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M3 Pharm B2 > Cardio and Renal 3 > Flashcards

Cardio and Renal 3 Flashcards

1
Q

Coronary Artery Disease (CAD): Risk Factors - Controllable

A

Controllable = Modifiable = I can treat

  1. HTN
  2. High Cholesterol
  3. DM
  4. Cigarette Smoking
  5. Obesity
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2
Q

CAD: Risk Factors - Uncontrollable

A

Uncontrollable = I can’t do anything about

  1. Age
  2. Gender (Male)
  3. Race
  4. Family History (Heredity)
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3
Q

Angina Pectoris: Defined and Characteristics (4)

A
  1. Burning, squeezing, or crushing chest pain that radiates to the left arm, shoulder, or jaw
  2. Mostly after physical exertion
  3. Emotional excitement, exposure to cold or heavy meal
  4. **Depressed ST segment
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4
Q

Angina Pectoris: Classification

A

Class I: Chest pain after strenous physical activity

Class II: Chest pain when walking > 2 blocks OR climbing > 1 flight of stairs

Class III: Chest pain when walking 1 to 2 blocks or climbing 1 flight of stairs

Class IV: Chest pain at rest

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5
Q

Angina Pectoris: MOA

A

Chest pain due to decrease blood and oxygen supply to the heart

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6
Q

Angina Pectoris: Types (3)

A
  1. Stable - Occurs with exercise or stress; relieved by rest
  2. Unstable - Occurs during rest and may progress to MI
  3. Vasospastic (Prinzmetal’s angina) - Due to vasospasm of coronary artery
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7
Q

Anti-anginal Drugs: Goal (2)

A
  1. Increase blood/oxygen supply by decreasing vasospasm

2. Decrease blood/oxygen demand by decreasing TPR, CO, or both

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8
Q

Anti-anginal Drugs: Drug Types (4)

A
  1. Vasodilators
  2. Beta Blockers
  3. CCBs
  4. Metabolic Modifier
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9
Q

Anti-anginal Drugs: Vasodilators - Nitrates: Buzzword

A

Buzzword: Activation of Nitric Oxide (NO)

endothelial NO synthase can be activated by: ACh, histamine, bradykinin, and serotonin

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10
Q

Anti-anginal Drugs: Vasodilators - Nitrates: MOA

A

GTP to cGMP via guanylyl cyclase –> Relaxation…

By dephosphorylation of myosin light chain, which prevents its interaction with actin, leading to relaxation and ultimately vasodilation

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11
Q

How do Nitrates decrease cardiac oxygen demand?

A

Dilation of large veins lead to decrease preload and decrease cardiac work (decrease oxygen demand)

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12
Q

How do Nitrates increase cardiac oxygen supply?

A

At high doses, nitrates cause arteriolar dilation (Aorta), causing decrease of afterload (increase oxygen supply)

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13
Q

Anti-anginal Drugs: Vasodilators - Nitrates: Other Actions (3)

A
  1. Improve collateral blood flow
  2. Decrease coronary vasospasm
  3. Inhibit platelets aggregation
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14
Q

Nitrates: Drugs

A
  1. Nitroglycerin - Sublingual, PO, transdermal, and IV forms
  2. Isosorbide: PO and extended relase (constant mild chest pain)
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15
Q

Nitrates: Side Effects

A
  1. Headache, flushing, and syncope
  2. Reflex Tachycardia and edema
  3. Tachyphylaxis that require rest of >12 hours (drug isn’t as sensitive as it used to be)
  4. *Methemoglobinemia (with amyl nitrate) –> antidote is methylene blue
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16
Q

Cyanide Poisoning Antidote

A

Cyanomethemoglobin is reconverted to methemoglobin by rx with Sodium thiosulfate –> thiocyanate ion (less toxic)

Antidote is Amyl Nitrate

Cyanide ions inhibit Compex IV of the ETC; Amyl nitrate forms methemoglobin that bins to CN- ions to form #cyanomethemoglobin

17
Q

Cyanide Poisoning Antidote: Drug Interactions

A

Ask patient at the ER if they are taking Sildenafil, it’s a deadly combo due to severe hypotension

18
Q

Anti-anginal Drugs: Beta Blockers

A

Atenolol, Metoprolo, Nadolol, Propranolol

Act directly on heart and no direct effect on blood vessels

19
Q

Anti-anginal Drugs: Beta Blockers MOA

A

Decrease force of contraction, HR, and CO –> decrease oxygen demand

20
Q

Anti-anginal Drugs: Beta Blockers - Cautions

A

With Prinzmetal’s Angina –> BBs keep alpha 1 open, causing vasospasm

21
Q

Anti-anginal Drugs: Beta Blocker That’s Shown Similar Effect to Nitrate

A

Carvedilol, because it’s an alpha and beta blocker

22
Q

Anti-anginal Drugs: CCBs

A

Dihydroperidine: Amlodipine, Nifedipine

Non-hydroperidine: Verapamil and Diltiazem

23
Q

Anti-anginal Drugs: CCBs Buzzword

A

Bepridil (FDA Approved for Angina)

Dilates coronary arteries
Blocks Na and K channels

**If it blocks K channel at risk for —–> Torsades de Pointes

24
Q

Anti-anginal Drugs: Metabolic Modifier

A

Ranolazine

Acts by modifying myocardial metabolism

Improves cardiac diastolic function by limiting sodium influx

25
Q

Angina Pectoris: Cause and EKG

A

Decrease blood/oxygen flow

EKG: ST Segment DEPRESSION (it’s a warning for MI)

26
Q

Myocardial Infarction: Cause and EKG

A

Decrease blood/oxygen flow from BLOOD CLOT FORMATION

EKG: ST Segment ELEVATION (damage has occurred)

27
Q

Myocardial Infarction: Goal of Treatment (3)

A
  1. Relieve Chest Pain
  2. Stabilize the heart rhythm
  3. Reduce cardiac workload
28
Q

Myocardial Infarction: ER Management (7)

A
  1. Oxygen
  2. Morphine for pain
  3. Nitroglycerin sublingually
  4. Aspiring to chew on (prevents platelets aggregation)
  5. Beta Blockers to decrease cardiac load
  6. ACE Inhibitors to reduce preload and afterload
  7. Buzzword: Thrombolytics to dissolve blood clots
29
Q

Differentials for Chest Pain: If the pain is exertional?

A

It’s MI

Stress test show EKG changes

30
Q

Differentials for Chest Pain: If the pain changes with respiration?

A

Pneumonia

Pulmonary embolism

Pericarditis

MI pain doesn’t change with respiration

31
Q

Differentials for Chest Pain: If pain is tender on palpation?

A

If tender –> costochondritis

MI pain is not tender on palpation

32
Q

Differentials for Chest Pain: If pain is tender on palpation?

A

If tender –> costochondritis

MI pain is not tender on palpation

33
Q

MI Diagnoses: EKG and Enzyes

A

ST Segment Eleveation

Elevated cardiac enzymes CPK-MB and Troponin

34
Q

MI Diagnoses: EKG and Enzyes

A

ST Segment Elevation

Elevated cardiac enzymes CPK-MB and Troponin

M3 Pharm B2 (10 decks)

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