Heart Disease Flashcards by Kiana Mullins

Drugs that increase LDL and TG

Diuretics
Efavirenz
Steroids
Immunosuppressants- Cyclosporine, Tacrolimus
Atypical antipsychotics
Protease inhibitors

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Increase LDL only

Fish oils (except Vascepa)

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Increase TG only

IV lipid emulsions
Propofol
Bile acid sequestrants

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Desirable TG range

<150

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Friedewald equation

LDL=TC-HDL-TG/5

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OTC fish oils can be used to

lower TG, but some can raise LDL

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Which cholesterol lowering drugs cause liver damage?

Niacin
Fibrates
Statins
Ezetimibe

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Statin benefit groups

-Clinical ASCVD
-Primary elevation of LDL >/=190
DM 40-75 yo with LDL 70-189 (if multiple RF- high, no RF-mod)
Age 40-75 with LDL between 70-189 (10 year risk>20-high, <19.9-Mod)

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Statin equivalent doses

Pharmacists Rock AT Saving Lives and Preventing Fat
Pitavastatin 2 mg
Rosuvastatin 5 mg
Atorvastatin 10 mg
Simvastatin 20 mg
Lovastatin 40 mg
Pravastatin 40 mg
Fluvastatin 80 mg

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Statin lipid effects

Increased HDL
Decreased LDL, TG

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CYP3A4 inhibitors

Grapefruit
Protease Inhibitors
Azole antifungals
Cyclosporine, cobicistat
Macrolides
Amiodarone- Simva 20mg/d max, Lova 40mg/d max
Non-DHP CCVs- Simva 10mg/d max, 20mg/d mac

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Which statins have the least DDI?

Rosuvastatin
Pravastatin

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Do not use statins with

gemfibrozil

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Which statins should be taken in the evening?

Lovastatin (Altoprev)
Fluvastatin
SImvastatin (Zocor)

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Which meds are used to target high TG?

FIsh oils
Fibrates

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Bile acid sequestrants

Cholestyramine
Colesevelam (Welchol)
Colestipol

Increase TG, Decrease LDL

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Which bile acid sequestrant is an option for pregnant patients?

Colesevelam

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Colesevelam (Welchol) safety

Bowel obstruction
Discoloration/erosion of teeth

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Colesevelam (Welchol) safety

Bowel obstruction
Discoloration/erosion of teeth
Increased TG

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Lopid

Gemfibrozil
Fibrate

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Antara

Fenofibrate

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MOA of fibrates

PPARa activators
Increases lipoprotein lipase activity leading to increased catabolism of VLDL particles.

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Trilipix

Fenofibrate

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Contraindications of fibrates

Severe liver disease
Gallbladder disease

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Lipid effects for fibrates

Decreased TG Can Increase LDL

Niacin MOA

Decreases the rate of hepatic synthesis of VLDL (decreases TG) and LDL

Niacin is also called

Vitamin B3 Nicotinic Acid

Niacin lab effects

Increased BG Increased Urica acid Increased HDL Decreased LDL and TG

Niacin and bile acid sequestrants DDI

Take niacin 4-6 hours after bile acid sequestrants

Niaspan

Take at bedtime after a low fat snack Less flushing and less hepatotoxicity Best choice

Fish oils use

Adjunct to diet with TG >/=500 Increases LDL (Lovaza, not seen with Vascepa)

Natural products used for HTN

Fish oil Coenzyme Q10 L-arginine Garlic

Exforge

Valsartan + Almodipine

Ziac

Bisoprolol + HCTZ

Diovan HCT

Valsartan HCT

Zestoretic

Lisinopril HCTZ

Lotrel

Benazepril + Amlodipine

Dyazide

Triamterene + HCTZ

Hyzaar

Losartan + HCTZ

Maxzide

Triamterene + HCTZ

Tenoretic

Atenolol Chlorthalidone

Benicar HCT

Olmesartan HCTZ

Thiazides agents

Chlorthalidone HCTZ

Thiazide CI

Hypersensitivity to sulfa

Which CCB is safest in HF?

Amlodipine

Tiazac

Diltiazem

Calan SR

Verapamil

All CCBs are major substrates of

3A4 Watch for G PACMAN interactions

Altace

Ramipril

Lotensin

Benazepril

Avapro

Irbesartan

Olmesartan warnings

Sprue-like enteropathy (severe chronic diarrhea, can occur at any time)

Tenormin

Atenolol

Brevibloc

Esmolol

Bystolic

Nebivolol

Beta 1 selective beta blockers

AMEBBA Atenolol Metoprolol Esmolol Bisoprolol Betaxolol Acebutolol

Lopressor and Toprol XL

take with or right after food

Metoprolol tartrate IV:PO

1:2.5

Direct vasodilators

Hydralazine Minoxidil

Alpha 2 agonists

Clonidine Guanfacine Methyldopa

Kapvay

Clonidine for ADHD

Catapres patch

Apply weekly Remove before MRI

Prinzmetal's angina

Occurs at rest. Caused by vasospasm

Stable Ischemic Heart Disease (SIHD) treatment

Beta blocker 1st line (CCBs and LA nitrates second line) PRN NTG High intensity stain Aspirin ACE/ARB if HTN or DM with albuminuria

How long is aspirin used in SIHD?

Indefinitely

Why are beta blockers used in SIHD?

Decreased HR Decreased contractility Decreased left ventricular wall tension

Why are CCBs used in SIHD?

non-DHP: Decreased HR DHP: Decreased SVR (afterload)

Avoid beta blockers in

Prinzmetal's angina

Nitrate patch

Wear for 12-14 hours and then remove. Rotate sites

Nitrate ointment dosing

Dosed BID 6 hours apart with a 10-12h nitrate free interval

RF for acute coronary syndrome

Age: Men >45, Women >55 FH: Men >44, Women > 65 Smoking HTN CAD Dyslipidemia DM Chronic stable angina Lack of exercise Excessive alcohol

When to call 911 with NTG SL

Give one dose every 5 minutes for up to 3 doses. If chest pain not improved or worse 5 minutes after 1st dose, call 911

Effient CI

Prasugrel H/O TIA or stroke

ReoPro

Abciximab

Integrilin

Eptifibatide

When a fibrinolytic is used, it should be given

30 minutes from hospital arrival (door to needle time)

How long is a P2Y12 inhibitor used after ACS?

At least 12 months

How long is a beta blocker used after ACS?

At least 3 years

How long is an ACE inhibitor used after ACS?

Indefinitely

Most common cause of heart failure in the US

MI or from long standing HTN

EF<40%

Systolic dysfunction

HR x SV

Cardiac Index (CI)

CO/BSA

Compensatory pathways activated in HF

Increased SNS- Increased HR and contractility Increased RAAS- vasoconstriction (increased afterload), Fluid retention (inc preload) Increased Vasopressin (ADH)- Fluid retention (Inc preload) Increased Natiuretic Peptides- Vasodilation, Diuresis, BENEFICIAL

Natural products in HF

Omega 3 Fatty Acid Hawthorn Coenzyme q10

Key drugs that cause or worsen HF

Drug Information NATION DPP4i Immunosuppressants- Adalimumab, etanercept, interferons Non-DHP CCBs Antiarrhythmics- quinidine, flecainide, dronedarone Thiazolidinediones Itraconazole Oncology drugs- anthracyclines NSAIDs

Vasotec HF target dose

10-20 mg PO BID

Prinivil HF target dose

20-40 mg QD

Accupril HF target dose

20 mg BID

Altace HF target dose

10 mg QD

Cozaar HF target dose

50-150 mg QD

Diovan HF target dose

160 mg BID

Toprol XL HF target dose

200 mg QD

Coreg HF target dose

<85kg- 25 mg BID >85kg- 50 mg BID CR- 80 mg QD

Loop diuretics oral dosing equivalents

Ethacrynic acid 50mg Furosemide 40mg Torsemide 20 mg Bumetanide 1mg

Digoxin HF therapeutic range

0.5-0.9 ng/ml

Potassium chloride oral solution

10% 20 mEq/15mL

Cardiac conduction pathway

SA node AV node Bundle of His Right and left bundle branch Purkinje dibers

Digoxin therapeutic range for AF

0.8-2ng/mL

Digoxin oral--> IV

Decrease by 20-25%