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Pharm 3 > HTN, CHF, Angina, and Lipid Lowering > Flashcards

HTN, CHF, Angina, and Lipid Lowering Flashcards

1
Q

Fiber

A

Decrease LDL via adsorbing cholesterol/bile acids and GI motility changes

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2
Q

Loraza

A

Polyunsaturated Fatty Acid

Increase clearance of TGs

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3
Q

Mechanism of statins

A

Inhibit HMG CoA reductase, decreases cholesterol synthesis in liver, increases hepatic LDL receptors, increased clearance of LDL/VLDL

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4
Q

Atorvastatin

A

Potent statin
Long half life (night time admin not necessary)
Metab by CYP3A4
Lipophilic, crosses BBB

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5
Q

Prevastatin

A

Night admin
Sulfation metabolism (not p450 dependent)
Hydrophilic, hepatoselective
Not used in renal impairment

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6
Q

Ezetimibe

A

Cholesterol absorption blocker
Reduction absorbed leads to upreg of receptors in liver
Not p450 metabolized
Well tolerated

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7
Q

Cholestyramine

A

Bile acid sequestrant/resin
Binds bile acids, promotes excretion, increase conversion of cholesterol to bile acids, upreg of LDL receptors
Can also lead to upreg of HMG CoA reductase (use w/ statin)
Binds other drugs

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8
Q

Niacin (B3)

A

Inc HDL

AE: flushing, hepatotoxicity, GI

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9
Q

Gemfibrozil

A 
Dec TG
Inc LPL synth which inc TG clearance
Renal/liver contraindicated
Myopathy w/ statins
Potentiates warfarin and OTC
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10
Q

Evolucumab

A 
PCSK9 inhibitor 
Binds to/inhibits LDL receptor
Injection, expensive 
Decrease in major CV events
AE: nasopharyngitis, URI
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11
Q

Nitroglycerin

A

Decreases contractile state of BV
Decreases preload
Reduces coronary steal

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12
Q

Isosorbide dinitrate

A

Organic nitrate

Chewable, half life 2-3 hr

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13
Q

Nifedipine

A

Ca channel blocker - dihydropyridine
Strong coronary and peripheral vasodilation
Reflex increase in HR and contractility

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14
Q

Verapamil

A

2+ coronary/peripheral vasodilation

Dec HR, contractility, and rate of recovery of Ca channels

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15
Q

Nimodipine

A

Ca channel blocker

High affinity for cerebral vessels

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16
Q

Diltiazem

A

Ca channel blocker

Inhibits central sympathetic activity

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17
Q

Ca channel blockers: use, contraindications, and AE

A

Use: best option for variant angina
AE: cardiac depression, cardiac arrest, bradycardia, constipation
Contra: heart failure

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18
Q

Propanolol

A

Beta adrenergic blocker
Decrease HR and contractility
AE: ED, depression, insomnia
Contra: respiratory problems

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19
Q

Ranexa

A

Tx for chronic angina
AE: prolonged QT
Only used in patients who have not responded to nitrates, CCB, or beta blockers

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20
Q

Fluticasone

A

ICS
Prevent asthma attacks by suppressing inflamm
AE: candidiasis, HPA suppression
Used in COPD if FEV < 50%

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21
Q

Methylprednisolone

A

Systemic glucocorticoids

Short term, for exacerbations (3-10 days)

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22
Q

Albuterol

A

SABA
Acts in 3-5 min, duration 3-6 h
AE: tremor, tachycardia, hypokalemia

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23
Q

Salmeterol

A

LABA
> 12 hr duration
Not prescribed w/o ICS

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24
Q

Ipratropium bromide

A

SAMA
Blocks ACh effects from vagus onto M3 receptors
Effective in COPD (less in asthma)
AE: dry mouth, caution in BPH

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25
Q

Tiotropium

A

LAMA
Blocks ACh from vagus onto M3 receptors
More effective in COPD
AE: dry mouth, beware in BPH

26
Q

Theophylline

A

Phosphodiesterase inhibitor
Taken orally
COPD: increases diaphragm contractility
AE: narrow TI, CV, CNS, GI effects

27
Q

Montelukast

A

Leukotriene receptor antagonist
Taken orally
Add on tx, effective in aspirin sensitive asthma (no COPD)
AE: hepatic dysfxn, neuropsychiatric

28
Q

Omalizumab

A

Anti-IgE monoclonal antibody
Binds and neutralizes at Fc position
AE: expensive, may inc malignancies, wide variation in response

29
Q

Substance use criteria 1-4: impaired control

A
  1. Larger amounts, longer periods
  2. Wants to quit (not able)
  3. Time consuming
  4. Craving
30
Q

Substance use criteria 5-7: social impairment

A
  1. Failure to fulfill social obligations
  2. Continued use despite negative social consequences
  3. Given up social/recreational/occupational activities
31
Q

Substance abuse criteria 8-9: risk use

A
  1. Uses in physical hazardous situations

9. Continued use despite negative physical/psych consequences

32
Q

Substance abuse criteria 10-11: pharmacological criteria

A
  1. Appearance of tolerance

11. Appearance of withdrawal sx

33
Q

Effects of aldosterone

A

Causes cardiac fibrosis, decreases CO, which leads to Na+ reabsorption –> inc preload

34
Q

Spironolactone

A

Aldosterone antagonist
CHF drug
Effects: inc Na excretion, dec fibrosis
AE: hyperkalemia, gynecomastia

35
Q

Eplerenone

A

Aldosterone antagonist
CHF drug
More selective for aldosterone inhibitors (less gynecomastia)

36
Q

Function of diuretics in treating CHF?

A

Reduce preload and cardiac size by decreasing plasma volume

37
Q

Function of ACE-i, ARBs and ARNIs in treating CHF?

A

Dec afterload by reducing peripheral resistance

Dec preload by reducing aldosterone secretion

38
Q

Captopril

A

ACE inhibitor
CHF drug
Blocks conversion of Ang I to II
AE: cough, angioedema, hyperkalemia (CAPTOPRIL)

39
Q

AE C.A.P.T.O.P.R.I.L

A 
Cough
Angioedema
Proteinuria/Potassium excess
Taste change
Orthostatic hypotension
Pregnancy (C)
Renal artery stenosis (C)
Inc renin
Leukopenia/liver toxicity
40
Q

Enalapril

A

ACE-inhibitor
CHF drug
Blocks conversion of Ang I to II
AE: cough, angioedema, hyperkalemia

41
Q

Candesartan

A

ARB
CHF drug
Blocks Ang II receptor
No cough

42
Q

Valsartan

A

ARB
CHF drug
Blocks Ang II receptor
No cough

43
Q

What does neprilysin do?

A

Same effects as AT II
Cross talk with AT II
Targets ANP/BNP which usually decrease renin, inc Na excretion, and inc vasodilation

44
Q

ARNIs

A

Angiotensin receptor-neprilysin inhibitor
(ARB plus nep blocker)
Inhibiting both pathways has greater effect and greater decrease in morbidity and mortality

45
Q

Sacubitril/valsartan

A

ARNI
Sacub blocks neprilysin, valsartan inhibits RAAS

AE: more angioedema, less renal, hypokalemia, and cough

46
Q

Beta blockers in CHF

A

Inhibits adverse remodeling
Start and discontinue lowly
AE: hypotension, bradycardia, bronchospasm

47
Q

CHF beta blocker drugs

A 
Carvedilol
Metoprolol (selective)
48
Q

Ivabradine

A

Dec HR
Inhibits If channel to dec SA node firing
AE: Afib, Bradyarrhythmias, visual disturbance

49
Q

Isosorbide Dinitrate

A

Vasodilator, dec preload
Mech: NO release, inc cGMP, less MLC phosphorylation (dec contraction)
Veins>arteries
Off time to prevent tolerance

50
Q

BiDil

A

Isosorbide dinitrate + hydralazine
Strong preload and afterload decrease
Good for Af Am with CHF

51
Q

Hydralazine

A

Dec afterload
Dilates arterioles
CHF drugs

52
Q

How to treat diastolic HF (preserved EF)?

A

ACE, ARB, nitrates, diur
Rate control w/ B blockers and Ca blockers
Inc contractility with positive inotropes

53
Q

Milrinone

A

Phosphodiesterase inhibitor
Increases contractility and vasodilators
Use: acute decompensated HF (not long term)

54
Q

Digoxin

A

Cardiac glycoside, inc Ca
Mech: inhibit Na/K ATPase
Narrow TI
Toxicity when combined w/ abx, diuretics

55
Q

HTN diuretics

A

HCTZ (Na/Cl inhibitor) - dec preload and vascular resistance

Amiloride (K sparing)

56
Q

HTN drugs that cause direct vasodilation

A

Hydralazine
Minoxidil
Sodium nitroprusside

57
Q

Prazosin

A

a-1 blockers (vasodilator)
HTN drug
Beware of first dose phenomenon

58
Q

Guanethidine

A

Adrenergic inhibitor
HTN drug
Replaces and depletes NE

59
Q

Reserpine

A

Adrenergic inhibitor
HTN drug
Binds to storage vesicles and makes them dysfunctional, long term treatment depletes NE

60
Q

Methyldopa, clonidine

A

a2 agonists
HTN drugs
Reduce activity of neurons in the brain responsible for maintaining sympathetic activity

61
Q

Which HTN drug can you use in pregnancy?

A

Methyldopa

Pharm 3 (7 decks)

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