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PAM Semester 3 > Pharm Cardiology Exam 2 > Flashcards

Pharm Cardiology Exam 2 Flashcards

1
Q

Weight loss lowers SBP in HTN by

A

5 mmhg

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2
Q

Healthy Diet lowers SBP in HTN by

A

11 mmhg

DASH

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3
Q

Reduced sodium lowers SBP in HTN by

A

5/6 mmhg

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4
Q

Aerobic physical activity lowers SBP in HTN by

A

5/8 mmhg

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5
Q

Lowering alcohol intake lowers SBP in HTN by

A

4 mmhg

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6
Q

1st line HTN Meds

A 
ABCD
ACE/ARB
Beta Blocker (only if HFrEF, MI or CAD)
CCB (dipines) (amlodipine)
Diuretics (low dose HCTZ)
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7
Q

Angiotensinogen pathway

RAAS

A 
Liver makes angiotensinogen
Kidney makes Renin
Renin makes angiotensin I
Lungs make ACE
Ace makes Angiotensin II
Angiotensin II Receptor
Vessels, Heart, Kidneys, CNS

Renin inhibitor,
ACE inhibitor,
Angiotensin II receptor blocker (ARB)

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8
Q

Amlodipine

A

Norvasc (CCB)
HTN
5mg QD

Contra:
Obstructive coronary disease, aortic stenosis, CHF

Interactions
May be potentiated by CYP3A inhibitors

Adverse:
Edema, Fatigue, drowsiness, palpitations, dizzy, nausea, flushing, abdominal pain

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9
Q

HCTZ

A

HTN (thiazide diuretic)
25mg QD

Contra:
Anuria, sulfa allergy

Warning:
Renal/hepatic impairment, arrhythmia, DM, Gout

Interactions
Digitalis, Lithium toxicity

Adverse
Electrolyte imbalance, hypokalemia, hyperkalemia, hyperuricemia

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10
Q

HCTZ vs Chlorthalidone

A

HCTZ has shorter half life

10-12 hours

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11
Q

Alpha 1 blockers

A

Associated with orthostatic hypotension
-zosin
Used in BPH

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12
Q

Alpha 2 agonists

A

stimulates alpha 2 in brain
decreases CO and PVR
Clonidine, methyldopa

Should be last line due side effects, cant discontinue suddenly

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13
Q

Clonidine

A 
Sympatholytic
Alpha 2 agonist
for 
HTN, 
ADHD, 
anxiety, 
Withdrawal, 
migraine, 
menopausal flushing, 
diarrhea
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14
Q

Methyldopa

A

Pro drug used as sympathoplegic
Alpha 2 agonist

Gestational HTN

Significant side effects are
Rebound HTN
depression
Sexual dysfunction
Memory impairment
tolerance
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15
Q

Direct acting vasodilators

A

Hydralazine
Sodium Nitroprusside

associated with sodium and water retention

Need to be used with diuretic and BB

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16
Q

Aliskiren

A

Direct renin inhibitor
HTN

Contraindications
ACE/ARB in diabetics

Warning
Fetal Toxicity

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17
Q

Indications for Systolic heart failure

A

ACE/ARB
BB
Diuretic
Aldosterone ag

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18
Q

Indications for Post MI

A

ACE
BB
ARB
Aldosterone ag

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19
Q

Indications for proteinuric CKD

A

ACE/ARB

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20
Q

Indications for Angina

A

BB,

CCB

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21
Q

Indications for A fib Rate control

A

BB,

CCB (Diltiazem/verapamil)

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22
Q

Indications for A flutter rate control

A

BB,

CCB (Diltiazem/verapamil)

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23
Q

Contraindications for Angioedema

A

ACE

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24
Q

Contraindications for Bronchospastic disease

A

BB

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25
Q

Contraindications for Depression

A

Reserpine

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26
Q

Contraindications for Liver disease

A

Methyldopa

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27
Q

Contraindications for Preganancy

A

ACE
ARB
Renin inhib

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28
Q

Contraindications for 2nd/3rd AV block

A

BB,

CCB (Diltiazem/verapamil)

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29
Q

Mean arterial pressure (MAP) reduction in HTN emergencies

A

Should be reduced by 10 - 20 percent in first hour then gradually during next 23 hours to a total of 25% of baseline
Otherwise can worsen organ ischemia

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30
Q

Common cause of HTN Emergency

A 
Drugs that produce hyperadrenergic state
Cocaine
amphetamine
PCP
MAOI
recent discontinuation of clonidine
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31
Q

Meds to use in HTN emrgencies

A

Sodium nitroprusside or nitro
CCB (clevidipne) (ultra short acting) (nicardipine)
Dopamine agonist - fenoldopam
BB - labetalol, esmolol, metoprolol

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32
Q

Nitroprusside indications

A

Vasodilator
HTN emergency
Caution with High ICP or azotemia

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33
Q

Nicardipine indications

A

CCB
HTN emergency
Not with acute heart failure
Caution with coronary ischemia

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34
Q

Nitro indications

A

Vasodilator

Coronary ischemia

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35
Q

Fenoldopam indications

A

Dopamine 1 agonist
HTN emergency
Caution with glaucoma

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36
Q

Hydralazine indications

A

Direct vasodilator

eclampsia

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37
Q

Fenoldopam

A

Dopamine Receptor agonist

Peripheral arteriolar dilator
for HTN Emergencies

For the in-hospital, short-term (up to 48 hours) management of severe hypertension when rapid, but quickly reversible, emergency reduction of blood pressure is clinically indicated, including malignant hypertension with deteriorating end-organ function.

Children: for the in-hospital, short-term (up to 4 hours) reduction in blood pressure.

Avoid in patients with glaucoma (Increased IOP)

Interactions: Avoid with BB

given with continuous IV infusion

Adverse
Reflex tachycardia, HA, Flushing

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38
Q

HTN in black patients

A

Monotherapy = CCB or thiazide

Dual therapy = CCB + ACE/ARB

If patient has edema or hypervolemia
ACE/ARB +Thiazide

If CCB+ Ace/ARB not working, add thiazide
next add spironolactone / eplerenone

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39
Q

HTN in pregnancy

Contraindicated Meds

A

ACE
ARB
direct renin inhibitors

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40
Q

HTN in pregnancy

A

For acute HTN lowering
IV labetalol or hydralazine

Treatment should begin when SBP >160

Classes

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41
Q

Labetalol class

A

Alpha and beta blocker

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42
Q

Hydralazine

A

Peripheral vasodilator

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43
Q

Nifedipine

A

CCB (dihydropyridine)

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44
Q

Methyldopa

A

Central acting alpha agonist

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45
Q

HTN in elderly

A 
1st line
Thiazide
CCB
ACE
ARB

CCB & Thiazide works best in elderly

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46
Q

Treatment for orthostatic HTN

A

Fludrocortisone

Starting with low-dosefludrocortisone(0.1 mg/day) for patients with volume depletion and disabling symptoms despite nonpharmacologic measures.

A sympathomimetic pressor agent, such asmidodrineordroxidopa, can be added or substituted in patients who remain symptomatic on or cannot tolerate fludrocortisone.

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47
Q

Fludrocortisone

A

Corticosteroid
0.1 mg QD
up to
0.3 mg QD

Up titrate0.1mg every week as needed

Max dose 1mg per day

Taken with high salt diet and plenty of fluid

Adverse
Hypokalemia, ankle edema, CHF

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48
Q

Midodrine

A

Symptomatic orthostatic hypotension
Alpha adrenergic agonist

10mg TID
during daytime hours
Staring does is 2.5mg

Contra:
Severe heart disease, acute renal disease, urinary retention, Pheochromocytoma, thyrotoxicosis, excessive supine hypertension

Adverse
Paresthesia, piloerection, dysuria, pruritis, supine hypertension

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49
Q

MOA midodrine

A

Rapidly absorbed after PO

Metabolized in liver/ tissues

Activates a1 receptor causing vasoconstriction increased SBP/DBP while standing, sitting, supine

For postural hypotension after non pharm fails

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50
Q

Shock Tx

A

Vasopressors (alpha 1)
Norepi, epi, phenylephrine, dopamine

ADH Vasopressin: Pitressin, vasostrict

Inotrope Beta 1: Dobutamine

Inotrope PDE 3 inhib: Milrinone

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51
Q

Vasopressors

A

Alpha 1 adrenergic

Norepi (levophed)
Epi
Phenylephrine
Dopamine

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52
Q

Norepi

A

Levophed
Sympathomimetic

Contra:
Hypotension due to blood volume deficits except in emergencies, mesenteric or peripheral vascular thrombosis

Adverse:
Ischemic injury, Reflex bradycardia, arrhythmias, anxiety

53
Q

EPI

A

Increase MAP in hypotension with shock
Sympathomimetic

Adverse
Anxiety, apprehensiveness, tremors, weakness, dizzy, sweating, palpitations

54
Q

Phenylephrine

A

Hypotension resulting from vasodilation in the setting of anesthesia
Sympathomimetic

Adverse
NV, HA, vasoconstriction, ischemia, severe bradycardia, renal toxicity

55
Q

Dopamine

A

Dopamine receptor and beta 1
at low dose it constricts vessels other than in kidney and brain

at high does it constricts all vessels

increases cardiac contractility and increases SBP

Used for shock related to under perfusion and reflex vasoconstriction

Used in renal failure with shock

56
Q

Vasopressin

A

Vasostrict
Synthetic vasopressin

contra
Chlorobutanol allergy

Adverse
Decreased CO, bradycardia, tachyarrhythmias, hyponatremia, ischemia

57
Q

Dobutamine

A

Dose = 2-20 mcg/kg/min (max 40)

Receptors B1, B2, A1

Adverse
Tachyarrhythmias, HTN, Hypotension, Nausea, HA

58
Q

Milrinone

A

Reduces left ventricular filling pressure in chronic heart failure patients

May be the preferred inotropic drug for patients receiving BB as it does not use the Beta receptor to drive cardiac contractility.
(unlike dopamine and dobutamine)

Through its enhancement of cAMP may reduce pulmonary artery pressure via a vasodilator mechanism and therefore may improve right heart failure due to pulmonary hypertension

59
Q

Statins

A 
Atorvastatin
Fluvastatin
Lovastatin
Pitavastatin
Pravastatin
Rosuvastatin
Simvastatin
60
Q

High intensity statins

A

Rosuvastatin 20-40mg
Atorvastatin 40-80mg

> 50% LDL reduction

Rosuvastatin, atorvastatin and simvastatin cause the greatest reduction in LDL

61
Q

Atorvastatin

A

HMG-COA reductase inhibitor

Contraindications
Active liver disease
Unexplained elevated serum transaminases
Pregnancy
Nursing mothers
62
Q

Bile acid sequestrants

A

Colesevelam binds with bile acids in the intestine to form an insoluble complex that is eliminated in feces.

This increased excretion of bile acids results in an increased oxidation of cholesterol to bile acid and a lowering of the serum cholesterol.

63
Q

colesevelam

A

Pregnancy cat B

Contra
Hx of bowel obstruction, Serum TGL over 500, Hx of hyperTGL induced pancreatitis

Adverse
Constipation, nausea, dyspepsia, dysphagia, pancreatitis

64
Q

Fibrates

A

Fenofibrate, Gemfibrozil

Adverse
Liver function tests increased (dose related; 3% to 13%; ALT/AST increased >3 x ULN: 5% to 13%)
Abdominal pain-5%; URI-6%

Can lower serum TGL up to 50% and
Raise serum HDL up to 20%

65
Q

Fenofibrate

A

hypertriglyceridemia
Fibrate

Contra:
Hepatic/renal dysfunction, primary biliary cirrhosis, gallbladder disease

Adverse
myopathy, abnormal LFT’s, elevated CPK

Warnings
renal impairment, monitor CBC for 1 yr, monitor LFT’s, discontinue if >3 x normal

Interactions
Avoid statins, potentiates oral coags

66
Q

Ezetimibe

A

Zetia (10mg QD)
Cholesterol absorption inhibitor

Interaction
Other fibrates except feonfibrate

Contra
with statin in active liver disease or unexplained elevations in serum transaminases

Adverse
Diarrhea 4%, Arthralgia 3%, URI 4%

67
Q

Ezetimibe MOA

A

Cholesterol absorption inhibitors that impair dietary and biliary cholesterol absorption at the brush border of the intestine without affecting the absorption of triglycerides or fat soluble vitamin.

68
Q

Statins in pregnancy

A

Statins are contraindicated in

pregnancy and nursing mothers

69
Q

Lipid regulating agents

A

Omega 3 acid ethyl esters (Lovaza)

Icosapent ethyl (vascepa)

70
Q

Omega 3 acid ethyl esters

A

(Lovaza)
Adjunct to diet to reduce very high TGL (>500)
Lipid regulating agent

Interaction
May potentiate anti coagulants (monitor)

Adverse
Eructation, dyspepsia, rash, taste perversion,
Increased ALT,AST,LDL

71
Q

Icosapent ethyl

A

(vascepa)
Lipid regulating agent

Increased risk of bleeding with antithrombotics (ASA, Clopidogrel, warfarin etc.)

Adjunct to maximally tolerated statin therapy to reduce the risk of myocardial infarction, stroke, coronary revascularization, and unstable angina requiring hospitalization in adults with elevated triglyceride (TG) levels (≥150mg/dL) and established cardiovascular disease (CVD), or diabetes plus ≥2 additional CVD risk factors.

The effect of Vascepa on the risk for pancreatitis in patients with severe hypertriglyceridemia has not been determined.

72
Q

Nicotinic acid

A

Niacin

Raises HDL up to 30-35%
by reducing lipid transfer of cholesterol from HDL to VLDL and by delaying HDL clearance

NO flush doesn’t work
Can use ASA 325mg 30 min / NSAID 200mg 60 min prior to reduce flush (reduce prostaglandin effect)
Sustained release can lead to Hepatotoxicity

73
Q

Niacin Adverse

A

Can increase glucose levels worsening uncontrolled DM

Worst with Extended release tablets

Can cause hyperuricemia and lead to gout

can cause hypotension if on vasodilators and worsen unstable angina

can cause bleeding in patients with bleeding issues

74
Q

PCSK9 Inhibitor

Proprotein convertase subtilisin/kexin type 9

A

Can lower LDL by 60% in patient on statins

Can reduce risk of CVA or MI

Alirocumab (praluent), Evolocumab (reptha)

75
Q

PCSK9 inhibitor MOA

A

Proprotein convertasesubtilisin/kexintype 9 (PCSK9) is an enzyme produced in the liver.

PCSK9 binds to the low density lipoprotein receptor on the surface of hepatocytes,

leading to its degradation and higher plasma LDL-cholesterol (LDL-C) levels.

Blocking PCSK9 with antibodies leads to lower plasma LDL-C levels.

76
Q

Alirocumab

A

PCSK9 Inhibitor

Warnings
2nd and 3rd trimester

77
Q

Hypertriglyceridemia

A

All such patients should have LDL-C lowered with statin therapy if indicated.

Statins typically lower TG levels by 5 to 15 percent; however, high-intensity statin therapy can lower TGs by 25 to 30 percent

78
Q

Hypertriglyceridemia over 885

A

For patients with TG levels persistently >885 mg/dL (10 mmol/L) after nonpharmacologic interventions,

we suggest starting drug therapy to lower the risk of pancreatitis.

We start treatment with a fibrate, which may lower TGs by up to 70 percent .

We choosefenofibraterather thangemfibrozildue to the likelihood of either concurrent or later use of a statin.

Gemfibrozil has a higher risk of muscle toxicity, especially when administered with many statins.

79
Q

Hypertriglyceridemia between 150 and 885

A

if already taking statins

add icosapent ethyl (vascepa)

80
Q

Which of the below HTN medications is not contraindicated in pregnant patients?

aliskiren (Tekturna)
lisinopril (Zestril)
valsartan (Diovan)
methyldopa (Aldomet)

A

methyldopa (Aldomet)

81
Q

Which electrolyte disorders is sometimes associated with HCTZ?

Hypernatremia
Hypokalemia
Hyperkalemia
Hyponatremia

A

Hypokalemia

82
Q

Which is not considered a first-line parenteral medication for HTN emergencies?

sodium nitroprusside (Nitropress)
clonidine (Catapress)
fenoldopam (Corlopam)
labetalol (Trandate)

A

clonidine (Catapress)

83
Q

What is the common dosage for the drug flurdrocortisone (Florinef) for the initial treatment of orthostatic hypotension?

0.1 mg-0.2 mg once a day
0.2 mg-0.4 mg once a day
0.4 mg-0.8 mg once a day
1-2 mg once a day

A

0.1 mg-0.2 mg once a day

84
Q

Which of the below medications is not considered a vasopressors (alpha-1 adrenergic?

norepinephrine (Levophed)
dobutamine (Dobutrex)
phenylephrine (Biorphen or Neo-Synephrine)
dopamine (Inotropin)

A

dobutamine (Dobutrex)

85
Q

Which of the vasopressors is generally used for patients with shock and renal failure?

norepinephrine (Levophed)
dobutamine (Dobutrex)
phenylephrine (Biorphen or Neo-Synephrine)
dopamine (Inotropin)

A

dopamine (Inotropin)

86
Q

Which of the following medications is considered a medication for high-intensity statin therapy for HLP?

pravastatin (Pravachol)
rosuvastatin (Crestor)
simvastatin (Zocor)
lovastatin (Mevacor)

A

rosuvastatin (Crestor)

87
Q

Which drug is contraindicated for pregnant patients with hyperlipidemia?

atorvastatin (Lipitor)
omega-3 (Lovaza)
niacin (Niaspan)
colesevelam (Welchol)

A

atorvastatin (Lipitor)

88
Q

Which drug is considered a cholesterol absorption inhibitor for HLP?

atorvastatin (Lipitor)
icosapent ethyl (Vascepa)
lomitapide mesylate (Juxtapid)
ezetimbe (Zetia)

A

ezetimbe (Zetia)

89
Q

Which of the following is not a contraindication for the drug fenofibrate (Tricor)?

Hepatic dysfunction
Primary biliary cirrhosis
History of myocardial infarction
Gallbladder disease

A

History of myocardial infarction

90
Q

Congenital disorders

A

Mostly surgical repair for all

Tetralogy of Fallot
Pulmonary atresia
Hypoplastic left heart syndrome
Transposition of great vessels

91
Q

Prostaglandin E1 threrapy

A

Relaxes arterial smooth muscle, producing vasodilation

Helps keep Ductus open

If ductus is large

PGE1 can be started at low dose of
0.01mcg/kg per min

92
Q

Alprostadil

A 
Prostaglandin E1 (PDE1)
Keep ductus arteriosus open

Warning
apnea, only use if ventilator is readily available
not recommended in respiratory distress syndrome

Adverse
Apnea, Hypotension, tachycardia, necrotizing enterocolitis, Deterioration, Transfer (apnea)

93
Q

Tetralogy of Fallot (TOF)

4 components

A

VSD
Overriding aorta
Pulmonary (RV) outflow tract obstruction
RVH

94
Q

Management of TOF

A

Severe RVOT obstruction – Neonates with severe RVOT obstruction may require intravenous prostaglandin therapy (alprostadil), ductal stenting, or palliative shunt placement to maintain adequate pulmonary blood flow pending surgical repair.

Heart failure symptoms – Patients with minimal obstruction and increased pulmonary blood flow may develop symptoms of heart failure and require pharmacologic treatment
(loop diuretic therapy anddigoxin).

NO ACE or ARB

95
Q

Indomethacin

A

Indocin
Closes ductus

Adverse
Renal failure, electrolyte imbalance, GI bleed

MOA
NSAID
Accelerates maturation of germinal matrix microvasculature

Closes PDA by inhibiting COX enzyme that catalyzes prostaglandin precursor formation from arachidonic acid (70% of patients)

96
Q

Acute infective endocarditis bug

A

Staph aureus and staph epidermis

97
Q

Subacute infective endocarditis bug

A

Strep viridans

98
Q

Infective endocarditis
Duke criteria
Major

A

Positive blood cultures of
S.Aureus, Strep viridans, Strep gallolyticus, HACEK, community acquired enterococcus

Persistently positive blood culture

New valvular regurgitation murmur

Coxiella burneti infection

Echo positive for vegetation

99
Q

Prosthetic valve endocarditis Treatment

A

Synergistic interaction of a cell wall active agent (penicillin,ampicillin, orvancomycin)

and

an aminoglycoside (gentamicinorstreptomycin) if possible

100
Q

Prevention of endocarditis prior to dental or respiratory procedure

Med/Dose

Oral
Amoxicillin

A

Oral
Amoxicillin
2G PO

101
Q

Prevention of endocarditis prior to dental or respiratory procedure

Med/Dose
Unable to take oral meds
Ampicillin

A

Unable to take oral meds
Ampicillin
2G IM/IV

102
Q

Prevention of endocarditis prior to dental or respiratory procedure

Med/Dose
Unable to take oral meds
Ceftriaxone/cefazolin

A

Unable to take oral meds
Ceftriaxone/cefazolin
1 Gm IM/IV

103
Q

Prevention of endocarditis prior to dental or respiratory procedure

Med/Dose
Allergic to penicillin
Cephalexin

A

Allergic to penicillin
Cephalexin
2gm PO

104
Q

Prevention of endocarditis prior to dental or respiratory procedure

Med/Dose
Allergic to penicillin
Clindamycin

A

Allergic to penicillin
Clindamycin
600mg PO

105
Q

Prevention of endocarditis prior to dental or respiratory procedure

Med/Dose
Allergic to penicillin
Azithromycin/clarithromycin

A

Allergic to penicillin
Azithromycin/clarithromycin
500mg PO

106
Q

Prevention of endocarditis prior to dental or respiratory procedure

Med/Dose
Allergic to penicillin
And unable to take oral medication
Cefazolin/Ceftriaxone

A

Allergic to penicillin
And unable to take oral medication
Cefazolin/Ceftriaxone
1 G IM/IV

107
Q

Prevention of endocarditis prior to dental or respiratory procedure

Med/Dose
Allergic to penicillin
And unable to take oral medication
Clindamycin

A

Allergic to penicillin
And unable to take oral medication
Clindamycin
600 mg IM/IV

108
Q

Prevention of endocarditis prior to dental or respiratory procedure

Med/Dose
Allergic to penicillin
And unable to take oral medication
Vancomycin

A 
Allergic to penicillin
And unable to take oral medication
Vancomycin
15-20 mg/kg IV
2g max
109
Q

Acute pericarditis tx

A

In cases of pericarditis due to an identifiable cause (eg, bacterial infection or malignancy),

management is focused upon the underlying disorder and, if necessary, drainage of an associated pericardial effusion.

For nearly all patients with acute idiopathic or viral pericarditis, we recommend combination therapy withcolchicineplus nonsteroidal anti-inflammatory drugs (NSAIDs) rather than NSAIDs alone.

Ibuprofen or ASA + Colchicine

If glucocorticoid is needed
we suggest the use of moderate initial dosing (eg, 0.2 to 0.5 mg/kg/day ofprednisone) followed by a slow taper

110
Q

Colchicine

A

Recurrent pericarditis

0.6mg PO BID-TID

Contra
Renal/hepatic impairment with use of CYP3A or P-glycoprotein inhibitors

Adverse
GI upset, abdominal pain

111
Q

Pericardial effusion

A

US guided Pericardiocentesis

If reappears, repeat pericardiocentesis

112
Q

Aortic aneurysm

A

for asymptomatic
control HTN with BB

Can use ACE/ARB if BB not tolerated

Can also add statin to help reduce aortic expansion

113
Q

Arterial embolism/thrombosis

A

For those who present with acute limb ischemia, anticoagulation typically with a heparin (bolus followed by infusion)

and

intravenous fluid therapy should be immediately initiated prior to making plans for intervention.

114
Q

Arterial embolism/thrombosis

with afib

A

Patients with ongoing atrial fibrillation and a prior embolic event are at a significantly increased risk of stroke or other embolic event and often warrant lifelong anticoagulation unless there is some other compelling factor.

For patients with coronary heart disease equivalents, treatment withaspirinand statins should be a component of their medical therapy.

115
Q

Giant cell arteritis (GCA)

A

Glucocorticoid treatment is central to the management of giant cell arteritis (GCA, also known as Horton disease, cranial arteritis, and temporal arteritis).

If vision is intact at the time appropriate glucocorticoid treatment is initiated, the risk of sight loss is reduced to less than 1 percent.

Treatment should be initiated promptly once the diagnosis is confirmed or there is a high index of suspicion for GCA.

For patients without visual loss at presentation:prednisone1 mg/kg or equivalent, not to exceed 60 mg, given in a single daily dose

IF GCA relapses add tocilizumab

116
Q

tocilizumab (Actemra)

A

Giant cell arteritis (Interleukin 6 antagonist)
in combination with steroids

Warning
Serious risk of infection

Interactions
Avoid live vaccines

117
Q

Peripheral artery disease PAD

A

Claudication is associated with an increased risk of coronary, cerebrovascular, and renovascular disease, and peripheral artery disease (PAD) is considered to be a coronary heart disease risk equivalent.

To reduce the risk for cardiovascular disease progression and complications, we recommend a secondary prevention strategy that includes

antiplatelet therapy (aspirin75 to 162 mg/day orclopidogrel75 mg/day),

smoking cessation, control of blood sugar and blood pressure, lipid-lowering therapy, and dietary modification (as needed) to achieve the goals set in national guidelines.

For most patients with lifestyle-limiting claudication who do not have an improvement in symptoms with risk modification and exercise therapy, we suggest a therapeutic trial of naftidrofuryl

118
Q

Cilostazol

A

Pletal (PDE-3 inhibitor)

for intermittent claudication

Contra
HF

Warning
HF, Tachycardia, palpitation, tachyarrhythmia, hypotension, exacerbating angina or MI inpatients with ischemic heart disease

Interactions
CYP3A inhibitors

Adverse
HA, GI, diarrhea, abdominal pain

MOA
PDE 3 inhibitor, prevents cAMP degradation which prevents platelet aggregation and promotes vasodilation

119
Q

Venous thrombosis

A

Anticoagulation administered immediately and for up to 10 days following a diagnosis of DVT to provide protection from recurrent thrombosis in this period of highest risk.

Long-term (finite) anticoagulation is administered for a minimum of three months and extended for 6 to 12 months in some cases.

A small population of patients will require indefinite anticoagulation

(LMW) heparin, subcutaneousfondaparinux, the oral factor Xa inhibitorsrivaroxabanorapixaban, orunfractionated heparin(UFH).

For most patients with a first episode of DVT (provoked and unprovoked, proximal and distal), anticoagulants should be administered forthree months

120
Q

Pregnant with DVT

A

LMWH (Lovenox) be selected as the initial and long-term anticoagulant

121
Q

Anticoagulation in Cancer

A

LMWH (lovenox)

122
Q

Anticoagulation in renal disease

Cr clearance <30

A

Vitamin K dependent antagonist

Warfarin

123
Q

Anticoagulation in CAD

A

Vitamin K dependent antagonist
Warfarin

rivoroxaban
apixaban
edoxaban

124
Q

Anticoagulation in Pregnancy

A

LMWH (lovenox)

125
Q

Warfarin

A

Coumarin anticoagulant. Vitamin K antagonist

for Venous thrombosis. Pulmonary embolism. Thromboembolic complications from atrial fibrillation and/or cardiac valve replacement. Reduce risk of death, recurrent MIs, and thromboembolic events (eg, stroke, systemic embolization) post-MI.

Dose Individualize. ≥18yrs: Initially 2–5mg once daily

Warnings
Risk of major or fatal bleeding. Monitor INR frequently. History of GI bleed. Hypertension. Cerebrovascular disease. Anemia. Malignancy. Trauma.

126
Q

Dabigatran

A

Pradaxa (Direct thrombin inhibitor)

To reduce risk of stroke and systemic embolism in non-valvular atrial fibrillation (AF). Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients treated with parenteral anticoagulant for 5–10 days. To reduce risk of recurrent DVT/PE in patients who have been previously treated. Prophylaxis of DVT/PE after hip replacement surgery.

Contra
Active bleeding. Mechanical prosthetic heart valve.

Warning
Premature discontinuation increases the risk of thrombotic events. Spinal/epidural hematoma

Adverse
Gastritis-like symptoms (eg, GERD, esophagitis, erosive gastritis, gastric hemorrhage, ulcer),

127
Q

Rivaroxaban

A

Xarelto (Factor Xa inhibitor)

To reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Treatment of deep vein thrombosis (DVT),

Contra
Active bleeding

Warning
Premature discontinuation increases the risk of thrombotic events. Spinal/epidural hematoma

Interactions
Increased risk of bleeding with concomitant aspirin, clopidogrel, enoxaparin, warfarin, chronic NSAIDs

128
Q

idarucizumab

A

Praxbind

Reversal of the anticoagulant effects of dabigatran in emergency surgery/urgent procedures and in life-threatening or uncontrolled bleeding.

129
Q

Venous insuffciency

A

For patients who are unable to tolerate, are not compliant with, or in whom compression therapy is contraindicated (eg, occlusive arterial disease),

we suggest horse chestnut seed extract. A typical dose is 300 mg (standardized to 50 mg of escin) twice daily.

Use horse chestnut extract as a dietary supplement for chronic venous insufficiency (when the veins of the lower leg are unable to send blood back toward the heart), hemorrhoids, and swelling after surgery. Preparations made from the tree’s bark are applied to skin sores.

side effects, include itching, nausea, gastrointestinal upset, muscle spasm, or headache.

PAM Semester 3 (8 decks)

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