Final Part 1 Flashcards
1
Q
Nitroglycerin
A
Nitrate (anti-angina)
2
Q
Isosorbide mononitrate
A
Nitrate (anti-angina)
3
Q
Ranolazine
A
Anti-angina
4
Q
PDE-5 Inhibitors
A
ED
5
Q
What anti-angina decreases preload? What anti-angina decreases O2 demand?
A
Decreases preload- nitrates
Decreases O2 demand- Ranolazine
6
Q
What anti-angina causes prolonged QT interval?
A
Ranolazine
7
Q
What anti-angina has interactions with PDE-5 inhibitors?
A
Nitrates (nitroglycerin and isosorbide monoitrate)
8
Q
Amidarone is primarily a ___ blocker. What class?
A
K+; 3
9
Q
What heart drug has an EXTREMELY long 1/2 life?
A
Amidarone (25-120 days)
10
Q
Amidarone can make your skin turn _____ due to photosensitivity
A
Blueish-grey
11
Q
Amidarone is ___ iodine. Increased risk for what?
A
40%; hypo/hyperthyroidism
12
Q
DIGOXIN IS VERY IMPORTANT TO KNOW ABOUT!!!!
Digoxin stimulates the ____ which releases ____, so it slows down the ____.
A
Vagus nerver; ACh; HR
13
Q
Digoxin is also good because it blocks the NaKATPase pump, so it causes ______
A
Increased contractility
14
Q
What is the therapeutic range for digoxin?
A
0.5-0.8
VERY NARROW
15
Q
Where is digoxin excreted?
A
Kidneys
16
Q
Digoxin adverse effects?
A
Seeing yellow; halos
17
Q
What is early digoxin toxicity signs?
A
Anorexia
N
V
18
Q
What is late digoxin toxicity signs?
A
Dysrhythmias MS changes (can progress to coma) Visual changes (seeing yellow and halos)
19
Q
Digoxin competes with ____ for the same sites. Why is this important?
A
Potassium!
If K+ levels are high, digoxin isn’t working well (little or no therapeutic effects)
If K+ levels are low, digoxin may be working too well (become toxic)
20
Q
HDL or LDL is good?
A
HDL
21
Q
Pravastatin
A
Dyslipidemia med (statin)
22
Q
Simvastatin
A
Dyslipidemia med (statin)
23
Q
Atorvastatin
A
Dyslipidemia med (statin)
24
Q
Rosuvastatin
A
Dyslipidemia med (statin)
25
Statins are dyslipidemia meds. They are the DOC for _____ LDL.
decreasing!!
26
Which statin has NO CYP interactions?
Pravastatin
27
Which statin is most commonly associated with rnhabdomyloysis?
Rosuvastatin
28
What are the pleiotropic effects of the statins?
1. Stabilizes arterial plaque
2. Anti-inflammatory properties
3. Anti-oxidant properties
4. Anti-platelet/thrombotic properties
29
A patient has nonalcoholic fatty liver disease and wants to know if they can take a statin. We know that statins have adverse effects of muscle pain (myopathy), hepatoxicity, and CYP interactions. Is it okay to still administer a stain?
Yes. With nonalcoholic fatty liver disease, there is no problems for hepatotoxicity.
*every other liver disease (hep, alcoholic), a statin would be contraindicated!
30
What preg category are statins?
X!!!!
31
How long does it take a statin to work? When should they be taken and why?
2 weeks; in the evening--that is when your body is making cholesterol and it works the best when it can block the production of cholesterol..if cholesterol is made at night, thats when it needs to be taken
32
Niacin (Vit. B3)
Dyslipidemia Med
33
#1 adverse effect of the dyslipidemia med Niacin?
Intense flushing (take aspirin 30 min prior to help) & itching
34
Bile acid sequestrants
Dyslipidemia
35
Cholesevelam
Bile acid sequestrates (dyslipidemia)
36
Ezetimibe
Dyslipidemia
37
Fibrates
Dyslipidemia
38
Fenofibrate
Fibrate-dyslipidemia
39
Gemfibrozil
Fibrate-dyslipidemia
40
The dyslipidemia meds that are fribrates (fenofibrate and gemifibrozil) are _____ and cannot be combined with ____. What is the most common adverse effects of these drugs?
Protein bound; can't be combined with WARFARIN
RASH and GI disturbances
41
Fish oil
Dyslipidemia
42
Non-statins do more of the _____ (effects on LDL, HDL, and TG). Statins do more of the _______ (decrease number of MI, stroke)
Non-statin: Surrogate endpoint
| Statin: Clinical endpoint
43
What level tell a doctor the patient has a hear problem. Elevated BNP or ANP?
BNP
44
Angiotensinogen is made by the ____
Liver
45
Renin is secreted by ____
Kidney
46
ACE is an enzyme found in the ____
Lungs
47
Angiotensin II causes _____
Vasoconstriction
48
ACE inhibitors
RAAS drugs
49
-Prils
ACE inhibitor (RAAS)
50
ARBs
RAAS drugs
51
-Sartans
ARBs (RAAS)
52
Adverse effects of ACE and ARBs (RAAS)?
```
HAHA
first-dose HYPOTENSION (fall risk!!!)
ACUTE kidney injury
HYPERKALEMIA
ANGIOEDEMA
```
53
What RAAS is cardioprotective?
ACE (-prils)
54
What RAAS causes dry cough?
ACE (-prils)
*because ACE normally breaks down bradykinin, when we block ACE with RAAS drugs, bradykinin doesn't get broken down so a cough happens
55
BB: Normal effects of A1, B1, B2?
A1- constrict
B1- Heart beats faster and with more force
B2- Dilation
56
BB: What happens when we block A1, B1, B2?
A1 block-dilation
B1- slow HR
B2- Constriction (BAD FOR ASTHMA PTS)
57
Cardioselective BB?
```
Atenolol
Metoprolol tartrate (2x/d)
Metoprolol succinate (long lasting)
```
58
What BB blocks B1 and B2?
Propranolol
59
What BB blocks A1, B1, and B2?
Carvedilol
60
Who takes BB?
HAHAP
- HTN
- Angina
- HF
- A-fib
- Post-MI
61
What else is Propranolol indicated for?
Crosses BBB so for MIGRAINE prophylaxis
Hemangioma
Stage fright
62
Big adverse effect of BB?
MASKING HYPOGLYCEMIA (signs to look for would be hungry, dizzy, forgetful NOT the usual shaking)
other adverse effects= symptoms of decreased BP or HR, fatigue/depression, bronchospasm [nonselective ones]
63
BBW for BB?
Do not abruptly stop a BB unless absolutely necessary!!!
64
Can we give a BB to someone with severe peanut allergy?
No; if they eat a peanut, we would need to give EPI...but if they are taking the BB, the BB blocked the EPI receptors, so the EPI WILL NOT HELP THE ALLERGIC REACTION!!
65
Dihydropyrindes and non-dihydropyridines
CCB
66
Nifedipine XL
D (CCB)
67
Amlodipine
D (CCB)
68
Amlodipine/benazepril
D (CCB) [combined with -pril {ACE inhibitor}]
69
CCB: D are arteries, heart, or both?
Effect the arteries only
| HTN and Angina
70
CCB: Non-d are arteries, heart, or both?
Both;
HTN
Angina
A-fib
71
Verapamil
Non-d (CCB)
72
Diltiazem
Non-d (CCB)
73
What if a client who is taking CCB says "my shoes don't fit"
They are experiencing DOSE-DEPENDENT PERIPHERAL EDEMA [most common complaint!!!]
74
4 adverse effects of CCB?
dose-dependent peripheral edema
headache
flushing
dizziness
75
What CCB class causes reflex tachycardia?
The D
| Primarily nifedipine IR--potentially dangerous!! Combine with BB to help reduce the risk of it!!
76
Since non-d blocks receptors in both arteries and heart, what are some side effects associated?
Bradycardia
CYP interactions
Constipation (VERAPAMIL)
Avoid with HF and blocks!
77
Furosemide
Loop diuretic
78
HCTZ
Thiazide diuretic
79
Spironolactone
Potassium sparing diuretic
80
Mannitol
Osmotic diuretic
81
___ & ___ diuretic cause HYPOkalemia
What foods to give?
Furosomide and HCTZ
Dried fruit, nuts, spinach, potatoes, bananas, avacado
82
____ diuretic causes HYPERKALEMIA
Spironolactone
83
BIG adverse effect of furosemide?
Ototoxicity (transient)
Do NOT combine with amino glycoside (gentemycine)
84
What 3 things does HCTZ increase?
Calcium, uric acid, and glucose!
85
Adverse effects of spironolactone?
HYPERkalemia
Gynecomastia
Menstrual irregularities
Impotence
86
Mannitol is given ___ and must be kept [warm or cold] so it won't crystalize. Indication?
IV; warm; cerebral edema [ICP]
87
Statins are pregnancy risk category ___
X
88
Talk about nitroglycerin (anti-angina)
Sit or lie down bc drops BP quick
DISSOLVE TAB UNDER TONGUE -do not swallow!
Wait 5 min
If angina is still there, take another tab and call 911
*can take up to 3 tabs q5 min
89
Talk about isorobide mononitrate teaching (anti-angina)
DO NOT CRUSH
Only lasts 12 hours
Must have "nitrate free interval"
Improves exercise tolerance
90
Nitrates cause VASODILATION. Expected SE?
Headache
Orthostatis (decreased BP)
FLushing
Dizziness
91
ST elevation with ___ angina
Prinzmetal
92
ST depression with ____ and ___
stable and unstable angina
93
Nitrates and _____ DO NOT COMBINE
PDE-5 Inhibitors (ED drugs)
94
Ranolazine (anti-angina) is long acting and it can cause _______
Torsades de pointes --which can lead to V-fib..which is FATAL
95
What drug has a REALLY LONG HALF life?
Amiodarone
96
What drug has a very narrow therapeutic range and is indicated for A-fib (stimulating vagus nerve) and HF (blocking NaKATPase pump)?
Digoxin
| therapeutic range= 0.5-0.8
97
What drug may you see yellow or halos?
DIGOXIN
98
Early toxicity of digoxin? late?
Early: anorexia, N/V
Late: dysrhythmias, MS changes, Visual changes
99
Digoxin competes with _____!!! MUST MONITOR BOTH THESE LEVELS
POTASSIUM!!!!!!!
100
Is digoxin cardioprotective?
NO; take an ACE to get cardioprotective benefits
*ACE are -prils
101
Aspirin
Blood thinner
102
Clopidogrel
Blood thinner
103
Big effects of aspirin?
GI problems
| Tinnitus (ringing of the ears)--dose dependent
104
Clopidogrel doesn't work for a lot of people due to genetic variance and it causes multiple interactions. Lots of people quit taking it. Is it okay to stop it abruptly??
NO; can cause thrombotic clot!
105
Warfarin
Blood thinner
106
Heparin
Blood thinner
107
Enoxaparin
Blood thinner
108
Warfarin is very unpredictable, meaning it has a high variable response..mainly due to diet and genetics. Warfarin blocks the reactivation of _____.
Vitamin K
109
Digoxin competes with ____.
| Eating lots of ____ can effect Warfarin.
Digoxin competes with K+ (potassium)
| Eating lots of Vit. K can effect warfarin (more vit. k, the higher the dose of warfarin!!)
110
What test do you monitor when taking Warfarin?
Prothrombin time (PT)
International normalized ratio (INR)
*INR corrects PT
111
It takes warfarin ~__days to reach the goal of thinning blood
~5 days
112
S/S of bleeding when taking warfarin?
Melena
Blooding looking urine
Coffee ground vomit
113
What are novel oral anticoagulants?? (POSSIBLE ATI QUESTION)
Dabigatran
RivaroXAban
ApiXAban
highly predictable, no routine blood work, works immediately, safer-more effective
114
Is heparin rapid acting or slow acting?
RAPID
115
Can heparin cross BBB?
NO
116
Heparin look at ___ levels
PTT
117
Heparin inhibits both ____ so it works immediately.
Warfarin blocks the reactivation of ____ so the liver stops making clotting factors. but the clotting factors that were already in the blood are still there up to ~___, which makes warfin a slower acting blood thinner.
Enoxaparin inhibits ____
Factor X and II
Vit. K; ~5 days
Factor X
118
Protamine sulfate
Antidote for heparin overdose!
119
Lots of monitoring with enoxaparin?
No
120
Special administration with enoxaparin?
- SQ ONLY
- Love handles preferred
- Predosed syringe
- LEAVE THE AIR BUBBLE IN
121
Normal Hgb range for women? men?
Women: 12-15
Men: 14-17
122
4 ingredients to RBC?
Basically you could have anemia if one (or more) of these "ingredients" are deficient
Iron
Vit B12
Folic Acid
Erythropoietin (EPO)
123
How can iron be administered?
PO, IV, IM
124
What are some weird things about iron?
Can cause dark green or black stools and this is NORMAL
| Stains the teeth (liquid version)
125
Iron taken with food or on empty stomach?
Empty stomach
*body can't absorb more than 200 mg/d
126
Ferrous sulfate
Iron (anemia med)
127
Vit B12 deficiency due to not getting enough in their diet or problems with absorption?
Problems with absorption
128
Can cause pernicious anemia
Vit. B12 deficiency
129
Cyanocobalamin
Vit. B12 drug (anemia med)
130
Clopidegril
Blood thinner (works poorly)
131
Vit. B12 can cause HYPO or HYPERkalemia?
HYPOkalemia
132
What GI disorder decreases the absorption of folic acid?
Sprue
133
If a mother doesn't have sufficient stores of folic acid very early in pregnancy, there is a significant risk of _____
Neural tube defects--spina bifida
take an additional 400-800 mcg/d if pregnant!!
134
Short term adverse effects of folic acid? long term?
Short term: none
| Long term: cancer
135
Epoetin alfa
EPO drug (anemia)
136
Darbepoetin alfa
EPO drug (anemia)
137
Who gets EPO drugs?
- anemia due to CHRONIC LIVER FAILURE
- Chemotherapy induced anemia
- HIV clients taking AZT
138
Most common issue for EPO drugs?
HTN--cant take EPO if you have uncontrolled BP
Others are cardiovascular effects and tumor progression (in the cancer patients)
139
We want to take EPO drugs only if they are REALLY NEEDED. Remember Hgb in males in 14-17 and in females 12-15. We want to stop taking the EPO when Hgb levels reach ____.
If Hgb gets above 11 because we don't want the Hgb to rise too quickly.
140
In a 2 week period, EPO drugs should NOT rise by more than ____.
1 gm/dL
7.1 initially...EPO and two weeks later the Hgb is 8.4. DOSE NEEDS LOWERED. It rose more than 1 gm/dL
141
How should EPO be stored?
Fridge
Don't freeze
Dont shake (its a protein and will break)
142
Short term complications of diabetes?
Hyperglycemia--Ketoacidosis and HHNS
| Hypoglycemia
143
Long term complications of diabetes?
Macrovascular damage (Heart disease, HTN, stroke)
Microvascular damage (Retinopathy, neuropathy, sensory and motor neuropathy, autonomic neuropathy [gastroparesis], infection & amputation, ED)
144
Know the difference between type 1 and type 2 diabetes.
Type 1: Beta cell destruction; can lead to DKA
| Type 2: Insulin resistance; HHNS
145
Hypoglycemia SNS [fight or flight responses] activation?
Tachycardia
Palpitations
Sweating
Nervousness
146
Hypoglycemia decreased glucose in CNS responses?
Headache
Confusion
Drowsiness
Fatigue
147
What drug blocks the SNS activation? What does this mean?
BETA BLOCKERS
Teach patints that low blood glucose is going to be shown as headache, confusion, drowsiness, and fatigue if they are also on a BB
148
Fasting plasma glucose indicating diabetes?
Greater than or equal to 126
149
Causal plasma gluocse indicating diabetes?
greater than 200 mg/dL PLUS symptoms
150
Hgb A1C indicating glucose?
greater than/equal to 6.5%
151
Symptoms of diabetes?
Polyuria
Polydipsia
Polyphagia
152
How many times do you check levels if you are preg. and diabetic ?
6-7x/d
153
Oral agents are approved only for type __ diabetes
Type2
154
Metformin
Oral agent diabetes
155
Sulfonylureas
Oral agent diabetes
156
TZDs
Oral agent diabetes
157
DPP-4 inhibitors
Oral agent diabetes
158
SGLT-2 inhibitors
Oral agent diabetes
159
Glipizide
Sulfonylureas (oral agent diabetes)
160
Rosiglitazone
TZD (oral agent diabetes)
161
TZD suffix?
-Glitazone
162
Sitagliptan
DPP-4 inhibitors (oral agent diabetes)
163
Canagliflozin
SGLT-2 inhibitors (oral agent diabetes)
164
Metformin
Oral agent diabetes
165
Glyburide
Sulfonylureas (oral agent diabetes)
166
Glimepridide
SUlfonylureas (oral agent diabetes)
167
Pioglitazone
TZD (oral agent diabetes)
168
DPP-4 Inhibtors (diabetes)?
Sitagliptan
169
SGLT-2 inhibitors (diabetes)?
Canagliflozin
170
TZDs (diabetes) ?
Rosilitazone
| Pioglitazone
171
Sulfonylureas (diabetes)?
Glipizide
Gluburide
Glimepiride
172
Most common adverse effect of metformin (oral diabetes), aka the DOC? Does metformin cause you to gain weight?
Diarrhea and flatulence
| No, weight NEUTRAL
173
Glipizide, glyburide, glimepiride are all sulfonylureas (oral agent diabetes). What are their 3 adverse effects?! They have a _____ reaction & ____ HYPOglycemic effects.
```
HYPOgltcemia
Weight gain (5-10 lbs)
Burn out (5-10 years)
```
Disulfiram like reaction; potentiate
174
Which glitazone (TZD-oral diabetic) causes mixed effects on the lipids?
*these take 3-4 months to start working
Pioglitazone
175
Sitagliptan (DPP4 inhibitor-oral diabetic) may cause ____ issues and pancreatitis [rare]
Upper respiratory issues (runny nose)
176
What oral diabetic med is taken BEFORE breakafst?
SGLT-2 inhibiors (canagliflozin)
177
What are the adverse effects of SGLT-2 inhibitors?
Weight loss (5-7 lbs)
Dehydration
HYPERkalemia
GENITAL INFECTIONS (fungal)
178
What oral diabetic has a rare adverse effect of lactic acidosis?
Metformin
179
What oral diabetic has weight gain of 5-10 lb?
Sulfonylureas (glipizide, glyburide, glimepiride)
180
What oral diabetic has weight loss of 5-7 lbs?
SGLT-2 inhibitors (canagliflozin)
181
What oral diabetic is weight neutral?
Metformin
182
Is TZD causing weight loss or weight gain? Why?
Gain--because it has Na+ retention and that causes edema which causes weight gain!!!
183
What oral agent diabetic do you take before breakfast?
SGLT-2 inhibitors (canagliflozin)
184
Major DPP-4 inhibitor (oral diabetic)?
Sitagliptan
185
Proton pump inhibitors & H2 blockers are what kind of meds?
Anti-ulcer
186
Proton pump inhibitors suffix?
-PRAZOLE
187
Most prazoles (proton pump inhibitor-antiulcer) are DR forms, meaning ____.
Don't crush the tab!!
188
Big adverse effect of parazole (proton pump inhibitor-antiulcer)?
Acid rebound (taper dose when discontinuing)
189
Controversial adverse effects of parazoles (proton pump inhibitors)?
Pneumonia
C.diff
Decreased levels in Vit.B12, iron, magnesium, calcium
Osteoporosis
190
When do you take a prozole?
AM before breakfast!!
191
H2 blocker suffix?
Tidine
192
Do H2 blockers have a rebound effect?
Yes! (taper dose when discontinuing)
193
Antacids
Antiulcer
194
Sucralfate
Antiulcer
195
What does sucralfate do? How long does it last?
| pH requirement?
Creates a cover/protective barrier around the ulcer; ~6hr
| A little acidic for it to work--pH less than 4
196
Antacids raise pH. They can work systemically. What happens if your pH is 7.5?
You have metabolic alkalosis
197
Docusate sodium
Stool softener laxative
198
Important thing to do if taking docusate sodium? How long till BM?
Take with full glass of water; several days
199
PEG 3350
Osmotic laxative
200
When is BM with PEG 3350? What is PEG 3350 good for? Teaching?
BM 2-4 days
Chronic constipation
Teaching: dissolve in 4-8 oz and takes 5-10 min to completely dissolve
201
Senna
Stimulant laxative
202
Bisacodyl
Stimulant laxative
203
Senna/docusate
Stimulate laxative + stool softener
204
When do you have BM with stimulate lax?
12 hour if taken PO, 1 hr if taken PR
205
What is the weird effect with senna?
Yellowish-brown or pink urine
206
PEG 3350 w/ electrolyes?
Bowel prep lax
207
Talk about PEG 3350 with electrolytes.
Must drink 4 L and it has high Na concentration so it tastes like salt
Teaching: Chill beforehand, add crystal light, chug-dont sip it, and have easy access to a toilet
208
Dicyclomine
What receptor?
What side effects?
```
Diarrhea med (anticholinergic-slows down bowel motility)
Typical anti-cholinergic effects
```
209
Loperamide
What receptor?
What side effects?
```
Diarrhea med (works on mu receptor-slows down bowel motility)
Well tolerated
```
210
Diphenoxylate/atropine
| What side effects?
```
Diarrhea med (opioid that slow down bowel motility and atropine is added for anticholinergic to help with the opiod effects f diphenoxylate)
If they took too high a dose, then anti-cholinergic effects and a buzz..if a normal dose, drug is well tolerated
```
211
Dicyclomine (diarrhea med) is given for a disorder that can cause diarrhea. Example?
IBS
212
Does loperamide (diarrhea med) cross BBB, since it's an opioid?
No...so no pain relief, euphoria, or addiction with it!
213
Diphenoxylate is an ____.
Atropine is an _____.
Why do we give atropine?
Diphenoxylate is an opioid and it can cause a buzz if you take too high of a dose of it. That's why atropine is added, because it atropine is an anticholinergic, because if this drug is taken in high doses, the pt. will experience anti-cholinergic effects. AKA ones no one wants. So the buzz happens if you take too high a dose, but all these other effects happen too, and people don't want those effects along with their "buzz"
Schedule 5
214
Atropine
Part of the diphenoxylate drug for diarrhea but ALSO USED IN CODE SITUATIONS
215
If someone has an acute infection of diarrhea, do we give anti-diarrhea drugs?
NO; we want to see what the underlying cause of the diarrhea is!!!! The drug only works on the receptors in the gut and don't necessarily treat the cause!
216
3 diarrhea drugs?
Dicyclomine
Loperamide
Diphenoxylate/atropine
217
4 antiemetics (anti-vomiting) drugs?
Ondansetron
Promethazine
Prochloperazine
Metoclopramide
218
What antiemetic is a "clean drug"? Why?
Ondansetron; it only blocks one receptor [5-HT3]
219
Big issue with Ondansetron (anti-vomiting)? But is this issue common or rare?
Can prolong QT interval
Rare--this only happens if you are taking a REALLY high dose of the drug..normal dose would be about 8mg, but if you took 30mg, you may be at risk for prolonged QT--who takes that high of a dose? CHEMO PATIENTS!!
220
Why is it good that Ondansetron (anti-vomiting) comes in all sorts of forms?
Bc sometimes you can't keep down anything and the PO route wouldn't work
221
What is the major receptor Phenothiazine blocks?
Histamine
222
Side effects of Phenothiazine?
EPS (bc blocks dopamine), orthostatic hypotension (bc blocks alpha1)
223
Who CANNOT take Phenothiazine (anti-vomiting)?
Children under age 2 because it can cause severe respiratory depression--deaths have occurred
224
If Phenothiazine (anti-vomiting) drug infiltrates, then what happens?
Can lead to gangrene and amputation
225
What receptor does Prochlorperazines (anti-vomiting) block? What does this mean?
Blocks DOPAMINE!
| EPS effects!!!
226
- What receptor does Metoclopramide block?'
- What does this mean?
- What does it increase (good thing), so who would that be good for??
- What's the big problem with it and the BBW?
- DOPAMINE
- EPS side effects!
- Increases gastric motility...a lot of long term diabetics experience this microvascular effect, and giving Metoclopramide is good for them to increase the gastric motility!
- EPS!!!! DO NOT TAKE METOCLOPRAMIDE MORE THAN 12 WEEKS!!! (the risk of tardive dyskinesia increases)
