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1. NAPLEX Prep > Heart Disease > Flashcards

Heart Disease Flashcards

1
Q

Drugs that increase LDL and TG

A

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

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2
Q

Increase LDL only

A

Fish oils (except Vascepa)

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3
Q

Increase TG only

A

IV lipid emulsions
Propofol
Bile acid sequestrants

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4
Q

Desirable TG range

A

<150

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5
Q

Friedewald equation

A

LDL=TC-HDL-TG/5

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6
Q

OTC fish oils can be used to

A

lower TG, but some can raise LDL

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7
Q

Which cholesterol lowering drugs cause liver damage?

A

Niacin
Fibrates
Statins
Ezetimibe

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8
Q

Statin benefit groups

A

-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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9
Q

Statin equivalent doses

A

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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10
Q

Statin lipid effects

A

Increased HDL
Decreased LDL, TG

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11
Q

CYP3A4 inhibitors

A

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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12
Q

Which statins have the least DDI?

A

Rosuvastatin
Pravastatin

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13
Q

Do not use statins with

A

gemfibrozil

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14
Q

Which statins should be taken in the evening?

A

Lovastatin (Altoprev)
Fluvastatin
SImvastatin (Zocor)

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15
Q

Which meds are used to target high TG?

A

FIsh oils
Fibrates

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16
Q

Bile acid sequestrants

A

Cholestyramine
Colesevelam (Welchol)
Colestipol

Increase TG, Decrease LDL

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17
Q

Which bile acid sequestrant is an option for pregnant patients?

A

Colesevelam

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18
Q

Colesevelam (Welchol) safety

A

Bowel obstruction
Discoloration/erosion of teeth

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19
Q

Colesevelam (Welchol) safety

A

Bowel obstruction
Discoloration/erosion of teeth
Increased TG

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20
Q

Lopid

A

Gemfibrozil
Fibrate

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21
Q

Antara

A

Fenofibrate

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22
Q

MOA of fibrates

A

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

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23
Q

Trilipix

A

Fenofibrate

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24
Q

Contraindications of fibrates

A

Severe liver disease
Gallbladder disease

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25
Q

Lipid effects for fibrates

A

Decreased TG
Can Increase LDL

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26
Q

Niacin MOA

A

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

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27
Q

Niacin is also called

A

Vitamin B3
Nicotinic Acid

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28
Q

Niacin lab effects

A

Increased BG
Increased Urica acid
Increased HDL
Decreased LDL and TG

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29
Q

Niacin and bile acid sequestrants DDI

A

Take niacin 4-6 hours after bile acid sequestrants

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30
Q

Niaspan

A

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

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31
Q

Fish oils use

A

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

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32
Q

Natural products used for HTN

A

Fish oil
Coenzyme Q10
L-arginine
Garlic

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33
Q

Exforge

A

Valsartan + Almodipine

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34
Q

Ziac

A

Bisoprolol + HCTZ

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35
Q

Diovan HCT

A

Valsartan HCT

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36
Q

Zestoretic

A

Lisinopril HCTZ

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37
Q

Lotrel

A

Benazepril + Amlodipine

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38
Q

Dyazide

A

Triamterene + HCTZ

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39
Q

Hyzaar

A

Losartan + HCTZ

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40
Q

Maxzide

A

Triamterene + HCTZ

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41
Q

Tenoretic

A

Atenolol
Chlorthalidone

42
Q

Benicar HCT

A

Olmesartan HCTZ

43
Q

Thiazides agents

A

Chlorthalidone
HCTZ

44
Q

Thiazide CI

A

Hypersensitivity to sulfa

45
Q

Which CCB is safest in HF?

A

Amlodipine

46
Q

Tiazac

47
Q

Calan SR

48
Q

All CCBs are major substrates of

A

3A4
Watch for G PACMAN interactions

49
Q

Altace

50
Q

Lotensin

A

Benazepril

51
Q

Avapro

A

Irbesartan

52
Q

Olmesartan warnings

A

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

53
Q

Tenormin

54
Q

Brevibloc

55
Q

Bystolic

56
Q

Beta 1 selective beta blockers

A

AMEBBA
Atenolol
Metoprolol
Esmolol
Bisoprolol
Betaxolol
Acebutolol

57
Q

Lopressor and Toprol XL

A

take with or right after food

58
Q

Metoprolol tartrate IV:PO

59
Q

Direct vasodilators

A

Hydralazine
Minoxidil

60
Q

Alpha 2 agonists

A

Clonidine
Guanfacine
Methyldopa

61
Q

Kapvay

A

Clonidine for ADHD

62
Q

Catapres patch

A

Apply weekly
Remove before MRI

63
Q

Prinzmetal’s angina

A

Occurs at rest. Caused by vasospasm

64
Q

Stable Ischemic Heart Disease (SIHD) treatment

A

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

65
Q

How long is aspirin used in SIHD?

A

Indefinitely

66
Q

Why are beta blockers used in SIHD?

A

Decreased HR
Decreased contractility
Decreased left ventricular wall tension

67
Q

Why are CCBs used in SIHD?

A

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

68
Q

Avoid beta blockers in

A

Prinzmetal’s angina

69
Q

Nitrate patch

A

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

70
Q

Nitrate ointment dosing

A

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

71
Q

RF for acute coronary syndrome

A

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

72
Q

When to call 911 with NTG SL

A

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

73
Q

Effient CI

A

Prasugrel
H/O TIA or stroke

74
Q

ReoPro

75
Q

Integrilin

A

Eptifibatide

76
Q

When a fibrinolytic is used, it should be given

A

30 minutes from hospital arrival (door to needle time)

77
Q

How long is a P2Y12 inhibitor used after ACS?

A

At least 12 months

78
Q

How long is a beta blocker used after ACS?

A

At least 3 years

79
Q

How long is an ACE inhibitor used after ACS?

A

Indefinitely

80
Q

Most common cause of heart failure in the US

A

MI or from long standing HTN

81
Q

EF<40%

A

Systolic dysfunction

82
Q

CO

83
Q

Cardiac Index (CI)

84
Q

Compensatory pathways activated in HF

A

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

85
Q

Natural products in HF

A

Omega 3 Fatty Acid
Hawthorn
Coenzyme q10

86
Q

Key drugs that cause or worsen HF

A

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

87
Q

Vasotec HF target dose

A

10-20 mg PO BID

88
Q

Prinivil HF target dose

A

20-40 mg QD

89
Q

Accupril HF target dose

90
Q

Altace HF target dose

91
Q

Cozaar HF target dose

A

50-150 mg QD

92
Q

Diovan HF target dose

A

160 mg BID

93
Q

Toprol XL HF target dose

94
Q

Coreg HF target dose

A

<85kg- 25 mg BID
>85kg- 50 mg BID

CR- 80 mg QD

95
Q

Loop diuretics oral dosing equivalents

A

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

96
Q

Digoxin HF therapeutic range

A

0.5-0.9 ng/ml

97
Q

Potassium chloride oral solution

A

10%
20 mEq/15mL

98
Q

Cardiac conduction pathway

A

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

99
Q

Digoxin therapeutic range for AF

A

0.8-2ng/mL

100
Q

Digoxin oral–> IV

A

Decrease by 20-25%

1. NAPLEX Prep (15 decks)

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