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Med School > Pharm Block 2 (Heart and Lung) > Flashcards

Pharm Block 2 (Heart and Lung) Flashcards

1
Q

Acetazolamide

A

Carbonic Anhydrase Inhibitor
decreases NaHCO3 reabsorption
Adverse: metabolic acidosis, others
Used to treat glaucoma/not used as a diuretic often

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2
Q

Amiloride

A

Sodium Channel Blocker (K sparing)
Inhibits Na channels (blocks Na reab) in collecting tubules, decreases K and H secretion
Used with thiazide or loop diuretic to save potassium
Adverse:hyperkalemia

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3
Q

Bumetanide

A

Loop Diuretic
Dose dependent, blocks salt reabsorption in thick ascending Henle by inhibiting Na/K/Cl cotransporter
Adverse: hypokalemia, metabolic alkalosis, hyperuricemia, hypomagnesemia, hypovolemia, hyponatremia, toxic, allergic

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4
Q

Chlorothiazide

A

Thiazide
Blocks salt reabsorption in distal convoluted tubule, also decreases vascular resistance long term, decreases calcium excretion
Adverse: hypokalemia, alkalosis, hyperuricemia, hyperglycemia, hyperlipidemia, hypovolemia, hyponatremia, allergy

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5
Q

Chlorthalidone

A

Thiazide
Blocks salt reabsorption in distal convoluted tubule, also decreases vascular resistance long term, decreases calcium excretion
Adverse: hypokalemia, alkalosis, hyperuricemia, hyperglycemia, hyperlipidemia, hypovolemia, hyponatremia, allergy

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6
Q

Eplerenone

A

Aldosterone antag
blocks aldosterone in collecting tubules
Adverse: hyperkalemia

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7
Q

Ethacrynic Acid

A

Loop Diuretic
Dose dependent, blocks salt reabsorption in thick ascending Henle by inhibiting Na/K/Cl cotransporter
Adverse: hypokalemia, metabolic alkalosis, hyperuricemia, hypomagnesemia, hypovolemia, hyponatremia, toxic, allergic

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8
Q

Furosemide

A

Loop Diuretic
Dose dependent, blocks salt reabsorption in thick ascending Henle by inhibiting Na/K/Cl cotransporter
Used with saline therapy to treat hypercalcemia
Adverse: hypokalemia, metabolic alkalosis, hyperuricemia, hypomagnesemia, hypovolemia, hyponatremia, toxic, allergic

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9
Q

Hydrochlorothiazide

A

Thiazide
Blocks salt reabsorption in distal convoluted tubule, also decreases vascular resistance long term, decreases calcium excretion
Adverse: hypokalemia, alkalosis, hyperuricemia, hyperglycemia, hyperlipidemia, hypovolemia, hyponatremia, allergy

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10
Q

Mannitol

A

Osmotic Diuretic
Filtered at glomerulus, increases osmolality of tubular fluid and decreases water and sodium reabsorption
Used as diuretic and intracranial pressure decreaser

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11
Q

Metolazone

A

Thiazide
Blocks salt reabsorption in distal convoluted tubule, also decreases vascular resistance long term, decreases calcium excretion
Adverse: hypokalemia, alkalosis, hyperuricemia, hyperglycemia, hyperlipidemia, hypovolemia, hyponatremia, allergy

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12
Q

Spironolactone

A

Aldosterone antag
blocks aldosterone in collecting tubules
Used in hyperaldosteronism
Adverse: hyperkalemia and gynecomastia

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13
Q

Torsemide

A

Loop Diuretic
Dose dependent, blocks salt reabsorption in thick ascending Henle by inhibiting Na/K/Cl cotransporter
Adverse: hypokalemia, metabolic alkalosis, hyperuricemia, hypomagnesemia, hypovolemia, hyponatremia, toxic, allergic

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14
Q

Triamterene

A

Sodium Channel Blocker (K sparing)
Inhibits Na channels (blocks Na reab) in collecting tubules, decreases K and H secretion
Used with thiazide or loop diuretic to save potassium
Adverse:hyperkalemia

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15
Q

Desmopressin

A

Like vasopressin but more antidiuretic than pressor (more V2 specific)
Increases permeability of collecting tubule to water through water channel (V2)
Used for diabetes insipidus
Adverse: water intoxication, allergy, vascular and GI (V1 mediated)

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16
Q

Vasopressin

A

ADH
Increases permeability of collecting tubule to water through water channel (V2)
Used for diabetes insipidus
Adverse: water intoxication, allergy, vascular and GI (V1 mediated)

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17
Q

Conivaptan

A

V1 and V2 receptor antag
Used for euvolemia and hypervolemia hyponatremia (not heart failure), IV
Adverse: Infusion site reaction, if Na saved too quickly can be a big problem, drug interactions

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18
Q

Tolvaptan

A

Selective V2 antag
used for hypervolemia and euvolemic hyponatremia (heart failure, cirrhosis, SIADH), Oral
Adverse: thirsty, dry mouth, polyuria, too much Na saving too soon bad, GI bleeds with cirrhosis, drug interatctions

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19
Q

Aliskiren

A

Inhibs Renin so decreased angio I and II
oral
Adverse: diarrhea, angioedema, cough, hyperkalemia, fetal toxicity

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20
Q

Captopril

A

ACE inhibitor
Inhibit Angiotensin I to AngII so decreased vasoconstriction and aldosterone, increase bradykinin (vasodilator)
Disease state uses: in bilateral renal artery stenosis can get decreased GFR and in chronic renal disease they diminish proteinuria and stabilize renal funct
Adverse: hypotension, cough, angioedema, hyperkalemia, decreased renal funct, fetal toxicity, skin rash, alteration in taste

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21
Q

Clonidine

A

CNS anti HTN
Stims alpha 2 decreasing symp output (also interacts with imidazoline receptors)
Adverse: sedation, depression, dry mouth, orthostatic hypotension, hypertensive crisis by sudden withdrawl

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22
Q

Diazoxide

A

Vasodilation HTN
IV HTN emergency
opens potassium channels
Adverse: hypotension, reflex symp stim (don’t use if ischemic heart disease), fluid retention, hyperglycemia

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23
Q

Enalapril

A

ACE inhibitor
Inhibit Angiotensin I to AngII so decreased vasoconstriction and aldosterone, increase bradykinin (vasodilator)
Disease state uses: in bilateral renal artery stenosis can get decreased GFR and in chronic renal disease they diminish proteinuria and stabilize renal funct
Adverse: hypotension, cough, angioedema, hyperkalemia, decreased renal funct, fetal toxicity, skin rash, alteration in taste

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24
Q

Fenoldopam

A

Vasodilation HTN
Continuous IV drug for hypertensive emergencies
acts through dopamine 1 receptors
Adverse: headache, flushing, tachycardia, increased intraocular pressure

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25
Q

Hydralazine

A

Vasodilator HTN
Relaxes smooth muscle through NO release, use with beta blocker and diuretic to combat compensatory response, combine with organic nitrate for heart failure
Adverse: palpitations, angina, headache, drug induced lupus
Eliminated via acetylation so watch for slow acetylators

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26
Q

Lisinopril

A

ACE inhibitor
Inhibit Angiotensin I to AngII so decreased vasoconstriction and aldosterone, increase bradykinin (vasodilator)
Disease state uses: in bilateral renal artery stenosis can get decreased GFR and in chronic renal disease they diminish proteinuria and stabilize renal funct
Adverse: hypotension, cough, angioedema, hyperkalemia, decreased renal funct, fetal toxicity, skin rash, alteration in taste

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27
Q

Losartan

A

Ang II receptor blocker
Oral
Adverse: hypotension, hyperkalemia, angioedema, cough, fetal toxicity

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28
Q

Methyldopa

A

CNS antiHTN
Alpha 2 ag (metabolite is)
Adverse: sedation, decrease concentration, depression, hyperprolactinemia, dry mouth, ortho hypotension, hepatotoxicity, positive Coombs and hemolytic anemia

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29
Q

Minoxidil

A

Vasodilator HTN
Opens potassium channels so smooth muscle can’t contract
Used with beta blocker and loop diuretic to overcome compensatory measures
Adverse: palpitations, angina, headache, hypertrichosis, pericardial effusion, ECG changes

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30
Q

Ramipril

A

ACE inhibitor
Inhibit Angiotensin I to AngII so decreased vasoconstriction and aldosterone, increase bradykinin (vasodilator)
Disease state uses: in bilateral renal artery stenosis can get decreased GFR and in chronic renal disease they diminish proteinuria and stabilize renal funct
Adverse: hypotension, cough, angioedema, hyperkalemia, decreased renal funct, fetal toxicity, skin rash, alteration in taste

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31
Q

Sodium Nitroprusside

A

Arterial and Venous dilation
Continuous IV (light sensitive) HTN emergency and severe heart failure, makes CN before eliminated via urine
Stimulates guanylyl cyclase (increase cGMP)
Adverse: hypotension, cyanide and thiocyanate toxicity

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32
Q

Diltiazem

A

Blocks L-type Ca channels (relax smooth muscle and slows heartbeat through decreased conduction)
Used for angina, HTN, arrythmias
Adverse: dizziness, flushing, hypotension, constipation, peripheral edema, bradycardia, AV block, cardiac arrest, heart failure

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33
Q

Nifedipine

A

Blocks L-type Ca channels (relax smooth muscle and slows heartbeat through decreased conduction)
More vascular selective
Used for angina, HTN, arrythmias
Adverse: dizziness, flushing, hypotension, constipation, peripheral edema, bradycardia, AV block, cardiac arrest, heart failure

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34
Q

Isosorbide dinitrate

A

Relax smooth muscle (veins then arteries) through NO release, has antiplatelet effect
Oral but significant 1rst pass effect
Adverse: headache, ortho hypo, sildenafil (viagra) increases hypotension is in contraindicated
Tolerance: develops if continuously exposed, don’t know why but if interrupt therapy for 8-12 hours each day efficacy returns

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35
Q

Isosorbide-5-mononitrate

A

Relax smooth muscle (veins then arteries) through NO release, has antiplatelet effect
Oral
Adverse: headache, ortho hypo, sildenafil (viagra) increases hypotension is in contraindicated
Tolerance: develops if continuously exposed, don’t know why but if interrupt therapy for 8-12 hours each day efficacy returns

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36
Q

Nitroglycerin

A

Relax smooth muscle (veins then arteries) through NO release, has antiplatelet effect
Sublingual-rapid onset (minutes) but short acting (20-30 mins), Oral but 1rst pass effect, transdermal patch
Adverse: headache, ortho hypo, sildenafil (viagra) increases hypotension is in contraindicated
Tolerance: develops if continuously exposed, don’t know why but if interrupt therapy for 8-12 hours each day efficacy returns

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37
Q

Ranolazine

A

Used for angina
Mechanism not exactly known, maybe blocks late sodium channels in pacemaker cells
Adverse: dizziness, headache, constipation, nausea, increased QT interval

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38
Q

Digoxin

A

Increases contractility by inhib Na/K ATPase pump (reduced if have hyperkalemia)
Used for heart failure and Afib
Adverse: arrhythmias at toxic levels, anorexia, nausea and vomiting, abnormal color vision, confusion
Drug interactions: thiazide or loop lead to hypokalemia, quinidine/verapamil/amiodarone lead to increased digoxin conc, antacids/kao pectin/cholestyramine decreases digoxin conc

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39
Q

Digoxin immune Fab

A

Used for digoxin toxicity to block it

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40
Q

Dobutamine

A

Beta 1 agonist

Adverse: tachycardia, arrhythmias

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41
Q

Milrinone

A

Inhibs phosphodiesterase (type 3) so increase cAMP and increased contractility and vasodilation
In heart failure: decrease pulmonary wedge pressure, decrease vascular resistance, increase CO
Only IV and only for acute heart failure or severe exacerbation of chronic heart failure
Adverse: arhythmias

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42
Q

Nesiritide

A

Recombinant human B-type natriuretic peptide (increases cGMP which decreases resistance and so decreases afterload and increases CO)
Decrease pulmonary wedge pressure and dyspnea
Only IV
Adverse: hypotension, renal damage

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43
Q

Adenosine

A

Anti-arrhythmic, used for conversion of paroxysmal supraventricular tachycardia to sinus, acts on adenosine receptor to slow AV conduction and increase refractoriness of AV
IV, halflife is seconds
Adverse: flushing, headache, hypotenstion, arrhythmias, heart block, asystole, dyspnea, drug interactions

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44
Q

Amiodarone

A 
Class III, all class actions, used for serious v arrhythmias and some supra ventricular, increase AP duration and QT, vasodilation
Oral, IV
Adverse:  bradycardia, heart block, pulmonary fibrosis (potentially fatal), thyroidism, eye probs, hepatotoxic, peripheral neuropathy, torsades de pointes or worse arrhythmias, decreases elimination of other drugs (warfarin), hypotension (IV)
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45
Q

Disopyramide

A

Class 1A, use with ventricular arrhythmias, Na and K blocker, anticholinergic effect and negative ionotropic
Oral
Adverse: Long QT, torsades de pointes, decreased contractility (cause heart failure)

46
Q

Dofetilide

A

Class III, K blocker, used for maintaining normal sinus with afib, also used to convert afib to normal rythm, increases AP duration, increases QT
Oral
Adverse: torsades de pointes

47
Q

Dronedarone

A

Class III, used for paroxysmal afib only when in sinus rythm
Oral?
Adverse: death with permanent afib, diarrhea, nausea, vomiting, long QT, hepatotoxic, drug interactions, don’t give to preggers or nursing

48
Q

Flecainide

A

Class 1C, supraventricular arrythmia, blocks Na and K, shortened AP in Purkinje but prolonged in ventricular cells
Oral
Adverse: blurred vision, makes fatal arrhythmias worse, DON’T use post MI

49
Q

Ibutilide

A

Class III, K block, used for rapid conversion of afib or flutter, increases AP duration, long QT
IV
Adverse: torsades de pointes

50
Q

Lidocane

A

Class 1B, use post MI, preferentially effects ischemic tissue, treats acute ventricular arrhythmias
IV
Adverse: few, tremor, lightheadedness, seizures
Mexiletine is Oral version

51
Q

Quinidine

A

Class 1A, used for afib and flutter and v arrythmias, blocks Na and K, also has alpha blockade and antivagal effects
Oral and IV, IV can causee hypotension
Adverse: Long QT, torsades de pointes, diarrhea, headache/tinnitus, decreased platelets, hepatitus

52
Q

Procainamide

A

Class 1A, Na and K channel blocker, slows conduction and increases AP duration.
Oral, IV or IM, metabolite active also (NAPA)
Adverse: Long QT, torsades de pointes, hypotension, slowed conduction, nausea, drug induced lupus, agranulocytosis

53
Q

Propafenone

A

Class IC, prolong time to recurrence of symptomatic paroxysmal afib with no heart probs
Adverse: exacerbate arrhythmias, DON’T use post MI

54
Q

Propranolol

A

Class II, used for afib, decreases Ca and cAMP, increases PR, used also in Vtach and SVT
Adverse: impotence, worse asthma, bradycardia, AV block, CHF

55
Q

Sotalol

A

Class III, K blocker, used for serious ventricular arrhythmias an to maintain sinus rythm in symptomatic afib/flutter when in sinus rythm, long AP duration, long QT, slow AV conduction
Oral
torsades de pointes, worsening heart failure

56
Q

Verapamil

A

Class IV, Ca block, used for certain supravent arrhythmias, decreases conduction and increases refractoriness of AV, vasodilates and decreases contractility
Oral, IV
Adverse: hypotension, decreased contractility, bradycard, AV block
Diltiazem another example of class IV
Blocks L-type Ca channels (relax smooth muscle and slows heartbeat through decreased conduction)
Used for angina, HTN, arrythmias
Adverse: dizziness, flushing, hypotension, constipation, peripheral edema, bradycardia, AV block, cardiac arrest, heart failure

57
Q

Aformoterol*

A

Inhaled Long Acting Beta Agonist (LABA), used with ICS for long term control of moderate to severe asthma, must be used with an ICS, preferred only until asthma under control
Adverse: muscle tremor, anxiety, palpitations, tachycardia, small decreases in potassium and magnesium. Tolerance can be seen.

58
Q

Albuterol*

A

Beta2 agonist, relaxes smooth muscle and inhibs inflammatory cells, used for relief of acute symptoms and prevention of exercise induced asthma (70% of effect in five minutes, max at 30 and duration of 4-6 hrs), not for daily use, excess use shows poor control with daily regements
Adverse: tachycardia, elderly ppl with heart issues shouldn’t use, tolerance develops

59
Q

Beclomethasone

A

Inhaled corticosteroid, anti-inflammatory (late phase), use terol more than 2 days a week or more than 2 awakenings a month
Adverse: Thrush, hoarsness (dysphonia), reflex cough and bronchospasm, Large doses: can impair child growth, osteoporosis (old ladies), varicella, dermal thickening and bruising, hypothalamic-pituitary-adrenal axis suppresion

60
Q

Ciclesonide

A

Inhaled corticosteroid, anti-inflammatory (late phase), use terol more than 2 days a week or more than 2 awakenings a month
Adverse: Thrush, hoarsness (dysphonia), reflex cough and bronchospasm, Large doses: can impair child growth, osteoporosis (old ladies), varicella, dermal thickening and bruising, hypothalamic-pituitary-adrenal axis suppresion

61
Q

Flunisolide

A

Inhaled corticosteroid, anti-inflammatory (late phase), use terol more than 2 days a week or more than 2 awakenings a month
Adverse: Thrush, hoarsness (dysphonia), reflex cough and bronchospasm, Large doses: can impair child growth, osteoporosis (old ladies), varicella, dermal thickening and bruising, hypothalamic-pituitary-adrenal axis suppresion

62
Q

Budesonide*

A

Inhaled corticosteroid, anti-inflammatory (late phase), use terol more than 2 days a week or more than 2 awakenings a month
Adverse: Thrush, hoarsness (dysphonia), reflex cough and bronchospasm, Large doses: can impair child growth, osteoporosis (old ladies), varicella, dermal thickening and bruising, hypothalamic-pituitary-adrenal axis suppresion

63
Q

Fluticasone*

A

Inhaled corticosteroid, anti-inflammatory (late phase), use terol more than 2 days a week or more than 2 awakenings a month
Adverse: Thrush, hoarsness (dysphonia), reflex cough and bronchospasm, Large doses: can impair child growth, osteoporosis (old ladies), varicella, dermal thickening and bruising, hypothalamic-pituitary-adrenal axis suppresion

64
Q

Formoterol*

A

Inhaled Long Acting Beta Agonist (LABA), used with ICS for long term control of moderate to severe asthma, must be used with an ICS, preferred only until asthma under control
Adverse: muscle tremor, anxiety, palpitations, tachycardia, small decreases in potassium and magnesium. Tolerance can be seen.

65
Q

Indacaterol

A

Inhaled Long Acting Beta Agonist (LABA), used with ICS for long term control of moderate to severe asthma, must be used with an ICS, preferred only until asthma under control
Adverse: muscle tremor, anxiety, palpitations, tachycardia, small decreases in potassium and magnesium. Tolerance can be seen.

66
Q

Ipratropium*

A

Inhaled anticholinergic, blocks muscarinic receptors, used to relieve bronchospasms in chronic bronchitis and COPD (with or without b2 ag), used in elderly asthma, allergic rhinorrhea, not approved for asthma but used off label when not well controlled
Adverse: drying of the mouth, constipation, tachycardia, blurred vision, narrow angle glaucoma

67
Q

Levalbuterol

A

Beta2 agonist, relaxes smooth muscle and inhibs inflammatory cells, used for relief of acute symptoms and prevention of exercise induced asthma (70% of effect in five minutes, max at 30 and duration of 4-6 hrs), not for daily use, excess use shows poor control with daily regements
Adverse: tachycardia, elderly ppl with heart issues shouldn’t use, tolerance develops

68
Q

Mometasone*

A

Inhaled corticosteroid, anti-inflammatory (late phase), use terol more than 2 days a week or more than 2 awakenings a month
Adverse: Thrush, hoarsness (dysphonia), reflex cough and bronchospasm, Large doses: can impair child growth, osteoporosis (old ladies), varicella, dermal thickening and bruising, hypothalamic-pituitary-adrenal axis suppresion

69
Q

Montelukast*

A

Oral Leukotriene modifiers, used instead of ICS for mild persistent asthma or with ICS for moderate persistent asthma (not preferred), blocks leukotriene receptor
Adverse: Neurophyschotic episodes

70
Q

Omalizumab*

A

Blocks IgE binding to mast and eosinophils and maybe other immune cells also, indicated for severe persistent asthma with positive skin test to allergens and whose symptoms are not controlled with ICS, LABA or LTRAs, used with ICS can help reduce ICS dose and rescue therapies, response can take weeks, dosing determined by IgE conc, expensive
Adverse: Malignancies and anaphylaxis (immediately following injection, watch for 2hrs)

71
Q

Predisolone (oral)

A

Systemic corticosteroids, for long term prevention (> 2 weeks) and suppression and control in severely uncontrolled asthma
Adverse: can impair child growth, osteoporosis (old ladies), varicella, dermal thickening and bruising, hypothalamic-pituitary-adrenal axis suppresion

72
Q

Prednisone

A

Systemic corticosteroids, for long term prevention (> 2 weeks) and suppression and control in severely uncontrolled asthma
Adverse: can impair child growth, osteoporosis (old ladies), varicella, dermal thickening and bruising, hypothalamic-pituitary-adrenal axis suppression

73
Q

Roflumilast*

A

Phosphodiesterase inhibitor, used in exacerbation of COPD (with chronic bronchitis), not a bronchodilator (don’t use for acute asthmatic bronchospasm)
Adverse: diarrhea, weight decrease, nausea, headache, back pain, flu, insomnia, dizziness, decreased appetite, acetylated so watch slow ones

74
Q

Salmeterol*

A

Inhaled Long Acting Beta Agonist (LABA), used with ICS for long term control of moderate to severe asthma, must be used with an ICS, preferred only until asthma under control
Adverse: muscle tremor, anxiety, palpitations, tachycardia, small decreases in potassium and magnesium. Tolerance can be seen.

75
Q

Theophylline*

A

Oral, don’t really know mechanism, may cause smooth muscle relax by inhib phosphodiesterase (so increased cAMP), also enhances histone deacetylase (so decreased inflammation), used for nocturnal asthma symptoms with ICS, not preferred but alternative to inhaled medicines when cost of adherence are an issue, not useful for acute, low dose more common now
Adverse: narrow therapeutic range, too much causes anorexia, nausea, vomiting, nervousness, insomnia, tremor, aggravation of ulcer or reflux, hyperactivity in children, difficulty of urination in old men, seizures, arrythmias, acetylated so watch slow ones.

76
Q

Tiotropium*

A

Inhaled anticholinergic, blocks muscarinic receptors, used to relieve bronchospasms in chronic bronchitis and COPD (with or without b2 ag), used in elderly asthma, allergic rhinorrhea, not approved for asthma but used off label when not well controlled, only has to be used once a day compared to Ipratronium
Adverse: drying of the mouth, constipation, tachycardia, blurred vision, narrow angle glaucoma

77
Q

Triamcinolone

A

Inhaled corticosteroid, anti-inflammatory (late phase), use terol more than 2 days a week or more than 2 awakenings a month
Adverse: Thrush, hoarsness (dysphonia), reflex cough and bronchospasm, Large doses: can impair child growth, osteoporosis (old ladies), varicella, dermal thickening and bruising, hypothalamic-pituitary-adrenal axis suppresion

78
Q

Zafirlukast

A

Oral Leukotriene modifiers, used instead of ICS for mild persistent asthma or with ICS for moderate persistent asthma (not preferred), blocks leukotriene receptor
Adverse: Neurophyschotic episodes, gi disturbances, headache, increases half life of warfarin, don’t take with food.

79
Q

Zileuton*

A

Oral Leukotriene modifiers, used instead of ICS for mild persistent asthma or with ICS for moderate persistent asthma (not preferred), inhibs lox (so no leukotrienes)
Adverse: Liver toxicity, don’t use when preggers, don’t use with warfarin or theophyline

80
Q

Atorvastatin*

A

HMG-CoA Reductase Inhibs, decrease liver cholesterol synthesis which increases LDL receptors which increases LDL clearance, knocks the crap out of LDL at first, each subsequent dose increase only knocks it down a little, raises HDL 5-15%, lowers TG 7-30%, also antithrombic (platelet ag) and anti-inflammatory and plaque stabalizing, mostly used to lower LDL and when used with bile acid sequestrant really lowers LDL, lowers risk of CHD and regression of coronary atherosclerosis
Adverse: myopathy, may increase HbA1C and fasting BG, impaired cognition, don’t give to preggers or breastfeeding or liver disease

81
Q

Cholestyramine*

A

Bile acid sequestrant, positive charged anion exchange resin, increase bile acid excretion and decrease cholesterol absorption, lowers LDL 15-30%, increases HDL 0-8%, increases TG 0-30%, mostly used to lower LDL and reduce CHD risk
Adverse: upper and lower GI (bloating, gas, constipation), can impair absorption of warfarin and digoxin and DAKE vits (can take them 1hr before or 4-6 hr after bile stuff), don’t use with patients TG > 400 (but can use in conjunction with a TG lowering med)

82
Q

Colesevelam*

A

Bile acid sequestrant,polymeric hydrophilic gel, increase bile acid excretion and decrease cholesterol absorption, lowers LDL 15-30%, increases HDL 0-8%, increases TG 0-30%, mostly used to lower LDL and reduce CHD risk
Adverse: upper and lower GI (bloating, gas, constipation), can impair absorption of warfarin and digoxin and DAKE vits (can take them 1hr before or 4-6 hr after bile stuff), don’t use with patients TG > 400 (but can use in conjunction with a TG lowering med)

83
Q

Ezetimibe*

A

Cholesterol Absorption blocker, stops Niemann-Pick C1-like 1 prot from absorbing cholesterol in the small intestine, lowers LDL, sort of raises HDL, lowers TG, even more if used with statin, used for Primary hypercholesterolemia, Homozygous Familial Hypercholesterolemia, Homozygous Sitosterolemia (rare disorder, used in adjunct with diet changes, only medicine approved)
Adverse: Diarrhea, depression, myalgia, plasma conc higher in older people than expected, don’t give to preggers and nursing unless desperate, fibrates can increases bio availability, cholystyremine can decrease absorption, don’t use with liver disease

84
Q

Fenofibrate*

A

Activate PPAR alpha which binds to PPRE which promotes beta-oxidation of fatty acids in the liver and muscles which reduces TG synthesis, lowers TG and LDL and raises HDL (mostly TG and HDL), can use with statins but get no extra HDL bump, not really efficacious at lowering heart disease
Adverse: myalgia, liver issues, gallstones, may prolong warfarin INR ,don’t use with renal or hepatic dysfunction or gallbladder issue or for nursing mothers

85
Q

Fenofibric acid*

A

Activate PPAR alpha which binds to PPRE which promotes beta-oxidation of fatty acids in the liver and muscles which reduces TG synthesis, lowers TG and LDL and raises HDL (mostly TG and HDL), can use with statins but get no extra HDL bump, not really efficacious at lowering heart disease
Adverse: myalgia, liver issues, gallstones, may prolong warfarin INR ,don’t use with renal or hepatic dysfunction or gallbladder issue or for nursing mothers

86
Q

Fluvastatin*

A

HMG-CoA Reductase Inhibs, decrease liver cholesterol synthesis which increases LDL receptors which increases LDL clearance, knocks the crap out of LDL at first, each subsequent dose increase only knocks it down a little, raises HDL 5-15%, lowers TG 7-30%, also antithrombic (platelet ag) and anti-inflammatory and plaque stabalizing, mostly used to lower LDL and when used with bile acid sequestrant really lowers LDL, lowers risk of CHD and regression of coronary atherosclerosis
Adverse: myopathy, may increase HbA1C and fasting BG, impaired cognition, don’t give to preggers or breastfeeding or liver disease

87
Q

Lovastatin*

A

HMG-CoA Reductase Inhibs, decrease liver cholesterol synthesis which increases LDL receptors which increases LDL clearance, knocks the crap out of LDL at first, each subsequent dose increase only knocks it down a little, raises HDL 5-15%, lowers TG 7-30%, also antithrombic (platelet ag) and anti-inflammatory and plaque stabalizing, mostly used to lower LDL and when used with bile acid sequestrant really lowers LDL, lowers risk of CHD and regression of coronary atherosclerosis
Adverse: myopathy, may increase HbA1C and fasting BG, impaired cognition, don’t give to preggers or breastfeeding or liver disease, acetylated so watch for slow and interactions

88
Q

Nicotinic acid (Niacin, B3)*

A

Receptor all over adipocytes, when B3 attaches, it decreases cAMP which decreases lipolysis by deactivating protein kinase A which would normally activate HSL, VLDL and TG and LDL all decrease, HDL increases but we don’t know why, also decreases lipoprot, use with statin for more
Adverse: Flushing of the face and upper body (eventually toleranced, aspirin helps), may increase insulin resistance and induce hyperuricemia, hepatotoxic, dyspepsia, increased myopathy with statin, don’t give to liver disease, active peptic ulcer, gout and watch diabetics

89
Q

Omega-3 PUFA*

A

EPA and DHA, don’t really know why they work, may reduce hepatic production of TG and VLDL, LDL increases but changes to less plaquey, raises HDL and lowers TG alot, can use with statin, used as adjunct to diet for treatment of high TG (> 500), may reduce CHD
Adverse: usually fine, eructation, dyspepsia, taste perversion, diabetic pts may have issues, no increase in myopathy with statins

90
Q

Pravastatin*

A

HMG-CoA Reductase Inhibs, decrease liver cholesterol synthesis which increases LDL receptors which increases LDL clearance, knocks the crap out of LDL at first, each subsequent dose increase only knocks it down a little, raises HDL 5-15%, lowers TG 7-30%, also antithrombic (platelet ag) and anti-inflammatory and plaque stabalizing, mostly used to lower LDL and when used with bile acid sequestrant really lowers LDL, lowers risk of CHD and regression of coronary atherosclerosis
Adverse: myopathy, may increase HbA1C and fasting BG, impaired cognition, don’t give to preggers or breastfeeding or liver disease

91
Q

Rosuvastatin*

A

HMG-CoA Reductase Inhibs, decrease liver cholesterol synthesis which increases LDL receptors which increases LDL clearance, knocks the crap out of LDL at first, each subsequent dose increase only knocks it down a little, raises HDL 5-15%, lowers TG 7-30%, also antithrombic (platelet ag) and anti-inflammatory and plaque stabalizing, mostly used to lower LDL and when used with bile acid sequestrant really lowers LDL, lowers risk of CHD and regression of coronary atherosclerosis
Adverse: myopathy, may increase HbA1C and fasting BG, impaired cognition, don’t give to preggers or breastfeeding or liver disease

92
Q

Simvastatin*

A

HMG-CoA Reductase Inhibs, decrease liver cholesterol synthesis which increases LDL receptors which increases LDL clearance, knocks the crap out of LDL at first, each subsequent dose increase only knocks it down a little, raises HDL 5-15%, lowers TG 7-30%, also antithrombic (platelet ag) and anti-inflammatory and plaque stabalizing, mostly used to lower LDL and when used with bile acid sequestrant really lowers LDL, lowers risk of CHD and regression of coronary atherosclerosis
Adverse: myopathy, may increase HbA1C and fasting BG, impaired cognition, don’t give to preggers or breastfeeding or liver disease, acetylated so watch for slow and interactions

93
Q

Vytorin*

A

Ezetimibe and Simvastin

94
Q

Abciximab

A

Fab fragment that blocks GpIIb/IIIa (GPI), so blocks platlet agg, used for ischemic heart disease pts about to go PCI, IV
Adverse: allergic rxn, thrombocytopenia, bleeding

95
Q

Alteplase

A

tPA, should theoretically only break clots and not destroy clotting factors (lytic state), used to treat MI (instead of PCI), IV, used more in stroke

96
Q

Amino Caproic Acid

A

inhibs activation of plasminogen to plasmin (tPA antidote)

97
Q

Argatroban

A

Direct thrombin inhibitor, used prohylax for HIT or treat HIT, IV until aPTT ratio of 1.5-2.5, eliminate via CYP3A4/5, can increase INR so make warfarin switch complicated
Adverse: bleeding

98
Q

Aspirin

A

Irrev blocks COX 1&2, low blocks 1, high blocks both. COX1 is TXA2 (thromboxane, proclot, from platelet), COX2 is PGI2(anticlotting from endoth), platelets blocked for their lifetime, endoth can overcome

99
Q

Bivalirudin

A

Direct thrombin inhibitor, used with aspirin and GPI instead of heparin for unstable angina when undergoing PCI.PCTA, IV bolus then infusion, monitor Activated Clotting Time
Adverse: Bleeding

100
Q

Clopidogrel

A

Blocks ADP binding to GIIb/IIIa receptor which inhibits fibrinogen activity, used with aspirin for ACS and STEMI, must stop for CABG
Adverse: CYP so watch, bleeding

101
Q

Dabigatran

A

Oral, reversible thrombin inhib, prodrug, indicated in stroke due to afib, no monitoring, renal clearance, interacts with antifungals
Adverse: gastritis like and bleeding

102
Q

Dipyridamole

A 
Phosphodiesterase inhib (increases cAMP) and blocks uptake of adenosine, don't really know, used for stroke prevention with aspirin
Adverse: headache
103
Q

Enoxaparin

A

LMWH

104
Q

Eptifibatide

A

GPI, blocks platlet agg, bleeding

105
Q

Fondaparinux

A

Like LMWH, almost exclusively blocks Xa over everything else, SC, can give to HIT pts
Adverse: bleeding

106
Q

Heparin

A

UHF is large, LMWH is smaller, both given IV, act mainly on venous side. Heperain needs antithrombin and inhibs IIa, Xa (and IXa, XIa, XIIa) and enhances Tissue Factor Pathway Inhibitor, monitor with aPTT (or Xa titration). Main difference with LMWH is that it can be given SC and UFH is metabolized a lot faster.
Adverse: Bleeding, osteoporosis with prolonged use, Hep Induced Thrombocytopenia (HIT) to embolis. If overdose on UFH can use protamine

107
Q

Phytonadione (VitK1)

A

use for overdose of warfarin if INR between 4 and 10, over 10 give VitK

108
Q

Prasugrel

A

same as clopidogrel but more likely to bleed

109
Q

Protamine

A

Give for UFH overdose, sort of works on LMWH but only for IIa, not Xa so only sort of works, doesn’t work for Fondaparinux

110
Q

Rivaroxaban

A

Oral direct Xa inhib, indicated for a fib stroke risk, prophylaxis of DVT.PE in hip and knee replacement, no lab test, CYP eliminated
Adverse: CYP stuff, bleeding

111
Q

Warfarin

A

VitK antag, Oral, suppresses II, VII, IX, X (prot C and S), takes a while to take effect (days), CYP eliminated, don’t give to preggers
Adverse: Use INR (PT)(2-3, valves 2.5-3.5), watch for CYP blockers/inducers, bleeding, recurrent skin necrosis, if INR >4.5 stop and give VitK1 (Phytonadione)

Med School (4 decks)

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