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Natsumi - NPLEX 2 > Natsumi Pharm - Cardio, Heme > Flashcards

Natsumi Pharm - Cardio, Heme Flashcards

1
Q

Pregnancy Category of ACEi

A

Preg category D

Contraindicated in pregnancy and use caution in lactation

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2
Q

The first dose side effect of ACEi

Other significant side effects:

ACEi is contraindicated in:

A

Acute renal failure!

Dry cough, hyperkalemia, angioedema, impotence, dizziness

C/I: pregnancy, bilateral renal stenosis, hx of angioedema

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3
Q

Nutrition depletion of ACEi

A

Zinc, Na+

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4
Q

-pri ending

A

ACE inhibitors

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5
Q

Ramipril, Lisinopril

Common indication and drug-specific indication

C/I

A

Anti-hypertensive drugs

Lisinopril: CHF, post-MI to reduce mortality
Ramipril: Tx of CHF after MI

“R comes after L”

DO NOT use in blacks

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6
Q

Which antihypertensive drugs are better for blacks?

NOT for black?

A

Hydrochlorothiazide, amlodipine

Do NOT use: ACEi, ARBs, Losartan

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7
Q

Clonidine class and indication

Caution using this drug?

Side effect (2)

A

alpha-2 agonist

I: ADHD, HTN

Caution: first dose SUPER anti-HTN, use in office!

S/E: Depression & LL edema

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8
Q

Doxazosin, Terazosin

  • Common indication
  • First dose effect
  • S/E (3)
  • Pregnancy category
A

Alpha-1 antagonist:
Antihypertensive, BPH

1st dose effect - syncope

S/E: priapism, asthenia, dizziness, increased BUN

Pregnancy category C

*Priapism = long-lasting painful erection

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9
Q

-artan ending

A

ARBs

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10
Q

Irbesartan, Losartan, Valsartan

  • Common indication and specific indication
  • S/E (3)
  • C/I
  • Pregnancy category
A

ARBs - Antihypertensive

Irbesartan & Losartan - Diabetic nephropathy

Losartan - LVH

Valsartan - HF

S/E: Hyperkalemia, cough, rhabdomyolysis, impotence

DO NOT use in blacks

Pregnancy category D

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11
Q

Caution with Clonidine if withdrawn too quickly?

Which drug can clonidine increase the toxicity of?

A

Rebound hypertension if withdrawn too quickly

Increase cyclosporin toxicity with clonidine

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12
Q

Signs of hyperkalemia

A

Confusion, body weakness, uneven heartbeat, numbness and tingling in finger/toes

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13
Q

ARB and ACEi with ___ can cause hyperkalemia

A

K+ sparing diuretics or K+ supplements

Increased risk of hyperkalemia and hypotension!

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14
Q

Beta-blockers deplete which nutrition

A

CoQ10, Melatonin, Chromium

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15
Q

Atenolol, Metoprolol, Propranolol, Carvedilol

  • Common indications and separate indications
  • Beta-blocker side effects
  • C/I
A

Beta-blockers - antihypertensive

Angina, MI: atenolol, propranolol, metoprolol

Propranolol - afib, migraine, hypertrophic subaortic stenosis, essential tremor, pheochromocytoma. Off label - anxiety and hyperthyroidism

Carvedilol - LV dysfxn post-MI & CHF

S/E: Depression, importance, nightmares, dyslipidemia, dysglycemia

C/I - asthma, COPD, diabetes

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16
Q

Caution with beta-blockers?

A

DO NOT abruptly stop, can cause tachycardia and rebound hypertension

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17
Q

Atenolol indication & caution

A

HTN, Diabetic nephropathy

Pregnancy category D

S/E: Depression, importance, nightmares, dyslipidemia, dysglycemia

C/I - asthma, COPD, diabetes

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18
Q

Metoprolol indication & caution

A

HTN in patients with LVH
Diabetic nephropathy

S/E: Depression, impotence, nightmares, dyslipidemia, dysglycemia

C/I - asthma, COPD, diabetes

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19
Q

Which drug is specifically for patients with HTN and LVH

Which one is not for blacks

A

Losartan and Metoprolol

Do NOT use Losartan with blacks

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20
Q

Propranolol indication and off-label indication

A

HTN, angina, CHF, afib, migraine, subaortic stenosis, essential tremor, pheochromocytoma

Off-label: hyperthyroidism and anxiety

S/E: Depression, importance, nightmares, dyslipidemia, dysglycemia

C/I - asthma, COPD, diabetes

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21
Q

Carvedilol indication & caution

A

LCH dysfunction post-MI, CHF

S/E: Depression, importance, nightmares, dyslipidemia, dysglycemia

C/I - asthma, COPD, diabetes

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22
Q

Beta-blockers with antidiabetics may cause what?

A

Decreased anti-glycemic control

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23
Q

Amlodipine indication & caution

A

CCB - HTN (arteriole dilator) and stable/Prinzmeta’s angina

CAUTION: emotional lability, depression, anxiety in petite elderly women

S/E: Peripheral edema, HA, stomach upset,

Contraindicated in sick sinus syndrome, 2nd/3rd degree AV block, hypotension, acute MI + pulmonary congestion

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24
Q

Verapamil indication, SE, CI

A

CCB - arrhythmia (works directly on the heart)

S/E: Peripheral edema, HA, stomach upset,

Contraindicated in sick sinus syndrome, 2nd/3rd degree AV block, hypotension, acute MI + pulmonary congestion

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25
Q

Diltiazem indication, SE, CI

A

CCB - arrhythmia (works directly on the heart)

S/E: Peripheral edema, HA, stomach upset,

Contraindicated in sick sinus syndrome, 2nd/3rd degree AV block, hypotension, acute MI + pulmonary congestion

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26
Q

CCB nutrient depletion for each specific CCB

A

Amlodipine - Potassium wasting & vitamin D

verapamil - vitamin E

Ditiazem - None known

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27
Q

Hydralazine indication & C/I, nutrient depletion

A

Other antihypertensive drug

C/I: coronary heart dz, mitral valvular rheumatic dz

Nutrient depletion: Vitamin B6

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28
Q

Epinephrine

  • indication
  • route of administration
  • SE
A

Beta agonist

  • Hypotensive crisis, bradycardia, HF, cardiac stabilization before pacemaker implantation, anaphylaxis
  • IV in the hospital

Part of crash cart for BOTTOMED out BP

Pregnancy category C

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29
Q

Nitroglycerin

  • indication
  • route of administration
  • SE
  • C/I
A

Nitrate - angina (acute & prophylaxis)

Half-life of about 5 minutes; active metabolites with 40 minute half-lives

Dosed sublingually for symptomatic discomfort, up to 3 doses (q 5 min); then to ER!!!

Available as transdermal patch and ointment, too

S/E: Headache; fast, slow, pounding, or uneven heart rate; blurred vision or dry mouth; feeling light-headed, nausea, vomiting, sweating, pale skin fainting; or fever, sore throat, and headache with a severe blistering, peeling, and red skin rash

Contraindicated with concomitant use of cGMP PDE-5 inhibitors**

30
Q

Isosorbide mononitrate

  • indication
  • route of administration
  • SE
  • C/I
A

Nitrate - angina prophylaxis only

Headache; fast, slow, pounding, or uneven heart rate; blurred vision or dry mouth; feeling light-headed, nausea, vomiting, sweating, pale skin fainting; or fever, sore throat, and headache with a severe blistering, peeling, and red skin rash

Contraindicated with concomitant use of cGMP PDE-5 inhibitors**

31
Q

Nitrate vasodilator Nutritional Considerations

A

Folate, B12 and vitamin C (folic acid & C may decrease tolerance)

Consider: Arginine, Lysine, L-carnitine

32
Q

Lidocaine

A

Class Ib anti-arrhythmics - Ventricular arrhythmias

Alternative (last resort) option anti-arrhythmic and anti-epileptic (status epilepticus)

Amide local anesthetic

No known nutrient depletions

Pregnancy category B

33
Q

Flecanide

A

Class Ic - Paroxysmal supraventricular tachycardias (PSVT) or paroxysmal atrial fibrillation/flutter (PAF) with disabling symptoms or life-threatening ventricular arrhythmias

DO not use in people with hx of MI

No known nutrient depletions

Pregnancy category C

Black box warning: increased mortality.

34
Q

Na+ channel blockers

A

Lidocaine and Flecanide

LAST RESORT after trying other anti-arrhythmic classes!

35
Q

Class II antiarrhythmics

A

Beta blockers

36
Q

Class III antiarrhythmics

A

K+ channel blockers - Amiodarone

37
Q

Amiodarone

Indication
What should you monitor with this drug?

A 
Mostly class III, but acts as class I, class II, class IV 
Mechanism of action may be due to  
a prolongation of the myocardial cell-action potential duration and refractory period (inhibits potassium channels—class III-like)
non-competitive antagonism of α- and β-adrenoceptors (class II-like)

Reverse use-dependency: prolongation most pronounced at slow rates (undesirable), least pronounced at fast rates (desirable)
Inhibits repolarization

Useful in recurrent ventricular fibrillation and recurrent hemodynamically unstable ventricular tachycardia

Monitor - thyroid state

38
Q

Amiodarone SE, C/I, nutrient depletion

A

Side effects: hypotension, pulmonary toxicities (potentially fatal), hyperthyroidism/hypothyroidism due to structural similarity to thyroxine, abnormal increase in hepatic enzymes, AV nodal block & bradycardia

Contraindicated in cardiogenic shock, second or third-degree heart block, severe SA node dysfunction with marked sinus bradycardia or syncope

Nutrient depletions: Vitamin B6

Pregnancy category D

39
Q

Class IV antiarrhythmics

A

CCB

40
Q

Class V antiarrhythmics

A

Digoxin, Potassium chloride

41
Q

Digoxin

  • Nutrient depletion
  • drug interaction
A

Bradycardic and inotropic

Used in heart failure (has not been shown to improve survival, but may palliate symptoms, improve functional status, reduce hospitalizations), atrial fibrillation, to control ventricular rate in patients with long-standing atrial fibrillation

Class V anti-arrhythmic (“Other”)
Excreted primarily via kidneys, unchanged; gut, liver metabolism

Reduce dose in chronic kidney disease
Watch potassium levels! Hypokalemia increases myocardial localization of digoxin; may use potassium to decrease symptoms of digoxin toxicity

Interacts with β-blockers, calcium channel blockers, potassium-wasting diuretics, many antibiotics, verapamil, quinidine, amiodarone
Anti-digoxin antibodies are available for life-threatening digoxin toxicity
Depletes calcium

Pregnancy category C

42
Q

Potassium chloride

A

Very narrow therapeutic window

Used in hypokalemia due to digitalis intoxication, familial periodic paralysis, diuretic use, cardiac arrhythmias

Side effects: hyperkalemia (contraindication), gastric/intestinal irritation and bleeding

Pregnancy category C

43
Q

Furosemide

A

Diuretic that exerts effect in loop of Henle
Used in edema (all causes) and hypertension
Also used in malignant hypertension and volume-based hypertension in patients with advanced chronic kidney disease
Use in mild-moderate chronic hypertension not as useful (short half-life)

SE: Electrolyte imbalances, thirst; Tinnitus, loss of hearing (dose-related ototoxicity)

44
Q

Furosemide nutrient depletion

A 
Calcium
Magnesium
Potassium
Vitamins B (1,6,12)
Sodium
Zinc
Folic Acid
CoQ10
Mixed tocopherols
Vitamin C
45
Q

Hydrochlorothiazide

A 
Thiazide diuretic
Until recently (JNC-8), was first step therapy for hypertension
Hydrochlorothiazide (HCTZ), Hydrodiuril
Used alone and/or in combination
Treatment of chronic hypertension

SE: Blurred vision, headache (may idiosyncratically cause acute myopia & secondary angle-closure glaucoma)
Upset stomach, nausea, vomiting, diarrhea
Weakness, dizziness
Cramps, thirst

46
Q

Hydrochlorothiazide Nutrient depletion

A 
CoQ-10
Magnesium
Sodium
Potassium
Zinc
47
Q

Spironolactone

A

K+ sparing diuretic

Aldosterone receptor antagonist, significant androgen receptor blocking action; competitive inhibitor of testosterone and dihydrotestosterone
Used in edema, CHF, primary aldosteronism, essential hypertension, hypokalemia
Triamterene, Dyrenium
Blocks epithelial sodium channels in the late distal convoluted tubule (DCT) and collecting duct which inhibits sodium reabsorption from the lumen. This effectively reduces intracellular sodium, decreasing the function of Na+/K+ ATPase, leading to potassium retention and decreased calcium, magnesium, and hydrogen excretion.
Used in edema. Off-label use: hypertension in children/adolescents and anti-hypertensive diuretic induced hypokalemia.
Used primarily in a combination (used alone, much less effective in reducing hypertension)

SE: Hyperkalemia, tumorigenic.

DO NOT USE WITH ACEi, ARB

48
Q

Besides HTN, what else can you use spironolactone for?

A

PCOS

49
Q

Triamterene nutrient depletion

A

Folic acid

Zinc

50
Q

Colesevelam

A

Indications for use: DMII (NIDDM) in conjunction with diet and exercise, heterozygous familial hypercholesterolemia, hyperlipidemia
Contraindications: history of bowel obstructions, TG > 500, history of hypertriglyceridemia-induced pancreatitis
Side effects: GI complaints

Pregnancy category B

51
Q

Colesevelam nutrient depletion

A

CRAP LOAD!

Riboflavin
Folic acid
Vitamin B12
Vitamin B6
Mixed tocopherols/tocotrienols
Coenzyme Q-10
Magnesium
Vitamin K
Vitamin D
Vitamin A
Carotenoids
Essential fatty acids
52
Q

Gemfibrozil

A

To be used in triad of LOW HDL + HIGH LDL + High Triglycerides**

To be used AFTER diet, exercise, weight loss, other pharmaceuticals (bile acid sequestrants, niacin) have been tried

Uses: Treatment of adult patients with very high elevations of serum triglyceride levels (Types IV and V hyperlipidemia) who present a risk of pancreatitis and who do not respond adequately to a determined dietary effort to control them. (Patients who present such risk typically have serum triglycerides over 2000 mg/dL.)

Warning: GALLBLADDER DISEASE, ABDOMINAL PAIN LEADING TO APPENDECTOMY AND OTHER ABDOMINAL SURGERIES,

SE: DVT, SOB, pulmonary embolism; Coughing up blood, Increase in homocysteine levels

53
Q

Gemfibrozil nutrient depletion

A 
Vitamin E, B12
Copper
Zinc
CoQ10
(Vitamins B6, folic acid) (because fibrates increase homocysteine)
54
Q

Atorvastatin, Simvastatin

Statins with gemfibrozil causes?

FIrst dose effect?

A

The increased risk with niacin for myopathy!

Statins with gemfibrozil inceases rhabdomyolysis

The first dose gives you the biggest reduction; takes abourt 3 weeks to figure out how it wil affect the blood look at the lipid panel to adjust dosing

Metabolized primarily in the liver (CYP450!)

55
Q

Simvastatin nutrient depletion

A

CoQ-10

Consider co-administration of L-carnitine, Vitamin C, omega-3 fatty acids

56
Q

Atorvastatin

A

SE: Neuropathy; rhabdomyolysis; Memory loss; ; Blood sugar irregularities

Contraindicated in acute liver disease

Pregnancy category X

57
Q

Ezetimibe

A

Used for: hyperlipidemia, including homozygous familial hypercholesterolemia (HoFH) and homozygous sitosterolemia
Contraindicated in patients with active liver disease, pregnant or nursing women, women who may become pregnant
No known nutrient depletions
Pregnancy category C

58
Q

Vitamin K

A

Pro-coagulation

59
Q

Clopidogrel

A

Anti-coagulant - anti-platelet agent

  • Combo with aspirin to prevent stent thrombosis post-op
  • Acute coronary syndrome, STEMI, recent MI, stroke, PAD
60
Q

Aspirin

A

Anti-coagulant - anti-platelet agent

61
Q

Warfarin

A

Anti-coagulant - Vitamin K recycling

62
Q

Pentoxifylline

A

Anti-coagulant - Xanthine derivative

63
Q

Heparin

A

Anti-coagulant - X factor inhibitor

64
Q

Enoxaparin

A

Anti-coagulant - X factor inhibitor

65
Q

Rivaroxaban

A

Anti-coagulant - Xa factor inhibitor

66
Q

Dabigatran

A

Anti-coagulant -

67
Q

Calcium EDTA

A

Chelator

mercury, lead, iron,

68
Q

DMPS

A

Chelator

69
Q

DMSA

A

Chelator

70
Q

Penicillamine

A

Chelator, wilson’s dz for copper

71
Q

Deferoxamine

A

Chelator

72
Q

Epoitin alpfa

A

Aplastic anemia

Natsumi - NPLEX 2 (37 decks)

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