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BBDA II EXAM II
Terms in this set (211)
What does PVR stand for?
peripheral vascular resistance
A pt stops by the pharmacy and checks his BP. He asks you if 152/88 is high. What do you say?
A. No, you are right where you should be
B. Yest, it is high. What medications do you take?
C. I am a P1, I have no clue.
Blood pressure = ?
A. CO X PVR
B. CO X SV
C. HR X SV
D. PVR X SV
A. Increase blood pressure
B. Decrease blood pressure
What is the goal for optimal blood pressure?
Increasing Aldosterone causes what on sodium?
Diuretics are often called "water pills" by the public
What pump do Thiazides block and where?
In the distal tube of the kidney filtration, blocks NaCl transporter.
What are thiazides primarily used for?
True or False - Thiazides are a good choice for edema?
Thalitone is brand name for?
Brand name for Metolazone?
Generic name for Zaroxolyn?
What is the drug class of Metolazone?
What thiazide does work in patients with Crcl< 30ml/min and is used for heart failure?
List 4 ADR to thiazides?
3. Hyperuricemia (gout)
Hyperuricemia and hyponatremia are unique to what class of drugs?
A. Loop diuretics
B. Angiotensin II Antagonists
D. Potassium-sparing diuretics
Where do loop diuretics work?
Loop of Henle
What are loop diuretics used for?
Edema/HTN in poor renal function
Which drug class causes tons of electrolytes to be lost?
Furosemide is generic for what drug?
The six in Lasix is significant for?
Action will be for last (next) six hours
List 3 ADR to Loop diuretics.
1. Acute renal failure
4. Ototoxicity (ringing in the ears)
How do potassium sparing diuretics work?
Directly ↑Na+ excretion and ↓K+ secretion in distal tubule collecting duct.
What is the most common ADR to potassium-sparing diuretics?
What do you want to monitor in patients taking diuretics? (name at least 3)
1. Blood pressure
5. Volume depletion
Elevation of blood urea nitrogen is suggestive of what?
A. Liver disease
B. Malfunction of kidneys
C. Over-filtration of the kidneys
A low BUN is suggestive of what?
If someone is over-diuresed, what symptoms might they have?
B. Unstable gait
C. Renal dysfunction
D. All of the above
What does the "R" in RAAS stand for?
What converts angiotensinogen to angiotensin I?
What converts angiotensin I to angiotensin II?
Angiotensin converting enzyme (ACE)
What causes aldosterone secretion?
Renin converts _______ to _________.
angiotensinogen to angiotensin I
ACE converts ______ to _______
angiotensin I to angiotensin II
Increased aldosterone causes increased
ACE inhibitors will
A. Increase bradykinin which causes vasoconstriction
B. Decrease bradykinin which causes vasocontriction
C. Increase bradykinin which causes vasodilation
D. Decrease bradykinin which causes vasodilation
Drugs ending in "-pril" are
A. Beta blockers
B. ACE inhibitors
What are the common indications for ACE-Is?
2. Heart failure
3. Post MI
4. Kidney protection
What electrolyte do ACE-I elevate?
List at least 3 ADR to ACE-Is.
1. Dry, unproductive cough
4. Skin eruptions, rash
Which work the best to lower blood pressure in the black population?
B. Thiazide diuretics
Which of the following is classified as an ARB?
Agents ending in "-sartan" are what drug classification?
A. Peripheral vasodilators
B. HMG-CoA reductase inhibitors
C. Antianginal agents
D. Angiotensin II Receptor Blockers
What is the brand name of Losartan?
Aldosterone Antagonists increase which electrolyte?
What are the ADRs of ARBs?
Same as ACE-I
What drug is an aldosterone antagonist?
What are aldosterone antagonists used for?
1. Resistant hypertension
2. Heart failure
3. Liver failure
4. Acne, PCOS
Which kinds of drugs can cause bilateral enlargement of male mammary glands?
A. Renin inhibitors
B. Aldosterone antagonists
List at least 2 ADRs to Aldosterone Antagonists.
3. Renal dysfunction
Aldosterone antagonists increase which electrolyte?
What is the brand name of Metolazone?
B-Blockers have shown effectiveness to (select all that apply)
A. Raise blood pressure
B. Lower blood pressure
C. Increase heart rate
D. Decrease heart rate
B. and D.
Where are alpha 1 receptors primarily located?
C. Peripheral vessels
Beta blockers have ______________ ionotropic effect and _____________ chronotropic effect.
B1 and B2 receptors are part of
A. Sympathetic system
B. Parasympathetic system
What are the indications for beta blockers?
1. Post MI
3. Heart failure
4. Headaches, tremors
Metoprolol brand names are?
Lopressor, and Toprol XL
Which Metoprolol brand name is a tartrate salt?
Which Metoprolol brand name is a succinate salt?
Which B-blocker is cardioselective and would be a good choice for an asthma patient?
A. Propranolol (Inderal)
B. Carvedilol (Coreg)
C. Nebivolol (Bystolic)
D. Labetalol (Trandate)
propranolol, carvedilol, labetalol are all?
beta blockers nonselective
List 4 adverse effects of B-blocker drugs
2. AV block
4. Decreased exercise tolerance
6. Potential to mask hypoglycemia
What will we monitor on Beta blockers?
Dihydropyridines are what class of medications?
A. Beta blockers
C. Alpha agonists
D. Calcium Channel Blockers
List 2 ADRs of dihydropiridines.
1. Orthostatic hypotension
2. Peripheral edema
3. Reflex tachycardia
What is the brand name of Amlodipine?
What is the brand name of Felodipine?
Dihydropiridines end in?
What are indications for Non-DHPs?
1. Atrial fibrillation
What are the two Non-DHP drugs?
What CCB causes bradycardia?
Non-DHP drugs commonly cause
What is the common side effects with Clonidine (Catapres)
Dry mouth and/or sedation
What drug is a a2 agonist?
Sudden withdrawal from Clonidine can cause?
Name the two a-1 antagonists.
1. Terazosin (Hytrin)
2. Doxazosin (Cardura)
What are the ADR to alpha 1 blockers?
1. Orthostatic hypotension
2. Reflex tachycardia
3. Nasal stuffiness
What is the problem with non-compliance with clonidine (Catapres)?
Sudden withdrawal can result in life-threatening hypertension.
What is hydralazine used for?
Hypertension (esp pregnancy)
What are some ADR to hydralazine?
2. GI complaints
3. Drug-induced lupus
A clinical syndrome resulting from ANY disorder that: impairs the ability of the ventricle to fill with (diastole) or eject blood (systole), and the heart is unable to pump blood at a rate sufficient to meet the metabolic demands of the body.
Chronic Heart Failure (CHF) or Congestive Heart Failure
What is ejection fraction?
The percentage of left ventricular blood volume "ejected" during systole (contraction).
What is HFrEF?
heart failure with reduced ejection fraction (systolic dysfunction)
What does HFpEF stand for?
Heart failure with preserved ejection fraction (Diastolic dysfunction)
What do you manipulate in HFrEF patients?
SNS and RAAS
What is the normal Ejection Fraction percentage?
What does neprilysin do?
Breaks down Natiuretic peptides
What is the only If channel inhibitor used for HFrEF?
Digoxin has a ______________ Inotropic effect and a _________________ chronotropic effect.
What is a medication that does not affect blood pressure but can affect angina pectoris?
What is the most common anti-arrhythmic medication?
Amiodarone (Pacerone, Cordarone)
Name 5 ADRs to Amiodarone.
1. Pulmonary fibrosis
2. Elevated AST/ALT (Liver)
3. Off-set thyroidism
4. Neurologic effects
5. Corneal microdeposits (Eyes)
6. Optic neuropathy
7. Skin pigmentation
8. N/V anorexia
9. Heart block
10. QT prolongation
What are the counseling pearls for pacerone (Amiodarone)
1. Monitoring is important
2. Use sunscreen!
3. Ask health care provider before taking other medications
4. Avoid grapefruit juice
In cases of sudden severe chest pain what medication would you use?
Sublingual nitroglycerin (Nitrostat)
nitroglycerin lingual spray (Nitrolingual)
List 2 ADRs to Nitroglycerin
2. Throbbing headache
What do you want to monitor with digoxin patients?
1. Electrolyte and renal function
3. Drug interactions
What medication is commonly associated with yellow tinged vision?
What are the ADRs to Entresto?
5. Renal failure
What medications between HFrEF and HFpEF are unique to only HFpEF?
True or False - The main role of ARBs in HFrEF is to be an alternative to ACE-I.
What kind of cholesterol is "bad cholesterol"?
What is the desired LDL cholesterol level?
What is the desired triglycerides level?
What is the desired total cholesterol level?
High cholesterol can lead to?
What is the biggest risk of having high level of triglycerides?
If there is an increase in cholesterol in hepatocytes, what will happen to LDL levels in the blood stream?
What types of fat do we want to reduce for lifestyle changes in hyperlipidemia?
What types of fat do we want to increase for lifestyle changes in hyperlipidemia?
Also add fiber
Which kind of medications are first-line therapy for management of dyslipidemia?
What is the first step in therapy for hyperlipidemia?
Dietary and lifestyle changes.
Increasing unsaturated fat intake will have what affect on LDL and HDL?
Lower LDL, Raise HDL
What are the two high intensity statins?
1. Atorvastatin 40-80 mg
2. Rosuvastatin 20-40 mg
What does high-intensity statin mean?
Lowers LDL-C by approx. >50%
List 5 moderate intensity statins.
1. Atorvastatin 10-20 mg
2. Rosuvastatin 5-10 mg
3. Simvastatin 20-40 mg
4. Lovastatin 40 mg
5. Pravastatin 40-80 mg
What is the first line therapy for lowering triglycerides?
What does red thrombus mainly contain?
Red blood cells
What does a white thrombus mainly contain?
platelets and fibrin, indication of myocardial infarction
True or False - Anticoagulants break down clots?
What is the only clotting factor in the extrinsic pathway?
What is plasminogen?
If a clot forms in the legs where will it go to?
If a clot forms in the heart where will it go to?
How many pulmonary veins are there?
Atrial fibrillation is associated with what risk?
If someone has a CHA2DS2VASc score of 2 or higher what do they need?
Which one is not a P2Y12 inhibitor?
A. Plavix Clopidogrel
B. Effient Prasugrel
C. Brilinta Ticagrelor
D. Savaysa Edoxaban
Shmegal Hobbitsees is a 56 year-old male that comes to your pharmacy asking about aspirin therapy. He has no significant past medical history. What should you tell him?
A. This is a great option for treating aches and pains
B. You shoul be taking an aspirin after the age of 50 to prevent a heart attack.
C. Baby aspirin would not be indicated for you at this time
D. My precious...
How many days does it take warfarin to take an effect?
What class of medications end in xaban?
Xa inhibitors (anticoagulants)
Lovenox (Enoxaparin) is used primarily for?
DVTs and patients that are unable to tolerate DOACs (direct oral anticoagulants).
Which anticoagulant medication can be measured to see if patient is compliant or not?
Which clotting factors does warfarin act on?
2,7,9,10 with II and X being the most important.
How much should you decrease the warfarin dose if the patient is already on warfarin and is prescribed Amiodarone?
What is the goal for INR levels?
Hydrochlorothiazide is what drug class?
What is the goal blood pressure in a patient with diabetes?
Explain what angina is?
Chest pain heart pain
Name a medication that causes bradycardia
Diltiazem, Verapamil, Carvedilol,
What is the role of ARBs in HF?
A. Main therapy in the black population
B. To replace ACE-I if the pt is intolerant
C. To be used in combination with ACE-I
What beta blocker is B1 selective and has vasodilitory effects mediated through NO?
What is a non-selective beta-blocker?
What is a B1 selective beta-blocker?
Which anti-hypertenzive drug come in a patch and tablets and should not be stopped suddenly for fear of rebound hypertension?
Which drug can cause gynecomastia due to its anti-androgen effects?
Name a side effect of nitrates that a patient should be educated on.
Can cause life-threatening hypotension, dizziness
Explain what the heart looks like in HFrEF
Saggy baggy <40%
Explain what the heart looks like in HFpEF
Thick hypertrophy >40%
Which of the following is used to lower bp and to treat BPH
What is the predominant adverse effect associated with ACE inhibitors?
Dry unproductive cough, angioedema
What is the brand name of Carvedilol?
HCTZ has which of the following effects?
A. Increase potassium
B. Decrease sodium
C. Increase uric acid
Felodipine is what type of CCB?
Which of the following is an aldosterone antagonist?
A. Losartan (Cozar)
B. Eplerone (Inspira
C. Lisinopril (Zestril)
D. Atenolol (Tenormin)
What lifestyle changes would you recommend for a patient with hyperlipidemia? high LDL
exercise 3-5 x weeks 30 minutes, decrease alcohol intake, smoking cessation, increase fiber, decrease weight
What is the first line therapy for high LDL?
What is the add-on therapy for patients who need additional LDL lowering?
What statins and doses are considered to be high intensity statins?
Atorvastatin 40-80 mg
Rosuvastatin 20-40 mg
What statins and doses are considered to be moderate intensity statins?
Lovastatin 40 mg
Simvastatin 20-40 mg
Pravastatin 40-80 mg
Atorvastatin 20-40 mg
What is a common side effect of statins?
Muscle pain, headache, nausea
What statins can be taken at any time during the day?
What baseline labs should be checked before a patient starts statin therapy?
What labs should be checked 4-6 weeks after the patient has started statin therapy?
What is the main reason we treat hyperlipidemia LDL?
To prevent adverse heart events
What is the first line therapy for patients with hypertriglyceridemia?
Which of the following anticoagulant agents requires 5-10 days of parenteral anticoagulation prior to starting?
A. and also edoxaban
Which is considered an endogenous anticoagulant?
Protein C and protein S
At what INR would you consider using vitamin K to reverse the effects of warfarin?
Which anticoagulant can cause dyspepsia?
Brand name of Fondaparinux?
What should you tell a patient about in regards to warfarin therapy and leafy green vegetables?
Be consistent on diet
What would be the correct subcutaneous prophylactic dose of enoxaparin in a patient with normal kidney function?
30 mg BID
What drug class is enoxaparin?
Low molecular weight heparin
Which anticoagulant has been shown to be superior for reduction of stroke risk, decreased major bleeds, decreased intracranial bleeds, and noninferior for GI bleeds when compared to warfarin?
What is the brand name of Betrixaban?
What is the reversal agent for unfractionated heparin?
BW is a 68 yr female that was recently started on Aggrenox, how should this medication be taken in regards to food?
1-hour prior to eating
What is the reversal agent for warfarin?
What are the best drugs for lowering LDL levels?
What is Ezetimibe (Zetia) used for?
Lowering LDLs (Add on to statins or statin intolerance)
What are bile acid sequestrants used for?
Lowering LDL levels but can raise triglycerides
What is Niacin used for?
Best drug for raising HDL, can be used to lower triglycerides, and helps lower LDL
What are fibrates used for?
Best used to lower triglycerides, and can raise HDL
What is fish oil used for? (Omega 3)
Used to lower triglycerides
Why should a patient be on a high-intensity statin?
Anyone with ASCVD
What is the Atorvastatin dose for high-intensity statin therapy?
What is the Rosuvastatin high-intensity statin dose?
20-40 mg *think of Atorvastatin's and half that.
What is the Atorvastatin moderate intensity statin dose?
10-20 mg *think of Rosuvastatin's high dose and half of that
What is the Rosuvastatin moderate intensity statin dose?
5-10 mg *think of Atorvastatin's moderate intensity dose and half of that.
What is the Simvastatin moderate intensity statin does?
What is the Lovastatin moderate intensity statin dose?
What is the Pravastatin moderate intensity dose?
What statin should be taken with food?
Is grapefruit juice safe to drink with most statins?
What are the common ADRs of statins?
2. GI upset
3. Myopathy (less common)
New onset diabetes
Should we give a statin to a person that is pregnant?
What do you want to monitor for statin patients?
1. Fasting lipid panel
2. Liver function test
3. Fasting blood sugars
4. Creatinine kinase
How does Ezetimibe work for lowering cholesterol?
Inhibits cholesterol transporter in the intestinal wall
What are the common side effects in Ezetimibe?
Colesevelam is what kind of medication?
Bile acid sequestrant
Should Colesevelam be taken with no food?
What are the common side effects to bile acid sequestrants?
If a patient has normal triglycerides should they continue to take fibrates?
No, take it off the med list.
An antiplatelet works by
Preventing activation, adhesion, or aggregation of platelets
What is the only kind of medication that will break up a clot?
What are the antiplatelet agents?
Aspirin, Clopidogrel, Prasugrel, Ticagrelor, Abciximab,
What are the P2Y12 inhibitors?
What is the correct loading dose for clopidogrel during a PCI?
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