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FA17 Cardio 2 > Jill Pharm > Flashcards

Jill Pharm Flashcards

(46 cards)

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1
Q

Tx goals in Ischemic Heart disease

Short term

A

Reduce or prevent symptoms of angina that limit exercise capability and impair QoL

Restore balance between supply and demand

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2
Q

Tx goals of ischemic heart dz

Long term

A

Prevent CHD events such as MI, arrhythmia, HF

Prevent morbidity and mortality

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3
Q

Classes of drugs in angina pectorals

A

Cardio selective beta blockers

Calcium channel blockers

Nitrates

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4
Q

First line maintenance therapy for stable angina

A

Beta blockers

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5
Q

MOA BB

A

Inhibit catecholamine neurotransmitters at B1 and B2 receptors

Lower HR and force of contraction, plasma renin activity
Prevent sympathetic response to exercise or stress

Increase coronary blood flow and decrease HR, contractility, wall tension

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6
Q

Beta blockers subtypes

A

Cardioselective - MC, decreased mortality, better in pts with HF, asthma, COPD, Dm

Non selective - no mortality data, worse for COPD/asthma/cough

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7
Q

BB use in therapy

A

Only anti-angina drug proven to prevent re-infarction and improve survival in pts with MI

NOT used in patients with vasospastic angina (can increase vasospasm)

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8
Q

What must be monitored in BB use?

A

HR (dc if <55bmp)

BP (dc if <115)

Nitrate usage and angina symptoms

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9
Q

Nitrates MOA

A

Converted to nitric oxide to cause venous dilation (some arterial)

Increase myocardial oxygen supply
Decrease in myocardial oxygen demand

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10
Q

Nitrate formulations

A

IV NTG (acute CP, HTN)

SL NTG (Acute CP)

Isosorbide dinitrate (chronic CP)

Isosorbide mononitrate (chronic CP)

NTG patch (chronic CP)

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11
Q

Side effects of nitrates

A

Tolerance (tachyphylaxis due to reduced C-GMP, can happen right away)

Headache

Flushing

Orthostasis

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12
Q

Nitrate drug interactions

A

PDE-5 inhibitors (pulmonary HTN and ED)

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13
Q

Contraindications for nitrates

A

PDE-5 inhibitors in past 24 hrs

Hypertrophic cardiomyopathy

Use with caution in aortic stenosis (decreased pre-load) and volume depletion

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14
Q

Monitoring in nitrates

A

BP, HR (may have hypotension, tachycardia)

SL PRN usage and CP

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15
Q

Sublingual nitroglycerin

A

Taken PRN (max 3 tabs or sprays 5 min apart over 15 min)

HA can mark potenentcy, sit down before placing under tongue and dont chew or swallow

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16
Q

Long acting nitrates

A

Isosorbide mononitrate - extended release, 1 per day

Isosorbide dinitrate - 2-3 times per day

Not PRN, given every day for stable angina (no acute episodes)

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17
Q

Calcium channel blockers MOA

A

Blocks calcium entry into vascular smooth muscle cells

Non-DHP = decrease HR and contractile force (verapamil, dilitiazem)

DHP = decrease smooth muscle tone vascular to decrease SVR (amlodipine, nifedipine, felodipine)

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18
Q

CCBS use and monitor

A

Use for stable angina when BB are CI or stopped bc of ADRs

Combo with BB when BB and nitrates are not enough

Monitor: HR, BP, PRN nitrate use, angina symptoms, edema, constipiation, rash

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19
Q

ranolazine (Ranexa)

Use/MOA

Study These Flashcards
A

Inhibits late phase of sodium channel

Prolongs ventricular AP
Reduces ventricular tension
Decrease oxygen demand

NO EFFECT ON HR or BP

Chronic stable angina in combo therapy or inadequate response with other anti-angina agents

20
Q

Side effects of Ranolazine

Study These Flashcards
A

Constipation
Headache
Nausea
Dizziness

LOW DC RATE, avoid in pts with cirrhosis

21
Q

Ranolazine drug drug interactions

Study These Flashcards
A 
D- digoxin  
A - azole derivatives
N - non-DHP CCB 
G - grapefruit
S- Simvastatin
22
Q

Ischemic heart disease treatment goals

Study These Flashcards
A
  1. Alteration of atherosclerosis via risk factor modification
  2. Provide symptomatic relief using pharm agents
23
Q

Risk factor - post menopausal hormone replacement

Study These Flashcards
A

Associated with lower CHD

HERS trial (no difference, increased thromboembolism issues)

Women’s health initiative (increases CHD, stroke, emboli events, breast cancer)

NOT recommended in primary or secondary prevention

24
Q

Acute coronary syndromes

Treatment goal

Study These Flashcards
A

Relieve chest discomfort

Optimize blood flow to infant or related artery

Prevent coronary occlusion

Prevent death

25
Acute drug therapy (8)
``` Analgesia Nitroglycerin Lidocaine Beta blockers Fibrinolytics Asa Heparin Mg ```
26
drugs NOTused during acute MI
``` Digoxin Nitroprusside CCB NSAID Enalapril Steroids ``` “Do Not Consider in aN Emergent Setting”
27
Morphine DOC and MOA
DOC for acute management of pain with MI NOT RELIEVED WITH NG OR BB Blocks sympathetic efferent discharge causing venous and arterial dilation
28
Morphine dose and monitor
1-5 mg IV q 5-15 min Pain relief, allergic response, vitals (BP, HR, RR), CNS/respiratory depression Can be reversed with NARCAN
29
Nitroglycerin in an acute setting
Relieves pain decreasing preload and oxygen demand SL nitro first, then IV drip if pain persists (should have gotten SL in ambulance) Avoid in BP <90, CI in cases of RV INFARCTION Don’t use for more than 48hrs (unless persistent CP, HF, or HTN)
30
Oxygen in an acute setting
Indicated in patients with O2 Sat under 90– otherwise induce vasospasm Given to pts with high oxygen demand Don’t over do in COPD
31
Beta blockers in the acute setting Actions
Immediate administration reduces the size of infarction via improving perfusion Decreases further infarction, recurrent ischemia, reinfarction Decreases mortality Decrease ventricular arrhythmia
32
Administration BB acute setting
Oral in first 24 hrs to pts w/o CI IV can be used, but not better (can cause HoTN) No benefit if given prior to PCI Titration to HR of 70 bpm
33
CI to BB in acute setting
Signs of HF Bradycardia (<55bpm) HoTN/cardiogenic shock Greater than first degree AV block ACTIVE asthma and bronchospasm
34
CCB in acute MI setting
symptom relief ONLY (after event normally) NSTEMI (no relief despite max BB and nitrates — still choose morphine) Pts with ACS, unable to tolerate BB Typically in drugs that we avoid
35
Anti-coagulation during acute event
Stops propagation of clot and assists in preventing re-occlusion unstable angina or NSTEMI - LMWH preferred or UFH UFH is given in PCI bc less drug interactions
36
Alternative to heparin in anticoagulant tx in acute event
Fondaparinux (Arixtra) Bilvalrudin (angiomax) - direct thrombin Rivaroxaban (Xarelto)
37
ASA MOA, ADR, CI
Block Cox1 and Cox 2 = Decreased thromboxane A2 formation ADRS= GI bleed, hypersensitivity, bleeding CI: EtOH use, high dose in CKD, children and teens, pregnancy
38
Thienopyridines
Plavix (CLopidogrel) Prasugrel (Effient) Ticagrelor (Brilinta) Blocks activation of GP 2b/3a receptor, reducing platelet aggregation
39
Clopidigrel Indications, brand, dosing
Plavix MI/ACS (UA/NSTEMI/STEMI) Stroke PAD Dosing: 75mg/day, 300-600mg loading dose
40
Plavix ADR
bleeding (esp. >70 or <60kg) TTP CKD can cause problems with serum [ ] Poor metabolizers - genetic disorder causing ineffective breakdown
41
Prasugrel (Effient) Indications and pharmacokinetics
ACS, CAD C/i in patients older than 75 or history of stroke/TIA No renal or hepatic adjustments needed but liver might be
42
Prasugrel Effient Dose, BBW
Dose: loading 60mg, 5-10 daily BBW: d/c in >75 yrs (fatal intercranial bleeding and uncertain benefit), hold 7+ days prior to six
43
Ticagrelor Brand, indications, dose
Brilinta ACS, CAD Dose: 180 mg loading, 90 mg bid
44
Brilinta ADR, BBW
Ticagrelor ADR: increased bleeding risk, dypsnea, caution in gout BBW: reduced efficacy with ASA use (low dose only), dc 5 days before sx, metabolized by liver, tablets crushed
45
IV GP 2b/3a
Used during PCI Intense inhibition of platelet function
46
Fibrinolytics
late please Activates plasminogen (converts plasmin) Beneficial in limiting infarct size, improving LV function and reducing mortality 12-24 hrs of CP (significant ST elevation, invasive strategy is not option) UFH/LMWH/fondaparinux

FA17 Cardio 2 (10 decks)

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