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Therapeutics > lecture 3 > Flashcards

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
Q

B blockers reduce

A

HR, contractility and BP

26
Q

Nifedipine reduces

A

Preload and to a smaller extent afterload

27
Q

does Ranolazine affect HR, contractility, afterload or pre load

A

no

28
Q

How does Ranolazine work

A

Ranolazine inhibits Na channel and interrupts angina without affect HR, BP or afterload

29
Q

Ranozaline brand name and dosing

A

Ranexa 500 mg ER tablets

30
Q

When can ranolazine be used as 1st line tx

A

Only when BP/HR is too low for 1st line agents

31
Q

ranolazine metabolized by

A

CYP3A4

32
Q

What effect does ranolazine being metabolized by CYP3A4 cause

A

causes drug drug interaction. SHould not be used with pther strong 3A4 inhibitors or inducers

33
Q

Name strong CYP3A4 inhibitors

A

Ketoconazole, itraconazole, protease inhibitors, clarithromycin

34
Q

Name strong CYP3A4 inducers

A

carbamezapine, rifampin, st johns wort

35
Q

how to adjust dose of ranolazine when taking with verapamil and diltiazem

A

500 mg BID

36
Q

adverse rxns of ranolazine

A

Dose related increase in QT interval (should not be used with other QT prolonging drugs)

37
Q

monoket

A

ISMN

38
Q

Norvasc

A

amlodipine (QD)

39
Q

when do we never use B blockers

A

if a patient has significant asthma. We can not use selective or non selective

40
Q

what patients are B blockers specifically useful in?

A

Stable HF, history of MI

41
Q

When to avoid B blockers? COntraindication?

A

Avoid in vasospastic angina
contraindicated in bradycardia (HR<50), high degree AV block or risk sinus syndrome

42
Q

Which is first line? BB, CCB or nitrate

A

BB

43
Q

If BB is contraindicated, what do we prefer to use

A

Non DHP CCBs

44
Q

when do we use non DHP CCBs

A
  • contraindication to B blockers
  • unacceptable B blocker side effects
45
Q

non DHP contraindications

A

HFrEF, bradycardia, high degree AV block or sick sinus syndrome

46
Q

DHP contraindications

A

HFrEF (except amlodipine and felodipine)

47
Q

Caution with nitrates

A

PDE 5 usage

48
Q

clinical conditions that favor use of b blocker

A

Prior ACS/MI
HF, LVD, hyperthyroidism

49
Q

name combo therapies

A

Nitrates + B blockers
DHP CCBs +B blocker
triple therapy (B blocker, nitrate and CCB)

50
Q

WHat combo should be avoided? why?

A

B blocker and non DHP CCB sghould be avoided due to HR lowering

51
Q

treatment algorithim of angina

A

-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
Q

treatment algorithim for risk factor modification

A

LSM
Vaccination
Aspirin or clopidogrel
ACE inhibitor

53
Q

WHich NSAIDs should be used? which should be avoided

A

Select ibuprofen or naproxen as 1st alternative
avoid diclofenac

54
Q

how to take ASA and NSAIDs

A

Take ASA 2 hrs before NSAID

55
Q

What is a vasospasm

A

Ischemia associated with spasm.

56
Q

Do vasospaqsm require plaque

A

no

57
Q

Does vasospasm occur with or without exertion

A

At rest (no exertion)

58
Q

symptoms of vasospasm

A

ST segment elevation
Mostly in early morning

59
Q

Tx of vasospasm 1st line

A

CCB (1st line)

60
Q

2nd line tx of vasospasm

A

Nitrate

61
Q

What should we never use for vasospasms

A

B blockers

62
Q
A

Therapeutics (38 decks)

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