C&R E1 Flashcards
Kidney Function Assessment Fluids Electrolytes HLD HTN (173 cards)
1
Q
Demeclocycline, drug class?
A
Vasopressin Antagonists
2
Q
Conivaptan, drug class?
A
V1 and V2 Vasopressin Antagonists
3
Q
Demeclocycline, dosing?
A
300mg PO BID-QID
4
Q
Conivaptan, formulation?
A
IV, $$$
5
Q
Conivaptan, indication?
A
Acute euvolemic hyponatremia
6
Q
Demeclocycline, warnings?
A
- Risk of renal tubular damage and AKI
- Avoid children <8yr and prego because of changes in tooth development
7
Q
Demeclocycline, MOA?
A
blocks ADH at collecting duct, inducing nephrogenic diabetes insipidus (very thirsty and pee a ton)
8
Q
Tolvaptan, drug class?
A
V2 receptor Vasopressin antagonist
9
Q
Tolvaptan, brand name?
A
Samsca
10
Q
Tolvaptan, indication?
A
Hypervolemia Hyponatremia OR Euvolemic Hyponatremia d/t HF, cirrhosis, SIADH, autosomal dominant polycystic kidney disease
11
Q
Tolvaptan, formulation?
A
15 - 60mg PO QD, $$$
12
Q
Tolvaptan, ADE?
A
thirst, polyuria, constipation
13
Q
Tolvaptan, BBW?
A
Hepatotoxicity
14
Q
Furosemide, brand name?
A
Lasix
15
Q
Bumetanide, brand name?
A
Bumex
16
Q
Torsemide, brand name?
A
Demadex
17
Q
Ethacrynic Acid, brand name?
A
Edecrin
18
Q
Loop diuretics ADE?
A
SHROM
Hypokalemia
Metabolic alkalosis
Renal injury
Otoxicity
Sulfa-reactions
19
Q
Furosemide IV –> Furosemide PO?
A
Double the IV dose
20
Q
Bumetanide IV –> Bumetanide PO
A
No change
21
Q
Torsemide IV –> Torsemide PO
A
no change
22
Q
Ethacrynic acid IV –> Ethacrynic acid PO
A
no change
23
Q
Furosemide PO
Bumetanide PO
Torsemide PO
A
40
1
20
24
Q
Thiazide diuretics vs Loop
A
Loop are stronger diuretics but thiazide better for bp
25
Thiazide ADE?
UCk
HyperUricemia
HyperCalcemia
Hypokalemia
26
Spironolactone, drug class?
K sparing, MRA
27
Eplerenone, drug class?
K sparing, MRA
28
Amiloride, drug class?
K sparing
29
Triamterene, drug class?
K sparing
30
K Sparing ADE?
HM
Hyperkalemia
Metabolic acidosis
31
4 Rx that cause hyperkalemia
K Sparing diuretics
ACE inhibitors
Beta blockers
NSAID
32
Na Polystyrene Sulfonate, brand name?
Kayexalate
33
Na Polystyrene Sulfonate, usage and indication?
Emergent HYPER K to REMOVE from body or for chronic control
34
Patiromer, brand name?
Veltassa
35
Sodium Zirconium Cyclosiliate, brand name?
Lokelma
36
Sodium Polystyrene Sulfonate, ADE?
GI upset **Constipation, N/V, Anorexia**
Electrolyte Disturbances, hypernatremia, hypoK/Ca/Mg
***INTESTINAL NECROSIS**
37
Patiromer, brand name?
Veltassa
38
Patiromer, indication?
DELAYED EFFECT
CHRONIC USE HYPERK ONLY
39
Patiromer, DDI?
Ciprofloxacin
Levothyroxine
Metformin
40
Patiromer, ADE?
GI
Hypomagnesemia
41
Patiromer and other Rx need to be ____ hrs apart?
3
42
Sodium Zirconium Cyclosilicate, brand name?
Lokelma
43
Sodium Zirconium Cyclosilicate and other rx need to be ___ hrs apart?
2
44
Sodium Zirconium Cyclosilicate, DDI?
Clopidogrel
Dabigatran
Warfarin
45
Sodium Zirconium Cyclosilicate, ADE?
Edema
46
Sodium Bicarbonate PO, ADE?
GI belching
Flatulence
Edema
47
Sodium Bicarbonate IV, ADE?
Edema/Hyper Na
Hypokalemia
Hypercalciuria + Urinary alkalinization
Paradoxical intracellular
Decreased ionized calcium
Overcorrection of pH
48
Thiazide Diuretics MOA
Inhibit Na and Cl reabsp
49
Thiazide Diuretics DDI
NSAIDS or drugs that cause Na and water rentention
50
Thiazide Diuretics ADE
sUCk mg low and sweet
51
Thiazide Diuretics Pearls
- caution in pt with hx of acute gout
- caution in pt with allergy of sulfonamide-derived rx
52
Chlorthalidone is ------- as potent as HCTZ
Chlorthalidone is preferred because of ------
1. Twice as potent
2. prolonged half-life
53
CCB DHP MOA
Inhibit Ca from entering the vascular smooth muscle and MI cells resulting in peripheral and coronary artery vasodilation
54
CCB DHP ADE
Peripheral edema***
HA
Dizziness
Flushing
potential for reflect tachycardia
55
CCB DHP Pearls
Can take up to a week to see the full effects
****DO NOT USE NIFIDEPINE IR IN ANY HTN, CAUSES HYPOTENSION, MI, DEATH***
56
What drug can cause MI, hypotension, and death if used for HTN?
Nifedipine IR
57
CCB NonDHP MOA
Inhibit Ca from entering the vascular smooth muscle and MI cells resulting in negative inotropy and chronotropy
58
Which CCB is more selective for the heart?
NonDHP
59
CCB NonDHP Contraindications
pts with hx of Hypotension or hx cardiogenic shock
avoid in HFrEF pt
60
CCB Non DHP DDI
CYP3A4 major substrates and moderate inhibitors (ALS for statins)
Avoid routine use with beta blockers
61
ACEi MOA
Decrease Angiotensin II production to decrease vasoconstriction and decreased aldosterone secretion
62
ACEi Contra
Prego
hx of angioedema
severe BILATERAL renal artery stenosis
63
ACEi ADE
Hyperkalemia, Dry Cough, Angioedema, Hypotension
64
ACEi Pearls
- Use in PTs with DM w/ albuminuria, HF, Post MI/Stroke, CKD
- 36 hr washout prior to ARNI use needed (entresto)
- No combo RAAS rx
- because of hyperkalemia risk, will need to assess potassium levels and consider when initiating
65
ACEi/ARB potassium level dosing rules
- not on drug yet (1)
- on drug (2)
1) if not on drug, DO NOT INITIATE >5mmol (because the goal is 4 - 5)
2) If on ace/arb already and <5.5, don't increase the dose
3) if on ace/arb already and >5.5, decrease dose or D/C
66
ARB MOA
Block Angiotensin II at the angiotensin receptor on vascular smooth muscle and preventing vasoconstriction
67
ARB Contra
Prego
Pt with severe bilateral renal artery stenosis
68
ARB ADE
Hyperkalemia
Hypotension
69
ARB Pearls
- Use in PTs with DM w/ albuminuria, HF, Post MI/Stroke, CKD
- NO washout with ARNI
- No combo RAAS rx
- because of hyperkalemia risk, will need to assess potassium levels and consider when initiating
- less dry cough/angioedema due to the lack of peripheral effects on bradykinin
70
Direct renin inhibitors MOA
Inhibits renin which results in overall decrease in angiotensin II
71
Direct renin inhibitors Contra
Prego
Avoid use in ACE/ARB in pts with DM
Severe bilateral renal artery stenosis
72
Direct renin inhibitors ADE
hyperkalemia, diarrhea, hypotension
73
Direct renin inhibitors Pearls
- no combo with RAAS rx
- long half life
74
B blockers MOA
inhibit beta 1 and beta 2 receptors
75
B blockers Contra
severe bradycardia
76
B blockers ADE
Bradycardia
Heart block
worsening HF
bronchospasm
cold extremities
fatigue
depression
reduced exercise tolerance
decreased libido
insomnia
impotence
77
B Blockers Pearls
- they have different levels of selectivity, cardioselective (Beta 1 only) or nonselective
- MUST TAPER ON D/C (Over 1 - 2 weeks)
- Can mask hypoglycemia in pts with DM (palpitations, shakiness, anxiety)
- Use of B1 selective agents in pts with bronchospastic diseases (COPD, asthma)
- for HF: bisoprolol, metoprolol succinate, carvedilol
78
Alpha 1 blockers MOA
- binds to alpha 1 adrenergic receptors which result in peripheral dilation of arterioles and veins
79
Alpha 1 blockers DI
use in caution when with PDE5 inhibitors (sildenafil)
80
Alpha 1 blockers ADE
syncope
orthostatic hypotension
drowsiness
dizziness
headache
81
Alpha 1 pearls
- increased risk for HF
- first dose orthostatic hypotension (admin first dose PM)
82
Central alpha 2 agonists MOA
stimulation of central alpha 2 adrenergic receptors in the brain resulting in decreased sympathetic outflow of ME and decreased systemic vascular resistance and HR
83
Central alpha 2 agonists Contra
concurrent use of MAOIs
Methyldopa contra in active liver disease
84
Central alpha 2 agonists ADE
dry mouth
somnolence
fatigue
constipation
bradycardia
85
Central alpha 2 agonists Pearls
- alpha 2 must be tapered on D/C to avoid rebound HTN/hypertensive crisis
- last line because of CNS effects (somnolence and fatigue) esp in elderly
- Methyldopa is the drug of choice in prego HTN pts
86
Loop diuretics MOA
inhibits Na, K, Cl reabsp in the thick ascending limb of loop of henle
87
Loop diuretics Monitoring
Assess electrolytes and renal function 2 - 4 weeks after initiating therapy or dose change
88
Loop diuretics ADE
Hypo Na, K, Mg, Cl, Ca
Hypovolemia
89
Loop diuretics Pearls
- preferred in pts with symptomatic HF
- caution with Pts with a sulfa allergy
90
K sparing diuretics MOA
inhibition of epithelial Na channel in the collecting duct of the nephron, decrease Na reabsp and increase K reabsp
91
K sparing diuretics ADE
Hyper K, dehydration, hypo Na
92
K sparing diuretics pearls
- consider in pts with hypo K on thiazide monotherapy
- can add to thiazide/loop tx with hypo K, the hyper K ade balances out
93
MRA MOA
Competitive antagonists of the MR result in decreasing Na reabsp and increase K reabsp
Spironolactone is non-selective
94
MRA Contra
Pts with hyperkalemia
Pts with anuria <50 ml
Spironolactone not rec when GFR <30ml/min
95
MRA DI
strong CYP3A4 inhibitors
96
MRA ADE
dehydration, hyponatremia, dizziness
Spironolactone: gynecomastia, breast tenderness, impotence
97
MRA Pearls
- Preferred agents in primary aldosteronism and resistant HTN
- Avoid initiation if K > 5 mEq/L and with significant renal dysfunction
- Avoid with K supplements (contra in hyperkalemia pts)
98
Direct Vasodilators MOA
direct vasodilation of arterioles which results in a decrease in SVR
99
Hydralazine ADE
it's a direct vasodilator
- reflex tachycardia, peripheral edema, palpitations, DILE (drug induced lupus erythematosus)
100
Direct Vasodilators Pearls
- associated with Na/water retention and reflex tachycardia (ADE)
- use with a diuretic (for fluid retention) and beta blocker for tachycardia...kinda like resistant HTN
101
Ezetimibe Dose
10mg PO QD with our without food
102
ezetimibe MOA
Inhibits cholesterol absorption at small intestine
103
Ezetimibe ADE
URTI
Diarrhea
Arthralgia
Sinusitis
Pain in extremities
104
cv outcomes for hld
Statins
Ezetimibe with mod statin
Pcsk9 with statin
105
Extra ldl lowering in hld?
Bempedoic acid with statin
Pcsk9 with statin
BAS with statin
Inclusion without statin
106
Bempedoic acid brand name
Nexletol
107
Bempedoic acid dosage
180mg PO QD with our without food
108
Bempedoic acid MOA
Inhibitor that brings more LDL into the liver to be metabolized. A pro drug so less muscle ade
109
Bempedoic acid ADE
gout with prior hx of hyperuricemia is
Tendon rupture
Myopathy with simvastatin and pravastatin
110
PCKS9 I pearls
Is an injection and a human mab rx
111
Pcsk9i MOA
Increases the number of LDL receptors on the liver to clear LDL
112
inclisiran brand name
Leqvio
113
Inclisiran MOA
Inhibits PCSK9 hepatic synthesis
114
Inclisiran pearls
Small interfering RNA lowering tx
Injectable
You inject at first dose, then 3mths, and every 6mths as MD
115
PCSK9 ADE
Nasopharyngitis
Injection site reaction
Influenza
URTI
back pain
116
Bile Aid Sequestrants (BAS) MOA
bind with LDL in the small intestine to poop out LDL
BAS - Bad ass shitter lmao
117
BAS ADE
Constipation, dyspepsia, Nausea
118
BAS Pearls
Many DDI because of drug binding, therefore need to separate by 4hrs especially phenytoin, warfarin, and thyroid rx
Has a strong pill burden
Can increase TG levels so not recommended in TG > 300
119
First line HTN Drugs
Thiazides
ACE/ARB
CCB
120
2nd line HTN Drugs
BLM
DKA
VA
Beta blocker
loop
MRA
Direct renin inhibitor
K sparing
Alpha 1 blocker
Vasodilator
Centra Alpha 2 agonist
121
Special Consideration HTN urgency Goals, Aortic Dissection
Less than 120 systolic within 20 - 60 mins and HR < 60 bpm
122
Special Consideration HTN urgency Goals, Ischemic Stroke
less than 185/110 before TPA
Less than <180/105 during TPA
Less than <220 if no tpa
123
Special Consideration HTN urgency Goals, Hemorrhagic Stroke
For systolic higher than 220, lower with infusion and monitor
For systolic 150 - 220 lower to 140 within 60 mins
124
Special Consideration HTN urgency Goals, Severe Pre-Eclampsia/Eclampsia
SBP less than 140 within 60mins
125
HTN Non pharm weight goal
-1kg in BW
126
HTN Non pharm Diet goal
DASH (Avisha + some meat)
127
HTN Non pharm Na goal
< 1.5g/day
128
HTN non pharm K+ goal
3.5 - 5 g/day
129
HTN non pharm Aerobic goal
90 - 150 mins/wl
130
HTN non pharm Alcohol
< or = 1 for females
< or = 2 for men
131
TAC
Thiazide Doses
Chlorthalidone
12.5 - 25 QD
132
Chlorthalidone Brand?
Hydroton
133
HCTZ brand?
Hydrodiuril
134
TAC
Thiazide Doses
HCTZ
25 - 50 QD
135
TAC
ACE Doses
Lisinopril
40 QD
136
Lisinopril Brand?
Prinivil/Zestril
137
Benazepril Brand?
Lotensin
138
TAC
ACE Doses
Benazepril
40 1/2 DD
139
TAC
ARB Doses
Losartan
100 1/2 DD
140
Losartan, Brand?
Lozaar
141
Valsartan, Brand?
Diovan
142
TAC
ARB Doses
Valsartan
320 QD
143
TAC
CCB Doses, DHP
Amlodipine
10 QD
144
Amlodipine brand?
Norvasc
145
Nifedipine ER brand?
Procardia
146
TAC
CCB Dose, DHP
Nifedipine ER
120 QD
147
TAC
CCB Dose, Non DHP
Diltiazem ER
360 QD
148
Diltiazem ER brand?
Cardizem
149
non DHP CCB?
Diltiazem (Cardizem)
150
DHP CCB?
Amlodipine (Norvasc)
Nifedipine ER (Procardia)
151
BLM DKA VA
Beta Blocker
Bisoprolol Dose?
10 QD
152
Bisoprolol brand?
Zebeta
153
Metoprolol Tartrate brand?
Lopressor
154
Metoprolol Succinate brand?
Toprol XL
155
Carvedilol brand?
Coreg
156
Doxazosin brand?
Cardura
157
Clonidine PO brand?
Catapres
158
Furosemide brand?
Lasix
159
Triamterene brand?
Dyrenium
160
Hydralazine brand?
Apresoline
161
Spironolactone brand?
Aldactone
162
Spironolactone brand?
Aldactone
163
BLM DKA VA
Beta Blocker
Metoprolol Tartrate Dose?
200 2 DD
164
BLM DKA VA
Beta Blocker
Metoprolol Succinate Dose?
200 QD
165
BLM DKA VA
Beta Blocker
Carvedilol Dose?
50 2 DD
166
Cardio selective beta blockers?
metoprolol tartrate, metoprolol succinate, bisoprolol
167
non cardio selective beta blockers?
carvedilol, resulting in more bp lowering effects
168
BLM DKA VA
Loop Diuretics
Furosemide Dose?
80 QD
169
BLM DKA VA
MRA
Spironolactone Dose?
100 QD
170
BLM DKA VA
K Sparing Diuretics
Triamterene Dose?
100 1/2 DD
171
BLM DKA VA
Alpha 1 Blocker
Doxazosin Dose?
16 QD
172
BLM DKA VA
Direct Vasodilator
Hydralazine Dose?
200 2/3 DD
173
BLM DKA VA
Centra alpha 2 agonist
Clonidine PO dose?
0.6, 3 DD
