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Pharmacology Flashcards

1
Q

mech of nitrates

A

inc. cGMP–> inhibit Ca influx–> smooth m. relaxation

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2
Q

do nitrates need intact endothelium to vasodilate?

A

no

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3
Q

what else can ranolazine possible do besides decrease chronic angina?

A

dec afib or ventricular arrhythmias

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4
Q

does ranolazine inc QT ?

A

yes

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5
Q

mech of ranolazine

A

alters late Na current and Na/Ca dependent channels

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6
Q

when is ranolazine contraindicated?

A

liver dz

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7
Q

which trial showed that clopidogrel with nexium had no difference in event rates?

A

COGENT

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8
Q

maximum ASA dose you can use with ticagrelor?

A

81mg

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9
Q

how is ticagrelor cleared?

A

hepatic ( do not use with severe impairment)

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10
Q

besides bleeding, what is a major side effect of ticagrelor?

A

SOB

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11
Q

important side effect to remember for abciximab

A

thrombocytopenia

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12
Q

if pt has had eptifibatide in past, can they get it again? why?

A

yes, it is not immunogenic

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13
Q

if a pt has had streptokinase in past year, can they get it again? why?

A

no. allergic rxn/;ess effective b/c of Ab’s to it.

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14
Q

what are differences b/w tPA and streptokinase?

A

higher bleeding with tPA, no allergy, less HoTN

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15
Q

what happens when someone is on dabigatran and you start amio? what to do?

A

amio increases dabigatran levels by 50%

cut dabigatran to 75 bid

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16
Q

mech of dabigatran

A

direct thrombin inhibitor

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17
Q

what enzyme metabolizes rivaroxaban (xarelto) and apixaban (eliquis)? what organ?

A

liver CYP3A4

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18
Q

when is rivaroxaban (xarelto) contraindicated?

A

renal failure

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19
Q

does rivaroxaban need to be given with food?

A

yes

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20
Q

can you give apixaban in renal failure?

A

yes

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21
Q

name 3 high risk groups for bleeding with NOAGs

A

older, renal impairment, skinny

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22
Q

what is the story with dabigatran (pradaxa) and MI?

A
  1. RE-LY showed slight increase in MI.
  2. review w/ revised results showed not statistically sig
  3. metanalysis confirmed inc risk of MI
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23
Q

which NOAG is dialyzable if pt. is bleeding?

A

dabigatran (pradaxa)

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24
Q

which type of pt. on procainamide witll get lupus?

A

slow acetylators bc of buildup of N-acetylprocainamide

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25
Q

2 drugs that can cause lupus-like syndrome?

A

procainamide

hydralazine

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26
Q

if a pt. has symptomatic HOCM and is already on BB or CCB, what med can you give?

A

disopyramide

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27
Q

what does liver dz do to lidocaine administration?

A

decreases metabolism (inc’d tox)

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28
Q

what is the dose-related toxicity of lidocaine?

A

CNS (dizzy, hallucinations, confusion, Sz)

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29
Q

if a patient has CHF and needs lidocaine, what do you have to remember?

A

use lower dose

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30
Q

which trial showed that flecainide can’t be used in ischemic HD?

A

CAST

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31
Q

which antiarrhythmics can be used to treat disabling PVCs?

A

flec/propafenone

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32
Q

which class Ic antiarrhythmic has a higher beta blocking effect (e.g. bronchospasm, slower HR) ?

A

propafenone

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33
Q

which of the following will slow heart rate more: flecainide or propafenone?

A

prop

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34
Q

what do D + L isomers of sotalol do?

A

D- prolong repol

L- Beta block

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35
Q

can stall prolong QT?

A

yes

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36
Q

should you admit a pt for starting sotalol?

A

yes, QT prolongation

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37
Q

what happens to sotalol with CRI?

A

prolonged half life

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38
Q

main use for sotalol

A

afib

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39
Q

what to remember about verapamil and dofetilide?

A

dofetilide tox possible because both use CYP3A4

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40
Q

why does amio cause hypothyroidism?

A

blocks conversion of T4 to T3

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41
Q

what is the active metabolite of amio?

A

desethylamiodarone

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42
Q

mortality rate of amio related plum fibrosis?

A

10%

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43
Q

name 7 drugs/drug classes using CYP3A4

A

antifungals, macrolide Abx, PI’s
verapamil, diltiazem
grapefruit juice
statins

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44
Q

two ocular effects of amio

A

corneal deposits

optic neuritis

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45
Q

which drug is the non-iodine version of amio?

A

dronedarone

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46
Q

mech of HCTZ

A

blocks reabsorption of Na in DCT

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47
Q

what is effect on K+ by HCTZ?

A

hypokalemia

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48
Q

what is effect of HCTZ on uric acid?

A

reduced excretion

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49
Q

why is there an increased risk of gout with HCTZ?

A

reduced uric acid excretion

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50
Q

why can you give HCTZ to prevent Ca stones?

A

Calcium excretion is decreased

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51
Q

does HCTZ affect GFR?

A

no

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52
Q

difference in potency b/w metolazone and HCTZ?

A

metolazone 10x more diuretic and hypokalemic effect

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53
Q

which is better for edema: HCTZ or metolazone?

A

metolazone

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54
Q

why does chlorthalidone have long half life?

A

90% bound to erythrocyte carbonic anhydrase

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55
Q

can thiazides cause torsades?

A

yes

56
Q

what to remember about thiazides and lithium?

A

decrease lithium dose by 50%

57
Q

effect of thiazides on LDL and TG’s

A

increase

58
Q

which loop diuretic does not have sulfa moiety?

A

ethacrynic acid

59
Q

because of better absorption, which loop diuretic is better to give in edematous state?

A

bumetanide/torsemide

60
Q

side effect of ethacrynic acid (and other loops)

A

ototoxicity

61
Q

if eGFR< 30-40, which diuretics should you use?

A

loops or metolazone

62
Q

alpha 1 receptor

A

vasoconstriction

63
Q

alpha 2 receptor

A

presynaptic, reduces catecholamine outflow

64
Q

Beta 1 receptor

A

heart, inc. inotropy/chronotropy

65
Q

Beta 2 receptor

A

vessels, vasodilation

66
Q

do you have to give IV BB during acute MI?

A

no

67
Q

what can BB mask the sxs of?

A

hypoglycemia

68
Q

which 2 BB’s have least CNS side effects b/c they are least lipid soluble?

A

atenolol, nadolol

69
Q

name 2 BB’s that have both beta and alpha blocking properties

A

labetalol, carvedilol

70
Q

name 4 selective BB’s

A

metoprolol, atenolol, bisoprolol, esmolol

71
Q

which BB also increases nitric oxide activity?

A

nebivolol

72
Q

which BB’s are best to use in reactive airway dz?

A

nebivolol, bisoprolol

73
Q

if pt has CHF and asthma and needs BB, which BB to use?

A

bisoprolol

74
Q

which BB’s have shown survival benefit?

A

metoprolol succinate, carvedilol, bisoprolol

75
Q

which BB can you use with dobutamine (b/c it doesnt blunt its effect)?

A

metoprolol, not coreg

76
Q

which BB is “less well tolerated in asthma?”

A

carvedilol

77
Q

what type of antihypertensive will ACEI’s work synergystically with?

A

diuretics

78
Q

on ACEI, what is BP level very sensitive to?

A

dietary sodium intake

79
Q

if you have MILD angioedema with an ACEI or hyperkalemia, what med can you cwitch to?

A

ARB

80
Q

mech of aliskiren

A

renin inhibitor

81
Q

what enzyme converts angiotensinogen to angiotensin I?

A

renin

82
Q

Which anti hypertensive class have been shown to have superior stroke risk reduction?

A

CCBs

83
Q

Name nondihydropyridines

A

Verapamil

Diltiazem

84
Q

What do dihidrooyridines names end in?

A

-dipine

Amlodipine, nicardipine, etc

85
Q

Which CCB has the most negative inotropic and chronotropic effect?

A

Verapamil

86
Q

Do dihidrooyridines have negative inotropic effects (norvasc)?

A

No

87
Q

GI side effect if verapamil

A

Constipation

88
Q

Largest disadvantage of alpha blockers

A

Orthostatic hypotension

89
Q

What do you increase the risk of with alpha blocker as mono therapy (ALLHAT)?

A

CHF

90
Q

Describe first dose phenomenon of prazosin or other alpha blockers

A

Postural hypotension/syncope 30-90 mins after first dose

91
Q

2 side effects of minoxidil (used for severe HTN) and treatment

A

Edema
Hirsutism
Always give with diuretic and BB

92
Q

Hydralazine MOA

A

Direct vasodilator via NO and cGMP

93
Q

Minoxidil MOA

A

Direct vasodilation by opening potassium channels in smooth muscle

94
Q

Which statins use CYP3A4?

A

“Sal”

Simvastatin, atorvastatin, lovastatin

95
Q

How common are serious liver problems with statins?

A

Very rare

96
Q

Definition myositis in statin use

A

CK 10x above normal

97
Q

Ezetimibe MOA

A

Blocks chol absorption at intestinal brush border

98
Q

Does ezetimibe effect fat soluble vitamin uptake?

A

No

99
Q

Best agent to raise HDL

A

Niacin

100
Q

Does niacin reduce coronary events?

A

Yes

101
Q

Why do you have to have a niacin free interval with sutained release niacin?

A

Hepatotoxicity

102
Q

Can statins be used in pregnancy?

A

No

103
Q

Do fibrates decrease LDL?

A

No

104
Q

Which fibrin acid can be used in pregnancy ?

A

Gemfibrozil

105
Q

Can you use fenofibrate, statins or fish oils in pregnancy?

A

No

106
Q

What is the AHA rec for fish oils?

A

Post MI, 1g/ day

107
Q

Do fish oils decrease CV risk?

A

No

108
Q

Does dialysis remove dig?

A

Yes

109
Q

Does digoxin have an effect in mortality?

A

No

110
Q

Which is better at increasing cardiac output: dobutamine or milrinone?

A

Dobutamine

111
Q

Which reduces BP more: dobutamine or milrinone ?

A

Milrinone

112
Q

Which has a faster onset: dobutamine or milrinone?

A

Dobutamine

113
Q

Which has shorter half life: dobutamine or milrinone?

A

Dobutamine

114
Q

Which receptors does dobutamine hit?

A

B1, B2

115
Q

Which receptors does dopamine hit?

A

B1, alpha 1, dopaminergic

116
Q

Does dobutamine h beta 1 or 2 receptor harder?

A

Beta 1 (inc inotropy)

117
Q

Biggest side effect of dobutamine?

A

Arrhythmias

118
Q

How long does it take to develop tolerance to dobutamine?

A

72h

119
Q

Milrinone MOA

A

Phosphodiesterase inhibitor

120
Q

Name a good inotrop to increase CO and decrease SVR

A

Milrinone

121
Q

Where does nitroprusside relax smooth muscle?

A

Arterioles, veins

122
Q

Does nitroprusside increase cAMP or cGMP?

A

cGMP

123
Q

Which IV anti hypertensive is light sensitive and causes thiocyanate tox?

A

Nitroprusside

124
Q

Phenylepheine receptor

A

Alpha 1

125
Q

Norepinephrine receptors

A

Alpha 1, Beta 1

126
Q

Which agent is preferred in septic shock and over dopamine in cardiogenic shock?

A

Norepinephrine (levophed)

127
Q

Name a potent press or used as a second agent in septic shock ?

A

Vasopressin

128
Q

what type of fat exactly does AHA want you to stay away from?

A

Saturated fat

129
Q

What percent of your calories should be from fat according to AHA ?

A

30%

130
Q

Less than 10% of what type of fat should be in AHA diet?

A

Saturated fat

131
Q

How many milligrams of cholesterol per day can you have in AHA diet?

A

300mg

132
Q

Has Mediterranean diet been shown to reduce CV event rate?

A

Yes

133
Q

Name 4 fish high in omega 3

A

Salmon, mackerel, herring, trout

134
Q

Does tilapia have high fish oils?

A

No

135
Q

Do fish oils increase bleeding time?

A

Yes

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