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Adv. Pharm > Cardiovascular > Flashcards

Cardiovascular Flashcards

Exam2 (150 cards)

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1
Q

ACE Inhibitor MOA?

A

ACE inhibition -> decreased angiotensin 2 -> dilated blood vessels -> decrease blood volume -> prevent/reverse pathological changes in heart d/t angiotensin 2 & aldosterone -> reduces cardiac afterload / increases cardia output

ACE inhibition -> increased bradykinin -> vasodilation -> promotes cough & angioedema

ACEi -> aldosterone inhibition -> dilation of renal blood vessels -> allows for sodium & water excretion -> decreases edema / decreases preload (venous return) -> prevents/reverses cardiac structure changes // slows/delays renal disease in diabetic nephropathy

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2
Q

ACE Inhibitor Indications?

A

Hypertension, heart failure, MI, diabetic (and non-) nephropathy, prevention of MI/Stroke/Death in pts at high cardiovascular risk

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3
Q

ACE Inhibitor Adverse Effects?

A

First dose hypotension <- widespread vasodilation <- lowered angiotensin 2 <- ACE inhibition

Cough: persistent, dry, nonproductive cough
ACE inhibition -> increased bradykinin -> cough & angioedema

Hyperkalemia:
ACE inhibition -> inhibition of aldosterone release -> increased potassium retention in kidneys

Acute kidney injury:
In those w bilateral renal artery stenosis (or stenosis in artery to a solitary kidney) bc their kidneys -> increased renin release -> increased levels of angiotensin 2 -> maintain glomerular filtration // inhibition of ACE interrupts the compensatory mechanism

Risk of hypoglycemia:
ACEi -> increased insulin uptake in muscles -> hypoglycemia

Renally adjusted

Increases lithium levels

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4
Q

What drugs are used for hypertension?

A

thiazide diuretic
ACEi
ARBs
Beta-blockers
Aplha1-blockers
CCB
Centrally acting alpha2-agonists
Vasodilators

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5
Q

What drug is a thiazide diuretic?

A

Hydrochlorothiazide

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6
Q

What drug is an ACEi?

A

Lisinopril

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7
Q

What drug is an ARB?

A

Losartan

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8
Q

What drugs are CCBs?

A

Dihydropyridine: Amlodipine

Non-dihydropyridine: Diltiazem

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9
Q

What drug is a beta-blocker?

A

Metoprolol

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10
Q

What drug is an Alpha1-blocker?

A

Prazosin

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11
Q

What drug is a centrally acting alpha2-agonist?

A

Methyldopa

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12
Q

What drug is a vasodilator?

A

Hydralazine

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13
Q

What drug is an aldosterone receptor antagonist?

A

Spironolactone

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14
Q

What drug is a loop diuretic?

A

Furosemide

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15
Q

What drug is a SGLT2i?

A

Dapagliflozin

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16
Q

Examples of causes of secondary hypertension?

A

Cushing’s syndrome
Pheochromocytoma
Medications
Lifestyle

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17
Q

What is the difference between primary and secondary hypertension?

A

Primary/essential hypertension: no identifiable cause

Secondary hypertension: secondary to identifiable cause

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18
Q

At what BP range are meds recommended versus lifestyle changes?

A

“elevated” 120-129 / less than 80: lifestyle change

HTN stage 1: 130-139 / 80-89: meds

HTN crisis: higher than 180 / 120: IV meds, emergent

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19
Q

Treatment of HTN goal?

A

BP maintenance at < 130 / < 80

Going lower can cause profound hypotension d/t being used to higher BP

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20
Q

Main part of diagnosing HTN?

A

Repeated BP readings above 130/80
(White coat syndrome)

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21
Q

Recommended sodium consumption?

A

<2300mg / day
<2.3g / day

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22
Q

What are lifestyle changes for managing HTN?

A

Reducing sodium intake
Diet: fruits/veggies, low fat/cholesterol
Lower alcohol
Increase exercise
Smoking cessation
Weight loss
Maintain potassium / calcium intake

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23
Q

First line agents for HTN?

A

Thiazide diuretics
ACEi
ARBs
CCBs

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24
Q

Drugs that aid in HTN & heartfailure

A

ACEi
Aldosterone antagonist
ARB
Beta blocker
CCB- DHP
Diuretic

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25
Drugs that aid in HTN and recurrent stroke prevention
ACEi Diuretic
26
Drugs that aid in HTN and risk of CAD
ACEi Beta blocker CCB Diuretic
27
Drugs that aid in HTN & post-MI
ACEi Aldosterone antagonist Beta blocker
28
Drugs that aid in HTN & diabetes
ACEi ARBs Beta blocker CCB Diuretic
29
Drugs that aid in HTN & CKD
ACEi ARBs
30
Drugs that are safe to aid HTN in pregnancy
Labetalol Nifedipine Methyldopa
31
Drugs for HTN that are contraindicated in pregnancy
ACEi ARBs Direct renin inhibitors All teratogenic
32
Thiazide diuretics- MOA
Prevents re-absorption of sodium in distal renal tubules Promotes urinary excretion of sodium, water, potassium, hydrogen Calcium, glucose, uric acid sparing
33
Thiazide diuretics- adverse effects
Photosensitivity - wear sunscreen Electrolyte disturbances- hypokalemia, hypomagnesemia, hyponatremia, hypercalcemia Orthostatic hypertension Gout Contains sulfa moiety (cross-reactivity w sulfa antibiotics is low)
34
ARBs Indications?
HTN Heart failure diabetic nephropathy MI Prevention of: MI Stroke Death for high risk of cardiovascular events
35
ACEi and ARBs: main difference?
ARBs have lower risk of coughing or hyperkalemia ACE are first choice, ARBs if not tolerated
36
ARBs MOA?
Prevents angiotensin 2 from binding to receptor -> decreased vasoconstriction -> vasodilation -> increased blood flow -> decreased BP // decreased aldosterone -> decreased re-absorption of sodium and water -> decreased blood volume -> decreased BP
37
ACEi: Contraindications?
Idiopathic/hereditary angioedema Coadministration within 36hours with a neprilysin inhibitor (ex. sacubitril)
38
ARBs: side effects?
Acute kidney injury Hyperkalemia First-dose hypotension Fetal injury Angioedema (less than ACEi) Monitor: Serum potassium (palpitations, irregular heart beat) Renal function (BUN/Cr/urine output
39
CCBs: MOA?
CCB block calcium from entering heart muscle -> vasodilation -> decreased contractility -> reduced HR
40
Effects calcium has on the heart?
Increased calcium influx into the heart -> increased vasoconstriction / contraction More calcium = constriction & contraction
41
What is a dihydropyridine (DHP) CCB?
Acts mostly on blood vessels Amlodipine
42
DHP CCB: side effects?
Flushing Peripheral edema First-dose hypotension Gingival hyperplasia - advise to floss regularly Hyperglycemia Headache (Amlodipine)
43
What drug is a nondihydropyridine?
Acts on heart and blood vessels (Diltiazem- CCB)
44
NDHP CCBs: Indications?
Arrythmias Angina HTN (Diltiazem)
45
Main difference between NDHP and DHP?
Non-dihydropyridine: affects heart AND blood vessels (Diltiazem) Dihydropyridine: affects only blood vessels (Amlodipine)
46
NDHP CCBs: MOA
Blocks calcium channels in vessels -> vasodilation -> decreased BP Blocks calcium channels in heart -> increases relaxation -> increases vasodilation -> increases coronary perfusion Blocks calcium channels at SA node -> decreases HR and heart -> decreases AV node conduction -> decreases dysrhythmias (Diltiazem)
47
NDHP CCB: side effect?
Constipation d/t CCB in GI Peripheral edema/flushing d/t vasodilation Bradycardia d/t CCB at SA node Hyperglycemia Heart failure Gingival hyperplasia- floss regularly Avoid grapefruit juice & st. John's Wort d/t inhibition of drug metabolism -> increased drug levels Contraindicated with heart failure or EF<40% (Diltiazem- less potent than verapamil)
48
DHP CCB: Indications?
Angina- vasospastic HTN (Amlodipine)
49
What drug is a beta blocker?
Metoprolol
50
Beta blocker- MOA?
Beta blocker -> blocks beta 1(heart/kidneys) -> decreases HR, contractility, cardiac output, inhibits renin release Beta blocker -> blocks beta 2 (lungs, pancreas, arteriolar muscle) -> peripheral vasoconstriction (decrease blood flow to extremities) / bronchoconstriction (caution w/ asthma) Decreases HF risks, decreases BP, decreases risk of sudden cardiac death (Metoprolol) (Metoprolol succinate for HF- beta 1 selective)
51
Beta blockers- side effects?
Bradyarrhythmia Fatigue, insomnia SOB/Bronchospasm- avoid starting if pt already experiencing Rebound hypertension- if stopped abruptly Avoid if pt is decompensated- more for Tx not for acute Counsel on abrupt withdrawal d/t increased mortality and avoid rapid titrations d/t side effects Hyperglycemia (masked Sx- tremors, palpitations, hunger, irritability) Hyperkalemia Increase cholesterol Intensify adverse effects of diltiazem (NDHP CCB) (Metoprolol)
52
Beta blocker- contraindications?
Bradycardia (HR < 45) AV block without functioning pacemaker Cardiogenic shock Acute heart failure exacerbation
53
What drug is an Alpha1-Blocker?
Prazosin
54
What drug class is prazosin?
Alpha1-Blocker
55
Alpha1-blocker- MOA?
Blocks alpha1 receptors -> prevents norepinephrine binding -> vascular vasodilation -> dilation of arterioles/veins & relaxation of smooth muscle -> decreases BP (Prazosin)
56
Alpha1-blocker- indications?
HTN- not first choice d/t hypotension BPH- off-label PTSD-related nightmares- off-label
57
Alpha1-blocker- side effects?
Orthostatic hypotension Angina Reflex tachycardia Nasal congestion Dizziness/drowsiness Not first-choice for HTN
58
What drug is a Centrally Acting Alpha2-Agonist?
Methyldopa
59
What drug class is Methyldopa?
Centrally acting alpha2-agonists
60
Alpha2-agonist- MOA?
Stimulates alpha2 receptor (in brain) -> decrease sympathetic outflow (norepinephrine release) -> -> decrease SNS activity -> decreases peripheral resistance renal vascular resistance heart rate blood pressure (Methyldopa)
61
Alpha2-agonist- indication?
Hypertension HTN in pregnancy (methyldopa)
62
Alpha2-agonist- side effects?
Neurologic effects- depression at higher doses- can worsen depression or increase risk of suicidal ideation- counsel Hemolytic anemia Transient sedation w initiation or dose increase Contraindicated w/ use of MAO inhibitors- counsel
63
What drug is a vasodilator?
Hydralazine
64
What drug class is hydralazine?
Vasodilator
65
Vasodilator- MOA?
Selective vasodilation of arterioles (Hydralazine)
66
Vasodilator- side effects?
Reflex tachycardia Increases intracranial pressure Headache, dizziness, weakness/fatigue, increased blood volume Not first-choice for HTN/HF (Hydralazine)
67
What are some common causes for arrythmias?
MI Electrolyte imbalances: decreased potassium or decreased magnesium
68
What are the classes of antiarrhythmics?
Class 2: beta blockers (Metoprolol) Class 3: Potassium channel blockers (Amiodarone) Class 4: NDHP if no HF (Diltiazem)
69
What drug is a potassium channel blocker?
Amiodarone
70
What drug class is Amiodarone?
Potassium channel blocker
71
Potassium channel blocker- side effects?
Hyper/hypothyroidism Hepatotoxic Optic neuropathy Pulmonary toxicity Bradycardia Hypotension Avoid grapefruit juice/ st.John's Wort Take with food (avoids GI upset) Limit sun exposure Long half-life (58days) Correct hypokalemia, hypomagnesemia, hypocalcemia prior to starting Contraindications: Iodine sensitivity (Amiodarone)
72
Amiodarone- indications?
Arrhythmias - not first-choice d/t toxicities
73
Potassium channel blocker- MOA?
Blocks potassium channels -> blocks repolarization of heart muscle -> prolongs AP (Amiodarone)
74
Which cholesterol increases risk for ASCVD?
Increased LDL (bad cholesterol) or decreased HDL (good cholesterol)
75
What are some ASCVD events?
MI Ischemic stroke Transient ischemic attack Coronary artery disease
76
What is the 10-year ASCVD score?
Concerned when score is >7.5%
77
What enzyme synthesizes cholesterol?
HMG-CoA Reductase- the main target for statins
78
What is the main target for statins?
HMG-CoA Reductase- the enzyme that synthesizes cholesterol
79
What range is ideal for total cholesterol?
<200mg/dL 200-239mg/dL borderline >240mg/dL high
80
What is primary prevention of ASCVD?
No history of ASCVD event, at risk Increased LDL > 190 Age 40-75 > 7.5% 10-year CV risk
81
What is secondary prevention of ASCVD?
History of ASCVD event -> more likely for another Age > 75: moderate intensity statin Age < 75: high intensity statin
82
What drug is a statin?
Atrovastatin
83
What drug class is atrovastatin?
Statin
84
Statin- MOA?
Competitively inhibits HMG-CoA reductase -> decreased cholesterol synthesis -> decreased LDL production increased LDL receptor expression -> LDLs get pulled from blood by liver -> increased LDL excretion -> decreased overall cholesterol mild increase in HDL (Atorvastatin)
85
Statins- Indications?
Hyperlipidemia Lowers risk of heart failure, MI & sudden death- primary and secondary prevention (Atorvastatin)
86
Statins- side effects?
Myalgia (muscle pain) Myopathy (muscle weakness/pain)- higher risk with higher log p (lipophilicity) Rhabdomyolysis (muscles breaking down -> release creatinine kinase increasing level // monitor creatinine kinase to check this) Headache Rash GI discomfort Memory issues Monitor LFTs and discontinue if severely low CYP substrate- Avoid grapefruit juice to prevent accumulation effect Try to take at night- when cholesterol synthesis is highest (Atorvastatin)
87
What drug is a bile acid seqeusterant?
Cholestyramine
88
What drug class is cholestyramine?
Bile acid sequestrant
89
Bile acid sequestrant- indications?
Hyperlipidemia Hypercholesteremia (high LDL) Used commonly with statins or if statin-tolerant (cholestyramine)
90
Bile acid sequestrant- MOA?
Non-digestible positive charge -> displaces chloride & binds to bile acids in GI -> form insoluble complex -> bile-acid bound LDL -> excreted in feces -> decreases LDL (Cholestyramine)
91
Bile acid sequestrant- side effects?
Constipation/GI upset Elevated triglycerides- don't take if TG> 500 Teeth discoloration/erosion/decay of tooth enamel- counsel on dental hygiene Don't take if bowel obstruction Other meds taken 1 hour before or 4-6hours after Oral contraceptives/fat-soluble vitamins (A, D, E, K) 4 hours prior or 6-12 hours after Can cause hemorrhage from lack of vit K Swallowing dry can cause esophageal irritation- counsel to mix powder with fluid (Cholestyramine)
92
Tiers of ASCVD therapy, what drug is high-, medium-, and low-intensity?
High: Atorvastatin 40-80mg, >50% lower Med.: Atorvastatin 10mg, 30-50% Low: Cholestyramine, 20% alone (40-60% combo w/ statin)
93
What drug is a fibric acid (fibrate) derivative?
Fenofibrate
94
What drug class is fenofibrate?
Fibrates derivative
95
Fibrates- indications?
High TG, ASCVD, high cholesterol Third-line drug d/t interactions, side effects, etc. (Fenofibrate)
96
Fibrates- MOA?
Activates PPAR-a in liver -> increased fat burned by liver -> increased breakdown of TG -> decreased TG Activates PPAR-a in liver -> decreased bad fats produced by liver -> decreased TG Increases HDL Reduces cholesterol buildup in blood Little to no effect on LDL (Fenofibrate)
97
Fibrates- side effects?
GI discomfort- take with food to avoid (high fat meal for absorption) Gallstones- contraindicated for preexisting gallbladder disease Myopathy Liver toxicity AKI Avoid grapefruit juice- accumulation effect Can be cautiously combined with statin (except gemfibrozil) (Fenofibrate)
98
What drug is a lipid lowering agent?
Ezetimibe
99
What drug type is Ezetimibe?
Lipid lowering agent
100
Ezetimibe- indications?
high cholesterol Adjunct to max statin Monotherapy if statin intolerant
101
Ezetimibe- MOA?
Binds to NPC1L1 protein in small intestine -> inhibits cholesterol absorption -> decreases absorbed cholesterol -> decreases effects of dietary cholesterol
102
Ezetimibe- side effects?
Myopathy/rhabdomyolysis Gallstones- when used w/ fibrates Hepatotoxicity- when used w/ statins Adjunct to max statin when high LDL Monotherapy if statin intolerant
103
What is angina pectoris?
Sudden pain beneath sternum, common to radiate to left shoulder, left arm and jaw Occurs when the heart isn't receiving enough oxygen to meet the body's demands Secondary to atherosclerosis of coronary arteries Can lead to MI, myocardial ischemia, anginal pain, death
104
What is chronic stable angina?
Triggered by physical activity, emotional excitement, large meals, cold exposure Underlying cause: CAD Treatment: decreasing cardiac oxygen demand <- vasodilation (only symptomatic relief)
105
What is an antianginal drug?
Nitroglycerin
106
What drug class is Nitroglycerine?
Antianginal agent
107
Nitroglycerin- indications?
Stable angina
108
Nitroglycerin- MOA?
Increases vasodilation -> decreases venous return -> decreases preload -> decreases oxygen demand
109
Nitroglycerine- side effects?
Headache- improves over time Washout period from last doses of sildenafil & tadalafil: 24- and 48-hours (all vasodilatory) Drug holiday to prevent tolerance Don't d/c abruptly- withdrawal effects/vasospasms
110
Nitroglycerine- doses allowed?
Repeat every 5 minutes, 3 doses max, call 911 if not alleviated Open bottle mist be replaced 6months d/t patch deterioration
111
Beta blocker- indications?
Angina -first line for angina w/ effort (decreases cardiac oxygen demands) Arrythmias (decreases HR / contractility) HTN (decreases HR) HF (metoprolol succinate) (Metoprolol)
112
What drug is an injectable anticoagulant?
Enoxaparin
113
What drug class is enoxaparin?
Injectable anticoagulant
114
Enoxaparin- MOA?
Inactivation of clotting factors: thrombin and factor Xa -> -> decreases fibrin production -> clotting suppressed -> prevents thrombosis
115
Enoxaparin- side effects?
Hemorrhage Spinal/epidural hematoma Heparin-Induced thrombocytopenia (HIT) Contraindicated for hx of HIT or uncontrolled active bleeding Monitor PTT/Xa levels on heparin drip Pork based Short half-life: 1.5hours From porcine products
116
117
What drug is a vitamin K antagonist?
Warfarin
118
What drug class is Warfarin?
Vitamin K antagonist
119
Warfarin- MOA?
Inhibits VKORC1 (enzyme that converts inactive vitamin K to active form) -> inactive vitamin K -> decreased production of vitamin K dependent clotting factors (SNTT) -> delayed anticoagulant effect INR goal: 2-3 INR goal for mitral valve replace.: 2.5-3.5
120
Warfarin- side effects?
Hemorrhage/bleeding Fetal harm Overdoes- tx w/ vitamin K (takes some time, only works w/ functioning liver) Narrow therapeutic index- monitor INR Goal: 2-3
121
Warfarin- indications?
Anticoagulation Preventing blood clots VTE
122
What drug is a direct thrombin inhibitor?
Dabigatran
123
What drug class is dabigatran?
Direct thrombin inhibitor
124
Dabigatran- indications?
DVT/PE Tx- 5 days of parenteral anticoagulation & dabigatran Stroke prevention w/ nonvalvular AFib VTE prevention after knee/hip replacement surgery Doesn't need anticoagulation monitoring few drug/food interactions (Direct thrombin inhibitor)
125
Dabigatran vs. Warfarin?
Dabigatran has higher efficacy and lower incidence of bleeding
126
Dabigatran- MOA?
Inhibits thrombin (in blood and bound to clots) -> prevents conversion of fibrinogen into fibrin (req. thrombin) -> decreases coagulation -> decreases VTE/PE/aFib (Direct thrombin inhibitor)
127
What does thrombin do?
Converts fibrinogen into fibrin- essential for coagulation
128
Dabigatran- side effects?
Bleeding GI discomfort Can't be crushed Premature d/c can increase thrombotic events
129
What drug is a direct oral anticoagulant Factor Xa inhibitor?
Rivaroxaban
130
What drug class is Rivaroxiban in?
Direct Oral anticoagulant (DOAC) Factor Xa Inhibitor
131
Rivaroxaban- MOA?
Inhibition of factor Xa -> inhibits production of thrombin -> decreases coagulation
132
Rivaroxaban- indications?
DVT/PE Tx DVT/PE prevention after hip/knee replace. surgery Stroke prevention for those w/ aFib
133
Rivaroxaban vs. Warfarin?
Rivaroxaban is: faster onset fixed dose-consistent dosing lower bleed risk few drug/food interactions No INR monitoring
134
Roxaroxaban- side effects?
Bleeding (less risk than Warfarin) Doses >10mg taken w high fat food for increased absorption Not safe in pregnancy Avoid grapefruit juice
135
What drug class is sacubitril/valsartan?
Angiotensin receptor neprilysin inhibitor (ARNI)
136
Sacubitril/valsartan- MOA?
inhibits breakdown of BNP and blocks angiotensin -> increased vasodilation -> decreased cardiac workload BNP- hormone that helps with loss of sodium/water and vasodilation (ARNI)
137
Sacubitril/valsartan- indications?
Heart failure (ARNI)
138
Sacubitril/valsartan- side effects?
Dizziness- reduce diuresis is management, chronic diuretic dose might be reduced 50% Hyperkalemia RAASi first choice- transition ACEi/ARBs to ARNI ANGIOEDEMA- contraindication If taking ACEi- need 36hr washout period prior to taking ARNI (ARNI)
139
Sacubitril/valsartan compared to ACEi/ARBs
Both are anti-RAAS ACEi/ARBs still used for HF and HFrEF Cost difference Sacubitril/valsartan- more hypotensive
140
What drug is a sodium glucose co-transporter 2 inhibitor (SGL2i)?
Dapagliflozin
141
What drug class is dapagliflozin in?
Sodium glucose co-transporter 2 inhibitor (SGL2i)
142
Dapagliflozin- indications?
HF T2DM CKD
143
Dapagliflozin- MOA?
Inhibits SGLT-2 in kidneys -> decreases SNS response -> decreases glucose & sodium reabsorption (kidneys) -> decreases plasma volume -> decreases cardiac workload increases mild ketosis -> 'sick' myocardium prefers ketone metabolism -> cardiac muscle has more 'food' available Can improve tolerance to MRAs & ARNI/ACEi/ARBs by decreasing hyperkalemia caused by them (SGL2i)
144
Dapagliflozin- side effects?
Glucosuria- increased risk of UTI Risk of yeast infection- proper urinary hygiene Volume losses- decrease diuretics 50% & correct volume depletion prior to starting SGL2i Increased urination/thirst Euglycemic ketoacidosis Necrotizing fasciitis risk Contraindicated for dialysis Control high blood sugar prior to starting Euglycemic ketoacidosis d/t NPO
145
What drug is a mineralocorticoid receptor agonist (MRA)?
Spironolactone
146
What drug class is spironolactone in?
Mineralocorticoid receptor agonist (MRA)
147
Spironolactone- indications?
HF (HFrEF) HTN
148
Spironolactone- MOA?
Antagonist of aldosterone receptors (in kidneys) -> decreases sodium & water retention & increase potassium retention // -> stops progression of myocardial scaring -> reverses remodeling (MRA)
149
Spironolactone- side effects?
Risk of hyperkalemia- caution w/ CKD: stop K+ supp. / oral K+ binder- check levels Gynecomastia Abnormal uterine bleeding- post-menopausal Check renal function (MRA)
150

Adv. Pharm (9 decks)

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