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lecture 3 Flashcards

1
Q

_______are potent vasodilators that could cause reflex tachycardia

_______ decrease HR with some vasodilatory effect

A

DHP

NON- DHP (verapamil (diltiazem)

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2
Q

CCB MOA

A

block L type calcium channels

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3
Q

how do CCBs affect cardiac cells

A

Lead to decrease in chronotropy and inotropy

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4
Q

How do DHPs affect HR, contractility, conduction and vasodilation

A

Increase HR
decrease contractility
no effect on conduction
increase vasodilation

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5
Q

How does verapamil affect HR, contractility, conduction and vasodilation

A

decrease HR
GREATLY decreases contractility
GREATLY decreases AV node
Increases vasodilation

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6
Q

How does diltiazem affect HR, contractility, conduction and vasodilation

A

decrease HR
decrease contractility
decrease conduction

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7
Q

DO DHPs have a stronger vasodilatory effect in vasculature or heart

A

Much stronger vasodilatory effect

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8
Q

amlodipine brand name and dosing

A

Norvasc (5-10 mg)

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9
Q

Verapamil brand name and dosing

A

Isoptin, 60-90 mg TID-QID

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10
Q

diltiazem brand name and dosing

A

Cardizen, 80-120 mg TID

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11
Q

adverse effects of DHPs

A

DHPs- hypotension, flushing, dizziness, edema

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12
Q

adverse effects of non DHPs

A

non-DHP (verapamil, diltiazem)- hypotension, constipation, decreased myocardial contractility, Contraindicated in HF

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13
Q

monitoring parameters for CCBs

A

edema, BP

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14
Q

why are nitrates never used as monotherapy

A

Tolerance

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15
Q

how to avoid tolerance in nitrates

A

Nitrate free period of atleast 10-12 hrs

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16
Q

How does nitrate tolerance occur?

A

ALDH2 inactivation

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17
Q

How to use NTG patch

A

Put on in morning, take off at night (7 AM-7 PM)
on for 12-14 hrs, off for 10-12 hrs

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18
Q

How to use ISDN tabs

A

2-3 x a day
8 AM, 12 PM, 4 PM
10 mg

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19
Q

How to use ISMN tabs

A

2 X/day 7 hrs apart
8 AM and 3 PM
20 mg

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20
Q

ISMN SR tabs use

A

QD 8AM
30 mg

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21
Q

patient counseling nitrate patches

A

Apply patches between elbow and knee
clean, dry and hairless region
differet area each day
you can shower while wearing it
do not cut patch
wash hands before and after

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22
Q

counseling on NTG ointment

A

DO not rub or massage ointment
DO not cover area

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23
Q

what are the primary agents that cause vasodilator induced tachycardia

A

Nitrates and DHPs

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24
Q

Nitrates primary effect is on ______ and ______ (much more on _______)

A

pre load and afterload (much more on preload)

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25
B blockers reduce
HR, contractility and BP
26
Nifedipine reduces
Preload and to a smaller extent afterload
27
does Ranolazine affect HR, contractility, afterload or pre load
no
28
How does Ranolazine work
Ranolazine inhibits Na channel and interrupts angina without affect HR, BP or afterload
29
Ranozaline brand name and dosing
Ranexa 500 mg ER tablets
30
When can ranolazine be used as 1st line tx
Only when BP/HR is too low for 1st line agents
31
ranolazine metabolized by
CYP3A4
32
What effect does ranolazine being metabolized by CYP3A4 cause
causes drug drug interaction. SHould not be used with pther strong 3A4 inhibitors or inducers
33
Name strong CYP3A4 inhibitors
Ketoconazole, itraconazole, protease inhibitors, clarithromycin
34
Name strong CYP3A4 inducers
carbamezapine, rifampin, st johns wort
35
how to adjust dose of ranolazine when taking with verapamil and diltiazem
500 mg BID
36
adverse rxns of ranolazine
Dose related increase in QT interval (should not be used with other QT prolonging drugs)
37
monoket
ISMN
38
Norvasc
amlodipine (QD)
39
when do we never use B blockers
if a patient has significant asthma. We can not use selective or non selective
40
what patients are B blockers specifically useful in?
Stable HF, history of MI
41
When to avoid B blockers? COntraindication?
Avoid in vasospastic angina contraindicated in bradycardia (HR<50), high degree AV block or risk sinus syndrome
42
Which is first line? BB, CCB or nitrate
BB
43
If BB is contraindicated, what do we prefer to use
Non DHP CCBs
44
when do we use non DHP CCBs
- contraindication to B blockers - unacceptable B blocker side effects
45
non DHP contraindications
HFrEF, bradycardia, high degree AV block or sick sinus syndrome
46
DHP contraindications
HFrEF (except amlodipine and felodipine)
47
Caution with nitrates
PDE 5 usage
48
clinical conditions that favor use of b blocker
Prior ACS/MI HF, LVD, hyperthyroidism
49
name combo therapies
Nitrates + B blockers DHP CCBs +B blocker triple therapy (B blocker, nitrate and CCB)
50
WHat combo should be avoided? why?
B blocker and non DHP CCB sghould be avoided due to HR lowering
51
treatment algorithim of angina
-management of angina (use NTG) -Is it vasospastic angina? if yes (if BP<130/80 add nitrate, if BP>or=130/80 add CCB) if no ( HR>60 use B blocker as 1st line and non DHP CCBs as second line) If there is still angina if BP<130/80 add ranolazine or nitrate If BP >130/80 add DHP
52
treatment algorithim for risk factor modification
LSM Vaccination Aspirin or clopidogrel ACE inhibitor
53
WHich NSAIDs should be used? which should be avoided
Select ibuprofen or naproxen as 1st alternative avoid diclofenac
54
how to take ASA and NSAIDs
Take ASA 2 hrs before NSAID
55
What is a vasospasm
Ischemia associated with spasm.
56
Do vasospaqsm require plaque
no
57
Does vasospasm occur with or without exertion
At rest (no exertion)
58
symptoms of vasospasm
ST segment elevation Mostly in early morning
59
Tx of vasospasm 1st line
CCB (1st line)
60
2nd line tx of vasospasm
Nitrate
61
What should we never use for vasospasms
B blockers
62

Therapeutics (38 decks)

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