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DCPA Cardio Pharm
| Question | Answer |
|---|---|
| Thrombolytics | "Clot Busters"Promote conversion of plasminogen to plasmin (lyse fibrin clots).ST elevated MI's (PTCI unavailable)4(best)-12 hours from onset |
| Thrombolytic drugs | Streptokinase (Streptase)Reteplase (r-PA, Retevase)Alteplase (t-PA, Activase)Tenecteplase (TKNase) |
| Streptokinase | Streptase |
| Streptokinase (streptase) contraindications | Avoid in patients with recent streptococcal infection or prior use of this drug |
| Reteplase | r-PA, Retevase |
| Alteplase | t-PA, Activase |
| Alteplase (t-PA, Activase)half life | Short - must use with heparin to prevent reocclusion |
| Alteplase (t-PA, Activase)benefits | Best for anterior (LAD) MI'sMore fibrin specific than r-PA |
| Tenecteplase | TKNase |
| Tenecteplase (TKNase) fibrin specificity | More fibrin specific than Alteplase |
| Fibrin specific | Affect fibrin bound plasminogen more than circulating plasminogen (more effective with less bleeding) |
| Thrombolytic contraindications | Hemorrhagic CVASurgery with last 2 weeksBleeding disordersAortic Aneurysm/dissectionUncontrolled hypertension (170/120)Endocarditis/pericarditisLV/LA thrombusPregnancyChest compressions last > 10 minutesDiabetic retinopathy |
| Thrombolytic reperfusion | Bradyarrhythmia, PVC's or non-sustained VT |
| Aspirin (Acetylsalicyclic Acid) | Inactivates cyclo-oxygenase (platelets life - 7 days)Prevents thromboxane A2 (vasoconstriction) formation |
| Acetylsalicyclic Acid | Aspirin |
| Acetylsalicyclic Acid (Aspirin)dosing | 81mg- low adult dose325mg |
| Acetylsalicyclic Acid (Aspirin) indications | Stable & unstable anginaMIPost CABG/PTCIAFIB (when coumadin is contraindicated) |
| Acetylsalicyclic Acid (Aspirin)side effects | GI problemsDecreases effectivness of ACE-I (low dose ASA)High dose = inhibits endothelial prostacyclin |
| Acetylsalicyclic Acid (Aspirin)contraindications | Allergy/intoleranceHemophilia/bleeding disorders |
| Clopidogrel | Plavix |
| Clopidogrel (Plavix) dose | 75mg PO QD |
| Clopidogrel (Plavix) indications | Atherosclerotic events (with aspirin)Coronary stents |
| Clopidogrel (Plavix) side effects | GI disturbancesCan't do surgery while on plavix |
| Glycoprotein 2b/3a inhibitors | Most potent antiplatelet agent |
| Glycoprotein 2b/3a inhibitor indication | Given IV during PTCIUnstable angina (resistant to nitroglyceride)Acute MI |
| Glycoprotein 2b/3a inhibitor drugs | Abciximab (Rheopro)Eptifibatide (Integrilin)Tirofiban (Aggrastat) |
| Abciximab | Rheopro |
| Eptifibatide | Integrilin |
| Tirofiban | Aggrastat |
| Heparin | Intrinsic PathwayIV or subcutaneous (DVT)Binds to Antithrombin III & Thrombin (prevents platelet aggregation)Short half-life (lab monitoring) |
| Heparin Indication | Acute MI with t-PAPost MIUnstable angina with aspirinDVTPEAFIB (until coumadin reaches therapeutic INR)Pregnancy |
| Heparin dosing | 5000 units BID adjusted based on PTT (should be 2x baselevel) |
| Heparin side effects | HemorrhageThrombocytopenia (HIT)Osteoporosis |
| Protamine Sulfate | Heparin antidote |
| Low Molecular Weight Heparin | SQCostlyNo lab monitoringOutpatient care |
| Low Molecular Weight Heparin drugs | Enoxaparin (Lovenox)Dalteparin (Fragmin)Tinzaparin (Innohep) |
| Tinzaparin | Innohep |
| Dalteparin | Fragmin |
| Enoxaparin | Lovenox |
| Enoxaparin (Lovenox) dose | 1mg/kg SC Q 12 hours during acute MI3x/day Post MI |
| Warfain | Coumadin |
| Warfarin (Coumadin) | Extrinsic PathwayInterferes with Vitamin K |
| Warfarin (Coumadin)Indications | DVT, PE, Apical akinesis,Significantly impaired EF, AFIB/flutter, Prosthetic/mechanical heart vlaves |
| Warfarin (Coumadin)dosing | 5mg PO QHS(every day) x 3 daysAdjusted by PT/INR (checked weekly) |
| INR values | 2.0-3.02.5-3.5 (mechanical heart valves) |
| Warfarin (Coumadin)DI | Too many[Vitamin K] (high) = increase dose of warfarin |
| Warfarin (Coumadin)side effects | Skin necrosisBleeding |
| Warfarin (Coumadin)contraindications | PregnancyBleeding disordersPatients with history of fallsNoncompliant patients |
| Warfain (Coumadin)overdose treatment | Withhold Warfain (Coumadin)Vitamin KFresh frozen plasma |
| Cholesterol | Cell wall membranesFormation of steroid hormonesVitamin D synthasisComponent of bile acidsEntire nervous system |
| Triglycerides | 3 fatty acids held by a glycerolLong term storage (adipose tissue) |
| Apoprotein | Covers lipid to transport it via bloodstream |
| Lipoprotein profile | 9-12 hour fast |
| LDL optimal value | 70-80 (Comorbidity) or <100 |
| LDL Near/above optimal value | 100-129 |
| LDL Borderline High value | 130-159 |
| LDL High Value | 160-189 |
| LDL Very High Value | >190 |
| Total cholesterol Borderline High Value | 200-239 |
| Total cholesterol high value | >240 |
| Low HDL value | <40 |
| High HDL value | >60 |
| High risk for CAD | Clinical CADSymptomatic carotid artery disease (TIA)Peripheral artery diseaseAbdominal aortic aneurysmDM |
| Risk factors for CAD | SmokingHypertension (140/90)AntihypertensivesFamily historyMen>45Women>55 |
| LDL Goal with >20% CAD risk | <100 (70-80) |
| LDL Goal with <20% CAD risk | <130 |
| LDL Goal with 0-1 CAD risk factors | <160 |
| Saturated fat | <7% of calories |
| Diet to decrease LDL | Increase fiber (10-25)Plant Stanols/sterols (2) |
| Life style change to increase HDL | Exercise |
| Resins (Bile Acid Sequestrants) | Bind t bile acid Promote sterol excretion in the fecesDecreases LDLRaises HDL/Triglycerides |
| Bile Acid Sequestrants | Resins |
| Resins (Bile Acid Sequestrants)Drugs | Colestipol (Colestid)Cholestyramine (Questran)Cholesevalam (Welchol) |
| Cholesevalam | Welchol |
| Cholestyramine | Questran |
| Colestipol | Colestid |
| Cholestyramine (Questran)form | Powder (served chilled w/ juice) |
| Cholesevalam (Welchol)dose | 3 tablets BID |
| Resins (Bile Acid Sequestrants)Side Effects | GI distressConstipation (Take with metamucil)Decrease absorption of other drugs (>2 hours) |
| Resins (Bile Acid Sequestrants)Contraindications | Triglycerides > 400 |
| Nicotinic Acid | Reduce triglycerides & LDL (higher doses)Increased HDL (highest) |
| Nicotinic Acid Side effects | Flushing HyperglycemiaHyperuricemiaHepatotoxicity |
| Nicotinic Acid Contraindications | Chronic liver disease Severe Gout |
| Nicotinic Acid Drug | NiacinNiaspan (slow release) |
| Fibric Acids | Increase HDLReduce triglycerides |
| Fibric Acids side effects | Abnormal LFT's, Elevated CPK/myopathy (with statins), dyspepsia, abdominal pain |
| Fibric Acids contraindications | Several renal/hepatic disease |
| Fibric Acids drugs | Gemfibrozil (Lopid)Fenofibrate (Tricor) |
| Gemfibrozil | Lopid |
| Fenofibrate | Tricor |
| HMG CoA reductase inhibitors | Statin |
| HMG CoA reductase inhibitors (statin)drugs | Atorvastatin (Lipitor)Fluvastatin (Lescol)Lovastatin (Mevacor)Pravastatin (Pravachol)Simvastatin (Zocor)Rosuvastatin (Crestor) |
| HMG CoA reductase inhibitors (statin) benefits | Reduces LDL & Triglycerides, Increases HDL & stabilizes atherosclerotic places |
| HMG CoA reductase inhibitors (statins) side effects | GI disturbances, elevated LFT's (AST&ALT)-dose dependant (reversible), elevated CPK/myopathy |
| HMG CoA reductase inhibitors (statins) contraindications | Active liver disease (high alcohol consumption)PregnancyCytochrome P450 |
| Ezetimibe | Zetia |
| Ezetimibe (Zetia) | Brush border inhibitor (intestinal absorption) - reduces LDL |
| Ezetimibe (Zetia) Indications | Can be used alone or in combination with Statins |
| Hypertension | 135/85 |
| Hypertension Diagnosis | Three high readings over 6 week period (unless over 180 or with comorbidities) |
| Primary hypertension | unknown cause |
| Hypertension lifestyle modifications | Exercise, Weight loss, Sodium restriction, alcohol reduction |
| Blood pressure (equation) | CO(HR*EF[SV])x SVR |
| Hypertensin treatment & age | Young = lower COElderly = lower SVR |
| Diuretics purpose | Best in decreasing hypertension in blacks,Use for CHF/edema |
| Diuretic side effects | Hypokalemia/natremia, hyperuricemia/calcemia(thiazide), glucose intolerance, hypercholesteremia. |
| Thiazide Diuretics | Enhances efficiency of other anti-hypertensives |
| Beta 1 | Increase heart rate & contractility |
| Beta 2 | Dialates bronchi & arteries |
| Beta blockers cause | Decrease in renin, heart rate & force of contraction |
| Beta blocker indications | CAD/angina pectoris/MI, Tachyarrhythmia, PVC's/PAC's, dissectiong aortic aneurysms, perioperative cardioprotection, migraine, anxiety, hyperthyroidism, senile tremor. |
| Beta blocker contraindications | Overt CHF, severe bradycardia, 2nd or 3rd degree AV block, asthma, severe depression, DM (hypoglycemia), active peripheral artery disease. |
| Beta blocker side effects | Fatigue, nightmares, impotence, depression |
| Cardioselective Beta Blockers | Beta 1 blockers (less bronch/vasoconstriction & doesn't interfere with insulin therapy) |
| Cardioselective drugs | Atenolol (tenormin - low lipid solubility), Metoprolol (lopressor/toprol XL - medium lipid solubility) |
| Low lipid soluble beta blockers | Acebutolol (sectral), Atenolol (Tenormin), Nadolol (Corgard)) |
| Alpha-beta blockers | Block alpha 1 (vasodilation) |
| Alpha-beta drugs | Carvedilol (Coreg- high lipid solubility), Labetalol (normodyne/trandate- medium lipid solubility) |
| Medium lipid soluble beta blockers | Labetalol (normodyne/trandate), Metoprolol (Lopressor/Toprol XL) |
| High lipid soluble beta blockers | Carvedilol (Coreg), Proporanolol (inderal) |
| Beta blockers with ISA | Do not use in CAD or MI patients |
| Cardioselective & ISA drug | Acebutolol (sectral) |
| Low-medium lipid solubility | Bisoprolol (Ziac) |
| Acebutolol | Sectral |
| Atenolol | Tenormin |
| Bisoprolol | Ziac |
| Carvedilol | Coreg |
| Labetalol | Normodyne/Trandate |
| Metoprolol | Lopressor/Toprol XL |
| Nadolol | Cogard |
| Proporanolol | Inderal |
| Regular beta blockers | Bisprolol (Ziac - low/medium lipid solubility), Nadolol (Corgard), Proporanolol (Inderal) |
| Calcium channel blockers | Decreases peripheral resistance (less Calcium),Types: dihydropyridines & non-dihydropyridines |
| Calcium channel blocker indications | Elderly (Increase peripheral resistance) & asthma patients with CAD |
| Calcium channel blocker contraindication | CHF except amlodypine (Norvasc) |
| Calcium channel blocker side effects | peripheral edema, constipation, headache, flushing & palpations |
| Dihydropyridines | Pure vasodilators (use with beta blockers b/c of rebund tachycardia) except amlodipine |
| Dihydropyridine drugs | Nifedipine (Adalat CC, Procardia XL), Amlodipines (Norvasc), Felodipine (Plendil), Isradipine (Dynacirc), Nicardipine (Cardene) |
| Non-Dihydropyridines | Vasodilate, negative chronotrope & inotrope |
| Non-Dihydropyridine indictaions | Hypertension & atrial tachyarrhythmias |
| Non-Dihydropyridines contraindications | 2nd & 3rd AV block |
| Non-Dihydropyridine drugs | Dilatiazem (Cardizem, Cartia, Dilacor, Tiazac) & Verapamil (Calan, Isoptin, Verelan, Covera) |
| ACE Inhibitor & ARB contraindications | Pregnancy (2nd & 3rd trimester), renal artery stenosis, hyperkalemia |
| ACE Inhibitor & ARB side effects | Angioedemia with initial dose |
| ACE Inhibitor indications | Diabetes (slows neuropathy), CHF (prolongs life), Post MI (reduces mortality), mitral regurgitation (afterload producttion = promotes forward flow) |
| ACE Inhibitor Drugs | Benazepril (Lotensin), Captopril (Capoten), Enalapril (Vasotec), Fosinopril (Monapril), Lisinopril (Prinivil, Zestril), Moexepril (univasc), Perindopril (Aceon), Quinapril (Accupril), Ramipril (Altace), Trandolapril (Mavik) |
| Benazepril | Lotensin |
| Captopril | Capoten |
| Enalapril | Vasotec |
| Fosinopril | Monapril |
| Lisinopril | Prinivil, Zestril |
| Moexepril | univasc |
| Perindopril | Aceon |
| Quinapril | Accupril |
| Ramipril | Altace |
| Trandolapril | Mavik |
| ARB Drugs | Candesartan (Atcand), Eprosartan (Teveen), Irbesartan (Avapro), Losartan (Cozaar), Telmisartan (Micardis), Valsartan (Diovan) |
| Alpha-1 blockers | Arterial & venous dilation |
| Alpha-1 blocker indications | Benign prostatic hypertrophy & Raises HDL |
| Alpha-1 blocker side effects | 1st dose syncope/hypotension, nasal congestion, headache, depression |
| Alpha-1 blocker drugs | Doxazosin (Cardura), Prazosin (Minipres), Terazosin (Hytrin) |
| Doxazosin | Cardura |
| Prazosin | Minipres |
| Terazosin | Hytrin |
| Central Alpha Agonists | Decrease vasoconstriction |
| Central Alpha Agonsit side effects | sedation & extreme dry mouth |
| Central alpha agonist drugs | Clonidine (Catapres) & Methyldopa (Aldomet) |
| Clonidine | Catapres |
| Methyldopa | Aldomet |
| Clondine (Catapres) | Pill/patch, abrupt discontinuation = rebound hypertension |
| Methyldopa (Aldomet) Indications | Hypertension & Pregnancy |
| Direct Renin Inhibitors | Aliskiren (Tecturna) |
| Aliskiren | Tecturna |
| Nonpharmacologic Treatment for CHF | Avoid fatigue, sodium & fluid (1500cc/day) restirction, surgery/transplant, biventricular pacing |
| Royal flush | Thiazide Diuretic (Zaroxalyn) one hour prior to loop diuretic (Furosemide) |
| Potassium sparing diuretics (Spiranolactone-Aldactone) | Chronic CHF management - not useful in acute setting |
| Natrecor (Nesiritide) | Recombinant form of human B-type natriuretic peptide (hBNP)IV for CHF |
| Natrecor | Nesiritide |
| Nitrate | Venous pooling - endothelial relaxation factor (best for ischemic heart disease) |
| Nitrate side effects | Hypotension, flushing, headaches (transient). Tolerance = must have nitrate free period everyday |
| Digoxin | Positive inotrope/negative chronotrope, improves EF 15% |
| Digoxin indications | CHF for atrial tachycardias (Works @ AV node) |
| Digoxin contraindications | HOCM, WPW syndrome, 2nd & 3rd degree AV block |
| Digoxin dosing | 1-2mg divided over a 24 hour period |
| Digoxin Toxicity | Nausea, anorexia, colored vision, confusion, arrhythmias |
| Digibind | Antedot of Digoxin |
| IV Dobutamine (Levophed) | Beta 1 & 2 agonist (increase contraction & heart rate) |
| Dobutamine | Levophed |
| Dobutamine (Levophed) indication | CHF with low EF |
| Dobutamine (Levophed) contraindications | HOCM & Tachycardia |
| Dopamine | acts on Beta 1 & 2, alpha receptors (varying effects depending on dose)& can use in combination with Dobutamine |
| Dopamine low dose (Renal) | Vasodilation of renal arteries |
| Dopamine high dose | Vasoconstriction (hypotension) |
| Dopamine contraindications | Pheochromocytoma, MAO-Inhibitors & Tachycardia |
| Phosphodiesterase Inhibitors | Increases CAMP (increases contraction & pulmonary vasodilation) |
| Phosphodiesterase Inhibitor indications | Patients no longer responding to beta blockers |
| Phosphodiesterase Inhibitor drugs | Amrinone IVMilrinone (20x more potent) |
| Phosphodiesterase Inhibitor side effect | Thrombocytopenia |
| Hydralazine | Vasodilation |
| Hydralazine indication | Use in patients that can't take ACEI/ARBs (hyperkalemia, pregnancy, renal failure) |
| Hydralazine contrindications | Reflex tachycardia (Don't use in ischemic pateints) |
| Hydralazine side effects | Lupus syndrome, hypotension, polyneuropathy |
| Carvedilol (Coreg) dose | Start: 3.125 mg PO BID - 25 mg PO BID |
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