Pharm --Lipid/HTN/CAD

Question 1

This class of antiHLD drugs is:

• -Large in size
• -Highly positively charged
• -Not absorbed, excreted in stool
• -

Answer 1

Bile acid sequestrants

• -positive charge lets it bind to negatively charged bile acids
• -

Question 2

What are the effects of the following drug classes on HDL, LDL, and TG:

• -Niacin
• -Fibrates
• -Bile acid sequestrants
• -Statins
• -Ezetimibe

Answer 2

• -Niacin = lower TG, increase HDL, lower LDL
• -Fibrates = lower TG, increase HDL, variable LDL
• -Bile sequestrants = increase TG, increase HDL, lower LDL
• -Statins = lower TG, increase HDL, lower LDL
• -Ezetimibe = lower TG, increase HDL, lower LDL

Question 3

Which 2 statins are lactone prodrugs that must be modified in the liver to the active hydroxy acid forms?

Answer 3

• -Lovastatin

- -Simvastatin

Question 4

This class of antiHLDs prevent endocytosis and lysosomal degradation of LDL receptors on hepatocytes leading to higher number of LDL receptors

Answer 4

PCSK9 Inhibitors = more receptors –> lower LDL-C

–Alirocuma, evolucumab = human monoclonal Ab

Question 5

This drug class inhibits cholesterol absorption by enterocytes in small intestines, but doesn’t affect TG absorption.

Answer 5

Ezetimibe

Question 6

This drug class affects blood cholesterol by inhibiting cholesterogenesis in the liver

Answer 6

Statins –HMG-CoA reductase inhibitors

Question 7

Which 2 statins have longer half-lives that can be administered once a day?

Answer 7

• -Atorvastatin (Lipitor)

- -Rosuvastatin (Crestor)

Question 8

This drug class reduces TG synthesis in the liver, decreases lipolysis in adipose tissue, and reduces hepatic clearance of HDL-apoA-1

Answer 8

Nicotinic Acid (Niacin)

Question 9

This drug class acts through PPARa to stimulate lipoprotein lipase(LPL) synthesis and inhibit apoC III expression. It also stimulates apoA-1 and apoA-5 expression.

Answer 9

Fibrates

• -LPL synthesis –> clear TG rich lipoproteins
• -apoCIII –> clear VLDL
• -apoA-1 and apoA-5 –> increase HDL

Question 10

What is the best agent for increasing HDL-C?

Answer 10

Nicotinic Acid (Niacin)

Question 11

This antiHLD drug class increases lithogenicity of bile –> risk of gallstones

Answer 11

Fibrates

Question 12

Severe hypertriglyceridemia is a contraindication for the use of this antiHLD drug class.

Answer 12

Bile acid sequestrants

Question 13

This antiHLD drug class binds cardiac glycosides (digoxin) and coumarin anticoagulants and interefere with their absorption.

Answer 13

Bile acid sequestrants

Question 14

These 2 antiHLD drug classes increase hepatic LDL receptor expression

Answer 14

• -Statins

- -Bile acid sequestrants

Question 15

This antiHLD drug class is contraindicated for pregnant or nursing women

Answer 15

Statins

Question 16

What are the 4 major risk factors for Polygenic-environmental hyperlipidemia?

Answer 16

• -serum LDL cholesterol
• -age
• -HTN
• -smoking

Question 17

How does myocardial ischemia affect [increase/decrease]:

• -intracellular ATP
• -Intracellular pH
• -Extracellular pH
• -Extracellular K, phosphate, fatty-acid levels

Answer 17

• -intracellular ATP = decrease
• -Intracellular pH = decrease (acidosis)
• -Extracellular pH = decrease (acidosis)
• -Extracellular K, phosphate, fatty-acid levels = all increase

Question 18

What 3 drugs can be used in a pharmacologic stress test?

Answer 18

• -Dobutamine = Beta-1 stimulation sympathomimetic –> increase contractility and heart rate
• -Adenosine, dipyridamole = coronary vasodilators –> stenotic arteries don’t respond to vasodilation stimulus

Question 19

Patients w/ stable angina taking his drug was associated w/ 33% reduction in risk of adverse cardiovascular events

Patients w/ unstable angina or acute MI taking this drug had reduced vascular mortality, nonfatal reinfarction, and nonfatal stroke

Answer 19

ASPIRIN!

Question 20

This drug is a thienopyridine derivative that inhibits platelet aggregation induced by adenosine diphosphate. It also reduces blood viscosity.

Answer 20

Ticlopidine

Question 21

What are the 3 thienopyridine class

Answer 21

• -Ticlopidine
• -Clopidogrel
• -Prasugrel

Question 22

This drug irreversibly binds to P2Y12 receptor (GPCR for ADP).

Answer 22

Prasugrel – Thienopyridine class

Question 23

This antiplatelet drug used in patients w/ stable angina can induce neutropenia, and in rare cases, TTP

Answer 23

Ticlopidine

Question 24

This drug is limited to patients less than 75years old, greater than 60kg, and with no history of stroke or TIA

Answer 24

Prasugrel

Question 25

This antiplatelet drug is a quinolone derivative that inhibits cellular phosphodiesterase which increases cAMP to inhibit platelet aggregation and vasodilation

Answer 25

Cilostazol

Question 26

What is/causes the Bezold-Jarisch reflesx?

Answer 26

Nitrates -- stimulation of cardiac sensory receptors --> vagal efferent discharge --> bradycardia

Question 27

In the setting of unstable angina/non-ST elevated MI, what anticoagulant therapy should be initiated?

Answer 27

Heparin

Question 28

Classification of HTN: - -Stage 1 - -Stage 2

Answer 28

- -Stage 1 = 140-159 systolic, 90-99 diastolic | - -Stage 2 = systolic over 160 OR diastolic over 100

Question 29

Risk of end organ disease from HTN increased in these 2 populations:

Answer 29

- -African American | - -Premenopausal women

Question 30

Angiotensin blockers [increase/decrease] TPR:

Answer 30

--Decrease -- inhibit production/action of Angiotensin II --> less vasoconstriction --> lower TPR

Question 31

In a patient w/ severe HTN, in the setting of CHF or cirrhosis, and with renal insufficiency (GRF less than 30-40), what diuretic class is used?

Answer 31

Loop diuretics

Question 32

Diuretics [increase/decrease] cardiac output

Answer 32

--Decrease -- Diuresis --> volume depletion --> low preload --> low CO --> low BP --CO returns to normal over time

Question 33

Angiotensin Receptor Blockers (ARBs) are [competitive/non-competitive] antagonists at the vascular endothelium

Answer 33

Competititve

Question 34

2 Mechanisms of ACE Inhibitors

Answer 34

- -Block endothelial ACE (converts Angiotensin I --> Angiotensin II) - -Inhibit breakdown of bradykinin (vasodilator)

Question 35

Bradykinin is a potent vaso (dilator/constrictor)

Answer 35

Vasodilator

Question 36

What do you use when you want a short acting ACEI

Answer 36

Captopril

Question 37

What ACEI is a prodrug that has a more active metabolite?

Answer 37

Enalapril --> enalaprilat (more active)

Question 38

What are the ARBs?

Answer 38

- -Losartan - -Valsartan - -Irbesartan

Question 39

What causes cough side effect of ACEI?

Answer 39

--Bradykinin

Question 40

Ca Channel blockers: - -2 Dihydropyridines: - -2 Non-dihydropyridines:

Answer 40

- -2 Dihydropyridines: amlodipine, nifedipine | - -2 Non-dihydropyridines: verapamil, diltiazem

Question 41

Ca Channel blockers (dihydropyridines vs non-dihydropiridines): - -Which raises heart rate? - -Which can cause Raynauds sydrome? - -Which decreases oxygen demand?

Answer 41

- -Which raises heart rate? = Dihydropyridine--> reflex tachy - -Which can cause Raynauds sydrome? = both - -Which decreases oxygen demand? = non-dihyropyridines

Question 42

What HTN drug has the following characteristics: - - primary antiHTN mechanism = reduce CO - -can mask symptoms of hypoglycemia in diabetics - -can cause depression - -worsens symptoms of peripheral vascular disease

Answer 42

Propranolol -- non-selective B blocker

Question 43

Unique B blockers (Labetolol, Carvedilol, Esmolol): - -Used in hypertensive urgency - -Used for ACS or CHF - -Used IV for AV nodal blocking b/c it's unique short T1/2

Answer 43

- -HTN emergency = labetolol - -ACS, CHF = Carvedilol - -IV, short half life = Esmolol

Question 44

This drug relaxes smooth muscle of peripheral arterioles. Is used for refractory HTN and hair loss.

Answer 44

Minoxidil

Question 45

This drug relaxes smooth muscle of peripheral arterioles. Is used IV for acute HTN urgency or chronic CHF

Answer 45

Hydralazine

Question 46

Sympathoplegic drugs stimluate a2 to reduce vasomotor tone - -Which is routinely? - -Which is used in pregnancy? - -The other one?

Answer 46

Routinely = Clonidine Pregnancy = a-methyl dopa Other one = Guanabenz

Question 47

2 Ganglion blockers used for HTN?

Answer 47

--Guanethidine = block NE release --Reserpine = depletes NE --> decreases CO and TPR

Question 48

Antiplatelets: which are reversible and irreversible - -Aspirin - -Ticlopidine - -Clopidogrel - -Prasugrel - -Ticagrelor

Answer 48

- -Aspirin = irreversible COX inhibitor - -Ticlopidine = reversible ADP receptor inhibitor - -Clopidogrel = irreversible ADP receptor inhibitor - -Prasugrel = irreversible ADP (P2Y12) receptor inhibitor - -Ticagrelor = allosteric ADP receptor blockade

Question 49

In the kidney, Angiotensin causes more constriction in the [afferent/efferent] arterioles of the glomerulus

Answer 49

--Efferent -- more blood in glomerulus --> increased glomerular pressure

Question 50

Bradykinin is associated with what 2 clinical symptoms?

Answer 50

- -Cough | - -Angioedema (swelling of skin around mouth, mucosa of mouth, tongue)

Question 51

2 Mechanisms of nitrates relieving angina:

Answer 51

- -Dilate coronary arteries --> increases oxygen delivery | - -Venous dilation --> reduce ventricular preload --> reduce myocardial oxygen demand

Question 52

If you use phosphodiesterase inhibitors for erectile dysfunction, what antianginal drug can't you give?

Answer 52

Nitrates = PDE inhibitors inhibit cGMP --> "may cause an unsafe drop in blood pressure ;)"