Pharm- Cardio

Question 1

3 forms of Angina:

Answer 1

Exertional

Variant (Prinzmetals) - spams, evening/early morning

Unstable- progressively less exertion, precedes MI

Question 2

Nitrates

Have a shelf life of:

How many doses can you take in 15 minutes?

How do you tell it’s active?

Answer 2

6 month shelf life (3mo once opened)

3 doses in 15 min

If active, tingling sensation

Question 3

ivabradine is an HCN blocker (hyperpolarization-activated cyclic nucleotide-gated receptor) used to treat Angina. What is a major side effect of ivabradine?

Answer 3

Bradycardia

Question 4

Diltiazem and verapamil should NOT be used in combination with what other meds?

Answer 4

ivabradine, ß-Blockers

Question 5

ivabradine has a useful in combination with:

ß-Blockers have a useful combination with:

Answer 5

Calcium channel blockers and nitrates

◦BB reduce reflex tachycardia caused by nitrates

◦Nitrates reduce bradycardia caused by BB

Question 6

For NSTEMI what is given instead of thrombolytics (that would have been given for STEMI)

Answer 6

Heparin

Question 7

Which zone of MI has oxygen-deprived cells that have died and will not regenerate?

Answer 7

Zone of infarction

• zone of ischemia can return function
• zone of hypoxic injury surrounds zone of infarction, can return function if circulation is restored

Question 8

Antithrombotics:

What do antiplatelets do?

What do anticoagulants do?

What do fibrinolytics do?

Answer 8

antiplatelets- prevent thrombus (aspirin, Gp IIa/IIIb)

anticoagulants- prevent extension of current thrombus (Heparin,direct thrombin inhibitor, factor Xa inhibitor)

fibrinolytics- lyse an active thrombus (-ase)

Question 9

clopidogrel (Plavix) is an ADP receptor inhibitor (irreversible). This means it interferes a receptor on platelets to block Gp IIa/IIIb which ultimately results in the decrease of aggregation of:

Answer 9

platelets

Question 10

Remember to stop this medication 7 days prior to surgery!

Answer 10

clopidogrel (Plavix)

(also avoid >75 yr old, intracranial hemorrhage risk)

Question 11

What drug potentiates the action of antithrombin (to inactivate thrombin) which prevents conversion of fibrinogen to fibrin?

This drug also induces thrombocytopenia.

Answer 11

Heparin

(also causes osteoporosis if used > 1month)

Question 12

clopidogrel is an irreversible ADP receptor inhibitor.

Which ADP receptor inhibitor is reversible?

Answer 12

ticagrelor (Brilinta)

*5day stop before surgery

-med not on drug list, but DOES appear on exam2 outline

Use: ACS (up to 1 year or more after NSTEMI or STEMI)

AE: dyspnea

CYP450 metabolite

Question 13

Heparin, LMWH, Fondaparinux, and Direct thrombin inhibitors are all:

(enteral or parenteral)

Answer 13

parenteral

• fondaparinux does not have a specific antidote, but no risk of HIT
• direct thrombin inhibitors do not pose risk of HIT
• LMWH no HIT either

Question 14

Which drug inhibits synthesis of multiple Factors (VII, IX, X, II), has CYP450 metabolism, and takes 3-5 days to take effect?

Answer 14

warfarin (Coumadin)

Question 15

What does a high INR value mean the patient is at risk of?

What is the normal INR range of someone on Warfarin?

Answer 15

A high INR is at risk for bleeding out- blood clots more slowly than average.

INR = 2.0 to 3.0 for someone on warfarin (higher for mechanical heart valve)

Question 16

Which PO med inhibits conversion of fibrinogen to fibrin, and is recommended to be taken with food to avoid dyspepsia?

Answer 16

PO Direct Thrombin Inhibitor:

dabigatran (Pradaxa)

Question 17

What is the suffix of the meds that reversibly bind FXa and have less intracranial bleed risk than warfarin?

-What is the antidote (or “reversal agent”) for this group?

Answer 17

-“xaban”

ie rivaroxaban (Xarelto), apixaban

Question 18

Which of the FXa inhibitors has the lowest bleed risk?

Answer 18

apixaban (Eliquis)

(reversal agent Andexxa)

Question 19

Which FXa inhibitor MUST be taken with food?

Answer 19

rivaroxaban (Xarelto)

Question 20

DOAC means

Answer 20

direct oral anti-coagulant

Question 21

Which class of antithrombotic mimics endogenous tissue plasminogen activator (TPA) which converts plasminogen to plasmin (plasmin breaks fibrin links in a thrombus)?

Answer 21

Fibrinolytics

(AE: internal bleeding)

Question 22

Long-term treatment for VTE prevention 1st line is normally DOAC. But for cancer patients, 1st line is:

Answer 22

low molecular weight heparin LMWH

Question 23

What is atherosclerosis?

Answer 23

plaque buildup hardening and narrowing arteries

Question 24

Is LDL or HDL the good cholesterol?

Answer 24

trick question! got you!

hah!

Low LDL : less likely to form plaques

High LDL: takes up LDL and carries it back to liver

Question 25

Atrial fibrillation:

1st line, 2nd line, 3rd line meds

Answer 25

1. DOAC
2. VKA
3. aspirin

Question 26

Athersclerosis

1. HMG-CoA reductase inhibitors: statins, DDI with CYP450, cheap
2. Cholesterol absorption inhibitor, fewer DDIs, moderate expensive
3. PCSK9 Inhibitors: injectable, effective, expensive

Answer 26

uh, just know the front side…

Question 27

Common AE with statins:

Answer 27

myalgia

Question 28

Cholesterol absorption inhibitor works by blocking cholesterol from passing through the:

Answer 28

small intestine

not CYP450

Question 29

Which drug class is generally well tolerated but ↑myopathy risk when combined with statins?

Answer 29

Fibrates

Question 30

Omega-3 fatty acids give a fishy burp and also increase the risk of:

Answer 30

bleeding

Question 31

Bile acid sequestrants have some unpleasant side effects in the GI tract, can bind other meds, and also keeps you from absorbing some important stuff in your intestines:

Answer 31

vitamins!

(ADEK)

Question 32

Grapefruit juice inhibits CYP3A4, linked to statin rhabdomyolysis (where muscle fibers die and flood the bloodstream with proteins= WAY BAD for kidneys).

Answer 32

Cool huh?

(watch for CYP450 interactions)

Question 33

Jugular distension and dependent edema is a sign of

Answer 33

Right ventricular failure

Question 34

Goals for treating Heart Failure with reduced Ejection Fraction (HFrEF):

Answer 34

↓ edema and congestion = diuretics

↑ contractility = positive inotropic drugs (digoxin)

↓ preload and afterload = vasodilators (hydralazine, isosorbide dinitrate, sacubitril), ACEi, or ARB

Question 35

ARNI have good mortality reduction, but have a higher risk of

Answer 35

angioedema

especially if combined with ACEi

Question 36

Which CHF med has a narrow therapeutic index, does NOT reduce mortality, and is only used if symptoms are not controlled on other cardiac meds?

Answer 36

digoxin (Lanoxin, Digox)

S/sx of toxicity: anorexia, nausea, vomiting, visual changes (halos around yellow-green color spectrum), cardiac arrhythmias

Question 37

Which cardiac med used mainly for rhythm control, also for

recurrent v-tach?

Answer 37

amiodarone (Nexterone)

Class III arrhythmia

Question 38

class IV arrhythmia treated by:

Answer 38

diltiazem, verapamil

Question 39

class II arrhythmia treated with:

Answer 39

beta blockers

atrial fib

Question 40

digoxin has a GI side effects, blurred vision, and would persist in the body longer if a patient was taking another med that was also processed by the:

Answer 40

kidneys