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Cardiology,HTN, HF, and Pharm > Pharmacology for Cardiac, HTN, HLD, HF, Arrhythmias > Flashcards

Pharmacology for Cardiac, HTN, HLD, HF, Arrhythmias Flashcards

1
Q

“Statins”-AKA

A

Are HMG CoA Reductase Inhibitors

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2
Q

Statin -MOA

A

Inhibit LDL synthesis, increase LDL catabolism and have some non steroidal anti-inflammatory activity

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3
Q

Statin -AE

A

Hepatic Toxicity- elevated transaminases
Myopathy and Rhabdomyolysis
Neuropathy
Small increased risk of DM with high doses

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4
Q

Statin- Contra

A

Pregnancy category X
Lactation
Active or Chronic Liver disease
Relative-concomitant use of cycolosporins, gemfibrozil and niacin

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5
Q

Statin- Drug interactions

A 
CYP substrate
Atorva-3A4
Prava-None
Rosuva-limited 2C9
Simva- 3A4&3A5-don't use
Myopathy when used with Cyclosporine, gemfibrozil, niacin, azole antifungals and erythromycin
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6
Q

GrapeFruit?

A

Is a CYP3A4 inhibitor… inhibits metabolism of Atorva and simva causing increase in circulating blood levels

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7
Q

Statin- other Interactions

A

May potentiate oral anticoagulants

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8
Q

Statin Myopathy Risk Factors

A

Small body frame,
end stage renal disease or multi system diseases, perioperative,
multiple meds

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9
Q

Statin Monitoring

A

Check ALT and CK at baseline, document preexisting muscle symptoms
Check fasting lipid panel at 2 months and then every 6-12 months
Recheck ALT and CK as indicated
Monitor for new onset DM, consider lowering dose if 2 consecutive LDL are lower than 40mg/dL

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10
Q

Lipophilic

A

Atorvastatin

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11
Q

Hydrophilic

A

Pravastatin and Rosuvastatin

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12
Q

High intensity Statin

A

Atorvastatin 80mg daily

Rosuvastatin 40Mg Daily

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13
Q

Moderate Intensity Statin

A

Atorvastatin 20mg Dail

Rosuvastatin 10 mg daily

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14
Q

Low Intensity Statin

A

Pravastatin 10 mg daily

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15
Q

High intensity Statins are for

A

lowering LDL by 50%

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16
Q

Moderate statins lower

A

LDL 30-50%

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17
Q

Clinical ASCVD

A

Group 1
High intensity STatin if<75
Moderate Intensity if >75 or not candidate for HIS

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18
Q

LDL>190

A

Group 2

High intensity Statin , moderate if not a candidate

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19
Q

DM and 40-75 yoa

A

Group 3
High Intensity Statin with ASCVD>7.5%
Moderate intensity for ASCVD <7.5%

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20
Q

ASCVD>7.5%

A

Group 4

Moderate to high intensity based on Pt

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21
Q

Nonstatins

A

Use if Triglycerides >500mg/dL

Pt cannot tolerate recommended statin dose or achieve expected statin response

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22
Q

Fibric Acids

A

Fenofibrate 145 mg daily

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23
Q

Fibric Acid MOA

A

increases VLDL clearance and decreases VLDL synthesis

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24
Q

Fibric Acid Therapy

A

Decreases LDL5-20% increases HDL 10-20%
Get a baseline ALT, ALK Phos, repeat at 6-12 weeks
Yearly ALK and FLP

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25
Q

Fibric Acid-AE and Drug interactions

A

GI complaints

Possible increased effects of warfarin and sulfonylureas

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26
Q

Fibric Acid Contraindications

A

Hepatic and or severe renal dysfunction

Pre-existing gall bladder disease

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27
Q

Bile Acid Resins(BAR)

A

Not really used or helpful

Colestipol 4gm BID

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28
Q

Bile Acid Resins(BAR) MOA

A

Decreases LDL 15-25%
Increase in LDL catabolism, Decrease in Cholesterol absorption,
May increase TG and VLDL

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29
Q

Bile Acid Resins(BAR) AE

Contraindications

A

GI symptoms- constipation, flatulence, nausea
CI-Monotherapy in TGs>500
-Familial hyperlipidemia
-Hx of Severe constipation

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30
Q

Bile Acid Resins(BAR) Drug interactions

A

Problems with compliance
-Binds to many coadministered acidic drugs, decreases absorption of Digoxin, warfarin, thyroxine, thiazides, beta blockers, TCN, PCN, Amiodarone
Decreases bioavailability of statins
Take BAR 1 hour Before or 4 hrs after

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31
Q

Bile Acid Resins(BAR) Monitor

A

FLP at 6 weeks and yearly

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32
Q

Nicotinic Acid MOA

A

Niacin 1-2 gm TID
decreases LDL and VLDL synthesis
Lowers LDL 5-25% and Increases HDL 15-35%

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33
Q

Nicotinic Acid AE

A

Flushing of skin, glucose intolerance and increased UA

Hepatotoxicity

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34
Q

Nicotinic Acid contra

A 
Liver disease(absolute cont)
DM type 2
Gout and Hyperuricemia
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35
Q

Nicotinic Acid Monitor

A

Baseline AL, Alk Phos,
6-12 weeks ALT, all phos, Uric acid, BGL, and FLP
Yearly ALT, alk Pos, FLP

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36
Q

Ezetimibe

A

Zetia 10mg daily
Blocks Cholesterol absorption
Drops LDL by 15% increase HDL by 3%

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37
Q

Ezetimibe AE and Contra

A

AE- Fatigue, abd pain, diarrhea, back pain, arthralgia

Cont- Combination with statin in active liver disease or with persistent LFT elevations

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38
Q

PCSK9 inhibitors

A

Evolocumab- SQ q2-4 weeks

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39
Q

PCSK9 inhibitors MOA

A

Prevents PCSK9 from degrading Liver LDL receptors

Decreases LDL 60%

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40
Q

PCSK9 inhibitors Downside

A

$14,000/year

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41
Q

Fish Oil

A

W/O CHD eat fish 2/week

with CHD 1 gm EPA DHA preferably from fish oil

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42
Q

Fish Oil

A

Omega 3 fatty acid can lower TG, Prescription is Lovaza($184/month)

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43
Q

Class 1a AAD MOA

Sodium channel blockers

A

Alters the myocardial cell membrane,

Slows conduction velocity, prolongs refractory phase and decreases automaticity

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44
Q

Class Ia AAD Example

Sodium channel blockers

A

Procainamide

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45
Q

Class Ia AAD Indication

Sodium channel blockers

A

Supraventricular and ventricular arrhythmias

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46
Q

Class 1a AAD AE

Sodium channel blockers

A

Widens QRS, Prolongs QT, bradycardia, hypotension, worsening CHF and torsades des pointes

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47
Q

Class 1a AAD Contra

Sodium channel blockers

A

Hypersensitivity to procainamide, 2nd and 3rd degree HB

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48
Q

Class 1a AAD Monitoring

Sodium channel blockers

A

MOnitor serum concentration especially in renal failure Pt

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49
Q

Class Ib AAD

Sodium channel blockers

A

Blocks the rapid influx of sodium ions-

Lidocaine

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50
Q

Class 1C AAD Example

Sodium channel blockers

A

Flecainide

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51
Q

Class IC AAD MOA

Sodium channel blockers

A

Conduction slows

Slows conduction in the purkinje fibers and av nodes

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52
Q

Class IC AAD Indications

Sodium channel blockers

A

SVT, converting fib to NSR

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53
Q

Class IC AAD AE

Sodium channel blockers

A

dizziness, headache, syncope, SOB, arrhythmias, worsening HF

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54
Q

Class IC AAD Contraindications

Sodium channel blockers

A

2nd/3rd degree HB, recent MI, cariogenic shock, HF and ischemic heart disease

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55
Q

Class IC AAD monitoring

Sodium channel blockers

A

monitor for drug interactions CYP system

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56
Q

Class II AAD Example

Beta Blockers

A

Metoprolol Succinate

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57
Q

Class II AAD MOA

Beta Blockers

A

Slows conduction velocity, prolongs refectory phase, decreases automaticity, slows AV node conduction

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58
Q

Class II AAD Indications

Beta Blockers

A

supra ventricular and ventricular rhythms

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59
Q

Class II AAD AE

Beta Blockers

A

Bradycardia, worsening HF, bronchospasm, hypotension

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60
Q

Class II AAD Contra

Beta Blockers

A

2nd/3rd degree HB, decompensated HF,

HR<45bpm

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61
Q

Class II AAD Monitoring

Beta Blockers

A

do not stop suddenly, reflex tacky and HTN, educate Pt on HR and BP

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62
Q

metoprolol tartrate

A

immediate release

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63
Q

Metoprolol Succinate

A

extended release

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64
Q

Class III AAD Examples

Potassium Channel Blockers

A

Amiodarone

Sotalol

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65
Q

Class III AAD Amiodarone-MOA

A

Increases the action potential

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66
Q

Class III AAD Amiodarone-

Indications

A

First line for VF/VT in cardiac arrest, stable Vtach, supra ventricular tachs,

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67
Q

Class III AAD Amiodarone-

AE

A

IV- Hypotension, bradycardia, blocks, phlebitis,

PO-Corneal deposits, optic neuritis, n/v/c, Anorexia, pulmonary fibrosis, elevated LFTs, blue discoloration

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68
Q

Class III AAD Amiodarone-

Contra

A

2nd/3rd degree HB

Sick SInus syndrome

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69
Q

Class III AAD Amiodarone-Monitoring

A

EKG monitoring, cautious with asthma Its, annual CXR, LFTs every 6mo, PFTs and Optho if symptoms
CYP interactions

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70
Q

Class III AAD- Sotalol MOA

A

Prolongs atrial and ventricular refractory period, also has Beta Blocker properties

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71
Q

Class III AAD- Sotalol Indications

A

Supraventricular and ventricular rhythms

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72
Q

Class III AAD- Sotalol AE

A

Bradycardia, Torsades, Worsening HF, blocks, bronchospasm

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73
Q

Class III AAD- Sotalol Contra

A

2nd/3rd degree HB, bradycardia, HF, asthma, and long QT syndrome

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74
Q

Class III AAD- Sotalol Monitoring/special

A

Pt must be hospitalized for 3 days for initiation of therapy, avoid other qt prolonging drugs, do not stop suddenly

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75
Q

Class IV AAD- Calcium Channel Blockers

Example

A

Diltiazem

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76
Q

Class IV AAD- Calcium Channel Blockers MOA

A

Nondihydropyridine- Slows conduction throughAV node

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77
Q

Class IV AAD- Calcium Channel Blockers Indications

A

PSVT, Afib/A flutter

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78
Q

Class IV AAD- Calcium Channel Blockers AE

A

dizzy, headaches, edema, blocks, bradycardia, worsening HF, and hypotension

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79
Q

Class IV AAD- Calcium Channel Blockers contra

A

WPW, caution in HF

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80
Q

Class IV AAD- Calcium Channel Blockers Special considerations

A

Negative inotrope, careful in combo with BB, dig or clonidine, CYP interactions

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81
Q

Digoxin MOA

A

Acts on AV node through parasympathetic simulation that increases vagal tone

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82
Q

Digoxin Indication

A

Controls ventricular rate in supra ventricular rhythms(Afib) and in HF does not convert afib into NSR

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83
Q

Digoxin- AE

A

anorexia, n/v/d, headache, vertigo, HB, brady

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84
Q

Digoxin- contra

A

2nd and 3rd degree HB

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85
Q

Digoxin- Special/monitoring

A

narrow therapeutic window,

requires loading dose

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86
Q

Adenosine MOA

A

Acts on the atrioventricular node to slow conduction and inhibit reentry pathways

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87
Q

adenosine Indications

A

PSVT

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88
Q

Adenosine- AE

A

headache, chest pain, dyspnea, flushing

89
Q

Adenosine- Contra

A

2nd and 3rd degree HB, sick sinus

90
Q

Adenosine special considerations

A

extremely short half life

will make you feel bad

91
Q

Atropine MOA

A

Blocks effects of acetylcholine on the SA and AV nodes. Increasing conduction velocity

92
Q

Atropine Indication

A

Symptomatic bradycardia

93
Q

Atropine AE

A

Palpitations, tachycardia, dry mouth, dizziness

94
Q

Atropine Contra

A

acute angle glaucoma, tachycardia, obstructive GI/GU

95
Q

Atropine special

A

give IV and monitor EKG

96
Q

Vasoactive/inotropes

A

Epi, Dopamine and Vasopressin

97
Q

Alpha 1 Stimulators

A

Norepi-vasoconstriction

98
Q

Beta 1 Stim

A

Epi-increased contractility

99
Q

Dopamine Stimulators

A

Dopamine-increased renal blood flow

100
Q

V1/V2

A

Vasopressin- peripheral vasoconstriction

101
Q

Beta 2 stimulators

A

Dobutamine- systemic vasodilation

102
Q

STEMI treatment

A

MONA-DAPT(ASA and P2Y12-I +/-GPIIb/IIIa inhibitor–Anticoag therapy–PCI in<90min

103
Q

MONA

A

Morphine- Anti-anxiety /pain relief decrease sympathetic response
Oxygen-Increase available O2 titrate SPO2 >90%
Nitrates-Vasodilation
Aspirin- anti-platelet therapy

104
Q

P2Y12-I-Dosing in the ACS Pt

A

Any Pt with ACS
Clopidogrel (Plavix)600mg loading dose, followed by 75mg PO daily x 1 year
Tricagrelor- 190mg loading dose followed by 90mg PO BID x 1 year

105
Q

Differentiate between non-modifiable and modifiable risk factors for CHD

A

Modifiable-Smoking, hyperlipidemia, HTN, Obesity, Diet, dibetes, inactivity
Non-modifiably- family Hx, age, gender

106
Q

Angina Treatment algorithm

A

chest pain–>EKG–>angina-no–.consider other causes
Angina-yes–>Pt ed, lifestyle modification, daily ASA, NTG —>infrequent episodes relieved-yes–>monitor and reevaluate periodically.
infrequent episodes relieved-no–> Monotherapy with BB–>if not relieved—>add CCB–>if still no relief refer to cardiology

107
Q

Lisinopril (ACS)

A

(ACE-Inhibitor)
MOA: Prevent conversion of angiotensin 1 to angiotensin 2 which is a potent vasoconstrictor, it also prevents cardiac remodeling
Indications: Give within 24 hrs to all Pts with ACS who also have HF, DM, or CKD
AE: Scr increase, cough, angioedema
Contraindications: Pregnancy, bilateral renal artery stenosis, Allergy
Special Considerations: May cause Hypotension and reduce renal function

108
Q

Losartan (ACS)

A

(ARB) Blocks the binding of Angiotension 2 at the ATI receptor, blocking Vasoconstriction and sympathetic activation. Similar to ACE inhibitors
Indications: Give within 24 hrs to all Pts with ACS who also have HF, DM, or CKD
AE: Scr increase, cough, angioedema
Contraindications: Pregnancy, bilateral renal artery stenosis, Allergy
Special Considerations: May cause Hypotension and reduce renal function- ARB can be given to Pt intolerant of ACE-I

109
Q

Nitroglycerin (NTG)(ACS)

A

Class:Nitrates
MOA- causes arterial and venous vasodilation by promoting release of nitric oxide from endothelium. This in turn lowers preload, BP and myocardial demand
Indications: ACS, angina
Dose: 0.4mg SL, can give IV drip and transdermal
AE: reflex tach, flushing, headaches, hypotension
Contra- Recent use of PD-5 inhibitor(Viagra/ Cialis)
ED: Tell Pt to call 911 if taken 3 doses and no still has angina

110
Q

Metoprolol succinate in ACS

A

Beta Blocker-succinate-slow
MOA: Competitive blockade of B1 adrenergic receptors decreases HR, myocardial contractility and BP
Indications-Give within 24 hrs of ACS Pt unless contraindicated and continue for 3 years
AE: bradycardia, hypotension, HB, acute HF, block typical hypoglycemia signs
CI: Bradycardia, Hypotension, 2/3rd degree HB and cardiogenic shock

111
Q

Amlodipine in ACS

A

Dihydropyridine Calcium Channel blocker
MOA: Stops calcium from entering smooth muscles which dilates arteries, reduces afterload and myocardial contractility
Indication: add on or substitution to BB
AE: Can cause reflex tachycardia
Special-Can be used in combination with BB
Great at reducing coronary spasm (Prinzmetal)

112
Q

Aspirin (ASA)

A

Anti-platelet agent
MOA-reduces platelet aggregation by inhibiting COX1
Indication: In ACS-325mg PO, daily after care or before care 81mg daily
No contraindications for ACS, with preventative care GI bleed is contraindication
Stop all other NSAIDs due to increased risk of death

113
Q

Ranolazine

A

MOA: Unclear- inhibits late influx of Na+ and decreases intracellular Ca++- decreasing myocardial contraction

Indication- adjunct therapy for Its non responsive to BB and CCB

AE-dizziness, constipation, headache, nausea
Contra-prolonged QT, watch for drug-drug interactions

Special-$$$EXPENSIVE$$$

114
Q

Unfractionated heparin (UFH)

A

Anticoagulants
MOA-potentiates the action of antithrombin3, inactivating thrombin and factor Xa- prevents the conversion of fibrinogen to fibrin (stops the coagulation cascade)

Indications: all Pt with ACS.

Dosing- 60 units/kg IV, stop shortly before PCI

AE: Bleeding, HIT

Contra- Hx of HIT, uncontrolled bleeding

115
Q

Enoxaparin (LMWH) Lovenox

A

Anticoagulants
MOA- potentiates action of antithrombin 3, mainly working on Factor Xa

Indication- Pt with ACS

Dosing- 1mg/kg SQ q 12 hrs

AE: Bleeding, HIT
Contra- Hx HIT uncontrolled bleeding

116
Q

Warfarin monitoring

A

INR between 2-3 for most indications, check daily until in target range then monthly

117
Q

Treatment for NSTEMI Ischemia guided

A

MONA- DAPT(ASA and PGY12-I)- Anitcoag Therapy(IV UFH, SQ LMWH, or Bivalirudin)

118
Q

Treatment for NSTEMI- early invasive strategy

A

MONA-DAPT(ASA, PGY12-I, +/-GP 2b/3a I)-Anticoag(IV UFH, SQ LMWH, or Bivalirudin)–Need for revascularization-(PCI-or CABG)
CABG Continue ASA stop DAPT 12 hrs emergent-5-7 days elective-
Continue UFH iv for both but discontinue SQ enoxaparin 12 hrs before and Bivalirudin 3 hrs before

119
Q

Treatment of STEMI

PCI capable facility

A

MONA-DAPT(ASA and P2Y12-I) and anticoag(IV UFH, or SQ LMWH, Bivalirudin) Door to balloon in 90 min

120
Q

Amlodipine HTN Class

A

CCB-Dihydropyridine

121
Q

Amlodipine HTN MOA

A

Block intracellular Ca++ influx, decreases smooth muscle contraction, Potent vasodilation(Turns vessel into firehose)

122
Q

Amlodipine HTN ADR

A

Tachy, Headache, Dizzy, flushing, edema

123
Q

Amlodipine HTN CI

A

AV node dysfunction, Sick SInus Syndrome, HF exacerbation

124
Q

Amlodipine HTN Dosing, Special consideration and Monitoring

A

2.5mg-10mg daily, Cheap, monitor BP

125
Q

Lisinopril HTN-Class

A

ACE Inhibitor

126
Q

Lisinopril HTN MOA

A

Inhibits ACE blocking the conversion angiotensin I to angiotensin II(A potent Vasoconstrictor) causes relaxation of vessels,
Decreases aldosterone decreasing Na+retention
Vasodilates efferent arterioles in kidney(protective with sufficent afferent blood flow)
Stops breakdown of bradykinin causing vasodilation (cough)

127
Q

Lisinopril HTN ADR

A

Cough!! Hyper K+, Hypotension, rash, angioedema, Acute renal failure in bilateral renal artery stenosis or dehydration

128
Q

Lisinopril HTN CI

A

2nd/3rd trimester of pregnancy, History of Angioedema

129
Q

Lisinopril HTN Monitoring

A

K+, Cr(30% bump is acceptable) BP

130
Q

Lisinopril HTN Dosing

A

5-40 mg daily

131
Q

Lisinopril HTN special considerations

A

Cheap, if cant tolerate cough switch to ARB

132
Q

Losartan HTN Dosing

A

25-100 mg daily

133
Q

Losartan HTN Class

A

ARB- cousin to ACE I

134
Q

Losartan HTN MOA

A

Block Angiotensin II receptor causing vasodilation, decreases aldosterone

135
Q

Losartan HTN ADR

A

Hyper K+, Hypotension, rash, angioedema, Acute renal failure in bilateral renal artery stenosis or dehydration

136
Q

Losartan HTN monitoring

A

K+, Cr and BP

137
Q

Losartan HTN Special

A

Consider if cannot tolerate ACE I

138
Q

Hydrochlorothiazide HTN Dosing

A

12.5-25 mg Daily

139
Q

Hydrochlorothiazide HTN Class

A

Thiazide diuretic

140
Q

Hydrochlorothiazide HTN MOA

A

increases Na+ excretion in distal tubule, decreasing plasma and extracellular volume

141
Q

Hydrochlorothiazide HTN ADR

A

Low K+ and Mg++, Hyperglycemia, hypercalcemia, hyperuricemia, mild increase to cholesterol and triglyceride

142
Q

Hydrochlorothiazide HTN CI

A

Caution in Hx of Gout, less effective if CrCl<30 use a loop diuretic instead

143
Q

Hydrochlorothiazide HTN Monitoring

A

Baseline and recheck in 2 weeks, BMP, BP dehydration and uric acid

144
Q

Metoprolol Succinate HTN Class

A

Cardioselective beta blocker

145
Q

Metoprolol Succinate HTN MOA

A

Block B1 receptors in heart and kidneys, causing decrease HR/CO causing a decrease in BP
Blocks some B2 blocking at higher doses
decrease in sympathetic stimulation of Renin secretion(RAAS)

146
Q

Metoprolol Succinate HTN ADR

A

fatigue, insomnia, nightmares, bradycardia, aggravates PVD, hypoglycemia signs can e masked, decreased HDL, increased TG

147
Q

Metoprolol Succinate HTN CI

A

bradycardia, heart blocks, sinus node disease, uncontrolled HR (caution)

148
Q

Metoprolol Succinate HTN Special considerations and Education

A

tartrate- immediate release
succinate- delayed release
may aggravate asthma or lung dz,
don’t stop abruptly if IHD (taper doses)

149
Q

Clonidine HTN Class

A

Centrally acting Alpha 2 agonist

150
Q

Clonidine HTN MOA

A

increase central A2 receptor to decrease peripheral symp activity, decreasing BP

151
Q

Clonidine HTN ADR

A

Dry mouth, sedation, fatigue, dizzy, orthostatic hypotension

152
Q

Clonidine HTN CI

A

Do not use in pregnancy, use methyldopa instead

153
Q

Clonidine HTN Special consideration

A

avoid abrupt d/c can cause severe rebound HTN, Rebound HTN will be worse if also on BB

154
Q

Spironolactone HTN Class

A

K+ sparing aldosterone antagonist diuretic

155
Q

Spironolactone HTN MOA

A

Aldosterone antagonist-decrease in Na+ and H2O retention

156
Q

Spironolactone HTN ADR

A

Hyperkalemia(especially if given w/ K+ supplements, ACE I or if renal insufficiency
gynecomastia

157
Q

Spironolactone HTN Special considerations

A

Gynecomastia( use Eplerenone as causes less gynecomastia

158
Q

Spironolactone HTN Monitoring

A

BMP, K+, and BP

159
Q

Terazosin HTN Class

A

A1 receptor Blocker

160
Q

Terazosin HTN MOA

A

Dilates arterioles and veins- relaxation of smooth muscles

161
Q

Terazosin HTN ADR

A

Hypotension, orthostatic hypotension, syncope with first dose, vivid dreams, interactions with PDE-5 Inhibitors (viagra)

162
Q

Terazosin HTN Special considerations and monitoring

A

Give dose at half strength due to orthostatic hypotension

BP - titrate to standing BP

163
Q

Hydralazine HTN Class

A

Direct vasodilation

164
Q

Hydralazine HTN MOA

A

arteriolar smooth muscle relaxation

165
Q

Hydralazine HTN ADR

A

Fluid retention,
rebound tachycardia
Headaches
Lupus like symptoms

166
Q

Hydralazine HTN Special

A

may need concomitant Diuretic and BB

167
Q

Warfarin class

168
Q

Warfarin MOA

A

Vitamin K antagonist, decreases synthesis of “1972” factors X, IX, VII, and II

169
Q

Warfarin ADR

A

Hemorrhage, skin necrosis, purple toe symptoms

170
Q

Warfarin CI

A

Pregnancy, High risk hemorrhage, noncompliance, EtOH abuse, surgery/dental work(may need to stop), spinal anesthesia

171
Q

Warfarin Special considerations

A

Onset 36-72 hrs- will need a bridge therapy of UFH or LMWH for 4-5 days
Protein bound drug
CYP metabolite
Caution with Amio, cimetidine, gemfibrozil, omeprazole, bactrim, rifampin, and carbamazepine

172
Q

Warfarin Education

A

Diet consistent Vit K intake

EtOH acute vs Chronic effects on INR

173
Q

Apixaban Class

A

DOAC- direct oral anticoag

174
Q

Apixaban MOA

A

Factor Xa inhibitor

175
Q

Apixaban ADR

176
Q

Apixaban CI

A

Active pathologic bleeding, severe hypersensitivity, prosthetic heart

177
Q

Apixaban Special considerations

A

Spendy, reversal agent is available but spendy
Pregnancy Cat B
CYP 3A4

178
Q

Apixaban monitoring

A

monitor renal function for need to adjust dose

179
Q

Clopidogrel Class

A

Anti platlet

180
Q

clopidogrel Indication

A

ischemic stroke(prevention and tx)
VTE prevention
ACS( prevention and stroke)
Stent thrombus prevention

181
Q

Clopidogrel MOA

A

P2Y11 inhibitor- inhibits ADP( which promotes platlet binding/aggregation)- decreases platelet aggregation

182
Q

Clopidogrel ADR

A

Bleeding and diarrhea

183
Q

Clopidogrel CI

A

Major active bleed, PUD, Intracranial hemorrhage

184
Q

Clopidogrel SPecial considerations

185
Q

Clopidogrel monitoring

A

Continue taking for 6 months post stent

186
Q

Apixaban Indications

A

Throboembolism( stroke) in afib
VTE prevention(post op)
DVT/PE treatment and prevention of reocurrence

187
Q

Warfarin Indications

A 
VTE (treatment and prophylaxis)
TIA stroke
AMI
Prosthetic heart valves
hypercoag state
Afib
PAD(occlusive)
188
Q

Heparin indications

A 
VTE (treatment and prophylaxis)
CABG
HD
Unstable angina
angioplasty
AMI
IV flush
189
Q

Enoxaparin indications

A

Prophylactic post hip/knee surgery

VTE bridge therapy

190
Q

Enoxaparin dosing for VTE

A

1mg/kg SQ q12hrs until INR is theraputic

191
Q

Metoprolol Succinate HF Dosing

A

12.5-25 mg daily increasing to 200mg daily

200mg daily is ideal dosing

192
Q

Beta Blockers effect in HF

A

Decrease HR, antiarrhythmic
Benefits- Reduce morbidity and mortality
Reduces hospitalization
Causes reverse remodeling of L ventricle(returning heart to normal size, shape and function)

193
Q

ACE inhibitors in HF impact and benefit

A

Decrease preload and after load
Reduces morbidity and mortality
Reduces hospitalization in HFrEF
Slows disease progression decreases/prevents remodeling

194
Q

Angiotensin II receptor blocker in HF benefits/effects

A

reduces morbidity and mortality in Pt with current or prior HF symptoms
Alternative if Pt cant handle or take an ACE I

195
Q

ANgiotensin receptor Neprilysin inhibitor (ARNI) in HF

Benefits

A

Reduce morbidity and mortality in Pt with prior or current HF symptoms
More effective than ACE inhib alone to decrease death or HF hospitalizations
In Pt with chronic symptomatic HFrEF NYHA class 2/3 who tolerate ACE I or ARB replacement by ARNI/ARB is recommended

196
Q

Aldosterone Antagonist in HF benefits

A

Decrease preload
Reduces morbidity and mortality
Reduces hospitalization

197
Q 
Aldosterone ANtagonists (Spironolactone)
Recommended for
A 
Pt with NYHA class 2-4 who have LVEF<35%
Pt following an acute MI who have LVEF<40% with symptoms of HF or DM
198
Q

Diuretics in HF benefit

A

Decreases Preload

Decreases symptoms not mortality

199
Q

Digoxin in HF benefits

A

Increases myocardial contractility(positive inotrope)
Antiarrhythmic for Pt in Afib
Alleviates six and improves clinical status in Pt with HFrEF decreasing Hospitalizations
No significant effect on survival

200
Q

Hydralazine in HF benefits and recommendations

A

Direct acting vasodilator-prevents nitrate tolerance, may interfere with HF progression(antioxidants)

A.A. with class 3-4 on guideline directed med therapy
Pt with HFrEF who cannot be given an ACE/ARB
LVEF <40% with persistent class 3/4 despite GDMT
201
Q

Nitrates(long term) in HF benefits and recommendations

A

Venodilation- decreasing preload, may inhibit ventricular remodeling

Recommended for
A.A. with class 3/4 HFrEF on GDMT
Pt with HFrEF who cannot take ACE/ARB
LVEF <40%with persistent class 3/4 despite GDMT

202
Q

Ivabradine in HF benefits

A

Works on funny channel slowing HR w/o decreasing BP

Prevents hospitalization but doesn’t reduce mortality

203
Q

Lisinopril Dosing in HF

A

Start at 5mg qday, (10mg if Pt has HTN)

Titrating dose upto 10 mg intervals of 2 weeks reaching goal of 20mg qday(max of 40mg qday)

204
Q

Lisinopril HTN Caution

A

Hyperkalemia
Hypotension
Renal dysfunction

205
Q

Lisinopril in HF Monitor

A

BP, K+, renal function

206
Q

ACE inhib recommendations in HF

A

All Pt’s with reduced EF to prevent HF

All pts with HFrEF unless contraindicated

207
Q

ACE inhib in CHF alternatives

A

ARBs, or Hydralazine+Isosorbide for Pts intolerant of ACE I

208
Q

Losartan in HF dosing

A

12.5-25 mg qday starting

50-100mg qday-ideal

209
Q

ARBs in HF monitoring

A

K+
BP
Renal function

210
Q

Carvedilol in HF

Class-MOA-AE-CI-Special, monitoring and Pt ED

A

BB, Given when Pt is stable,
Blocks the beta 1 adernergic receptors
Hypotension, fluid retention, bradycardia
CI in unstable HF Pt
Low starting dose titrations up slowly with close monitoring
BP, HR and fluid status
Teach to take BP, HR and monitor weight

211
Q

Sacubitril/Valsartan in HF

Class, MOA, Indication, AE, CI, special, monitoring and Pt ED

A

ARNI/ARB
Increases sodium loss and vasodilation and enhances ARBs efficacy
For Pt with SYstolic HF(HFrEF)
Hypotension, angioedema
Hf of angioedema, concurrent with ACE I or with in last 36 hrs of last ACE I dose due to risk of angioedema
K+, BP and renal function

212
Q

Furosemide in HF

Class, MOA, Indication, AE, CI, special, monitoring and Pt ed

A 
Loop Diuretic
Inhibits sodium reabsorbtion in ascending renal loop, proximal and distal CT, water follows salt
Moderate overload-PO
Severe overload-IV
Dehydration, hypotension
Anuria
BP, K+
Avoid over diuresis especially in starting ACE I
Emphasize Sodium restrictions
213
Q

Metolazone cautions

A

Potent thiazide diuretic, inhibits Na+ reabsorption in distal tubule
2.5 mg trial dose
Monitor K+, Weight, UO(urine output)
Cautiously as out Pt treatment PRN based on weight(1-2 times per week)

214
Q

Stages of HF

A

A:Pt at High Risk of HF-no structural heart disease no Sx of HF
B:Pt with structural heart disease but no Signs or sX of HF
C: Pt with structural heart disease and current or prior Sx of HF
D: Pt with refractory HF requiring specialized interventions

215
Q

Classes of HF

A

I: Pt with cardiac disease but no limitations, ordinary activity doesn’t cause issues
II:Pt with cardiac disease that have slight limitations of activity ordinary physical activity results in fatigue
III: Pt with cardiac disease with marked limitations of physical activity-Pt is comfortable at rest
IV: Pt with cardiac disease-unable to carry on physical activity w/o discomfort, Sx of CHF are present at rest

216
Q

Goals of HF treatment

A

Improve quality of Life
Decrease Mortality
Reduce compensatory mechanisms causing Sx

217
Q

Aldosterone ANtagonists in HF

Monitoring

A

BP, K+, renal Function(check at baseline, 3 days, 1 week and q3 months for Spironolactone)

218
Q

Standard First line therapies for HFrEF

A

ACE I/ ARB/ ARNI-ARB/ Hydralazine+Isosorbide (Lisinopril/Losartan)
Beta Blocker(Metoprolol ER, Carvedilol, Bisoprolol)
Aldosterone Antagonists (Spironolactone)
Diuretics (Thiazide-LooP)
Digoxin

219
Q

Management of Decompensated HF

A

Hospitalization
IV loop diuretics( add a thiazide if needed)
IV dobutamine to increase renal blood flow and diuresis
IV NTG if not hypotension

Cardiology,HTN, HF, and Pharm (3 decks)

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