Term
___________ Indications
Acute myocardial infarction
Pulmonary embolism
Deep venous thrombosis
Ischemic stroke (special circumstances only) - CAT scan, MRI first |
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Definition
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| ________: a nonenzymatic activator of plasminogen extracted from hemolytic streptococci |
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Definition
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| serious side effect of thrombolytic agents? |
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Definition
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Term
ASA – ________ block of cycloxygenase
- will inactivate platelets for __ days |
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| ASA Should be administered routinely to virtually all patients with _______ |
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Definition
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Definition
| Prevents fibrinogen binding to glycoprotein GP IIb-IIIa, thus inhibiting platelet aggregation |
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Term
| Clopidogrel used for? (3) |
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Definition
Stents
Acute coronary syndrome
prevention of ischemic events in atherosclerosis |
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Definition
| Approved as antithrombotic during angioplasty |
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Definition
Inhibits PDE III (increases cyclic AMP)
Inhibits platelet aggregation
Stimulates vasodilation |
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Term
| Cilostazol Indicated for? |
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Definition
| reduction of symptoms of intermittent claudication |
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Term
| Cilostazol contraindicated in? |
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Definition
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Definition
Hemorrheologic Agent = improves blood flow
Mechanism enhances RBC flexibility, decreases blood viscosity
may decrease TXA 2 levels and increase PGI2 levels |
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Term
| Pentoxifylline indications? (2) |
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Definition
intermittent claudication
chronic occlusive arterial disease of the limbs |
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Term
heparin route?
warfarin route? |
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Definition
heparin iv - in hospital - fast onset
warfarin po - outpatient - slow onset |
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Definition
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Definition
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Term
| what lab used to monitor heparin? |
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Definition
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Term
| aPTT of __-__ times control is the typical therapeutic goal when using Heparin |
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Definition
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Definition
Stop Heparin
Protamine sulfate
binds to and inactivates heparin
must be given slowly IV
FFP |
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Definition
| prophylaxis of DVT associated with hip, knee, and abdominal surgery |
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Definition
inhibits vitamin K epoxide reductase
inhibits vitamin K-dependent post-translation modification of clotting factors: thrombin, VII, IX, X, Protein C and S
without addition of the carboxyglutamic acid residue the clotting factors cannot bind Ca++ and are inactive |
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Term
| Contraindications to Warfarin Therapy |
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Definition
Absolute
Pregnancy
teratogenicity
fetal hemorrhage |
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Term
| indirect thrombin inhibitors |
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Definition
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Term
| direct thrombin inhibitors |
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Definition
Parenteral Oral
Hirudin Ximelagatran
Argatroban **Dabigatran**
Bivalirudin etexilate |
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Definition
Anticoagulant
Direct thrombin inhibitor |
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Definition
| Prevention of stroke and systemic embolism in non-valvular atrial fibriliation |
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Definition
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Term
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Definition
| α-adrenoceptor antagonists |
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Definition
| α-adrenoceptor antagonists |
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Term
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Definition
| α-adrenoceptor antagonists |
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Definition
| nonspecific β-adrenoceptor antagonists: |
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Definition
| nonspecific β-adrenoceptor antagonists: |
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Term
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Definition
| β1-adrenoceptor antagonists: |
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Term
| metoprolol succinate and metoprolol tartrate |
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Definition
| β1-adrenoceptor antagonists: |
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Definition
| Calcium channel blockers: |
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Definition
| Calcium channel blockers: |
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Definition
| Calcium channel blockers: |
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Definition
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Definition
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Definition
| Centrally acting antihypertensives: |
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Definition
| Centrally acting antihypertensives: |
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Term
| ARBs – two that are FDA approved in HF in place of ACE-Is – |
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Definition
| candesartan and valsartan |
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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Term
Diuretics
Adverse Effects and Side Effects |
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Definition
Electrolyte Imbalance (most common hypokalemia, then hyperkalemia but can include calcium imbalance, hypomagnesemia, hyponatremia)
Biggest concern here is dysrhythmias
Hyperlipidemia
Glucose Intolerance and Insulin Resistance
Hyperuricemia
Rare Nephritis, blood dyscrasias, cholecystitis, pancreatitis, necrotizing vasculitis |
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Term
| Central Acting Adrenergic Blockers MOA? |
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Definition
| Action – Lower sympathetic activity, modest decrease in PVR/CO and Renin Level |
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Term
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Definition
| Central Acting Adrenergic Blockers |
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Term
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Definition
| Central Acting Adrenergic Blockers |
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Term
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Definition
| Central Acting Adrenergic Blockers |
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Term
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Definition
| Central Acting Adrenergic Blockers |
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Term
| Peripheral Acting Adrenergic Blocker MOA? |
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Definition
(blocks norepinephrine uptake)
Action - Decreases PVR |
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Term
| Central Acting Adrenergic Blockers Side Effects? |
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Definition
| sedation, dry mouth, rebound HTN, fluid retention |
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Term
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Definition
| Peripheral Acting Adrenergic Blocker |
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Term
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Definition
| Peripheral Acting Adrenergic Blocker |
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Term
| Alpha 1 Adrenergic Blockers MOA? |
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Definition
(Selective Post Synaptic Catecholamine Blocker)
Action – Decreases PVR and Pre Load |
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Term
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Definition
| Alpha 1 Adrenergic Blockers |
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Term
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Definition
| Alpha 1 Adrenergic Blockers |
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Term
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Definition
| Alpha 1 Adrenergic Blockers |
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Term
| Peripheral Acting Adrenergic Blockers Side Effects? |
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Definition
| CNS depression (sedation and depression), nasal stuffiness |
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Term
Alpha 1 Adrenergic Blockers
Side Effects? |
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Definition
| – headache, drowsiness, fatigue, dizziness, asthma type response, first dose hypotensive response |
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Term
| Beta Adrenergic Blockers (Beta 1 and 2) MOA? |
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Definition
| Action – Reduces CO and HR, diminishes renin release, decrease PVR (usually with time), inhibit catecholamine release |
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Term
| Beta Adrenergic Blockers (Beta 1 and 2) Side Effects? |
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Definition
| CNS side effects (insomnia, depressed mood, nightmares, sexual dysfunction), hypoglycemia, hypotension, bradycardia dyslipidemia (HDL,TGY), bronchospasm |
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Term
| what are the two combined alpha and beta blockers? |
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Definition
Carvedilol
Labetalol - impt in heart failure – not as effective for just HTN |
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Term
| Beta blocker will decrease contractility – will decrease stroke volume on the wiggers diagram |
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Definition
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Definition
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Definition
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Definition
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Definition
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| Direct vasodilators side effects? |
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Definition
| Tachycardia, Lupus like symptoms, headaches, hirsutism (primarily Minoxidil) |
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
| Ankle edema, headaches, flushing, gingival hyperplasia (primarily dihydropyridine) |
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Term
| The only CCB you can use in HF patient is ____– doesn’t hurt or help HF = neutral |
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Definition
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Term
| Angiotensin Converting Enzyme Inhibitors MOA? |
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Definition
| Inhibits Angiotensin II (direct vasoconstrictor) and increased kinin levels |
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Term
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Definition
| Dry hacking cough, angioedema, rash, first dose hypotension, hyperkalemia, caution with increasing renal insufficiency |
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Term
| ____ Contraindicated in 2nd & 3rd trimester pregnancy |
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Definition
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Term
| Angiotensin Release Blocking MOA? |
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Definition
| Action – Directly displaces Angiotensin II (direct vasoconstrictor) |
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Term
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Definition
| Side Effects – hyperkalemia, angioedema, first dose hypotension, caution with increasing renal insufficiency |
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Term
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Definition
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Term
In contrast to ACE-I, no ___ with ARBs
Less chance of ___ |
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Definition
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Term
A patient is started on a drug for treatment of hypertension. On a return visit to your office, he states that shortly after he started taking the drug, he experienced a persistent cough that has not improved even though he has taken the medication as prescribed. What is the most likely drug that he was taking, and what drug could you substitute that would have similar beneficial pharmacodynamic effects while likely producing less cough?
Initial Drug Substituted Drug
moexipril telmisartan
chlorothiazide torsemide
diltiazem nifedipine
hydralazine alpha-methyldopa |
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Definition
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Term
A patient is found to have new onset hypertension 145/95 mmHg. The patient is African American. Which of the following antihypertensive agents would be used initially because it is typically more effective in African Americans?
HCTZ
Lisinopril
Captopril
Valsartan
Atenolol
Prazosin |
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Definition
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Term
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Definition
Thiazides
ACE-I - ATII blockers (ARBS)
Beta blockers
Calcium channel blockers
Alpha blockers
Vasodilators |
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Term
| FOR HTN in Coronary heart disease, Tx w/? |
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Definition
| beta blockers, ACE inhibitors |
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Term
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Definition
| ACE inhibitors, beta blockers, ARBs, spiranolactone |
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Term
| For HTN in Diabetics, Tx w/? |
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Definition
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Term
| For HTN in Renal insufficiency, Tx w/? |
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Definition
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Term
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Definition
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Term
| What are the 3 classes of antianginals? |
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Definition
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Term
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Definition
Late Sodium Blocker
decreased myocardial stress, increased coronary perfusion |
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Term
| what antianginal drug can you use as an adjunct when you don't think any other drug is working? |
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Definition
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Term
| HMG-CoA Reductase Inhibitors are for _____ |
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Definition
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Term
| HMG-CoA Reductase Inhibitors MOA? |
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Definition
| Action – Primarily works in enhancing hepatocyte LDL receptors and increases LDL clearing from plasma |
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Term
| HMG-CoA Reductase Inhibitors Indications? |
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Definition
| Use – Increased LDL, TC, Apo B, Non-HDL primarily; modest effect on increased TGY; much less effect on low HDL |
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Term
| HMG-CoA Reductase Inhibitors Side Effects? |
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Definition
Myopathy/Rhabdomyolysis
Increased Liver Enzymes |
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Term
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Definition
| HMG-CoA Reductase Inhibitors |
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Term
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Definition
| HMG-CoA Reductase Inhibitors |
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Term
| Bile Acid Sequestrants MOA? |
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Definition
| Action – Primarily works in the liver by increasing LDL clearance and increased cholesterol losses in the bile |
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Term
| Bile Acid Sequestrants Indications? |
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Definition
| Increased LDL, TC, Non-HDL primarily; no effect or may increase TGY |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| Bile Acid Sequestrants SE? |
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Definition
| GI distress, constipation, decreased absorption other drugs, |
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Term
| Fibric Acids are used to treat? |
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Definition
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Term
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Definition
| Action – Enhances lipoprotein lipase in the peripheral tissues and improved removal of triglycerides |
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Term
| Fibric Acids indications? |
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Definition
| Use - Increased TGY primarily with good effect on LDL, TC, Non-HDL; modest effect on low HDL |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| Side Effects - Dyspepsia, Gallstones, Myopathy, Rhabdomyolysis (Myoglobinuria) |
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Term
| Nicotinic Acids are used to treat? |
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Definition
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Term
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Definition
| Action – Limits FFA from adipose tissue which decreases hepatic release of VLDL |
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Term
| Nicotinic acids indications? |
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Definition
| Use – Primarily elevates HDL, high modest lowering of LDL and Apo B, low modest effect on increased TGY |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| Flushing, hyperglycemia, hyperuricemia, UGI distress, hepatotoxicity |
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Term
| Cholesterol Absorption Inhibitors MOA? |
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Definition
| Action – Decreases cholesterol absorption in the gut |
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Term
| Cholesterol Absorption Inhibitors Indications? |
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Definition
| Use - Increased LDL and TC, Apo B; no substantial effect on HDL or TGY |
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Term
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Definition
| Cholesterol absorption inhibitor |
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Term
| Cholesterol absorption ihibitor Side Effects? |
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Definition
| Arthralgias, Back Pain, Abdominal Pain, Diarrhea, Cough |
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Term
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Definition
| Action – Reduced production of VLDL and remnants |
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Term
| Omega 3 Fatty Acids Indications? |
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Definition
| Use – Primarily for elevated TGY but with mild modest effects on LDL and HDL. |
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Term
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Definition
| Side Effects - Eructation, infection, flu like syndrome, dyspepsia, taste changes, back pain |
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Term
| statin toxicity can cause? |
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Definition
| hepatic damage & rhabdomyolysis |
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Term
| What lab Indicates muscle breakdown = rhabdomyolysis and need to monitor on statins? |
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Definition
| Monitor creatine phosphokinase (CPK; CK) |
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Term
| DOC for ↓ levels of TG (VLDL) in pts at risk for pancreatitis? |
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Definition
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Term
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Definition
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Term
| How to treat niacin toxicity flushing? |
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Definition
| Give aspirin (blunts, but does not remove, this effect). |
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Term
| _________ is used for Reduction of triglycerides when VLDL is very high, or when IDL is elevated. Follow VLDL. If it is elevated, this is a candidate drug. If LDL is elevated but VLDL is not elevated, do not use this drug. |
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Definition
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Term
What class of drug has this MOA?
Enhanced excretion of bile acids, leading to conversion of cholesterol to bile acids in the liver.
Loss of cholesterol triggers up regulation of LDL receptors in the liver: therefore, LDL |
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Definition
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Term
| What drug Inhibits absorption of phytosterols and cholesterol |
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Definition
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Term
Ezetimibe Primarily useful for reducing ____ cholesterol
Does not modify ____ absorption
Often used in combination with a ___ |
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Definition
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Term
A 52 y/o African-American male presents for routine follow-up. He has a history of aortic valve replacement, hyperlipidemia, and hypertension. He also has a history of benign prostatic hypertrophy. He states for the past two months he has noticed progressive generalized soreness and discomfort in the muscles of his extremities especially the upper extremities. His medications include amlodipine 10 mg daily, warfarin 2.5 mg daily, doxazosin 2 mg daily, lovastatin 40 mg daily, and Centrum-multivitamin/mineral supplement.
What labs to order? |
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Definition
Would order a CPK – based on muscle problems
Would get a liver panel |
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Term
What medication is at most concern for causing
peripheral edema?
Amlodipine
Warfarin
Lovastatin
Doxazosin |
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Definition
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Term
Which drug is most likely to cause sedation & dryness of mouth?
Telmisartan
HCTz
asa
Clonidine |
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Definition
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Term
Which drug most likely to cause rebound HTN?
Telmisartan
HCTz
Clonidine
asa |
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Definition
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Term
What agen should not be stopped abruptly?
Ramipril
Metoprolol |
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Definition
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Term
| What causes respiratory depression? |
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Definition
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Term
| What causes progressive hypotension |
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Definition
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Term
| With Mobitz type II – what med should not be used? |
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Definition
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Term
| Pt. w/ pulmonary edema & ankle edema, what tx will help with both? |
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Definition
| Furosemide will help with both |
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Term
| High trigs are treated w/? |
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Definition
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Term
| Which masks hypoglycemia? |
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Definition
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Term
| ____ is probalby best HTN drug for someone w/ DM |
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Definition
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Term
BP is reduced by:
Reduced CO
Increased vagus nerve activity
Decreased central sympathetic outflow
Reduced angiotensin II levels
What drug to do this? |
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Definition
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Term
| What inhibits peptidyl dipeptidase? |
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Definition
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Term
| Cutting spinal cord below T8 would _____ afterload |
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Definition
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Term
| If stellate gangion (sympathetic outflow to heart) was cut? |
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Definition
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Term
| Class I Anti-arrhythmics? |
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Definition
Na+ Channel Blocker; Blocks Conduction
Common Uses – AFib, Flutter; V-Tach, WPW
Medications – Quinidine, Lidocaine, Flecainide
Side Effects – Dysrhythmias, GI symptoms, Toxic, blood dyscrasias |
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Term
| Class II Anti-arrhythmics? |
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Definition
Beta Adrenergic Blockers; decreases SA node automaticity; sympatholytic activity
Common Uses – Primarily AFib, Flutter; PVC's
Medications – Propranolol, Metoprolol, Atenolol, Sotalol
Side Effects – Bradycardia, bronchospasm, fatigue |
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Term
| Class III Anti-arrhythmics? |
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Definition
Prolongs the action potential
Common Uses – Atrial Dysrhythmias such as AFib, Flutter, PVST; Ventricular Dysrhythmias, WPW
Medications – Amiodarone, Sotalol, Bretylium
Side Effects – Thyroid function, pulmonary function, dysrhythmias |
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Term
| Class IV Anti-arrhythmics? |
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Definition
Calcium Channel Blockers; decreases SA nodal rate and AV conduction
Common Uses – Atrial Dysrhythmias
Medications – Verapamil, Diltiazem
Side Effects – Bradycardia, nausea and vomiting, hypotension |
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Term
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Definition
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Term
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Definition
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Term
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Definition
Anti-Arrhythmic
Na+ channel blocker |
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Term
|
Definition
Anti-Arrhythmic
Na+ channel blocker |
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Term
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Definition
Anti-Arrhythmic
Na+ channel blocker |
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Term
|
Definition
Anti-Arrhythmic
K+ channel blocker |
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Term
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Definition
Anti-Arrhythmic
K+ channel blocker |
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Term
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Definition
Anti-Arrhythmic
K+ channel blocker |
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Term
| First Line Agents for HF? (3) |
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Definition
Diuretics
Typically Loop Diuretics
If wet -> Diurese
Beta Blockers (Don’t start or increase if wet)
Carvidelol
Metoprolol XL
ACEI/ARB |
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Term
| _____ is the only oral inotrope and is a weak inotrope at best. Use is primarily useful in heart failure but is controversial. |
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Definition
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Term
IV Inotropes -> Used primarily in left ventricular dysfunction such as in acute and chronic heart failure.
Medications? (2) |
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Definition
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Term
| Drug used in severe cases of shock for vasoconstriction? |
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Definition
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Term
| Thiazides function at what part of the renal tubule? |
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Definition
|
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Term
| Carbonic anhydrase inhibitors MOA? |
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Definition
prevent formation of H+ and HCO3-.
Less H+ to exchange for Na+
Less Na+ reabsorbed
Water follows Na+ so less water reabsorbed. |
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Term
|
Definition
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Term
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Definition
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Term
|
Definition
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Term
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Definition
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Term
|
Definition
|
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Term
| Osmotic Diuretics: Uses (3) |
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Definition
Acute renal failure (i.e., maintain urine flow)
Reduce cerebrospinal fluid volume and pressure Often used after head injury to reduce CSF pressure
Hemodialysis Facilitate urinary excretion of toxic substances |
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Term
| What is a good tx for Acute pulmonary edema? |
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Definition
|
|
Term
| Loop diuretics indications? |
|
Definition
1. Edema
2. Acute pulmonary edema
3. HTN that can not be controlled with other diuretics
4. Acute renal failure
5. Hypercalcemia |
|
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Term
| good drug to use in hyperparthyroidism where there is hypercalcemia? |
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Definition
|
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Term
|
Definition
“thiazide-like” drug
These agents work at the same site as thiazides but have different structures. When loop diuretics fail, these agent may serve as a adjunct with the loop diuretic to produce diuresis. |
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Term
|
Definition
“thiazide-like” drug
These agents work at the same site as thiazides but have different structures. When loop diuretics fail, these agent may serve as a adjunct with the loop diuretic to produce diuresis. |
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Term
| Spiranolactone Site of Action in renal tubule? |
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Definition
|
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Term
|
Definition
| competes for the aldosterone receptor |
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