N210 Cardiovascular Pharmacology Lecture

Front 1

Which type of cholesterol is associated with coronary disease?

Back 1

LDL

Front 2

Which type of cholesterol is easier to change levels of pharmacologically?

Back 2

LDL

Front 3

What level of LDL is considered at risk?

Back 3

> 100
> 70 for diabetics

Front 4

Risk factors for heart disease:

Back 4

Age (45/55)
Family history (55/65)
HTN
Smoking
Low HDL (if it's over 60, you lose a risk factor!)

Front 5

Risks equivalent to having CAD:

Back 5

Diabetes
PAD, AAA

Front 6

How do statins work?

Back 6

HMG CoA reductase inhibition; increases LDL receptors in the liver

Front 7

Uses of statins:

Back 7

Dyslipidemias, prevention of CV events, diabetes

Front 8

Non-LDL results of statin use:

Back 8

Regression of atherosclerosis
Promote plaque stability
Reduce inflammation
Improve endothelial function
Decrease thrombogenicity

Front 9

Adverse effects of statins:

Back 9

Hepatotoxicity
Myopathy/rhabdomyolysis
GI effects
** Typically very well tolerated

Front 10

Interactions with statins:

Back 10

Fibrates, ezetimibe
CYP3A4 inhibitors (PI, azoles, erythromycin)
Grapefruit juice

Front 11

Contraindications of statin use:

Back 11

Most liver diseases, pregnancy
They ARE indicated for nonalcoholic fatty liver

Front 12

Administration of statins:

Back 12

All oral
Best taken at bedtime or evening

Front 13

Action of nicotinic acid:

Back 13

Decreases VLDL, which decreases LDL

Front 14

Use of nicotinic acid:

Back 14

Lowers triglycerides, increases HDL, lowers LDL

Front 15

Adverse effects of nicotinic acid:

Back 15

Flushing occurs with almost all patients!
Hepatotoxic
N/V/D, GI upset
Hyperglycemia
Worsening of gouty arthritis

Front 16

Administration of nicotinic acid:

Back 16

Take 325mg of aspirin 30 min before dose for flushing
Give at bedtime to decrease GI effects

Front 17

Examples of fibrates:

Back 17

gemfibrozil (Lopid)
fenofibrate (Tricor)
fenofibric acid (Trilipix)

Front 18

Action of fibrates:

Back 18

complex; has to do with receptors in liver/brown adipose tissue

Front 19

Use of fibrates:

Back 19

Reduces triglyceride levels
Little effect on LDL!
Increases HDL

Front 20

Which fibrate is approved for use in combination with a statin?

Back 20

fenofibric acid (Trilipix)

Front 21

Adverse effects of fibrates:

Back 21

Liver injury
Increased risk of rhabdomyolysis with statin use
Increased risk of gallstones
Increased risk of bleeding w/ warfarin

Front 22

Action of bile-acid sequestrants:

Back 22

Forms an insoluble complex with bile acids in the gut

Front 23

Use of bile-acid sequestrants:

Back 23

Lowers LDL in combination with statins or nicotinic acid

Front 24

Adverse effects of bile-acid sequestrants:

Back 24

GI effects
Decreases fat-soluble vitamins (ADEK)

Front 25

Example of bile-acid sequestrant:

Back 25

colesevelam (Welchol) is the drug of choice

Front 26

Action of ezetimibe (Zetia):

Back 26

Inhibits cholesterol absorption at brush border

Front 27

Adverse effects of ezetimibe (Zetia):

Back 27

Myopathy, LFT increase

Front 28

Effect of fish oil supplements:

Back 28

anti-inflammatory
Decreases risk of CHD, CVA

Front 29

What is Lovaza?

Back 29

Prescription omega-3

Front 30

Action of plant stanols:

Back 30

Reduce intestinal absorption of cholesterol

Front 31

Statins work best on:

Back 31

LDL

Front 32

Tolerability of statins:

Back 32

Good

Front 33

Ezetimibe works best on:

Back 33

LDL

Front 34

Tolerability of ezetimibe:

Back 34

Good

Front 35

Bile acid sequestrants work best on:

Back 35

LDL

Front 36

Tolerability of bile acid sequestrants:

Back 36

Poor

Front 37

Nicotinic acid works best on:

Back 37

HDL and triglycerides

Front 38

Tolerability of nicotinic acid:

Back 38

Reasonable to poor

Front 39

Fibrates work best on:

Back 39

Triglycerides

Front 40

Tolerability of fibrates:

Back 40

Good

Front 41

What is a thrombus platelet plug reinforced with?

Back 41

Fibrin (the end of the coagulation cascade)

Front 42

What enzyme digests fibrin and removes clots?

Back 42

Plasmin

Front 43

Treatment of arterial thrombus:

Back 43

Anti-platelet medications (or prevention)

Front 44

Treatment of venous thrombus:

Back 44

Anticoagulants

Front 45

What does thrombin convert?

Back 45

Fibrinogen to fibrin

Front 46

Action of anticoagulants:

Back 46

Disrupt the coagulation cascade

Front 47

Action of anti-platelets:

Back 47

Inhibit platelet aggregation

Front 48

Types of anticoagulants:

Back 48

Heparin, LMWH, warfarin, direct thrombin inibitors

Front 49

Types of anti platelets:

Back 49

Aspirin, Plavix (clopidogrel)

Front 50

Action of thrombolytics:

Back 50

Lysis of fibrin, dissolution of clots

Front 51

Action of heparin:

Back 51

Decreases fibrin formation by promoting action of antithrombin

Front 52

Adverse effects of heparin:

Back 52

Hemorrhage
Heparin-induced thrombocytopenia
Hypersensitivity

Front 53

Acute uses of heparin:

Back 53

PE, stroke, DVT, DIC, MI

Front 54

Preventitive uses of heparin:

Back 54

Prevention of post-op DVT, cardiac surgery, dialysis

Front 55

Safety of heparin in pregnancy:

Back 55

Safe

Front 56

Contraindications for heparin:

Back 56

Thrombocytopenia
Hemorrhagic stroke
Bleeding, surgery on eye/brain/spinal cord

Front 57

Use heparin with caution in:

Back 57

Trauma, hemophilia, dissecting aneurysm, PUD, severe HTN, threatened abortion, severe liver/kidney disease

Front 58

Lab value to monitor heparin use:

Back 58

aPTT
Normal: 40 sec
Target w/ heparin: 60-80 sec

Front 59

Antidote to heparin:

Back 59

Protamine sulfate

Front 60

Administration of heparin:

Back 60

IV (continuous, weight based dosing)
SC (deep injection, rotate sites, avoid umbilicus)

Front 61

Therapeutic range of heparin:

Back 61

Narrow!!

Front 62

Base for dosing of heparin:

Back 62

Weight-based

Front 63

In what environments are heparin used?

Back 63

Only inpatient

Front 64

Examples of low molecular weight heparin:

Back 64

enoxaparin (Lovenox)
dalteparin (Fragmin)
tinzaparin (Innohep)

Front 65

Action of LMWH:

Back 65

Decreases fibrin formation by enhancing activity of antithrombin

Front 66

Uses of LMWH:

Back 66

Prevent/treat DVT
Prevent ischemic complications of unstable angina/MI

Front 67

Availability of heparin vs. LMWH:

Back 67

LMWH is more available

Front 68

Advantages of LMWH:

Back 68

No lab monitoring
Outpatient use
Predictable response/fixed dose
Greater duration
Self administration

Front 69

Action of direct thrombin inhibitors:

Back 69

Directly inhibits thrombin, duh.

Front 70

Only oral anticoagulant in US:

Back 70

Warfarin

Front 71

Onset of action of warfarin:

Back 71

Delayed

Front 72

Half-life of warfarin:

Back 72

~2 days

Front 73

Interactions with warfarin:

Back 73

Many many drug interactions
99% protein bound

Front 74

Action of warfarin:

Back 74

Blocks synthesis of factors VII, IX, X, and prothrombin by blocking enzyme that converts vitamin K

Front 75

Uses of warfarin:

Back 75

Treat/prevent embolic/thrombotic events, prosthetic heart valves, a fib

Front 76

Adverse effects of warfarin:

Back 76

Bleeding

Front 77

Contraindications for warfarin:

Back 77

Vitamin K deficiency
Liver disease
Alcoholism
Pregnancy

Front 78

Goal INR for a fib:

Back 78

2-3

Front 79

interactions with warfarin:

Back 79

Heparin
Aspirin
Acetaminophen
Phenobarbitol
Carbamazepine
Rifampin
Azoles
Cimetidine

Front 80

Lab values to monitor warfarin:

Back 80

PT, INR
Every 2 weeks

Front 81

Treating warfarin overdose:

Back 81

IV vitamin K

Front 82

Dietary teaching with warfarin:

Back 82

Avoid fluctuations in vitamin K (leafy greens, multivit, mayo, canola oil)

Front 83

Therapeutic index of warfarin:

Back 83

Low - don't change brands

Front 84

Action of dabigatran (Pradaxa):

Back 84

Direct thrombin inhibitor

Front 85

Administration of dabigatran (Pradaxa):

Back 85

Strictly BID
wait until INR is <2, then 150mg BID

Front 86

Downsides to dabigatran (Pradaxa):

Back 86

Cost
Moisture sensitive
No antidote (must give FFP)

Front 87

Use of dabigatran (Pradaxa):

Back 87

Replace warfarin
Only approved for preventing clots in a fib

Front 88

Use of aspirin:

Back 88

Primary/secondary prevention of MI
Prevention of stroke with TIA hx

Front 89

Action of aspirin:

Back 89

Inhibits COX, needed by platelets for TXA2

Front 90

Use of clopidogrel (Plavix):

Back 90

Secondary prevention of MI, stroke, and other vascular events
Prevent coronary stent stenosis

Front 91

Action of clopidogrel (Plavix):

Back 91

ADP receptor antagonist

Front 92

Tolerance of clopidogrel (Plavix):

Back 92

Well tolerated

Front 93

Adverse effects of clopidogrel (Plavix):

Back 93

Bleeding
Abdominal pain
Dyspepsia
Diarrhea
Rash
RARELY: TTP

Front 94

Interactions with clopidogrel (Plavix):

Back 94

PPIs