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Flashcards in Pharmacology Deck (135):
1

mech of nitrates

inc. cGMP--> inhibit Ca influx--> smooth m. relaxation

2

do nitrates need intact endothelium to vasodilate?

no

3

what else can ranolazine possible do besides decrease chronic angina?

dec afib or ventricular arrhythmias

4

does ranolazine inc QT ?

yes

5

mech of ranolazine

alters late Na current and Na/Ca dependent channels

6

when is ranolazine contraindicated?

liver dz

7

which trial showed that clopidogrel with nexium had no difference in event rates?

COGENT

8

maximum ASA dose you can use with ticagrelor?

81mg

9

how is ticagrelor cleared?

hepatic ( do not use with severe impairment)

10

besides bleeding, what is a major side effect of ticagrelor?

SOB

11

important side effect to remember for abciximab

thrombocytopenia

12

if pt has had eptifibatide in past, can they get it again? why?

yes, it is not immunogenic

13

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.

14

what are differences b/w tPA and streptokinase?

higher bleeding with tPA, no allergy, less HoTN

15

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

16

mech of dabigatran

direct thrombin inhibitor

17

what enzyme metabolizes rivaroxaban (xarelto) and apixaban (eliquis)? what organ?

liver CYP3A4

18

when is rivaroxaban (xarelto) contraindicated?

renal failure

19

does rivaroxaban need to be given with food?

yes

20

can you give apixaban in renal failure?

yes

21

name 3 high risk groups for bleeding with NOAGs

older, renal impairment, skinny

22

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

23

which NOAG is dialyzable if pt. is bleeding?

dabigatran (pradaxa)

24

which type of pt. on procainamide witll get lupus?

slow acetylators bc of buildup of N-acetylprocainamide

25

2 drugs that can cause lupus-like syndrome?

procainamide
hydralazine

26

if a pt. has symptomatic HOCM and is already on BB or CCB, what med can you give?

disopyramide

27

what does liver dz do to lidocaine administration?

decreases metabolism (inc'd tox)

28

what is the dose-related toxicity of lidocaine?

CNS (dizzy, hallucinations, confusion, Sz)

29

if a patient has CHF and needs lidocaine, what do you have to remember?

use lower dose

30

which trial showed that flecainide can't be used in ischemic HD?

CAST

31

which antiarrhythmics can be used to treat disabling PVCs?

flec/propafenone

32

which class Ic antiarrhythmic has a higher beta blocking effect (e.g. bronchospasm, slower HR) ?

propafenone

33

which of the following will slow heart rate more: flecainide or propafenone?

prop

34

what do D + L isomers of sotalol do?

D- prolong repol
L- Beta block

35

can stall prolong QT?

yes

36

should you admit a pt for starting sotalol?

yes, QT prolongation

37

what happens to sotalol with CRI?

prolonged half life

38

main use for sotalol

afib

39

what to remember about verapamil and dofetilide?

dofetilide tox possible because both use CYP3A4

40

why does amio cause hypothyroidism?

blocks conversion of T4 to T3

41

what is the active metabolite of amio?

desethylamiodarone

42

mortality rate of amio related plum fibrosis?

10%

43

name 7 drugs/drug classes using CYP3A4

antifungals, macrolide Abx, PI's
verapamil, diltiazem
grapefruit juice
statins

44

two ocular effects of amio

corneal deposits
optic neuritis

45

which drug is the non-iodine version of amio?

dronedarone

46

mech of HCTZ

blocks reabsorption of Na in DCT

47

what is effect on K+ by HCTZ?

hypokalemia

48

what is effect of HCTZ on uric acid?

reduced excretion

49

why is there an increased risk of gout with HCTZ?

reduced uric acid excretion

50

why can you give HCTZ to prevent Ca stones?

Calcium excretion is decreased

51

does HCTZ affect GFR?

no

52

difference in potency b/w metolazone and HCTZ?

metolazone 10x more diuretic and hypokalemic effect

53

which is better for edema: HCTZ or metolazone?

metolazone

54

why does chlorthalidone have long half life?

90% bound to erythrocyte carbonic anhydrase

55

can thiazides cause torsades?

yes

56

what to remember about thiazides and lithium?

decrease lithium dose by 50%

57

effect of thiazides on LDL and TG's

increase

58

which loop diuretic does not have sulfa moiety?

ethacrynic acid

59

because of better absorption, which loop diuretic is better to give in edematous state?

bumetanide/torsemide

60

side effect of ethacrynic acid (and other loops)

ototoxicity

61

if eGFR< 30-40, which diuretics should you use?

loops or metolazone

62

alpha 1 receptor

vasoconstriction

63

alpha 2 receptor

presynaptic, reduces catecholamine outflow

64

Beta 1 receptor

heart, inc. inotropy/chronotropy

65

Beta 2 receptor

vessels, vasodilation

66

do you have to give IV BB during acute MI?

no

67

what can BB mask the sxs of?

hypoglycemia

68

which 2 BB's have least CNS side effects b/c they are least lipid soluble?

atenolol, nadolol

69

name 2 BB's that have both beta and alpha blocking properties

labetalol, carvedilol

70

name 4 selective BB's

metoprolol, atenolol, bisoprolol, esmolol

71

which BB also increases nitric oxide activity?

nebivolol

72

which BB's are best to use in reactive airway dz?

nebivolol, bisoprolol

73

if pt has CHF and asthma and needs BB, which BB to use?

bisoprolol

74

which BB's have shown survival benefit?

metoprolol succinate, carvedilol, bisoprolol

75

which BB can you use with dobutamine (b/c it doesnt blunt its effect)?

metoprolol, not coreg

76

which BB is "less well tolerated in asthma?"

carvedilol

77

what type of antihypertensive will ACEI's work synergystically with?

diuretics

78

on ACEI, what is BP level very sensitive to?

dietary sodium intake

79

if you have MILD angioedema with an ACEI or hyperkalemia, what med can you cwitch to?

ARB

80

mech of aliskiren

renin inhibitor

81

what enzyme converts angiotensinogen to angiotensin I?

renin

82

Which anti hypertensive class have been shown to have superior stroke risk reduction?

CCBs

83

Name nondihydropyridines

Verapamil
Diltiazem

84

What do dihidrooyridines names end in?

-dipine

(Amlodipine, nicardipine, etc)

85

Which CCB has the most negative inotropic and chronotropic effect?

Verapamil

86

Do dihidrooyridines have negative inotropic effects (norvasc)?

No

87

GI side effect if verapamil

Constipation

88

Largest disadvantage of alpha blockers

Orthostatic hypotension

89

What do you increase the risk of with alpha blocker as mono therapy (ALLHAT)?

CHF

90

Describe first dose phenomenon of prazosin or other alpha blockers

Postural hypotension/syncope 30-90 mins after first dose

91

2 side effects of minoxidil (used for severe HTN) and treatment

Edema
Hirsutism
Always give with diuretic and BB

92

Hydralazine MOA

Direct vasodilator via NO and cGMP

93

Minoxidil MOA

Direct vasodilation by opening potassium channels in smooth muscle

94

Which statins use CYP3A4?

"Sal"

Simvastatin, atorvastatin, lovastatin

95

How common are serious liver problems with statins?

Very rare

96

Definition myositis in statin use

CK 10x above normal

97

Ezetimibe MOA

Blocks chol absorption at intestinal brush border

98

Does ezetimibe effect fat soluble vitamin uptake?

No

99

Best agent to raise HDL

Niacin

100

Does niacin reduce coronary events?

Yes

101

Why do you have to have a niacin free interval with sutained release niacin?

Hepatotoxicity

102

Can statins be used in pregnancy?

No

103

Do fibrates decrease LDL?

No

104

Which fibrin acid can be used in pregnancy ?

Gemfibrozil

105

Can you use fenofibrate, statins or fish oils in pregnancy?

No

106

What is the AHA rec for fish oils?

Post MI, 1g/ day

107

Do fish oils decrease CV risk?

No

108

Does dialysis remove dig?

Yes

109

Does digoxin have an effect in mortality?

No

110

Which is better at increasing cardiac output: dobutamine or milrinone?

Dobutamine

111

Which reduces BP more: dobutamine or milrinone ?

Milrinone

112

Which has a faster onset: dobutamine or milrinone?

Dobutamine

113

Which has shorter half life: dobutamine or milrinone?

Dobutamine

114

Which receptors does dobutamine hit?

B1, B2

115

Which receptors does dopamine hit?

B1, alpha 1, dopaminergic

116

Does dobutamine h beta 1 or 2 receptor harder?

Beta 1 (inc inotropy)

117

Biggest side effect of dobutamine?

Arrhythmias

118

How long does it take to develop tolerance to dobutamine?

72h

119

Milrinone MOA

Phosphodiesterase inhibitor

120

Name a good inotrop to increase CO and decrease SVR

Milrinone

121

Where does nitroprusside relax smooth muscle?

Arterioles, veins

122

Does nitroprusside increase cAMP or cGMP?

cGMP

123

Which IV anti hypertensive is light sensitive and causes thiocyanate tox?

Nitroprusside

124

Phenylepheine receptor

Alpha 1

125

Norepinephrine receptors

Alpha 1, Beta 1

126

Which agent is preferred in septic shock and over dopamine in cardiogenic shock?

Norepinephrine (levophed)

127

Name a potent press or used as a second agent in septic shock ?

Vasopressin

128

what type of fat exactly does AHA want you to stay away from?

Saturated fat

129

What percent of your calories should be from fat according to AHA ?

30%

130

Less than 10% of what type of fat should be in AHA diet?

Saturated fat

131

How many milligrams of cholesterol per day can you have in AHA diet?

300mg

132

Has Mediterranean diet been shown to reduce CV event rate?

Yes

133

Name 4 fish high in omega 3

Salmon, mackerel, herring, trout

134

Does tilapia have high fish oils?

No

135

Do fish oils increase bleeding time?

Yes