Pharmacology Flashcards
mech of nitrates
inc. cGMP–> inhibit Ca influx–> smooth m. relaxation
do nitrates need intact endothelium to vasodilate?
no
what else can ranolazine possible do besides decrease chronic angina?
dec afib or ventricular arrhythmias
does ranolazine inc QT ?
yes
mech of ranolazine
alters late Na current and Na/Ca dependent channels
when is ranolazine contraindicated?
liver dz
which trial showed that clopidogrel with nexium had no difference in event rates?
COGENT
maximum ASA dose you can use with ticagrelor?
81mg
how is ticagrelor cleared?
hepatic ( do not use with severe impairment)
besides bleeding, what is a major side effect of ticagrelor?
SOB
important side effect to remember for abciximab
thrombocytopenia
if pt has had eptifibatide in past, can they get it again? why?
yes, it is not immunogenic
if a pt has had streptokinase in past year, can they get it again? why?
no. allergic rxn/;ess effective b/c of Ab’s to it.
what are differences b/w tPA and streptokinase?
higher bleeding with tPA, no allergy, less HoTN
what happens when someone is on dabigatran and you start amio? what to do?
amio increases dabigatran levels by 50%
cut dabigatran to 75 bid
mech of dabigatran
direct thrombin inhibitor
what enzyme metabolizes rivaroxaban (xarelto) and apixaban (eliquis)? what organ?
liver CYP3A4
when is rivaroxaban (xarelto) contraindicated?
renal failure
does rivaroxaban need to be given with food?
yes
can you give apixaban in renal failure?
yes
name 3 high risk groups for bleeding with NOAGs
older, renal impairment, skinny
what is the story with dabigatran (pradaxa) and MI?
- RE-LY showed slight increase in MI.
- review w/ revised results showed not statistically sig
- metanalysis confirmed inc risk of MI
which NOAG is dialyzable if pt. is bleeding?
dabigatran (pradaxa)
which type of pt. on procainamide witll get lupus?
slow acetylators bc of buildup of N-acetylprocainamide
2 drugs that can cause lupus-like syndrome?
procainamide
hydralazine
if a pt. has symptomatic HOCM and is already on BB or CCB, what med can you give?
disopyramide
what does liver dz do to lidocaine administration?
decreases metabolism (inc’d tox)
what is the dose-related toxicity of lidocaine?
CNS (dizzy, hallucinations, confusion, Sz)
if a patient has CHF and needs lidocaine, what do you have to remember?
use lower dose
which trial showed that flecainide can’t be used in ischemic HD?
CAST
which antiarrhythmics can be used to treat disabling PVCs?
flec/propafenone
which class Ic antiarrhythmic has a higher beta blocking effect (e.g. bronchospasm, slower HR) ?
propafenone
which of the following will slow heart rate more: flecainide or propafenone?
prop
what do D + L isomers of sotalol do?
D- prolong repol
L- Beta block
can stall prolong QT?
yes
should you admit a pt for starting sotalol?
yes, QT prolongation
what happens to sotalol with CRI?
prolonged half life
main use for sotalol
afib
what to remember about verapamil and dofetilide?
dofetilide tox possible because both use CYP3A4
why does amio cause hypothyroidism?
blocks conversion of T4 to T3
what is the active metabolite of amio?
desethylamiodarone
mortality rate of amio related plum fibrosis?
10%
name 7 drugs/drug classes using CYP3A4
antifungals, macrolide Abx, PI’s
verapamil, diltiazem
grapefruit juice
statins
two ocular effects of amio
corneal deposits
optic neuritis
which drug is the non-iodine version of amio?
dronedarone
mech of HCTZ
blocks reabsorption of Na in DCT
what is effect on K+ by HCTZ?
hypokalemia
what is effect of HCTZ on uric acid?
reduced excretion
why is there an increased risk of gout with HCTZ?
reduced uric acid excretion
why can you give HCTZ to prevent Ca stones?
Calcium excretion is decreased
does HCTZ affect GFR?
no
difference in potency b/w metolazone and HCTZ?
metolazone 10x more diuretic and hypokalemic effect
which is better for edema: HCTZ or metolazone?
metolazone
why does chlorthalidone have long half life?
90% bound to erythrocyte carbonic anhydrase
can thiazides cause torsades?
yes
what to remember about thiazides and lithium?
decrease lithium dose by 50%
effect of thiazides on LDL and TG’s
increase
which loop diuretic does not have sulfa moiety?
ethacrynic acid
because of better absorption, which loop diuretic is better to give in edematous state?
bumetanide/torsemide
side effect of ethacrynic acid (and other loops)
ototoxicity
if eGFR< 30-40, which diuretics should you use?
loops or metolazone
alpha 1 receptor
vasoconstriction
alpha 2 receptor
presynaptic, reduces catecholamine outflow
Beta 1 receptor
heart, inc. inotropy/chronotropy
Beta 2 receptor
vessels, vasodilation
do you have to give IV BB during acute MI?
no
what can BB mask the sxs of?
hypoglycemia
which 2 BB’s have least CNS side effects b/c they are least lipid soluble?
atenolol, nadolol
name 2 BB’s that have both beta and alpha blocking properties
labetalol, carvedilol
name 4 selective BB’s
metoprolol, atenolol, bisoprolol, esmolol
which BB also increases nitric oxide activity?
nebivolol
which BB’s are best to use in reactive airway dz?
nebivolol, bisoprolol
if pt has CHF and asthma and needs BB, which BB to use?
bisoprolol
which BB’s have shown survival benefit?
metoprolol succinate, carvedilol, bisoprolol
which BB can you use with dobutamine (b/c it doesnt blunt its effect)?
metoprolol, not coreg
which BB is “less well tolerated in asthma?”
carvedilol
what type of antihypertensive will ACEI’s work synergystically with?
diuretics
on ACEI, what is BP level very sensitive to?
dietary sodium intake
if you have MILD angioedema with an ACEI or hyperkalemia, what med can you cwitch to?
ARB
mech of aliskiren
renin inhibitor
what enzyme converts angiotensinogen to angiotensin I?
renin
Which anti hypertensive class have been shown to have superior stroke risk reduction?
CCBs
Name nondihydropyridines
Verapamil
Diltiazem
What do dihidrooyridines names end in?
-dipine
Amlodipine, nicardipine, etc
Which CCB has the most negative inotropic and chronotropic effect?
Verapamil
Do dihidrooyridines have negative inotropic effects (norvasc)?
No
GI side effect if verapamil
Constipation
Largest disadvantage of alpha blockers
Orthostatic hypotension
What do you increase the risk of with alpha blocker as mono therapy (ALLHAT)?
CHF
Describe first dose phenomenon of prazosin or other alpha blockers
Postural hypotension/syncope 30-90 mins after first dose
2 side effects of minoxidil (used for severe HTN) and treatment
Edema
Hirsutism
Always give with diuretic and BB
Hydralazine MOA
Direct vasodilator via NO and cGMP
Minoxidil MOA
Direct vasodilation by opening potassium channels in smooth muscle
Which statins use CYP3A4?
“Sal”
Simvastatin, atorvastatin, lovastatin
How common are serious liver problems with statins?
Very rare
Definition myositis in statin use
CK 10x above normal
Ezetimibe MOA
Blocks chol absorption at intestinal brush border
Does ezetimibe effect fat soluble vitamin uptake?
No
Best agent to raise HDL
Niacin
Does niacin reduce coronary events?
Yes
Why do you have to have a niacin free interval with sutained release niacin?
Hepatotoxicity
Can statins be used in pregnancy?
No
Do fibrates decrease LDL?
No
Which fibrin acid can be used in pregnancy ?
Gemfibrozil
Can you use fenofibrate, statins or fish oils in pregnancy?
No
What is the AHA rec for fish oils?
Post MI, 1g/ day
Do fish oils decrease CV risk?
No
Does dialysis remove dig?
Yes
Does digoxin have an effect in mortality?
No
Which is better at increasing cardiac output: dobutamine or milrinone?
Dobutamine
Which reduces BP more: dobutamine or milrinone ?
Milrinone
Which has a faster onset: dobutamine or milrinone?
Dobutamine
Which has shorter half life: dobutamine or milrinone?
Dobutamine
Which receptors does dobutamine hit?
B1, B2
Which receptors does dopamine hit?
B1, alpha 1, dopaminergic
Does dobutamine h beta 1 or 2 receptor harder?
Beta 1 (inc inotropy)
Biggest side effect of dobutamine?
Arrhythmias
How long does it take to develop tolerance to dobutamine?
72h
Milrinone MOA
Phosphodiesterase inhibitor
Name a good inotrop to increase CO and decrease SVR
Milrinone
Where does nitroprusside relax smooth muscle?
Arterioles, veins
Does nitroprusside increase cAMP or cGMP?
cGMP
Which IV anti hypertensive is light sensitive and causes thiocyanate tox?
Nitroprusside
Phenylepheine receptor
Alpha 1
Norepinephrine receptors
Alpha 1, Beta 1
Which agent is preferred in septic shock and over dopamine in cardiogenic shock?
Norepinephrine (levophed)
Name a potent press or used as a second agent in septic shock ?
Vasopressin
what type of fat exactly does AHA want you to stay away from?
Saturated fat
What percent of your calories should be from fat according to AHA ?
30%
Less than 10% of what type of fat should be in AHA diet?
Saturated fat
How many milligrams of cholesterol per day can you have in AHA diet?
300mg
Has Mediterranean diet been shown to reduce CV event rate?
Yes
Name 4 fish high in omega 3
Salmon, mackerel, herring, trout
Does tilapia have high fish oils?
No
Do fish oils increase bleeding time?
Yes