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