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Pharm III Final > CV > Flashcards

CV Flashcards

1
Q

Which diuretics are highly efficient at moving large volumes of fluids (ie in HF)?

A

Loop diuretics

Furosemide
Torsemide
Bumetanide
Ethacrynic acid

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2
Q

How are loop diuretics usually used?

A

To treat edema

SYMPTOMATIC relief of HF, not first line antihypertensive)

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3
Q

Side effects of loop diuretics

A

HYPOkalemia - my require K+ supplementation
HYPOnatremia
HYPOcalcemia
HYPERuricemia

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4
Q

Which loop diuretics are contraindicated in patients with sulfa allergies?

A

Furosemide
Torsemide
Bumetanide

Ethacrynic Acid is OK (not a sulfa)

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5
Q

Which loop diuretic has the highest risk of ototoxicity

A

Ethacrynic acid

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6
Q

How are thiazides used?

A

To treat HTN, or to enhance antihypertensive actions of other drugs

Can be used for edema/MILD fluid retention in HF, but they are better as antihypertensives than they are at diuresis

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7
Q

What are the three thiazide diuretics?

A

HCTZ (Microzide)
Chlorothiazide (Diuril)
Metolazone (thiazide-related)

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8
Q

HCTZ and Chlorothiazide are contraindicated in patients with…

A

Sulfa allergy

Anuria

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9
Q

Anuria is a contraindication for…

A

Loop and thiazide diuretics

They’re gonna make you pee a lot, and if you CAN’T pee, you’re gonna be in trouble

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10
Q

Is metolazone contraindicated in patient’s with sulfa allergies?

A

Not contraindicated but use with CAUTION

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11
Q

Side effects of thiazide diurectics

A 
HYPOkalemia
HYPOnatremia
HYPERuricemia
Hypercholesterolemia 
Hyperglycemia
ED
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12
Q

What should you monitor in patients on thiazides?

A

BP/orthostatic
Electrolytes
Renal function

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13
Q

Loops and thiazides may precipitate _____ at high doses

A

Gout

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14
Q

How are aldosterone antagonists and potassium sparing diuretics used?

A

Overall weak diuretic effect, used in combo with other diuretics to eliminate need for K+ supplementation)

Used to treat edema, HF (not first line for HTN)

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15
Q

What are the contraindications for aldosterone antagonists and potassium sparing diuretics?

A

HYPERKALEMIA
Anuria
Severe, progressive kidney disease/dysfunction

Use with caution with ACE-Is/ARBs

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16
Q

Which drugs are aldosterone antagonists?

A

Spironolactone (Aldactone)

Eplerenone (Inspra)

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17
Q

Which drugs are direct inhibitors of Na+ flux (used as potassium sparing diuretics)?

A

Triamterene (Dyrenium)

Amiloride

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18
Q

Major side effect of potassium sparing diuretics and aldosterone antagonists

A

Hyperkalemia (DUH)

Monitor potassium, BP, and renal function in these patients

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19
Q

Which HTN drugs are best for reducing mortality AND improving Sx of HF?

A

ACEIs (ie Lisinopril)

BBs (ie Metoprolol)

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20
Q

Which drugs are good at improving Sx of HF but do not reduce overalls mortality?

A

Loop diuretics

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21
Q

Contraindications for ACEIs and ARBs

A

Angioedema

Pregnancy

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22
Q

MOA for ACEIs

A

Block angiotensin converting enzyme and stop formation of angiotensin II

—> lower preload and afterload

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23
Q

Which drug is considered first-line in all patients with diabetes, CKD, and HFrEF?

A

ACEIs and ARBs

Can be used to treat HFrEF, HTN, STEMI

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24
Q

SE of ACEIs

A 
DRY COUGH
Orthostatic hypotension
Hyperkalemia
Angioedema
Rash

Monitor: electrolytes, renal function, BP

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25
MOA for beta blockers
ß-adrenergic antagonists —> negative chronotropy, negative inotropy, and reduced CO Decrease mortality rate s/p MI, stable class II and III HF
26
How are beta blockers used?
To treat angina, HFrEF, and HTN (not first line but useful)
27
When are beta blockers contraindicated?
Severe bradycardia 2nd/3rd degree AV block Uncompensated HF SBP <100 Cardiogenic shock
28
Which beta blockers are non-selective?
Propranolol Nadolol Timolol
29
SE of NON-selective BBs
``` BRONCHOSPASM WORSEN CHF Raise lipids Impaired glucose tolerance FATIGUE Decreased libido/impotence Depression Insomnia ```
30
Which beta blockers are cardioselective?
Acebutolol Atenolol Metoprolol Nebivolol
31
What happens to side effects when you used cardioselective BBs instead of non-selective?
They are reduced but not eliminated Can raise lipids
32
Which beta blockers have intrinsic sympathomimetic activity?
Acebutolol | Pindolol
33
What is the biggest caution when using beta blockers?
Avoid abrupt withdrawal - can precipitate acute coronary events and severe increases in BP
34
What drug should you consider if you put your patient on an ACE and they can’t handle the cough?
Angiotensin Receptor Blocker (ARB) - the “sartans”
35
MOA for ARBs
Block angiotensin II from binding to AT1 receptors —> reduced preload and afterload
36
How are ARBs used?
To treat HFrEF, HTN, STEMI Considered first-line in all patients with diabetes CKD, HFrEF
37
Effects of Digoxin
(+) Inotropy, (-) Chronotropy, increased CO
38
How is Digoxin used?
To treat mild to moderate HFrEF, a fib
39
Side effects of Digoxin
Arrhythmias HA Fatigue Drowsiness
40
Digoxin has a narrow margin of safety, especially in patients with...
Reduced renal clearance and hypokalemia Monitor ECG, electrolytes, renal function, and serum digoxin concentrations
41
What is considered to be “pre-hypertension”?
120-139 SBP or 80-89 DBP
42
What is considered to be stage 1 hypertension?
140-159 SBP or 90-99 DBP
43
What is considered to be Stage 2 hypertension?
≥160 SBP or ≥100 DBP
44
Lifestyle mods recommended to patients with HTN
``` Smoking cessation Salt restriction DASH Diet Exercise/physical activity Weight management ```
45
What are considered to be the four first line meds for HTN?
HCTZ, ACEIs, ARBs, CCBs
46
Which first line HTN meds are more effective in black patients?
HCTZ, CCB
47
Which HTN meds are more effective in non-black patients?
ACE-I, BBs
48
Which HTN meds are first line for patients with CKD?
ACE/ARBs
49
MOA for CCBs and how are they used?
(-) inotropy, relax smooth muscles (esp vascular) Used to treat HTN, vasospastic angina
50
When are CCBs contraindicated?
SA or AV node abnormalities BB HF
51
Which type of CCBs are more potent vasodilators?
Dihydropyridines - ex: Nifedipine and other dipines Cause arterial smooth muscle relaxation and decrease in PVR
52
SE of dihydropyridines
Short acting CCBs - may cause mild to moderate reflex tachycardia, may see SA, flushing, or PERIPHERAL EDEMA Long-acting CCBs - usually only cause EDEMA
53
Which drugs are non-dihydropyridines?
Verapamil and Diltiazem Less vasodilation effect, (-) inotropy, (-) chronotropy
54
SE of non-dihydropyridines
Constipation Bradycardia SA dysfunction Heart block Monitor BP, HR, edema
55
How do alpha blockers work?
Decrease vasoconstriction and reduce peripheral vascular resistance Used to treat HTN in patients with BPH
56
Which drugs are alpha blockers?
Prazosin Doxazosin Terazosin Non-selective: Phenoxybenzamine
57
Major side effect of alpha blockers
Orthostatic hypotension (first dose phenomenon) Others: fatigue, weakness, nasal congestion, and HA
58
MOA for central alpha agonists?
Reduce sympathetic vasoconstriction and total peripheral vascular resistance Used to treat refractory HTN (not first line)
59
What drugs are central alpha agonists?
``` Clonidine Methyldopa (recommended for use in pregnancy) ```
60
SE of central alpha agonists
Sedation/drowsiness Xerostomia Orthostatic hypotension
61
What should you warn patients about when taking central alpha agonists
Avoid abrupt withdrawal - can precipitate hypertensive crisis
62
What patient ed should you provide with sublingual nitro?
SE: orthostatic hypotension, THROBBING HA, tachycardia Take one dose every 5 min for up to 3 doses —> call EMS if not improved after first dose
63
What drug is preferred for treatment of vasospastic (Prinzmetal) angina?
CCBs
64
When is nitro contraindicated?
Within 24 hours of Sildenafil HCM RV infarction
65
What are the different antianginal options?
Rapid-acting nitrates (ie Nitroglycerin) for acute angina or prophylaxis Long-acting nitrates (ie Isosorbide dinitrate) for long term management of chronic stable angina BBs/CCBs for long term management of chronic stable angina, sometimes unstable angina

Pharm III Final (8 decks)

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