Pharm Cardiology Exam 1 Flashcards

Question

Calcium Channel Blockers | Non Dihydropyridines

Answer 1

Di-Ver Diltiazem Verapamil

Answer 2

``` Dizzy HA Edema (pedal edema) Constipation Facial redness Gingival overgrowth Altered HR ```

Answer 3

+ Ionotrope (increased contraction) - Chronotrope (slows heart rate) - dromotrope (decreased AV node conduction) For SVT , afib/aflut, cardiogenic shock and HF Cardiac glycoside Antidote is digibind Therapeutic range is 0.5-2 monitor for toxicity S/S of tox = N/V, dysrhythmias, vision changes (yellow/green hue & halos)

Answer 4

Nitroglycerine | Sodium nitroprusside

Answer 5

Always treat as if having an MI

Answer 6

Manage dyslipidemia Stain (improves mortality) Antiplatelet ASA Beta blocker Slow the heart, allow for increased ventricular filling and reduce oxygen demand Calcium channel blocker Reduce afterload and contractility and dilate coronary arteries (not nifedipine due to reflex tachycardia) Nitroglycerine Decrease preload, dilate cornary arteries (Acute or chronic use) PCI/CABG

Answer 7

Increased LFT's Check AST/ALT and AP at baseline

Answer 8

Atorvastatin Rosuvastatin LDL Goal is <70

Answer 9

Beta Blockers Calcium channel blockers and long acting nitrates are alternatives if Beta Blockers are contraindicated

Answer 10

``` Lifestyle mods Sublingual Nitro Long acting Nitrates (isosorbide mononitrate) Beta Blockers ACE (for unstable and s/s of HF) CCB (considered alternative to BB) ```

Answer 11

Decrease in HR Decrease in BP Decreased Pump function

Answer 12

Decrease in HR Decrease in BP Decreased Pump function + vasodilation

Answer 13

Increased HR Decreased BP Vasodilation

Answer 14

No change in HR No change in BP Reduces Cardiac Stiffness

Answer 15

Ranexa Chronic stable angina can be used with BB, nitrates, CCB, ACE, ARB, Anti platelet and lipid lowering therapies. Contra: Liver cirrhosis Warnings: Not for acute angina or Diabetes Adverse: Prolonged QT, Dizziness, headache, constipation, nausea

Answer 16

Inhibits the late inward sodium current Prevents diastolic stiffness and thereby preserves myocardial blood flow.

Answer 17

Calcium channel blocker Start with diltiazem Sublingual nitro in an attempt to decrease the frequency of myocardial infarction and life threatening arrhythmia Nonselective beta blockers such as propranolol should be avoided

Answer 18

STEMI, NSTEMI, Unstable angina

Answer 19

Reduce progression to Acute MI Antiplatelet - ASA Beta blockers ACE Statin Revascularization

Answer 20

``` Known intracranial neoplasm Active internal bleeding Suspected aortic dissection Recent head trauma History of Hemorrhagic CVA Major surgery or trauma <2 weeks ``` C B D T S S

Answer 21

Benzos Lorazepam 2-4 mg IV q 15 mins as needed to relive symptoms DO NOT GIVE BB

Answer 22

Acute relief of angina Acute prophylaxis of angina Dose: 0.4mg tab 1 tab sublingual at onset, q 5mins x 3 (max=3 tabs in 15mins) Contraindications: Severe anemia, Increased ICP, TBI, Cerebral hemorrhage, Acute circulatory failure or shock. PDE-5 use. Interactions: PDE-5 Adverse reactions: HA, dizzy, paresthesia, vertigo, weakness, palpitations, postural hypotension, syncope

Answer 23

Improves symptoms by decreasing HR and contractility Decrease myocardial oxygen consumption Increase ventricular diastolic filling Decrease cardiac output gradient

Answer 24

Lopressor (immediate release) Cardioselective Beta blockers For use in stabilized patients after MI to reduce mortality Contra: All Heart blocks, BP under 100, HR under 45 Moderate/Severe cardiac failure Warning: Avoid abrupt discontinuation in ischemic heart disease Adverse reactions: Fatigue, dizzy, depression, hypotension (discontinue), bronchospasm, heart block

Answer 25

``` Alteplase Reteplase Tenecteplase Streptokinase Anistreplase ```

Answer 26

Treatment of acute myocardial infarction to reduce mortality and the incidence of heart failure Interactions: Increased risk of bleeding with anti-coags, anti platelets. Angioedema risk with ACE Adverse: Bleeding (fatal)

Answer 27

Cox inhibitors ASA ``` ADP inhibitor Clopidogrel Ticlopidine Prasugrel Ticagrelor ``` GP IIB/IIIA inhibitor Abciximab Eptifibatide Tirofiban

Answer 28

Vitamin K antagonists Warfarin ``` Thrombin inhibitors (direct) Dabigatran Argatroban Hirudin Bivalidurin ``` ``` Thrombin Inhibitors (indirect) Heparin Enoxaparin Dalteparin Tinzeparin -Xabans ```

Answer 29

Abciximab (irreversible) Eptifibatide (reversible) Tirofiban (reversible)

Answer 30

The goals of management is to reduce morbidity (including reducing symptoms, improving health-related quality of life and functional status, and decreasing the risk of hospitalization), and to reduce mortality.

Answer 31

Stops angiotensin I from converting to angiotensin II

Answer 32

Stops renin from converting to angiotensin I

Answer 33

Helps stop cardiac remodeling

Answer 34

Helps stop cardiac remodeling Suppress renin secretion

Answer 35

Increases cardiac output | improves CO and decreases HF (ionotropics)

Answer 36

Decrease NA+ and H2O retention

Answer 37

Decreases vasoconstriction

Answer 38

Decrease cardiac remodeling Inhibits angiotensin from converting to aldosterone Decreases vasoconstriction

Answer 39

inhibit the activity of angiotensin-converting enzyme Stops angiotensin I from becoming angiotensin II There by decreasing the formation of angiotensin II, a vasoconstrictor, and increase the level of bradykinin, a peptide vasodilator Causes relaxation of blood vessels as well as a decrease in blood volume, which leads to lower blood pressure and decreased oxygen demand from the heart

Answer 40

Drugs that bind to and inhibit the angiotensin II receptor type 1 (AT1) and thereby block the arteriolar contraction and sodium retention effects of renin–angiotensin system

Answer 41

Sacubitril / valsartan Entresto Inhibit BNP breakdown

Answer 42

ACE inhibitor and ARNI (but not single agent ARB) | Angiotensin receptor neprilysin inhibitor

Answer 43

Vasodilation Reduce cardiac preload and afterload which improves systolic function and CO Facilitate salt and water excretion by complex effects on the kidneys (attenuation of aldosterone effect) ACE inhibitors and ARBS reduce LVH, Myocardial fibrosis and stiffness

Answer 44

Reduce symptoms of systolic HF Contraindications History of ACE associated or other angioedema Warning: Fetal Toxicity Adverse reactions HA, cough, angioedema, dizzy, hypotension, chest pain, hyperkalemia, renal impairment

Answer 45

``` HF (NYHA class II-IV) Reduce cardiovascular mortality in stable post MI patients with LV failure or dysfunction ``` Contra: Concomitant aliskiren in patients with diabetes Warning: Fetal toxicity Adverse: Dizzy, hypotension, diarrhea, arthralgia, back pain, fatigue, hyperkalemia

Answer 46

``` Carvedilol (coreg) Metoprolol Succinate (Toprol XL) Bisoprolol fumerate (Zebeta) ```

Answer 47

Non-cardioselective BB / Alpha 1 blocker (Coreg) Mild to severe heart failure, increase survivability and reduce hospitalization risk. Reduce post MI mortality with left ventricular EF <40% Contraindications Cardiogenic shock, decompensated HF, Asthma with bronchospasms, 2nd/3rd degree AV blocks, sick sinus syndrome, severe bradycardia (unless paced) Adverse: dizzy, edema, hypotension, syncope, bradycardia, AV block

Answer 48

Spironolactone Eplerenone (K+ sparring)

Answer 49

Has diuretic and blood pressure lowering effects, raises serum potassium concentration via reduced urinary potassium loss Side effects: spironolactone has anti-androgen effects such as erectile dysfunction and gynecomastia in men (use eplerenone in men)

Answer 50

K+ sparring diuretic NYHA class III–IV HF and reduced ejection fraction to increase survival, manage edema, and reduce the need for hospitalization for HF, when used in addition to standard therapy. Contra: Hyperkalemia, Addison's disease, concomitant eplerenone Warnings: Hyperkalemia in renal patients Interactions: Severe hyperkalemia with K+ supplements Adverse: Gynecomastia, GI upset, Hyperkalemia

Answer 51

Neprilysin inhibitor + angiotensin II receptor blocker Dose: 49mg/51mg BID (initial) To reduce risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart failure (NYHA Class II–IV) and reduced ejection fraction; usually given with other therapies, in place of an ACEI or other ARB. To treat symptomatic heart failure with systemic left ventricular systolic dysfunction in children aged ≥1 year. Contra: History of angioedema, Concomitant ACE or aliskiren use. Warning Fetal toxicity Adverse Hypotension, hyperkalemia, cough, angioedema, renal failure

Answer 52

Hydralazine (25-50mg TID-QID) (Target=300mg QD)

Answer 53

Isosorbide dinitrate (20-30mg TID-QID) (target=120mg QD)

Answer 54

Bidil The combined use of hydralazine and nitrates reduces cardiac afterload and preload, and may also enhance nitric oxide bioavailability. Indicated when ACE and ARBS are contraindicated (i.e. renal failure) Systolic dysfunction Acute episodes of CHF (via preload and afterload reduction) Indicated for black patients

Answer 55

``` Dizzy HA Blurred vision Yellow or green vision AV / SA block PR prolongation ST Depression Diarrhea ```

Answer 56

Inhibits the NA+ K+ ATPase pump

Answer 57

Severe systolic dysfunction Used as an inotrope (does not reduce mortality but does reduce hospitalizations) Positive pressure ventilation

Answer 58

Cardiac Glycoside Mild-to-moderate heart failure (with a diuretic and an ACE inhibitor when possible). Increase myocardial contractility in pediatrics with heart failure Contra V-Fib

Answer 59

Most common type 95% Common cause = ETOH Diagnostics Chest X ray for cardiomegaly Echo for LV dilation and dysfunction (high diastolic pressures with low CO) Treatment: Treat underlying cause or offending agent

Answer 60

Massive septum hypertrophy small left ventricle diastolic dysfunction Usually autosomal dominant, genetic or chronic hypertension Diagnostics Echo LVH, asymmetrical septal hypertrophy, small LV, diastolic dysfunction

Answer 61

``` Dopamine dobutamine epi/norepi Digoxin PDE inhibitors (milrinone) Glucagon Insulin Amiodarone ```

Answer 62

Beta Blockers Calcium channel blockers Class 1A antiarrhythmics (Quinidine, procainamide) Class 1C antiarrhythmics (flecainide)

Answer 63

Monotherapy with a nondihydropyridine calcium channel blocker can be considered or, in the appropriate patient, proceeding directly to combination therapy with an atrioventricular nodal blocking agent and disopyramide.

Answer 64

Start at very low doses and gradually increase if lower doses are well tolerated Start as soon as LV dysfunction is diagnosed

Answer 65

``` Dihydropyridines -dipines Amlodipine Felodipine Nicardipine Nifedipine Nimodipine ``` Non dihydropyridines "di-ver" Di - Diltiazem Ver - Verapamil

Answer 66

``` -dipines Amlodipine Felodipine Nicardipine Nifedipine Nimodipine ```

Answer 67

"di-ver" Di - Diltiazem Ver - Verapamil

Answer 68

"di-ver" Di - Diltiazem Ver - Verapamil

Answer 69

CCB Non dihydropyridine Contraindications Severe left ventricular (LV) dysfunction or LV dysfunction treated with β-blockers. ``` Moderate to severe heart failure. Hypotension. Cardiogenic shock. Sick sinus syndrome, 2nd- or 3rd-degree AV block, ```

Answer 70

Cardizem CCB Non dihydropyridine Vasospastic or chronic unstable angina Contra sick sinus syndrome, 2nd- or 3rd-degree AV block (unless paced), hypotension Adverse Edema, HA, fatigue, dizzy, asthenia, 1st degree AV block, bradycardia

Answer 71

use in combination with BB or CCB Negative inotrope (for CHF and CM) Anti-arrhythmic

Answer 72

Cardiogenic shock. 2nd- or 3rd- degree AV block, unless paced. QT prolongation

Answer 73

Avoid strenuous exercise, sports, dehydration Do not give diuretics, ACE, Vasodilators or positive inotropes Screen 1st degree relative with EKG and Echo

Answer 74

transient regional left ventricular dysfunction in the absence of significant coronary artery disease Causes may include catecholamine excess, microvascular dysfunction, and multi-vessel coronary artery spasm Generally a transient disorder managed with supportive therapy. Conservative treatment and resolution of physical or emotional stress usually results in rapid resolution of symptoms

Answer 75

Secondary / infiltrative causes include Amyloidosis Sarcoidosis Treatment Relieve congestive symptoms with loop diuretics

Answer 76

Intermediate dissociation Procainamide Disopyramide Quinidine P D Q

Answer 77

Rapid dissociation Lidocaine mexilitine

Answer 78

slow dissociation Propafenone Flecainide

Answer 79

Beta blockers non selective Carvedilol propranolol nadolol

Answer 80

K+ channel blockers and openers

Answer 81

Voltage dependent K+ channel blockers ``` Amiodarone dronedarone dofetilide ibutilide sotalol ```

Answer 82

Ca2+ handling modulators

Answer 83

Beta Blockers selective ``` atenolol bisoprolol betaxolol celiprolol esmolol metoprolol ```

Answer 84

Surface membrane Ca2+ channel blockers Diltiazem verapamil

Answer 85

``` PDQ = Police department questions LM = Liquored man FP = For peeing BB = Behind building ADSID = After drinking scotch in dark DV = Dirty vehicle ``` ``` Ia = procainamide, disopyramide, quinidine Ib = lidocaine, mexilitine Ic = Flecainide, propafenone II = Beta blockers III = Amiodarone, dronedarone, sotalol, ibutilide, dofetilide IV = Diltiazem, verapamil ```

Answer 86

inhibits the muscarinic actions of acetylcholine on structures innervated by postganglionic cholinergic nerves, and on smooth muscles, which respond to endogenous acetylcholine but are not so innervated

Answer 87

Bradycardia | 0.5mg IV q3-5min PRN

Answer 88

If the R is far from P, | then you have a first degree

Answer 89

Longer longer longer drop, | then you have a Wenkebach

Answer 90

If some P's don't get through, then you have a Mobitz 2. Pacemaker for you

Answer 91

If the p's and Q's don't agree, | then you have a 3rd degree

Answer 92

Newly diagnosed Afib decisions regarding anti-coag treatment, and rate and rhythm control strategies Previously diagnosed and managed afib Periodic assessments of the adequacy of treatment TEE to check for clot in left atrial appendage Don't cardiovert if clot present (could dislodge) Start on lovenox if clot present (reevaluate in 1 month)

Answer 93

prevention of systemic embolization The choice between rhythm and rate control strategy, both of which may improve symptoms

Answer 94

``` Warfarin dabigatran rivaroxaban apixaban edoxaban ``` Reduce the risk by almost 70% (embolization)

Answer 95

International normalized ratio therapeutic range usually between 2 and 3

Answer 96

slowing of ventricular rate to improve symptoms (afib with RVR is really just uncontrolled afib) Treatment then focuses on normalizing ventricular rate (60-99bpm) to decrease symptoms and restoring NSR

Answer 97

Treatment guided by the presence or absence of left atrial thrombus on TEE and the presence of HF

Answer 98

``` Anticoagulants Heparin or lovenox and warfarin or dabigatran and rate control for 3-4 weeks before attempting cardiovert ```

Answer 99

cardioversion once anticoagulation with heparin is established

Answer 100

In presence of HF digoxin or amiodarone In absence of HF IV beta blockers (metoprolol, propranolol, or esmolol) or dihydropyridine Calcium channel blockers

Answer 101

Generally use drugs that slow conduction across the AV node such as Beta blockers non-dihydropyridine calcium channel blockers or digoxin

Answer 102

For a patient who is hemodynamically unstable due to afib and is at low risk for thrombus and aspiration, Urgent cardioversion is recommended

Answer 103

Most patients with afib do not need emergent cardioversion. rate slowing will often improve symptoms Best to defer cardioversion until anti-coag treatment with heparin is initiated. For select stable patients, the restoration of sinus rhythm with either electrical or pharmacological cardioversion is necessary or reasonable

Answer 104

the ventricular rate controlled and the need for anti-coag assessment prior to cardioversion For patients with no structural heart disease (including no evidence of CAD) Flecainide or propafenone is the recommended pharmacological choice

Answer 105

Beta blockers are modestly effective in maintaining NSR and can be tried first in select patients. (those without structural heart disease or who are concerned about proarrhythmic) Compared to placebo amiodarone, sotalol, dofetilide, dronedarone, fecainide, and propafenone are effective for the maintenance of sinus rhythm. (maintenance rates at one year are significantly less than 75 %) Amiodarone is consistently more effective than the other antiarrhythmic drugs

Answer 106

flecainide or propafenone is recommended as the preferred antiarrhythmic Amiodarone, dofetilide, dronedarone or sotalol may be used For patients with HF Amiodarone is recommended.

Answer 107

T = Thyroid = hyper or hypo (iodine in amiodarone) 2P = Photosensitive (gray/blue skin discoloration when sun exposed) Peripheral neuropathy = (shoulder, pelvic girdle) 2L = Lung = Fibrosis (progressive and fatal) (most serious) Liver = Liver damage 2C = Cardiac depression = Decreased HR , decreased BP (usually due to IV) Corneal micro deposits = (usually reversible or self correcting after drug is stopped)

Answer 108

Class IIIa antiarrhythmic Life threatening recurrent v fib or hemodynamically unstable v tac Contra: Cardiogenic shock sick sinus syndrome, 2nd or 3rd degree block, bradycardia with syncope unless paced Adverse: Pulmonary fibrosis, thyroid, heart block, sinus bradycardia, corneal deposits, optic neuritis, photosensitivity, skin pigment, peripheral neuropathy

Answer 109

All are done at base line and then...... ``` LFT = q 6mo TSH = q 6mo Cr/electrolytes = PRN Chest x ray = annually Ophthalmic = PRN for symptoms PFT = Symptoms EKG = annually ```

Answer 110

Control of the ventricular rate beta blocker, calcium channel blocker Reversion to normal sinus rhythm Radiofrequency catheter ablation (preferred treatment)

Answer 111

If vagal maneuvers are ineffective pharmacological therapy with an AV node blocking agent should be instituted. (adenosine, verapamil, BB) IV adenosine over IV verapamil initially due to its high efficacy and short half life. If Adenosine is ineffective, use verapamil. If AVRT persists, use IV procainamide and BB (propranolol, metoprolol, esmolol) Consider amiodarone

Answer 112

Contra 2nd/3rd block, sinus node disease unless paced, bronchoconstriction, asthma Interactions Adenosine may be potentiated by: BB, cardiac glycosides (dig), CCB; use with caution Adverse Flushing, chest discomfort, dyspnea, head, neck, throat discomfort, gi discomfort, lightheadedness, dizziness, cardiac arrest, v tac, MI, bronchoconstriction, hypo or hyper tension, CVA, seizure, a fib

Answer 113

6mg IV once Then 12mg IV after 1-2 mins repeat dose again once after 1-2 mins

Answer 114

Synchronized cardioversion

Answer 115

``` 1st line = Vagal 2nd = IV adenosine 3rd = IV verapamil or diltiazem Other = IV procainamide or IV BB Cardiovert if other therapies are ineffective or unfeasible. ```

Answer 116

``` Hypovolemia Hypothermia Hypoxia Hydrogen ions (acidosis) Hypo/Hyperkalemia ``` ``` Tension pneumo Tamponade Toxins Thrombus pulmonary Thrombus cardiac ```

Answer 117

``` Hypovolemia Hypothermia Hypoxia Hydrogen ions (acidosis) Hypo/Hyperkalemia ```

Answer 118

``` Tension pneumo Tamponade Toxins Thrombus pulmonary Thrombus cardiac ```

Answer 119

Epi IV/IO 1 mg q 3-5 min Amiodarone IV/IO 1st dose = 300mg bolus 2nd dose - 150mg bolus or Lidocaine IV/IO 1st dose = 1.0 - 1.5 mg/kg 2nd dose = 0.5 - 0.75 mg/kg

Answer 120

IV Mag sulfate 1 to 2 grams IV over 15 mins (can be followed by an infusion)

Answer 121

Beta blockers if BP allows metoprolol 5mg IV q 5mins, max of 15mg IV amiodarone may prevent a recurrent episode

Answer 122

Amiodarone is the most commonly studied antiarrhythmic for prevention of SCD

Answer 123

For treatment of hypertension (SBP >140) in patients with chronic Aortic regurg, vasodilators such as ACE inhibitors, ARBs, or dihydropyridine calcium channel blockers (eg, amlodipine) are favored since they may reduce systolic blood pressure in this setting.

Answer 124

In symptomatic patients with severe Tricuspid regurg, Diuretics are indicated to treat volume overload and congestion

Answer 125

Loop diuretics are typically used. Aldosterone antagonists may provide additional benefit, particularly in those with hepatic congestion with secondary hyperaldosteronism.

Answer 126

If heart failure due to left ventricular systolic dysfunction is present, standard therapy, including beta-blockers and agents that inhibit the rennin-angiotensin-aldosterone system, are recommended.

Answer 127

In patients with severe Tricuspid stenosis symptoms of systemic venous hypertension, including lower extremity edema and hepatic congestion, are treated with loop diuretics.

Answer 128

Symptomatic patients with chronic primary MR (stage D) and left ventricular ejection fraction (LVEF) <60 percent who are awaiting valve surgery or who are not candidates for valve surgery are treated with standard guideline-based medical therapy for heart failure with reduced ejection fraction (including angiotensin converting enzyme [ACE] inhibitor [or angiotensin II receptor blocker or angiotensin receptor-neprilysin inhibitor], beta blocker, diuretics, and possibly also mineralocorticoid receptor antagonist).

Answer 129

Long-term oral anticoagulation (with vitamin K antagonist; target International Normalized Ratio 2.5, range 2.0 to 3.0) (Warfarin) in patients with mitral stenosis who have a prior embolic event, left atrial thrombus, or paroxysmal, persistent, or permanent atrial fibrillation (AF).

Answer 130

Magnesium supplementation may benefit a subset of patients with symptoms and magnesium deficiency. Beta blockers (i.e. propranolol) may be helpful in patients who present with hyperadrenergic symptoms such as tachycardia, palpitations, nervousness, and an exaggerated heart rate response to exercise.

Answer 131

Pen G IM 1.2 million units q 21-28 days Pen V oral 250mg BID

Pharm Cardiology Exam 1 Flashcards

(156 cards)