Pharm Cardiology Exam 2 Flashcards

Question

Contraindications for Depression

Answer 1

Methyldopa

Answer 2

ACE ARB Renin inhib

Answer 3

BB, | CCB (Diltiazem/verapamil)

Answer 4

Should be reduced by 10 - 20 percent in first hour then gradually during next 23 hours to a total of 25% of baseline Otherwise can worsen organ ischemia

Answer 5

``` Drugs that produce hyperadrenergic state Cocaine amphetamine PCP MAOI recent discontinuation of clonidine ```

Answer 6

Sodium nitroprusside or nitro CCB (clevidipne) (ultra short acting) (nicardipine) Dopamine agonist - fenoldopam BB - labetalol, esmolol, metoprolol

Answer 7

Vasodilator HTN emergency Caution with High ICP or azotemia

Answer 8

CCB HTN emergency Not with acute heart failure Caution with coronary ischemia

Answer 9

Vasodilator | Coronary ischemia

Answer 10

Dopamine 1 agonist HTN emergency Caution with glaucoma

Answer 11

Direct vasodilator | eclampsia

Answer 12

Dopamine Receptor agonist Peripheral arteriolar dilator for HTN Emergencies For the in-hospital, short-term (up to 48 hours) management of severe hypertension when rapid, but quickly reversible, emergency reduction of blood pressure is clinically indicated, including malignant hypertension with deteriorating end-organ function. Children: for the in-hospital, short-term (up to 4 hours) reduction in blood pressure. Avoid in patients with glaucoma (Increased IOP) Interactions: Avoid with BB given with continuous IV infusion Adverse Reflex tachycardia, HA, Flushing

Answer 13

Monotherapy = CCB or thiazide Dual therapy = CCB + ACE/ARB If patient has edema or hypervolemia ACE/ARB +Thiazide If CCB+ Ace/ARB not working, add thiazide next add spironolactone / eplerenone

Answer 14

ACE ARB direct renin inhibitors

Answer 15

For acute HTN lowering IV labetalol or hydralazine Treatment should begin when SBP >160 Classes

Answer 16

Alpha and beta blocker

Answer 17

Peripheral vasodilator

Answer 18

CCB (dihydropyridine)

Answer 19

Central acting alpha agonist

Answer 20

``` 1st line Thiazide CCB ACE ARB ``` CCB & Thiazide works best in elderly

Answer 21

Fludrocortisone Starting with low-dose fludrocortisone (0.1 mg/day) for patients with volume depletion and disabling symptoms despite nonpharmacologic measures. A sympathomimetic pressor agent, such as midodrine or droxidopa, can be added or substituted in patients who remain symptomatic on or cannot tolerate fludrocortisone.

Answer 22

Corticosteroid 0.1 mg QD up to 0.3 mg QD Up titrate0.1mg every week as needed Max dose 1mg per day Taken with high salt diet and plenty of fluid Adverse Hypokalemia, ankle edema, CHF

Answer 23

Symptomatic orthostatic hypotension Alpha adrenergic agonist 10mg TID during daytime hours Staring does is 2.5mg Contra: Severe heart disease, acute renal disease, urinary retention, Pheochromocytoma, thyrotoxicosis, excessive supine hypertension Adverse Paresthesia, piloerection, dysuria, pruritis, supine hypertension

Answer 24

Rapidly absorbed after PO Metabolized in liver/ tissues Activates a1 receptor causing vasoconstriction increased SBP/DBP while standing, sitting, supine For postural hypotension after non pharm fails

Answer 25

Vasopressors (alpha 1) Norepi, epi, phenylephrine, dopamine ADH Vasopressin: Pitressin, vasostrict Inotrope Beta 1: Dobutamine Inotrope PDE 3 inhib: Milrinone

Answer 26

Alpha 1 adrenergic Norepi (levophed) Epi Phenylephrine Dopamine

Answer 27

Levophed Sympathomimetic Contra: Hypotension due to blood volume deficits except in emergencies, mesenteric or peripheral vascular thrombosis Adverse: Ischemic injury, Reflex bradycardia, arrhythmias, anxiety

Answer 28

Increase MAP in hypotension with shock Sympathomimetic Adverse Anxiety, apprehensiveness, tremors, weakness, dizzy, sweating, palpitations

Answer 29

Hypotension resulting from vasodilation in the setting of anesthesia Sympathomimetic Adverse NV, HA, vasoconstriction, ischemia, severe bradycardia, renal toxicity

Answer 30

Dopamine receptor and beta 1 at low dose it constricts vessels other than in kidney and brain at high does it constricts all vessels increases cardiac contractility and increases SBP Used for shock related to under perfusion and reflex vasoconstriction Used in renal failure with shock

Answer 31

Vasostrict Synthetic vasopressin contra Chlorobutanol allergy Adverse Decreased CO, bradycardia, tachyarrhythmias, hyponatremia, ischemia

Answer 32

Dose = 2-20 mcg/kg/min (max 40) Receptors B1, B2, A1 Adverse Tachyarrhythmias, HTN, Hypotension, Nausea, HA

Answer 33

Reduces left ventricular filling pressure in chronic heart failure patients May be the preferred inotropic drug for patients receiving BB as it does not use the Beta receptor to drive cardiac contractility. (unlike dopamine and dobutamine) Through its enhancement of cAMP may reduce pulmonary artery pressure via a vasodilator mechanism and therefore may improve right heart failure due to pulmonary hypertension

Answer 34

``` Atorvastatin Fluvastatin Lovastatin Pitavastatin Pravastatin Rosuvastatin Simvastatin ```

Answer 35

Rosuvastatin 20-40mg Atorvastatin 40-80mg >50% LDL reduction Rosuvastatin, atorvastatin and simvastatin cause the greatest reduction in LDL

Answer 36

HMG-COA reductase inhibitor ``` Contraindications Active liver disease Unexplained elevated serum transaminases Pregnancy Nursing mothers ```

Answer 37

Colesevelam binds with bile acids in the intestine to form an insoluble complex that is eliminated in feces. This increased excretion of bile acids results in an increased oxidation of cholesterol to bile acid and a lowering of the serum cholesterol.

Answer 38

Pregnancy cat B Contra Hx of bowel obstruction, Serum TGL over 500, Hx of hyperTGL induced pancreatitis Adverse Constipation, nausea, dyspepsia, dysphagia, pancreatitis

Answer 39

Fenofibrate, Gemfibrozil Adverse Liver function tests increased (dose related; 3% to 13%; ALT/AST increased >3 x ULN: 5% to 13%) Abdominal pain-5%; URI-6% Can lower serum TGL up to 50% and Raise serum HDL up to 20%

Answer 40

hypertriglyceridemia Fibrate Contra: Hepatic/renal dysfunction, primary biliary cirrhosis, gallbladder disease Adverse myopathy, abnormal LFT's, elevated CPK Warnings renal impairment, monitor CBC for 1 yr, monitor LFT's, discontinue if >3 x normal Interactions Avoid statins, potentiates oral coags

Answer 41

Zetia (10mg QD) Cholesterol absorption inhibitor Interaction Other fibrates except feonfibrate Contra with statin in active liver disease or unexplained elevations in serum transaminases Adverse Diarrhea 4%, Arthralgia 3%, URI 4%

Answer 42

Cholesterol absorption inhibitors that impair dietary and biliary cholesterol absorption at the brush border of the intestine without affecting the absorption of triglycerides or fat soluble vitamin.

Answer 43

Statins are contraindicated in | pregnancy and nursing mothers

Answer 44

Omega 3 acid ethyl esters (Lovaza) Icosapent ethyl (vascepa)

Answer 45

(Lovaza) Adjunct to diet to reduce very high TGL (>500) Lipid regulating agent Interaction May potentiate anti coagulants (monitor) Adverse Eructation, dyspepsia, rash, taste perversion, Increased ALT,AST,LDL

Answer 46

(vascepa) Lipid regulating agent Increased risk of bleeding with antithrombotics (ASA, Clopidogrel, warfarin etc.) Adjunct to maximally tolerated statin therapy to reduce the risk of myocardial infarction, stroke, coronary revascularization, and unstable angina requiring hospitalization in adults with elevated triglyceride (TG) levels (≥150mg/dL) and established cardiovascular disease (CVD), or diabetes plus ≥2 additional CVD risk factors. The effect of Vascepa on the risk for pancreatitis in patients with severe hypertriglyceridemia has not been determined.

Answer 47

Niacin Raises HDL up to 30-35% by reducing lipid transfer of cholesterol from HDL to VLDL and by delaying HDL clearance NO flush doesn't work Can use ASA 325mg 30 min / NSAID 200mg 60 min prior to reduce flush (reduce prostaglandin effect) Sustained release can lead to Hepatotoxicity

Answer 48

Can increase glucose levels worsening uncontrolled DM Worst with Extended release tablets Can cause hyperuricemia and lead to gout can cause hypotension if on vasodilators and worsen unstable angina can cause bleeding in patients with bleeding issues

Answer 49

Can lower LDL by 60% in patient on statins Can reduce risk of CVA or MI Alirocumab (praluent), Evolocumab (reptha)

Answer 50

Proprotein convertase subtilisin/kexin type 9 (PCSK9) is an enzyme produced in the liver. PCSK9 binds to the low density lipoprotein receptor on the surface of hepatocytes, leading to its degradation and higher plasma LDL-cholesterol (LDL-C) levels. Blocking PCSK9 with antibodies leads to lower plasma LDL-C levels.

Answer 51

PCSK9 Inhibitor Warnings 2nd and 3rd trimester

Answer 52

All such patients should have LDL-C lowered with statin therapy if indicated. Statins typically lower TG levels by 5 to 15 percent; however, high-intensity statin therapy can lower TGs by 25 to 30 percent

Answer 53

For patients with TG levels persistently >885 mg/dL (10 mmol/L) after nonpharmacologic interventions, we suggest starting drug therapy to lower the risk of pancreatitis. We start treatment with a fibrate, which may lower TGs by up to 70 percent . We choose fenofibrate rather than gemfibrozil due to the likelihood of either concurrent or later use of a statin. Gemfibrozil has a higher risk of muscle toxicity, especially when administered with many statins.

Answer 54

if already taking statins add icosapent ethyl (vascepa)

Answer 55

methyldopa (Aldomet)

Answer 56

Hypokalemia

Answer 57

clonidine (Catapress)

Answer 58

0.1 mg-0.2 mg once a day

Answer 59

dobutamine (Dobutrex)

Answer 60

dopamine (Inotropin)

Answer 61

rosuvastatin (Crestor)

Answer 62

atorvastatin (Lipitor)

Answer 63

ezetimbe (Zetia)

Answer 64

History of myocardial infarction

Answer 65

Mostly surgical repair for all Tetralogy of Fallot Pulmonary atresia Hypoplastic left heart syndrome Transposition of great vessels

Answer 66

Relaxes arterial smooth muscle, producing vasodilation Helps keep Ductus open If ductus is large PGE1 can be started at low dose of 0.01mcg/kg per min

Answer 67

``` Prostaglandin E1 (PDE1) Keep ductus arteriosus open ``` Warning apnea, only use if ventilator is readily available not recommended in respiratory distress syndrome Adverse Apnea, Hypotension, tachycardia, necrotizing enterocolitis, Deterioration, Transfer (apnea)

Answer 68

VSD Overriding aorta Pulmonary (RV) outflow tract obstruction RVH

Answer 69

Severe RVOT obstruction – Neonates with severe RVOT obstruction may require intravenous prostaglandin therapy (alprostadil), ductal stenting, or palliative shunt placement to maintain adequate pulmonary blood flow pending surgical repair. Heart failure symptoms – Patients with minimal obstruction and increased pulmonary blood flow may develop symptoms of heart failure and require pharmacologic treatment (loop diuretic therapy and digoxin). NO ACE or ARB

Answer 70

Indocin Closes ductus Adverse Renal failure, electrolyte imbalance, GI bleed MOA NSAID Accelerates maturation of germinal matrix microvasculature Closes PDA by inhibiting COX enzyme that catalyzes prostaglandin precursor formation from arachidonic acid (70% of patients)

Answer 71

Staph aureus and staph epidermis

Answer 72

Strep viridans

Answer 73

Positive blood cultures of S.Aureus, Strep viridans, Strep gallolyticus, HACEK, community acquired enterococcus Persistently positive blood culture New valvular regurgitation murmur Coxiella burneti infection Echo positive for vegetation

Answer 74

Synergistic interaction of a cell wall active agent (penicillin, ampicillin, or vancomycin) and an aminoglycoside (gentamicin or streptomycin) if possible

Answer 75

Oral Amoxicillin 2G PO

Answer 76

Unable to take oral meds Ampicillin 2G IM/IV

Answer 77

Unable to take oral meds Ceftriaxone/cefazolin 1 Gm IM/IV

Answer 78

Allergic to penicillin Cephalexin 2gm PO

Answer 79

Allergic to penicillin Clindamycin 600mg PO

Answer 80

Allergic to penicillin Azithromycin/clarithromycin 500mg PO

Answer 81

Allergic to penicillin And unable to take oral medication Cefazolin/Ceftriaxone 1 G IM/IV

Answer 82

Allergic to penicillin And unable to take oral medication Clindamycin 600 mg IM/IV

Answer 83

``` Allergic to penicillin And unable to take oral medication Vancomycin 15-20 mg/kg IV 2g max ```

Answer 84

In cases of pericarditis due to an identifiable cause (eg, bacterial infection or malignancy), management is focused upon the underlying disorder and, if necessary, drainage of an associated pericardial effusion. For nearly all patients with acute idiopathic or viral pericarditis, we recommend combination therapy with colchicine plus nonsteroidal anti-inflammatory drugs (NSAIDs) rather than NSAIDs alone. Ibuprofen or ASA + Colchicine If glucocorticoid is needed we suggest the use of moderate initial dosing (eg, 0.2 to 0.5 mg/kg/day of prednisone) followed by a slow taper

Answer 85

Recurrent pericarditis 0.6mg PO BID-TID Contra Renal/hepatic impairment with use of CYP3A or P-glycoprotein inhibitors Adverse GI upset, abdominal pain

Answer 86

US guided Pericardiocentesis If reappears, repeat pericardiocentesis

Answer 87

for asymptomatic control HTN with BB Can use ACE/ARB if BB not tolerated Can also add statin to help reduce aortic expansion

Answer 88

For those who present with acute limb ischemia, anticoagulation typically with a heparin (bolus followed by infusion) and intravenous fluid therapy should be immediately initiated prior to making plans for intervention.

Answer 89

Patients with ongoing atrial fibrillation and a prior embolic event are at a significantly increased risk of stroke or other embolic event and often warrant lifelong anticoagulation unless there is some other compelling factor. For patients with coronary heart disease equivalents, treatment with aspirin and statins should be a component of their medical therapy.

Answer 90

Glucocorticoid treatment is central to the management of giant cell arteritis (GCA, also known as Horton disease, cranial arteritis, and temporal arteritis). If vision is intact at the time appropriate glucocorticoid treatment is initiated, the risk of sight loss is reduced to less than 1 percent. Treatment should be initiated promptly once the diagnosis is confirmed or there is a high index of suspicion for GCA. For patients without visual loss at presentation: prednisone 1 mg/kg or equivalent, not to exceed 60 mg, given in a single daily dose IF GCA relapses add tocilizumab

Answer 91

Giant cell arteritis (Interleukin 6 antagonist) in combination with steroids Warning Serious risk of infection Interactions Avoid live vaccines

Answer 92

Claudication is associated with an increased risk of coronary, cerebrovascular, and renovascular disease, and peripheral artery disease (PAD) is considered to be a coronary heart disease risk equivalent. To reduce the risk for cardiovascular disease progression and complications, we recommend a secondary prevention strategy that includes antiplatelet therapy (aspirin 75 to 162 mg/day or clopidogrel 75 mg/day), smoking cessation, control of blood sugar and blood pressure, lipid-lowering therapy, and dietary modification (as needed) to achieve the goals set in national guidelines. For most patients with lifestyle-limiting claudication who do not have an improvement in symptoms with risk modification and exercise therapy, we suggest a therapeutic trial of naftidrofuryl

Answer 93

Pletal (PDE-3 inhibitor) for intermittent claudication Contra HF Warning HF, Tachycardia, palpitation, tachyarrhythmia, hypotension, exacerbating angina or MI inpatients with ischemic heart disease Interactions CYP3A inhibitors Adverse HA, GI, diarrhea, abdominal pain MOA PDE 3 inhibitor, prevents cAMP degradation which prevents platelet aggregation and promotes vasodilation

Answer 94

Anticoagulation administered immediately and for up to 10 days following a diagnosis of DVT to provide protection from recurrent thrombosis in this period of highest risk. Long-term (finite) anticoagulation is administered for a minimum of three months and extended for 6 to 12 months in some cases. A small population of patients will require indefinite anticoagulation (LMW) heparin, subcutaneous fondaparinux, the oral factor Xa inhibitors rivaroxaban or apixaban, or unfractionated heparin (UFH). For most patients with a first episode of DVT (provoked and unprovoked, proximal and distal), anticoagulants should be administered for three months

Answer 95

LMWH (Lovenox) be selected as the initial and long-term anticoagulant

Answer 96

LMWH (lovenox)

Answer 97

Vitamin K dependent antagonist | Warfarin

Answer 98

Vitamin K dependent antagonist Warfarin rivoroxaban apixaban edoxaban

Answer 99

LMWH (lovenox)

Answer 100

Coumarin anticoagulant. Vitamin K antagonist for Venous thrombosis. Pulmonary embolism. Thromboembolic complications from atrial fibrillation and/or cardiac valve replacement. Reduce risk of death, recurrent MIs, and thromboembolic events (eg, stroke, systemic embolization) post-MI. Dose Individualize. ≥18yrs: Initially 2–5mg once daily Warnings Risk of major or fatal bleeding. Monitor INR frequently. History of GI bleed. Hypertension. Cerebrovascular disease. Anemia. Malignancy. Trauma.

Answer 101

Pradaxa (Direct thrombin inhibitor) To reduce risk of stroke and systemic embolism in non-valvular atrial fibrillation (AF). Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients treated with parenteral anticoagulant for 5–10 days. To reduce risk of recurrent DVT/PE in patients who have been previously treated. Prophylaxis of DVT/PE after hip replacement surgery. Contra Active bleeding. Mechanical prosthetic heart valve. Warning Premature discontinuation increases the risk of thrombotic events. Spinal/epidural hematoma Adverse Gastritis-like symptoms (eg, GERD, esophagitis, erosive gastritis, gastric hemorrhage, ulcer),

Answer 102

Xarelto (Factor Xa inhibitor) To reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Treatment of deep vein thrombosis (DVT), Contra Active bleeding Warning Premature discontinuation increases the risk of thrombotic events. Spinal/epidural hematoma Interactions Increased risk of bleeding with concomitant aspirin, clopidogrel, enoxaparin, warfarin, chronic NSAIDs

Answer 103

Praxbind Reversal of the anticoagulant effects of dabigatran in emergency surgery/urgent procedures and in life-threatening or uncontrolled bleeding.

Answer 104

For patients who are unable to tolerate, are not compliant with, or in whom compression therapy is contraindicated (eg, occlusive arterial disease), we suggest horse chestnut seed extract. A typical dose is 300 mg (standardized to 50 mg of escin) twice daily. Use horse chestnut extract as a dietary supplement for chronic venous insufficiency (when the veins of the lower leg are unable to send blood back toward the heart), hemorrhoids, and swelling after surgery. Preparations made from the tree’s bark are applied to skin sores. side effects, include itching, nausea, gastrointestinal upset, muscle spasm, or headache.

Pharm Cardiology Exam 2 Flashcards

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