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Exam II Flashcards

1
Q

What are the types of anemia?

A
  1. Macrocytic (megaloblastic and non-meg)
  2. Iron Deficiency Anemia
  3. Anemia of Chronic Disease
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2
Q

What is the treatment for iron deficiency anemia?

A

Ferrous salts: take with OJ (vitC) and divided doses if side effects (constipation, heartburn, nausea). Avoid taking with milk, tea, antacids and multivitamins (space 4 hours).

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3
Q

What drugs interact with folic acid synthesis?

A

hydroxurea, triamtrene (K sparing diuretic)

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4
Q

What are the IV drugs for low iron?

A

Ferumoxytol- CKD
Na3Fe2 Gluconate- hemodialysis and esa (in)
Fe dextran- avoid d/t anaphylaxis
Fe sucrose- hemodialysis and epoetin alfa (out)

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5
Q

What are reasons for IV therapy?

A

malabsorption, no transfusion, CKD, hemodialysis and cancer pts

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6
Q

What is the dose for B12?

A

1,000 mcg of cyanocobalamin for 1 week, daily 1 mg

symptoms include: parasthesia, neuro

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7
Q

What is the dose for folic acid?

A
  1. 4 mg for pregnancy to prevent spinal bifida, 1 mg/day o/w (up to 5mg)
    * synthetic has good absorption
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8
Q

Which drugs can cause megaloblastic anemia?

A

metformin B12 and hydroxurea

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9
Q

What is the treatment for sickle cell anemia?

A
  • hydration, analgesic (opoid), hydroxurea to increase HbF)steriods decrease stay but may increase readmit
  • prophylactic- PCN (erythromycin if allergic) until age 5, pneumococcal vaccine
  • folic acid- 1 mg/day in adults
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10
Q

What are the two IV drugs for DVT/PE?

A

heparin or fondaparinux with coumadin

  • start together and keep heparin on for 5 days until INR >2 for 24 hours (if supratherapeutic before that, then discontinue heparin)
  • tPA, alteplase, reteplase= fibrinolytic agent
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11
Q

What are two contraindications for lovenox?

A

creatinine clearance less than 30 ml/min and obesity

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12
Q

How do you treat a hypercoaguability disorder found incidentally?

A

Do nothing.

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13
Q

What do loop diuretics do? What are the side effects? Which drug do you avoid?

A

fuorosemide/lasix (40:1): bumetanide/bumex, ethacrynic acid

  • inhibits Na, K, Cl symporter so increase Na, K, Ca excretion.
  • ototoxic, gout, hyperglycemia
  • NSAIDs
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14
Q

What do thiazide diuretics do? What drug interaction do they have? What is the caveat with thiazides?

A

cholorothiazide (diuril)

  • inhibit Na/Cl transporter so increase Na, K excretion.
  • quinidine- pronlonged QT, hyperglycemia
  • can only use if creatinine is greater than 30 ml/min *metalozone is the only caveat
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15
Q

What are the K sparing diuretics?

A

triamterene (dyrenium) and amiloride (midamor)

-inhibit renal epithelial Na channels so increase Na, Cl excretion

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16
Q

What are the aldosterone antagonists? What is the side effect? Contraindicated?

A

spironolactone (aldactone), eplerenone
-increase Na excretion (spare K and H)
-spirolactone causes gyenclomastia and menstrual irregularities
-renal function, hyperkalemia
*try to avoid combining with ACE or ARB high dose
(only supplement if K <4mmol/L)

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17
Q

What are the ACE-inhibitors? What do they improve? What should you avoid? Side effects?

A

lisinopril (prinvivil) and enalapril (vasotec)
-decrease intraglomerular pressure by dilating the efferent arteriole
-decrease risk of stroke and kidney protective
-Avoid pregnancy, NSAIDs
-watch for dry cough (switch to ARBs)
angioedema (switch to diff. anti-HTN), and hyperkalemia

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18
Q

What do beta blockers do? When do you not give them?

A

Decrease HR and contractility
-non-selective are propranolol, nadolo, pindolol
B1 selective are metoprolol (lopressor)
B/a labetolol (hypertensive crisis) and carvedilol (HF pts)
-avoid in pts with HR <55 and COPD

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19
Q

If someone is non-black hypertensive?

A

ACE or ARB or thiazide or CCB or combo

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20
Q

If someone is black hypertensive?

A

thiazide or CCB or combo

ACE+thiazide

21
Q

If someone has CKD with or w/o diabetes?

A

ACE or ARB alone or in combo with another class

22
Q

HTN drugs: LV issues? Post-MI? DM or CKD? Recurrent CVA?

A

ACE+BB+ diuretic
ACE+ BB
ACE
ACE+diuretic

23
Q

What are the goals for under 60 years or CKD or diabetes? For over 60 years?

24
Q

When time of day do you give diuretics? What do you give with pregnancy?

A 
Morning
Methyldopa (or low dose thiazide)
25
If TG and LDL are high, which do you treat first?
TG
26
What are the TLCs?
sat fat <200 mg, increase physical activity, decrease weight, eat plant sterols (2g) and soluble fiber (10-25g)
27
What are statins? Target? Side Effects? Contraindications? Intensities? Reasons to stop therapy?
``` HMG CoA reductase inhibitors. LDL. Myopathy and elevated liver enzymes. Liver dz. migraines (use lov or prav) Rosuvastatin high= 20 mg, mod=5-10mg Atorvastatin high=40-80 mg, mod= 10-20mg Simvastatin mod=20-40mg-->no amlodipine or amiodarone Pravastatin mod=40 mg Lovastatin- mod=40 mg *if myopathy on high dose, try low dose on higher intensity but STOP if rhabdomyolysis* ```
28
What are bile acid sequestrators? Targets? Side Effects? Contraindications?
Cholestyramine, colestipol, colesevelam. LDL. GI distress dysbetalipoproteinemia, TG >400
29
What is nicotinic acid? Target? Side Effects? Contraindications?
niacin. HDL. flushing (take aspirin 30 min prior), hyperglycemia/uremia, GI distress, hepatotoxicity liver dz, gout, peptic ulcer, use of statins
30
What is fibric acid? Target? Side Effects? Contraindications?
``` Gemfibrozil, Fenofibrate, Clofibrate. TG Dyspepsia, gallstones, myopathy. Severe renal or hepatic dz. *dont use Gem w/ statins *Feno w/ low or mod statin if appropriate (keep eye on renal fx) ```
31
What are the 4 benefit groups?
1. clinical ASCVD- age 7.5% high 3. LDL >190-high 4. Risk >7.5% mod to high Risk 5-<7.5% mod o/w ATP III
32
What do you use for Stage A HF?
ACE (if AA then diuretic and ACE) | *if intolerant, try ARB or hydralzaine with oral nitrate
33
What do you use for Stage B?
(ACE or ARB) + BB
34
What do you use for Stage C?
- ACE + BB - fluid? loop - sxs still? ARA or ARB or digoxin or hydralizine/ISDN - HTN? ARA or ARB or hydralizine/ISDN or CCB dihydro - Angina? nitrates, CCB dihydro * aldosterone antag shown to improve mortality esp if EF<40%
35
Which drugs precipitate HF?
anti-arrhythmics, BB, CCB, NSAIDs, COX2 inhibitors
36
What are the Ca channel blockers?
``` Non-dihydro= verapimil and diltiazem= HR Dihydro= nifedipine and amlodipine (extended release)= Vasodilate ```
37
Which drugs for Stage D?
none- surgery or palliative care
38
What are digoxin drug interactions?
antacids and bile acid seq decrease availability of dig | diuretics= dig toxicity (nausea, vomitting, abd pain, vision changes, AV block)
39
How do you monitor acute decompensating HF?
weight--> loop want CI >2 positive ionotrops- NE
40
What drugs for class I recommendation for chronic angina?
- aspirin if prior MI - BB in prior MI - statin if LDL >130 if CAD - ACE with CAD + DM or LVSD
41
What drugs for class IIa chronic angina?
- aspirin if no prior MI - BB if no prior MI - Statins w/ CAD LDL 100-129 - ACE with CAD or vascular dz * if suspect CAD and LDL 100-129=TLC, fibric or nicotinic acid - nitrates but have free period if taking continuously
42
Why use BB and nitrates together?
nitrates cause venodilation and hypotension so HR increases--> BB keep HR normal
43
What are the types of nitrates?
isosorbide dinitrate (dose free 14 hr), isosorbide monotrate (7 hr interval), long-acting transdermal (on 12-14, off 10-12 hr), nitroglycerin sl
44
What does ranolazine do?
reduce arrhythmias but doesn't drop BP or HR | don't use with statins or liver cirrhosis
45
For subset II (warm-perfuse and wet-congested) what is the treatment?
need to monitor bp before starting diuretics (don't start if SBP 1. start IV bolus loop and/or vasodilator 2. increase dose of loop 3. switch to continuous infusion 4. add different type, like thiazide 5. IV inotrope(milrinone or dobutamine) + PAC to guide therapy
46
What is the class I recommendation for acute angina?
-Nitrates
47
What do you do if BB don't work or are contraindicated in chronic angina Class I?
1. Don't work: Add CCB non-dihydro or long-acting nitrates 2. Contraindicated: CCB non-dihyrdo and/or long-acting nitrates
48
What are some benefits of using nitrates?
antithrombotic and antiplatelet effects
49
Which drugs affect iron absorption?
``` Al, Mg, Ca antacids tetracycline/docxycycline histamine proton pump inhibitors cholestyramine methyldopa fluoroquinolones ```

Pharm (8 decks)

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