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63 Cards in this Set
- Front
- Back
Normal Triglyceride levels
Boderline High High Very High |
<150 g/dL
150-199 g/dL 200-499 g/dL >500 g/dL |
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Total Cholesterol Equation
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LDL + HDL+VLDL
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How do you determine hypercholesteremia?
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Determine the lipoprotein levels after a 9 hour fast
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CAD Risk Factors
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Age- male 45 female 55 or premature menopause w/o estrogen therapy.
Family history of premature CHD. SMOKER Hypertension (>/= 140/90) Low HDL |
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LDL Goals
CAD, Diabetes Mellitus, 2+ risk factors. 2+ risk factors 0-1 risk factors |
<100 (60-70)
<130 mg/dL <160 mg/dL |
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What is Non-HDL?
What is the equation? |
Takes into consideration triglycerides in atherosclerosis.
Total cholesterol- HDL |
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HMG CoA Reductase Inhibitors
-MOA -Lipoprotein profile -Contraindications -General ADEs -Serious ADEs |
-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 |
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Rhabdomyolysis
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-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 |
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Proteinuria
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The spilling of protein into the urine.
Mainly seen with Rosuvastatin 40 mg Clinical significance is unknown |
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Lovastatin absorption
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Food increases F
Fiber decreases F Dosed at night |
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Elimination half life HMG-CoA
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Short half life for FLUVASTATIN and PRAVASTATIN.
Dose at bedtime |
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CYP 3A4 Inhibitors
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Ketoconoazole
Itraconazole Erythromycin Trandeolamycin Cyclosporin Nefazadone Grapefruit Juice Verapamil Amiodarone Diltiazem Ritinavir Indinavir Saquinavir Amprenavir |
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Changes in package insert for lovastatin and simvastatin
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-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 |
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Explain the effects of Lactone - Open acid equilibrium
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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 |
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P-Glycoprotein intrxns w/ statins
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Atorvastatin increases digoxin via P-glycoprotein inhibition
Pravastatin, Rosuvastatin and Fluvastatin have NO DIGOXIN INTRXN |
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Bile Acid Sequestrants
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Cholestyramine
Colestipol Colesevam |
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Bile Acid Sequestrants
MOA Dosage Forms ADEs |
-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!!!! |
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Bile Acid Sequestrants
Drug Interactions |
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 |
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Nicotinic Acid
*Niacin *Vitamin B3 -Lipoprotein Profile |
Decreases LDL profile, Increases HDL A LOT!!! Decreases triglycerides A LOT!!!
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Nicotinic Acid side effects, precautions and contraindications
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-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 |
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Nicotinic Acid Dosing
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2-3 mg/day
Target dose of 6 g/day |
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Nicotinic acid clinical pearls
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Niacin may give a false positive for urine glucose
Niaspan is sustained releases niacin and reduces the flushing effect |
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Fibric Acid Derivatives MOA
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Increase in LPL and increase cholesterol secretion in bile.
-Decreases triglycerides and increases HDL - changes LDL to light LDL |
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Gemfibrozil contraindications
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hepatic or renal dysfunction or gall bladder disease
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Gemfibrozil side effects
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abdominal pain, flatulence, and nausea
-Risk of gall stone formation -rare risk of rhabdomyolysis |
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Fenofibrate Contraindications
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Severe hepatic dysfunction and gallbladder disease.
- |
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Fenofibrate Side Effects
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skin rash
risk of gallstone and rhabdomyolysis |
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Ezetimibe
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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 |
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Cholestin
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derived from yeast fermented brown rice.
Has active ingredient in lovastatin |
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Estrogen Lipoprotein profile and benefits
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Raises HDL very well and raises triglycerides
-decreases post menopausal sx and also risk of Alzheimers |
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Estrogen contraindications and precautions
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breast cancer
genital bleeding thromboembolism gall bladder disease unopposed estrogen |
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Estrogen counseling points
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mammograms
pain in claves abnormal vaginal bleeding severe abdominal pain may be indicative of gall bladder disease or pancreatitis |
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Stable angina
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no clot formation, O2 supply and demand imbalance
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Normal CPK
CPK-MB levels |
<5% is normal
CPK- 60-400 u/L |
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3 CRITERIA NEED TO DIAGNOSE MI
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ST elevation, pain longer than 30 min after 3 SL tablets, enzymes
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Chief elderly complaint
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-SOB
-Squeezing, tightness, pressing pain and burning |
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Chronic Drugs for Stable Anigina
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non-dihydropyridine CCBs and beta blockers
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Acute PRN drugs for pain relief for stable angina
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SL nitro or nitro spray
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What agents are used to reduce the event of angina of mi
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Aspirin or ADP inhibitors
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At what dose do you begin to lose antiplatelet effects with aspirin
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> 650 mg loses antiplatelet effect
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Clopidogrel
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ADP inhibitor
takes 7-10 days to have its effect |
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Clopidogrel Dosing
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75 QD ...300 mg LD gives effects in 8 hrs
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Clopidogrel Clinical pearls
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CYP219
Use cautiously with warfarin DC 7 days before surgery can be used in bronchoconstriction\ |
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What are some things to look out for in a patient who is on NTG tablets or spray
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Look out for anti-cholinergic drugs and dont shake aerosal sprays
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Ranolazine
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shifts metabolism of myocardial cells to glucose instead of FFA oxidation.
-CYP3A4 SUBSTRATE!!!! -Prolongs Qtc interval |
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drugs for unstable angina
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clopidogrel and aspirin
dose same for clopidogrel and aspirin dose 162.5 or 325 for first 30 days and 81 mg for the maintenance |
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Heparin MOA
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inhibits thrombin factor 10
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Heparin Clinical pearls and dosing
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60u/kg LD and 12u/kg/hr
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IBW male
female obese |
50kg + 2.3 (# of inches over 5 ft)
45kg " IBW + (ABW-IBW/2) |
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When do you draw aPTTs
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6 hrs post loadd
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Protamine
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1mg clears 100 units of heparin
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Thrombocytopenia
Type 1 Type 2 treatment |
-benign and monitor
-IgG induced and deems rapid DC. -Onset is usually 10 days -treat with direct thrombin inhibitors -Fondapiranox |
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Glycoprotein IIb IIIa
Tirofiban and eptifibatide are beneficial to whom |
those who arent getting angioplasty
effects last for 4 hrs |
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Abcixmab
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benefits those who did angioplasty
48hr duration |
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CYP 2D6 Ihibitors
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fluoxetine
paroxetine diphenhydramine propafenone quinidine |
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highlyimplicated SLE drugs
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hydralazine
procanamide isoniazid phenytoin |
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Digoxin Loading Dose
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10mcg/kg/day
*Give 1/2LD now, 1/4LD in 4-6hrs and final 1/4LD dose in 4-6hrs |
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Digoxin Maintenance Dose Equation
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% 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 |
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Digoxin Maintenance Dose Equation Short Cut
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0.25 for big people
0.125 for little people |
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S/S of digoxin toxicity
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Arrhythmias
Worsening Heart Failure Yellowing or greening of visual field anorexia, nausea, vomitting |
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Digoxin drug interactions
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Antacids
kaolin cholestyramine lasix (causes hypokalemia) |
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Beta blockers that are RENALLY eliminated
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Atenolol
nadolol |
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Beta Blockers that are HEPATICALLY eliminated
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Metoprolol
Carvedilol Propranolol |