Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiology > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Nitrates

A

Nitroglycerin (Nitrostat, Nitroquick

Isosorbide dinitrate/mononitrate

-(Isordil/Imdur)

Transdermal patch (Nitrodur)

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

Nitrates MOA

A

Decrease O2 demand of heart by

  • decreasing arteriolar and venous tone -> Systemic and coronary vasodilation
  • Decreasing preload
  • Decrease afterload at higher doses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Short acting nitrate use and dose

A

Immediate anginal relief

Sublingual nitro tablet/spray -> 0.4 mg

Repeat in 3-5 min if needed

Pain >20 min -> ED

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

Nitroglycerin side effects

A

HA

Dizziness

Hypotension

Flushing

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

Nitrate contraindications

A

Hypotension

Aortic stenosis

Severe volume depletion

Acute RV infarct

Hypertrophic cardiomyopathy

Recent erectile dysfunction meds

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

Long acting nitrate use

A

Not first line

Can develop a tolerance over time

Have to have 8-10 hour nitrate-free interval/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Long acting nitrates and dose

A

Isosorbide mononitrate (Imdur) - 30-120 mg QD/BID

Isosorbide dinitrate (Isordil) - 5-40 mg BID/TID

Transdermal patch (NitroDur) - 0.1, 0.2, .4, 0.6 mg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Beta Blocker indications

A

HTN

Tachycardia

CHF (not acute)

Ischemic heart disease

CAD post MI - prolongs life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Beta Blocker drugs

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
10
Q

Beta Blocker contraindications

A

Severe bronchospasm

Bradyarrhythmias

Decompensated heart failure (Acute CHF)

Prinzmetal’s angina -> Alpha 1 receptors not balanced w/ beta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Beta Blocker cessation

A

Abrupt withdrawl may precipitate tachycardia, HTN, angina, MI

-taper off to prevent withdrawl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Calcium Channel Blockers indications

A

Best single agent to just lower BP

HTN

Tachycardia

Angina

Coronary vasospasm

Peripheral vasospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Calcium channel blockers MOA

A

Cause peripheral and coronary vasodilation

All decrease preload and blood pressure while increasing oxygen supply

-Verapamil and diltiazem decrease heart rate and contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Calcium channel blockers and classes

A

Dihydropyridines (-dipine)

  • Amlodipine (Norvasc) - only one used w/ systolic heart failure
  • Nifedipine (Adalat, Procardia)

Nondihydrophyridines

  • Diltiazem (Cardizem)
  • Verapamil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Calcium channel blocker side effects

A

HA

Edema

Constipation

Hypotension

Dizziness

Bradycardia (nondihydrophyridines)

Worse BBB (non-dihydopyridines)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nondihydrophyridine contraindications

A

Systolic CHF (lower ejection fracture too much)

AV block/bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Calcium channel blocker caution

A

Use caution in pts w/ peripheral edema or hypotension hx

Multiple drug interaction - be careful

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

Antiplatelet MOA and Goal

A

Interfere either w/ platelel adhesion/aggregation

Goal: prevent initial clot formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Fibrinolytic MOA and Goal

A

degrade fibrinogen/fibrin

Goal: eliminate formed clots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Anticoagulants MOA and goal

A

Inhibit the clotting mechanism

Goal: prevent thrombosis progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Antiplatelet agents

A

Aspirin

P2Y12 Antagonists

GPIIB/IIIA Antagonists

  • decrease platelet aggregation, can work acutely
  • Used in an MI, can give IV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Aspirin

A

Potent, irreversable anti-platelet agent

Inhibit cyclooxygenase (platelet aggregation stimulant)

Inhibit platelet plug formation

Rapid absorption, peak effects in 1 hr

Beneficial in unstable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Aspirin dosing

A

Vary depending on indication

Primary CVA/MI prevention: 81 mg daily

Secondary CVA/MI prevention: 325 mg daily, depends on other meds

Acute coronary syndrome: chew 1X 325 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Aspirin side effects

A

BLEEDING - always check for GI bleeds, take w/ food

Tinnitis (high dose)

Resistance - no effect on platelet aggregation

Allergy

Stop 4 days before surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

P2Y12 Antagonists and dose

A

All need loading doses to reach therapeutics levels quickly

  • Clopidogrel (Plavix): 300-600 mg LD, w/in 2 hrs, 5 days to normal
  • Presugrel (Effient): 60 mg LD w/in 30 mins, 5-9 days to normal
  • Ticagrelor (Brilinta): 180 LD w/in 30 mins, 3 days to normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

P2Y12 Antagonist side effects

A

Bleeding, non-reversable

Some people are resistant to Clopidogrel

Dont use Prasugrel if >75 or <60 kg - increases bleeding risk

Ticagrelor causes SOB in 10-14% pts w/in few days starting -> is transient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

GPIIB/IIIA Antagonists

A

IV, only for acute MI during percutaneous coronary intervention

Abciximab (Reopro)

Eptifibatide (Integrelin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

GPIIB/IIIA Antagonist Pharmacokinetics

A

Immediate onset of action

Reversible - platelet function returns to normal 4-8 hours after drug cessation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

GPIIB/IIIA Antagonist side effects

A

Bleeding

Thrombocytopenia - takes a few days to resolve

Allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Anticoagulants

A

Only for Acute MI

Inhibit clotting mechanism

Enoxapain (Lovenox) - LMWH

Heparin (unfractionated Heparin)

Bivalirudin (Angiomax)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Heparin

A

Activates anticlotting factors (antithrombin III) to indirectly inhibit thrombin

Monitor w/ aPTT

Give IV for acute/SQ for DVT prevention in post-surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Heparin contraindications and side effects

A

CI: Anaphylaxis, recent surgery

Side effects: bleeding, hypersensitivity, transaminitis, Heparin induced thrombocytopenia (HIT)

HIT -> Immune reaction, cant ever have again

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Enoxaparin (Lovenox)

A

Inhibits Xa (more so than UFH) and antithrombin III

indirectly inhibits thrombin

IV followed by SQ in acute MI

Has to wear off, only nonreversable anticoagulant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Bivalirudin (Angiomax)

A

Direct thrombin inhibitor

Immediate onset, reversable (~1hr post cessation)

side effect: bleeding

CI: allergy, recent major surgery, trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Fibrinolytics

A

AKA Thrombolytics

tPA

Streptokinase (Streptase)

Urokinase (Abbokinase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Thrombolytic MOA and indications

A

Convert plasminogen to plasmin -> breakdown fibrin strands

Short activation and half life

Use to tx existing clots (MI, stroke, massive PA, limb threatening ischemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Diuretic types

A

Thiazide (HCTZ)

Loop diuretics

K+ sparing diuretics

Combo HCTZ and K+ sparing

Use caution when combining w/ ACE inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Thiazide and MOA

A

Diuretic

Hydrochlorothiazide (HCTZ)

inhibits NaCl reabsorption in DCT

First line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Thiazide side effects

A

May cause hypokalemia, hyponatremia

Pts allergic to sulfa may be allergic to this

Sun sensitivity

Ineffective w/ creatinine >2.5 (kidney failure)

40
Q

Loop diuretics indications and MOA

A

Selectively inhibit NaCl reabsoption in thick ascending loop in loop of Henle

Usually use only in CHF and chronic renal insufficiency

Give w/ K+ (10 K+ for 20 lasix

41
Q

Loop diuretics

A

Furosemide (Lasix)

Torsemide (Demedex)

Bumetanide (Bumex)

Metolazone (Zaroxolyn)

42
Q

K+ Sparing diuretics MOA and use

A

Antagonize aldosterone effects in late distal and cortical collecting tubule

Weak, but spare K+ and Mg loss

43
Q

K+ sparing diuretics

A

Aldactone (Spironolactone)

Midamor (Amiloride)

Dyrenium (Triamterene)

44
Q

Combo HCTZ and K+ sparing diuretics

A

High maintenance

Altaxtazide (Spironolactone/HCTZ)

Dyazide (Triameterene/HCTZ)

Maxzide (Triamterene/HCTZ) - stonger dose

Moduretic (Amiloride/HCTZ)

45
Q

Beta Blockers

A

Decrease sympathetic drive, renin release

Cardioprotective - only drug to prolong CAD post MI life

Anti-HTN, also used to control ischemic heart disease

1st line for chronic angina, CAD post MI

Decrease heart rate and contraction to reduce amount of O2 needed

46
Q

Beta 1 selective Beta Blockers

A

Metopropol (Lopressor, Toprol XL)

Atenolol (Tenormin)

Bisopropol (Zebeta)

Acebutolol (Sectrol)

47
Q

Nonselective Beta Blockers

A

Propanolol (Inderal)

Sotalol (Betapace)

Timolol (Blocadren)

48
Q

Combo nonselective Beta Blockers and Alpha 1 Blockers

A

Carvedilol (Coreg)

Labetolol (Trandate)

49
Q

Beta Blocker combos

A

Atenolol-chlorthalidone (Tenoretic)

Metoprolol/HCTZ (Lopressor HCT)

Bisoprolol/HCTZ (Ziac)

50
Q

Beta Blocker side effects

A

Bradycardia

Heart failure

Bronchospasm (Careful w/ asthmatic)

CNS depression

Erectile dysfunction

Mask Hypoglycemia and shock

Lower HDLs

Cannot abruptly discontinue (Rebound HTN, depression)

Drug interactions

51
Q

Only CCB you can use w/ CHF

A

Amlodipine

Is neither a negative chronotrope (decrease HR) or isotrope (decrease contractility force)

52
Q

Reversible antiplatlets

A

Only GPIIB/IIIA Antagonists

53
Q

Beta blocker drug interactions

A

NSAIDS - blunt BB effect

Epinephrine - need more to work, cause severe HTN

Calcium channel blockers - additive effects can cause ectopic foci/arrhythmias

54
Q

ACE Inhibitors are first line in:

A

Diabetes

CHF

Chronic kidney disease

Myocardial infarction

55
Q

Drugs that can cause a hypertensive crisis

A

MAO (monoamine oxidase) inhibitors - depression

-get Malignant HTN/stroke if they eat tyromine-containing foods

Sympathomimetics (sudafed)

Recreational drugs

56
Q

Good HTN drug combinations

A

BB + diuretic

ARB + diuretic

ACEI + diuretic

CCB + ACEI

ACEI + BB

57
Q

HTN Drug combinations to avoid

A

BB + CCD (Non-dihydropyridines)

ACEI/ARB + K+ sparing diuretics

Centrally acting agent combinations

Clonidine (Urgent HTN crisis) + BB

58
Q

Heart failure recommended drugs

A

Diuretic

BB

ACEI/ARB

Aldosterone antagonist

59
Q

Post-MI recommended drugs

A

BB

ACEI/ARB

Aldosterone antagonist

60
Q

High CAD risk recommended drugs

A

Diuretic

BB

ACEI

CCB

61
Q

Diabetes recommended drugs

A

Diuretic

BB

ACEI/ARB

CCB

62
Q

Chronic kidney disease recommended drugs

A

ACEI/ARB

63
Q

Black pts w/ HTN

A

Thiazide

CCB

64
Q

HTN pts w/ CAD

A

BB

65
Q

HTN pts w/ LV systolic dysfunction or overt heart failure

A

Diuretics

ACEI

BB (watch out for CHF increase)

DO NOT GIVE CCB

66
Q

HTN diabetic pts w/ nephropathy

A

ACEI

ARB

Check kidney function in a week

67
Q

HTN development during pregnancy

A

Methyldopa

68
Q

Pts w/ renal insufficiency/CRF

A

ACEI

ARB

69
Q

ACE Inhibitors

A

-prils

Block aldosterone release to prevent vasoconstriction and RAAS

Renal protectice and cardioprotective

70
Q

ACE Inhibitor contraindications

A

Renal artery stenosis

K+ sparing diuretics

Pregnancy

71
Q

ACE Inhibitor side effects

A

Cough

Acute renal failure

Angioedema

Hypotension

72
Q

ACE Inhibitor drugs

A

Captopril (Capoten)

Lisinopril (Zestril)

Enalapril (Vasotec)

Benazpril (Lotensin)

Ramipril (Altace)

Quinapril (Accupril)

73
Q

Angiotensin II Receptor Blockers (ARBs)

A

-sartans

Everything like an ACEI w/o the cough

74
Q

ARBs contraindications

A

Pregnancy

Renal artery stenosis

75
Q

ARB drugs

A

Irbesartan (Avapro)

Candesartan (Atacand)

Losartan (Cozaar)

Valsartan (Divoan)

Olmesartan Medoxomil (Benicar)

76
Q

Alpha-1 blockers

A

-zosin

Cause vasodilation to reduce PVR

Also used to tx benign prostatic hyperplasia

Use low dose - cause syncope

77
Q

Alpha-1 Blocker drugs

A

Prazosin (Minipress)

Terazosin (Hytrin)

Doxazosin (Cardura)

78
Q

Alpha - 2 receptor agonists

A

Work centrally - stimulate brain alpha-2 to decrease vasoconstriction

Used only in difficult to control HTN or w/ Pregnancy

SE: dry mouth, depression

79
Q

Alpha-2 receptor agonist drugs

A

Clonidine - patch

Methyldopa - pregnancy

80
Q

Vasodilators

A

Used in emergencies to rapidly drop pressure

cGMP increase to relax smoothe muscles

Can build tolerance over time

81
Q

Vasodilating drugs and SE

A

Hydralazine - lupus-like syndrome

Minoxidil - severe Na/H2O retention, Hirsutism

Reserpine - Mental depression w/ serotonin loss

-Give w/ a diuretic

82
Q

Digoxin

A

Atria rate control, CHF positive inotrope

Stimulates PNS to increase vagal tone - doesn’t work w/ exercise

Slow onset, loading dose, week till steady state - 0.8-2 ng/mL (0.5-1 w/ CHF)

83
Q

Digoxin Toxicity

A

Decreased renal function, electrolyte disturbances

DI w/ amiodarone, verapamil

Sx: AV block, junctional tachycardia, ventricular arrhythmias, visual disturbances (yellow-green, halos), dizziness, weakness, N/V/D, anorexia

84
Q

Adenosine

A

Convert PSVT to sinus rhythm

Activates potassium channels to hyperpolarize cell membrane

Very short half-life - 10 seconds

CI: 2/3 degree block, sick sinus syndrome w/o pacemaker

85
Q

Atropine

A

Used to tx symptomatic bradycardia

Parasympatholytic = enhance SA and AV automaticity by blocking PNS/ACh

CI: angle-closure glaucoma, obstructive uropathy (BPH), Tachycardia, Bowel obstruction/altered transit (ischemic bowel)

May induce tachycardia

86
Q

Class I

A

Sodium channel blockers

Grouped according to how quickly they move on/off sodium channels

87
Q

Class Ia

A

Proarrhythmic - emergent only

Use for atrial and ventricle rhythms - increase SA/AV automaticity

A-fib/flutter - need BB/CCB on board to prevent tachycardia

Procainamide IV

88
Q

Class Ib

A

Used for ventricular arrhythmias (ACLS)

Work on ischemic/infarcted tissue (acute MI)

Lidocaine IV, Mexiletine PO

89
Q

Class Ib toxicity

A

Seizure

Respiratory arrest

90
Q

Class Ic

A

Use only when nothing else works - Amiodarone is more effective

Flecainide = rhythm control a-fib/flutter

Propafenone = rhythm control w/ atrial dysrhythmias

CI w/ structure heart disease

91
Q

Class II

A

Beta blockers - Metroprolol best w/o kidney SE

Used for ventricular/supraventricular arrhythmias

Slow AV/SA rates/conduction, negative inotrope to decrease O2 consumption

SE: bronchospasm, depression, bradycardia, ED, worsen CHF

92
Q

Class III

A

Potassium channel blockers

Antiarrhythmics - prolong action potential

Monitor for EKG changes

CI w/ drugs that prolong QT interval

93
Q

Amiodarone

A

Class III - a-fib/flutter, ventricular arrhythmias

Need large dose, goes everywhere, 6 mo 1/2 life

Toxicities w/ deposition into organs - pulmonary is life-threatening

Monitor PFT, CXR, DLCO yearly - take off w/ changes

Monitor TSH, CBC, LFTs q6mo

SE: GI w/ high dose, DI - CYP3A4, increase warfarin and digoxin effects

94
Q

Sotalol

A

Class III, BB like properties

Prolongs QT - monitor 3 days after start

Use for V-tach, A-fib/flutter

Renal clearance

Risk for Torsades

95
Q

Dofetilide

A

Class III - proarrhythmic

a-fib/flutter

SE: Prolong QT, torsades, HA, dizziness, many DI w/ common Abx - macrolides, Bactrim, CCB

96
Q

Ibutilide

A

Class III

IV only, acute a-fib/flutter conversion to sinus

SE: torsades

97
Q

Class IV

A

Calcium Channel Blockers - Nondihyrodpyridine

Decrease SA/AV automaticity, no ventricle effect

CI w/ LVSD, WPW, accessory pathway

SE: Bradycardia, Heart block, flushing, dizziness, edema, constipation and HOTN

Cardiology (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions