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FA17 Cardio 2 > Jill Pharm > Flashcards

Jill Pharm Flashcards

1
Q

Tx goals in Ischemic Heart disease

Short term

A

Reduce or prevent symptoms of angina that limit exercise capability and impair QoL

Restore balance between supply and demand

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2
Q

Tx goals of ischemic heart dz

Long term

A

Prevent CHD events such as MI, arrhythmia, HF

Prevent morbidity and mortality

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3
Q

Classes of drugs in angina pectorals

A

Cardio selective beta blockers

Calcium channel blockers

Nitrates

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4
Q

First line maintenance therapy for stable angina

A

Beta blockers

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5
Q

MOA BB

A

Inhibit catecholamine neurotransmitters at B1 and B2 receptors

Lower HR and force of contraction, plasma renin activity
Prevent sympathetic response to exercise or stress

Increase coronary blood flow and decrease HR, contractility, wall tension

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6
Q

Beta blockers subtypes

A

Cardioselective - MC, decreased mortality, better in pts with HF, asthma, COPD, Dm

Non selective - no mortality data, worse for COPD/asthma/cough

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7
Q

BB use in therapy

A

Only anti-angina drug proven to prevent re-infarction and improve survival in pts with MI

NOT used in patients with vasospastic angina (can increase vasospasm)

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8
Q

What must be monitored in BB use?

A

HR (dc if <55bmp)

BP (dc if <115)

Nitrate usage and angina symptoms

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9
Q

Nitrates MOA

A

Converted to nitric oxide to cause venous dilation (some arterial)

Increase myocardial oxygen supply
Decrease in myocardial oxygen demand

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10
Q

Nitrate formulations

A

IV NTG (acute CP, HTN)

SL NTG (Acute CP)

Isosorbide dinitrate (chronic CP)

Isosorbide mononitrate (chronic CP)

NTG patch (chronic CP)

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11
Q

Side effects of nitrates

A

Tolerance (tachyphylaxis due to reduced C-GMP, can happen right away)

Headache

Flushing

Orthostasis

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12
Q

Nitrate drug interactions

A

PDE-5 inhibitors (pulmonary HTN and ED)

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13
Q

Contraindications for nitrates

A

PDE-5 inhibitors in past 24 hrs

Hypertrophic cardiomyopathy

Use with caution in aortic stenosis (decreased pre-load) and volume depletion

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14
Q

Monitoring in nitrates

A

BP, HR (may have hypotension, tachycardia)

SL PRN usage and CP

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15
Q

Sublingual nitroglycerin

A

Taken PRN (max 3 tabs or sprays 5 min apart over 15 min)

HA can mark potenentcy, sit down before placing under tongue and dont chew or swallow

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16
Q

Long acting nitrates

A

Isosorbide mononitrate - extended release, 1 per day

Isosorbide dinitrate - 2-3 times per day

Not PRN, given every day for stable angina (no acute episodes)

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17
Q

Calcium channel blockers MOA

A

Blocks calcium entry into vascular smooth muscle cells

Non-DHP = decrease HR and contractile force (verapamil, dilitiazem)

DHP = decrease smooth muscle tone vascular to decrease SVR (amlodipine, nifedipine, felodipine)

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18
Q

CCBS use and monitor

A

Use for stable angina when BB are CI or stopped bc of ADRs

Combo with BB when BB and nitrates are not enough

Monitor: HR, BP, PRN nitrate use, angina symptoms, edema, constipiation, rash

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19
Q

ranolazine (Ranexa)

Use/MOA

A

Inhibits late phase of sodium channel

Prolongs ventricular AP
Reduces ventricular tension
Decrease oxygen demand

NO EFFECT ON HR or BP

Chronic stable angina in combo therapy or inadequate response with other anti-angina agents

20
Q

Side effects of Ranolazine

A

Constipation
Headache
Nausea
Dizziness

LOW DC RATE, avoid in pts with cirrhosis

21
Q

Ranolazine drug drug interactions

A 
D- digoxin  
A - azole derivatives
N - non-DHP CCB 
G - grapefruit
S- Simvastatin
22
Q

Ischemic heart disease treatment goals

A
  1. Alteration of atherosclerosis via risk factor modification
  2. Provide symptomatic relief using pharm agents
23
Q

Risk factor - post menopausal hormone replacement

A

Associated with lower CHD

HERS trial (no difference, increased thromboembolism issues)

Women’s health initiative (increases CHD, stroke, emboli events, breast cancer)

NOT recommended in primary or secondary prevention

24
Q

Acute coronary syndromes

Treatment goal

A

Relieve chest discomfort

Optimize blood flow to infant or related artery

Prevent coronary occlusion

Prevent death

25
Q

Acute drug therapy (8)

A 
Analgesia 
Nitroglycerin 
Lidocaine 
Beta blockers 
Fibrinolytics 
Asa 
Heparin 
Mg
26
Q

drugs NOTused during acute MI

A 
Digoxin 
Nitroprusside 
CCB 
NSAID 
Enalapril 
Steroids

“Do Not Consider in aN Emergent Setting”

27
Q

Morphine

DOC and MOA

A

DOC for acute management of pain with MI NOT RELIEVED WITH NG OR BB

Blocks sympathetic efferent discharge causing venous and arterial dilation

28
Q

Morphine dose and monitor

A

1-5 mg IV q 5-15 min

Pain relief, allergic response, vitals (BP, HR, RR), CNS/respiratory depression

Can be reversed with NARCAN

29
Q

Nitroglycerin in an acute setting

A

Relieves pain decreasing preload and oxygen demand

SL nitro first, then IV drip if pain persists (should have gotten SL in ambulance)

Avoid in BP <90, CI in cases of RV INFARCTION

Don’t use for more than 48hrs (unless persistent CP, HF, or HTN)

30
Q

Oxygen in an acute setting

A

Indicated in patients with O2 Sat under 90– otherwise induce vasospasm

Given to pts with high oxygen demand

Don’t over do in COPD

31
Q

Beta blockers in the acute setting

Actions

A

Immediate administration reduces the size of infarction via improving perfusion

Decreases further infarction, recurrent ischemia, reinfarction

Decreases mortality

Decrease ventricular arrhythmia

32
Q

Administration BB acute setting

A

Oral in first 24 hrs to pts w/o CI

IV can be used, but not better (can cause HoTN)

No benefit if given prior to PCI

Titration to HR of 70 bpm

33
Q

CI to BB in acute setting

A

Signs of HF

Bradycardia (<55bpm)

HoTN/cardiogenic shock

Greater than first degree AV block

ACTIVE asthma and bronchospasm

34
Q

CCB in acute MI setting

A

symptom relief ONLY (after event normally)

NSTEMI (no relief despite max BB and nitrates — still choose morphine)

Pts with ACS, unable to tolerate BB

Typically in drugs that we avoid

35
Q

Anti-coagulation during acute event

A

Stops propagation of clot and assists in preventing re-occlusion

unstable angina or NSTEMI - LMWH preferred or UFH

UFH is given in PCI bc less drug interactions

36
Q

Alternative to heparin in anticoagulant tx in acute event

A

Fondaparinux (Arixtra)
Bilvalrudin (angiomax) - direct thrombin
Rivaroxaban (Xarelto)

37
Q

ASA

MOA, ADR, CI

A

Block Cox1 and Cox 2 = Decreased thromboxane A2 formation

ADRS= GI bleed, hypersensitivity, bleeding

CI: EtOH use, high dose in CKD, children and teens, pregnancy

38
Q

Thienopyridines

A

Plavix (CLopidogrel)
Prasugrel (Effient)
Ticagrelor (Brilinta)

Blocks activation of GP 2b/3a receptor, reducing platelet aggregation

39
Q

Clopidigrel

Indications, brand, dosing

A

Plavix

MI/ACS (UA/NSTEMI/STEMI)

Stroke

PAD

Dosing: 75mg/day, 300-600mg loading dose

40
Q

Plavix ADR

A

bleeding (esp. >70 or <60kg)

TTP

CKD can cause problems with serum [ ]

Poor metabolizers - genetic disorder causing ineffective breakdown

41
Q

Prasugrel (Effient)

Indications and pharmacokinetics

A

ACS, CAD

C/i in patients older than 75 or history of stroke/TIA

No renal or hepatic adjustments needed but liver might be

42
Q

Prasugrel Effient

Dose, BBW

A

Dose: loading 60mg, 5-10 daily

BBW: d/c in >75 yrs (fatal intercranial bleeding and uncertain benefit), hold 7+ days prior to six

43
Q

Ticagrelor

Brand, indications, dose

A

Brilinta

ACS, CAD

Dose: 180 mg loading, 90 mg bid

44
Q

Brilinta

ADR, BBW

A

Ticagrelor

ADR: increased bleeding risk, dypsnea, caution in gout

BBW: reduced efficacy with ASA use (low dose only), dc 5 days before sx, metabolized by liver, tablets crushed

45
Q

IV GP 2b/3a

A

Used during PCI

Intense inhibition of platelet function

46
Q

Fibrinolytics

A

late please

Activates plasminogen (converts plasmin)

Beneficial in limiting infarct size, improving LV function and reducing mortality

12-24 hrs of CP (significant ST elevation, invasive strategy is not option)

UFH/LMWH/fondaparinux

FA17 Cardio 2 (10 decks)

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