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Cardio textbook Qs (Ch 19, 20, 21, 22, 23)
Terms in this set (35)
What drug may exacerbate HF?
Ibuprofen (NSAIDS--> fluid retention)
Describe the action of ACEi on the failing heart
What makes Losartan different from other ARBs?
Losartan has an active metabolite (undergoes first-pass metabolism to its active metabolite)
How to beta blockers improve cardiac function in HF?
Dec renin release
Prevent direct effects of NE on cardiac muscle to dec remodeling
70yo female with HFrEF, PMHx significant for HTN, A fib. Meds are HCTZ, Lisinopril, Metoprolol Tartrate, and Warfarin. Denies cough, SOB, and edema. Which med should be changed?
Change metoprolol tartrate to metoprolol succinate (Metoprolol succinate should be used in HF)
75yo male with HF presents c/o SOB, inc pitting edema, and 5lb wt gain over 2 days. Meds are Losartan and Metoprolol succinate. Denies CP. What do you recommend for out pt tx?
How is spironolactone beneficial in HF?
Antagonizes aldosterone, preventing salt and water retention
Which is important to monitor in pts taking digoxin?
Potassium (Hypokalemia can lead to arrhythmia and increase risk of cardiac toxicity with digoxin)
Describe MOA of Milrinone in HF
Phosphodiesterase inhibitor that leads to inc cAMP, inc intracellular Ca, and therefore inc contractility.
MC ADR associated with fixed-dose hydralazine/isosorbide dinitrate
Clinical term for angina caused by coronary vasospasm
Prinzmetal angina (aka vasospastic, variant)
Clinical terms for angina caused by atherosclerosis
Classic angina, unstable angina, MI
List 3 meds that can be useful for managing stable angina in pt with CAD
72yo male presents to PCP c/o chest tightness and pressure worsening in severity and frequency. Meds are Atenolol, Lisinopril, and NTG. Most appropriate intervention?
Refer to nearest ER for evaluation (this is crescendo angina indicative of unstable angina, requiring work-up)
62yo pt with hx of asthma and vasospastic angina reports CP on exertion and at rest about 10x/week. Relieved by 1 SL NTG, but c/o bad HA with NTG. What is the best option for improvinghis angina?
Side effect associated with Amlodipine?
Med rx all anginal pts to treat acute attack
65yo male c/o uncontrolled angina limiting activity. Currently takes maximal dose of BB. HR and BP are low and he was unable to tolerate increased isosorbide mononitrate d/t HA. What is an appropriate addition to his current therapy?
Ranolazine (use if other meds are maximized and esp if BP is well controlled. BL EKG and labs necessary)
68yo male w/ Hx angina and recent MI. Echo reveals HF with reduced EF. Pt was started on Diltiazem, Analapril, and NTG. Atenolol was added at DC. What is a long-term goal for his meds?Stop
Stop Diltiazem and change Atenolol to Bisoprolol (Diltiazem should be avoided in HF w/ reduced EF)
Meds that interact with Ranolazine
Pt with angina that was previously well controlled with Isosorbide mononitrate qd has recently been taking it bid d/t increasing angina in the morning hours. What should be changed?
Continue Isosorbide mononitrate qd but advise pt to take it in the evening
70yo female with nonvalvular a fib. PMHx CKD, renal function diminished. Three meds that would require reduced dosing in this pt
(key: NOT Warfarin)
In which dz is Cilostazol contraindicated?
HF with reduced EF
What does heparin bind to to exert its anticoagulant effect?
Which is considered "fibrin selective" because it rapidly activates plasminogen that is bound to fibrin?
MC side effect of antihHLD drug therapy
Which HLD is characterized by elevated plasma levels of chylomicrons and has no drug therapy available to lower the plasma protein levels?
Type I HLD (hyperchylomicronemia, tx with low-fat diet, drug therapy ineffective)
MOA: dec chol synthesis by inhibiting enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase
Which drug causes dec liver TG synthesis by eliminating free fatty acids needed as building blocks?
Which drug binds bile acids in the intestine, preventing their return to the liver via enterohepatic circulation?
65yo male most recent LDL=165mg/dL. Best option to initiate tx?
Simvastatin (HMG CoA reductase inhibitor)
62yo female with HLD and hypothyroidism. Current meds include Cholestyramine and Levothyroxine. Describe how to avoid interaction.
Take Levothyroxine 1h before Cholestyramine on an empty stomach.
Recommended to avoid flushing with Niacin
ASA 30 min prior to taking Niacin
72yo male treated for HLD with high-dose Atorvastatin for the past 6mo. PMHx renal insufficiency. Most recent LDL=131, TG=510, HDL=32. What is the best additional choice to reduce HLD?
Niacin (d/t significantly elevated TG and low HLD)
Pt population most likely to experience myalgias while taking HMG CoA reductase inhibitors
Hx renal insufficiency (higher chance of developing myalgias, myopathy, and rhabo)
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