CV1-PharmChart Flashcards
(168 cards)
1
Q
what are the 2 drugs that are vasodilator: Nitrates
A
Isosorbide Dinitrate
Nitroglycerin
2
Q
MOA of Isosorbide Dinitrate
A
Smooth muscle dilation of arteries and veins
3
Q
Class of Isosorbide Dinitrate
A
Vasodilator: Nitrates
4
Q
Indication of Isosorbide Dinitrate
A
frequent stable angina
5
Q
SE with Isosorbide Dinitrate
A
Headache, hypotension, tachycardia, re-bound HTN
6
Q
Common Dx-Dx interaction of ALL vasodilators: Nitrates
A
PDE-5 inhibitors
7
Q
What is important to remember time wise about Isosorbide Dinitrate
A
want a 6-12 hour of nitrate free interval DAILY!
8
Q
Drug class of Nitroglycerin
A
Vasodilator: Nitrates
9
Q
MOA of Nitroglycerin
A
Smooth muscle dilation of the arteries and veins
10
Q
Indications of Nitroglycerin
A
Angina, CHF
11
Q
What forms does Nitroglycerin come in
and what are the two most important SE:
A
SL spray
SL or buccal tablet
topical
IV
SE: headache, dizzyness
12
Q
What is it important to remember about storage of Nitroglycerin (2 things)
A
kept in a glass bottle to help minimize moisture
kept in dark container because sensitive to sunlight!
13
Q
What are the four Vasodilator: Calcium Channel Blockers?
A
- Dihydropyridine: Amlodipine
- Dihydropyridine: Nifedipine
- NonDihydropyridine: Dilitiazem
- NonDihydropyridine: Verapam
14
Q
Is Amlodipine a nonDihydropyridine or Dihydropyridine?
A
Dihydropyridine
15
Q
MOA of Amlodipine
A
Vasodilation due to blocking calcium channels in vascular smooth muscle and myocardium
16
Q
Indications of Amlodipine
A
Angina
HTN
17
Q
Common SE of Amlodipine (2)
A
Peripheral edema
ELDERLY HYPOTENSION
18
Q
Dx-Dx interactions of Amlodipine and Nifedipine
A
Grapefruit juice
19
Q
what can Amlodipine be used instead of
A
Beta Blockers
20
Q
Is Nifedipine a Dihydropyridine or nonDihydropyridine
A
Dihydropyridine
21
Q
MOA of Nifedipine
A
Vasodilation due to blocking calcium channels in vascular smooth muscle and myocardium
22
Q
Indications of Nifedipine
A
Angina
HTN
sound familiar?
23
Q
Common SE of Nifedipine (3)
A
Palpitations
peripheral edema
ELDERLY HYPOTENSION
24
Q
what is Nifedipine most likely to do?
A
Most likely to produce hypotension
25
is Diltiazem a Dihydropyridine or nonDihydropyridine
nonDihydropyridine
26
MOA of Diltiazem
Dilate coronary arteries and decrease myocardial oxygen demands
27
indications of Diltiazem (5)
1) Angina
2) HTN
3) A FIB
4) A FLUTTER
5) PSVT
28
SE of Diltiazem
Edema
29
what has the contraindications of both Bradycardia and SSS if no pacer
Nondihydropyridine's
| Diltiazem and Verapamil
30
What can you not use in combo with Diltiazem
Not for combo use with Beta blockers
31
What increased the half life of Diltiazem
half life increased in cirrhosis
32
is Verapamil a nondihydropyridine or dihydropyridine
nondihydropyridine
33
MOA of Verapamil
Dilate coronary arteries and decrease myocardial oxygen demands
sound familiar?
34
indications of Verapamil (3)
PSVT
A fib
A flutter
35
SE of Verapamil (1)
Gingival hyperplasia
36
Dx-Dx interactions with Verapamil
Grapefruit juice
37
What can you not use Verapamil in combo with
Beta Blockers
| it will decrease nodal conduction!
38
What are the selective (B1) beta blockers
1. Metoprolol Tartrate/ Metoprolol succinate
| 2. Atenolol
39
MOA of Metoprolol Tartrate/ Metoprolol succinate
Selective B1 adrenergic receptor inhibitor
40
Indications of selective (B1) beta blockers
Angina
HTN
hemodynamically stable MI
41
SE of selective (B1) beta blockers (6)
1. fatigue
2. sleep disturbance
3. depression
4. bradycardia
5. rebound angina/hypertension
6. hypotension
42
Contraindications for selective (B1) beta blockers (4)
1. bradycardia
2. heart block
3. uncompensated heart failure
4. severe depression
43
What can high doses cause in selective (B1) beta blockers
High doses can lose B1 selectivity
44
what do you do Post MI or in compensated HF with selective (B1) beta blockers... what about when stopping?
up titrate slowly
when stopping? down titrate slowly
45
which Beta blocker drug has an increase absorption with food?
Metoprolol Tartrate/ Metoprolol succinate
46
MOA of Atenolol
Selective B1 adrenergic receptor inhibitor
47
when do you adjust the dose of Atenolol
Adjust dose in CKD (50% renally excreted unmetab)
48
Non-selective (B1 and B2) : Beta blockers
Propranolol
49
MOA of Propranolol
Adrenergic B1 and B2 receptor inhibitor
Reduction in myocardial oxygen demand
50
indications of Propranolol
Tachyarrhythmia
Essential Tremor
migraine Px
anxiety
51
the 3 SE of Propranolol
fatigue
sleep disturbance
depression
52
contraindications of Nonselective Beta blockers (6)
1. Hypersensitivity
2. Bradycardia
3. Heart Block
4. Uncompensated heart failure
5. Severe depression
6. Bronchospasm
53
what may increase or decrease concentration of Propranolol
Ethanol aka alcohol
54
what may Propranolol mask
may mask hypoglycemia
55
what do we have to know about HR relate to Propranolol
| what about when stopping
titrate to HR 50-60 bpm or increase HR 20 bpm with exercise
| when stopping: down titrate
56
when does the bioavailability increase in Propranolol and by how much
Bioavail increases x2 in elderly
57
drug class of Carvediliol
Beta blocker: Non selective (B1 , B2, Alpha 1)
58
MOA of Carvediliol
Mixed alpha beta receptor inhibition
59
indications of Carvediliol
angina (off label)
HTN
Stable HF
Stable Post MI
60
SE of Carvediliol (hint ... youve seen this before)
1. fatigue
2. sleep disturbance
3. depression
4. bradycardia
5. rebound angina/hypertension
6. hypotension
61
when do you titrate slowly in Carvediliol
Post MI or Compensated HF
62
Anti-anginal Agent: Miscellaneous
Ranolazine
63
MOA of Ranolazine
Inhibits inward sodium channel in ischemic cardiac myocytes during repolarization thereby reducing Na+/Ca++ exchange which relaxes cardiac muscle and reduces myocyte oxygen consumption (proposed mechanism)
64
Indication of Ranolazine
CHRONIC ANGINA
65
SE of Ranolazine
HYPERHYDROSIS
also: constipation, HA, bradycardia, hypotension etc
66
Contraindications of Ranolazine (2)
1. any degree of hepatic cirrhosis
| 2. concurrent strong CYP3A4 inhibitors or inducers
67
Common dx-dx interactions with Ranolazine
1. CYP3A4 inhibitors (diltiazem, eythromycin, verapamil etc)
2. P-glycoprotein inhibitors (cyclosporine)
3. simcastatin (max dose is 20mg/day)
68
what do you NOT do with Ranolazine
SO NO CRUSH OR CHEW
69
what is Ranolazine not for?
not for acute episodes of angina
70
do not use Ranolazine with
grapefruit juice or st johns wort
71
how much is Ranolazine
AWP at full dose is $476.51
72
how do you dose Nitroglycerin?
Sublingually… if chest pain 1 tab every 5 min due to chest pain
3 pills max in 15 min.
you can also use it prophylactically
73
what is the drug class for asprin?
anti-platelet aggregation drug COX 1 inhibitor
74
what is the MOA of aspirin?
Irreversible inactivation (via acetylation) of cyclo-oxygenase (COX1)- inhibits synthesis of thromboxane A2 – prevents platelet aggregation & vasoconstriction by thromboxane A2
75
what is the indication for aspirin?
secondary prophylaxsis
| especially with MI, CVA
76
what person of people experience gastritis with aspirin?
30%!!
77
what are the two contraindications for asprin?
nasal polyps
| bronchospasm
78
what should you not take ASA with (2)
NSAIDS
| other anticoagulants
79
what is one thing you want to monitor for a pt taking ASA?
melena
80
what do higher doses of ASA more than 325 mg do?
inhibit PGI2 (inhibits platelet aggreagation in vivo
81
what is the drug class for clopidigrel?
platelet ADP inhibitor
82
what is the indication for clopidigrel? (4)
secondary prevention
AMI
CVA
PAD
83
what is the MOA of clopidigrel?
irreversibly blocks ADP receptor on platelets preventing platelet/fibrinogen binding and platelet aggregation
84
what are the 3 negative effects experienced by those who take clopidigrel?
27% experience gastritis
abdominal pain
thrombocytopenia
85
what are the 4 drug interactions that interact with clopidigrel?
1. antiplatelet/anticoagulant (increase)
2. atorvastatin (decrease)
3. macrolides abx (decrease)
4. ginko biloba (increase)
86
Is clopidigrel used for ASA allergy?
why yes, yes it is
87
what is the dosing for clopidigrel?
300 mg loading, 75 maitenance
88
what are the three drugs in the Diuretics: Loop diuretics
1. Furosemide
2. Torsemide
3. Ethacrynic Acid
89
MOA of Furosemide
Inhibits NA+, K+, Cl2, symporter in TAL of loop and distal tubule
90
Indications of Furosemide
Edema 2nd to CHF, kidney, liver failure
HTN
91
SE of Furosemide and Ethacrynic Acid (6)
1. hypotension
2. dehydration
3. hyperglycemia
4. increased then decreased uric acid
5. electrolyte abnormalities
6. jaundice
92
Contraindications of Furosemide
Hypersensitive to sulfa
93
DX-DX interactions of Furosemide
1. Increases impact of anti-HTN meds and lithium
| 2. corticosteroids increase furosemide impact
94
what is the outpatient target with Furosemide
outpatient target 2lbs body weight loss/day to get to dry weight, then down titrate
95
MOA of Torsemide
Inhibits NA+, K+, Cl2, symporter in TAL of loop and distal tubule
96
Indications of Torsemide
Edema of cardia, renal and hepatic failure
HTN
97
SE of Torsemide
1. Constipation
| 2. diarrhea
98
Contraindications of Torsemide
anuria
sulfa sensitivity
99
Dx-Dx interactions of Torsemide
Other K+ wasting drugs
100
2 things to monitor with Torsemide
k+
| eGFR
101
how much Torsemide is equal to Furosemide
10-20mg Torsemide about equal to Furosemide 40mg
102
MOA of Ethacrynic Acid
Inhibits NA+, K+, Cl2, symporter in TAL of loop and distal tubule
103
indications of Ethacrynic Acid
Edema 2nd to CHF, kidney, liver failure
104
contraindications of Ethacrynic Acid and Dx-Dx interactions (2)
Contraindications: H/o of severe watery diarrhea with ethacrynic acid
Dx-Dx:
1. Increase anti-HTN impact
2. corticosteroids increase diuretic impact
105
what about outpatient target
outpatient target 2lbs body weight loss/day to get to dry weight, then down titrate
106
what are the 2 Diuretics: aldosterone Antagonists
1. Spironolactone
| 2. Eplerenone
107
MOA of Spironolactone
Inhibit Na reabsorption by distributing the aldosterone-dependent NA+/K+ pump
108
Indications of Spironolactone
1. Excessive aldosterone excretion or HF
2. HTN
3. hypokalema
4. liver cirrhosis with edema or ascites
109
SE of Spironolactone
SJS
gynecomastia
amenorrhea
110
contraindications of Spironolactone
Addisons dx
K+>5.5
eGRF
111
monitoring Spironolactone
K+
112
what does K+ need to be below for Spironolactone
K+ needs to be below 5.5 in order to initiate
113
MOA of Eplerenone
- -> more specific aldosterone receptor antagonist in kidney, heart, blood vessels, brain
- -> reduces vascular and cardiac fibrosis
114
Indications of Eplerenone
1. excessive aldosterone excretion
2. heart failure
3. HTN
4. hypokalema
5. liver cirrhosis with edema or ascites
115
Dx-Dx of Eplerenone
1. K+ >5.5 (K must be below 5.5 to start)
| 2. eGFR
116
monitor with Eplerenone
K+
117
referring to Eplerenone
1. what is it less likely to cause
2. when do you reduce dose
3. what to be cautious with?
less likely to cause gynecomastia
reduce dose for renal, hepatic insufficiency
caution in DM (hyperkalemia risk)
118
3 Vasodilators: ACE inhibitors
1. Captopril
2. Lisinopril
3. Fosinopril
ok- so these are all the same so the next cards are for all three together
119
MOA of Vasodilators: ACE inhibitors
Competitive inhibitor of ACE preventing angiotensin I conversion to angiotensin II decreasing vasoconstriction by angiotensin II and decreases aldosterone secretion
120
Indications of Vasodilators: ACE inhibitors (4)
1. HTN
2. HF
3. left ventricular dysfunction after MI
4. DM neuropathy
121
SE of Vasodilators: ACE inhibitors (3)
cough
hyperkalmia
angioedema
122
Contraindications of Vasodilators: ACE inhibitors (3)
1. Hx angioedema
2. concurrent use of Aliskerin in DM patients
3. bilat renal artery stenosis
123
Dx-Dx of Vasodilators: ACE inhibitors
don’t use with ARB’s, aliskerin
124
Pregnancy category of Vasodilators: ACE inhibitors
PG. D
TERTOGEN
AHHHH!
125
what do you watch for during first time dose of Vasodilators: ACE inhibitors
watch for first dose hypotension
126
Drug class of Losartan
Vasodilators:
Angiotensin 2 Receptor Blockers
ARB
127
MOA of Losartan
Selectively and competitively blocks AT1 and AT2 receptors
128
indication of Losartan
1. HTN
2. DM neuropathy
3. stroke
4. LVH
129
SE of Losartan
1. hyperkalemia
2. especially in people with T2DM:
- ->chest pain
- ->fatigue
- ->hypogycema
- ->diarrhea
- ->UTI
130
dx-dx interactions of Losartan
Aliskerin
ACEI
131
what increases with Losartan
incr excretion of uric acid
132
which drug is a Direct-Acting Vasodilators
Hydralazine
+
Isosorbide Dinitrate
133
MOA of
Hydralazine
+
Isosorbide Dinitrate
Direct-acting arteriolar vasodilators
134
Indication of
Hydralazine
+
Isosorbide Dinitrate
adjunct in HF esp. afro-americans
135
SE of
Hydralazine
+
Isosorbide Dinitrate
1. Angina
2. orthostatic htn
3. SLE-like syndrome
136
contraindications of
Hydralazine
+
Isosorbide Dinitrate
Mitral valve rheumatic heart disease
137
Which drug is a
Positive Inotropic Agents:
Cardiac Glycoside
Digoxin
138
MOA of Digoxin
1. Inhibits Na/K ATPase pump in myocardial cells promoting influx Ca++ leading to increased contractility
2. direct suppressor of AV node decr ventricular rate
139
indications of Digoxin
Afib rate control
140
SE of Digoxin
1. incomplete heart block may proceed to complete block
2. digoxin toxicity
3. SSS
141
Contraindications of Digoxin
- -> V-fib
- -> co-existing thyroid d/o
- -> recent MI
142
what is a list to remember in Digioxin and what kinda of effect is important to remember
BEERS list: cautious use in elderly
proarryhthmic effect
143
What drug is under the drug class
Positive Inotropic Agents:
B-agonists
Dobutamine
144
MOA of Dobutamine
Stimulates B1 adrenergic receptors increasing cardiac contractility and HR
little impact on B2 or alpha receptors
145
Indications of Dobutamine
Short-term management of cardiac decompensation
146
SE of Dobutamine
incr HR
paradoxical hypotension
exacerbation of ventricular ectopy
147
contraindications of Dobutamine
1. allergy to sulfites
| 2. recent MAOI
148
Which drug is under the class
Positive Inotropic Agents:
Phosphosdiesterase
Inhibitors
Milrinone
149
MOA of Milrinone
Selective PDE inhibitor in cardiac and vascular tissue producing vasodilation and inotropic effects with little chronotropic activity
150
indications of Milrinone
Short-term IV therapy of acutely
151
contraindications of Milrinone
- -> AMI
| - -> severe obstructive or pulmonic valvular disease
152
Drug class of Nesiritide
Miscellaneous:
| Recombinant BNP
153
MOA of Nesiritide
Increases intracellular GMP in vascular smooth muscle cells and endothelium resulting in smooth muscle relaxation reducing pulmonary capillary wedge pressure (PCWP) and systemic arterial pressure
154
indication of Nesiritide
acutely decompensated HF with dyspnea at rest or with minimal activity
155
SE of Nesiritide
- -> Increase creatinine
| - -> arryhthmias
156
contraindications of Nesiritide
cardiogenic shock
hypotension (SBP
157
drug class of Aliskiren
Miscellaneous:
| Direct Renin Inhibitor
158
MOA of Aliskiren
Direct renin inhibitor preventing conversion of angiotensinogen to angiotensin I which reduces conversion to angiotensin II producing arteriolar vasodilation
159
indication of Aliskiren
HTN
160
Contraindications of Aliskiren
itraconazole
161
Dx-Dx interactions of Aliskiren (2)
1. decr effect of furosemide
| 2. NSAIDs decr effect of Aliskerin
162
what do you not take with Aliskiren!!!!!
Not with grapefruit juice!
163
which drug just has the drug class Miscellaneous
Ivabradine
164
MOA of Ivabradine
Selective and specific inhibition of If SA node and prolonging diastolic depolarization and reducing HR
165
indications of Ivabradine
Stable HF with EF70 and who are on max tolerated doses of B-blocker or unable to take B-blocker
166
indications of Ivabradine (3)
1. afib
2. heart block
3. phosphene
167
SE of Ivabradine
- SSS
| - BP
168
"other category" Ivabradine
| and what to avoid
Retinal Ih (similar to If) channel partial inhibition may account for phosphene
avoid grapefruit juice
