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CPRII > HF & PAD/DVT > Flashcards

HF & PAD/DVT Flashcards

1
Q

Population among which a diagnosis of diastolic HF is now fairly common

A

older women

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2
Q

Furosemide & Hydrochlorothiazide cause this type of HSN rxn

A

sulfa HSN rxn

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3
Q

This type of discontinuation of carvedilol can trigger rebound angina or MI

A

abrupt

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4
Q

Loop diuretic w/ longer 1/2 life & better oral absorption than furosemide

A

Torsemide

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5
Q

Type of deadly pulmonary edema w/ sudden increase in LA pressure caused by ischemia in pt w/ HFpEF

A

flash pulmonary edema

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6
Q

Major concern w/ use of digoxin w/ K+ losing diuretics

A

digoxin toxicity

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7
Q

Tx for digoxin toxicity

A

lidocaine & anti-digitalis ABs

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8
Q

Type of overload due to aortic stenosis or chronic HTN

A

pressure overload

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9
Q

changes in heart due to pressure overload

A

concentric hypertrophy (parallel addition of new myofibrils)

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10
Q

Antidote for too much heparin

A

protamine

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11
Q

challenge w/ heparin & warfarin that requires frequent monitoring thru coagulation tests

A

highly variable plasma levels

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12
Q

What is milrinone?

A

PDE3 inhibitor that increases cAMP in heart & BVs to increase contractility & vasodilation (may decrease survival if used w/ sympathomimetic drugs)

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13
Q

What are contraindicated in HF b/c impair of salt & H2O excretion?

A

NSAIDs (worsen HF sxs)

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14
Q

What dz is contraindication for use of carvedilol in HF pts?

A

bronchospastic dz

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15
Q

Type of overload due to valvular regurgitation

A

volume overload

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16
Q

changes seen in heart in volume overload

A

eccentric hypertrophy due to addition of sarcomeres in series

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17
Q

What is dabigatran?

A

orally active & reversible direct inhibitor of thrombin

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18
Q

Dietary rec for HF pts

A

<3g of salt per day

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19
Q

Digoxin decreases what tone due to decrease in CO?

A

decreases sympathetic tone (lowers HR, inootropy & peripheral vascular resistance)

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20
Q

What is HFpERF?

A

diastolic HF where EF is preserved

due to smaller ventricular vol & poor filling

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21
Q

What is bivalirudin?

A

synthetic peptide similar to hirudin

direct inhibitor of thrombin but limited use b/c only used IV & v expensive

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22
Q

What should be greater than 60 before digoxin is administered?

A

Heart Rate

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23
Q

What is enoxaparin?

A

low molec weight heparin

binds to anti thrombin to inhibit factor Xa but unable to form ternary complex to inhibit thrombin

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24
Q

What is the antidote for dabigatran?

A

Idarucizumab

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25
Q

What are cardiac glycosides that were previously used for HF & now only used in systolic HF w/ low EF?

A

digitalis (aka digoxin)

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26
Q

What is vitamin K needed for?

A

synthesis of biologically active clotting factors II, VII, IX, X & protein C & S

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27
Q

What is an antidote for warfarin?

A

vitamin K

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28
Q

What is the MOA of aspirin?

A

irreversibly blocks synthesis of thromboxane A2 by platelets (which promotes activation & aggregation of platelets if pts w/ PAD)

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29
Q

What are added to loop diuretics if they alone are insufficient to eliminate edema of HF?

A

thiazides

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30
Q

What is a well known toxicity of loop diuretics?

A

ototoxicity

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31
Q

What is the primary reason pts stop taking ACEi to control BP?

A

COUGH

sign of CHF

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32
Q

What is alteplase?

A

glycoprotein that is identical to aa sequence to human tPA

can be injected directly into large peripheral blood clots that are obstructing flow

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33
Q

What is the advantage of dabigatran & rivaroxaban in comparison to warfarin?

A

rapid onset

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34
Q

What is a contraindication for aliskiren, ACEi & ARB?

A

pregnancy

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35
Q

What is digoxin used for in pregnancy?

A

safe tx of supraventricular arrythmias

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36
Q

Which CCBs cause arterial vasodilation and used in HF?

A

amlodipine

felodipine

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37
Q

Which CCBs are contraindicated in HF?

A

verapamil

dilitazem

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38
Q

What is a critical component of HF therapy?

A

DIURETICS to eliminate fluid causing congestion in acute decompensated HF

prevent accumulation of fluid in stable HF

decrease blood vol to keep blood from overfilling

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39
Q

What drug suppresses platelet aggregation by irreversible blocking P2Y12 receptors?

A

clopidogrel

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40
Q

What increases the incidence & prevalence of HF?

A

age

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41
Q

What is the main focus of heart failure therapy?

A

blocking vicious cycle of remodeling

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42
Q

What is an antidote for factor Xa inhibitors like rivaroxaban & apixaban?

A

andexanet alfa

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43
Q

What is sacubitril?

A

neutral endopeptidase inhibitor that prolongs 1/2 life of BNP

marketed in combo w/ valsartan to tx HF

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44
Q

What is a class III anti-arrythmic drug used to tx arrhythmias in HF pts?

A

amiodarone

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45
Q

What metabolizes the more potent S warfarin to more potent form?

A

CYP2C9

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46
Q

What must a pt be to administer carvedilol w/ symptomatic CHF & EF<40?

A

clinically stable (to prolong survival)

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47
Q

What is systolic HF?

A

HF w/ reduced EF that manifests as progressive chamber dilation w/ eccentric remodeling

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48
Q

What is used as a diagnostic marker for HF in pts taking sacubitril?

A

BNP

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49
Q

What is seen in dixogin toxicity on ECG?

A

bigeminy (ectopic beat alternating w/ normal beat)

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50
Q

What is used to assess anticoagulation caused by dabigatran?

A

diluted thrombin time

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51
Q

What is a potential adverse effect of spironolactone use in females?

A

hirsutism

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52
Q

What is always a concern when anti platelet or anti coagulant drugs are administered?

A

bleeding

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53
Q

Why are Blacks more resistant to warfarin & Asians more sensitive to it?

A

genetic availability of VKORC1

54
Q

What is used to monitor anticoagulant activity of heparin?

A

aPPT

55
Q

What is an indication for rivaroxaban or dabigatran?

A

non-valvular atrial fibrillation

56
Q

Why can fondaparinux & low molec heparins be self administered at home?

A

b/c have predictable pharmacokinetics

57
Q

What are signs of digoxin toxicity?

A

yellowish green halos in eyes

also anorexia, N/V, salivation

58
Q

Which drugs to tx HF did not show prolongation of life?

A

cardiac glycosides (digitalis)

59
Q

What is a prototype of ARBs that is now available as a generic drug?

A

losartan

60
Q

What is dobutamine?

A

synthetic catecholamine that selectively activates B1 receptors

preferred for symptomatic hypoTN or hypoperfusion even if have optimal cardiac filling pressure w/ low CO

61
Q

What type of heart valve does dabigatran NOT decrease risk of thromboembolism for?

A

mechanical heart valve

62
Q

Which receptor does digoxin compete w/ K+ for binding?

A

Na/K ATPase

why must keep K+ levels in normal range

63
Q

What is the MOA of warfarin?

A

slow onset anticoagulation effects by blocking conversion of vit K epoxide to active reduced form

depletes active vit K results in inability to produce clotting factors

64
Q

What is the route of administration for warfarin, dabigatran & rivaroxaban?

A

ORAL

65
Q

What is the route of administration for heparin & argatroban?

A

IV

66
Q

What is seen in lead II of ECG by therapeutic levels of digoxin?

A

ST depression

67
Q

How do deficiencies in clotting factors present?

A

deep tissue bleeding that forms large subcutaneous & soft tissue hematomas, hemarthroses

may be delayed & oozing after procedures

68
Q

What is a potentially deadly adverse effect assoc w/ use of ACEi?

A

angioedema

69
Q

What is ivabradine?

A

“funny” current blocker used in HF if sinus rhythm but EF<35% & HR <75 when B blockers are contraindicated or @ max dose of Bblocker

70
Q

What is a contraindication of carvedilol in HF & digoxin & class II/IV antiarrythmic drugs?

A

heart block

71
Q

What is Stage C in HF?

A

HF & structural dz w/ prior or current sxs

72
Q

How do you tx Stage C of HF?

A 
w/ ACEi or ARB
B blocker
Diuretics
Aldosterone Antagonist
Ivabradine

as necessary to control sxs

73
Q

What is Stage A of HF?

A

@ risk for HF but neither structural dz nor sxs

should promote healthy lifestyle, prescribe ACEi or ARB +/- statins to reduce risk

74
Q

What is HFrEF?

A

systolic HF when EF is reduced

75
Q

What is a loop diuretic w/ longer 1/2 and better oral absorption than furosemide?

A

torsemide

76
Q

What can cause fall in CO, hypoTN & death in pts on loop diuretics?

A

super decreased preload

77
Q

What is the transporter in TAL that is target of loop diuretics?

A

Na K 2CL

78
Q

What is argatroban?

A

IV thrombin inhibitor for prophylaxis & tx of thrombosis in pts w/ or @ great risk for developing HIT

79
Q

What is commonly seen in platelet defects but uncommon with clotting factor defects?

A

petechiae

80
Q

Which alpha/beta blocker initially appeared to work best in HF & L systolic dysfunction post MI?

A

carvedilol

81
Q

What is major benefit of carvedilol use?

A

reduces mortality in HF pts

82
Q

What is rivaroxaban?

A

direct inhibitor of activated factor X

rapidly inhibits generation of thrombin from prothrombin

83
Q

Which drugs require a loading dose due to long 1/2 life?

A

digoxin & amiodarone

84
Q

What is angiotensin II and what is its role?

A

potent vasoconstrictor that causes renal retention of salt & H2O by promoting aldosterone secretion

mitogen for CV remodeling that causes progressive deterioration of CV fxn in HF pts

85
Q

What is furosemide?

A

loop diuretic that works when GFR is LOW

important for mobilizing LARGE volumes of fluid that accumulate in HF pts that causes congestion

86
Q

In what type of bottle must dabigatran be stored?

A

dessicator (b/c is an unstable drug)

87
Q

What are ACE inhibitors?

A

class of drugs that partially correct adverse consequence of chronic HTN on blood vessels & preserve failing HF fxn & prolong life

88
Q

What is cilostazol & what is it used for?

A

PDE3 inhibitor used to suppress platelet aggregation & cause peripheral vasodilation

indicated for intermittent claudication

89
Q

What is heparin & its MOA?

A

mix of highly negative polysaccharide chains

binds to antithrombin to facilitate its inhibition of factor Xa & INACTIVATES THROMBIN

90
Q

What is bidil?

A

a vasodilator combo containing isosorbide dinitrate to dilate veins & hydralazine to dilate arteries in chronic HF

more useful in Black pts who cannot use ACEi or ARB

91
Q

Does dopamine spare renal function?

A

no

92
Q

What is the mechanism of HIT?

A

platelet Fc receptors bind an IgG bound to heparin & PF4

leads to platelet activation/thrombosis & platelet removal by splenic macrophages

93
Q

What is the result of increased CO w/ digoxin?

A

increased urine production

94
Q

What is a potential adverse effect of spironolactone use by males?

A

gynecomastia

95
Q

What is the major pathway for Mg2+ reabsorption in TAL?

A

paracellular

96
Q

What is a relative contraindication for alteplase when severe and uncontrolled?

A

hypertension

97
Q

What is nitroglycerin and what are its uses?

A

venous vasodilator used to tx angina

can administer w/ loop diuretic in normotensive to tx acute decompensated HF if heart overfilled & venous pooling of blood until diuretics get kidneys to excrete excess volume

98
Q

What is Stage D in HF?

A

@ risk for HF w/ advanced structural dz & sxs @ rest despite max therapy including digoxin

discuss end of life goals & advanced care measures

99
Q

What is the ending for ACE inhibitors?

A

“pril”

100
Q

What was the 1st prototypical ACEi?

A

captopril

101
Q

What is metoprolol & its use?

A

B1 selective blocker w/ ability to prolong life in HF when other txs are ineffective

102
Q

What can occur with abrupt discontinue of carvedilol?

A

trigger rebound angina & MI

103
Q

What is fondaparinux & its MOA?

A

synthetic pentasaccharide

binds to anti-thrombin & inhibits factor Xa, no effect on thrombin

104
Q

What color are arterial clots?

A

WHITE

due to abundance of platelets

105
Q

What type of drugs are used for white clots?

A

platelet targeting drugs

106
Q

Ending for drug names that tells you it is a AT1 blocker

A

“sartan”

ARBs

107
Q

What color are venous clots?

A

RED

due to large fibrin mesh that forms

108
Q

What is the more selective aldosterone antagonist?

A

eplerenone

109
Q

What is significant about overdosage of carvedilol?

A

prevents sympathetic agents from exerting positive inotropic effects

where milrinone might be of benefit

110
Q

What mineralocorticoid is secreted by blood vessels adj to MIs that promotes myocardial fibrosis?

A

aldosterone

111
Q

What is the alternative drug of first choice for pts @ risk for developing HF?

A

ARB

112
Q

What is activated by heparin, LMW hepain & fondaparinux?

A

anti-thrombin (plasma protein)

113
Q

Which drugs do NOT require INR monitoring?

A

dabigatran & rivaroxaban

114
Q

What is diastolic HF?

A

EF is preserved but problem is that heart doesn’t fill enough

concentric remodeling w/ sitffness

115
Q

What is prolonged on ECG by therapeutic levels of digoxin?

A

PR interval

may result in heart block w/ toxic levels

116
Q

What serum level of K+ is safe to administer ACEi or ARB to pt w/ HF?

A

K+ <5.5 mEq/L

117
Q

What occurs in skin w/ warfarin? Why?

A

skin necrosis

when rapid fall in protein C leads to hypercoaguable state

118
Q

What is stage B of HF?

A

@ risk for HF & structural dz but no sxs

use ACEi or ARB +/- B blocker, defib or revasc to prevent further cardiac remodeling

119
Q

Why are loop diuretics used in HF?

A

to reduce edema in lungs in L sided HF & edema in legs & ankles in R sided HF

120
Q

What do you do when a person w/ chronic HF is already on furosemide & now presents w/ volume expansion edema due to acute decompensation?

A

GIVE MORE FUROSEMIDE

121
Q

What is the first choice drug for tx & prevention of DVT?

A

LMW heparin

122
Q

What is bivalirudin & its MOA?

A

synthetic peptide similar to hirudin

direct inhibitor of thrombin

123
Q

How does metabolic alkalosis occur?

A

when K+ & Cl- are lost in urine due to diuretics or hyperaldosteronism

cells donate K+ while taking up H+ & leave HCO= in effort to maintain hypokalemic plasma K+ levels closer to normal

124
Q

What drug class is the 1st line therapy for decreasing risk for PAD?

A

Statins

125
Q

What is INR?

A

normalized prothrombin time

126
Q

How is INR used?

A

if <2, increased risk for thromboembolism in pts on warfarin

if >3, higher risk of intracranial hemorrhage in pts on warfarin

127
Q

What do both heparin & warfarin drugs increase risk for?

A

hematomas forming in brain, eye or spinal cord

128
Q

What influences activity of warfarin & mandates regular testing whenever changes made to daily tx regimen?

A

many drug interactions

129
Q

What loop diuretic can be used in pts w/ sulfa allergy?

A

ethacrynic acid

130
Q

How does the LV change in cardiac remodeling in systolic HF?

A

changes from V to U shape

increased ventricular capacitance but also has requires increased wall tension to eject blood

CPRII (4 decks)

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