Flashcards in Pharmacology Deck (135):
mech of nitrates
inc. cGMP--> inhibit Ca influx--> smooth m. relaxation
do nitrates need intact endothelium to vasodilate?
what else can ranolazine possible do besides decrease chronic angina?
dec afib or ventricular arrhythmias
does ranolazine inc QT ?
mech of ranolazine
alters late Na current and Na/Ca dependent channels
when is ranolazine contraindicated?
which trial showed that clopidogrel with nexium had no difference in event rates?
maximum ASA dose you can use with ticagrelor?
how is ticagrelor cleared?
hepatic ( do not use with severe impairment)
besides bleeding, what is a major side effect of ticagrelor?
important side effect to remember for abciximab
if pt has had eptifibatide in past, can they get it again? why?
yes, it is not immunogenic
if a pt has had streptokinase in past year, can they get it again? why?
no. allergic rxn/;ess effective b/c of Ab's to it.
what are differences b/w tPA and streptokinase?
higher bleeding with tPA, no allergy, less HoTN
what happens when someone is on dabigatran and you start amio? what to do?
amio increases dabigatran levels by 50%
cut dabigatran to 75 bid
mech of dabigatran
direct thrombin inhibitor
what enzyme metabolizes rivaroxaban (xarelto) and apixaban (eliquis)? what organ?
when is rivaroxaban (xarelto) contraindicated?
does rivaroxaban need to be given with food?
can you give apixaban in renal failure?
name 3 high risk groups for bleeding with NOAGs
older, renal impairment, skinny
what is the story with dabigatran (pradaxa) and MI?
1. RE-LY showed slight increase in MI.
2. review w/ revised results showed not statistically sig
3. metanalysis confirmed inc risk of MI
which NOAG is dialyzable if pt. is bleeding?
which type of pt. on procainamide witll get lupus?
slow acetylators bc of buildup of N-acetylprocainamide
2 drugs that can cause lupus-like syndrome?
if a pt. has symptomatic HOCM and is already on BB or CCB, what med can you give?
what does liver dz do to lidocaine administration?
decreases metabolism (inc'd tox)
what is the dose-related toxicity of lidocaine?
CNS (dizzy, hallucinations, confusion, Sz)
if a patient has CHF and needs lidocaine, what do you have to remember?
use lower dose
which trial showed that flecainide can't be used in ischemic HD?
which antiarrhythmics can be used to treat disabling PVCs?
which class Ic antiarrhythmic has a higher beta blocking effect (e.g. bronchospasm, slower HR) ?
which of the following will slow heart rate more: flecainide or propafenone?
what do D + L isomers of sotalol do?
D- prolong repol
L- Beta block
can stall prolong QT?
should you admit a pt for starting sotalol?
yes, QT prolongation
what happens to sotalol with CRI?
prolonged half life
main use for sotalol
what to remember about verapamil and dofetilide?
dofetilide tox possible because both use CYP3A4
why does amio cause hypothyroidism?
blocks conversion of T4 to T3
what is the active metabolite of amio?
mortality rate of amio related plum fibrosis?
name 7 drugs/drug classes using CYP3A4
antifungals, macrolide Abx, PI's
two ocular effects of amio
which drug is the non-iodine version of amio?
mech of HCTZ
blocks reabsorption of Na in DCT
what is effect on K+ by HCTZ?
what is effect of HCTZ on uric acid?
why is there an increased risk of gout with HCTZ?
reduced uric acid excretion
why can you give HCTZ to prevent Ca stones?
Calcium excretion is decreased
does HCTZ affect GFR?
difference in potency b/w metolazone and HCTZ?
metolazone 10x more diuretic and hypokalemic effect
which is better for edema: HCTZ or metolazone?
why does chlorthalidone have long half life?
90% bound to erythrocyte carbonic anhydrase
can thiazides cause torsades?
what to remember about thiazides and lithium?
decrease lithium dose by 50%
effect of thiazides on LDL and TG's
which loop diuretic does not have sulfa moiety?
because of better absorption, which loop diuretic is better to give in edematous state?
side effect of ethacrynic acid (and other loops)
if eGFR< 30-40, which diuretics should you use?
loops or metolazone
alpha 1 receptor
alpha 2 receptor
presynaptic, reduces catecholamine outflow
Beta 1 receptor
heart, inc. inotropy/chronotropy
Beta 2 receptor
do you have to give IV BB during acute MI?
what can BB mask the sxs of?
which 2 BB's have least CNS side effects b/c they are least lipid soluble?
name 2 BB's that have both beta and alpha blocking properties
name 4 selective BB's
metoprolol, atenolol, bisoprolol, esmolol
which BB also increases nitric oxide activity?
which BB's are best to use in reactive airway dz?
if pt has CHF and asthma and needs BB, which BB to use?
which BB's have shown survival benefit?
metoprolol succinate, carvedilol, bisoprolol
which BB can you use with dobutamine (b/c it doesnt blunt its effect)?
metoprolol, not coreg
which BB is "less well tolerated in asthma?"
what type of antihypertensive will ACEI's work synergystically with?
on ACEI, what is BP level very sensitive to?
dietary sodium intake
if you have MILD angioedema with an ACEI or hyperkalemia, what med can you cwitch to?
mech of aliskiren
what enzyme converts angiotensinogen to angiotensin I?
Which anti hypertensive class have been shown to have superior stroke risk reduction?
What do dihidrooyridines names end in?
(Amlodipine, nicardipine, etc)
Which CCB has the most negative inotropic and chronotropic effect?
Do dihidrooyridines have negative inotropic effects (norvasc)?
GI side effect if verapamil
Largest disadvantage of alpha blockers
What do you increase the risk of with alpha blocker as mono therapy (ALLHAT)?
Describe first dose phenomenon of prazosin or other alpha blockers
Postural hypotension/syncope 30-90 mins after first dose
2 side effects of minoxidil (used for severe HTN) and treatment
Always give with diuretic and BB
Direct vasodilator via NO and cGMP
Direct vasodilation by opening potassium channels in smooth muscle
Which statins use CYP3A4?
Simvastatin, atorvastatin, lovastatin
How common are serious liver problems with statins?
Definition myositis in statin use
CK 10x above normal
Blocks chol absorption at intestinal brush border
Does ezetimibe effect fat soluble vitamin uptake?
Best agent to raise HDL
Does niacin reduce coronary events?
Why do you have to have a niacin free interval with sutained release niacin?
Can statins be used in pregnancy?
Do fibrates decrease LDL?
Which fibrin acid can be used in pregnancy ?
Can you use fenofibrate, statins or fish oils in pregnancy?
What is the AHA rec for fish oils?
Post MI, 1g/ day
Do fish oils decrease CV risk?
Does dialysis remove dig?
Does digoxin have an effect in mortality?
Which is better at increasing cardiac output: dobutamine or milrinone?
Which reduces BP more: dobutamine or milrinone ?
Which has a faster onset: dobutamine or milrinone?
Which has shorter half life: dobutamine or milrinone?
Which receptors does dobutamine hit?
Which receptors does dopamine hit?
B1, alpha 1, dopaminergic
Does dobutamine h beta 1 or 2 receptor harder?
Beta 1 (inc inotropy)
Biggest side effect of dobutamine?
How long does it take to develop tolerance to dobutamine?
Name a good inotrop to increase CO and decrease SVR
Where does nitroprusside relax smooth muscle?
Does nitroprusside increase cAMP or cGMP?
Which IV anti hypertensive is light sensitive and causes thiocyanate tox?
Alpha 1, Beta 1
Which agent is preferred in septic shock and over dopamine in cardiogenic shock?
Name a potent press or used as a second agent in septic shock ?
what type of fat exactly does AHA want you to stay away from?
What percent of your calories should be from fat according to AHA ?
Less than 10% of what type of fat should be in AHA diet?
How many milligrams of cholesterol per day can you have in AHA diet?
Has Mediterranean diet been shown to reduce CV event rate?
Name 4 fish high in omega 3
Salmon, mackerel, herring, trout
Does tilapia have high fish oils?