Therapeutics Exam 2

Front 1

Normal Triglyceride levels
Boderline High
High
Very High

Back 1

<150 g/dL
150-199 g/dL
200-499 g/dL
>500 g/dL

Front 2

Total Cholesterol Equation

Back 2

LDL + HDL+VLDL

Front 3

How do you determine hypercholesteremia?

Back 3

Determine the lipoprotein levels after a 9 hour fast

Front 4

CAD Risk Factors

Back 4

Age- male 45 female 55 or premature menopause w/o estrogen therapy.
Family history of premature CHD.
SMOKER
Hypertension (>/= 140/90)
Low HDL

Front 5

LDL Goals
CAD, Diabetes Mellitus, 2+ risk factors.
2+ risk factors
0-1 risk factors

Back 5

<100 (60-70)
<130 mg/dL
<160 mg/dL

Front 6

What is Non-HDL?
What is the equation?

Back 6

Takes into consideration triglycerides in atherosclerosis.
Total cholesterol- HDL

Front 7

HMG CoA Reductase Inhibitors
-MOA
-Lipoprotein profile
-Contraindications
-General ADEs
-Serious ADEs

Back 7

-inhibits necessary step in cholesterol synthesis.
-Decreases LDL, increases HDL,decreases triglycerides
-Prego, Breast feeding, liver disease
-GI upset,rash and headache
- AST ~35 ALT~35 LDH ~50-150 (3X THESE ARE A PROBLEM)
*HMG- CoA RIs + fibrates or niacin inc risk of hepatic failure

Front 8

Rhabdomyolysis

Back 8

-CPK > 10,000 u/L
-pt complains of muscle pain
-black or brown urine
-CPK MM will be elevated if due to drug (normal levels = 10-150 u/L)
-Dose response relationship EXCEPT for pravastatin

Front 9

Proteinuria

Back 9

The spilling of protein into the urine.
Mainly seen with Rosuvastatin 40 mg
Clinical significance is unknown

Front 10

Lovastatin absorption

Back 10

Food increases F
Fiber decreases F
Dosed at night

Front 11

Elimination half life HMG-CoA

Back 11

Short half life for FLUVASTATIN and PRAVASTATIN.
Dose at bedtime

Front 12

CYP 3A4 Inhibitors

Back 12

Ketoconoazole
Itraconazole
Erythromycin
Trandeolamycin
Cyclosporin
Nefazadone
Grapefruit Juice
Verapamil
Amiodarone
Diltiazem
Ritinavir
Indinavir
Saquinavir
Amprenavir

Front 13

Changes in package insert for lovastatin and simvastatin

Back 13

-Use <10 mg of simvastatin or 20 mg of lovastatin w/cyclosporin, fibric acid derivatives, or niacin.
-Use <20 mg or 40 mg of S and L w/ amiodarone and verapamil

Front 14

Explain the effects of Lactone - Open acid equilibrium

Back 14

Fibric acids prevent the formation of the inactive lactone which increases the amount of active statin in the blood.
Pravastatin and rosuvastatin have less intrxn.
Fenofibrate is a stonger inhibitor that gemfibrozil

Front 15

P-Glycoprotein intrxns w/ statins

Back 15

Atorvastatin increases digoxin via P-glycoprotein inhibition
Pravastatin, Rosuvastatin and Fluvastatin have NO DIGOXIN INTRXN

Front 16

Bile Acid Sequestrants

Back 16

Cholestyramine
Colestipol
Colesevam

Front 17

Bile Acid Sequestrants
MOA
Dosage Forms
ADEs

Back 17

-Exchange of chloride ions for bile acids in gut. Not allowing reabsorption of bile acids in the ILEUM.
-ONLY LOWERS LDL
-TK W/IN 1 HR OF MEAL
-POWDER AND TABLETS
-nausea crammping and constipation
-Increase fluid and fiber intake to help
-Never take powder dry!!!!

Front 18

Bile Acid Sequestrants
Drug Interactions

Back 18

Drugs with a F less than 80%
ADEK
Warfarin Digoxin and Thyroid Hormones (SPACE 1 hr)
*Colesevam is better tasting and does NOT interact with vitamins or blood thinners

Front 19

Nicotinic Acid
*Niacin
*Vitamin B3
-Lipoprotein Profile

Back 19

Decreases LDL profile, Increases HDL A LOT!!! Decreases triglycerides A LOT!!!

Front 20

Nicotinic Acid side effects, precautions and contraindications

Back 20

-Warming and itching that lasts 30-60 min after ingestion
-Effects are increase by warm drinks
-Aspirin 30 min before helps OR sustained released NIASPAN
1.HEPATIC DYSFUNTION
***MAIN THING is to tcheck LFTs! Anything 3x the normal limit needs DC.
2. Active PUD
3. History of Hemmorhaging
4. Severe pre-existing HYPOTENSION
Be cautious of hyperuremia because uric acid levels rise and cause gout.
5Transient increase in glucose levels

Front 21

Nicotinic Acid Dosing

Back 21

2-3 mg/day
Target dose of 6 g/day

Front 22

Nicotinic acid clinical pearls

Back 22

Niacin may give a false positive for urine glucose
Niaspan is sustained releases niacin and reduces the flushing effect

Front 23

Fibric Acid Derivatives MOA

Back 23

Increase in LPL and increase cholesterol secretion in bile.
-Decreases triglycerides and increases HDL
- changes LDL to light LDL

Front 24

Gemfibrozil contraindications

Back 24

hepatic or renal dysfunction or gall bladder disease

Front 25

Gemfibrozil side effects

Back 25

abdominal pain, flatulence, and nausea
-Risk of gall stone formation
-rare risk of rhabdomyolysis

Front 26

Fenofibrate Contraindications

Back 26

Severe hepatic dysfunction and gallbladder disease.
-

Front 27

Fenofibrate Side Effects

Back 27

skin rash
risk of gallstone and rhabdomyolysis

Front 28

Ezetimibe

Back 28

Selective inhibitor of upper intestinal cholesterol absorption
Only one dose 10 mg
LOWERS LDL
RAISES HDL
NO EFFECT ON TRIGLYCERIDES
Good with HMG CoA RIs
Some risk of increases LFTs

Front 29

Cholestin

Back 29

derived from yeast fermented brown rice.
Has active ingredient in lovastatin

Front 30

Estrogen Lipoprotein profile and benefits

Back 30

Raises HDL very well and raises triglycerides
-decreases post menopausal sx and also risk of Alzheimers

Front 31

Estrogen contraindications and precautions

Back 31

breast cancer
genital bleeding
thromboembolism
gall bladder disease
unopposed estrogen

Front 32

Estrogen counseling points

Back 32

mammograms
pain in claves
abnormal vaginal bleeding
severe abdominal pain may be indicative of gall bladder disease or pancreatitis

Front 33

Stable angina

Back 33

no clot formation, O2 supply and demand imbalance

Front 34

Normal CPK
CPK-MB levels

Back 34

<5% is normal
CPK- 60-400 u/L

Front 35

3 CRITERIA NEED TO DIAGNOSE MI

Back 35

ST elevation, pain longer than 30 min after 3 SL tablets, enzymes

Front 36

Chief elderly complaint

Back 36

-SOB
-Squeezing, tightness, pressing pain and burning

Front 37

Chronic Drugs for Stable Anigina

Back 37

non-dihydropyridine CCBs and beta blockers

Front 38

Acute PRN drugs for pain relief for stable angina

Back 38

SL nitro or nitro spray

Front 39

What agents are used to reduce the event of angina of mi

Back 39

Aspirin or ADP inhibitors

Front 40

At what dose do you begin to lose antiplatelet effects with aspirin

Back 40

> 650 mg loses antiplatelet effect

Front 41

Clopidogrel

Back 41

ADP inhibitor
takes 7-10 days to have its effect

Front 42

Clopidogrel Dosing

Back 42

75 QD ...300 mg LD gives effects in 8 hrs

Front 43

Clopidogrel Clinical pearls

Back 43

CYP219
Use cautiously with warfarin
DC 7 days before surgery
can be used in bronchoconstriction\

Front 44

What are some things to look out for in a patient who is on NTG tablets or spray

Back 44

Look out for anti-cholinergic drugs and dont shake aerosal sprays

Front 45

Ranolazine

Back 45

shifts metabolism of myocardial cells to glucose instead of FFA oxidation.
-CYP3A4 SUBSTRATE!!!!
-Prolongs Qtc interval

Front 46

drugs for unstable angina

Back 46

clopidogrel and aspirin
dose same for clopidogrel and aspirin dose 162.5 or 325 for first 30 days and 81 mg for the maintenance

Front 47

Heparin MOA

Back 47

inhibits thrombin factor 10

Front 48

Heparin Clinical pearls and dosing

Back 48

60u/kg LD and 12u/kg/hr

Front 49

IBW male
female
obese

Back 49

50kg + 2.3 (# of inches over 5 ft)
45kg "
IBW + (ABW-IBW/2)

Front 50

When do you draw aPTTs

Back 50

6 hrs post loadd

Front 51

Protamine

Back 51

1mg clears 100 units of heparin

Front 52

Thrombocytopenia
Type 1
Type 2
treatment

Back 52

-benign and monitor
-IgG induced and deems rapid DC. -Onset is usually 10 days
-treat with direct thrombin inhibitors -Fondapiranox

Front 53

Glycoprotein IIb IIIa
Tirofiban and eptifibatide are beneficial to whom

Back 53

those who arent getting angioplasty
effects last for 4 hrs

Front 54

Abcixmab

Back 54

benefits those who did angioplasty
48hr duration

Front 55

CYP 2D6 Ihibitors

Back 55

fluoxetine
paroxetine
diphenhydramine
propafenone
quinidine

Front 56

highlyimplicated SLE drugs

Back 56

hydralazine
procanamide
isoniazid
phenytoin

Front 57

Digoxin Loading Dose

Back 57

10mcg/kg/day
*Give 1/2LD now, 1/4LD in 4-6hrs and final 1/4LD dose in 4-6hrs

Front 58

Digoxin Maintenance Dose Equation

Back 58

% daily loss = CrCl (in ml/min)/5 + 14
1. Convert % to decimal
2. Multiply by LD for IV
OR
3. Multiply by 0.8 for PO dose

Front 59

Digoxin Maintenance Dose Equation Short Cut

Back 59

0.25 for big people
0.125 for little people

Front 60

S/S of digoxin toxicity

Back 60

Arrhythmias
Worsening Heart Failure
Yellowing or greening of visual field
anorexia, nausea, vomitting

Front 61

Digoxin drug interactions

Back 61

Antacids
kaolin
cholestyramine
lasix (causes hypokalemia)

Front 62

Beta blockers that are RENALLY eliminated

Back 62

Atenolol
nadolol

Front 63

Beta Blockers that are HEPATICALLY eliminated

Back 63

Metoprolol
Carvedilol
Propranolol