Exam 1 - Pharm Blessings Flashcards by Paige LaPointe

What is the first-line drug for angina?

nitroglycerin [nitrostat] PRN

How well did you know this?

Not at all

Perfectly

What is the MOA of nitroglycerin [nitrostat]

vasodilator:

dilates the smooth muscle of arteries and veins

decreases the cardiac preload

How well did you know this?

Not at all

Perfectly

What drug class will eliminate the S/E of tachycardia with nitroglycerin, and how?

beta blockers

by decreasing cardiac contractility and HR, thus decreasing workload of heart

How well did you know this?

Not at all

Perfectly

What are the MC side effects of nitro? (think of MOA)

tachycardia, orthostatic hypotension, HA

How well did you know this?

Not at all

Perfectly

What drug class has been shown to decrease mortality after MIs?

beta blockers

How well did you know this?

Not at all

Perfectly

What else would you prescribe for stable angina?

an aspirin a day keeps the MI away

How well did you know this?

Not at all

Perfectly

What is an alternative for a person who is allergic to aspirin?

clopidogrel [plavix]

How well did you know this?

Not at all

Perfectly

Your patient has HTN, and his ECG shows LVH. What does this indicate has happened, and what should you look for on PE?

indicates end-organ involvement

do a fundascopic exam to look for A-V nicking and sclerosing of vessels

Look for JVP, peripheral edema

How well did you know this?

Not at all

Perfectly

This same patient with HTN and LVH is having stable angina. What will you prescribe for him?

[more things: he is on HCTZ for HTN, but his BP is 140/90]

Give nitroglycerin [nitrostat] for angina

Give aspirin for angina

Give metoprolol [lopressor] for HTN and angina

How well did you know this?

Not at all

Perfectly

Is it okay to have a person on HCTZ and metoprolol at the same time?

Yeah looks like it

How well did you know this?

Not at all

Perfectly

When a person is having chest pain and takes nitro, after how long should they call 911?

If the chest pain has lasted longer than 5 minnies

How well did you know this?

Not at all

Perfectly

Where are beta 1 receptors located?

myocardium of the heart around the SA and AV nodes

How well did you know this?

Not at all

Perfectly

Where are beta 2 receptors located?

lungs and skeletal muscles

How well did you know this?

Not at all

Perfectly

If a person has asthma (or any lung disease) and angina, what type of drug should you use?

a selective agent (b1 blocker) like metoprolol [lopressor]

How well did you know this?

Not at all

Perfectly

if a person has CAD, what is the diagnostic gold standard test?

cardiac catheterization and angiography

(there’s some random blessington input for you)

How well did you know this?

Not at all

Perfectly

What type of drug class are erectile dysfunction pills?

PDE5 inhibitors

How well did you know this?

Not at all

Perfectly

What are the rules with prescribing nitro and PDE5 inhibitors (like erectile dysfunction pills) together?

CANNOT use nitro if you have taken PDE5 inhibitors within 24 hours prior

How well did you know this?

Not at all

Perfectly

What disease is absolutely contraindicated with nitroglycerin?

head trauma/stroke (risk of brain bleed)

How well did you know this?

Not at all

Perfectly

What is a S/E of amlodipine [norvasc] and other dihydropyridines to be aware of?

peripheral edema

How well did you know this?

Not at all

Perfectly

What is another extremely common SE of amlodipine?

How well did you know this?

Not at all

Perfectly

What are some options if your patient is on amlodipine for heart disease, but is developing peripheral edema from it?

Could decrease dose of amlodipine

Could switch to another class of calcium channel blockers: the nondihydropyridines

Could close your eyes and just point to something on the drug table and hope that it doesn’t kill them

How well did you know this?

Not at all

Perfectly

Why do beta blockers cause orthostatic hypotension?

When we stand, the HR normally increases.

On a beta blocker, that adrenergic reaction is blocked to maintain a low HR.

How well did you know this?

Not at all

Perfectly

If a person has orthostatic hypotension, and is also prescribed nitro, what instructions should you give them for taking their nitro?

sit dat ass down when taking the nitro!

How well did you know this?

Not at all

Perfectly

Your person with once stable angina is now getting symptoms more often. What should you do for them?

Add a calcium channel blocker like amlodipine

if pt has HTN (which, let’s be real, I bet they do) it will also help with the HTN

How well did you know this?

Not at all

Perfectly

Your patient is on salmeterol diskus for her COPD and is developing unstable angina. Why is the salmeterol diskus dangerous?

Salmeterol is a b2 agonist, and will affect her heart. Switch to LAA. She shoulda been on that in the first place anyway.

What is the diuretic class of choice for patients who have peripheral edema and CKD?

loop diuretics

All diuretics inhibit sodium reabsorption in the kidneys, so why are loop diuretics the choice drug in patients with CKD?

they work at the loop of henle so they work better _{get it... loop diruetics... :)}

How often per day should you be "nitrate free?" What happens if you don't do this?

Should be nitrate free for 8-12 hours per day otherwise, the efficacy of nitro goes down

What forms does nitro come in?

sunlingual spray sublingual/buccal tablet topical IV

What drug comes in a dark glass bottle?

nitroglycerin

What is the effective time frame of furosemide [lasix]?

6 hours | (so take 1 in AM, take 1 in afternoon)

Should a person take furosemide [lasix] before bed?

not unless they wanna be peein' all night

if a patient gains ___ lbs in 24 hours, they should take a dose of furosemide [lasix]

3 (pretty sure I gain 3 lbs over the course of a meal)

If a person is taking furosemide [lasix] twice daily, and they finally get down to their water weight, should they continue taking furosemide [lasix]?

Yep, they can take it PRN instead though!

What if a person is on Salmeterol diskus for COPD, and is also on a loop diuretic?

No bueno. Salmeterol decreases the effect of the loop diuretic Change to tiotroprium

What heart failure drug class does tiotroprium interact with?

ACE inhibitors

What do you have to do with a person's furosemide [lasix] if they have been on it for a long time/have used it very often?

often have to up the dose from 20mg to 40mg to get an impact

What are some side effects of furosemide [lasix]?

**Dehydration** leading to hypotension **hypokalemia** (AKA potassium depletion) decreases other electrolytes

For a person on furosemide [lasix], how many pounds is the patient aiming to lose daily?

2 lbs

Is furosemide [lasix] indicated for a person with renal disease?

YAAASSSSS it's like, only for **renal failure** (fun fact: that's not actually true, it's also for **liver failure** and **edema from CHF**)

What stages of CKD is furosemide [lasix] best for?

stage 3 and 4

Pt. has a sulfa allergy, and has water retention from CKD. What drug **can't** you give him?

CAN'T give **furosemide [lasix]** it won't technically cause an "allergic rxn" but there's a warning about it. so you could get sued. Can't give **torsemide [demadex]** either

So that doesn't change the fact that your pt has a sulfa allergy and water retention from CKD. What **do** you give him?

ethacrynic acid [edecrin]

How do you feel about the BP 110/70 for a 70y/o?

doesn't matter how you feel it's low old people should develop higher blood pressure

So if your patient is on metoprolol [lopressin] and she has a BP of 110/70, what drug class might she benefit from more than a beta blocker??

Ace inhibitors

When should you take ethacrynic acid [edecrin]?

morning and afternoon, not before bed | (again, the whole peeing thing)

Your patient needing a diuretic also has low potassium. What should you prescribe her?

spironolactone (aldactone) or eplerenone (inspra) these spare potassium

Your patient in need of a diuretic with low potassium is a MALE. You *will* Rx him Eplerenone [inspra]. Why *won't* you Rx him spironolactone [aldactone]?

spironolactone [aldactone] can give him **man boobies** _{(for anyone more mature than me that is interested, the proper term for this is gynecomastia)} **Hint:** think lactone = lactate

Are thiazide diuretics useful in patients with renal disease?

Nosiree you want da loopz

So what exactly do the loop diuretics do, in the kidneys and in the heart?

In kidneys: inhibit reabsorption of Na and Cl in the body, so these get excreted and **H2O follows** (and K+ tags along too) In heart: Decrease preload

ACE inhibitors are for HTN, but what other disease are they good in?

renal disease, esp in diabetics

Hey Professor White, should I know about using ACE inhibitors for HTN for exam 1?

"No." - Tommy W So don't bother! :) But DO know about ACE inhibitors for HF.

What are the S/E of ace inhibitors?

hyperkalemia, **coughing**

What causes the cough with ACE inhibitors?

production of bradykinin

What are C/I of ACE inhibitors?

angioedema\*\*\* (won't respond to drugs) bilat renal artery stenosis

What is the PG category of ace inhibitors?

D teratogenic

Which diuretic is equally effective IV or orally at the same dosage?

torsemide [demadex]

Which diuretics can be used IV?

furosemide [lasix] torsemide [demadex]

What are the 3 major diseases that often coexist in patients?

CKD COPD HF hard to tell which is causing what symptoms

Your pt is on Furosemide [lasix] PRN, but he's been eating super salty food and has gained 7# and has orthopnea. What can you do for him?

Tell him to get his shit together And put him on Furosemide [lasix] 40mg twice daily until he gets his shit together

**This is a break card**

You are on card #61. Go get some water or take a lap or pet your animal or your friend, then grab some snacks/sanity and then come back. It's a big deck, you're killing it!

What is the MOA of spironolactone [aldactone]?

this diuretic competitively inhibits aldosterone in the kidney

What would every single one of these patients benefit from **once they are at their dry weight?**

cardiac rehab program

Pt on metoprolol [lopressor] for afib is in sinus bradycardia. what will you do?

titrate down the dosage of his metoprolol he could also be switched to an anticoag for his afib

What do African Americans not produce as much of?

Angiotensin I

What is the potential dx-dx interaction between lisinopril and furosemide [lasix]?

hypotension

Rx-ing Lisinopril vs. Captopril. GO!

Lisinopril is on the $4 list. Once daily. MC prescribed. Captopril is more expensive and must be taken 2x daily. Both are good drugs.

Who is a candidate for hydralazine + isosorbide dinitrate [BiDil]?

a person who has failed on other HF treatment, **especially African Americans**

What is the MOA of hydralazine (one of the combos in BiDil)?

decreases total peripheral resistance by **relaxing smooth muscle** in arterioles thus **decreases afterload** thus **decreases blood pressure**

More commonly in white patients, what can hydralazine + isosorbide dinitrate [BiDil] cause?

Lupus

Dobutamine is a heavy hitter drug that we will not rx. But what's the drug class? What are indications?

inotropic agent afib, mild-mod HF

Diuretics decrease ______ while hydralazine + isoborbide dinitrate [BiDil] decreases \_\_\_\_\_\_

diuretics: decrease preload bidil: decreases afterload

What do nitrates decrease, preload or afterload?

preload

do diuretics dilate more veins or arteries?

veins

YAY CONGRATS YOU MADE IT THRU THE BLESSINGS

h;raeng;rnse;igohaeo;gnalwhg[02hgsjk.erzdmvzk.n losing my mind getting food bye \<3

Exam 1 - Pharm Blessings Flashcards

(75 cards)