Pharmacology Test 3

Front 1

Name that Vaughn-Williams Class!
On/Off - Intermediate

Back 1

Class IA

Front 2

Name that Vaughn-Williams Class!
Class I

Back 2

Sodium channel blockers

Front 3

Name that Vaughn-Williams Class!
Primarily considered sodium channel blockers, but some potassium channel blockade

Back 3

Class IA

Front 4

Name that Vaughn-Williams Class!
Effective for both supraventricular and ventricular arrhythmias

Back 4

Class IA

Front 5

Name that Vaughn-Williams Class!
On/Off - Fast

Back 5

Class IB

Front 6

Name that Vaughn-Williams Class!
Blockade more apparent as heart rate increases; relatively weak sodium channel blocker at normal rates

Back 6

Class IB

Front 7

Name that Vaughn-Williams Class!
More effective in ventricular than supraventricular arrhythmias

Back 7

Class IB

Front 8

Name that Vaughn-Williams Class!
On/Off - slow

Back 8

Class IC

Front 9

Name that Vaughn-Williams Class!
Extremely potent sodium channel blockers that profoundly slow conduction velocity

Back 9

Class IC

Front 10

Name that Vaughn-Williams Class!
Effective in both supraventricular and ventricular arrhythmias, but use is limited by the risk of causing other drug-induced arrhythmias

Back 10

Class IC

Front 11

Name that Vaughn-Williams Class!
Tend to increase defibrillation threshold; may require more energy for successful cardioversion

Back 11

Class I

Front 12

Name that Vaughn-Williams Class!
List subclass IA drugs...

Back 12

Disopyramide (Norpace) p.o.
Quinidine p.o., i.v.
Procainamide p.o., i.v.
Double Quarter Pounder

Front 13

Name that Vaughn-Williams Class!
List subclass IB drugs...

Back 13

Lidocaine (Xylocaine) i.v.
Mexiletine p.o.
Lettuce and Mayo

Front 14

Name that Vaughn-Williams Class!
List subclass IC drugs...

Back 14

Flecainide (Tambocor) p.o.
Moricizine (Ethmozine) p.o.
Propafenone (Rhythmol) p.o.
Frenches Mustard and Pickles

Front 15

Which Vaughn-Williams class would you use for a patient with a dysrythmia and high heart rate?

Back 15

Class I drugs

Front 16

Cinchonism - tinitis and dizziness is associated with which antiarryhthmic?

Back 16

Quinidine (Class IA)

Front 17

List three effects when beta-adrenergic receptors are blocked.

Back 17

1. Reduces conduction velocity
2. Increases refractory period
3. Decreases automaticity in nodal tissue

Front 18

Name that Vaughn-Williams Class!
List Class II drugs...

Back 18

Esmolol (Brevibloc) i.v.
Acebutolol (Sectral) p.o.
Propranolol (Inderal) p.o. & i.v.
Eat Apple Pie

Front 19

Name that Vaughn-Williams Class!
This class works best for patients with slow heart rates.

Back 19

Class III potassium channel blockers

Front 20

Name that Vaughn-Williams Class!
"Reverse use dependence"

Back 20

Class III potassium channel blockers

Front 21

Name that Vaughn-Williams Class!
May cause Torsade de Pointes by provoking early atrial depolarizations

Back 21

Class III potassium channel blockers

Front 22

Name that Vaughn-Williams Class!
Used in atrial fibrillation and atrial flutter

Back 22

Class III potassium channel blockers

Front 23

Name that Vaughn-Williams Class!
List the Class III drugs...

Back 23

Dronedarone (Multaq)
Dofetilide (Tikosyn)
Amiodarone (Cordarone)
Sotalol (Betapace)
Ibutilide (Corvert)
Dunkin Doughnuts And Strawberry Icecream

Front 24

List two Vaughn-Williams class III drugs that work in patients with ventricular fibrillation.

Back 24

Amiodarone
Sotalol

Front 25

Your patient enters your office with blue/gray skin on his face. What drug would you d/c?

Back 25

Amiodarone

Front 26

Name that Vaughn-Williams Class!
Non-dihydropyridine

Back 26

Class IV calcium channel blockers

Front 27

Name that Vaughn-Williams Class!
Blocks calcium channels in SA and AV nodal tissue

Back 27

Class IV calcium channel blockers

Front 28

Name that Vaughn-Williams Class!
List Class IV drugs...

Back 28

Diltiazem (Cardizem)
Verapamil (Isoptin)

Front 29

Blocking calcium channels at the SA and AV nodes has what effects on the conduction cells of the heart?

Back 29

1. Reduces rate of Phase 0 depolarization
2. Reduces conduction velocity
3. Reduces excitability
4. Increase the P-R interval

Front 30

This antiarrhythmic is a potent vasodilator and is the drug of choice for supraventricular tachycardia (duration ~15 seconds)

Back 30

Adenosine (Adenocard)

Front 31

This antiarrhythmic has strong ionotropic effects (increases cardiac contractility) and is used to control ventricular response rate in atrial fibrillation and atrial flutter

Back 31

Digoxin (Lanoxin)

Front 32

Pro or Anti (arrythmic)?
Class I

Back 32

Pro
Sodium channel blockers

Front 33

Pro or Anti (arrythmic)?
Class III

Back 33

Pro
Potassium channel blockers

Front 34

Pro or Anti (arrythmic)?
Class IV

Back 34

Anti
Calcium channel blockers

Front 35

Pro or Anti (arrythmic)?
Class II

Back 35

Anti
Beta blockers

Front 36

This Vaughn Williams Class is use dependent meaning the drugs greatest degree of blockade is in frequently depolarizing tissue (e.g. tachycardia)

Back 36

Class I

Front 37

This Vaughn Williams subclass is a proarrhythmic and is known to cause Torsade de Pointes

Back 37

Class IA

Front 38

This drug can exacerbate heart failure and can cause hypotension, dry mouth, urinary retention, blurred vision and constipation

Back 38

Disopyramide
Class IA

Front 39

Boxed Warning: Use only for life-threatening ventricular arrythmias

Back 39

Disopyramide
Class IA

Front 40

Boxed Warning: May be proarrhythmic

Back 40

Quinidine
Class IA

Front 41

This drug has a >10% occurrence of hypotension, QT complex prolongation, light-headedness, GI upset and exacerbates heart failure

Back 41

Quinidine
Class IA

Front 42

Your patient is already at risk for falls. Which drug known to cause syncope and other CNS adverse affects (Cinchonism) would you avoid prescribing?

Back 42

Quinidine
Class IA

Front 43

Boxed warning: Potentially fatal blood dyscrasias, long-term administration can lead to an increase in antinuclear antibodies (ANA); may result in drug-induced 'lupus-like syndrome'

Back 43

Procainamide
Class IA

Front 44

This antiarrythmic is know to cause depression, hallucinations and psychosis

Back 44

Procainamide
Class IA

Front 45

Use this drug only for patients with life-threatening arrythmias.

Back 45

Procainamide
Class IA

Front 46

This Vaughn Williams subclass does not slow conduction in the heart. Therapeutic uses include ventricular tachycardia, premature ventricular complexes, ventricular fibrillation but CANNOT BE USED IN ATRIAL ARRYTHMIAS

Back 46

Class IB

Front 47

Because of this drugs extensive first pass metabolism you should reduce the dose for patients with hepatic dysfunction and/or when used with propranolol which is known to decrease hepatic blood flow.

Back 47

Lidocaine
Class IB

Front 48

This drug has a wide therapeutic index (toxic-to-therapeutic) but can cause drowsiness, slurred speech, parathesia, agitation, confusion and convulsions.

Back 48

Lidocaine
Class IB

Front 49

The oral dosage form of this drug can be used chronically for ventricular arrhythmias associated with post myocardial infarction.

Back 49

Mexiletine
Class IB

Front 50

This Vaughn Williams subclass markedly slows the rate of phase 0 depolarization and markedly decreases conduction.

Back 50

Class IC

Front 51

What might you prescribe for a patient with refractory ventricular arrhythmias?

Back 51

Flecainamide or Propafenone
Class IC

Front 52

What might you prescribe to prevent paroxysmal atrial fibrillation or paroxysmal supraventricular tachycardia?

Back 52

Flecainamide or Propafenone
Class IC

Front 53

Boxed warning: use in life-threatening ventricular arrhythmias (proarrhythmic) and adverse events include dizziness, fatigue, bronchospasm (COPD and asthma), taste disturbances, bradycardia or AV block and nausea and vomiting

Back 53

Propafenone
Class IC

Front 54

This Vaughn Williams class causes direct AV nodal inhibition

Back 54

Class II
Beta blockers

Front 55

In order to reduce sudden death from ventricular arryhthmias following a myocardial infarction you may consider prescribing this drug but keep in mind the drug loses selectivity at higher doses.

Back 55

Class II
Beta blockers

Front 56

In addition to controlling atrial fibrillation and atrial flutter this class of drugs controls tachyarrhythmias caused by increase sympathetic tone, AV-nodal reentrant tachycardia and is administered via I.V. for rapid rate control.

Back 56

Class II
Beta blockers

Front 57

Because this antiarrhythmic is very short acting the drug is used mostly during surgeries and for emergencies. The patient may experience hypotension, bradyarrhythmias, diaphoresis or nausea.

Back 57

Esmolal
Class II

Front 58

Boxed warning: should not be withdrawn abruptly; taper slowly. Use these drugs with caution in patients with heart failure or asthma. Further, additive effects have been seen with digoxin and CCBs.

Back 58

Metoprolol and Acebutolol
Class II

Front 59

Watch for elevated BUN and hepatic enzymes in addition to CNS disturbances (amnesia, catatonia, cognitive dysfunction, confusion, depression, dizziness, emotional lability, fatigue, hallucinations, hypersomnolence, insomnia, lethargy, lightheadedness, psychosis, vertigo and vivid dreams) when prescribing this drug. Do not prescribe this drug for patients with HF or asthma.

Back 59

Propranolol
Class II

Front 60

List Vauhgn Williams class III drugs.

Back 60

Amiodarone
Dronedarone
Dofetilide
Ibutilide
Sotalol

Front 61

Patient has a severe refractory supraventricular (or ventricular) tachyarrhythmia. Tx?

Back 61

Amiodarone
Class III

Front 62

This drug is extensively distributed in adipose tissue and will reach full clinical effect in `6 weeks

Back 62

Amiodarone
Class III

Front 63

Box warning: lung damage (interstitial pulmonary fibrosis) may occur without symptoms

Back 63

Amiodarone
Class III

Front 64

GI intolerance, tremor, ataxia, dizziness, hyper/hypothyroidism, liver toxicity, photosensitivity, neuropathy, muscle weakness, blue skin. But low doses retain clinical effecacy while decreasing toxicity and AEs.

Back 64

Amiodarone
Class III

Front 65

This drug is a potent inhibitor of CYP enzymes and transport proteins so watch for drug-drug interactions. Drug also has additive effect with drugs that prolong QT interval.

Back 65

Amiodarone
Class III

Front 66

What will you monitor for patients taking amiodarone?

Back 66

Pulmonary function test (CXR)
Thyroid panel
Liver enzymes
Ophthalmoscopic exam
Drug-drug Interactions (digoxin, quinidine, warfarin)

Front 67

Describe oral dosing strategy for amiodarone.

Back 67

Week 1: 800 mg/day
Week 2-4: 400 mg/day
Continue: 200-400 mg/day

Front 68

Indication: paroxysmal or persistent atrial fibrillation or atrial flutter with recent episode of AF/AFL and associated cardiovascular risk factors (>70 y.o., HTN, DM, CVA, LA diameter >50mm or LV EF < 40%)

Back 68

Dronedarone
Class III

Front 69

Boxed warning: potentially fatal arrhythmias can occur; patients with chronic atrial fibrillation are not the best candidates since they often revert after conversion
Use this drug only for supraventricular arrhythmias.

Back 69

Ibutilide
Class III

Front 70

If you want to prescribe this medication to control an arrhythmia you need to complete a manufacturers training program and you must admit the patient to the hospital (inpatient only).

Back 70

Dofetilide
Class III

Front 71

This antiarrhythmic has the lowest risk of acute and long-term adverse events but does prolong the QT interval (TdP) and can cause fatigue, bradycardia, hypotension and can be arrhythmogenic in high doses.

Back 71

Sotalol
Class III (BB)

Front 72

This drug corrects arrhythmias by blocking L-type calcium channels and is a non-hydropyridine agent.

Back 72

N-HDP Calcium Channel Blockers
Class IV

Front 73

This Vaughn Williams drug class decreases inotropy, chronotropy and dromotropy and is used to for reentrant supraventricular arrhythmias and rate control in AF/AFL.

Back 73

N-HDP Calcium Channel Blockers
Class IV

Front 74

Describe the dosing of diltiazem.

Back 74

Loading dose: 0.25 mg/kg (i.v.) over 2 minutes - Repeat if necessary after 15 minutes w/ 0.35 mg/kg (i.v.) over 2 minutes
Maintenance dose:
IV - 5-15 mg/hr
PO - 60-90 mg/3x
XR - 180-360 mg/day

Front 75

Describe dosing of verapimil.

Back 75

Loading dose: 5-10 mg IV over 2 minutes - repeat after 15 minutes if necessary w/ 10 mg
Maintenance dose:
IV 5-10 mg/hr
PO 40-120 mg/3x
XR 120-480 mg/day

Front 76

Name the drug of choice for acute supraventricular tachycardia. (Watch out for flushing)

Back 76

Adenosine
Class 'other'

Front 77

When use with potassium wasting agents (diuretics) this drug can reach toxic levels thus causing arrhythmias.

Back 77

Digoxin

Front 78

Becuse Digoxin is only effective for rate control at _______ it should only be used as a second-line agent for rate control in atrial fibrillation. Preferred drugs for rate control (in order)...

Back 78

rest
Atenolol
Metroprolol
Diltiazem
Verapamil

Front 79

List Joint Panels 6 recommendations for Newly Diagnosed Atrial Fibrillation.

Back 79

1) Rate control with anticoagulation
2) Anticoagulation (warfarin)
3) Rate control (Atenolol, Metropolol, Diltiazem, Verapamil, Digoxin)
4) Elective cardioversion
5) TEE, pre and post anticoagulation
6) Risks of rhythm maintenance outweigh benefits but... (Amiodarone, Dysopyramide, Propafenone, Sotalol)

Front 80

List the dosage for Aspirin in patients with known CAD.

Back 80

75-162mg PO daily

Front 81

Contraindications for Aspirin

Back 81

salicylate or NSAID allergy
bleeding disorders
asthma
nasal polyps
rhinitis
pregnancy

Front 82

Should a patient with history of tinnitis take Aspirin?

Back 82

No

Front 83

If you prescribed this drug during an ischemic stroke you should avoid Aspirin therapy for 24 hours.

Back 83

alteplase

Front 84

If patient is experiencing gastric upset when taking clopidogrel you can prescribe this drug/class but avoid this drug/class.

Back 84

Tagamet HB (H2 blocker)
Nexium (PPIs decrease antiplatelet activity)

Front 85

If ASA is absolutely CI or with stent placement or STEMI you would prescribe this drug for antiplatelet therapy.

Back 85

Clopidogrel (Plavix)

Front 86

List the three conditions in which you would use clopidogrel instead of ASA for antiplatelet therapy.

Back 86

1) ASA allergy
2) Stent placement
3) STEMI

Front 87

Black Box Warning: may cause life-threatening hematologic reactions, including neutropenia, agranulocytosis, thrombotic thrombocytopenia purpura (TTP), and aplastic anemia

Back 87

Ticlopidine (Ticlid)

Front 88

What antiplatelet drug is approved for the prevention of thrombotic stroke?

Back 88

Ticlopidine

Front 89

Your patient has unstable angina and is allergic to ASA and unresponsive to clopidogrel so you prescribe ticlidopine for antiplatelet therapy. What should you monitor closely?

Back 89

WBC (neutropenia, agranulocytosis, thrombotic thrombocytopenia purpura (TTP), and aplastic anemia)

Front 90

Used for antiplatelet therapy these drugs binds receptors on platelets & prevent platelet aggregation (Abciximab, Eptifibatide, Tirofiban)

Back 90

GP IIb/IIIa inhibitors

Front 91

Your patient is undergoing percutaneous transluminal angioplasty and there is a delay to the PCI Unit. In addition to ASA and heparin what drug would you consider?

Back 91

Abciximab
GP IIb/IIIa inhibitor
monoclonal antibody

Front 92

Because monoclonal antibodies such as abciximab are large molecules you should always do this but never do this!

Back 92

Always filter!
Never shake the vial!

Front 93

This GP IIb/IIIa Inhibitor reversibly blocks receptors while the other does not. Name both respectively.

Back 93

Eptifibatide (reversible)
Abciximab (non-reversible)

Front 94

Your patient is delayed to the PCI unit and has a CrCl = 40ml/min. Which GP IIb/IIIa inhibitor would you use without a dosage adjustment? Which GP IIb/IIIa inhibitor would you have to adjust the dosage for?

Back 94

Eptifibatide CrCl < 50ml/min adjust dosage
Tirofiban CrCl < 30ml/min no dosage adjustment

Front 95

Match GP IIb/IIIa Inhibitor...
1) Long duration of action
2) Platelet function restored after 4 hours post d/c
3) incompatible with diazepam

Back 95

Abciximab
Eptifibatide
Tirofiban

Front 96

For what condition is tirofiban CI?

Back 96

Acute pericarditis

Front 97

Your patient's platelet count is 200,000/mm3. Can you use a GP IIb/IIIa inhibitor?

Back 97

Yes. CI if platelets < 100,000/mm3

Front 98

What would you monitor in a patient using a GP IIb/IIIa inhibitor?

Back 98

Sx/Sx of bleeding
CBC
Serum Cr
PT/aPTT

Front 99

This drug inhibits vitamin K dependent clotting factors II, VII, IX and X.

Back 99

Warfarin (coumadin)

Front 100

A patient using warfarin should have this monitored weekly.

Back 100

INR - ratio of patient's PT time to a normal control sample

Front 101

These two drugs used for throbmolytic therapy have a high potential antigenicity (ability to cause allergic reaction).

Back 101

streptokinase and anistreplase

Front 102

Which antithrombolytic has the highest specificity for fibrin?

Back 102

Tenecteplase

Front 103

Your patient has had an acute ischemic stroke two hours ago. Would you consider thrombolytic therapy?

Back 103

Yes (Acute Ischemic Stroke < 3 hours)

Front 104

To Thrombolytic Therapy of NOT?
Ischemic stroke w/i 3 months

Back 104

NO

Front 105

To Thrombolytic Therapy of NOT?
Major surgery 4 weeks ago

Back 105

YES (major surgery < 3 weeks)

Front 106

To Thrombolytic Therapy of NOT?
Current us of warfarin

Back 106

NO

Front 107

To Thrombolytic Therapy of NOT?
Menses

Back 107

YES (active internal bleeding EXCEPT menses)

Front 108

To Thrombolytic Therapy of NOT?
Known intracranial pathology or dementia

Back 108

NO

Front 109

To Thrombolytic Therapy of NOT?
Current blood pressure: 188/112

Back 109

NO (BP < 180/110)

Front 110

To Thrombolytic Therapy of NOT?
History of peptic ulcer > 5 weeks

Back 110

YES (recent w/i 2-4 weeks internal bleeding or active peptic ulcer)

Front 111

To Thrombolytic Therapy of NOT?
Pregnancy

Back 111

NO

Front 112

To Thrombolytic Therapy of NOT?
Head or facial tramau 2 months ago

Back 112

NO (head/facial trauma w/i 3 months)

Front 113

These drugs can slow down and even reverse ventricular remodeling thus decreasing morbidity and mortality in patients with CHF or hx of MI.

Back 113

ACEi and ARBs

Front 114

Your patient has an ejection fraction of 35%. What drug will you start and how long will the patient take this drug?

Back 114

ACEi indefinitely

Front 115

Your patient has bilateral renal artery stenosis. What drug is contraindicated?

Back 115

ACEi

Front 116

Your patient develops angioedema and hyperkalemia while being treated for a MI. What drug should you d/c?

Back 116

ACEi

Front 117

The goal of low dose nitrates is to reduce what and by what mechanism? High dose?

Back 117

Reduce preload by venous vasodilation
Reduce afterload by arterial vasodilation

Front 118

If you want to decrease cardiac oxygen demand while increasing cardiac oxygen supply what would you prescribe?

Back 118

Nitrates

Front 119

Other than IV which nitrate is fastest acting (drug/mode)?

Back 119

Nitroglycerine (sublingual 1-3 minutes)

Front 120

Name the long-acting nitrates

Back 120

Isosorbide dinitrate
Isosorbide mononitrate

Front 121

What form of nitroglycerine is longest acting? What is the drawback?

Back 121

Transdurmal patch (>8hours)
Slow onset (40-60 minutes)

Front 122

Your patient brings her nitroglycerine pills to the ER. What do you do with them and why?

Back 122

Throw them away because the pills are cheap and you always assume patient has stored pills incorrectly:
1) too hot/cold
2) soft plastic container
3) exposed to air
4) mixed with other meds
5) expired

Front 123

If patient took Cialis 25 hours ago can he use his nitroglycerine pills?

Back 123

Not within 48 hours of Cialis
(can take after 24 hours for Viagra and Levitra)

Front 124

Patient has taken first dose of NTG and has called 911. Can he take more NTG?

Back 124

Yes - continue NTG q5minutes x 3

Front 125

When taking long acting nitrate how do patients avoid developing tolerance?

Back 125

Allow for nitrate free interval of at least 8-12 hours (usually at night when oxygen demand is lowest)
BID - 8am and 3pm
TID - 7am and noon and 5pm

Front 126

List the beta-1 selective BBs

Back 126

A- acebutalol
M- metoprolol
E- esmolol
B- betaxolol
B- bisoprolol
A- atenolol

Front 127

By what mechanism do BBs improve mortallity following MI?

Back 127

decreased afterload

Front 128

What is the mechanism of verapamil and diltiazem?

Back 128

decrease coronary vascular resistance, decrease conduction through AV node, decrease HR and decrease contractility
(Non-Dihydropiridine CCBs)

Front 129

'-pine'

Back 129

CCBs

Front 130

What might occur if you prescribe a beta blocker and verapamil or diltiazem?

Back 130

Bradycardia

Front 131

Your patient has severe left ventricular dysfunction and slow conduction through the AV node. CI?

Back 131

verapamil and diltiazem (non-DH CCBs)

Front 132

Your patient develops flushing and gingival hyperplasia. d/c?

Back 132

CCBs

Front 133

Which anti-anginal meds increase oxygen supply to the heart?

Back 133

CCBs and Nitrates (not BBs)

Front 134

Which anti-anginal meds decrease HR?

Back 134

BB, non-DH CCBs

Front 135

Which anti-anginal meds increase HR?

Back 135

Nitrates

Front 136

Which anti-anginal meds decrease cardiac wall tension?

Back 136

CCB's and nitrates (not BB's)

Front 137

Which anti-anginal meds do not affect cardiac contractility?

Back 137

nitrates (BBs and CCBs decrease cardiac contractility)

Front 138

Your patient has a fast heart rate. Would you use nifedipine or verapamil?

Back 138

Verapamil decreases HR (nifedipine increases HR)

Front 139

This drug can maintain cardiac function without decreasing HR or BP by inhibiting late phase inward sodium channels during cardiac repolarization.

Back 139

Ranolazine (Ranexa)

Front 140

This drug relies on CYP3A and should not be used with strong-moderate CYP3A inhibitors.

Back 140

Ranolazine

Front 141

Patients with chronic stable angina should avoid this drug.

Back 141

Dipyridamole (Persantine) - an antiplatelet agent

Front 142

What two drug classes should patients avoid as initial treatments for chronic stable angina?

Back 142

short acting DH-CCBs and long acting nitrates

Front 143

How do you treat a patient with newly diagnosed chronic stable angina?

Back 143

TLC, ASA, ACEi or ARB, BB and statin and SL NTG

Front 144

If you are going to administer DHP-CCB in a patient with UA/NSTEMI what must you also order for the patient?

Back 144

BB

Front 145

What drugs should NOT be given to a patient with UA/NSTEMI?

Back 145

NSAIDS

Front 146

When would IV NTG be indicated in the first 48 hours of UA/NSTEMI?

Back 146

persistent ischemia, HF or HTN

Front 147

In the first 24 hours of UA/NSTEMI when would you use an ACEi?

Back 147

pulmonary congestion
LV EF < 40%

Front 148

For patients with UA/NSTEMI when are BB CI?

Back 148

HF, decrease CO, risk for cardiogenic shock

Front 149

List drugs for management of UA/NSTEMI within first 24 hours.

Back 149

Oxygen
SL NTG (q5min x 3 total)
BB (or NDP-CCB)
ACEi (CI w/ hypotension)
IV morphine for pain

Front 150

What should patients undergoing PCI receive prior to the procedure?

Back 150

ASA
clopidogrel - 300mg loading dose (po) or GP IIb/IIIa inhibitor (IV)

Front 151

Your patient is taking an ACEi. She has DM and CHF and her EF = 35%. What treatment would you add? What will you monitor?

Back 151

Spironolactone
(aldosterone receptor blocker)
CrCl < 30ml/min (renal dysfunction)
K > 5mEq/L (hyperkalemia)

Front 152

Low Molecular Weight Heparin

Back 152

enoxaparin (Lovenox)

Front 153

Factor Xa inhibitor

Back 153

Fondaparinux

Front 154

Direct thrombin inhibitor

Back 154

Bivalirudin

Front 155

What drug would you prescribe if your patient is not tolerating a BB?

Back 155

Verapamil (NDHP CCB)

Front 156

If your patient has a high CAD risk and is intolerant of clopidagrel what would you prescribe?

Back 156

warfarin with or without ASA

Front 157

Goals for patients with CAD:
BP

Back 157

<140/90 mmHg

Front 158

Goals for patients with CAD:
BP with DM or CKD

Back 158

<130/80 mmHg

Front 159

Goals for patients with CAD:
LDL w/ no risk factors

Back 159

< 100 mg/dl

Front 160

Goals for patients with CAD:
LDL w/ multiple risk factors

Back 160

< 70 mg/dl

Front 161

Goals for patients with CAD:
Hemoglobin A1c

Back 161

< 7%

Front 162

Goals for patients with CAD:
Waist circumference men/women
BMI

Back 162

< 40in / <35in
BMI 18.5-24.9 kg/m2

Front 163

For patients >75 years old describe use of clopidogrel during a STEMI.

Back 163

75mg QD (no loading dose)

Front 164

Class IIb recommendation for all post PCI STEMI stented patients?

Back 164

ASA
Clopidogrel Loading Dose 300mg then 75mg QD

Front 165

Patients undergoing reperfusion with PCI should NOT receive this drug (Class I recommendation).

Back 165

fondaparinux (fibrinolytic)

Front 166

T/F CCBs with negative inotropic effects (verapamil and diltiazem) are useful in asymptomatic patients with decreased LV EF after MI.

Back 166

False - NDHP CCBs can be harmful if LV EV is decreased

Front 167

T/F ACEi increase CO without increasing HR.

Back 167

True

Front 168

T/F ACEi decrease preload and afterload.

Back 168

True - decrease PCWP and systolic pressure

Front 169

List the two drugs that are the 'cornerstone' of HF therapy.

Back 169

ACEi and BBs

Front 170

List the ACEi used for first line therapy for patients with CHF.

Back 170

Captopril
Enalapril
Lisinopril
Perindopril
Trandolapril

Front 171

T/F ACEi should be taken with food.

Back 171

False - food decreases absorption of ACEi and should be taken on an empty stomach

Front 172

T/F ACEi are potassium sparing

Back 172

True (watch for hyperkalemia)

Front 173

'-sartan'

Back 173

Angiotensin receptor blockers

Front 174

List the angiotensin receptor blockers that are available with HCTZ for patients with CHF and LV EF < 40%.

Back 174

Losartan
Olmesartan
Valsartan

Front 175

If your patient is intolerant of the dry cough and angioedema with ACEi what is an alternative therapy?

Back 175

Angiotensin Receptor Blocker (ARB)

Front 176

List the beta blockers useful for patients with CHF and LV EV < 40%.

Back 176

bisoprolol
carvedilol
metroprolol

Front 177

List drug classes to avoid for patients with stage C CHF and LV EF < 40%.

Back 177

NSAIDs
Antiarrhythmics
CCBs

Front 178

Add this TLC for stage C CHF.

Back 178

salt restriction

Front 179

What drug therapy would you add for an African American with CHF with moderate to severe symptoms while taking ACEi, BB and diuretics?

Back 179

hydralazine
nitrates

Front 180

This drug has been shown to decrease hospitalizations for patients with CHF.

Back 180

digitalis

Front 181

Your patient with CHF has sx/sx of renal insufficiency and hypotension using ACEi. What would your prescribe?

Back 181

hydralazine and nitrates

Front 182

T/F The routine use of ACEi, ARBs and aldosterone antagonists is effective in managing patients with CHF.

Back 182

False - combined use of all three drugs is NOT recommended

Front 183

What causes thiazides to lose efficacy?

Back 183

CrCl < 50ml/min

Front 184

Your patient is complaining of gynomastia and impotence. What drug would you d/c?

Back 184

spironolactone

Front 185

Your patient has right heart failure. Would you use digoxin?

Back 185

No

Front 186

When does digoxin toxicity begin (mcg/L)?

Back 186

2 mcg/L

Front 187

Your patient is hyperkalemic and hypocalcemic. Should you d/c digoxin?

Back 187

No. Digoxin causes hypokalemia and hypercalcemia

Front 188

T/F Advanced age is a CI for digoxin.

Back 188

True

Front 189

Your patient is vomiting and complains of seeing everything in red and green. Her HR is dropping. What would you d/c?

Back 189

Digoxin

Front 190

What is the Tx for digoxin toxicity?

Back 190

Stop digoxin
Add potassium chloride

Front 191

Severe digoxin toxicity may require these therapies...

Back 191

Lidocaine to control Vtach
magnesium
Atropine
Digibind

Front 192

What is the primary therapy for acute HF in the hospital setting?

Back 192

Dobutamine
(inotropic agent)

Front 193

If dobutamine is CI what other inotropic agent could be ordered?

Back 193

Milrinone
(phophodiesterase inhibitor)

Front 194

Patient with HF is cold and dry. Tx?

Back 194

Inotropes (dobutamine and milirinone)

Front 195

Patient with HF is cold and wet. Tx?

Back 195

Diuretics, vasodilators (nitroprusside) OR natriuretic peptides (nesiritide)

Front 196

What are the most commonly used drugs for acute HF?

Back 196

Hydralazine (vasodilator) and isosorbide dinitrate (nitrates)

Front 197

Dilates both arterial and venous vessels to reduce preload and afterload.

Back 197

Nitropursside

Front 198

Dilates mainly venous vessels to reduce preload.

Back 198

Nitroglycerine

Front 199

Patient has a PCWP of 25 mmHg not responding to diuretics and NTG (IV). Tx?

Back 199

Nesiritide
(natriuretic peptide)

Front 200

Which drug is NOT known to cause HF due to negative inotropic effects:
propranolol
verapamil
doxorubicin
disopyramide

Back 200

doxorubicin
propranolol (BB)
verapamil (CCB)
disopyramide (antiarrhythmic)

Front 201

Which drugs can cause HF through proarrhythmic effects that lead to QT interval widening and Torsade de pointe?

Back 201

Class IA, IB and III antiarrhythmics

Front 202

List drugs that cause sodium retention that can lead to HF.

Back 202

Metformin (high doses)
NSAIDs
estrogen
licorice
hydralazine
antacids, cephalosporins and penicilins (high sodium content)