
72 AA female with lot of shit wrong
>55 yo
family members not alived due to bp
high bp
low hdl-c
this case is probably not on the test
but answer is
4 risk factors
3 affected organs
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?
HCTZ 12.5MG QD
doxazosin monitoring paramater does not match
seated BP
58 latino dude treated with ______ bc he is chunky, DMT2, depression (real), and HTN
LISINOPRIL
lisniopril causes _______ due to inhibiting bradykinin breakdown
cough
ACEi lowers BP by inhibiting formation of ______
angiontenisin II
beta blockers decrease _____ concentrations
________ generated by cardiac myocytes and decrease HR
bb’s decrease
cAMP concentrations
peak forces generated by cardiac myocytes
decrease HR of course
pedal edema from dihydropyridines from incrased outward capillary hydrostatic pressure gradient, moving fluid ______ (in relation to the capillary)
out of the capillary
Verapamil should be used with caution in patients with:
HF
reduced cardiac contractility
and on a B-Receptor antagonist
Amlodipine binds to the outer surface of the _ - Type calcium channel toward the Lipid molecules
L-type calcium channel
CKD = ACE/ARB
DM = ACE/ARB
ELDERLY + ONE =
MINERALOCORTICOID
felodipine (amlodipine cousin) has what affect on
HR
preload
afterload
contractility
^HR
no effect on preload,
decreases afterload
no effect on contractility.
37 yo
white male
HTN
asthma
impotence
what are we putting bro on
amlodipine
Uncontrolled BP dx can be given under what circumstances
on at least 3 drugs of DIFFERENT CLASSES at max tolerated doses
including a diuretic
Amlodipine is monitored by these paramaters (3)
Orthostatic BP
PERIPHERAL EDEMA
FATIGUE
Chylomicrons have the highest _______ content
triglyceride
ApoA-1 serves a critical role in ___
HDL
______ 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
MTP
A principal part of the exogenous lipid pathway is that triglycerides arising from dietary lipids are metabolized by lipoprotein lipase to deliver
FATTY ACIDS to peripheral tissues
________ (drug) activates PPAR-alpha which promotes HDL synthesis and reverse cholesterol transport
fenofibrate
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.
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.
T/F - Catalyzing the conversion of cholesterol to cholesterol esters not a major role for apoproteins.
True
Bile acid resins should be used in caution in combinatino with other therapeutic agents because they affect the
absorption of other compounds
NPC1L1 is a key protein that facilitates uptake of _________ into enterocytes of lipid metabolism
cholesterol
The primary MOA of PCSK9 inhibitors is to prevent ____-____ receptor degredation in endosomes
LDL-LDL receptor degredation
T/F - Contractility is not a factor contributing to myocardial oxygen supply
TRUE
A key factor underlying the transition of atherosclerotic plaques from fatty to fibrous is
smooth muscle cells migrating from the turnica media to the tunica intima
Is HTN considered ASCVD
NO
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 _______
Lower
Patients should come in how long after statin initiation for a repeat lipid panel draw
4-12 weeks after statin initiation
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?
Emphasize lifestyle changes
no itiation of statin therapy
doesn’t fall into four statin benefit groups
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
high intensity statin
atorvastatin 40mg
primary prevention first and second statin benefit group
age 40-75 yo
t2dm
requires high intensity statin
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?
Start high intensity statin
Stop gemfibrozil
Clinical ASCVD (secondary prevention)
hasn’t tried statin
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 ________
TRIAL rosuvastatin 40mg
secondary prevention statin has benefit due to:
intolerance
switch to moderate intensity statin
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
Evolucumab (Repatha) 140mg SQ every 2 weeks.
High Risk ASCVD
Statin + Ezetemibe
not at target LDL
start PSCK9. (repatha)
The four potential secondary causes of hypertriglyceridemia are
underlying disease
diet/lifestyle
drugs
metabolic disorders
The REDUCE IT (NEJM 2019) showed cardiovascular benefit with which drug/medication
Icosapent ethyl (vascepa)
A false misconception about rx fish oils is that
OTC fish oil is a good replacement because they have the same potency and contents
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.
All of the above
change HCTZ to alternative BP med,
eliminate alcohol
reduce carbohydrate consumption
and improve control of diabetes.
Ther therapeutic effects of verapamil are that
A. slows heart rate
b. reduces afterload
c. relaxes vasospastic coronary vessels
d. all of the above
D is correct, all of the above
A. slows heart rate
b. reduces afterload
c. relaxes vasospastic coronary vessels
d. all of the above
T/F - Metoprolol is NOT the first line in treatment of vasospastic angina
True
The MOA of ranolazine is it inhibits late ______ currents in cardiomyocytes
inhibits late SODIUM currents in cardiomyocytes
ranolazine is used as an anti-anginal agent because it decreases _______ consumptions during _______
decreases oxygen consumption during diastole
Why can drugs that slow heart rate be used to treat stable angina.
- 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.
Glyceryl trinitrate (nitroglycerin prevents angina by decreasing ______
preload
combining a beta blocker and non-dhp for angina is not advised due to what?
Both cause bradycardia
PDE5 inhibitors can potentiate the action of which class of drug and cause profound HYPOtension
nitrovasodilators (ex. nitroglycerin)
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
Start SL NTG
clopidogrel 75mg
empagliflozin (jardiance) 10mg,
semaglutide (ozempic) 0.25mg,
return in 2 weeks.
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
f. none of the above.
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
ranolazine (ranexa) 500mg
When a patient is diagnosed with sihd what should be discussed immediately?
prognosis
Treatment
Physical Activity
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.
ALL OF THEM ARE CONTRAINDICATED
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
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
BETA ADRENERGIC BLOCKERS ARE PRESCRIBED IN SIHD TO BALANCE WHAT?
myocardial oxygen supply and demand
________ BP measurements is a monitoring paramater for SIHD
ORTHOSTATIC BP
Which of these can cause harm to a patient with SIHD
sympathomimetic weight loss drugs chronic use of opioids
PDE5 inhibitors
all of them
sympathomimetic weight loss drugs, chronic use of opioids, and PDE5 inhibitors.
A patient experiencing MI from small clots at the ruptured plaque site without concomitant necrosis.
What is this patient likely experiencing
Chest Pain
A rupture of a thin fibrous cap on a stenotic lipid-rich plaque can lead to….
a thrombus forming on an atheromatous plaque
The accumulation of ADP, thromboxane, and thrombin in areas of disturbed blood flow lead to…..
activation and accumulation of platelets
the interaction of platelets with damaged endothelial surfaces is most affected in which disease
von willebrands disease
ADP activating P2Y12 on platelets results in a conformational change in GPIIb/IIIa receptors that triggers ________
aggregation
Platelet aggregation blocking drugs least to worst.
Options, aspirin, clopidogrel, abciximab
aspirin<clopidogrel< abciximab
Prasugrel is better than clopidogrel in the sense that the _______ and _______ of prasugrel is higher
- absorption
- bioactivation
MOA of vorapaxar
block PAR-1 receptors on platelets
decreased antithrombin activity can lead to _______ formation
thrombus
intrinsic x-ase complex (FIXa/FVIIIa/FX) is on the surface of what
phosphatidylserine-positive activated platelets
the initiation of clot formation is most affected by
inactivated tissue factor
the function of activated protein C is to _____________ at the site of injury
limit coagulation
homeostasis example
cutting yourself shaving then bleeding stops 10 minutes later
patients at high risk of bleeding should avoid anticoagulation therapy and should do what instead
sequential compression devices instead of anticoag tx
for hemodynamically stable patient, oral _______ is the best therapy and does NOT require injection
DOAC
T/F- DOACs should NOT be taken when breastfeeding
TRUE- no DOAC when breastfeeding
If switching from injection tx to warfarin for anticoag, typically in pregnant patients, what do you need to do
overlap for 5 days
______-_____ or ______ is contraindicated in alteplase
recent surgery or trauma
Alteplase binds fibrin clots with high affinity which helps localize what to the clot
plasmin formation
What is the best anticoag treatment for factor V Leiden while pregnant
enoxaparin
Fondaparinux MOA for inhibiting coagulation is by
increasing the binding of antithrombin to factor Xa
Idarucizumab can rapidly reverse the effects of ________
dabigatran
Warfarin should be monitored by prothrombin time (PT) displayed as _____
INR
Warfarin affects which important clotting factor(s)
factor X and factor II
Warfarin should be overlapped during with treatment with another UHF or LMWH. Stops activation of __________ dependent clotting factor and crosses the __________
- vitamin k
- placenta
Anticoag therapy should be initiated until the VTE has been objectively confirmed so patient should obtain a __________ ultrasound
compression ultrasound
__________ helps form coagulation complexes on phospholipid surfaces during fibrin formation
calcium
A fractured ankle with plaster cast would cause _______ formation as part of Virchow’s triad
thrombus
Fibrin is most likely to be formed during the ________ phase
propagation
Which of the following are contraindications to receiving a fibrinolytic:
all of the above
severe uncontrolled HTN, significant closed head trauma within the last 3 months, and active bleeding
SECONDARY prevention of atherosclerotic ischemic stroke is _______
aspirin
PREIMARY prevention of CARDIOEMBOLIC ischemic stroke is
apixaban
best plan to reverse warfarin with an active bleed is
vitamin k 5mg IV
patients with suspected acute ischemic stroke can be eligible for fibrinolysis if they present
within 4.5 hours asn does not have an acute bleed
Suspected NSTE-ACS at PCI capable, getting cath lab in 24 hours, pt takes atorvastatin 20, metformin 500 BID, and amlodipine 5. Treatment plan:
Treatment plan: ASA 325 CHEW, hold P2Y12 until table, hold BB, heparin, increase atorvastatin to 40mg, SL NTG prn, continue lisinopril, hold metformin
t/f- NSAIDs should not be given in CVD patients
true
It is appropriate to give a fibrinolytic in a STEMI with symptoms within _____ hours and unable to get PCI capable within ______ minutes of presenting
- 12 hours
- 120 minutes
Ticagrelor should not be given with more than 100mg of ______
aspirin
CVD patient + headache, what OTC do we recommend
acetaminophen
Avoid prasugrel in patients
> 75 years
hx of stroke
weight <60 kg
Ticagrelor is an _________ medication should be avoided in an _________ patient post STEMI-ACS with DES
- expensive
- uninsured
Post STEMI-ACS regimen for patient on with DES placed and taking lisinopril 10:
aspirin 81, prasugrel 10, atorvastatin 80, metoprolol 25, continue lisinopril
Dual antiplatelet therapy should be continued for ____ months post-ACS with a DES
12 months
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
All of the above
signs of cardiogenic shock, active wheezing, and 2nd degree heart block without a pacemaker
which study showed lower rates of death & no difference in bleeding risk between prasugrel and ticagrelor
ISAR-REACT 5 (2019) showed lower rates of death & no difference in bleeding risk between prasugrel and ticagrelor
which study compared clopidogrel + ASA 81 is better than ASA alone
CURE (2001) compared clopidogrel + ASA 81 is better than ASA alone
which study showed that long-term beta blockers may not have strong benefit for ACS with normal EF
REDUCE-AMI (2024) showed that long-term beta blockers may not have strong benefit for ACS with normal EF
which study showed low-dose colchicine may reduce risk of ischemic events in patients post-ACS
COLCOT (NEJM 2019) showed low-dose colchicine may reduce risk of ischemic events in patients post-ACS
which of the following contribute to the progression of HFrEF: neuroendocrine stimulation, increased myocyte energy expenditure, and enhanced myocyte apoptosis
All of the following contribute to the progression of HFrEF: neuroendocrine stimulation, increased myocyte energy expenditure, and enhanced myocyte apoptosis
Accumulation and inflammation of adipose tissue contributes to the progression of _______. (HF)
Accumulation and inflammation of adipose tissue contributes to the progression of HFpEF
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
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
The range for HFmrEF is __-__%
The range for HFmrEF is 40-49%
_______ P-V loop is shifted to the right (larger EDV and ESV) compared to the normal and HFpEF P-V loops
HFrEF’s P-V loop is shifted to the right (larger EDV and ESV) compared to the normal and HFpEF P-V loops
In heart failure, Endothelin I causes potent ____________ in paracrine signaling
In heart failure, Endothelin I causes potent vasoconstriction in paracrine signaling
To slow progression of HFrEF, treatments rely on roles of _______ and ________
To slow progression of HFrEF, treatments rely on roles of ang II and norepi
WHICH DRUG inhibits PDE3 which increases cardiac contractility and relaxes vascular smooth muscle
Milrinone inhibits PDE3 which increases cardiac contractility and relaxes vascular smooth muscle
Which drug is beneficial because it increases plasma concentrations of natriuretic peptides and block ang II receptors
Entresto is beneficial because it increases plasma concentrations of natriuretic peptides and block ang II receptors
IV _____ should be administered for severe hypotension and in states of cardiogenic shock
IV dopamine should be administered for severe hypotension and in states of cardiogenic shock
Adding carvedilol after an MI is to do what
Adding carvedilol after an MI is to slow the progression of heart failure
The Frank Starling curve shows what two metrics
The Frank Starling curve shows EDV (preload) vs systole (cardiac output)
An example of an SGLT2 inhibitor is
Dapagliflozin (Farxiga)
In the EMPEROR trial showed what
In the EMPEROR trial, Empagliflozin (Jardiance) showed to reduce CV death or hospitalization for heart failure in HFpEF
Give adenosine for what
paroxysmal supraventricular tachycardia
If there is a delay at the AV node, you will have an elongated ____ _______ (look at ECG)
If there is a delay at the AV node, you will have an elongated PR segment (look at ECG)
If you have HFrEF, you will have what 3 primary symptoms
If you have HFrEF, you will have fatigue, dyspnea, and edema
T/F - Aflutter does not have multiple or unstable ectopic pacemakers
TRUE
Aflutter does not have multiple or unstable ectopic pacemakers
WHICH TYPE OF arrhythmias require fast current, slow current, and island of UNexcitable tissue
Re-entrant arrhythmias require fast current, slow current, and island of UNexcitable tissue
TZDs are pretty chill to use in HF
no TZD will kill your patient.
SAY NO TO TZD IN HF
WPW involves an accessory pathway between the a______ and the _________
WPW involves an accessory pathway between the atrium and the ventricle
If pt has severe symptoms of irregularly irregular ventricular rhythm arrhythmia and faints, they need rhythm control → give them _________
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)
Magnesium sulfate treats _____
Magnesium sulfate treats TdP
T/F - A patient with mild symptoms of afib for last few days does need rhythm control
FALSE
A patient with mild symptoms of afib for last few days does NOT need rhythm control
Decreasing PCWP = (INCREASING OR DECREASING) mortality rate
Decreasing PCWP = decreased mortality rate
If a patient has a mechanical heart valve but has Vfib, send them home on long term ________
If a patient has a mechanical heart valve but has Vfib, send them home on long term warfarin
If a patient has a mechanical heart valve and Vfib but needs to be DCC, use _______ first
If a patient has a mechanical heart valve and Vfib but needs to be DCC, use UFH first
Use amiodarone for WHAT TYPE OF arrhythmias
Use amiodarone for refractory ventricular arrhythmias
When using nesiritide, monitor for what?
When using nesiritide, monitor for low blood pressure
Amiodarone can lead to which of the following:
pulmonary fibrosis
corneal microdeposits
hepatotoxicity
all of the above
Amiodarone can lead to pulmonary fibrosis, corneal microdeposits, and hepatotoxicity
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
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
Proarrhythmic means what
Proarrhythmic= when drugs cause arrhythmias
If you are NYHA stage 3, your number one priority is what
If you are NYHA stage 3, your number one priority is exercise tolerance
Before starting spironolactone (aldosterone antagonist) check which labs
Before starting spironolactone (aldosterone antagonist) check labs: SCr and K
If a HF patient wants non-pharm measures, make sure they get which of the following:
vaccines needed
exercise
diet
All of the above
If a HF patient wants non-pharm measures, make sure they get vaccines needed, exercise, and diet (all)
If you’re going to DCC someone, give them _________ first
If you’re going to DCC someone, give them Midazolam first
If a patient has renal diuretic resistance, first try what before adding anything else on
If a patient has renal diuretic resistance, first try increasing their diuretic dose before adding anything else on
if a patient is WARM and WET
deal with that
If a patient is on ⅘ of the pillars and doesn’t want to start a new med…..
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 ?)
Propranolol can cause ______ in OD
Propranolol can cause seizures in OD
Superwarfarins have what kind of half life compared to warfarin
Superwarfarins have a longer half-life than warfarin
If a patient has HF, ibuprofen and diltiazem CCBs can do what
If a patient has HF, ibuprofen and diltiazem CCBs can worsen it
High BUN (>43)
High SCr(>2.75)
low SBP (<115)
What does this mean for a hospitalized patient
High BUN (>43), High SCr(>2.75), and low SBP (<115)= BAD for in hospital mortality
If you eat rat poison and your INR is ok 2 days later, what should you do
If you eat rat poison and your INR is ok 2 days later, check it again in a day
Most common AE when giving IV glucagon for BB OD is _______
Most common AE when giving IV glucagon for BB OD is vomiting
MOA of high dose insulin on cardiac myocytes in ccb or bb od=
MOA of high dose insulin on cardiac myocytes in ccb or bb od= increased glucose utilization
___________ is an indicator of NDHP CCB overdose
Hyperglycemia is an indicator of NDHP CCB overdose
Give digoxin immune fab (Digifab) in acute digoxin toxicity if potassium of what level
Give digoxin immune fab (Digifab) in acute digoxin toxicity if potassium of 6.5mEq/L (hyperkalemia >5)
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
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
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
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
If a patient passes out from Vfib, they should get IV _________ to terminate it
If a patient passes out from Vfib, they should get IV amiodarone to terminate it
Digoxin increases _____ _____ in Afib
Digoxin increases vagal tone in Afib
________ is responsible for the rapid depolarization of the SA node
Calcium is responsible for the rapid depolarization of the SA node
t/f- VFib is the most immediately life threatening arrhythmia
TRUE
VFib is the most immediately life threatening arrhythmia
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
ALL OF THE ABOVE (DUH)
If a patient with HFrEF is on an ace or an arb, monitor for orthostatic bp, angioedema, and BMP
T/F- Ivabridine is not shown to decrease morbidity and mortality
TRUE
Ivabridine is not shown to decrease morbidity and mortality
If patient has HFrEF & is not on spironolactone…….
If patient has HFrEF & is not on spironolactone, start them on it
The age of degenerative and civilization associated disease is related to________ and reduced _________ ________
The age of degenerative and civilization associated disease is related to smoking and reduced physical activity
PUT THESE IN ORDER
CV continuum order: HF, Death, risk factor, CAD, MI,
CV continuum order: risk factor, CAD, MI, HF, Death
If patient not on all pillars, put them on ___________ if they’re not on it
If patient not on all pillars, put them on empagliflozin if they’re not on it
Lidocaine preferentially inhibits what
Lidocaine preferentially inhibits RAPIDLY depolarizing ventricular myocytes
Use dependence of Na channel blocker will (speed up or slow down) conduction of depolarization in Cardiac myocyte
Use dependence of Na channel blocker will SLOW conduction of depolarization in Cardiac myocyte
is DOAC tx for MG with palpitations over last 3 days recommended
Yes DOAC tx for MG with palpitations over last 3 days
TdP is from what
TdP from prolonged QT
___________ is the preferred treatment for hypothyroidism because its tolerated and has a long ½ life
Levothyroxine is the preferred treatment for hypothyroidism because its tolerated and has a long ½ life
Overproduction of Thyroxine (T4) is associated with exophthalmos in which disease
Overproduction of Thyroxine (T4) is associated with exophthalmos in graves disease
_________ is preferred in hyperthyroidism because it has a longer ½ life and fewer adverse effects compared to PTU
Methimazole is preferred in hyperthyroidism because it has a longer ½ life and fewer adverse effects compared to PTU
Type __ diabetes is associated with Diabetic Ketoacidosis
Type 1 diabetes is associated with Diabetic Ketoacidosis
Central diabetes insipidus is treated with _________
Central diabetes insipidus is treated with desmopressin
Phenytoin could potentially decrease or increase? the efficacy of levothyroxine by enhancing its metabolism (P450 enzymes)
Phenytoin could potentially DECREASE the efficacy of levothyroxine by enhancing its metabolism (P450 enzymes)
HbA1c of ___ or higher is diagnostic criteria indicative of diabetes mellitus
HbA1c of 6.5% or higher is diagnostic criteria indicative of diabetes mellitus
A complete lack of insulin characterizes Type __ diabetes
A complete lack of insulin characterizes Type 1 diabetes
______ facilitates glucose uptake into muscle and adipose tissues in response to insulin during glucose metabolism
GLUT4 facilitates glucose uptake into muscle and adipose tissues in response to insulin during glucose metabolism
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
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
Glucagon is released from alpha cells and primarily acts as a catabolic counterpart to _______
Glucagon is released from alpha cells and primarily acts as a catabolic counterpart to insulin
Microvascular complications is a consequence of prolonged _________ in diabetes
Microvascular complications is a consequence of prolonged hyperglycemia in diabetes
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
Enhanced insulin secretion and reduced postprandial hyperglycemia would be seen if a drug increased the release of incretin hormones in a patient with T2DM
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
Injection site, dose, and physical activity can affect the onset and duration of its action
Enhanced ketogenic and elevated blood ketone levels is the effect if _________ secretion is absent
Enhanced ketogenic and elevated blood ketone levels is the effect if insulin secretion is absent
Higher fasting glucose levels due to impaired insulin release is the most direct effect of ______ cell loss in T2DM
Higher fasting glucose levels due to impaired insulin release is the most direct effect of Beta cell loss in T2DM
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
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
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 <______
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
_________ breakfast dose of insulin lispro if pre lunch glucose level is 156 mg/dL
→ preprandial should be 80-130
Increase breakfast dose of insulin lispro if pre lunch glucose level is 156 mg/dL→ preprandial should be 80-130
_________ evening insulin dose if fasting glucose levels are 64 mg/dL → 80-130 is normal range
Decrease evening insulin dose if fasting glucose levels are 64 mg/dL → 80-130 is normal range
or a flexpen, admin it ____ mins before a meal but it can be given up to ___ mins after meal
or a flexpen, admin it 15 mins before a meal but it can be given up to 20 mins after meal
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
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
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
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
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
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
MOA of metformin =
MOA of metformin = activate AMPK, reduce gluconeogenesis in the liver
GLP1 cardiovasc effect=
GLP1 cardiovasc effect= increased NO production and decreased ROS
Metformin should be used in caution with ________ impaired patients
Metformin should be used in quation with renally impaired patients
GLP1 agonists promote ______ and _______ gastric emptying
GLP1 agonists promote satiety and slows gastric emptying
Metformin __________ TGs, VLDL, and LDL, increases HDL
Metformin decreases TGs, VLDL, and LDL, increases HDL
Tirxepatide is a (what class)
Tirxepatide is a GLP1+GIP
DPP4 inhibitor inhibits DPP4 to prolong action if _________ (Question of the Year!)
DPP4 inhibitor inhibits DPP4 to prolong action if incretins (Question of the Year!)
T/F- Glyburide cannot be combod with bolus insulin
TRUE
Glyburide cannot be combod with bolus insulin
If a patient has recurrent UTI, T2DM, CKD obesity, on metformin, glimepiride and has high A1C, give her __________
If a patient has recurrent UTI, T2DM, CKD obesity, on metformin, glimepiride and has high A1C, give her semaglutide
Pt has gained 5 lbs in 6mo. ____________ (drug) IS contributing to his weight gain
Pt has gained 5 lbs in 6mo. Pioglitazone contributing to his weight gain
Pt with t2dm and ckd and on metformin 1000 BID -> eGFR decreased so now what
Pt with t2dm and ckd and on metformin 1000 BID -> eGFR decreased so reduce metformin to 500mg BID
if picking up liraglutide for first time, teach him what
if picking up liraglutide for first time, teach him proper self-injection technique, including site rotation and needle disposal
· The glucose lowering effects of SGLT2i are less pronounced at lower _______ levels
· The glucose lowering effects of SGLT2i are less pronounced at lower eGFR levels
Metformin should be started at _______mg QD then slowly titrated up to a max dose of ________mg QD
- 500mg qd
- 2000mg qd
Pt wants to lose weight and does not want to inject any meds -> give him
Pt wants to lose weight and does not want to inject any meds -> give him sitagliptin (januvia)
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
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
· Patient develops ulcer on foot and already on a bunch of meds so he needs ________
· Patient develops ulcer on foot and already on a bunch of meds so he needs insulin
· Patient with hx of pancreatitis (no glp1 and no dpp4) wants to avoid meds that cause weight gain= what med
· Patient with hx of pancreatitis (no glp1 and no dpp4) wants to avoid meds that cause weight gain= canagliflozin
· If diabetes patient loses their insurance and is on metformin, you can give them _______ , they don’t need insulin unless >10
· 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
· 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
· 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
· A patient centered approach should be utilized to select diabetes pharmacotherapy according to ______
· A patient centered approach should be utilized to select diabetes pharmacotherapy according to_____
· If patient has t2dm, HTN, PVD and an A1c of 7.6, already on metformin 2000, lisinopril 20, amlodipine 10, add ____________ bc ascvd benefit
· 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
· DCCT and UKPDS 33 trials looked at what
· DCCT and UKPDS 33 trials looked at preventing microvascular complications with early intensive glycemic control
· Comprehensive foot exams should be performed at least annually starting when with T2DM
· Comprehensive foot exams should be performed at least annually starting at the time of diagnosis with T2DM
· To prevent macrovascular complications in a tobacco dependent diabetic patient, initiate a ______ and repeat lipid panel in 4-12 weeks
· To prevent macrovascular complications in a tobacco dependent diabetic patient, initiate a statin and repeat lipid panel in 4-12 weeks
· Gastroparesis is a neuropathic complication of ________
· Gastroparesis is a neuropathic complication of _______
· According to ADA, patients should incorporate more _____________________ into meals and snacks
· According to ADA, patients should incorporate more non starchy vegetables into meals and snacks
T/F- · Core component of comprehensive care plan for patients with diabetes does not include counting carbs
· TRUE
Core component of comprehensive care plan for patients with diabetes does not include counting carbs
______ _________ occurs in patients when they are frustrated with their treatment
· Diabetes distress occurs in patients when they are frustrated with their treatment
T/F- Depending on intensity of exercise, diabetic patients can experience hypo or hyperglycemia
TRUE
Depending on intensity of exercise, diabetic patients can experience hypo or hyperglycemia
T/F- IV dextrose for DKA used when hyperglycemia is NOT resoled and ketoacidosis is not yet resolved
FALSE
IV dextrose for DKA used when hyperglycemia is resolving but ketoacidosis is not yet resolved
· If patient is admitted with DKA, initial treatment should be
· If patient is admitted with DKA, initial treatment should be IV fluid, K, IV regular insulin
T/F- Infection can cause DKA
TRUE
Infection can cause DKA
· 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
· 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
· Corticosteroids can ________ blood glucose
· Corticosteroids can increase blood glucose
_______ insulin glargine by 20-25% for NPO
decrease insulin glargine by 20-25% for NPO
______ metformin in hospital (AKI), reduce glargine dose to 5 u and start aspart sliding scale
Hold metformin in hospital (AKI), reduce glargine dose to 5 u and start aspart sliding scale
· Dose of levothyroxine calculation = ____ - _____ mcg/kg IBW/day
· Dose of levothyroxine calculation = 1.6-1.8 mcg/kg IBW/day
Bg goal in hospital is
Bg goal in hospital is 140-180
· Following dose adj of levothyroxine, recheck TSH in
· Following dose adj of levothyroxine, recheck TSH in 4-8 weeks
· If TSH is too low and showing signs of hyperthyroidism, decrease levothyroxine by
· If TSH is too low and showing signs of hyperthyroidism, decrease levothyroxine by 12.5-25mcg
· Methimazole for _______ disease hyperT
· Methimazole for graves disease hyperT
· If patient develops recurrent hypoglycemia despite glucose tx following SUR OD , administer _________
· If patient develops recurrent hypoglycemia despite glucose tx following SUR OD , administer octreotide
· Levothyroxine OD most like ____________ toxidrome
· Levothyroxine OD most like sympathomimetic toxidrome
· Check ______ ______ for metformin OD
· Check serum lactate for metformin OD
· SUR have highest risk of ______glycemia
· SUR have highest risk of hypoglycemia
· Oral contraceptive might be less effective after _______ surger
· Oral contraceptive might be less effective after bariatric surger
· Obesity classes: BMI=
· Obesity classes: BMI=weight (kg)/ height in m^2
· First line tx for obesity management is _________ modifications
· First line tx for obesity management is behavioral modifications
· Best recommendation for weight management when patient has been trying to lose weight with diet exercise fro 6mo= ________ (medication)
· Best recommendation for weight management when patient has been trying to lose weight with diet exercise fro 6mo=tirzepatide
· Stop phentermine/ topiramate due to lack of full response to treatment if don’t lose _% of weight in _ mo
· Stop phentermine/ topiramate due to lack of full response to treatment if don’t lose 5% of weight in 3 mo
which weight loss med is Inappropriate med if HTN/ hx of ascvd
· Inappropriate med if HTN/ hx of ascvd = phentermine
· Tirzepetide should be started at low dose and titrated to max dose to avoid ____
· Tirzepetide should be started at low dose and titrated to max dose to avoid AE
We expect pts to regain portion of weight back after stopping ___________ (weight loss med)
We expect pts to regain portion of weight back after stopping semaglutide
________have the smallest energetic contribution to drug binding
Van der Waals have the smallest energetic contribution to drug binding
____________ doesn’t violate lipinski’s rule of 5
Acetaminophen doesn’t violate lipinski’s rule of 5
Which statement(s) are true
Drugs bind to multiple biological targets
GPCRs are targets
binding is mediated by molecular interactions
all of the above!
Drugs bind to multiple biological targets, GPCRs are targets, and binding is mediated by molecular interactions
which statement(s) are true
Stereochemistry determines pharmacokinetics
Stereochemistry determines pharmacodynamics
Biomolecules are chiral
all of the above are true
Stereochemistry determines pharmacokinetics and pharmacodynamics. Biomolecules are chiral
Added _____ groups on structures can cause phenolic oxygens to bind tighter and be more basic and less stable
Added methyl groups on structures can cause phenolic oxygens to bind tighter and be more basic and less stable
Halogens can make structures more acidic and more stable
Halogens can make structures ____ acidic and _____ stable
Lipinski’s rule of 5
are ?
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)
_-thalidomide causes birth defects because it’s active but _-thalidomide is not active
D-thalidomide causes birth defects because it’s active but L-thalidomide is not active
Carboxyl groups have ______ like tetrazoles, sulfonamide
Carboxyl groups have isosteres like tetrazoles, sulfonamide
Phase __ metabolism contains hydroxylation, demethylation, hydrolysis, and epoxidation
Phase 1 metabolism contains hydroxylation, demethylation, hydrolysis, and epoxidation
Phase _ metabolism contains sulfation, acetylation, and glucuronidation
Phase 2 metabolism contains sulfation, acetylation, and glucuronidation
Phase _ metabolism occur in the gut microbiome
Phase 3 metabolism occur in the gut microbiome
___________ can be triggered by ANG 2 which is 2HN-Asp-Arg-Val-Tyr-Ile-His-Pro-Phe-COOH
Vasoconstriction can be triggered by ANG 2 which is 2HN-Asp-Arg-Val-Tyr-Ile-His-Pro-Phe-COOH
ACEi accumulate bradykinin which causes ______
ACEi accumulate bradykinin which causes cough
LMWH is obtained from ______________. They do not have the same half-lives
LMWH is obtained from unfractionated heparin (UFH). They do not have the same half-lives
T/F- heparin activates inactivate vit k reductase
FALSE
heparin DOES NOT inactivate vit k reductase
Warfarin mimic_____ and affects recycling
Warfarin mimic vitAMIN k and affects recycling
Heparin functions as an ______________ (class)
Heparin functions as an anticoagulant
P2Y12 inhibitor that requires CYP activation (clopidogrel) - know this structure
P2Y12 inhibitor that requires CYP activation (clopidogrel) - know this structure
know what captopril looks like
know captopril structure
identify a pro-drug
identify pro-drug structure
Aspirin inhibits COX enzymes in the ________
Aspirin inhibits COX enzymes in the platelet
Ticagrelor inhibits platelet activation, it mimics adenosine and a ribose ring
Ticagrelor inhibits platelet activation, it mimics _________ and a ribose ring
know structure The Antiplatelet agent (Tirofiban)
know structure The Antiplatelet agent (Tirofiban)
know structure - Angiotensin Receptor Blocker (biphenyl ring, carboxylic acid, and an isostere)
know structure - Angiotensin Receptor Blocker (biphenyl ring, carboxylic acid, and an isostere)
SGLT2 inhibitors have a ______ like functional group
SGLT2 inhibitors have a glucose like functional group
know ccb structure
know ccb structure
know antianginal agent structure
know antianginal agent structure
Cholesterol lowering agents mimic HMG-CoA or can have a cyclic lactone that acts as a prodrug aspect that gets activated to mimic _____-___
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
know structure lipid lowering agent that targets PPAR receptor
know structure lipid lowering agent that targets PPAR receptor
KNOW COXi structure
COXi structure
know mixed beta blocker (carvedilol) structure
know mixed beta blocker (carvedilol) structure
_______ channel blockers include procainamide, procaine, verapamil, and lidocaine
Sodium channel blockers include procainamide, procaine, verapamil, and lidocaine
know structure arrhythmia drug
.
know structure for anticoag that mimics vit k
..
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 _______ ______
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
cGMP mediated vasodilation is regulated by nitric oxide which is released from organic ______
cGMP mediated vasodilation is regulated by nitric oxide which is released from organic nitrates
