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Module 5: Mali: CARDIO2 > CV2 pharm lectures > Flashcards

CV2 pharm lectures Flashcards

1
Q

what are the systolic and diastolic readings for normal BP?

A

stystolic: 120/80

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2
Q

what are the systolic and diastolic readings for prehypertension?

A

systolic 120-140

diastolic: 80-90

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3
Q

what are the systolic and diastolic readings for HTN stage 1?

A

systolic 140-160

diastolic: 90-100

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4
Q

what are the systolic and diastolic readings for HTN stage II?

A

systolic: >160
diastolic: >100

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5
Q

what are the systolic and diastolic readings for isolated SYSTOLIC HTN?

A

systolic >140

diastolic

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6
Q

what are the systolic and diastolic readings for isolated DIASTOLIC HTN?

A

systolic 90

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7
Q

what are the systolic and diastolic readings for mixed HTN?

A

systolic >140
diastolic >90

most common

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8
Q

what is the biggest predictor of cardiovascular risk?

in patients

A

greatest predictor is HTN!!

if

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9
Q

what is felt to be the most accurate gage of measurement for BP when dx someone with HTN?

A

home BP measurements
ambulatory BP measurements

new wave of thinking that these more accurately reflect their actual BP than the one you take in the office

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10
Q

if someone is measuring their home BP, what are the three ways doing these measurements they could qualify for HTN?

A
  1. 24 average BP of 130/80 (aka add them all up and average)
  2. awake average BP of 135/85
  3. asleep average BP of 120/70
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11
Q

what is considered a HTN EMERGENCY? (this is difference than urgency)

A

a diastolic BP >120 with end organ damage (aka CKD, retinopathy, LVH)

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12
Q

what is considered HTN URGENCY?

A

a diastolic BP>120 WITHOUT end organ damage and asymptomatic

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13
Q

at what systolic BP should you treat a patient under 60?

A

140 mmHg systolic

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14
Q

at what systolic BP should you treat a patient over 60?

A

150 mmHG systolic

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15
Q

despite the age rules for tx of systolic HTN…..what what are the two rules that override this and indicate treatment for a patient?

A
  1. DBP>90 mmHg AFTER trial lifestyle modifications

2. BP of 160/100 or higher START THESE PTS ON 2 DRUGS at the SAME time

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16
Q

if a ELDERLY patient has a BP of over 160/100 what are the treatment recommendations? what are you trying to prevent?

A

START ON TWO DRUGS, just like you would for a non elderly patient

for elderly: need to decrease the doses of both drugs and uptitrate them slowly….trying to prevent against ACUTE HYPOTENSION!!

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17
Q

what are the four clinical pearls to keep in mind about diuretics when treating HTN?

A
  1. low Na diet, high K diet (this is what you want to pt to have)
  2. start with a low dose and titrate up
  3. watch for K+ depletion and HYPOvolemia
  4. DOC for mild to moderate HTN
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18
Q

what is the DOC for mild to moderate HTN?

A

dieuretics

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19
Q

what are the two most common diuretics used to treat HTN? what is the relationship between the two?

A

DOC1: thiazide HCTZ

DOC 2: thiazide like: Cholthalidone

typically start with HCTZ, if it doesn’t work, switch to Cholthalidone because it is twice as potent as HCTZ

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20
Q

what do you need to keep in mind about the thiazide (HCTZ) and thiazide like diuretics (chlorthalidone) drugs?

A

going beyond their maximum dose doesn’t increase the effectiveness

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21
Q

how many times stronger is chlorthalidone than HCTZ?

A

twice as strong!!

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22
Q

what is a K sparing diuretic Triamtrene used for HTN? do you use this alone to treat HTN?

A

in conjunction with a thiazide

too weak to use on its own

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23
Q

do you typically use loop diuretics to treat HTN? why?

A

not as much anymore because they aren’t good to use long term

they also INTERACT WITH OTHER ANTI HTN MEDS…so not a good thing if you are trying to treat a pt with HTN. better to start with thiazide or thiazide like diuretic!!

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24
Q

do you typically use BB to treat HTN?

A

not as much now unless the pt has had a MI….

….ACE, ARB, and even CCB are more effective, so we like to use these first unless the pt has had a MI

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25
Q

although we don’t use BB as much for HTN, what added benefit does Carvedilol have in regards to Tx of HTN?

A

also blocks NE so it has an additive effect of lowering BP

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26
Q

what are the 3 effects that BB have on the heart?

A

lower HR
lower SV
lower systemic vascular resistance by decreasing renin/angiotensin II

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27
Q

what are 3 clinical pearls to keep in mind about BB?

A
  1. caution in patients with pulmonary disorder
  2. cardio protective in post MI pts
  3. many uses including anxiety, headache, PTSD, panic disorders
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28
Q

what is the MOA of ACE inhibitors?

A

prevent the conversion of angiotensin I to angiotensin II by inhibiting the angiotensin converting enzyme

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29
Q

what are the 3 effects the ACE inhibitors have on the body?

A
  1. decrease arteriolar resistance
  2. increase venous capacity
  3. increase cardiac output
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30
Q

what do you need to monitor particularly close when a patient is taking ACE inhibitor? (2 things)

A

creatine levels

K levels, can cause HYPERkalemia and K retention!

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31
Q

what patients do you want to consult their nephrologist before prescribing an ACE inhibitor?

A

pts on hemodyalysis

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32
Q

what SE is contraindicated to take a ACE inhibitor?

A

angioedema, this can be life threatening so if it i happened once on an ACE inhibitor you should’ have it again

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33
Q

what is the name of the angiotensin receptor blocker drug used for HTN?

A

losartan

prevents angiotensin from binding to SM

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34
Q

what is the name of the direct renin inhibiting drug used for HTN?

A

aliskren

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35
Q

of the CCB which one has a short halflife and can cause hypotension so it isn’t used as much?

A

Nifedipine

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36
Q

what calcium channel blocker can cause a positive ANA and COOMBS test?

A

nifedipine

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37
Q

explain the properties of dihydropyridines in respect to their ability to cause vasodilation and contractility/conduction?

A

they are POTENT vasodilators

they have little to no effect on contractility or conduction

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38
Q

explain the properties of nondihydropyridines in respect to their ability to cause vasodilation and contractility/conduction?

A

less potent vasodilators

they have a greater DEPRESSIVE effect on contractilitiy and conduction

think about it, this is why they are used for arrhythmia*

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39
Q

should you use grapefruit juice with CCBs?

A

absolutely not!!

it effects CYP34A and can cause the CCB concentration to INCREASE!! making the effects more than you want!

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40
Q

why do you need to education patients about dental care when taking verapamil?

A

because it can cause gingival hyperplasia, so you want to include dental education

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41
Q

which drugs do you NOT want to use in HEART FAILURE?

A

don’t use the nondihydropyridines

  • verapamil
  • diltiazem
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42
Q

what are two strange SE of the direct acting vasodilator hydralazine?

A
  1. can cause LUPUS esp in WHITE PEOPLE

2. increase growth of hair

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43
Q

when is hydralazine used in an emergency?

A

DOC for HTN emergency in pregnant women usually due to PREECLAMPSIA or PREEXISTING HTN

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44
Q

what is the name of the drug that is a alpha blocker?

A

prazosin

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45
Q

what is the MOA of prazosin?

A

selective alpha 1 blocker that relaxes smooth muscle in arteries, veins, and prostate

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46
Q

what do you NOT want to take with the alpha 1 blocker prazosin?

A

PDE5 inhibitor like viagra

can cause dangerous hypotension

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47
Q

what is another use of the alpha 1 blocker prazosin and why?

A

used for benign prostatic hypertrophy since alpha 1 receptors are found here

48
Q

what is an interesting thing that prazosin can cause in the eye?

A

FLOPPY IRIS SYNDROME

worry about this if pt is going to get lense replacement

49
Q

what is the name of the two central acting alpha 2 agonists? where do they act and what do they decrease the release of?

A

clonidine
methyldopa

these act in the brain/CNS and decrease the release of NE

50
Q

what are the 3 SE of clonidine and methyldopa you should be aware of?

A
  • rebound HTN
  • depression and mood alteration
  • H2O retention
51
Q

what is clonidine is often included as a part of what protocol?

A

ETOH detox protocols

52
Q

what are the three indications for clonidine?

A
  1. hypertension
  2. ADHD
  3. narcotic addiction
53
Q

what are two major contraindications for clonidine?

A

pre-existing CNS depression

SEVERE CAD

54
Q

what are the 6 HMG-COA reductase inhibitors?

A 
atorvastatin
lovastatin
pravastatin
rosuvastatin
simvastatin
fluvastatin
55
Q

what are the two strongest HMG-COA reductase inhibitors?

A

strongest: atorvastatin

2nd strongest: rosuvastin

56
Q

how to HMG-COA reductase inhibitors decrease lipid panel?

A

decrease LDL, Triglycerides

Increase HDL

57
Q

what is the best drug to decrease the combo of LDL/Tri?

A

ATORVASTATIN

58
Q

when should you take atorvastatin?

A

at night!

59
Q

what are the two bile sequestrian drugs?

A

cholestyramine

colestrevelam

60
Q

how is the lipid panel effected by bile acid sequestriants?

A

decrease LDL

may increase tri

61
Q

what are the two fibric acids?

A

gemfibrazil

fenofibrate

62
Q

how do fibric acids effect the lipid panel?

A

decrease TRI

increase HDL

63
Q

what is the drug under the nicotinic acid?

A

niacin

64
Q

what does niacin do to the lipid panel?

A

decrease TRI with minimal LDL lowering

increase HDL

65
Q

what is the cholesterol absorption inhibitor? and what dose it lower?

A

exetimibe lowers LDL

66
Q

what does the omega fatty acid 3 increase and decrease?

A

increases LDL

decreases TRI

67
Q

what does the PCSK9 inhibitor do? what does it lower?

A

increases functioning of the LDL receptors in the liver

decreases LDL

68
Q

when does the most cholesterol synthesis take place? w

A

at night

69
Q

why is it suggested that you take atorvastatin at night?

A

because this is when the most lipid synthesis occurs!

70
Q

for primary prevention….what are the qualifications for high intensity statin therapy?

A

LDL >190 AND family history

71
Q

for primary prevention…what are the qualifications for moderate intensitiy statin therapy? what is the exception that would pump this pt up to high intensity therapy?

A

LDL 70-190 AND diabetes AND 40-70 years old

EXCEPTION: if a patient has this AND 10 year risk >7.5% then bump them up to high intensity

72
Q

what is the over arching rule for mod to high intensity therapy with statins?

A

10 year global risk score >7.5% and 40-70 years old!!

73
Q

what is secondary hyperlipidemia prevention?

A

when you give someone a statin because they have hyperlipidemia and history of heart disease….trying to prevent progression

74
Q

in someone with hx of heart disease and hyperlipidemia what intensity statin do you use?

what is the one exception to this?

A

high intensity statin

exception: if 75 and older drop down to moderate dose

75
Q

what is the rule of 6 that you see with atorvastatin?

A

as you increase the dose you get decreased lipid reduction….lowest dose is most effective

76
Q

how much do you expect high intensity statin to reduce LDL by?

A

50%

77
Q

what is the dosing of atorvastatin and rousuvastatin that are considered high dose statin therapy?

A

atrovastatin high intensity: 40-80 mg

rousuvastatin high intensity: 20-40 mg

78
Q

how much do you expect a moderate intensity statin to decrease LDL by?

A

30-40%

this is accomplished by all statins in lower doses

79
Q

what are the two statins you use as high intensity statins?

A

atorvastatin and rousuvastatin

80
Q

what are two of the most important SE of atorvastatin?

A

myopathy and rhabdomyolysis

81
Q

what drug do you not want to use with atorvastatin?

A

dabigitran

82
Q

what do you need to monitor when taking atorvastatin?

A

CK

83
Q

can you drink grapefruit juice with any of the statins? what is the one exception?

A

NOPE CYP450/CYP34A baby

one exception: pravastatin

84
Q

what do you need to be concious in when giving lovastatin?

A

don’t use it in those with EGFR

85
Q

what is the only statin that is NOT METABOLIZED BY CYP34A?

A

pravastatin

86
Q

what does long term use of bile sequestriants cholestyramine and colesevelam cuase?

A

decreased folate absorption

87
Q

what is one random and beneficial SE of the bile sequestriant colesevelam?

A

modestly lowers BS in T2DM

88
Q

what is the most effective triglyceride lowering agent?

A

fibrinic acid!!!! (Gemfibrazil and fenofibrate)

89
Q

what do you need to be particulally mindful of for medicationswhen prescribing a fibrinic acid like gemfibrazil and fenofibrate in a patient? (2)

A

don’t combine with clopidigrel

also increases the effects of WARFARIN so may need to decrease the dose

90
Q

fibrinic acids gemfibrazil and fenofibrate lower triglycerides what percent? how long does it take to accomplish this?

A

20-50%

3-4 weeks

91
Q

what are the side effects you see with niacin (nicotininc acid B3) 3 of them!

A

itchying, flushing, blurred vision

92
Q

what is important to consider prescribing to a patient who experiences flushing from niacin?

A

have them take ASA 30 mins before taking the med to prevent flushing!

93
Q

what does niacin (nicotinic acid B3) increase in meds?

A

increase effects of HMG-CoA statins

94
Q

who should you avoid using niacin in? 2

A

alcoholics, PVD

95
Q

what does the cholesterol absorption inhibitor exetimibe interact with?

A

fibrates

96
Q

what allergy are omega 3 contra indicated in?

A

fish allergy

97
Q

what are three side effects of taking omega 3

A

change in taste, flu type illness, angina

98
Q

what drugs do you not want to combine with omega 3?

A

anticoagulants

99
Q

WHAT IS THE MAIN INDICATOR FOR THE NEW MONOCLONAL ANTIBODY PCSK9 INHIBITOR EVOLOCUMAB?

A

HOMOZYGOUS FAMILIA HYPERCHOLESTEROLEMIA

100
Q

explain how evolocumab works?

A

human monoclonal antibody that binds to proptein convertase sk9 and inhibits the degredation of LDL receptors on the liver so that more can absorb the LDL to be degraded

101
Q

how is evolocumab administered?

A

SQ

102
Q

what are the three side effects of evolocumab?

A

nasopharyngitits, gastroenteritis, URI

103
Q

what are the three drugs under the class 1 antiarrythmics?

A

1a: procainamide
1b: lidocaine
1c: flecainide

104
Q

what is the 1a class 1 antiarrythmic? AP duration?

A

procainamide, prolongs AP duration

105
Q

what is the 1b class 1 antiarrythmic? AP duration?

A

lidocaine, shorten AP duration

106
Q

what is the 1c class 1 antiarrythmic? AP duration?

A

flecainide, no effect on AP

107
Q

of the class 1 drugs which can cause QT prolongation and hypotension?

A

procainimide

108
Q

which drug causes a METALIC taste and should not be used in bronchospasm?

A

lidocaine

109
Q

which drug in class 1 has a significant proarrythmia effect?

A

flecainimide

110
Q

what are the class II drugs made up of?

A

Beta blockers

111
Q

what are three things you need to be concious of when using a beta blocker?

A

hypotension, masks hypoglycemia, bradycardia

112
Q

what is the most frequently used antiarrythmic?

A

amiodarone

113
Q

what do you need to be careful of when using amiodarone?

A

extreme pulmonary toxicity

114
Q

what is the class 3 antiarrythmic?

A

amiodarone

115
Q

what is the class 4 antiarrythmics consist of?

A

Nondihydropyridines Verapamil and diltiazem

116
Q

which is the drug that is used in stress testing? why?

A

ADENOSINE

it increases the BF in normal arteries but not stenotic arteries so it makes the difference more noticeable

Module 5: Mali: CARDIO2 (4 decks)

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