Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Cardiology > Pharm for ischemic heart disease > Flashcards

Pharm for ischemic heart disease Flashcards

1
Q

Nitrates class?

A
  • nitroglycerin (nitrostat, Nitroquick)
  • isosorbide dinitrate (Isordil)
  • isosorbide mononitrate (Imdur)
  • transdermal patch (nitrodur)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Indications for Nitrates use?

A
  • acute angina
  • chronic angina
  • CHF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MOA of nitrates?

A
  • decrease O2 demand of heart
  • decrease arteriolar and venous tone
  • decrease preload and decrease afterload (at higher doses)
  • cause vasodilation
  • increases O2 to the heart
  • decreases BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In what diseases is preload increased?

A
  • hypervolemia
  • regurgitation of cardiac valves
  • heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In what diseases is afterload increased?

A
  • HTN and vasoconstriction

increased after load = increased cardiac workload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are short acting nitrates used for?

- dosage?

A
  • immediate relief of anginal sxs
  • sublingual nitro tablets or spray: 0.4 mg and repeat in 3-5 minutes if needed (up to 3)
  • pain lasting more than 20 minutes should go to ED via EMS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the most common SEs from nitrates?

A
  • HA
  • dizziness (from lowering BP)
  • Hypotension
  • flushing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CIs to nitrates?

A
  • hypotension
  • aortic stenosis
  • severe volume depletion
  • acute RV infarction
  • hypertrophic cardiomyopathy
  • recent meds for ED: sildenafil (viagra), vardenafil (levitra), tadalafil (Cialis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When are long acting nitrates used?

A
  • added to B blockers or CCBs to control stable angina (not first line because you want to save nitrate for when angina can’t be controlled by other meds, don’t want to become tolerant)
  • limited by development of tolerance
  • need a nitrate free interval for 8-10 hours a day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Types of long acting nitrates?

A
  • isosorbide dinitrate (Isordil)L 5-40 mg BID to TID
  • Isosorbide mononitrate (Imdur - most common) 30-120 QD to BID
  • transdermal patch (NitroDur): 0.1, 0.2, 0.4, 0.6 mg/hr (low dose for people with hypotension)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

B blockers class?

A
  • metoprolol (Lopressor, toprol)
  • bisoprolol (zebeta)
  • atenolol (tenormin)
  • carvedilol (coreg)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Indications for B blockers use?

A
  • HTN
  • tachycardia
  • CHF
  • ischemic heart disease
    NSTEMI
    STEMI
    unstable angina
    chronic angina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

B blockers are first line therapy for tx of what?

A
  • tx of chronic angina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MOA of B blockers?

A
  • blocks b receptors in heart causing a decrease in HR, decrease in force of contraction, decrease of AV conduction
  • only antianginal agents that have been demonstrated to prolong life in pts with CAD post MI
  • most commonly used is Metoprolol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

B blocker CIs

A
  • severe bronchospasm (asthmatics)
  • bradyarrhythmias
  • decompensated heart failure (in midst of acute exacerbation)
  • may worsen Prinzmetal’s (variant) angina due to leaving alpha 1 receptors unopposed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Caution in B blocker use

A
  • they may mask sxs of hypoglycemia (tachycardia, diaphoresis) - so caution in diabetics
  • abrupt withdrawal may precipitate tachycardia, HTN crisis, angina or MI so it must be tapered off slowly (especially high doses) to prevent these sxs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Drugs in CCB class?

A

Amlodipine (Norvasc)
Nifedipine (Adalat, Procardia)
DIltiazem (Cardizem)
Verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Indications for CCB use?

A
  • HTN
  • tachycardia
  • chronic angina
  • coronary vasospasm
  • peripheral vasospasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MOA of CCBs?

A
  • decrease O2 demand
  • decrease preload
  • decrease HR (verapamil and diltiazem)
  • decrease BP
  • decrease contractility (verapmil, diltiazem)
  • increase O2 supply
  • cause coronary vasodilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

2 different subclasses of CCBs?

A
  • dihydropyridines:
    Amlodipine (Norvasc) - can be used in HF
    Nifedipine (Adalat, Procardia)
  • Nondihydropyridines:
    Diltiazem (Cardizem), and Verapamil
    (have neg chronotropic rate and neg inatropic effect)>
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Common SEs of CCBs?

A
  • HA
  • edema
  • constipation
  • hypotension
  • dizziness
  • bradycardia (nondihydropyridines)
22
Q

CI for nondihydropyridines?

A
  • systolic CHF: b/c low EF

- AV block or bradycardia

23
Q

CI for all CCBs?

A
  • caution when using in pt’s with peripheral edema or hx of hypotension (elderly), multiple drug interactions - metabolized by the liver (use caution)
24
Q

What are anti platelet drugs function?

A
  • interfere either with platelet adhesion and/or aggregation

goal: prevent initial clot formation

25
Fxn of fibrinolytic agents?
- degrade fibrinogen/fibrin | goal: eliminate already formed clots
26
Fxn of anticoagulants?
- inhibit clotting mechanism, goal: prevent progression of thrombosis
27
What are the antiplatet agents?
- aspirin - clopidogrel (plavix) - prasugrel - Ticagrelor - acute situations IV: Abiciximab and Eptifibatide
28
MOA of aspirin?
- inhibits cox: this then inhibits synthesis of thromboxane A2, a potent stimulator of platelt aggregation - irreversible platelet inhibitor - prevents form. of clots by inhibition of platelet plug - rapid absorption with peak effects in 1 hr
29
Dosing recommendations of aspirin and indication?
- primary prevention of CVA/MI: 81 mg daily - 2nd prevention of CVA/MI: depends on other meds. acutely 325 mg daily for MI and CVA - acute coronary syndrome: 325 mg chewed x 1
30
Is ASA beneficial in unstable angina?
- study showed that aspirin lead to a 51% reduction in CV events
31
Major SE of aspirin?
- always assess for GI bleeding - H2 blockers or PPIs may decrease gastritis and GI bleeding - administer with food to decrease GI disturbance - Tinnitus at higher doses - Resistance - allergy - stop 4 days before surgery
32
Class of P2Y12 antagonists of antiplatelet agents?
- clopidogrel (plavix) - prasugrel (effient) - ticagrelor (brilinta)
33
MOA of P2Y12 antagonists?
- inhibit binding of fibrinogen to activated platelets by blocking the P2Y12 receptor site as a result the GP IIb/IIIa receptor isn't activated - blocks receptor which is the binding site for fibrinogen, von WIllebrand factor and other ligands - resulting in blockage of platelet aggregation and prevention of thrombosis
34
Indications for P2Y12 antagonists?
- unstable angina - NSTEMI - STEMI - post intracoronary stent placement - post stroke - peripheral vascular disease - No indication for primary prevention of MI/CVA unless pt is allergic to aspirin
35
P2Y12 drugs?
- clopidogrel (plavix): 300-600 mg loading dose - detected within 2 hours, platelet function returns to normal about 5 days after discontinuation - prasugrel (effient): 60 mg loading dose: less than 30 minutes, platlet aggregation gradually returns to baseline values over 5-9 days after d/c - ticagrelor (Brilinta) 180 mg loading doses: wthin 30 minutes, platelet fxn returns normal in 3 days
36
SEs of P2Y12 inhibitors?
- major: bleeding - prasugrel not recommended for 75 and older, or those who weigh less than 60 kg - (LOPs) - = increased bleeding risk - ticagrelor: 10-14% of pts = SOB first few days after initiating therapy - no antidote for reversal of medication in event of significant bleeding - some people have genetic variant and are resistant to clopidogrel
37
GPIIb/IIa antagonists?
- abciximab (Reopro) | - eptifibatide (integrelin)
38
MOA of GPIIb/IIIa antagonists?
- IV - used for acute coronary syndrome - during percutaneous coronary intervention
39
Onset of GPIIb/IIIa antagonists?
- immediate (IV) - platelet fxn is restored to normal 4-8 hrs after d/c of infusions (reversible)
40
SEs of GPIIb/IIIa antagonists?
- bleeding - thrombocytopenia: reversible once d/c meds (takes a couple of days) - allergy
41
Anticoagulants class for acute situations (MI)?
- enoxaparin (Lovenox - LMWH) - Heparin (UFH) - Bivalirudin (angiomax)
42
MOA of Heparin?
activation of anticlotting factors (especially antithrombin III) - indirect thrombin inhibitor - rapid onset of action and short half life - dose adjusted by following aPTT - given IV for acute tx, (SQ use for DVT prevention in post surgical pts)
43
CIs and complications of Heparin?
- CIs: anaphylaxis and recent major surgery | - adverse effects: bleeding, hypersensitivity rxns, transaminitis, HIT
44
MOA of Enoxaparin (Lovenox), indications
- inhibits Xa and antithrombin III - indirect thrombin inhibitor - stronger inhibition of Xa than UFH - for use in MI pts: IV dose followed by SQ dose
45
MOA of Bivalirudin (angiomax)
- direct thrombin inhibitor - immediate onset of action - coagulation times return to normal about hour after d/c of infusion - IV infusion only
46
Major SEs and CIs of Bivalirudin?
- SE: bleeding | - CIs: allergy or recent major surgery or trauma
47
Fibrinolytics class?
- tPA (activase) - streptokinase (streptase) - Urokinase (Abbokinase)
48
MOA of fibrinolytics?
- convert plasminogen to plasmin to breakdown fibrin strands | - short activation times and short half lives
49
Indications of fibrinolytics?
tx of existing clots: - MI - stroke - Massive PE (life threatening) - limb threatening ischemia
50
SEs of thrombolytics?
- massive life threatening bleeding
51
Absolute CIs of thrombolytics?
- previous intracranial bleeding at any time - CVA within last 3 months - closed head or facial trauma within 3 months - suspected aortic dissection - active bleeding diathesis - uncontrolled HTN: SBP greater than 180 and DBP greater than 100 - known CV lesions
52
Relative CIs of fibrinolytics?
- current AC use - invasive or surgical procedure in last 2 weeks - prolonged CPR defined as more than 10 minutes - known bleeding diathesis - pregnancy - hemorrhagic or diabetic retinopathies - active peptic ulcer - controlled severe HTN

Cardiology (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions