Cardiovascular Conditions * Flashcards

Question

Dihydropyridine CCBs

Answer 1

Treat HTN, angina, raynauds -amlodipine (Norvasc) -nifedipine Er (Procardia) --> pregos, can leave ghost tab -Nicardipine (Cardene) IV/PO Warnings: hypotension, caution in HF SE: peripheral edema, headache, flushing, palps + tachycardia, gingival hyperplasia --> Clevidipine (Cleviprex) = lipid emulsion (2 kcal/ml) *must calculate caloric intake CI: egg and soy/soybean allergy Warnings: hypotension, reflex tachycardia, infections SE: hypertriglyceridemia

Answer 2

used to TX arrhythmias (afib), angina, HTN -Diltiazem (Cardizem) -Verapamil (Verelan) CI: hypotension, 2nd or 3rd degree heart block Warnings: HF, bradycardia SE: edema (V), gingival hyperplasia, constipation (D) --> DDI: use caution with BB, digoxin, clonidine, amiodaraon, simva, lova

Answer 3

--> CKD: eGFR < 60 and/or albuminuria -slow progression of chronic kidney disease -dec vasoconstriction of efferent arterioles, resulting in dec workload in glomeruli --> Heart Failure: with EF < 40% -reduction in mortality and morbidity -dec ventricular remodeling that occurs secondary to angiotensin II

Answer 4

-stop the conversion of angiotensin I to 2 & bradykinin conversion (= accumulation) --> Benazepril (Lotensin) --> Enalapril (Vasotec), Enalaprilat (Vasotec IV) --> Lisinopril (Zestril) --> Quinapril (Accupril) --> Ramipril (Altace) BBW: do not use in pregnancy due to fetal injury/death CI: angioedema (DO NOT USE IF PT HAS HX), using within 36 hrs of valsartan (needs washout) Warnings: hyperkalemia, hypotension/dizziness, renal impairment (do not use in bilateral renal stenosis) SE: cough

Answer 5

-block the angiotensin 2 receptor = inhibit vasoconstriction & aldosterone secretion --> Irbesartan (Avapro) --> Losartan (Cozaar) --> Olmesartan (Benicar) --> Warning: Sprue-like enteropathy = severe, chronic diarrhea w/ weight loss --> Valsartan (Diovan) BBW: do not use in pregnancy due to fetal injury/death Warnings: hyperkalemia, hypotension/dizziness, renal impairment (do not use in bilateral renal stenosis), angioedema (do not use if pt has hx) --> less cough and no need for washout with Entresto

Answer 6

-lithium: renally excreted *avoid with RAS inhibitors due to risk of dec clearance --> increase toxicity

Answer 7

-work in the collecting duct & inc excretion of sodium, water and dec K excretion -->Spironolactone (Aldactone) -->Eplerenone (Inspra) -->Triamterene (+ HCTZ = Maxzide) -->Amiloride CI: hyperkalemia (K >5.5), severe renal impairment, Addison's disease (spirono), strong CYP3A4 (eplere) SE: inc serum creatinint, dizziness, gynecomastia, breast tenderness, impotence (spiron)

Answer 8

-Heart failure (Bisoprolol, Carvedilol, metoprolol succinate -post myocardial infarction -stable ischemic heart disease -arrhythmias -noncardiac (nonselective agents) --> migraine prophylaxis, variceal hemorrhage prophylaxis

Answer 9

--> Atenolol (Tenormin) --> Esmolol (Brevibloc) IV --> Meto tar (Lopressor) IV, PO (Po:IV - 1: 2.5) --> Met Succ (Toprol) --> Nebivolol (Bystolic) - also nitric oxide vasodilation BBW: do not d/c abruptly Warnings: use caution w/ pt: DM (masks symptoms of hypogly), bronchospastic idease, raynaud's/peripheral vascular disease SE: bradycardia, hypotension, CNS effects, impotence

Answer 10

--> proprabolol (inderal) - has inc lipid solubility (can cross BBB), so it is used fro non cardiac things - migraine ppx and tremor = inc CNS effects --> Nadolol (corgard) -all agents can be useful for pts w/ portal HTN to prevent veriacial hemorrhage

Answer 11

--> Carvedilol (Coreg) - take all formulations with food --> Labetalol: drugs of choice in PREGNANCY!

Answer 12

--> Clonidine (Carapres) -Kapvay - for ADHD, also has a patch (skin rash, pruritus, eryhtema, change weekly, remove before MRI) --> Guanfacine -Intuniv - for ADHD Warnings:do not d/c abruptly (rebound hypotension, sweating, anxiety) SE: bradycardia, hypotension, CNS-related, dry mouth, constipation, Impotence

Answer 13

CI: concurrent use with MAOi, liver disease Warnings: risk of hemolytic anemia (positive coombs test) -d/c drug SE: drug-induced lupus eythemtosus (DILE) - ANA testing --> CANNOT be used in pregnancy

Answer 14

--> Hydralazine: PO,IV - Warning: DILE -SE: peripheral edema, headache, flushing, tachycardia, palpitations -->Minoxidil: PO, topical -BBW: potent vasodilator, canc ause pericardial effusion and angina -SE: hair growth, fluid retention, tachycardia *use only for resistant hypertension and administer with a BB and diuretic

Answer 15

--> Doxazosin --> Prazosin --> Terazosin -not rec for tx of HTN, have worse cardiac outcomes --> can use if comirbid BPH

Answer 16

D-CCBs: clevidipine, nicardipine ACE inhibitors: Enalaprilat BBs: esmolol, labetalol Vasodilators: hydralazine, nitroglycerin, nitroprusside

Answer 17

-acute organ damage present (encephalopathy, stroke, AKI, acute coronary syndrome) --> treat w/ IV meds --> dec BP by no more than 25% in first hour --> dec BP to ~160/100 mmHg in the next 2-6 hrs

Answer 18

-no acute organ damage, more severe, asymptomatic HTN -treat with oral meds: home regimen or short acting meds (captopril, clonidine) -dec BP gradually over 24-48 hrs

Answer 19

A: anti-platelet and antianginal drugs B: blood pressure and beta-blocker C: Cholesterol (statins) and cigarettes (cessation) D: Diet and diabetes E: Exercise and education

Answer 20

--> Aspirin (Bayer) - 1st line - inhibits COX 1, preventing platelet aggregation CI: salicylate allergy Warnings: Reye's syndrome (teens after viral infection) SE: dyspepsia, heartburn, nausea, bleeding (Yosprola = asa and omperazole combo- high GI bleed risk) --> Clopidogrel (Plavix) BBW: CYP2C19 active metabolism --> will not convert the drug to its active form (DDI w/ omeprazole/espoprazole - prevent conversion) Warnings: serious bleeding, stop 5 days before surgery, thrombotic thromboytopenic purpura (TTP) -do not use dual antiplatelets therapy unless a pt has a stent

Answer 21

--> asa and clopidogrel 1) bare metal stent (at least 1 month) 2) drug-eluting stent (at least 6 months) 3) post-CABG (12 months) -ASA is dosed 81 mg daily and is continued indefinitely

Answer 22

-BBS (1st line): titrate to HR 55-60 BPM, do not stop abruptly -CCBs: preferred for Prinzmetal's angina, avoid Nifedipine IR, use D CCB if adding on to BB -Nitrates: use for fast relief and for chronic symptoms -Ranolazine: *does not decrease HR or BP*, QT prolongation, CYP3A4

Answer 23

-ALL are CI with PDE-5 inhibitors and riociguat SE: HA, hypotension, flushing, dizziness Short acting --> Nitroglycerin SL, -give 3 doses at 5 min intervals -keep SL in original bottle -do not swallow or chew- let dissolve Long acting--> ointment, isosorbide mononitrate- once daily (bi dil is combo with hydralazine) (used for chronic pain) -pathc- requires 10-12 hr nitrate - free interval to dec tolerance

Answer 24

--> UA: chest pain, neg cardiac enzymes, no ECG changes, partial blockage -->NSTEMI: chest pain, pos cardiac enzymes, no ECG changes, partial blockage --> STEMI: chest pain, pos cardiac enzymes, ST segment elevation, completed blockage

Answer 25

MONA-GAP-BA M: morphine O: oxygen N: nitrates A: aspirin --> give right away G: gplla (epitfibate, tirofiban) A: anticoagulants P: P2y12 inhibitors (clopidogrel, prasugrel, ticagrelor) --> depends on PCI or not B: beta blockers A: ace inhibitors --> give within 24 hrs

Answer 26

BBW: prodrug (CYP2C19) LD: 300-600mg MD: 75 mg Warnings: bleeding, do not use with omeprazole or esomeprazole

Answer 27

*do not use in pts with hx of stroke or TIA LD: 60 mg MD: 10 mg --> only for ACS pts receiving a PCI -dispense in original container

Answer 28

*maintenance dose of asapirin must be less than 100 mg LD: 180 mg MD: 90 mg BID for 1 yr then 60 mg BID after

Answer 29

--> Abciximab (ReoPro) --> Eptifibatide (Integrilin) --> Tirofiban (Aggrastat) -all IV, w/ short half lives, used in cath lab CU: thrombocytopenia, active bleeding, uncontrolled HTN, recent surgery or trauma, HX of stroke (past 1 yr)

Answer 30

*only used for STEMI (complete blockage) MOA: bind to fibrin in the clot + convert plasminogen to plasmin --> Alteplase (Activase) -also used for acute stroke --> Tenecteplase (TNKase) --> Reteplase (Retavase) -PCI preferred (optimal time = 90 mins) -If not able to recienve PCI within 120 mins = use fibrinolytics -optimal door to needle time for fibrinolytic = 30 mins CI: active bleeding, hx of recent stroke, uncontrolled HTN SE: bleeding

Answer 31

-Aspirin: 81 mg indefinitely -P2Y12 inhibitor: --> medically mananged: clopidogrel/ticagrelor + ASA fro 12 months --> PCI: any oral med + ASA for at least 12 months -NTG forever PRN -Beta Blocker: target HR 50-60, for 3 yrs - forever -ACE inhibitor: use for reduced EF, HTN, CKD or DM forever -Aldosterone antagonist: reduced LVEF and systematic HF or DM -statin: high intensity forever

Answer 32

-inc BNP, inc NT-proBNP -SOB: orthopnea- when you lay down, dyspnea- when you exert yourself -cough -weakness/fatigue -reduced exercise capacity -fluid overload: edema, ascites, jugular venous distention, hepatojugular reflux

Answer 33

DPP-4 inhibitors (alogliptin) Immunosuppressants (TNF, interferons) Non-DHP CCBs (V,D) Antiarrhythmics (quinidone, felcainide) Thiazolidinediones (inc risk of edema) Itraconazole Oncology agents (doxorubicin) NSAIDs MOA; either increasing fluid retention or inc BP

Answer 34

-ARNI(entresto), ACE, or ARB: dec mortality (entresto is preferred over an ACE or ARB to further reduce morbidity and mortality) -BB: met succ, carvedilol provide benefit in dec mortality, controlling HR and reducing arrhythmia risk -ARA: spirno, dec morbidity and mortality in class 2-4 HF -SGLT2: dec morbidity and mortality in pts with or w/o DM -Loop diuretics: reduce blood volume, which dec edema and congestion; most HF pts need a loop diuretic for symptom relief

Answer 35

-hydralazine and nitrate (BiDil): dec morbidity and mortality in self-identified black pts with class 3-4 HF when added to optimized initial meds -Ivabradine (Corlanor): dec risk of hospitalization in stable class 2-3 HF with resting HR of > 70 BPM on max tolerated dose of a BB -Digoxin: provides small increase in cardiac output, improves symptoms and decreases cardiac hospitalization; can be considered in pts who remain symptomatic w/ 1st line agents -Vericiguat: dec risk of hospitalization and CV death after HF hospitalization or need for IV diuretics

Answer 36

PO: lasix 40 mg = 20 mg torsemide (demadex) = 1 mg bumex IV: lasix 20 mg = 20 mg torsemide = 1 mg bumex

Answer 37

-furosemide (lasix) -bumetanide (bumex) -torsemide SEs: --> dec Na, K, Mg, Cl, Ca --> inc UA, BG, TG, Tc, HCO3 -monitor: renal function, fluid status, BP, electrolytes, audiology testing, s/sx of HF -avoids NSAIDs

Answer 38

-mortality benefit BBW: pregnancy, hx of angioedema, ACE inhibitors require 36 hr washout period before starting Entresto -titrate to target doses used in trials -Enalapril (Vasotec): 10-20 mg BID -Lisinopril (Zestril): 20-40 mg qd -Quinapril (Accupril): 20 mg BID -Ramipril (Altace): 10 mg qd -- -Losartan (Cozar): 50-150 mg qd -Valsartan (Diovan): 160 mg BID

Answer 39

-entresto (valsartan + sacubitril) -indicated in NYHA class 2-4 to reduce hospitalization and death -add on to other key therapies SE: cough, hyperkalemia, inc SCR, hypotentsion **washout period: DO NOT use within 36 hrs of an ACE inhibitor

Answer 40

-mortality benefit -for all HF pts, do not abruptly BB, only stop in acute decompensated HF or hypotension or hypo perfusion is present --> metoprolol succ (Toprol XL): 200 mg daily (1: 2.5 ratio IV:PO) --> bisoprolol --> Carvedilol (Coreg): 25-50 mg BID - nonselective, lowers HR a lot, take w/ food to reduce hypotension/dizziness

Answer 41

-mortality benefit --> spironolactone and eplerenone -used in NYHA class 2-4 pts do NOT start therapy in HF pts with: - K > 5 meq/L -eGFR < 30 ml/min or -Scr > 2.5 in males and > 2 in females -start low and titrate

Answer 42

-mortality benefit -indicated for blacks with class 3-4 HF who are symptomatic despite optimal tx and other pts who cannot tolerate ACE/ARB SE: hypotension, HA, Warnings: DILE; drug induced lupus -do not use with PP drugs (PDE5 inhibitors)

Answer 43

-no mortality benefit -therapeutic range: 0.5-0.9 ng/nL antidote: digifab -toxicity; N/V, see halos around objects, inc risk of hypo mag, kalemia and magnesia

Answer 44

no mortality benefit, reduced hospitalizations Criteria for use: -stable, symptomatic HF -EF < 35% -normal sinus rhythm and resting HR > 70 -taking max tolerated doses of BB or have CI to BB use target resting HR: 50-60 BPM

Answer 45

-potassium chloride SE: N/V/D, inc K Formulations: -Micro-K: can open capsules and sprinkle contents on food -Klor-Con M: tablet can be cut in half or dissolved in 4 oz water -Klor-Con, K-Tab: swallow whole

Answer 46

-the rate and rhythm of the heartbeat are set by the rapidly firing cells in the SA note. The SA node is called the heart's natural pacemaker An arrhythmia is caused be a disruption somewhere in the conduction system: -the SA node can be firing at an abnormal rate or rhythm -scar tissue from a prior heart attack can block and divert signal transmission -another part of the heart may be acting as the pacemaker

Answer 47

-higher doses -multiple QT prolonging drugs taken at the same time -reduced drug clearance -electrolyte abnormalities -other cardiac conditions -female gender

Answer 48

-antiarrhythmics -abx: macrolindes, quinolones, lefamilin -azole antifungals -antimalarials (hydroxychloroquine) -antidepressants: SSRI (citalopram, escitalopram), TCAs, mirtazapine, trazadone, venlafaxine -antiemetics: 5-HT3 receptor antagonists, droperidol, metoclopramide, promethazine -haloperidol, chloprpromazine, thioridazine) -leuprolide, nilotinib, oxaliplatin

Answer 49

Class 1: Sodium Channel Blockers Ia: disopyramide, quinidine, procainamide Ib: Lidocaine, mexiletine Ic: fleccainide, propafenone Class 2: BBs Class 3: Potassium Channel Blockers -Dronedarone, sofetilide, sotalol, ibutilidine, amiodarone Class 4: calcium channel blockers -verapamil, diltiazam

Answer 50

Rate control: pt stays in Afib with rate control --> BBs, non-DHP CCBs, sometimes digoxin Rhythm Control: try to restore and/or maintain NSR --> class Ia, Ic, or III antiarrhythmics

Answer 51

-clots can form when a pt is in Afib, which can embolus when the pt returns to NSR -for many pts it is safer to remain in AFIB with rate control, require anticoagulation with (based on chad score) --DOAC --Warfarin

Answer 52

Class 1: na-channel blockers Class 2: beta blockers Class 3: K- channel blockers (Amiodarone) Class 4: non-CCBs Digoxin Adenosine - used for PSVTs: proximal supraventicular tachyarythmias

Answer 53

*antiarrthymic drug of choice with HF! --> infusions require a non-PVC container (Nexterone comes like that) - T1/2 = 40-60 days BBW: pulmonary toxicity, hepatotoxicity (pt must be hospitalized when loading dose is given) CI: iodine hypersensitivity Warnings: hypo/hyper thyroidism (monitor TSH), optic neuropathy, photosensitivity (blue skin tint) SE: hypotension, bradycardia, corneal microdeposits, dizziness, ataxia, skin protection needed IV use: 0.22 micron= filter needed, centeral line preferred

Answer 54

-interactions with: Warfarin dec dose 30-50% Digoxin: dec dose 50% Statins: do not exceed 20 mg simva, 40 mg lova (use rosuva!) -do not use with sofosbuvir

Answer 55

-Diltiazem (Cardizam) -Verapamil (Calan SR) --> only these can be used as antiarrthymics! CI: HFrEF SE: edema, HA, hypotension, arrthythmias, HF, constipation, gingival hyperplasia DDI: grapefruit, 10-20 mg simva dose

Answer 56

-blocks Na-K-ATPase pump, inc contraction force (positive ionotrip) and dec HR (neg cornotrop) --> therapeutic range: 0.125-0.25 mg = narrow therapeutic index drug Toxicity: N/V, loss of appetite, blurred vision, green/yelow halos, bradycardia, life threatening arrhythmias --> low K and Mg can increase risk of digoxin toxicity, high Ca and hypothyroidism can also inc toxicity renally cleared antidote = digifab

Answer 57

-Disopyramide: anticholinergic AEs -Quinidine: Cinhonism (tinnitus, hearing loss, blurred vision, headache, delirium) DILE -Procainamide: NAPA drug, renally cleared --> can wipe out agranlocytosis, ANA+ = DILE -Dronedrone: cardiovascule issues, liver toxicity, QT prolongation -Sotalol: non- selective BB, use betapase AF -Ibutilide: make sure K and Mg are normal -Dofetilide: continuous ECG monitoring, assess crcl for min 3 days, very proarrhythmic -Adenosine: drug for PSVTs!

Answer 58

caused by a temporary clot, or block of blood flow in the brain -does not last long enough to have perm. damage -symptoms are the same as stroke, but resolve within mins or hours -often a warning sign for future stroke

Answer 59

F: face dropping A: arm weakness S: speech difficulty T: time to call 911

Answer 60

-alteplase breaks up existing clots -before tx: evaluate for bleeding risk: --> active bleed (intracranial hemorrhage) --> conditions (uncontrolled HTN) or labs (INR > 1.7) that increase bleeding --> additive risks (anticoagulant use)

Answer 61

-Active Bleed: active internal bleeding (head CT to rule out) -Conditions, labs or vitals that increase bleeding risk --> hx of recent stroke or head trauma within last 3 months, intracranial hemorrhage, aneurysm --> BP > 185/110 --> INR > 1.7, aPTT > 40 sec, platelets < 100,000 --> BG < 50 -Drug interactions with additive bleeding risk --> tx dose LMWH (in past 24 hrs) - 1 mg or 1.5 mg/kg --> direct thrombin inhibitor or direct factor Xa inhibitor (on past 48 hrs) - dibagatran, DOAC

Answer 62

-door to needle time: within 60 min to hospital arrival (FDA approved within 3 hrs of last known well) --> stroke dose = 0.9 mg/kg (Max 90 mg)- 10% as bolus (1 min), remainder administered over an hour SE: major bleeding

Answer 63

-ASA 162-325 mg PO within 24-48 hrs after a stroke -BP management --> before alteplase: BP must be < 185/110 --> during and after alteplase: maintain BP < 180/105 during and for at least 24 hrs after --> permission HTN (> 220/120 may be treated) -BG control: 140-180 mg/dL -DVT prophylaxis : UF or LMWH can be started 24 hrs after alteplase

Answer 64

--> HTN: < 130/80, tx with thiazides, ACE/ARB --> Dyslipidemia: high - intensity statin --> DM: DM + ASCVD: glp-1 or sglt2 --> lifestyle: smoking cessation, nutrition, physical activity, weight reduction, reduce alcohol

Answer 65

-ASA (Abyer, Bufferin, Durlaza-ER, Yosprala-DR) -Clopidogrel (avoid parasagrul - if TIA) -ASA/ER Dipyridamole (aggrenox) --> ASA + clopidogrel can be used together for 21-90 days

Answer 66

-reverse anticoagulation -treat seizures -decrease intracranial pressure (ICP) --> elevation of head of bed --> hypertonic saline, mannitol

Answer 67

CI: severe renal disease, severe hypovolemia, pulmonary edeam/congestion, active intracranial bleed Warnings: CNS toxicity, extravasation, nephrotoxicity, fluid and electrolyte imbalances SE: dehydration, headache, lethargy, inc or dec BP --> inspect for crystals, use a filter

Answer 68

-surgical intervention -prevent cerebral artery vasospasm --> vasospasms occur 3-21 days after the bleed --> ORAL nimodipine 60 mg Q4 h for 21 days

Answer 69

BBW: do not adminster IV = death -label oral syringes for "oral use only) CI: risk of hypotension with use of CYP2A4 inhibitors SE: hypotension

Cardiovascular Conditions * Flashcards

(93 cards)