Pharm- Cardio, Pulm Flashcards
1st line HTN treatment in those with DM, CKF, and Heart failure
ACE-I
“prils” i.e. Lisinopril
SE of Lisinopril
and all “prils”
angioedema
dry cough
hypotension
hyperkalemia
CONTRA: pregnant, angioedema
ARBs are good alternates to ACE-I but downfall
more expensive
“sartans”
Metoprolol
“lol” are CONTRA in
Asthma, anytime heart is going too slow
Avoid abrupt cessation of
beta blockers!
can precipitate MI and HTN crisis
Digoxin has a narrow margin of safety, esp with
Renal insufficiency
Low potassium
Loop diuretics CONTRA
Sulfa allergy!!
there is only one that doesn’t have sulfa
The One Loop diuretic that doesn’t have sulfa
Ethacrynic Acid
downfall of Ethacrynic Acid
Ototoxic
If person has gout, need to be careful with Loop diuretics because
a SE of Loops is High uricemia (may precipitate gout)
Other SE of Loops
Low everything- K, Na, Ca
often supplement with K+
Thiazides are used as
moreso in treating HTN
not 1st line for Heart Failure
Aldosterone antagonists
Spironolactone
Eplerenone
Direct Na inhibitor
Triamterene
Amiloride
Four 1st line treatments for HTN
HCTZ (thiazide), ACE-I, ARB, CCB
African American pts with HTN should use
HCTZ
CCB
Goal BP for someone >60YO
if no DM or CKD, can have goal at: 150/90
Goal BP for everyone else
140/90
CCB side effect
the Dihydropyridine type
Peripheral edema
Dihydropyridine CCBs
Nifedipine
Amlodipine
Non-dihydro CCBs
Verapamil
Diltiazem
A blockers are good choice to treat HTN is pt also has
BPH
Prazosin
53 YO with RESISTANT HTN, already on Lisinopril (ACE-I), HCTZ (thiazide), and Amlodipine (CCB)
what else can we add?
B-blocker
Refractory HTN treatment
Centrally acting sympatholytic
Clonidine, Methyldopa
HTN med for pregnant momma
Methyldopa
Coombs test, hemolytic anemia, liver enzymes
Avoid abrupt cessation of what two HTN meds to avoid HTN crisis???
B-blocker
Clonidine and Methyldopa
Cannot give Nitro to someone who is taking
Viagra
Give sublingual Nitro how often?
Every 5 min up to 3 doses
Treatment for long term Stable Angina
B-blocker
CCB
HTN crisis bc someone stopped meds too soon
Was either:
B-blocker
Central acting sympatholytic
(might also see proteinuria)
What is in “Duo neb”?
Albuterol + Ipratropium
Ipratropium
Anti-Muscarinic
Fluticasone
Steroid
In office setting, Tx for Acute Asthma Exacerbation/ Bronchospasm is…
Duo neb every 20 minutes for up to 3 doses
How long does Albuterol’s effects last?
about 4 hours
Rx to send home after treating an Asthma exacerbation
Rx: ProAir HFA 90 mcg/puff
Sig: 1-2 puffs every 4-6 hours prn for wheezing
Quantity: 1 inhale
Refills: 1
After treating an Asthma exacerbation, how soon should you f/u?
2-3 days
After treatment with SABA for Asthma, if it not controlled
Add:
Fluticasone (steroid)
OR
Singulair (montelukast)
SE of Singulair (montelukast)
Upper respiratory inf
Headache
Abd pain
Mood changes
What is the preferred tx to add to Albuterol as step 2?
Fluticasone (steroid) > Singulair (montelukast)
Rx for Singulair (montelukast)
Rx: Singulair 4 mg chewable tablet
Sig: chew 1 tablet qPM
Qty: 30 tablets
Refills:2
Why to take Singulair at night
can cause drowsiness
When does someone become a candidate for Omalizumab (Xolair)?
> 6 YO
Tx to start in office when treating Acute Exacerbation of COPD
Duoneb 2 puffs q6hr x 2 days
Steroid 40 mg tablet daily x 5 days
Abx to give for COPD exacerbation
Macrolide (if uncomplicated)
or
FluoroQ (complicated)
Macrolides
Azithromycin (Z pack)
Clarithromycin
Anti-muscarinics
SAMA- Ipratropium
LAMA- Tiotropium
ends in “tropium”
Antimuscarinic
ends in “sone”
steroid
Salmeterol
LABA
Advair
Salmeterol + Fluticasone
LABA + steroid
Symbicort
Formoterol + Budesonide
LABA + steroid
