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MQW U4 > Pharm --Lipid/HTN/CAD > Flashcards

Pharm --Lipid/HTN/CAD Flashcards

1
Q

This class of antiHLD drugs is:

  • -Large in size
  • -Highly positively charged
  • -Not absorbed, excreted in stool
  • -
A

Bile acid sequestrants

  • -positive charge lets it bind to negatively charged bile acids
  • -
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2
Q

What are the effects of the following drug classes on HDL, LDL, and TG:

  • -Niacin
  • -Fibrates
  • -Bile acid sequestrants
  • -Statins
  • -Ezetimibe
A
  • -Niacin = lower TG, increase HDL, lower LDL
  • -Fibrates = lower TG, increase HDL, variable LDL
  • -Bile sequestrants = increase TG, increase HDL, lower LDL
  • -Statins = lower TG, increase HDL, lower LDL
  • -Ezetimibe = lower TG, increase HDL, lower LDL
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3
Q

Which 2 statins are lactone prodrugs that must be modified in the liver to the active hydroxy acid forms?

A
  • -Lovastatin

- -Simvastatin

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4
Q

This class of antiHLDs prevent endocytosis and lysosomal degradation of LDL receptors on hepatocytes leading to higher number of LDL receptors

A

PCSK9 Inhibitors = more receptors –> lower LDL-C

–Alirocuma, evolucumab = human monoclonal Ab

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5
Q

This drug class inhibits cholesterol absorption by enterocytes in small intestines, but doesn’t affect TG absorption.

A

Ezetimibe

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6
Q

This drug class affects blood cholesterol by inhibiting cholesterogenesis in the liver

A

Statins –HMG-CoA reductase inhibitors

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7
Q

Which 2 statins have longer half-lives that can be administered once a day?

A
  • -Atorvastatin (Lipitor)

- -Rosuvastatin (Crestor)

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8
Q

This drug class reduces TG synthesis in the liver, decreases lipolysis in adipose tissue, and reduces hepatic clearance of HDL-apoA-1

A

Nicotinic Acid (Niacin)

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9
Q

This drug class acts through PPARa to stimulate lipoprotein lipase(LPL) synthesis and inhibit apoC III expression. It also stimulates apoA-1 and apoA-5 expression.

A

Fibrates

  • -LPL synthesis –> clear TG rich lipoproteins
  • -apoCIII –> clear VLDL
  • -apoA-1 and apoA-5 –> increase HDL
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10
Q

What is the best agent for increasing HDL-C?

A

Nicotinic Acid (Niacin)

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11
Q

This antiHLD drug class increases lithogenicity of bile –> risk of gallstones

A

Fibrates

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12
Q

Severe hypertriglyceridemia is a contraindication for the use of this antiHLD drug class.

A

Bile acid sequestrants

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13
Q

This antiHLD drug class binds cardiac glycosides (digoxin) and coumarin anticoagulants and interefere with their absorption.

A

Bile acid sequestrants

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14
Q

These 2 antiHLD drug classes increase hepatic LDL receptor expression

A
  • -Statins

- -Bile acid sequestrants

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15
Q

This antiHLD drug class is contraindicated for pregnant or nursing women

A

Statins

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16
Q

What are the 4 major risk factors for Polygenic-environmental hyperlipidemia?

A
  • -serum LDL cholesterol
  • -age
  • -HTN
  • -smoking
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17
Q

How does myocardial ischemia affect [increase/decrease]:

  • -intracellular ATP
  • -Intracellular pH
  • -Extracellular pH
  • -Extracellular K, phosphate, fatty-acid levels
A
  • -intracellular ATP = decrease
  • -Intracellular pH = decrease (acidosis)
  • -Extracellular pH = decrease (acidosis)
  • -Extracellular K, phosphate, fatty-acid levels = all increase
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18
Q

What 3 drugs can be used in a pharmacologic stress test?

A
  • -Dobutamine = Beta-1 stimulation sympathomimetic –> increase contractility and heart rate
  • -Adenosine, dipyridamole = coronary vasodilators –> stenotic arteries don’t respond to vasodilation stimulus
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19
Q

Patients w/ stable angina taking his drug was associated w/ 33% reduction in risk of adverse cardiovascular events

Patients w/ unstable angina or acute MI taking this drug had reduced vascular mortality, nonfatal reinfarction, and nonfatal stroke

A

ASPIRIN!

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20
Q

This drug is a thienopyridine derivative that inhibits platelet aggregation induced by adenosine diphosphate. It also reduces blood viscosity.

A

Ticlopidine

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21
Q

What are the 3 thienopyridine class

A
  • -Ticlopidine
  • -Clopidogrel
  • -Prasugrel
22
Q

This drug irreversibly binds to P2Y12 receptor (GPCR for ADP).

A

Prasugrel – Thienopyridine class

23
Q

This antiplatelet drug used in patients w/ stable angina can induce neutropenia, and in rare cases, TTP

A

Ticlopidine

24
Q

This drug is limited to patients less than 75years old, greater than 60kg, and with no history of stroke or TIA

A

Prasugrel

25
Q

This antiplatelet drug is a quinolone derivative that inhibits cellular phosphodiesterase which increases cAMP to inhibit platelet aggregation and vasodilation

A

Cilostazol

26
Q

What is/causes the Bezold-Jarisch reflesx?

A

Nitrates – stimulation of cardiac sensory receptors –> vagal efferent discharge –> bradycardia

27
Q

In the setting of unstable angina/non-ST elevated MI, what anticoagulant therapy should be initiated?

A

Heparin

28
Q

Classification of HTN:

  • -Stage 1
  • -Stage 2
A
  • -Stage 1 = 140-159 systolic, 90-99 diastolic

- -Stage 2 = systolic over 160 OR diastolic over 100

29
Q

Risk of end organ disease from HTN increased in these 2 populations:

A
  • -African American

- -Premenopausal women

30
Q

Angiotensin blockers [increase/decrease] TPR:

A

–Decrease – inhibit production/action of Angiotensin II –> less vasoconstriction –> lower TPR

31
Q

In a patient w/ severe HTN, in the setting of CHF or cirrhosis, and with renal insufficiency (GRF less than 30-40), what diuretic class is used?

A

Loop diuretics

32
Q

Diuretics [increase/decrease] cardiac output

A

–Decrease – Diuresis –> volume depletion –> low preload –> low CO –> low BP

–CO returns to normal over time

33
Q

Angiotensin Receptor Blockers (ARBs) are [competitive/non-competitive] antagonists at the vascular endothelium

A

Competititve

34
Q

2 Mechanisms of ACE Inhibitors

A
  • -Block endothelial ACE (converts Angiotensin I –> Angiotensin II)
  • -Inhibit breakdown of bradykinin (vasodilator)
35
Q

Bradykinin is a potent vaso (dilator/constrictor)

A

Vasodilator

36
Q

What do you use when you want a short acting ACEI

A

Captopril

37
Q

What ACEI is a prodrug that has a more active metabolite?

A

Enalapril –> enalaprilat (more active)

38
Q

What are the ARBs?

A
  • -Losartan
  • -Valsartan
  • -Irbesartan
39
Q

What causes cough side effect of ACEI?

A

–Bradykinin

40
Q

Ca Channel blockers:

  • -2 Dihydropyridines:
  • -2 Non-dihydropyridines:
A
  • -2 Dihydropyridines: amlodipine, nifedipine

- -2 Non-dihydropyridines: verapamil, diltiazem

41
Q

Ca Channel blockers (dihydropyridines vs non-dihydropiridines):

  • -Which raises heart rate?
  • -Which can cause Raynauds sydrome?
  • -Which decreases oxygen demand?
A
  • -Which raises heart rate? = Dihydropyridine–> reflex tachy
  • -Which can cause Raynauds sydrome? = both
  • -Which decreases oxygen demand? = non-dihyropyridines
42
Q

What HTN drug has the following characteristics:

    • primary antiHTN mechanism = reduce CO
  • -can mask symptoms of hypoglycemia in diabetics
  • -can cause depression
  • -worsens symptoms of peripheral vascular disease
A

Propranolol – non-selective B blocker

43
Q

Unique B blockers (Labetolol, Carvedilol, Esmolol):

  • -Used in hypertensive urgency
  • -Used for ACS or CHF
  • -Used IV for AV nodal blocking b/c it’s unique short T1/2
A
  • -HTN emergency = labetolol
  • -ACS, CHF = Carvedilol
  • -IV, short half life = Esmolol
44
Q

This drug relaxes smooth muscle of peripheral arterioles. Is used for refractory HTN and hair loss.

A

Minoxidil

45
Q

This drug relaxes smooth muscle of peripheral arterioles. Is used IV for acute HTN urgency or chronic CHF

A

Hydralazine

46
Q

Sympathoplegic drugs stimluate a2 to reduce vasomotor tone

  • -Which is routinely?
  • -Which is used in pregnancy?
  • -The other one?
A

Routinely = Clonidine
Pregnancy = a-methyl dopa
Other one = Guanabenz

47
Q

2 Ganglion blockers used for HTN?

A

–Guanethidine = block NE release

–Reserpine = depletes NE –> decreases CO and TPR

48
Q

Antiplatelets: which are reversible and irreversible

  • -Aspirin
  • -Ticlopidine
  • -Clopidogrel
  • -Prasugrel
  • -Ticagrelor
A
  • -Aspirin = irreversible COX inhibitor
  • -Ticlopidine = reversible ADP receptor inhibitor
  • -Clopidogrel = irreversible ADP receptor inhibitor
  • -Prasugrel = irreversible ADP (P2Y12) receptor inhibitor
  • -Ticagrelor = allosteric ADP receptor blockade
49
Q

In the kidney, Angiotensin causes more constriction in the [afferent/efferent] arterioles of the glomerulus

A

–Efferent – more blood in glomerulus –> increased glomerular pressure

50
Q

Bradykinin is associated with what 2 clinical symptoms?

A
  • -Cough

- -Angioedema (swelling of skin around mouth, mucosa of mouth, tongue)

51
Q

2 Mechanisms of nitrates relieving angina:

A
  • -Dilate coronary arteries –> increases oxygen delivery

- -Venous dilation –> reduce ventricular preload –> reduce myocardial oxygen demand

52
Q

If you use phosphodiesterase inhibitors for erectile dysfunction, what antianginal drug can’t you give?

A

Nitrates = PDE inhibitors inhibit cGMP –> “may cause an unsafe drop in blood pressure ;)”

MQW U4 (9 decks)

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