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152 Cards in this Set

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  • Back
what is aspirin used for?
unstable angina, NSTEMI and STEMI
why is aspirin good?
it blocks thromboxane A2 from arachidonic acid thus irres inhibiting platelet COX
how does the high molecular weight heparin work?
heparin blankets thrombin (II) and antibhrombin III
how does the low molecular weight heparin work?
it involves Xa, V, antithrombin III and Platelet Factor 4
is there prophylaxis for heparin?
YES, protamine derived from fish so watch out for fish allergies
use for unfractionated heparin?
inactivates IIa, IXa, Xa
does UFH lyses existing thrombi?
no, it only prevents propagation; fibrinolytics only do
what are limitations of heparins?
stimulates platelet aggregation, HIT
what do we have to watch out for when using LMWH?
it inhibits more of Xa than thrombin (other heparins do); sub q, dose by age, weight and kidney functions
when to use enoxaparin?
for pts w/ invasive strategy OR conservative strategy (so for both)
what is Fondaparinux?
indirect Xa inhibitor
what is the half time of fondaprinux?
17-21 hrs, thus once a day dose
when to use fondaprinux?
when pts are going into the cathlab
what to watch out for when considering fondaprinux?
low BW and renal function, bld creatinine level (kidney)
what is abcximab?
glycoprotin IIb/IIIa antagonist AND monoclonal antibody
when is abcximab used?
upfront in STEMI and pts w/ renal dysfuction
what is eptifibatide?
another GLYCO IIb/IIIa antagonist >> good for NSTEMI and bolus in the ED 24-72 b/4 cathlab
what is bivalirudin?
bivalent direct thrombin inhibitor; effective on clot-bound/free thrombin and NO platelet activation
what does bivalirudin inhibit?
inhibits both fibrin-bound and circulating thrombin
when is bivalirudin used?
given only in the cathlab, also used for HIT, UA, NSTEMI pts going to cathlab
what is clopidogrel?
Plavix (remember the Clinton story), takes about 5 hrs to start working
what is prasugrel?
it irrs inhibits the ADP receptor of the platelet, good for UA, NSTEMI and STEMI
what are some limitations of prasugrel?
need to give for 12 months, can't use in pts less than 60kg, eq/over 75 age, history of TIA/stroke
SE of prasugrel?
fatal bleeding!
what is ticagrelor?
reversible ADP receptor blocker; given for NSTEMI or STEMI b/4 PCI (coronary intervention) - 12 months required
TPA?
thrombolytic only used in stroke
TNKase?
thrombolytic only used in STEMI less than 75 age, WB-based dose
what is wafarin affecting in the cascade?
2,7,9,10
when is warfarin used?
DVT, pumonary embolism, atrial fibrilllation, mechanicaal heart valves, prosthetic heart for 3 months
how to dose warfarin?
pts need to be monitored; new pts usually bridged w/ heparinn or LMWH till warfarin reaches the therapeutic window
what is dibigatran?
oral direct thrombin inhibitor; alternative to warfarin w/ non-valvular atrial fibrilation - no monitoring
what is rivaroxaban?
specific direct competitive factor Xa inhibitor; for post-op, DVT, PE and ACS
why is rivaroxaban good?
no antidote, no monitoring, very few drug interactions
how to calculate blood pressure?
CO x SVR
what blocks Na+ reabsoprtion in the distal CT?
thiazides
when to perscribe thiazide?
1st line in therapy
adrx of thiazide?
hypokalemia, hypotension, DM, gout, ARF
what to watch out for when using thiazide?
less effective if renal clearance is 10-20 mL/min
what are some examples of loop diuretics?
furosemide and torsemide
how does furosemide work?
it blocks Na and Cl reabsorption from the Loop of Henle thus increasing the urine volume
adrx of furosemide?
hypokalemia, hypomagnesemia, acute renal failure, hypotension, ototoxicity in higher doses
what to use when creatinine CL is <20 considering diuretics?
furosemide (a loop)
what are examples of K sparing diuretics?
triamterene, amiloride
where does amiloride work?
@ collecting tubule to prevent Na+ reabsorption
when to use amiloride?
w/ other diuretics to prevent hypokalemia
what is triamterene?
amiloride + HCTZ
what to watch out for when using amiloride?
chronic renal insufficiency, K+ supplements, ACEI, ARBs and Mrs. Dash = KCl
what are some beta blockers?
metoprolol, atenolol, carvedilol
how does BB work?
blocking beta-1 adrenergic receptors in cardiac tissues, thus lowering CO
when to consider using BB?
1st line and good for: coronary artery disease, CHF, atrial fibrilation requiring rate control
adrx of BB?
bradycardia, hypotension, bronchospasm (asthma), masking hypoglycemia
what to watch out for when using BB?
careful w/ poor left ventricular function, not good for pts w/ asthma, bradycardia, 2/3rd heart block, severe hypotension
what are some examples of alpha blockers?
terazoxin, prazosin, doxazosin
how does alpha blocker lower BP?
by blocking alpha adrenergic receptors in the vasculature thus lowering SVR
when to use alpha B?
limited: reserved for pts who need extra control despite being on other agents
adrx of alpha b?
orthostatic hypotension, syncope, hypotension
what are examples of ACEI?
lisinopril, captopril, ramipril
when to use ACEI?
HF, DM (CV/renal benefits), coronary artery disease
adrx of ACEI?
hyperkalemia, acute renal failure, cough, angioedema
what are some angiotensin receptor blockers?
valsartan, losartan, candesartan, irbesartan
how does ARB work?
blocking angiotensin II type 1 receptor
when to use ARB?
if cough is bothersome when using ACEI
adrx of ARB?
similar to ACEI except the angioedema
what are aldosteron antagonists?
spironolactone, eplerenone
adrx of spironolactone?
hyperkalemia, acute renal failture
what is aliskiren?
renin inhibitor; prevents conversion of angiotensinogen to antiogensin I
what are some examples of Ca++ b?
dihydropyridines: amlodipine and nifedipine AND dilitiazem/verapamil (both are dihydropyridines)
how does ca blockers work?
blocking L ca++ channels >> decrease ca++ influx into vascular SM
SE of verapamil?
constipation
SE of nifedipine?
reflex tachycardia
SE of amlodipine and nifedipine?
hypotension and peripheral edema
clonidine
rebound hypertension w/ abrupt discontinuation - taper
hydralazine
TID dosing >> SLE like reaction
minoxidil
2nd line vasodilator >> orthostasis, reflex tachycardia
what blocks COX so that less thromboxane A2 produced ultimately lowering platelet activation?
aspirin
adrx of aspirin?
bleeding, GI upset
T/F aspirin reduces mortality in post-MI pts
TRUE
what blocks ADP receptor and causes irrs inhibition of platelets?
clopidogrel
when to use clopidogrel?
when pts have aspirin allergies, so bleeding is common SE
what is prasugrel?
irrs inhibition of platelet activation by blocking ADP receptor
when to use prasugrel?
when clopidogrel fails; better efficacy but more bleeding
adrx of prasugrel?
must stop 7 days prior to surgery if possible and no-go for people greater 75 of age or less than 60kg
what is ticagrelor?
reversible inhibition of platelet by blocking ADP receptor
when is ticagrelor not recommended?
when aspirin doses greater than 100mg
beta blockers reduce what?
HR and contractility
what is the first line of management for stable angina?
beta blockers
which ca++ bs vasodilates thus increased myocardial O2 supply?
dihydropyridines: amlodipine and nifedipine AND dilitiazem/verapamil (both are dihydropyridines)
which ca++ bs vasodilates and decreases contractility/HR?
non-hydropyridines (they increase O2 demand but decrease myocardial O2 demand)
what is the 2nd line for stable angina?
ca++ bs
what is the 3rd line for stable angina?
nitrates
what is ranolazine?
MOA unkown, but pts w/ lower BP w/ stable angina are good
adrx of ranolzaine?
QTc prolongation and torsades
what blocks HMG CoA reductase?
statins
T/F most pts w/ acute coronary syndrome will be started on a statin upon admission
TRUE
when statin contraindicated?
cyclosporin, -azole antifungles, microlide antibiotics and w/ some HIV meds
SE of statin + fibrate?
rhabdomyolysis
what does angiotensinogen II cause?
vasoconstriction, sympathetic, vasopressin, aldosterone
what angiotensinogen receptors are responsible for vasoconstriction?
AT1
what angiotensinogen receptors are responsible for vasodilation?
AT2
what are the benefits of using ACEI?
decreased mortality, slow prog of CHF, improve symptoms
adxn of ACEI?
hyperkalemia, dry cough, increased serum creatinine, angioedema
what are the benefits of using ARBs?
decreased mortality when ACEI can't be used
DD with ACEI and ARBs?
watch out for drugs that increase K+
what to what out for when using ACEI?
serum creatinine, K, and S/S cough
who gets ACEI?
anyone w/ cardiac insufficiency OR asym LVH
how do thiazides work?
by inhibiting active exchange of Cl-Na in the DCT
how does the k-sparing diuretic work?
by inhibiting reabsoprtion of Na in the DCT/collecting tube
how does the loop diuretics work?
by inhibiting Cl-Na-K in the thick ascending loop
what do diuretics do?
decrease V and preload >> less congestive symptoms
adxn of diuretics?
hypovolemia, hypo k, mg, ca; metabolic alkalosis, deafness with loops
DD with diureticcs?
NSAIDS and fluid retention, digoxin
how does spironalactone work?
antagonist of aldosterone receptor in kidney, myocardium and arterial walls
does spironalctone help with survival?
YES
adrx of spiro?
hyperK, gynecomastia
DDI w/ spiro?
ACE add hyperkalemia, cyclosporine hyperK, digoxin and competitive renal secretion
who gets spiro?
for pts in class III/IV CHF, and can be added to ACEI, DIURETICS and DIG
how does digoxin work?
by working w/ Na-K ATPase, delivers more Ca++ to myofilaments >> increased contractility
benefits of dig?
inc LVEF, CO and exercise capacity
adxn of dig?
bradycardia, arrythmias, diarrhea, visual disturbances, gynecomastia, CNS
trimethoprime and dig?
impaired renal secretion
amiodarone and dig?
increased in dig level
erythromycin and dig?
increased in dig level
colestipol, sucralfate and dig?
impaired absorption
how to get the dig level from pts?
draw only AFTER 6-12 hrs post dose
what to watch out for when using dig?
RENAL FUNCTION
how do BBs work?
by blocking the beta-receptors in the heart (b-1)
what are the effects of BB?
inhibit cardiotoxicity of catecholamines, increase density of the beta-1 receptors and decrease neurohormonal activation
what classes of pts are improved by BB?
II, III and IV
adxn of BB?
bradycardia, AV block, and hypotension
DDI w/ BB?
additive hypotension or bradycardia/ AV block
has evidence shown that BB could decrease mortality?
YES
what are some BB used for CHF?
metoprolol and carvedilol
if you don't titrate BBL slowly, what happens?
HF exacerbation
how does hydralazine work?
direct activing vasodilator: arterial dilation thus lowering afterload
how does nitrates work?
convert to NO and cause venous dilation, reduced preload
benefits of hydralazine/nitrate?
improve survival and exercise capacity
adxn of hydrlazine?
hypo, reflex tachycardia, SLE
adxn of nitrates?
flushing, hypotension, headache
who gets the hydra/nitrate combo?
pts who can not tolerated ACEI
what is dobutamine?
beta-receptor agonist >> increase CI and SV
DDI w/ dobutamine?
w/ BBs
what is milrinone?
phosphodiesterase inhibitor >> no break-down of cAMP, more Ca++ influx and more muscle contraction
what agent is positive inotrope and chronotrope?
milrinone
what to watch out for when using milrinone?
long-term might increase mortality
how does nitroprusside work?
SNP > NO and cyanide > liver > thiocyanate > renal elimination
benefits of nitroprusside?
reduce preload and afterload
adxn of nitroprusside?
cyanide and thocyanate toxicity > CNS and abdominal pains, convulsions
what is nesiritide?
synthetic analogue of brain natiuretic peptide
amiodarone?
antiarrythmic in CFH pt
dofetilide?
class III antiarrythmic in CFH pt
amlodipine?
I and II pts: antianginal/antihypertensive for CHF pts
tolvatan?
correction of hyponatremia in pts w/ heart failure