Cardiac/Renal Flashcards
(102 cards)
1
Q
nitrates MOA
A
vasodilator
2
Q
nitroglycerin preparation and onset
A
sublingual q5 minutes
onset 1-3 minutes
3
Q
nitrates examples
A
nitroglycerin
isosorbide mononitrate
4
Q
isosorbide mononitrate onset
A
30-60 mins
5
Q
nitrate precautions
A
tolerance
avoid with PDE5 inhibitors for erectile dysfunction
6
Q
ranolazine MOA
A
antianginal inhibits sodium
does not cause hypotension
7
Q
ranolazine vs. nitrates
A
ranolazine does not lower HR or BP
ranolazine is more expensive ($400/mo)
8
Q
aspirin MOA
A
inhibits cyclooxygenase-1
9
Q
aspirin dosing for acute MI
A
162-325 mg
10
Q
aspirin use
A
decrease mortality and acute MI by 50%
11
Q
platelet aggregation inhibitors MOA
A
bind to ADP which decreases platelet aggregation
12
Q
platelet aggregation inhibitors examples
A
clopidogrel
prasugrel
13
Q
which enzyme is responsible for clot lysis?
A
plasmin
14
Q
fibrinolytics MOA
A
convert plasminogen to plasmin
15
Q
indications for tPA
A
stroke and MI
16
Q
calcium channel blocker MOA
A
coronary vasodilator in peripheral blood vessels
increase o2 supply to heart
17
Q
which CCBs decrease O2 demand? how?
A
verapamil and diltiazem
decrease HR and contractiity
18
Q
when should CCBs be avoided?
A
heart block
post MI
bradycardia
HF or pulm edema - but CAN use amlodipine and felodipine
19
Q
CCBs are first line in what type of angina?
A
prizmental’s
20
Q
ACE inhibitors MOA
A
reduces aldosterone secretion to decrease sodium and water retention in kidneys
reduce preload and afterload
arterial dilation
used for hypertension and CHF
21
Q
indications for ACE inhibitors
A
DM
HF
renal insufficiency
22
Q
contraindications to ACEI
A
pregnancy
angioedema
23
Q
ACE inhibitors examples
A
lisinopril (Privinil)
fosinopril (Monopril)
24
Q
commonly used ARB
A
valsartan (diovan)
25
angiotensin II receptor blockers MOA
reduces secretion of aldosterone, reducing sodium and water retention
vasodilation
26
which has a worse cough? ACE or ARB?
ACE inhibitors
27
lab monitoring for ACE/ARBs
potassium
creatinine (within 2 weeks of starting)
hypotension
cough
28
contraindication to ARB
pregnancy
do not use with ACEI!!! can cause renal dysfunction
29
direct renin inhibitor MOA
binds to binding pocket of renin, inactivating renin
30
loop diuretics MOA
inhibit NaK2Cl cotransporter in the loop of henle
31
loop diuretics AEs
lowers K, Na, Mg
| increases uric acid
32
loop diuretics examples
furosemide (lasix), torsemide (demadex)
33
thiazide diuretics MOA
inhibit NaCl co-transporter in the distal tubule
34
thiazide diuretics examples
chlorthalidone (hydone)
| metolazone (zaroxolyn)
35
preferred diuretics for CHF
loop diuretics, metolazone
36
spironolactone AEs
gynecomastia and sexual dysfunction in men and women
37
alternative for spironolactone
eplerenone (Inspra) does not have sexual side effects
38
potassium sparing diuretics MOA
inhibit epithelial sodium channel in the collecting duct
spironolactone & eplerenone are aldosterone antagonists
39
spironolactone MOA
lowers aldosterone
40
potassium sparing diuretics examples
spironolactone
eplerenone
triamterene
41
dyazine (HCTZ/triamterene) MOA
HCTZ - thiazide diuretic
triamterene - potassium sparring diuretic
used for K regulation
42
commonly used statins
rosuvastatin (Crestor)
atorvastatin (Lipitor)
simvastatin (Zocor)
pravastatin (Prevacol)
43
which statins can be taken at any time of day?
rosuvastatin
| atorvastatin
44
which statins need to be taken at bedtime?
simvastatin
| pravastatin
45
rosuvastatin dosing
20-40 mg
46
atorvastatin dosing
40-80 mg
47
precautions for atorvastatin?
many drug interactions and grapefruit
48
precautions for simvastatin
many drug interactions and grapefruit
49
statins MOA
inhibition of HMG-CoA
50
benefit of prevastatin
low incidence of muscle pain
51
statins AEs
muscle pain (rhabdomyolysis) can lead to kidney damage - stop if CK >10x normal
elevated LFTs - stop if >3x normal AST
52
lab work for statins
baseline LFTs
| baseline CK & with muscle problems
53
supplement option for muscle pain with statins
CoQ-10 or vitamin D
54
PCSK9 inhibitors MOA and use
inhibit PCSK9 which increase number of LDL receptors in liver to decrease LDL
second line after statins
55
examples of PCSK9 inhibitor and dosing
alirocumbab (praluent) SQ every 2 weeks
evolocumab (Repatha) SQ every 2 weeks
56
ezetimibe (zetia) MOA and use
cholesterol absorption inhibitor in small intestine
3rd line add on to statins for high cholesterol
57
bile acid sequesterants examples
colestipol (colestid)
| colesevalem (welchol)
58
bile acid sequestrants MOA and use
bind to bile acid to decrease LDL
59
bile acid sequesterants AEs
constipation, drug interactions - dont take with other meds
can lead to deficiency of fat soluble vitamins
60
Niacin MOA and use
inhibits triglycerides and decreases secretion of VLDL and LDL particles
add on therapy for high LDL
61
niaspan MOA and AEs
niacin
can cause liver dysfunction and failure
62
fibric acids MOA and use
induces clearance of triglyceride-rich particles
lowers triglyceridades
63
fibric acids examples
gemfibrozil (lopid)
| fenofibrate (tricor)
64
omega 3 fatty acids use and examples
treat triglycerids >500
lovaza
vascepa
OTC fish oils - cheaper
65
treatment for homozygous familial hypercholesterolemia & precautions
MTP inhibitor - lomitapide (Juxtapid)
antisense oligonucleotide inhibitor - mipomersen (kynamro)
both have BBW for hepatotoxicity!
66
routine treatment of stage B HFrEF
ACEI & beta blocker
67
routine treatment of stage C HFrEF
ACEI/Entresto + Beta blocker + loop diuretic
68
commonly used ARB
valsartan (diovan)
69
Entresto (sacubitril/valsartan) MOA and use
valsartan - ARB, sacubitril- neprilysin inhibitor
preferred agent for HF but expensive
70
precaution before starting Entresto
stop ACEI or ARB 2 days before starting Entresto.... can cause angioedema
71
indication for hydralazine + nitrate
CHF in african americans
72
hydralazine MOA
direct vasodilator
73
digoxin MOA
inhibits Na-K-ATPase pump
74
digoxin indication
used to improve fatigue in patients with CHF
75
s/s of dig toxicity
nausea, yellow halos
76
AE of digoxin
dig toxicity
| bradycardia
77
ivabradine (Corlanor) MOA and use
HCN (funny) - channel blocker
used in place of beta blocker in CHF
78
are calcium channel blockers used for CHF?
no
ESPECIALLY not verapimil/diltiazem
79
which medications should be avoided in CHF?
NSAIDS
antihyperglycemics - pioglitazone, saxagliptin, alogliptin
sudafed
amiodarone
80
treatment for acute HF warm and wet
loop diuretics
| IV nitro
81
treatment for acute HF cold and dry
dobutamine
82
treatment for acute HF cold and wet
dobutamine
milrinone
then start diuretics
83
diuretics dosing for acute HF
1-2x home dose up to 4 times a day
84
nesiritide MOA and precautions
vasodilates, decreases aldosterone secretion
may cause hypotension
85
milrinone (primacor) MOA
phosphodiesterase inhibitor
increases contractility
86
indication for milrinone
useful in patients taking beta blockers with acute HF
can be used alone or w dobutamine
87
dobutamine MOA and precautions
increases contractility - B1 agonist
may worsten ischemia
88
dopamine indication
increase renal perfusion, positive inotrope/chronotrope, vasoconstriction
depends on dose
89
class I antiarrhythmics
Na channel blockers
IB - lidocaine, mexiletine
IC - flecainide
90
class II antiarrhythmics
B blockers
91
class III antiarrhythmics
K channel blockers
amiodarone
92
class IV antiarrhythmics
CCBs - verapamil, diltiazem
93
class V antiarrhythmics
adenosine, digoxin
94
amiodarone precautions/AE
very long half life! days
pulmonary interstitial pneumonitis, hepatotoxicity, hypothyroid
95
sinus tachycardia treatment
beta blockers
96
a fib treatment
oral anticoagulants
rate control - amiodarone or digoxin, beta blocker
cardiovert + amio for symptomatic
97
stable v tach treatment
adenosine, amiodarone, ICD
98
stable torsades treatment
cardiovert, epi, amio
99
dronedarone AEs
worsten HF
100
flecainide AE
worsten HF
101
mexiletine AE
hepatotoxicity
102
procainamide AE
neutropenia
