Exam 2 Drugs Flashcards
(165 cards)
1
Q
Hydrochlorothiazide
chlorthalidone
metalozone
indapamide
A
thiazide diuretics
2
Q
Furosemide
Torsemide
Bumetanide
Ethacrynic Acid
A
Loop Diuretics
3
Q
Amiloride
Triamterene
A
Potassium-Sparing diuretics
4
Q
Nifedipine
Amlodipine
A
Calcium Channel Blockers (Dihydropyridine)
5
Q
Verapamil
Diltiazem
A
Calcium Channel Blockers (Non-dihydropiridine)
6
Q
Captopril Enalapril Fosinopril Lisinopril Perindopril Quinapril Ramipril Trandolapril
A
ACE Inhibitors (“-opril”)
7
Q
Azilsartan Candesartan Eprosartan Irbesartan Losartan Olmesartan Temisartan Vaslartan
A
ARBs (“-sartan”)
8
Q
Doxazosin
Prazosin
Terazosin
A
Alpha-1 Antagonists (“-zosin”)
9
Q
Clonidine
Methyldopa
Guanfacine
Guanabenz
A
Alpha-2 Agonists
10
Q
Reserpine
A
Peripheral Sympathetic Inhibitor
11
Q
Isosorbide dinitrate/hydralazine
Hydralazine
Minoxidil
A
Direct Vasodilators
12
Q
Atorvastatin Fluvastatin Lovastatin Pravastatin Rosuvastatin Simvastatin
A
Statin
13
Q
Alirocumab
Evolocumab
A
PCSK9 Inhibitor (cholesterol) - other treatments
14
Q
Lovaza
Vascepa
Epanova
Omtryg
A
Omega 3 Fatty Acids (fish oil) - other cholesterol treatment
15
Q
Digoxin - Method of Action
A
Use in Heart Failure (sometimes)
MOA: + inotropic effects (heart beats harder); decreases hospitalization, DOES NOT decrease or improve HF progression
16
Q
ACE-I pharmacological use
A
blocks creation of angiotensin II
17
Q
ARBs pharmacological use
A
blocks angiotensin II’s receptor
18
Q
Fondaparinux
A
Xa Inhibitor (indirect)
19
Q
Apixaban
Rivaroxaban
A
Xa inhibitor (direct)
20
Q
Bivalirudin
Desirudin
Aragatroban
Dabigatrin
A
Direct Thrombin inhibitors
21
Q
Amiodarone
Dofetilide
Ibutilide
Propafenone
A
Pharmacological Cardio Conversion
22
Q
Dabigatran
Rivaroxaban
Warfarin
Apixaban
A
Anticoagulants
23
Q
Aspirin
Dipyridamole
A
Antiplatelets
24
Q
Clopidogrel
Prasugrel
Ticagrelor
Cangrelor (IV)
A
P2Y12 Inhibitor - reduces platelet activation/aggregation
25
Abciximab
Eptifibatide
Tirofiban
Glycoprotein lIb/IIIa Receptor Inhibitor
26
Alteplase
Reteplase
Tenecteplase
Fibrinolytics (fibrin-specific)
27
Streptokinase
| Urokinase
Fibrinolytics (nonfibrin-specific)
28
Nitroglycerin
Short-acting nitrate (angina)
29
Nitroglycerin ER
Isosorbide dinitrate
isosorbide mononitrate
Long-acting nitrates
30
this diuretic used in Edema and Heart Failure, works on loop of henle, and can be used even in poor renal function (decreases renal vascular resistance, increased renal blood flow)
Loop Diuretics
31
this diuretic used commonly in Hypertension; decreases BP by increasing sodium and water excretion by the kidneys (decreases blood volume)
Thiazide Diuretics
32
This diuretic is good for RESISTANT hypertension; they increase NaCl excretion, decrease K+ secretion), diminishing cardiac remodeling in heart failure
Aldosterone antagonists
spironolactone
eplerenone
33
Adverse effects of potassium sparing diuretics
HyperK; decrease or D/C K+ supplements and avoid high potassium foods
34
Spironolactone
| Eplerenone
Aldosterone antagonists (diuretic)
35
Types of Diuretics?
Thiazide, Loop, Potassium Sparing, Aldosterone Antagonists
36
Aspirin MOA?
inhibits COX (cyclooxygenase)
37
Types of antiplatelets
aspirin, dipyridamole, P2Y12 inhibitors, Glycoprotein IIa/IIIb inhibitors
38
when to use fibrinolytics?
Acute Coronary syndrome if PCI is too far away, in ischemic stroke, in VTE
39
treatment for acute stroke; give within 3 hours after onset to reverse symptoms
Alteplase (fibrinolytics)
40
how do potassium sparing diuretics work?
inhibit sodium transport at late distal and collecting ducts
41
dihydropiridines vs. nondihydropyridines (CCB)
dihydropyridines have greater affinity for peripheral vasculature calcium channels (legs), while nondihydropyridines have affinity for both peripheral and cardiac calcium channels (not just legs)
42
DO's and DONT's of using nondihydropyridines (CCBs)
DONT use if EF is low; use for angina, Afib, HTN (blocks cardiac conduction through AV node, has vasodilating properties)
43
Which dihydropyridine (CCB) is safe for reduced EF?
Amlodipine
44
Verapamil
| Diltliazem
Non-dihydropyridine (CCB)
45
Nifedipine
| Amlodipine
dihydropyridine (CCB)
46
method of action ARBs?
block angiotensin II from binding to angiotensin receptor (RAAS)
47
Aliskren
Direct Renin Inhibitor (antihypertensive) - less common. MOA: directly inhibits renin
48
Doxazosin
Prazosin
Terazosin
Alpha-1 Antagonists (antihypertensive) - less common. MOA: add-on treatment, NOT monotherapy due to a risk for increase in cardiovascular events
49
Clonidine
Methyldopa
Guanfacine
Guanabenz
Alpha-2 agonists (antihypertensives) - less common. MOA: reduces sympathetic outflow, enhances parasympathetic activity
50
1st line medication for hypertension in PREGNANCY?
methyldopa - alpha 2 agonist. Labetalol ok too
51
Reserpine
peripheral sympathetic inhibitors. MOA: reduces sympathetic tone and peripheral resistance, depletes NE from nerve endings. (anti-hypertensive) - not tolerated well
52
isosorbide dinitrate/hydralazine
hydralazine
minoxidil
Direct Vasodilators (antihypertensive) - MOA: relaxes smooth muscle in arterioles, activates baroreceptors.
53
best time to prescribe direct vasodilators? (antihypertensive)
Resistant hypertension, but also ADD diuretics and BB (causes reflex tachycardia)
54
Blood pressure definition?
BP = CO x PVR
(CO: cardiac output)
PVR: peripheral vascular resistance
55
role of angiotensin II in Heart failure?
increases systemic vascular resistance, increasing BP. ALSO, potentiates release of NE, inducing vascular hypertrophy = cardiac remodeling
56
ACE-Inhibitor function?
blocks conversion of angiotensin I --> angiotensin II
57
ARB function?
blocks receptors of angiotensin II
58
CONTRAINDICATIONS for ACE-I/ARB?
pregnancy, renal artery stenosis (ACE can cause decline in renal function)
59
function of nitrates in HF?
venous dilation = reduced preload
60
function of hydralazine in HF?
direct arterial smooth muscle relaxation = reduce AFTERLOAD
61
Purpose of Beta Blockers in HF?
block influence of SNS (NE) at beta adrenergic receptors, improving EF and reducing hospitalizations
62
Do you give BB with volume overload?
NO! wait until euvolemic and initiate a low-dose
63
Aldosterone impact on HF? Why are aldosterone antagonists important for treating HF?
Aldosterone is responsible for sodium and water retention, electrolyte abnormalities. ALDOSTERONE ANTAGONISTS are important because ACE-I do not suppress production/release of aldosterone
64
Importance of antiplatelets (aspirin and warfarin) in Heart Failure?
Bad valves can cause stasis blood, endothelial dysfunction, hypercoagulability increasing risk of thromboembolic events
65
importance of Aspirin in HF?
reduces risk of stroke (embolism)
66
importance of anticoagulant in HF?
prevents blood clots, especially in LV dysfunction and prosthetic valves
67
Role of Digoxin in HF?
Positive inotropic effects = heart beats harder (increases intracellular Na by binding to Na and K pumps)
Restoration baroreceptor sensitivity
if AFib too, use to slow HR
*DOES NOT decrease progression of HF, but has a role in decreasing hospitalizations due to HF*
68
Risks of Digoxin
high risk of toxicity; monitor electrolytes
69
Heart failure with PRESERVED LVEF also known as?
diastolic HF - impaired ventricular relaxation and filling; EF not affected
70
How to manage ACUTE heart failure episode?
FIRST: manage congestion and hypoperfusion:
congestion: IV diuretic (furosemide) & IV vasodilators (nitro)
hypoperfusion: positive inotropes to make heart beat faster (dobutamine)
71
What are the 4 groups that need a statin?
1. Established ASCVD
2. LDL > 190
3. Diabetic, age 40-70, LDL 70-189
4. Nondiabetic, age 40-75, LDL 70-189, 10 year risk >7.5%
72
What do statins do?
inhibit MHG-CoA reductase, responsible for cholesterol synthesis
73
Atorvastatin
Fluvastatin
Lovastatin
Pravastatin
Statins
74
Low intensity statins?
Lovastatin
Pravastatin
(10-20 mg)
75
Moderate intensity statins
all of them...(40 mg)
| reduces LDL by 30-50%
76
high intensity statins
Atorvastatin
Rosuvastatin
(40-80 mg)
reduces LDL by 50%
77
Adverse effects of statins
constipation, abdominal pain
| Severe: myopathy, rhabdo, elevated liver function tests
78
Treatment for hypercholesterolemia?
1st: LIFESTYLE TREATMENT
| then statins
79
If NOT using statin for high cholesterol, other options?
```
Ezetimibe
PCSK9 inhibitor
Nicotinic Acid
Fibric acid derivatives
Omega 3 fatty acids
```
80
MOA ezetimibe?
inhibit cholesterol absorption in small intestine and prevents delivery to liver. used post CV event.
81
Alirocumab
| Evolocumab
PCSK9 inhibitor : used in combo with statin. Binds to LDL receptor and prevents its degradation--> longer breakdown and excretion of LDL. NEW, so don't be the first!
82
Type of antihypertensive to use for resistant HTN?
Alpha-2 agonists
83
How to D/C clonidine? (Alpha-2 agonist)
Avoid severe rebound HTN. Taper B.B. first, wait several days, and then taper clonidine
84
What to do if INR >10?
Vitamin K! Takes 24 hours to see effects
85
INR >4 , under 10 - what do you do?
Hold warfarin until therapeutic
86
How long does warfarin take to be eliminated?
5-7 days
87
fondaparinoux (indirect Xa inhibitor) MOA?
Accelerates antithrombin (binds to AT)
88
Warfarin MOA? When to use?
Vitamin K antagonist
Treatment of VTE and stroke prevention in Afib
89
How to dose warfarin
Start it in combo w/ heparin, because it’s effects take 5-7 days. D/C warfarin 5 days before surgery and restart 12-24 hours post-op
90
Fondaparinoux MOA
SubQ; indirectly inhibits Xa in coagulation cascade - no effect against thrombin
Binds to Antithrombin
91
Contraindications and cautions of Fondaparinoux
CrCl<30 (rental impairment)
Hypersensitivity, thrombocytopenia
CAUTION in elderly (bleeding)
92
Apixaban and rivaroxaban MOA?
Inhibit Xa directly; bind reversible to Xa and prevent thrombus formation
93
Things to know about direct Xa inhibitors
Shorter 1/2 life than warfarin, missed doses more serious, no labs to measure effectiveness, no antidotes
94
Which anticoagulant to use with patient who has Heparin induced thrombocytopenia(HIT)?
Direct thrombin inhibitors
| Bivalirudin, aragatroban
95
Drug of choice for RAPID anticoagulation?
Infractioned heparin
96
True or false: UFH dissolves a formed clot.
False! Prevents propagation and growth
97
UFH is eliminated enzymatically in low doses and renally in high doses (true or false)
True
98
What is HIT?
Heparin-induced thrombocytopenia- when platelets drop by >50%; discontinue UFH / LMWH immediately!!! Switch to direct thrombin inhibitors or fondaparinoux
99
Dalteparin
| Enoxaparin
LMWH
100
LMWH MOA?
Prevent growth of formed thrombus, inhibits thrombin (factor IIa and factor Xa)
101
Is LMWF safe in treating pregnancy?
Dalteparin
Enoxaparin
Yes- does not cross placenta
102
Are nitrates done first at ER?
No- they relieve angina but they do not change outcomes
103
Adverse effects of P2Y12 Inhibitors?
bleeding, TTP (thrombotic thrombocytopenic purpura) (clopidogrel), dyspnea, bradyarrhythmias
104
How to dose P2Y12 inhibitors post-procedure
start immediately, continue for 2 weeks to 12 months
105
What Antiplatelet do you Rx for patient with poor CYP2C19 metabolizers?
Prasugrel or Ticagrelor; Clopidogrel is converted to active form by CYP2C19, so won't be as effective in these patients
106
What do you do with antiplatelet meds for person who is having surgery?
WITHHOLD for 7 days to decrease chances of uncontrolled bleeding
107
When to use GP lib/llla?
for antiplatelet therapy; specifically when P2Y12 inhibitor are not adequate OR in large thrombus burden - not recommended if patient is on fibrinolytics or bivalrudin (bleed risk)
108
Role of thrombolytics?
break up life-threatening thrombus
109
Types of Antiplatelets
Aspirin
Dipyridamole
P2Y12 Inhibitors
GP lib/llla receptor inhibitors
110
Which drug is considered 1st line therapy in ACS?
fibrin-specific (Alteplase, Reteplase, Tenecteplase); opens greater percentage of infarcted arteries
111
Contraindications for Fibrinolytics
for use in NSTE-ACS and if too much time has passed since the cardiac event
112
Fibrinolytics in VTE?
Streptokinase, Urokinase, Alteplase - use for treatment in VTE ONLY IF shock, hypotension, massive DVT w/ limb gangrene
113
If PCI is too far away, what do you do?
use fibrinolytics - FIRST LINE (fibrin-specific)
114
HTN treatment >140/90 blacks?
Thiazide diuretic OR CCB
115
HTN treatment >140/90 white/nonblack?
ACE-I/ARB (or thiazide/CCB)
116
HTN treatment for >140/90 in patients with CKD
Add ACE-I/ARB, even in African Americans.
117
Guidelines for starting TWO Hypertensive drugs?
systolic >20mmHg or diastolic >10mmHg
118
What are the types of direct cardioversion? DCC
unstable (emergency- shock) and stable (medication)
| sedate before electrical cardioversion
119
When thinking Rate vs Rhythm control, which do we try and achieve first?
RATE! - be careful with amiodarone, works like K blocker, CCB, BB - last ditch effort
120
When can you consider DCC?
w/ Afib lasting <48 hours
121
When is Delayed cardioversion considered?
in patients with Afib >48 hours; MUST anticoagulate for 3 weeks PRIOR to conversion and continue for 4 weeks AFTER as well.
122
Treatment for PCI (including time)
preferred treatment, within 90 min!
| Dual antiplatelet therapy: ASA + P2Y12, anticoagulate w/ UFH
123
Treatment for Fibrinolysis
within 30 min! do if PCI not available. Dual antiplatelet therapy (ASA + clopidogrel P2Y12), and Anticoagulate with IV UFH
124
Two factors to address in acute heart failure episode
congestion and hypoperfusion, use
| IV diuretics, IV vasodilators, Dobutamine (positive inotropes)
125
Purpose of amiodarone
treat Afib and ventricular arrhythmias
126
Factors that describe stage B HF
Previous MI, LV remodeling, low EF, valvular disease (but no symptoms)
Treat w/ ACEI + BB
127
Factors describing stage A HF
risk factors: HTN, smoking, lipids, DM, lack of exercise
Treat w/ ACEI
128
Stage C HF
Symptoms! DOE, edema, SOB, fatigue
Treat w/ ACEI, BB, Diuretic
129
ACE-I and renal function
ACE-I can cause renal insufficiency, and is CONTRAINDICATED in bilateral renal stenosis, however it can be beneficial chronically
130
Nitrates reduce _______ and hydralazine reduces ___________
preload, afterload
131
when do you initiate beta blockers in HF?
wait until patient is euvolemically stable (volume overload + BB = worsening effects)
132
When to use nondihydropyridines vs dihydropyridines
nondihydros - angina and AFib
| dihydros - peripheral vasodilation
133
in acute HF exacerbation, we give IV diuretics, IV vasodilators, and IV positive inotropes (dobutamine)...why?
IV dobutamine - increases cardiac contractility, makes heart pump harder
IV vasodilators - rapidly decreases arterial tone
IV diuretics - decrease blood volume/fluid
134
CCB Method of Action?
Relaxes arterioles by blocking calcium from entering cell
135
True or False: Rechallenging statins in those who experience rhabdomyolysis is okay, but wait 2-4 weeks
FALSE! If patient has rhabdo from a statin, DO NOT rechallenge that same one! In other cases, where patient simply does not tolerate, re-challenging is ok, but wait 2-4 weeks.
136
Safest CCB to use in reduced EF?
Amlodipine
137
Why do we take a baseline CK when prescribing statins?
Need to have a baseline INCASE patients complain of myopathy, muscle pain, weakness, brown urine (signs of rhabdo)
138
True or False: Rechallenging statins in those who experience rhabdomyolysis is okay, but wait 3-4 weeks
FALSE! If patient has rhabdo from a statin, DO NOT rechallenge that same one! In other cases, where patient simply does not tolerate, re-challenging is ok.
139
Statins metabolized by which enzyme?
CYP450s
140
Quinidine
Procainamide
Disopyramide
Class 1A Na channel blockers (antiarrhythmic class)
| -intermediate potency
141
Lidocaine
| Mexilitine
Class 1B Na channel blockers (antiarrhythmics)
| -lowest potency
142
Flecainide
| Propafenone
Class 1C Na channel blockers (antiarrhythmics
| -greatest potency
143
Class 2 antiarrhythmics?
Beta Blockers
144
Class 3 antiarrhythmics?
Potassium channel blockers
```
Amiodarone
Dofetilide
Dronedarone
Ibutilide
Sotolol
```
145
which anticoagulants bind the Von Willebrand factor in the coagulation cascade?
heparin
146
Adenosine MOA
Direct AV node inhibition; drug of choice for PSVT
147
Uses for anticoagulation
Prevention of stroke, VTE, thrombus formation (Afib, procedures), thromboembolism (PE)
148
Types of Anticoagulants
```
Warfarin
Xa Inhibitors
Direct Thrombin inhibitors
Heparin
LMWH
```
149
What is the importance of aPPT in UFH dosing?
adjust dose based on the aPPT; should be 1.5-2.5x control aPPT value
150
What do you do if there is HIT or thrombosis while patient is on UFH?
D/C immediately and switch to direct thrombin inhibitors OR Fondaparinoux
151
Dalteparin
| Enoxaparin
LMWH
152
Which anticoagulants have antidotes, and what are they?
Protamine --> LMWH
Vit K --> warfarin
Praxbind --> direct thrombin inhibitors
153
which antiarrhythmics are IV form?
Class 1A and 1B Na channel blockers
154
Which antiarrhythmics are PO?
Class 1C Na channel blockers
155
Where in conduction system do BB affect rhythm?
Blocks conduction at AV node
156
does Amiodarone have a long or short 1/2 life?
EXTREMELY long (antiarrhythmic)
157
common side effects and severe side effects of Amiodarone
hypotension, sinus bradycardia (acts like all classes of antiarrhythmics)
pulm toxicity, hepatotoxicity, hypo/hyperthyroidism, exacerbated arrhythmias
158
Which antiarrhythmics slow conduction at AV node?
BB and CCB (class 2 and 4)
159
Why are we cautious with verapamil + digoxin?
verapamil (CCB) can mess with concentration of digoxin (digoxin has low therapeutic index, so small changes can cause large effects)
160
Which antiarrhythmic causes DIRECT AV nodal inhibition?
Adenosine
161
Which antiarrhythmic drug is 1st line choice in treating PSVT?
Adenosine
162
How can you tell if your patient has digoxin toxicity?
CNS effects(psychosis confusion), GI effects (nausea, vomiting), Visual disturbances (green halos around objects), new cardiac arrhythmias
163
How to monitor for digoxin toxicity
Look for HypoK, HypoMg
164
which drugs provide 24 hour protection for angina?
BB and CCB
165
door-to-needle time for Alteplase in stroke?
60 minutes
