Test 2 Flashcards
0
Q
Warfarin lavender (light purple)
A
2 mg
1
Q
Warfarin Pink
A
1 mg
2
Q
Warfarin Green
A
2.5 mg
3
Q
Warfarin Tan
A
3 mg
4
Q
Warfarin Blue
A
4 mg
5
Q
Warfarin Peach (light orange)
A
5 mg
6
Q
Warfarin teal (blue-green)
A
6 mg
7
Q
Warfarin Yellow
A
7.5 mg
8
Q
Warfarin White
A
10 mg
9
Q
What are the broad adverse effects of anticoagulants?
A
Bleeding! and hypersensitivity
10
Q
What clotting factors (Vitamin K dependent factors) does Warfarin decrease?
A
Factor II (prothrombin) Factor XII Factor IX Factor X Protein C & S
11
Q
Warfarin’s mechanism of action
A
Inhibits VKORC1 (Vitamin K epioxide reductase complex 1)
12
Q
What is VKORC1 and what does it do?
A
Vitamin K epoxide reductase complex 1
VKORC1 converts Vitamin K from inactive to active
13
Q
Warfarin is a(n)…
A
Vitamin K antagonist!
14
Q
How is Warfarin metabolized?
A
Several CYP (cytachrome P) pathways
15
Q
How is Warfarin monitored?
A
INR/PT
16
Q
Factors that affect INR value
A
herbal drugs (G’s and St. John’s wart), ETOH, smoking, fever, diarrhea, malnutrition, Vitamin K rich foods, drugs
17
Q
Drugs that affect INR value & how INR is affected
A
Azoles (increase INR b/c CYP inhibitor)
Amiodarone (increase INR b/c CYP inhibitor)
Bactrim (increase INR b/c CYP inhibitor)
Metronidzole (unknown)
18
Q
Drugs for anticoagulation
A
Warfarin Rivaroxaban Dabigatran Heparin Low Molecular Weight Heparin (LMWH)
19
Q
Rivaroxaban mechanism of action
A
Factor XA inhibitor
20
Q
Dabigatran mechanism of action
A
Direct thrombin inhibitor
21
Q
2 examples NOACs (new oral anticoagulants)
A
1) Rivaroxaban
2) Dabigatran
22
Q
NOAC that is superior to Warfarin
A
apixiban
23
Q
What anticoagulant is preferred in pregnancy?
A
Heparin! (only one)
24
LMWH's mechanism of action
Factor XA inhibitor
25
How can heparin be administered?
subq or drip
26
Inpatient drugs for acute MI (without stent placement)
morphine, oxygen, nitroglycerin, aspirin
| think MONA
27
What does MONA stand for?
morphine
oxygen
nitroglycerin
aspirin
28
What is MONA used for?
inpatient drug scheme for acute myocardial infarction
29
Outpatient drugs for acute MI
```
aspirin
statin
ACE inhibitor
beta blocker
clopidogrel (if patient received stent)
```
30
What are nitrates used for?
chest pain
31
What are the adverse effects of nitrates?
hypotension
| orthostatic hypotension
32
With what drugs are nitrates contraindicated?
"fils": sildenafil, vardenafil, tadalafil (viagra drugs of world)
33
How long should patients have a nitrate free window?
8-18 hours per day
34
Why do patients need a nitrate-free window?
to prevent tolerance to nitrates from building
35
Equation for cardiac output
CO = HR (heart rate) x SV (stroke volume)
36
Equation for arterial pressure
AP = PR (peripheral resistance) x CO (cardiac output)
37
definition primary hypertension
hypertension without a known cause
38
primary hypertension is also known as
essential hypertension
39
definition of secondary hypertension
hypertension with a known cause
40
RAAS stands for
renin-angiotensin-aldosterone system
41
3 important players of the RAAS
1) angiotensin (I & II)
2) angiotensin-converting enzyme (ACE) aka Kinase II
3) aldosterone
42
Lisinopril mechanism of action
ACE enzyme inhibitor
| blocks conversion angiotensin I to angiotensin II
43
What does Lisinopril have mortality data for?
heart failure
44
ACE inhibitors decrease levels of _____ and increase levels of ______
decrease levels of ANGIOTENSIN II
| increase levels of BRADYKININ
45
What causes the cough some people experience with ACE inhibitors?
increased levels of bradykinin due to block action of ACE inhibitors in converting bradykinin to an inactive product
46
Decreased levels of angiotensin result in...
vasodilation
decreased blood volume
decreased cardiac and vascular remodeling
potassium retention
47
Drugs with side effect of hyperkelemia
Lisinopril
Losartan
Spironlactone
Eplerenone
48
Drugs with side effects hypokelemia
hydrocorothiazide (HCTZ)
furosemide
digoxin (arrythmias secondary to hypokelemia)
49
The only active ACE inhibitor is...
Lisinopril
50
Losartan mechanism of action
angiotensin II receptors blockers (ARBs)
51
Spironlactone mechanism of action
aldosterone receptor antagonist
| potassium sparing diuretic
52
Eplerenone mechanism of action
aldosterone receptor antagonist
53
Example first generation beta blocker
Propranolol
54
Example second generation beta blocker
Metoprolol
55
Third generation beta blocker
Carvedilol
56
Ending for beta blocker medications
"lol"
57
Ending ACE inhibitors
"pril"
58
Important beta blocker side effect
Mask all hypoglycemia symptoms except sweating
59
Verapamil mechanism of action
Calcium channel blocker w/ calcium channels mainly in cardiac tissue
60
Nifedeipine mechanism of action
calcium channel inhibition less localized in heart, more peripheral
61
Where does hydrochorothiazide (HCTZ) works in the nephron?
early distal convoluted tubule
62
Where furosemide works in the nephron?
thick segment--ascending limb Henle's Loop
63
NYHA functional classification categories
I - Asymptomatic
II - Symptomatic w/ moderate exertion
III - Symptomatic w/ minimal exertion
IV - Symptomatic at rest
64
ACC/AHA stages heart failure
A - high risk HF; no structural heart disease; no symptoms HF
B - structural heart disease; no symptoms HF
C - structural heart disease; prior or current symptoms HF
D - advanced structural heart disease; marked symptoms HF at rest despite max medical therapy
65
Digoxin mechanism of action
blocks Na-K ATPase pump
66
When is digoxin used?
late stage heart failure (stage C)
67
INR range with high risk of clotting
less than 2
68
INR range high risk bleeding
greater than 3
69
INR ranges 2-3
A. Fib
VTE
heart valve
hypercoagulable state
70
INR ranges 2.5-3.5
mitral heart valve
71
Is a loading dose of Warfarin good or bad practice?
poor practice & weakly supported by evidence!
72
RAAS suppressants subsets include:
ACE inhibitors
Angiotensin II receptor blockers (ARBs)
Aldosterone antagonists
73
Diuretic subsets include:
thiazides (and related diuretics)
loop diuretics
potassium-sparing diuretics
74
Intermediate Acting Insulins
NPH
| Detemir
75
Short-acting Insulins
Regular
76
Rapid-acting Insulins
aspart
lispro
glulisine
77
Long-acting Insulins
Detemir
| Glargine
78
Onset Aspart
10-20 mins
79
Onset Glulisine
10-15 minutes
80
Onset lispro
15-30 mins
81
Onset regular insulin
30-60 mins
82
Onset NPH
1-2 hours
83
Onset detemir
1-2 hours
84
Onset glargine
70 mins (approx.)
85
Peak regular insulin
1-5 hours
86
Peak NPH
6-14 hours
87
Peak detemir
```
12-24 hours (if intermediate)
no peak (if long-acting)
```
88
Peak lispro
30 mins-2.5 hours
89
Peak glargine
NO PEAK
90
Peak aspart
1-3 hours
91
Peak glulisine
1-1.5 hours
92
Duration NPH
16-24 hours
93
duration detemir
varies (long or intermediate)
94
Duration glargine
24 hours (approx.)
95
Duration aspart
3-5 hours
96
Duration glulisine
3-5 hours
97
Duration lispro
3-6 hours
98
Duration regular insulin
6-10 hours
99
ergocalciferol & cholecalciferol are...
vitamin D replacements
100
epoetin alfa works by...
mimicking endogenous erythropoietin made in kidneys
101
Iron dextran is...
used in patients that can't take iron supplements PO (ex, if they are on dialysis)
102
Major risk of iron dextran:
FATAL ANAPHYLACTIC REACTIONS (why must do a test dose in a controlled setting!)
103
Canagliflozin mechanism of action:
inhibition Na-glucose co-transporter-2 in kidney (prevents kidney re-uptake of glucose, glucose excreted through urine)
104
Major side effect canagliflozin:
yeast infections (think CAN-dida when see CAN-agliflozin)
105
Repaglinide is a...
secretagogue (increases insulin release)
106
Secretagogue drugs:
repaglinide
| glipizide
107
Major risk of secretagogues & the secretagogue drugs:
Major risk of hypoglycemia!
| repaglinide & glipizide
108
Pioglitazone mechanism of action:
Insulin sensitizer! (increases insulin sensitivity & decreases hepatic glucose production)
109
Pioglitazone metabolism:
CYP2C8 pathway
110
2 DM drugs that increase insulin sensitivity and decrease hepatic gluconeogenesis:
pioglitazone
| metformin
111
Ferrous sulfate is...
iron supplement used to transport oxygen on hemoglobin!
112
Major side effects ferrous sulfate:
GI effects & HEARTBURN
113
Glipizide is a(n)...
sulfonylurea secretagogue (stimulates the secretion insulin)
114
Secretagogue mechanism of action...
close potassium channel, open calcium channel which stimulates the release of insulin.
115
These 2 drugs shouldn't be taken with beta blockers for risk of severe hypoglycemia...
1) glipizide
2) repaglinide
(both secretagogues)
116
Exenatide mechanism of action...
increases glucose-dependent insulin secretion by mimicking incretin.
117
Sitagliptin mechanism of action...
DPP-4 inhibitor (allows incretin to stimulate insulin and inhibit glucagon)
3rd line drug!
118
Acarbose mechanism of action...
inhibits carbohydrate absorption through inhibiting the alpha-glucosidase enzyme at the GI brush border.
119
Metformin as therapy...
1st line of therapy DM-II
120
Metformin mechanism of action...
increases insulin receptor sensitivity & decreases liver gluconeogenesis!
121
Metformin belongs to what class drugs...
biguanide!
122
Major risk metformin:
stop before and after procedures with iodated IV contrast dyes due to lactic acidosis!
123
Pramlintide mechanism of action...
mimics amylin and therefore prevents postprandial hyperglycemia!
