IHD pharm

Question 1

What is nitroglycerin used for?

Answer 1

Short acting nitrate used for immediate relief of anginal symptoms

Question 2

What are the dosage forms of nitroglycerin?

Answer 2

0.3-0.6 mg SL repeat Q 3-5 min until relief of CP. Max dose: 3 doses w/in 15min

Question 3

What are long acting nitrates used for?

Answer 3

Added to beta blockers or calcium channel blockers to control stable angina

Question 4

What is the MOA of beta blockers?

Answer 4

antagonize effects of catecholamines on the heart. Non-selective act on both B1 and B2 receptors

Question 5

What is the black box warning for metoprolol (Lopressor), atenolol?

Answer 5

severe angina exacerbation, MI, and ventricular arrhythmias in angina pts after abrupt discontinuation. taper gradually over 1-2 wks and re-initiate therapy if angina worsens

Question 6

What should be monitored in diabetic patients prescribed carvedilol (Coreg)?

Answer 6

Monitor BP, HR Cr/BUN at baseline, glucose in diabetics

Question 7

What are the side effects of beta-1 blockers?

Answer 7

Bradycardia, heart block, heart failure

Question 8

What are the side effects of beta-2 blockers?

Answer 8

bronchospasm, worsening PVD, Raynaud’s phenomenon

Question 9

What are side effects for both beta-1 and beta-2 blockers?

Answer 9

Fatigue, depression, nightmares, impotence. May mask hypoglycemia and worsen glycemic control in diabetics

Question 10

What is the MOA of calcium channel blockers?

Answer 10

Prevent opening of voltage-gated calcium channels. Vasodilator effect on resistance vessels

Question 11

When should you be cautious to prescribe a calcium channel blocker?

Answer 11

pt’s with peripheral edema or history of hypotension. Multiple drug interactions

Question 12

What is the MOA of aspirin?

Answer 12

inhibits cyclo-oxygenase and thromboxane A2 synthesis

Question 13

What is the MOA of Theinopyridines (clopidogrel)?

Answer 13

block binding of ADP to platelet receptor

Question 14

What is the black box warning for clopidogrel (plavix)?

Answer 14

diminished effect in poor metabolizers (CYP450)

Question 15

What are antiplatelet agents?

Answer 15

aspirin, clopidogrel (plavix), Prasugrel (Effient),

Ticagrelor (Brilinta)

Question 16

Name the statins

Answer 16

Lovastatin, fluvastatin, pravastatin, simvastatin (zocor), atorvastatin (lipitor), and rosuvastatin (crestor)

Question 17

What is important about the pharmokinetics of statins?

Answer 17

extensive first-pass metabolism by the liver. Greater than 95% of most of these drugs are bound to plasma proteins.

Question 18

At what time of day should statins be taken?

Answer 18

taken orally at bedtime because of diurnal rhythm of cholesterol synthesis, except atorvastatin taken at any time because of its long half-life (14 hours).

Question 19

What is the MOA of statins?

Answer 19

inhibit cholesterol synthesis in the liver, so they deplete the intracellular supply of cholesterol, which triggers an up-regulation of hepatic LDL receptors causing increased clearance of plasma LDL .

Question 20

What are side effects of statins?

Answer 20

GI upset, HA, hepatotoxicity, Myopathy (increased creatine kinase) when combined with: Fibrates, Niacin, erythromycin, cyclosporine, verapamil, ketoconazole)

Question 21

What needs to be routinely measured with statin therapy?

Answer 21

Liver transaminases and CK

Question 22

What is the maximum dose of aspirin?

Answer 22

4 grams/day