flashcard test
(160 cards)
1
Q
What drug class does HCTZ belong to?
A
Thiazide diuretics
2
Q
What drug class does chlorthalidone belong do?
A
Thiazide diuretics
3
Q
What drug class does metolazone belong to?
A
Thiazide diuretics
4
Q
How often is metolazone dosed?
A
1x/week (most potent thiazide diuretic)
5
Q
What is the MOA of thiazide diuretics?
A
Inhibits sodium reabsorption in the distal tubule
6
Q
What is the dose for HCTZ?
A
25mg (can start at 12.5 mg); if you go higher than 25mg, just increase side effects, not efficacy
7
Q
What are 4 ADRs for thiazide diuretics?
A
- Orthostatic hypotension
8
Q
What are 3 precautions for thiazide diuretics?
A
- Caution in sulfa allergic pts
9
Q
Counseling points for thiazide diuretics
A
- Get up slowly from lying down/sitting
10
Q
What drug class does Furosemide belong to?
A
Loop diuretics
11
Q
What class does Bemetanide belong to?
A
Loop diuretics
12
Q
What drug class does Torsemide belong to?
A
Loop diuretics
13
Q
What is the MOA of loop diuretics?
A
Inhibits active transport of Na, Cl, and K in the thick ascending limb of the Loop of Henle, causing excretion of these ions (works earlier in kidney than thiazide diuretics)
14
Q
What are 3 uses for loop diuretics?
A
- CHF (preferred diuretic)
15
Q
What is the initial dosing for (A) Furosemide (B) Bumetanide and (C) Tursemide?
A
A: Furosemide: 10-40mg/day
16
Q
What is the goal dosing for loop diuretics?
A
-Lowest possible dose or consider d/c’ing
17
Q
What is the onset and duration of action for loop diuretics?
A
Oral: onset 30min, duration 6 hrs
18
Q
How does the PO dose translate to the IV dose for loop diuretics?
A
IV dose = 1/2 PO dose
19
Q
What are 4 ADRs of loop diuretics?
A
- Electrolyte abnormalities (decreased K, Na, Ca, Mg; increased Uric acid and glucose)
20
Q
What are 2 precautions of loop diuretics?
A
- Caution in sulfa allergic pts
21
Q
What drug class does spironolactone belong to?
A
Potassium Sparing Diuretics (aldosterone receptor blockers)
22
Q
What drug class does eplerenone belong to?
A
Potassium sparing diuretics (aldosterone receptor blockers)
23
Q
What is the MOA of potassium sparing diuretics (aldosterone receptor blockers)?
A
NAME?
24
Q
What drug class does triamterene belong to?
A
Potassium sparing diuretics
25
What drug class does amiloride belong to?
Potassium sparing diuretics
26
What is the MOA of potassium sparing diuretics?
Blocks Na reabsorption and K excretion; effect is INDEPENDENT OF ALDOSTERONE
27
When are potassium sparing diuretics considered?
Not first line; may be used to treat HTN/chronic HF when pt is resistant to first line therapies
28
What is an ADR of all potassium sparing diuretics?
Hyperkalemia
29
What is an ADR of spironolactone?
Gynecomastia; menstrual irregularities
30
What is an advantage/disadvantage of eplerenone?
More selective, thus less side effects (& more expensive)
31
What is an important counseling point for potassium sparing diuretics?
-Salt substitutes --> can exacerbate hyperkalemic effect
32
When would you consider using aldosterone blockers for the treatment of HF?
-Stages C and D
33
What are the doses for aldosterone blockers?
Spironolactone: 12.5-25 mg/day
34
If a medication ends in "pril" what drug class does it most likely belong to?
Angiotensin converting enzyme inhibitors (ACE-I)
35
What is the MOA of ACE Inhibitors?
#NAME?
36
How often are ACE Inhibitors dosed?
-Often dosed 1x/day; sometimes 2x/day
37
What is enalapril?
It is a prodrug of enalaprilat (only ACE-I that is available for IV dosing)
38
(A) What is the most commonly used ACE-I and (B) what is the dosing?
A: Lisinopril
39
What are ACE Inhibitors used to treat?
HTN, CKD, CHF (1st line for all 3 dz's)
40
What are 5 ADRs for ACE Inhibitors?
1. Cough (up to 20% pts, d/t increased bradykinin)
41
What are 4 contraindications for ACE Inhibitors?
1. Pregnancy category C/D (2 forms of BC if used)
42
What are 3 drug interactions of ACE Inhibitors and ARBs?
1. Potassium supplements
43
Why should pts not use NSAIDs long term if they are on an ACE-I / ARB (describe MOA)?
NSAIDs block prostaglandins, another inflammatory mediator. Prostaglandins work on AFFERENT arterioles in kidney, causing vasodilation. NSAIDs therefore block vasodilation of the afferent arterioles in kidney. It would be bad to block the afferent arteriole w/ NSAIDs and the efferent arteriole w/ an ACE-I/ARB
44
What are the counseling points for ACE-I?
1. Monitor serum K + SCr (increase >30% bad)
45
If a drug name ends in "sartan" what drug class does it most likely belong to?
ARB (angiotensin receptor blockers)
46
What is the MOA of ARBs?
#NAME?
47
What are ARBs used for treating?
The same things as ACE-I (first line for HTN, CKD, & chronic HF). If cough develops on an ACE-I, then an ARB will be used
48
How often are ARBs dosed?
Often once daily
49
What are 5 ADRs for ARBs?
1. Hypotension / orthostatic hypotension
50
What are the contraindications of ARBs?
1. Pregnancy Category C/D (2 forms of BC if used)
51
What are the counseling points for ARBs?
1. Monitor K and for angioedema
52
When should ACE-I / ARBs be used in the tx of HF?
All stages of HF
53
What drug class does aliskiren belong to?
Renin inhibitor
54
What are 3 ADRs of Renin Inhibitors?
1. Do not use in combo w/ an ACE-I/ARB (all work on same system)
55
What are the cardioselective (dose-dependent) beta blockers?
AMEBBA
56
What are the mixed alpha and beta blockers?
-Carvedilol (take w/ food)
57
What are the beta blockers with intrinsic sympathomimetic activity (ISA)?
CAPP
58
What are the non-specific beta blockers?
#NAME?
59
Which beta blocker is also a class II antiarrythmic agent?
Sotalol (Betapace)
60
What is the MOA for beta blockers?
-Beta-1 receptors are located in the heart; beta-2 receptors are located in the lungs
61
How often is atenolol dosed?
1x/day
62
How often is metoprolol succinate dosed?
1x/day (extended release form)
63
How often is metoprolol tartrate dosed?
2x/day
64
When would beta blockers be used for the tx of HTN?
In pts with a significant cardiac history (HF, post-MI, CAD, CKD)
65
What are 2 other uses of propranolol?
1. Migraine prophylaxis (very lipophilic, can cross BBB)
66
What are the 3 beta blockers approved by FDA for use in HF?
1. Bisoprolol
67
What is the dosing (initial and goal) for metoprolol succininate (toprol)?
Initial: 6.25-12.5 mg/day
68
What is the dosing (initial and goal) for bisoprolol?
Initial: 1.25 mg/day
69
What is the dosing (initial and goal) for carvedilol (BID)?
Initial: 3.125mg twice daily
70
What stages of HF would beta blockers be used in?
#NAME?
71
What ADR is observed with cardioselective beta blockers?
Bradycardia
72
Which type of beta blocker will not have the same bradycardia effects as the other types?
ISA (intrinsic sympathomimetic activity)
73
What are 4 ADRs of beta blockers?
1. initial "Beta blocker blues" (should resolve w/in first month or so)
74
What are 6 relative contraindications of beta blockers?
1. Asthma & COPD (prevents effectiveness of rescue inhaler)
75
What are counseling points for beta blockers?
1. Beta blocker blues (will resolve after 1st month)
76
Describe the role of calcium channels
-When calcium channels are opened: causes Ca influx into smooth muscle (specifically cardiac & vascular smooth muscle)
77
What is the MOA of calcium channel blockers (CCBs)?
#NAME?
78
What drug class does verapamil belong to?
Non-dihydropyridine calcium channel blockers
79
What drug class does Diltiazem belong to?
Non-dihydropyridine calcium channel blockers
80
What is the MOA of non-dihydropyridine CCBs?
Inhibits Ca influx into CARDIAC SMOOTH MUSCLE-->decreased rate and force of contraction of the heart
81
What else are diltiazem & verapamil used to treat (besides HTN)?
#NAME?
82
What are 6 ADRs of non-dihydropyridine CCB??
1. Hypotension
83
What are verapamil drug interactions?
-Metabolized by CYP450 3A4 (lots of interactions
84
If a drug ends in "ipine", what drug class does it belong to?
Dihyropyridine calcium channel blockers
85
What is the MOA of dihyropyridine CCBs?
Inhibits Ca influx at VASCULAR SMOOTH MUSCLE-->peripheral vasodilation
86
Why should sublingual nifedipine not be used?
Severe hypotension, reportedly increased risk for MI & death
87
What are 5 ADRs of dihydropyridine CCBs?
1. Hypotension
88
(A) Which dihydropyridine has the worst peripheral edema side effect? (B) which 3 dihydropyridines are ok to use in CHF pts?
A: Nifedipine
89
Which dihydropyridine CCB is contraindicated in soy or egg allergy?
Clevidipine I (IV only)
90
For condition are dihydropyridine CCBs particularly useful?
Isolated systolic HTN (elderly)
91
If a drug ends in "osin" what drug class does it belong to?
Alpha-1 blockers (alpha antagonists)
92
What is the MOA of alpha-1 blockers (antagonists)
Competitively inhibits alpha-1 receptors in the periphery --> vasodilation
93
When would you consider an alpha-1 blocker (antagonist) for the tx of HTN?
Not 1st line, not as monotherapy for HTN; only as add-on therapy; esp in males (BPH)
94
What 3 alpha-1 blockers (antagonists) are approved to tx HTN?
1. Doxazosin (1x/day)
95
What 2 drugs are FDA approved to tx BPH?
1. Tamsulosin
96
What are 4 ADRs of alpha-1 blockers (antagonists)
1. "First dose effect" - significant orthostatic hypotension w/ 1st dose & subsequent titrations
97
What is a contraindication to alpha-1 blockers (antagonists)?
ED drugs (i.e. Cialis/viagra --> risk of life-threatening hypotension (block both alpha-1 and alpha-2)
98
What are some counseling points for alpha-1 blockers (antagonists)?
1. Take at night d/t orthostatic hypotension/dizziness
99
What drug class does methyldopa belong to?
Centrally acting alpha-2 agonists
100
What drug class does clonidine (catapres) belong to?
Centrally acting alpha-2 agonist
101
What is the MOA of centrally acting alpha-2 agonists?
Stimulates alpha-2 receptors in brain; reduces sympathetic outflow from brain-->decreased BP and PVR
102
What two drugs are approved for use in pregnancy?
Methyldopa and labetolol
103
What is clonidine used to tx?
#NAME?
104
Which medication used to tx HTN comes as a transdermal patch that can be changed every 7 days?
Clonidine (Catapres TTS)
105
What are 4 ADRs of centrally acting alpha-2 agonists?
1. Orthostatic hypotension, dizziness
106
What are ADRs specific to methyldopa?
Liver toxicities, hemolytic anemia
107
What are ADRs specific to clonidine?
Rash w/ patch, "anticholinergic-like" side effects (i.e. dry mouth, sedation, constipation, urinary retention)
108
What are some counseling points for centrally acting alpha-2 agonist?
**Cannot stop med abruptly-->rebound tachycardia/HTN**
109
What drug class does hydralazine belong to?
Direct vasodilators
110
What drug class does minoxidil belong to?
Direct vasodilators
111
What is the MOA of direct vasodilators?
Directly vasodilate, esp in arteries & arterioles, leading to decreased PVR
112
Which arteries does hydralizine predominantly vasodilate?
Coronary, cerebral, and renal arteries
113
What is the MOA for Isosorbide dinitrate (ISDN)?
#NAME?
114
What are 3 ADRs of direct vasodilators?
1. Reflex tachycardia (consider coadministration of a beta blocker)
115
What are some ADRs specific to hydralazine?
#NAME?
116
What are some ADRs of hydralazine + nitrates (ISDN)?
#NAME?
117
When would you consider using hydralazine + nitrates to treat HF?
-Used in place of ACE-I (if ACE-I is contraindicated)
118
What is an ADR specific to minoxidil?
Hirsuitism (active ingredient in Rogaine)
119
What are some counseling points for direct vasodilators?
1. Watch for lupus rash (indication to stop drug)
120
What 4 drug classes are first line options for the treatment of HTN?
Thiazides
121
What drug class would you use for a diabetic pt w/ HTN?
According to JNC8, any of 4 first line drugs (ACE-I/ARB, CCB, or Thiazide), in clinical practice, would start with an ACE-I/ARB
122
What drug class would you use to treat a pt w/ CKD w/ HTN?
ACE-I or ARB
123
At what age are you at higher risk for HTN?
Men >55 yrs
124
What is the age cutoff for family history to be considered "premature" cardiovascular dz?
Men
125
Describe the JNC 8 BP Goals
Pts >= 60yrs goal:
126
What two drug classes should not be stopped abruptly d/t potentially lifethreatening rebound HTN / tachycardia?
Beta blockers and centrally acting alpha-2 agonists
127
Name 5 OTC drugs that can cause HTN
1. NSAIDs
128
Name 11 Rx drugs that can cause HTN
1. Corticosteroids
129
What is the MOA of digoxin (Digitalis)?
#NAME?
130
What should be noted about the pharmacokinetics of digoxin (Digitalis)?
-Large volume of distribution (larger in obese / smaller in elderly)
131
What is the dosing for digoxin (Digitalis) for (A) normal renal fxn and (B) elderly or renal insufficiency?
A: 0.125 mg/day
132
What are the ADRs of digoxin (Digitalis)?
1. High potential for digoxin toxicity
133
What levels of digoxin should you be monitoring for in the blood?
Toxicity = >2 ng/dL
134
What is the MOA of Nitroprusside (Nipride)?
#NAME?
135
What should be noted about the metabolism of nitroprusside (Nipride)?
It breaks down to thiocyanate/cyanide (orange-->dark brown-->blue solution) --> protect from light
136
What are 2 ADRs of nitroprusside (Nipride)?
1. Hypotension
137
When is nitroprusside (Nipride) used?
When pts develop resistance to nitroglycerin (2nd line)
138
What is the MOA of nitroglycerin?
Primarily a venous vasodilator; acts as a nitric oxide donor
139
How is nitroglycerin dosed when treating ADHF?
#NAME?
140
What are the ADRs of nitroglycerin?
1. Risk of tachyphylaxis
141
When is nitroglycerin used?
Useful in HF w/ MI
142
What is the MOA of Nesiritide (Natrecor)?
#NAME?
143
How is nesiritide (Natrecor) dosed to treat ADHF?
IV infusion, short term use only (hospital stay)
144
What are 3 ADRs of nesiritide (Natrecor)?
1. Hypotension (esp if on an ACE-I)
145
When is nesiritide (Natrecor) used?
In pts who consistently fail Lasix and Nitro tx (has potential to shorten life expectancy)
146
What is the MOA of dopamine?
#NAME?
147
When is dopamine potentially used?
-Typically used in "cold" - almost cardiogenic shock
148
What is the MOA of dobutamine?
Beta agonist: binds to beta-1 reeceptors and increases calcium influx during systole --> increases squeeze of heart
149
How is dobutamine available for dosing?
IV only
150
What are 3 ADRs of dobutamine?
1. Tachycardia
151
When is dobutamine used for HF?
-Acute CHF: "cold" pts (hospital stay)
152
What is the MOA of milrinone?
#NAME?
153
What are 5 ADRs of milrinone?
1. Arrhythmogenic
154
When is milrinone used for tx of HF?
Acute CHF (hospital stay); remove tx before discharge (if heart can handle it)
155
Name 4 drug classes that can cause Na and water retention (and thus can precipitate ADHF)
1. Corticosteroids (usually short course)
156
Name 5 drug classes that can decrease cardiac contractility (and thus can precipitate ADHF)
1. Alcohol
157
What are the 3 predictive factors tracked by the ADHERE registry?
1. BUN >= 43mg/dL
158
How do you treat a pt who is "warm and wet"?
diuretics and vasodilators
159
How do you treat a pt who is "cold and dry"?
gentle rehydration and inotropes
160
How do you treat a pt who is "cold and wet"?
diuretics, inotropes, and occasional vasodilators (low SBP prevents use of vasodilators)
