Natsumi Pharm - Cardio, Heme Flashcards

Question

Diltiazem indication, SE, CI

Answer 1

CCB - arrhythmia (works directly on the heart) S/E: Peripheral edema, HA, stomach upset, Contraindicated in sick sinus syndrome, 2nd/3rd degree AV block, hypotension, acute MI + pulmonary congestion

Answer 2

Amlodipine - Potassium wasting & vitamin D verapamil - vitamin E Ditiazem - None known

Answer 3

Other antihypertensive drug C/I: coronary heart dz, mitral valvular rheumatic dz Nutrient depletion: Vitamin B6

Answer 4

Beta agonist - Hypotensive crisis, bradycardia, HF, cardiac stabilization before pacemaker implantation, anaphylaxis - IV in the hospital Part of crash cart for BOTTOMED out BP Pregnancy category C

Answer 5

Nitrate - angina (acute & prophylaxis) Half-life of about 5 minutes; active metabolites with 40 minute half-lives Dosed sublingually for symptomatic discomfort, up to 3 doses (q 5 min); then to ER!!! Available as transdermal patch and ointment, too S/E: Headache; fast, slow, pounding, or uneven heart rate; blurred vision or dry mouth; feeling light-headed, nausea, vomiting, sweating, pale skin fainting; or fever, sore throat, and headache with a severe blistering, peeling, and red skin rash Contraindicated with concomitant use of cGMP PDE-5 inhibitors**

Answer 6

Nitrate - angina prophylaxis only Headache; fast, slow, pounding, or uneven heart rate; blurred vision or dry mouth; feeling light-headed, nausea, vomiting, sweating, pale skin fainting; or fever, sore throat, and headache with a severe blistering, peeling, and red skin rash Contraindicated with concomitant use of cGMP PDE-5 inhibitors**

Answer 7

Folate, B12 and vitamin C (folic acid & C may decrease tolerance) Consider: Arginine, Lysine, L-carnitine

Answer 8

Class Ib anti-arrhythmics - Ventricular arrhythmias Alternative (last resort) option anti-arrhythmic and anti-epileptic (status epilepticus) Amide local anesthetic No known nutrient depletions Pregnancy category B

Answer 9

Class Ic - Paroxysmal supraventricular tachycardias (PSVT) or paroxysmal atrial fibrillation/flutter (PAF) with disabling symptoms or life-threatening ventricular arrhythmias DO not use in people with hx of MI No known nutrient depletions Pregnancy category C Black box warning: increased mortality.

Answer 10

Lidocaine and Flecanide LAST RESORT after trying other anti-arrhythmic classes!

Answer 11

Beta blockers

Answer 12

K+ channel blockers - Amiodarone

Answer 13

``` Mostly class III, but acts as class I, class II, class IV Mechanism of action may be due to a prolongation of the myocardial cell-action potential duration and refractory period (inhibits potassium channels—class III-like) non-competitive antagonism of α- and β-adrenoceptors (class II-like) ``` Reverse use-dependency: prolongation most pronounced at slow rates (undesirable), least pronounced at fast rates (desirable) Inhibits repolarization Useful in recurrent ventricular fibrillation and recurrent hemodynamically unstable ventricular tachycardia Monitor - thyroid state

Answer 14

Side effects: hypotension, pulmonary toxicities (potentially fatal), hyperthyroidism/hypothyroidism due to structural similarity to thyroxine, abnormal increase in hepatic enzymes, AV nodal block & bradycardia Contraindicated in cardiogenic shock, second or third-degree heart block, severe SA node dysfunction with marked sinus bradycardia or syncope Nutrient depletions: Vitamin B6 Pregnancy category D

Answer 15

Digoxin, Potassium chloride

Answer 16

Bradycardic and inotropic Used in heart failure (has not been shown to improve survival, but may palliate symptoms, improve functional status, reduce hospitalizations), atrial fibrillation, to control ventricular rate in patients with long-standing atrial fibrillation Class V anti-arrhythmic (“Other”) Excreted primarily via kidneys, unchanged; gut, liver metabolism Reduce dose in chronic kidney disease Watch potassium levels! Hypokalemia increases myocardial localization of digoxin; may use potassium to decrease symptoms of digoxin toxicity Interacts with β-blockers, calcium channel blockers, potassium-wasting diuretics, many antibiotics, verapamil, quinidine, amiodarone Anti-digoxin antibodies are available for life-threatening digoxin toxicity Depletes calcium Pregnancy category C

Answer 17

Very narrow therapeutic window Used in hypokalemia due to digitalis intoxication, familial periodic paralysis, diuretic use, cardiac arrhythmias Side effects: hyperkalemia (contraindication), gastric/intestinal irritation and bleeding Pregnancy category C

Answer 18

Diuretic that exerts effect in loop of Henle Used in edema (all causes) and hypertension Also used in malignant hypertension and volume-based hypertension in patients with advanced chronic kidney disease Use in mild-moderate chronic hypertension not as useful (short half-life) SE: Electrolyte imbalances, thirst; Tinnitus, loss of hearing (dose-related ototoxicity)

Answer 19

``` Calcium Magnesium Potassium Vitamins B (1,6,12) Sodium Zinc Folic Acid CoQ10 Mixed tocopherols Vitamin C ```

Answer 20

``` Thiazide diuretic Until recently (JNC-8), was first step therapy for hypertension Hydrochlorothiazide (HCTZ), Hydrodiuril Used alone and/or in combination Treatment of chronic hypertension ``` SE: Blurred vision, headache (may idiosyncratically cause acute myopia & secondary angle-closure glaucoma) Upset stomach, nausea, vomiting, diarrhea Weakness, dizziness Cramps, thirst

Answer 21

``` CoQ-10 Magnesium Sodium Potassium Zinc ```

Answer 22

K+ sparing diuretic Aldosterone receptor antagonist, significant androgen receptor blocking action; competitive inhibitor of testosterone and dihydrotestosterone Used in edema, CHF, primary aldosteronism, essential hypertension, hypokalemia Triamterene, Dyrenium Blocks epithelial sodium channels in the late distal convoluted tubule (DCT) and collecting duct which inhibits sodium reabsorption from the lumen. This effectively reduces intracellular sodium, decreasing the function of Na+/K+ ATPase, leading to potassium retention and decreased calcium, magnesium, and hydrogen excretion. Used in edema. Off-label use: hypertension in children/adolescents and anti-hypertensive diuretic induced hypokalemia. Used primarily in a combination (used alone, much less effective in reducing hypertension) SE: Hyperkalemia, tumorigenic. DO NOT USE WITH ACEi, ARB

Answer 23

Folic acid | Zinc

Answer 24

Indications for use: DMII (NIDDM) in conjunction with diet and exercise, heterozygous familial hypercholesterolemia, hyperlipidemia Contraindications: history of bowel obstructions, TG > 500, history of hypertriglyceridemia-induced pancreatitis Side effects: GI complaints Pregnancy category B

Answer 25

CRAP LOAD! ``` Riboflavin Folic acid Vitamin B12 Vitamin B6 Mixed tocopherols/tocotrienols Coenzyme Q-10 ``` ``` Magnesium Vitamin K Vitamin D Vitamin A Carotenoids Essential fatty acids ```

Answer 26

To be used in triad of LOW HDL + HIGH LDL + High Triglycerides** To be used AFTER diet, exercise, weight loss, other pharmaceuticals (bile acid sequestrants, niacin) have been tried Uses: Treatment of adult patients with very high elevations of serum triglyceride levels (Types IV and V hyperlipidemia) who present a risk of pancreatitis and who do not respond adequately to a determined dietary effort to control them. (Patients who present such risk typically have serum triglycerides over 2000 mg/dL.) Warning: GALLBLADDER DISEASE, ABDOMINAL PAIN LEADING TO APPENDECTOMY AND OTHER ABDOMINAL SURGERIES, SE: DVT, SOB, pulmonary embolism; Coughing up blood, Increase in homocysteine levels

Answer 27

``` Vitamin E, B12 Copper Zinc CoQ10 (Vitamins B6, folic acid) (because fibrates increase homocysteine) ```

Answer 28

The increased risk with niacin for myopathy! Statins with gemfibrozil inceases rhabdomyolysis The first dose gives you the biggest reduction; takes abourt 3 weeks to figure out how it wil affect the blood look at the lipid panel to adjust dosing Metabolized primarily in the liver (CYP450!)

Answer 29

CoQ-10 Consider co-administration of L-carnitine, Vitamin C, omega-3 fatty acids

Answer 30

SE: Neuropathy; rhabdomyolysis; Memory loss; ; Blood sugar irregularities Contraindicated in acute liver disease Pregnancy category X

Answer 31

Used for: hyperlipidemia, including homozygous familial hypercholesterolemia (HoFH) and homozygous sitosterolemia Contraindicated in patients with active liver disease, pregnant or nursing women, women who may become pregnant No known nutrient depletions Pregnancy category C

Answer 32

Pro-coagulation

Answer 33

Anti-coagulant - anti-platelet agent - Combo with aspirin to prevent stent thrombosis post-op - Acute coronary syndrome, STEMI, recent MI, stroke, PAD

Answer 34

Anti-coagulant - anti-platelet agent

Answer 35

Anti-coagulant - Vitamin K recycling

Answer 36

Anti-coagulant - Xanthine derivative

Answer 37

Anti-coagulant - X factor inhibitor

Answer 38

Anti-coagulant - X factor inhibitor

Answer 39

Anti-coagulant - Xa factor inhibitor

Answer 40

Anti-coagulant -

Answer 41

Chelator | mercury, lead, iron,

Answer 42

Chelator, wilson's dz for copper

Answer 43

Aplastic anemia

Natsumi Pharm - Cardio, Heme Flashcards

(72 cards)