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Pharmacology Flashcards

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1
Q

Nitrates

A

Nitroglycerin (Nitrostat, Nitroquick

Isosorbide dinitrate/mononitrate

-(Isordil/Imdur)

Transdermal patch (Nitrodur)

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2
Q

Nitrates MOA

A

Decrease O2 demand of heart by

  • decreasing arteriolar and venous tone -> Systemic and coronary vasodilation
  • Decreasing preload
  • Decrease afterload at higher doses
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3
Q

Short acting nitrate use and dose

A

Immediate anginal relief

Sublingual nitro tablet/spray -> 0.4 mg

Repeat in 3-5 min if needed

Pain >20 min -> ED

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4
Q

Nitroglycerin side effects

A

HA

Dizziness

Hypotension

Flushing

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5
Q

Nitrate contraindications

A

Hypotension

Aortic stenosis

Severe volume depletion

Acute RV infarct

Hypertrophic cardiomyopathy

Recent erectile dysfunction meds

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6
Q

Long acting nitrate use

A

Not first line

Can develop a tolerance over time

Have to have 8-10 hour nitrate-free interval/day

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7
Q

Long acting nitrates and dose

A

Isosorbide mononitrate (Imdur) - 30-120 mg QD/BID

Isosorbide dinitrate (Isordil) - 5-40 mg BID/TID

Transdermal patch (NitroDur) - 0.1, 0.2, .4, 0.6 mg/hr

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8
Q

Beta Blocker indications

A

HTN

Tachycardia

CHF (not acute)

Ischemic heart disease

CAD post MI - prolongs life

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9
Q

Beta Blocker drugs

A

Metoprolol (Lopressor, Toprol)

Bisoprolol (Zebeta)

Atenolol (Tenormin)

Carvedilol (Coreg)

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10
Q

Beta Blocker contraindications

A

Severe bronchospasm

Bradyarrhythmias

Decompensated heart failure (Acute CHF)

Prinzmetal’s angina -> Alpha 1 receptors not balanced w/ beta

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11
Q

Beta Blocker cessation

A

Abrupt withdrawl may precipitate tachycardia, HTN, angina, MI

-taper off to prevent withdrawl

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12
Q

Calcium Channel Blockers indications

A

Best single agent to just lower BP

HTN

Tachycardia

Angina

Coronary vasospasm

Peripheral vasospasm

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13
Q

Calcium channel blockers MOA

A

Cause peripheral and coronary vasodilation

All decrease preload and blood pressure while increasing oxygen supply

-Verapamil and diltiazem decrease heart rate and contractility

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14
Q

Calcium channel blockers and classes

A

Dihydropyridines (-dipine)

  • Amlodipine (Norvasc) - only one used w/ systolic heart failure
  • Nifedipine (Adalat, Procardia)

Nondihydrophyridines

  • Diltiazem (Cardizem)
  • Verapamil
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15
Q

Calcium channel blocker side effects

A

HA

Edema

Constipation

Hypotension

Dizziness

Bradycardia (nondihydrophyridines)

Worse BBB (non-dihydopyridines)

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16
Q

Nondihydrophyridine contraindications

A

Systolic CHF (lower ejection fracture too much)

AV block/bradycardia

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17
Q

Calcium channel blocker caution

A

Use caution in pts w/ peripheral edema or hypotension hx

Multiple drug interaction - be careful

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18
Q

Antiplatelet MOA and Goal

A

Interfere either w/ platelel adhesion/aggregation

Goal: prevent initial clot formation

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19
Q

Fibrinolytic MOA and Goal

A

degrade fibrinogen/fibrin

Goal: eliminate formed clots

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20
Q

Anticoagulants MOA and goal

A

Inhibit the clotting mechanism

Goal: prevent thrombosis progression

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21
Q

Antiplatelet agents

A

Aspirin

P2Y12 Antagonists

GPIIB/IIIA Antagonists

  • decrease platelet aggregation, can work acutely
  • Used in an MI, can give IV
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22
Q

Aspirin

A

Potent, irreversable anti-platelet agent

Inhibit cyclooxygenase (platelet aggregation stimulant)

Inhibit platelet plug formation

Rapid absorption, peak effects in 1 hr

Beneficial in unstable angina

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23
Q

Aspirin dosing

A

Vary depending on indication

Primary CVA/MI prevention: 81 mg daily

Secondary CVA/MI prevention: 325 mg daily, depends on other meds

Acute coronary syndrome: chew 1X 325 mg

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24
Q

Aspirin side effects

A

BLEEDING - always check for GI bleeds, take w/ food

Tinnitis (high dose)

Resistance - no effect on platelet aggregation

Allergy

Stop 4 days before surgery

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25
P2Y12 Antagonists and dose
All need loading doses to reach therapeutics levels quickly - Clopidogrel (Plavix): 300-600 mg LD, w/in 2 hrs, 5 days to normal - Presugrel (Effient): 60 mg LD w/in 30 mins, 5-9 days to normal - Ticagrelor (Brilinta): 180 LD w/in 30 mins, 3 days to normal
26
P2Y12 Antagonist side effects
Bleeding, non-reversable Some people are resistant to Clopidogrel Dont use Prasugrel if \>75 or \<60 kg - increases bleeding risk Ticagrelor causes SOB in 10-14% pts w/in few days starting -\> is transient
27
GPIIB/IIIA Antagonists
IV, only for acute MI during percutaneous coronary intervention Abciximab (Reopro) Eptifibatide (Integrelin)
28
GPIIB/IIIA Antagonist Pharmacokinetics
Immediate onset of action Reversible - platelet function returns to normal 4-8 hours after drug cessation
29
GPIIB/IIIA Antagonist side effects
Bleeding Thrombocytopenia - takes a few days to resolve Allergy
30
Anticoagulants
Only for Acute MI Inhibit clotting mechanism Enoxapain (Lovenox) - LMWH Heparin (unfractionated Heparin) Bivalirudin (Angiomax)
31
Heparin
Activates anticlotting factors (antithrombin III) to indirectly inhibit thrombin Monitor w/ aPTT Give IV for acute/SQ for DVT prevention in post-surgical
32
Heparin contraindications and side effects
CI: Anaphylaxis, recent surgery Side effects: bleeding, hypersensitivity, transaminitis, Heparin induced thrombocytopenia (HIT) HIT -\> Immune reaction, cant ever have again
33
Enoxaparin (Lovenox)
Inhibits Xa (more so than UFH) and antithrombin III indirectly inhibits thrombin IV followed by SQ in acute MI Has to wear off, only nonreversable anticoagulant
34
Bivalirudin (Angiomax)
Direct thrombin inhibitor Immediate onset, reversable (~1hr post cessation) side effect: bleeding CI: allergy, recent major surgery, trauma
35
Fibrinolytics
AKA Thrombolytics tPA Streptokinase (Streptase) Urokinase (Abbokinase)
36
Thrombolytic MOA and indications
Convert plasminogen to plasmin -\> breakdown fibrin strands Short activation and half life Use to tx existing clots (MI, stroke, massive PA, limb threatening ischemia)
37
Diuretic types
Thiazide (HCTZ) Loop diuretics K+ sparing diuretics Combo HCTZ and K+ sparing Use caution when combining w/ ACE inhibitors
38
Thiazide and MOA
Diuretic Hydrochlorothiazide (HCTZ) inhibits NaCl reabsorption in DCT First line
39
Thiazide side effects
May cause hypokalemia, hyponatremia Pts allergic to sulfa may be allergic to this Sun sensitivity Ineffective w/ creatinine \>2.5 (kidney failure)
40
Loop diuretics indications and MOA
Selectively inhibit NaCl reabsoption in thick ascending loop in loop of Henle Usually use only in CHF and chronic renal insufficiency Give w/ K+ (10 K+ for 20 lasix
41
Loop diuretics
Furosemide (Lasix) Torsemide (Demedex) Bumetanide (Bumex) Metolazone (Zaroxolyn)
42
K+ Sparing diuretics MOA and use
Antagonize aldosterone effects in late distal and cortical collecting tubule Weak, but spare K+ and Mg loss
43
K+ sparing diuretics
Aldactone (Spironolactone) Midamor (Amiloride) Dyrenium (Triamterene)
44
Combo HCTZ and K+ sparing diuretics
High maintenance Altaxtazide (Spironolactone/HCTZ) Dyazide (Triameterene/HCTZ) Maxzide (Triamterene/HCTZ) - stonger dose Moduretic (Amiloride/HCTZ)
45
Beta Blockers
Decrease sympathetic drive, renin release Cardioprotective - only drug to prolong CAD post MI life Anti-HTN, also used to control ischemic heart disease 1st line for chronic angina, CAD post MI Decrease heart rate and contraction to reduce amount of O2 needed
46
Beta 1 selective Beta Blockers
Metopropol (Lopressor, Toprol XL) Atenolol (Tenormin) Bisopropol (Zebeta) Acebutolol (Sectrol)
47
Nonselective Beta Blockers
Propanolol (Inderal) Sotalol (Betapace) Timolol (Blocadren)
48
Combo nonselective Beta Blockers and Alpha 1 Blockers
Carvedilol (Coreg) Labetolol (Trandate)
49
Beta Blocker combos
Atenolol-chlorthalidone (Tenoretic) Metoprolol/HCTZ (Lopressor HCT) Bisoprolol/HCTZ (Ziac)
50
Beta Blocker side effects
Bradycardia Heart failure Bronchospasm (Careful w/ asthmatic) CNS depression Erectile dysfunction Mask Hypoglycemia and shock Lower HDLs Cannot abruptly discontinue (Rebound HTN, depression) Drug interactions
51
Only CCB you can use w/ CHF
Amlodipine Is neither a negative chronotrope (decrease HR) or isotrope (decrease contractility force)
52
Reversible antiplatlets
Only GPIIB/IIIA Antagonists
53
Beta blocker drug interactions
NSAIDS - blunt BB effect Epinephrine - need more to work, cause severe HTN Calcium channel blockers - additive effects can cause ectopic foci/arrhythmias
54
ACE Inhibitors are first line in:
Diabetes CHF Chronic kidney disease Myocardial infarction
55
Drugs that can cause a hypertensive crisis
MAO (monoamine oxidase) inhibitors - depression -get Malignant HTN/stroke if they eat tyromine-containing foods Sympathomimetics (sudafed) Recreational drugs
56
Good HTN drug combinations
BB + diuretic ARB + diuretic ACEI + diuretic CCB + ACEI ACEI + BB
57
HTN Drug combinations to avoid
BB + CCD (Non-dihydropyridines) ACEI/ARB + K+ sparing diuretics Centrally acting agent combinations Clonidine (Urgent HTN crisis) + BB
58
Heart failure recommended drugs
Diuretic BB ACEI/ARB Aldosterone antagonist
59
Post-MI recommended drugs
BB ACEI/ARB Aldosterone antagonist
60
High CAD risk recommended drugs
Diuretic BB ACEI CCB
61
Diabetes recommended drugs
Diuretic BB ACEI/ARB CCB
62
Chronic kidney disease recommended drugs
ACEI/ARB
63
Black pts w/ HTN
Thiazide CCB
64
HTN pts w/ CAD
BB
65
HTN pts w/ LV systolic dysfunction or overt heart failure
Diuretics ACEI BB (watch out for CHF increase) DO NOT GIVE CCB
66
HTN diabetic pts w/ nephropathy
ACEI ARB Check kidney function in a week
67
HTN development during pregnancy
Methyldopa
68
Pts w/ renal insufficiency/CRF
ACEI ARB
69
ACE Inhibitors
-prils Block aldosterone release to prevent vasoconstriction and RAAS Renal protectice and cardioprotective
70
ACE Inhibitor contraindications
Renal artery stenosis K+ sparing diuretics Pregnancy
71
ACE Inhibitor side effects
Cough Acute renal failure Angioedema Hypotension
72
ACE Inhibitor drugs
Captopril (Capoten) Lisinopril (Zestril) Enalapril (Vasotec) Benazpril (Lotensin) Ramipril (Altace) Quinapril (Accupril)
73
Angiotensin II Receptor Blockers (ARBs)
-sartans Everything like an ACEI w/o the cough
74
ARBs contraindications
Pregnancy Renal artery stenosis
75
ARB drugs
Irbesartan (Avapro) Candesartan (Atacand) Losartan (Cozaar) Valsartan (Divoan) Olmesartan Medoxomil (Benicar)
76
Alpha-1 blockers
-zosin Cause vasodilation to reduce PVR Also used to tx benign prostatic hyperplasia Use low dose - cause syncope
77
Alpha-1 Blocker drugs
Prazosin (Minipress) Terazosin (Hytrin) Doxazosin (Cardura)
78
Alpha - 2 receptor agonists
Work centrally - stimulate brain alpha-2 to decrease vasoconstriction Used only in difficult to control HTN or w/ Pregnancy SE: dry mouth, depression
79
Alpha-2 receptor agonist drugs
Clonidine - patch Methyldopa - pregnancy
80
Vasodilators
Used in emergencies to rapidly drop pressure cGMP increase to relax smoothe muscles Can build tolerance over time
81
Vasodilating drugs and SE
Hydralazine - lupus-like syndrome Minoxidil - severe Na/H2O retention, Hirsutism Reserpine - Mental depression w/ serotonin loss -Give w/ a diuretic
82
Digoxin
Atria rate control, CHF positive inotrope Stimulates PNS to increase vagal tone - doesn't work w/ exercise Slow onset, loading dose, week till steady state - 0.8-2 ng/mL (0.5-1 w/ CHF)
83
Digoxin Toxicity
Decreased renal function, electrolyte disturbances DI w/ amiodarone, verapamil Sx: AV block, junctional tachycardia, ventricular arrhythmias, visual disturbances (yellow-green, halos), dizziness, weakness, N/V/D, anorexia
84
Adenosine
Convert PSVT to sinus rhythm Activates potassium channels to hyperpolarize cell membrane Very short half-life - 10 seconds CI: 2/3 degree block, sick sinus syndrome w/o pacemaker
85
Atropine
Used to tx symptomatic bradycardia Parasympatholytic = enhance SA and AV automaticity by blocking PNS/ACh CI: angle-closure glaucoma, obstructive uropathy (BPH), Tachycardia, Bowel obstruction/altered transit (ischemic bowel) May induce tachycardia
86
Class I
Sodium channel blockers Grouped according to how quickly they move on/off sodium channels
87
Class Ia
Proarrhythmic - emergent only Use for atrial and ventricle rhythms - increase SA/AV automaticity A-fib/flutter - need BB/CCB on board to prevent tachycardia Procainamide IV
88
Class Ib
Used for ventricular arrhythmias (ACLS) Work on ischemic/infarcted tissue (acute MI) Lidocaine IV, Mexiletine PO
89
Class Ib toxicity
Seizure Respiratory arrest
90
Class Ic
Use only when nothing else works - Amiodarone is more effective Flecainide = rhythm control a-fib/flutter Propafenone = rhythm control w/ atrial dysrhythmias CI w/ structure heart disease
91
Class II
Beta blockers - Metroprolol best w/o kidney SE Used for ventricular/supraventricular arrhythmias Slow AV/SA rates/conduction, negative inotrope to decrease O2 consumption SE: bronchospasm, depression, bradycardia, ED, worsen CHF
92
Class III
Potassium channel blockers Antiarrhythmics - prolong action potential Monitor for EKG changes CI w/ drugs that prolong QT interval
93
Amiodarone
Class III - a-fib/flutter, ventricular arrhythmias Need large dose, goes everywhere, 6 mo 1/2 life Toxicities w/ deposition into organs - pulmonary is life-threatening Monitor PFT, CXR, DLCO yearly - take off w/ changes Monitor TSH, CBC, LFTs q6mo SE: GI w/ high dose, DI - CYP3A4, increase warfarin and digoxin effects
94
Sotalol
Class III, BB like properties Prolongs QT - monitor 3 days after start Use for V-tach, A-fib/flutter Renal clearance Risk for Torsades
95
Dofetilide
Class III - proarrhythmic a-fib/flutter SE: Prolong QT, torsades, HA, dizziness, many DI w/ common Abx - macrolides, Bactrim, CCB
96
Ibutilide
Class III IV only, acute a-fib/flutter conversion to sinus SE: torsades
97
Class IV
Calcium Channel Blockers - Nondihyrodpyridine Decrease SA/AV automaticity, no ventricle effect CI w/ LVSD, WPW, accessory pathway SE: Bradycardia, Heart block, flushing, dizziness, edema, constipation and HOTN

Cardiology (7 decks)

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