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Pharm II MHM - Exam 2 > Stable CAD Lecture > Flashcards

Stable CAD Lecture Flashcards

1
Q

When should aspirin be chewed and swallowed?

A

During ACS

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2
Q

What factors influence GI bleeding with aspirin use?

A
  • Age
  • Dose
  • Drug burden
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3
Q

What should be used with aspirin to protect stomach from bleeding?

A
  • H2 receptor antagonists

- PPIs

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4
Q

What is clopidogrel bioactivated by? What should be avoided because of this?

A
  • CYP 2C19

- Avoid PPIs

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5
Q

What is the advantage of prasugrel over clopidogrel?

A
  • Marginally more effective

- Avoids CYP 2C19 interaction with PPIs

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6
Q

Why should prasugrel be avoided in patients less than 60 kg or older than 75?

A

Increase in minor bleeding

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7
Q

Which anti-platelet is reversible?

A

Ticagrelor

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8
Q

When is ticagrelor contraindicated and why?

A
  • Active liver disease

- 99+% protein bound

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9
Q

What class is preferred as anti-anginals? Why?

A

Beta blockers

-Best data for reducing CV events

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10
Q

What classes are used as anti-anginals?

A
  • Beta blockers
  • CCBs
  • Nitrates
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11
Q

How do Beta blockers alter electrical conduction in the heart?

A

PR interval and ventricular rate prolonged

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12
Q

How do beta blockers affect renin?

A
  • Reduction in renin output

- Reduction in RAAS activity (aka decreased BP)

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13
Q

Describe the half life of beta blockers

A

Short

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14
Q

___ predicts response in beta blocker use

A

Hepatic metabolism

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15
Q

What are the outcome benefits of beta blockers?

A
  • Reduce mortality in HTN pts w/recent MI

- Improve survival in HTN pts after recent stroke

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16
Q

What is the functional importance of beta blockers?

A

Improves exercise tolerance (though initially difficult)

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17
Q

Downsides of beta blockers

A
  • Symptomatic bradycardia
  • Initial reduction in exercise tolerance (adapts w/in 30 days)
  • CNS (fatigue, insomnia, unpleasant dreams)
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18
Q

What type of beta blocker is metoprolol?

A

Selective b-1 blocker

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19
Q

Which beta blocker can precipitate decompensated HF if used in unstable Stage 3/4 pts?

A

Bisoprolol

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20
Q

Which beta blocker requires adjustment in renal dysfunction due to long half life?

A

Bisoprolol

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21
Q

What type of beta blocker is carvedilol?

A

Non selective plus selective alpha 1 blocker

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22
Q

Which beta blocker has less rebound tachy and why?

A

Carvedilol and Labetalol

due to alpha blocking effects

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23
Q

Which beta blocker has extensive hepatic metabolism through CYP 2D6?

A

Carvedilol

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24
Q

Which beta blocker may reduce smooth muscle infiltration in vascular remodeling, limit free radicals, and reduce lipid peroxidation?

A

Carvedilol

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25
Q

What are the unique features of propranolol?

A
  • Nonselective
  • Lipophilic
  • Very high 1st pass metabolism
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26
Q

Which beta blocker has a longer duration of action which makes it good for daily dosing?

A

Nadolol

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27
Q

What type of beta blocker is nadolol?

A

Nonselective

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28
Q

Which beta blocker has NO CV outcomes data in HTN pts with CAD, HF?

A

Atenolol

29
Q

Atenolol is which type of beta blocker?

A

Selective beta 1 blocker

30
Q

What type of beta blocker is labetalol?

A
  • Non selective beta blocker

- Selective alpha 1 blocker

31
Q

Which beta blocker has an ultra short action time?

A

Esmolol

so it is reserved for perioperative use

32
Q

What is the most selective beta 1 blocker?

A

Nebivolol

33
Q

Which beta blocker results in NO dependent vasodilation?

A

Nebivolol

34
Q

Which beta blocker should be dose reduced in Child-Pugh Class B patients and CrCl less than 30?

A

Nebivolol

35
Q

When should Nebivolol be dose reduced?

A
  • Child-Pugh Class B patients

- CrCl less than 30

36
Q

All CCBs are ____ vasodilators

A

Arterial

37
Q

Which CCBs are alternatives to BBs?

A

Verapamil and diltiazem

38
Q

Which CCBs lower myocardial oxygen demand?

A

Verapamil and diltiazem

39
Q

What are examples of dihydropyridine CCBs?

A

Nifedipine
Amlodipine
Felodipine

40
Q

Which CCB is long acting and gives the best 24 hr BP control?

A

Amlodipine

41
Q

What is a disadvantage to dihydropyridine CCBs?

A

Can result in edema

42
Q

Which CCBs are CYP3A4 inhibitors?

A

Verapamil

43
Q

Which CCBs are inhibitors of P-glycoprotein?

A

Verapamil and dilt

Nifedipine

44
Q

What 2 indications can CCBs be used for?

A
  • Vasospastic angina

- Vasospasm a/w hemorrhagic stroke (nimodipine, nicardipine, verapamil)

45
Q

Which CCBs should be avoided in heart failure patients?

A

Non-dihydropyridines (verapamil and dilt)

46
Q

How is the dose of verapamil adjusted?

A

BP, HR, exercise tolerance

47
Q

Which is tolerated better - verapamil or diltiazem?

A

Diltiazem

48
Q

MC ADE reported with diltiazem?

A

Peripheral edema

49
Q

Which CCBs are strong CYP3A4 substrates?

A

Diltiazem

50
Q

How does Nifedipine work?

A
  • Relaxes coronary and peripheral smooth muscle
  • Can be used carefully with B blockers
  • Never use SL or orally in HTN emergencies (increases rebound activity)
51
Q

Which CCB can be used in Raynaud’s?

A

Nifedipine

52
Q

When can dosing of amlodipine be adjusted?

A

Every 14 days

53
Q

What is considered a last line CCB and why?

A
  • Bepridil

- A/w LV dysfunction

54
Q

Describe nitrates

A

Mixed venous AND arterial dilating drugs

55
Q

What is the benefit of nitrates?

A
  • Symptom relief, delays ED/urgent care visits

- No CV outcome benefits

56
Q

What should we be cautious about with nitrates?

A

Regular use depletes glutathione which results in tolerance to nitrate

57
Q

ADEs of nitrates?

A
  • Migraine like HAs (d/t temporal and meningeal artery dilation)
  • Rebound tachy
  • Enhanced Na retention
58
Q

What meds should be help for 24 hours after any nitrate and why?

A 
PDE inhibitors (used for ED)
-Can cause excessive vasodilation
59
Q

What is the intended use of nitroglycerin?

A

Rapid relief of angina

  • SL duration = 20-30 mins
  • TD duration = 6-8 hrs (remove patch before MRI and defib)
60
Q

What can nitro be used to prevent?

A

Exercise induced angina

61
Q

What is the purpose of isosorbide mononitrate?

A

XR tablet to allow for treatment of nocturnal angina

62
Q

Which nitrate has the highest levels of tolerance?

A
  • Isosorbide dinitrate

- Last dose should be no later than 7pm

63
Q

Why should nitrates and alcohol be avoided?

A
  • CV collapse

- Arrhythmia

64
Q

How does Ranolazine work?

A
  • Reduces ventricular wall tension and MVO2
  • Enhanves metabolic efficiency w/o changing hemodynamics (no effect on BP and HR)
  • Improves treadmill exercise tolerance by 30 secs
65
Q

Where is Ranolazine’s place in therapy?

A

When BB, CCB and nitrates are maximized

66
Q

What happens with higher doses of Ranolazine?

A

Prolongs QT interval

67
Q

How does Ivabradine work?

A
  • Alternative node blocking agent
  • Selective Na blocker
  • Hyperpolarizes SA node
68
Q

What are nicorandil and trimetazidine?

A

Newer agents not yet available in US

Pharm II MHM - Exam 2 (5 decks)

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