cardio 2

Question 1

Drug Tx for angina?

Answer 1

to restore balance b/w myocardial O2 supply/demand

Question 2

MOA of nitrates?

available as

Answer 2

dilate vascular smooth muscle
decrease cardiac pre/afterload.

paste/sublingual/transderma/oral/spray

no more than 3 sprays in 15 mins. call ambulance after first 5 mins

Question 3

ADR of nitrates?

Answer 3

reflex tachycardia from drop in BP
dizzy
orthostatic hypotension
headache**
burn under tongue

Question 4

What are the platelet aggregator inhibitors?

Answer 4

aspirin
clopidogrel (plavix)
Reopro

Question 5

MOA of aspirin?

Answer 5

block thromboxane A2 synthesis from AA in platelet.

single dose followed by daily of 81 mg

Question 6

MOA of clopidogrel (plavix)?

side effect is

Answer 6

inhibit ADP induced platelet aggregation. comparable to medium dose aspirin.

bleeding

Question 7

MOA of anticoagulants?

heparin

Answer 7

incativate factors involved in normal coagulation

preventing conversion of prothrombin to thrombin. which induces fibrin

Question 8

MOA of lmw heparin?

Answer 8

decrease affinity to bind plasma proteins.

Question 9

indication for anti-coagulants.

Answer 9

DVT/PE/MI/after surgery

every 12 hours

bleeding.

Question 10

MOA of warfarin?

Answer 10

interfere with liver synthesis of vitamin K dependent clotting factors.

watch for INR

Question 11

use of warfarin?

Answer 11

prophylaxis
DVT/PE
prevent stroke in fib
acute MI
mechanical heart valved.

Question 12

Tx for warfarin skin necrosis?

Answer 12

drug withdrawal
vit K
heparin
fresh frozen plasma
protein C

Question 13

lots of drugs make unstable plaque stable … whats one?

Answer 13

Lipitor

Question 14

shelflife for nitrate?

Answer 14

6 mo closed

3 open. away from sunlight

Question 15

MOA of Reopro?

Answer 15

inhibit binding of fibrin and vWF to glycoprotein 2b/3a

prevents restenosis after angioplasty

Question 16

long standing HTN?

Answer 16

rough lining of artery, causing it to get sticky and possible clottingg factor.

Question 17

explain formation of thrombus?

Answer 17

prothrombin turns to thrombin which cause platelets to firm by attracting fibrin (think of a scar)

anticoagulants block thrombin/production of clotting factors by liver to prevent this.

Question 18

wafarin has a lot of interactions with

Answer 18

drugs and food (broccoli)

Question 19

MOA for Pradaxa?

antidote for it?

Answer 19

Clot buster

Thrombin inhibitor through competitive inhibition. for stroke in a fib and DVT.

no antidote. ppl can bleed to death. especially with fall.

Question 20

Dosing of Pradaxa?

what to note

Answer 20

32-38 days for THR. 10-14 for TKA. within 12-24 hr window.

pt can bleed. no interaction with vitamin K foods.

Question 21

MOA for thrombolytics?

clot buster.

Answer 21

convert plasminogen to plasma to break down fibrin clots.

after CVA.. unless it happened overnight.

Question 22

Dosing for Thrombolytics

Answer 22

3-4.5 hrs after stroke,

wishing 12 hours of MI

Question 23

Contraindications of thrombolytics?

Answer 23

head trauma, ulcer, bleeding issue, uncontrolled HTN

preggo, Glucose <50/

Question 24

MOA of statins?

Answer 24

competitive inhibitor of HMG CoA reductase. synthesizes cholesterol reduced LDL.
liver is target organ

lowers cholesterol

Question 25

ADR of statins?

Answer 25

gas/cramps/headache/nausea new onset diabetes peripheral neuropathy tendon rupture

Question 26

what cant you have with statins?

Answer 26

grapefruit juice

Question 27

what are other effects of statins?

Answer 27

``` protect brain from stroke increase NO inhibit action of cytokine prevent thrombus increase bone formation (ww) ```

Question 28

Muscle pain due to statins treated with

Answer 28

Vitamin D

Question 29

Muscle ache or weakness w/o elevated Creatine Kinase?

Answer 29

Myalgia very common with statins

Question 30

Muscle symptoms with elevated CK?

Answer 30

myositis

Question 31

muscle symptoms with CK elevation greater than 10x upper limit. brown urine

Answer 31

Rhabdomyolysis. rare

Question 32

Risk factor for muscle pain with statin?

Answer 32

``` large dose taken with med that inhibit statin metabolism >70 y./o female impaired liver/renal skinny alcohol untreated hypothyroid. ```

Question 33

Prevent muscle injury with statin

Answer 33

``` low dose monitor CK level switch statin withdraw. measure grip strength ```

Question 34

Zetia MOA?

Answer 34

reduce cholesterol absorption through small intestine. combine with simvastatin= Vytorin. more beneficial.

Question 35

Goals for pharmacotherapy in CHF?

Answer 35

``` remove salt+water (loop diuretic) improve contractility (+inotropic) decrease pre/afterload (vasodilator) dec after load and retain salt/water (ACE 1 ARB) antagonize aldosterone. ```

Question 36

MOA of Digoxin?

Answer 36

Block Na/K pump. enhancing Na/Ca2+ pump increasing force of contraction w/o decreasing BP or HR. helps L ventricle pump more effectively (CHF) parasympathetic action at SA node. also for arrhythmia

Question 37

ADR of Digoxin?

Answer 37

arrhythmia CNS effects nausea/vomit/diarrhea digitalis toxicity* result in bradycardia, halo vision.

Question 38

What are some agents for CHF?

Answer 38

``` Diuretics-increase excretion Betablockers-dec contractility ACE 1 + ARB-v renin release Vasodilators Spironolactone-bind to aldosterone Beta activation-vasodilation relieve edema. ```

Question 39

What cant happen during ERP? when does it? what doe anti-arrhythmias do?

Answer 39

AP can during relative refractory . increase duration of effective refractory period. (widen AP)

Question 40

What are dysarrhythmic drugs?

Answer 40

class 1: Sodium blockers 2: beta blockers 3: true anti arrhythmia prolong repo. 4: calcium channel blockers 5: digoxin

Question 41

Therapeutic concerns with anti-arrhythmics?

Answer 41

widely used but don't work very well.

Question 42

Exercise and anti-arrhythmia:

Answer 42

meds not effective with exercise. some negative inotropic effects (performance or BP_ don't stop exercise abruptly.

Question 43

Alpha blockers do what?

Answer 43

dilate arteries and reduces BP