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C&R TPX > C&R E1 > Flashcards

C&R E1 Flashcards

Kidney Function Assessment Fluids Electrolytes HLD HTN

1
Q

Demeclocycline, drug class?

A

Vasopressin Antagonists

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2
Q

Conivaptan, drug class?

A

V1 and V2 Vasopressin Antagonists

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3
Q

Demeclocycline, dosing?

A

300mg PO BID-QID

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4
Q

Conivaptan, formulation?

A

IV, $$$

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5
Q

Conivaptan, indication?

A

Acute euvolemic hyponatremia

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6
Q

Demeclocycline, warnings?

A
  1. Risk of renal tubular damage and AKI
  2. Avoid children <8yr and prego because of changes in tooth development
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7
Q

Demeclocycline, MOA?

A

blocks ADH at collecting duct, inducing nephrogenic diabetes insipidus (very thirsty and pee a ton)

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8
Q

Tolvaptan, drug class?

A

V2 receptor Vasopressin antagonist

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9
Q

Tolvaptan, brand name?

A

Samsca

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10
Q

Tolvaptan, indication?

A

Hypervolemia Hyponatremia OR Euvolemic Hyponatremia d/t HF, cirrhosis, SIADH, autosomal dominant polycystic kidney disease

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11
Q

Tolvaptan, formulation?

A

15 - 60mg PO QD, $$$

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12
Q

Tolvaptan, ADE?

A

thirst, polyuria, constipation

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13
Q

Tolvaptan, BBW?

A

Hepatotoxicity

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14
Q

Furosemide, brand name?

A

Lasix

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15
Q

Bumetanide, brand name?

A

Bumex

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16
Q

Torsemide, brand name?

A

Demadex

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17
Q

Ethacrynic Acid, brand name?

A

Edecrin

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18
Q

Loop diuretics ADE?

A

SHROM

Hypokalemia
Metabolic alkalosis
Renal injury
Otoxicity
Sulfa-reactions

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19
Q

Furosemide IV –> Furosemide PO?

A

Double the IV dose

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20
Q

Bumetanide IV –> Bumetanide PO

A

No change

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21
Q

Torsemide IV –> Torsemide PO

A

no change

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22
Q

Ethacrynic acid IV –> Ethacrynic acid PO

A

no change

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23
Q

Furosemide PO
Bumetanide PO
Torsemide PO

A

40
1
20

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24
Q

Thiazide diuretics vs Loop

A

Loop are stronger diuretics but thiazide better for bp

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25
Q

Thiazide ADE?

A

UCk

HyperUricemia
HyperCalcemia
Hypokalemia

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26
Q

Spironolactone, drug class?

A

K sparing, MRA

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27
Q

Eplerenone, drug class?

A

K sparing, MRA

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28
Q

Amiloride, drug class?

A

K sparing

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29
Q

Triamterene, drug class?

A

K sparing

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30
Q

K Sparing ADE?

A

HM

Hyperkalemia
Metabolic acidosis

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31
Q

4 Rx that cause hyperkalemia

A

K Sparing diuretics
ACE inhibitors
Beta blockers
NSAID

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32
Q

Na Polystyrene Sulfonate, brand name?

A

Kayexalate

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33
Q

Na Polystyrene Sulfonate, usage and indication?

A

Emergent HYPER K to REMOVE from body or for chronic control

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34
Q

Patiromer, brand name?

A

Veltassa

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35
Q

Sodium Zirconium Cyclosiliate, brand name?

A

Lokelma

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36
Q

Sodium Polystyrene Sulfonate, ADE?

A

GI upset Constipation, N/V, Anorexia

Electrolyte Disturbances, hypernatremia, hypoK/Ca/Mg

*INTESTINAL NECROSIS

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37
Q

Patiromer, brand name?

A

Veltassa

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38
Q

Patiromer, indication?

A

DELAYED EFFECT
CHRONIC USE HYPERK ONLY

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39
Q

Patiromer, DDI?

A

Ciprofloxacin
Levothyroxine
Metformin

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40
Q

Patiromer, ADE?

A

GI
Hypomagnesemia

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41
Q

Patiromer and other Rx need to be ____ hrs apart?

A

3

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42
Q

Sodium Zirconium Cyclosilicate, brand name?

A

Lokelma

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43
Q

Sodium Zirconium Cyclosilicate and other rx need to be ___ hrs apart?

A

2

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44
Q

Sodium Zirconium Cyclosilicate, DDI?

A

Clopidogrel
Dabigatran
Warfarin

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45
Q

Sodium Zirconium Cyclosilicate, ADE?

A

Edema

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46
Q

Sodium Bicarbonate PO, ADE?

A

GI belching
Flatulence
Edema

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47
Q

Sodium Bicarbonate IV, ADE?

A

Edema/Hyper Na
Hypokalemia
Hypercalciuria + Urinary alkalinization
Paradoxical intracellular
Decreased ionized calcium
Overcorrection of pH

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48
Q

Thiazide Diuretics MOA

A

Inhibit Na and Cl reabsp

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49
Q

Thiazide Diuretics DDI

A

NSAIDS or drugs that cause Na and water rentention

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50
Q

Thiazide Diuretics ADE

A

sUCk mg low and sweet

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51
Q

Thiazide Diuretics Pearls

A
  • caution in pt with hx of acute gout
  • caution in pt with allergy of sulfonamide-derived rx
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52
Q

Chlorthalidone is ——- as potent as HCTZ
Chlorthalidone is preferred because of ——

A
  1. Twice as potent
  2. prolonged half-life
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53
Q

CCB DHP MOA

A

Inhibit Ca from entering the vascular smooth muscle and MI cells resulting in peripheral and coronary artery vasodilation

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54
Q

CCB DHP ADE

A

Peripheral edema***
HA
Dizziness
Flushing
potential for reflect tachycardia

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55
Q

CCB DHP Pearls

A

Can take up to a week to see the full effects
*DO NOT USE NIFIDEPINE IR IN ANY HTN, CAUSES HYPOTENSION, MI, DEATH

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56
Q

What drug can cause MI, hypotension, and death if used for HTN?

A

Nifedipine IR

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57
Q

CCB NonDHP MOA

A

Inhibit Ca from entering the vascular smooth muscle and MI cells resulting in negative inotropy and chronotropy

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58
Q

Which CCB is more selective for the heart?

A

NonDHP

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59
Q

CCB NonDHP Contraindications

A

pts with hx of Hypotension or hx cardiogenic shock
avoid in HFrEF pt

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60
Q

CCB Non DHP DDI

A

CYP3A4 major substrates and moderate inhibitors (ALS for statins)
Avoid routine use with beta blockers

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61
Q

ACEi MOA

A

Decrease Angiotensin II production to decrease vasoconstriction and decreased aldosterone secretion

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62
Q

ACEi Contra

A

Prego
hx of angioedema
severe BILATERAL renal artery stenosis

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63
Q

ACEi ADE

A

Hyperkalemia, Dry Cough, Angioedema, Hypotension

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64
Q

ACEi Pearls

A
  • 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
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65
Q

ACEi/ARB potassium level dosing rules
- not on drug yet (1)
- on drug (2)

A

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

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66
Q

ARB MOA

A

Block Angiotensin II at the angiotensin receptor on vascular smooth muscle and preventing vasoconstriction

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67
Q

ARB Contra

A

Prego
Pt with severe bilateral renal artery stenosis

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68
Q

ARB ADE

A

Hyperkalemia
Hypotension

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69
Q

ARB Pearls

A
  • 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
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70
Q

Direct renin inhibitors MOA

A

Inhibits renin which results in overall decrease in angiotensin II

71
Q

Direct renin inhibitors Contra

A

Prego
Avoid use in ACE/ARB in pts with DM
Severe bilateral renal artery stenosis

72
Q

Direct renin inhibitors ADE

A

hyperkalemia, diarrhea, hypotension

73
Q

Direct renin inhibitors Pearls

A
  • no combo with RAAS rx
  • long half life
74
Q

B blockers MOA

A

inhibit beta 1 and beta 2 receptors

75
Q

B blockers Contra

A

severe bradycardia

76
Q

B blockers ADE

A

Bradycardia
Heart block
worsening HF
bronchospasm
cold extremities
fatigue
depression
reduced exercise tolerance
decreased libido
insomnia
impotence

77
Q

B Blockers Pearls

A
  • 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
Q

Alpha 1 blockers MOA

A
  • binds to alpha 1 adrenergic receptors which result in peripheral dilation of arterioles and veins
79
Q

Alpha 1 blockers DI

A

use in caution when with PDE5 inhibitors (sildenafil)

80
Q

Alpha 1 blockers ADE

A

syncope
orthostatic hypotension
drowsiness
dizziness
headache

81
Q

Alpha 1 pearls

A
  • increased risk for HF
  • first dose orthostatic hypotension (admin first dose PM)
82
Q

Central alpha 2 agonists MOA

A

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
Q

Central alpha 2 agonists Contra

A

concurrent use of MAOIs
Methyldopa contra in active liver disease

84
Q

Central alpha 2 agonists ADE

A

dry mouth
somnolence
fatigue
constipation
bradycardia

85
Q

Central alpha 2 agonists Pearls

A
  • 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
Q

Loop diuretics MOA

A

inhibits Na, K, Cl reabsp in the thick ascending limb of loop of henle

87
Q

Loop diuretics Monitoring

A

Assess electrolytes and renal function 2 - 4 weeks after initiating therapy or dose change

88
Q

Loop diuretics ADE

A

Hypo Na, K, Mg, Cl, Ca
Hypovolemia

89
Q

Loop diuretics Pearls

A
  • preferred in pts with symptomatic HF
  • caution with Pts with a sulfa allergy
90
Q

K sparing diuretics MOA

A

inhibition of epithelial Na channel in the collecting duct of the nephron, decrease Na reabsp and increase K reabsp

91
Q

K sparing diuretics ADE

A

Hyper K, dehydration, hypo Na

92
Q

K sparing diuretics pearls

A
  • 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
Q

MRA MOA

A

Competitive antagonists of the MR result in decreasing Na reabsp and increase K reabsp

Spironolactone is non-selective

94
Q

MRA Contra

A

Pts with hyperkalemia
Pts with anuria <50 ml

Spironolactone not rec when GFR <30ml/min

95
Q

MRA DI

A

strong CYP3A4 inhibitors

96
Q

MRA ADE

A

dehydration, hyponatremia, dizziness

Spironolactone: gynecomastia, breast tenderness, impotence

97
Q

MRA Pearls

A
  • 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
Q

Direct Vasodilators MOA

A

direct vasodilation of arterioles which results in a decrease in SVR

99
Q

Hydralazine ADE

A

it’s a direct vasodilator
- reflex tachycardia, peripheral edema, palpitations, DILE (drug induced lupus erythematosus)

100
Q

Direct Vasodilators Pearls

A
  • 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
Q

Ezetimibe Dose

A

10mg PO QD with our without food

102
Q

ezetimibe MOA

A

Inhibits cholesterol absorption at small intestine

103
Q

Ezetimibe ADE

A

URTI
Diarrhea
Arthralgia
Sinusitis
Pain in extremities

104
Q

cv outcomes for hld

A

Statins
Ezetimibe with mod statin
Pcsk9 with statin

105
Q

Extra ldl lowering in hld?

A

Bempedoic acid with statin
Pcsk9 with statin
BAS with statin
Inclusion without statin

106
Q

Bempedoic acid brand name

A

Nexletol

107
Q

Bempedoic acid dosage

A

180mg PO QD with our without food

108
Q

Bempedoic acid MOA

A

Inhibitor that brings more LDL into the liver to be metabolized. A pro drug so less muscle ade

109
Q

Bempedoic acid ADE

A

gout with prior hx of hyperuricemia is
Tendon rupture
Myopathy with simvastatin and pravastatin

110
Q

PCKS9 I pearls

A

Is an injection and a human mab rx

111
Q

Pcsk9i MOA

A

Increases the number of LDL receptors on the liver to clear LDL

112
Q

inclisiran brand name

A

Leqvio

113
Q

Inclisiran MOA

A

Inhibits PCSK9 hepatic synthesis

114
Q

Inclisiran pearls

A

Small interfering RNA lowering tx
Injectable
You inject at first dose, then 3mths, and every 6mths as MD

115
Q

PCSK9 ADE

A

Nasopharyngitis
Injection site reaction
Influenza
URTI
back pain

116
Q

Bile Aid Sequestrants (BAS) MOA

A

bind with LDL in the small intestine to poop out LDL

BAS - Bad ass shitter lmao

117
Q

BAS ADE

A

Constipation, dyspepsia, Nausea

118
Q

BAS Pearls

A

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
Q

First line HTN Drugs

A

Thiazides
ACE/ARB
CCB

120
Q

2nd line HTN Drugs

A

BLM
DKA
VA

Beta blocker
loop
MRA
Direct renin inhibitor
K sparing
Alpha 1 blocker
Vasodilator
Centra Alpha 2 agonist

121
Q

Special Consideration HTN urgency Goals, Aortic Dissection

A

Less than 120 systolic within 20 - 60 mins and HR < 60 bpm

122
Q

Special Consideration HTN urgency Goals, Ischemic Stroke

A

less than 185/110 before TPA
Less than <180/105 during TPA
Less than <220 if no tpa

123
Q

Special Consideration HTN urgency Goals, Hemorrhagic Stroke

A

For systolic higher than 220, lower with infusion and monitor
For systolic 150 - 220 lower to 140 within 60 mins

124
Q

Special Consideration HTN urgency Goals, Severe Pre-Eclampsia/Eclampsia

A

SBP less than 140 within 60mins

125
Q

HTN Non pharm weight goal

A

-1kg in BW

126
Q

HTN Non pharm Diet goal

A

DASH (Avisha + some meat)

127
Q

HTN Non pharm Na goal

A

< 1.5g/day

128
Q

HTN non pharm K+ goal

A

3.5 - 5 g/day

129
Q

HTN non pharm Aerobic goal

A

90 - 150 mins/wl

130
Q

HTN non pharm Alcohol

A

< or = 1 for females
< or = 2 for men

131
Q

TAC

Thiazide Doses
Chlorthalidone

A

12.5 - 25 QD

132
Q

Chlorthalidone Brand?

A

Hydroton

133
Q

HCTZ brand?

A

Hydrodiuril

134
Q

TAC

Thiazide Doses
HCTZ

A

25 - 50 QD

135
Q

TAC

ACE Doses
Lisinopril

A

40 QD

136
Q

Lisinopril Brand?

A

Prinivil/Zestril

137
Q

Benazepril Brand?

A

Lotensin

138
Q

TAC
ACE Doses
Benazepril

A

40 1/2 DD

139
Q

TAC
ARB Doses
Losartan

A

100 1/2 DD

140
Q

Losartan, Brand?

A

Lozaar

141
Q

Valsartan, Brand?

A

Diovan

142
Q

TAC
ARB Doses
Valsartan

A

320 QD

143
Q

TAC
CCB Doses, DHP
Amlodipine

A

10 QD

144
Q

Amlodipine brand?

A

Norvasc

145
Q

Nifedipine ER brand?

A

Procardia

146
Q

TAC
CCB Dose, DHP
Nifedipine ER

A

120 QD

147
Q

TAC
CCB Dose, Non DHP
Diltiazem ER

A

360 QD

148
Q

Diltiazem ER brand?

A

Cardizem

149
Q

non DHP CCB?

A

Diltiazem (Cardizem)

150
Q

DHP CCB?

A

Amlodipine (Norvasc)
Nifedipine ER (Procardia)

151
Q

BLM DKA VA
Beta Blocker
Bisoprolol Dose?

A

10 QD

152
Q

Bisoprolol brand?

A

Zebeta

153
Q

Metoprolol Tartrate brand?

A

Lopressor

154
Q

Metoprolol Succinate brand?

A

Toprol XL

155
Q

Carvedilol brand?

A

Coreg

156
Q

Doxazosin brand?

A

Cardura

157
Q

Clonidine PO brand?

A

Catapres

158
Q

Furosemide brand?

A

Lasix

159
Q

Triamterene brand?

A

Dyrenium

160
Q

Hydralazine brand?

A

Apresoline

161
Q

Spironolactone brand?

A

Aldactone

162
Q

Spironolactone brand?

A

Aldactone

163
Q

BLM DKA VA
Beta Blocker
Metoprolol Tartrate Dose?

A

200 2 DD

164
Q

BLM DKA VA
Beta Blocker
Metoprolol Succinate Dose?

A

200 QD

165
Q

BLM DKA VA
Beta Blocker
Carvedilol Dose?

A

50 2 DD

166
Q

Cardio selective beta blockers?

A

metoprolol tartrate, metoprolol succinate, bisoprolol

167
Q

non cardio selective beta blockers?

A

carvedilol, resulting in more bp lowering effects

168
Q

BLM DKA VA
Loop Diuretics
Furosemide Dose?

A

80 QD

169
Q

BLM DKA VA
MRA
Spironolactone Dose?

A

100 QD

170
Q

BLM DKA VA
K Sparing Diuretics
Triamterene Dose?

A

100 1/2 DD

171
Q

BLM DKA VA
Alpha 1 Blocker
Doxazosin Dose?

A

16 QD

172
Q

BLM DKA VA
Direct Vasodilator
Hydralazine Dose?

A

200 2/3 DD

173
Q

BLM DKA VA
Centra alpha 2 agonist
Clonidine PO dose?

A

0.6, 3 DD

C&R TPX (4 decks)

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