Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
137 Cards in this Set
- Front
- Back
|
Where do thiazide diuretics work?
|
distal convoluted tubule
|
|
|
where do loop diuretics work?
|
ascending loops of henle
|
|
|
where do potassium sparing diuretics work?
|
collecting duct
|
|
|
Where do carbonic anhydrase inhibitors work?
|
Proximal convoluted tubule
|
|
|
Where does mannitol (osmotic diuretic) work?
|
Descending loop of henle
|
|
|
Indications for thiazide diuretics.
(3) |
1. HTN
2. Heart failure 3. Nephrolithiasis due to idiopathic hypercalcemia |
|
|
Adverse effects of thiazide diuretics
|
hypo(k,mg)
hyper (Ca, uric acid, Gl, lipids), sexual disfunction caution with sulfa allg. |
|
|
Are thiazide diuretics effective in patients with severe fluid overload?
|
NO
|
|
|
What disease are thiazide diuretics first line treatment?
|
HTN
|
|
|
MOA of thiazide diuretics
|
Inhibit NA and Cl reabsorption
loss of K, Na, Cl causes increased urination decreases BP and CO |
|
|
MOA of loop diuretics
|
Inhibits Cl reabsorption in ascending loops of henle
|
|
|
Indications for loop diuretics
|
Pulmonary edema
large fluid volume acute hypercalcemia |
|
|
Side effects of loop diuretics
|
Hypo (Na, K, Ca, Mg, volemia)
Hyper (uric acid) ototoxicity |
|
|
Are loop diuretics derived from sulfa?
|
yes, except ethacrinic acid (but it's the most ototoxic)
|
|
|
What is the most potent loop diuretic?
|
Bumex
|
|
|
MOA of potassium sparing diuretics
|
Increase Na excretion and decreased K secretion in collecting duct
|
|
|
Name the aldosterone receptor blockers
|
spironolactone
eplerenone |
|
|
Which aldosterone receptor blocker is more selective?
|
eplerenone (doesn't cause androgen syndrome)
|
|
|
Name a carbonic anhydrase inhibitor
|
Acetazolamide
|
|
|
What are the indications for a carbonic anhydrase inhibitor?
|
Glaucoma
urinary alkalization metabolic alkalosis acute mountain sickness |
|
|
What are the SE of carbonic anhydrase inhibitors?
|
metabolic acidosis (mild)
K depletion renal stones drowsiness |
|
|
What is a contraindication to the use of carbonic anhydrase inhibitors?
|
hepatic cirrhosis - can lead to decreased excretion of ammonia and hepatic encephalopathy
|
|
|
What is the MOA of mannitol?
|
osmotically inhibits Na and water reabsorption, promotes diuresis
|
|
|
What are the indications for mannitol?
|
toxic ingestion
increased ICP decreased occular pressure before eye procedure |
|
|
What are the SE for mannitol?
|
Decreased Na, headache, N/V
|
|
|
What are the 1st choice for LDL lowering?
|
Statins
|
|
|
What is the MOA of statins?
|
increased LDL catabolism
inhibit LDL synthesis |
|
|
What are the SE of statins?
|
myopathy, rhabdo, hepatotoxicity
|
|
|
How are statins metabolized?
|
Hepatic
P450 3A4 - Atorva/lova/simvastatin increased chance of rhabdo with azoles, macrolides, protease inhib, grapefruit juice, amiodarone, cyclosporin |
|
|
When are statins contraindicated?
|
active or chronic liver disease
|
|
|
What are the lipid outcomes with statin treatment?
|
Decreased LDL 18 - 55%
decreased TG 7 - 30 % increased HDL 5 - 15% |
|
|
Name the bile acid sequestrants
|
cholestyramine (4-16 gm/day)
colestipol (5-30 gm/day) colesvelam 3 tabs BID |
|
|
What 2 things make bile acid sequestrants not frequently used?
|
GI upset
decreased absorption of other drugs. |
|
|
What is MOA of bile acid sequestrants?
|
Increased LDL catabolism, decreased chol. absorption,
decreased LDL and VLDL synthesis |
|
|
What is a contraindication to bile acid sequestrants?
|
biliary obstruction
|
|
|
What are the lipid outcomes with bile acid sequestrants?
|
decreased LDL 15 - 30%
TG 0 change or increased Increased HDL 3 -5% |
|
|
What are the 2nd most powerful diuretics?
|
Thiazides
|
|
|
Which diuretics are very effective in patients with poor renal function?
|
Loops
|
|
|
If you are converting your patient from IV to PO furosemide and the dose is currently 10mg IV - what is your PO dose?
|
20 MG
|
|
|
Name 2 potassium sparing diuretics (not aldosterone receptor blockers).
|
Amiloride
Trianterene |
|
|
What are some indications for Spironolactone?
|
secondary hyperaldosteronism, cirrhosis, nephrotic syndrome heart failure
|
|
|
What is the best agent to increase HDL?
|
Nicotinic acid
|
|
|
What are absolute contraindications to nicotinic acid? (2)
|
chronic liver disease
severe gout |
|
|
What are relative (caution) contraindications to nicotinic acid?
|
diabetes
peptic ulcer disease hyperuricemia |
|
|
What is the MOA of nicotinic acid?
|
Decrease LDL and VLDL synthesis and catabolism of HDL
|
|
|
What are the SE of nicotinic acid?
|
Flushing (take ASA or NSAID before dose)
hyperglycemia**(DM?) hyperuricemia**(gout?) GI distress hepatotoxicity |
|
|
Nicotinic Acid
Effect on lipid profile |
Decrease LDL 5-25%
decrease TG 20-50% **Increase HDL 15-35%** |
|
|
What are 2 fibric acid products available?
|
Gemfibrozil 600 BID (lopid)
Fenofibrate 48-145 QD (tricor) |
|
|
What is a drug class used to treat metabolic syndrome?
(assoc. with high TG and low HDL?) |
Fibric acid
|
|
|
What are contraindications of fibric acid?
(gemfibrozil and fenofibrate) |
severe renal dz
severe hepatic dz pre-existing gallbladder dz |
|
|
What is the MOA of fibric acid? (gemfibrizil and fenofibrate)
|
decrease synthesis of VLDL and release of fatty acids from peripheral adipose tissue.
increase lipoprotein activity and remove TG from plasma. |
|
|
Fibric acid SE?
|
GI (abd pn, nausea, diarrhea)
gallstones myopathy rhabdo (esp combo with statin) |
|
|
Fibric acid
Effect on lipid profile |
decrease LDL 5-20%
decrease TG 20-50% increae HDL 10-20% |
|
|
Name a cholesterol absorption blocker
|
Ezetimibe (zetia) 10MG QD
|
|
|
MOA of cholesterol absorption blocker (ezetimibe)
|
inhibits absorption of cholesterol at the brush border of the small intestine to reduce LDL
|
|
|
SE of cholesterol absorption blocker (ezetimibe)
|
GI effects
Headache slight increase LFT's when combo with statins |
|
|
cholesterol absorption blocker (ezetimibe)
Effects on lipid profile |
Decrease LDL 17%
Decrease TG 12-34% Increase HDL 8-10% |
|
|
Which drugs decrease LDL?
|
statins (DOC)
Nicotinic acid cholesterol absorption blocker |
|
|
Which drugs increase HDL?
|
Nicotinic acid (DOC)
Fibrates |
|
|
Which drugs decrease TG?
|
fibrates (DOC)
Nicotinic acid |
|
|
What drug class is ASA?
|
platelet aggregation inhibitor
|
|
|
Name 2 thienopyridines
|
Ticlopidine (ticlid)
Clopidogrel (plavix) |
|
|
MOA of ASA?
|
Inhibits thromboxane A2 synthesis from arachadonic acid in platelets, inhibits COX-1 resulting in inhibition of platelet aggregation
|
|
|
SE of ASA?
|
GI bleeding
prolonged bleeding time |
|
|
How long does platelet inhibition last with ASA?
|
7-10 days (lifespan of the platelet)
|
|
|
MOA of thienopyridines (Ticlopidine (ticlid)
Clopidogrel (plavix) |
inhibit ADP pathway of platelet aggregation
irreversibly block ADP pathway on plt - thus inhibiting activation of GP IIb/IIIa receptor |
|
|
SE of ticlopidine (ticlid)
|
neutropenia** most serious
thrombocytopenia, N/V/D |
|
|
Which of the thienopyridines is preferred agent?
|
Clopidogrel (rarely assoc. with neutropenia)
|
|
|
What are indications for thienopyridines?
(Ticlopidine (ticlid) Clopidogrel (plavix) |
Prevent CV, Cerebrovascular, and PVD.
prevention of thrombosis in pts undergoing coronary stent placement |
|
|
Name 3 Glycoprotein Inhibitors (GP IIb/IIIa).
|
Abciximab (reopro)
Eptifibatide (integrillin) Tirofiban (aggrastat) |
|
|
What does GP IIb/IIIa receptor of platelet do?
|
final common pathway for platelet aggregation
|
|
|
Indication for GP IIb/IIIa inhibitor?
Abciximab (reopro) Eptifibatide (integrillin) Tirofiban (aggrastat) |
Unstable angina
NSTEMI undergoing PCI (abciximab) NSTEMI/UA not undergoing PCI |
|
|
SE of GP IIb/IIIa inhibitors?
|
Bleeding
Thrombocytopenia (more with abciximab) |
|
|
Which GP IIb/IIIa inhibitor is not renally excreted, has short half life but stong affinity for the receptors, and is contraindicated in pts with high risk of bleeding?
|
Abciximab (reopro)
|
|
|
What drug is a vasodilator that inhibits platelet function, used in combo with ASA to prevent cerebrovascular ischemia?
|
Dipyridamole
|
|
|
Which drug binds to antithrombin III and irreversably inactivates clotting factors II (thrombin) and Xa?
|
Unfractionated Heparin
|
|
|
Which clotting factor does heparin have more affinity for?
|
Factor II (thrombin)
|
|
|
What are indications for heparin?
|
Prophylaxis and tx of DVT, PE, ACS, PCI.
|
|
|
What anticoagulant is used during pregnancy?
|
Heparin
|
|
|
What are SE of heparin?
|
Bleeding, Hyperkalemia, Osteoporosis, HIT, hematomas
|
|
|
What inactivates Heparin?
|
protamine sulfate
|
|
|
What is goal of heparin therapy?
|
1.5 - 2.5 times patient PTT baseline
|
|
|
Name the low molecular weight heparins
|
Enoxaparin (lovenox)
Deltaparin (fragmin) |
|
|
What factor does LMW heparin inactivate?
|
X
|
|
|
Can LMW heparin be used during pregnancy?
|
Yes
|
|
|
Is a renal adjustment necessary for LMW heparin in renal failure?
|
yes
|
|
|
Name a pentasaccharide that binds selectively to antithrombin III which inhibits factor X.
|
Fondaparinux (arixtra)
|
|
|
Name 3 direct thrombin inhibitors
|
Argatroban (acova)
Lepirudin (Angiomax) Bivalirudin (refludan) |
|
|
Which direct thrombin inhibitor can only be used in PCI?
|
Bivalirudin
|
|
|
Indications for direct thrombin inhibitor.
|
Prophylaxis and tx of thrombosis in pt's with HIT
alternative anticoag during PCI |
|
|
Which drug inhibits vitamin K dependent clotting factors (II, VII, IX, X) and protein C and S?
|
Warfarin
|
|
|
Which drug is given for pts with a fib or artificial heart valves?
|
Warfarin
|
|
|
What is antidote to warfarin?
|
Vitamin K
|
|
|
Which test is used to monitor warfarin?
|
INR
|
|
|
Which 2 fibrinolytics require weight adjustment?
|
Alteplase
Tenctaplase |
|
|
Which fibrinolytic has antigenicity?
|
Streptokinase
|
|
|
What drug class is used to lyse thrombi in ischemic coronary arteries after MI?
|
Fibrinolytics
[Streptokinase Altepase Reteplase Tenecteplase] |
|
|
What is the time window for use of fibrinolytics
|
within 12 hrs of symptoms
preferably within 6 hrs and ideally within 30 min of arrival to hospital |
|
|
Are all fibrinolytics hepatically eliminated?
|
all except Reteplase which is both hepatic and renal
|
|
|
What is SE of fibrinolytics?
|
Major bleeding, allergic rxn and hypotension (greater with streptokinase)
|
|
|
Which drug class inhibits the enzyme that cleaves ANG I to ANG II; decreases adrenergic stimulation and causes vasodilation; and decreases the breakdown of bradykinin?
|
ACE inhibitors
|
|
|
1) Which drug class causes arterial and venous dilation?
2) What does that do to preload and afterload? |
1) ACE inhibitors
2) decrease preload and afterload |
|
|
Which drug is the cornerstone of treatment for heart failure?
|
ACE inhibitors
|
|
|
Have ACE inhibitors been shown to improve symptoms and survival in heart failure?
|
YES
|
|
|
ACE inhibitors prevent development of HF in patients with asymptomatic LV disfunction.
TRUE/FALSE |
TRUE
|
|
|
Contraindications for ACE inhibitors
|
SBP <90
Hyperkalemia Pregnant B renal artery stenosis |
|
|
SE of ACE inhibitors
|
Hypotension
Hyperkalemia angioedema cough leukopenia renal insufficiency taste disturbance |
|
|
Which ACE inhibitor has SE of angioedema, cough, leukopenia, and taste disturbance more commonly?
|
Captopril (which is short acting - by the way)
|
|
|
What is MOA of ARB's?
|
Antagonist at ANG II receptor of vascular tone
|
|
|
What are the ACE inhibitors actions on the heart?
|
Decrease vascular resistance, venous tone, and blood pressure = increased CO
|
|
|
Which drug class is standard therapy for pt's with stable mild to severe HF and has been shown to slow progression, decrease hospitalizations and increase survival?
|
Beta Blockers
|
|
|
Which drug class blocks adrenergic stimulation; decreases release of renin which attenuates RAAS?
|
Beta Blockers
|
|
|
What are SE of Beta Blockers?
|
Bradycardia
AV abnormalities mask hypoglycemia abnormal lipid profile fatigue depression sexual disturbance |
|
|
At high doses B1 selective BB can become less selective and block B2 receptors in lung.
TRUE/FALSE |
TRUE
|
|
|
Contraindications of Beta Blockers?
|
Bradycardia
2nd and 3rd degree HB SBP <90 Decompensated HF |
|
|
Relative contraindications of Beta Blockers?
|
COPD, asthma, poorly controlled DM
PVD - but coreg may be used (has alpha properties which cause vasodilation and doesn't increase lipids) |
|
|
Which drug is an arterial direct acting vasodilator?
|
Hydralazine
(Decreases afterload) |
|
|
What drug can be considered for a patient that cannot take ACEI or ARB?
|
Hydralazine/Isosorbide
|
|
|
Are Nitrates venodilators?
[NTG, isosorbide dinitrate or mononitrate] |
yes
(decrease preload) |
|
|
Which drug causes arterial and venous dilation, enhances Na excretion, diuresis, and suppresses the RAAS?
|
Nesiritide (BNP)
|
|
|
SE of vasodilators
|
hypotension
tachycardia headache lupus (long term hydralazine) |
|
|
Name a synthetic catecholamine that has B1>b2>alpha1.
|
Dobutamine
|
|
|
When are IV positive inotropes used in HF?
|
As a bridge to transplant
|
|
|
What is the MOA of milrinone?
|
PDE inhibitor
(phosphodiesterase) |
|
|
Does Milrinone require renal adjustment?
|
Yes
|
|
|
SE of IV positive inotropes
|
arrthymias
Increased HR Increased or decreased BP palpitations CP |
|
|
Can milrinone cause severe hypotension?
|
Yes!
|
|
|
1) Which drug inhibits Na/K ATPase pump?
2) What does this cause? |
1) Digoxin
2) influx of Ca++ which increases cardiac contractility and decreases HR; also enhances diastolic filling time. |
|
|
Which drug slows ventricular rate in a fib/a flutter?
|
Digoxin
|
|
|
Does digoxin have beneficial impact on mortality?
|
Nope
|
|
|
Does digoxin improve symptoms of HF and frequency of hospitalizations?
|
Yes
|
|
|
Non-cardiac SE of digoxin
|
N/V
abdominal pain visual disturbances |
|
|
Cardiac SE of digoxin
|
Ventricular arrythmias
AV block Atrial arrythmias Sinus brady |
|
|
these drugs increase or decrease digoxin conc?
amiodarone, erythromycin, quinidine, tetracycline, verapamil |
Increase
|
|
|
these drugs increase or decrease digoxin conc?
antacids, metocloperamide, cholestyramine |
Decrease
|
|
|
A decreased K level enhances toxicity of which drug?
name 3 drugs that decrease K level |
Digoxin
(corticosteroids, thiazide and loop diuretics) |
|
|
Increased survival and decreased hospital rates in pt's with systolic disfunction is seen with adding this drug...(in HF)
|
Aldosterone Antagonists
(spironolactone, eplerenone) |
