Pharmacology Flashcards
(135 cards)
1
Q
mech of nitrates
A
inc. cGMP–> inhibit Ca influx–> smooth m. relaxation
2
Q
do nitrates need intact endothelium to vasodilate?
A
no
3
Q
what else can ranolazine possible do besides decrease chronic angina?
A
dec afib or ventricular arrhythmias
4
Q
does ranolazine inc QT ?
A
yes
5
Q
mech of ranolazine
A
alters late Na current and Na/Ca dependent channels
6
Q
when is ranolazine contraindicated?
A
liver dz
7
Q
which trial showed that clopidogrel with nexium had no difference in event rates?
A
COGENT
8
Q
maximum ASA dose you can use with ticagrelor?
A
81mg
9
Q
how is ticagrelor cleared?
A
hepatic ( do not use with severe impairment)
10
Q
besides bleeding, what is a major side effect of ticagrelor?
A
SOB
11
Q
important side effect to remember for abciximab
A
thrombocytopenia
12
Q
if pt has had eptifibatide in past, can they get it again? why?
A
yes, it is not immunogenic
13
Q
if a pt has had streptokinase in past year, can they get it again? why?
A
no. allergic rxn/;ess effective b/c of Ab’s to it.
14
Q
what are differences b/w tPA and streptokinase?
A
higher bleeding with tPA, no allergy, less HoTN
15
Q
what happens when someone is on dabigatran and you start amio? what to do?
A
amio increases dabigatran levels by 50%
cut dabigatran to 75 bid
16
Q
mech of dabigatran
A
direct thrombin inhibitor
17
Q
what enzyme metabolizes rivaroxaban (xarelto) and apixaban (eliquis)? what organ?
A
liver CYP3A4
18
Q
when is rivaroxaban (xarelto) contraindicated?
A
renal failure
19
Q
does rivaroxaban need to be given with food?
A
yes
20
Q
can you give apixaban in renal failure?
A
yes
21
Q
name 3 high risk groups for bleeding with NOAGs
A
older, renal impairment, skinny
22
Q
what is the story with dabigatran (pradaxa) and MI?
A
- RE-LY showed slight increase in MI.
- review w/ revised results showed not statistically sig
- metanalysis confirmed inc risk of MI
23
Q
which NOAG is dialyzable if pt. is bleeding?
A
dabigatran (pradaxa)
24
Q
which type of pt. on procainamide witll get lupus?
A
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
