Antianginal Drugs

Antianginal Drugs

• Prinzmetal angina is the clinical term used to describe angina caused by coronary vasospasm
• Immediate-release nifedipine is not useful for managing stable angina in a patient with coronary artery disease
• A patient presenting with chest tightness and pressure increasing in severity and frequency while on atenolol, lisinopril, and nitroglycerin should be referred to the nearest emergency room for evaluation.
• Amlodipine is best to add to improve angina in a patient with asthma and vasospastic angina who gets chest pain with exertion and at rest, about ten times per week
• Edema is a side effect associated with amlodipine
• Diltiazem is a useful drug for the prophylaxis of angina of effort in patients experiencing more frequent attacks
• Ranolazine is the most appropriate addition to antianginal therapy for a patient experiencing uncontrolled angina attacks despite being adherent to a maximized dose of β-blocker with a low heart rate and low blood pressure
• The eventual goal is to stop diltiazem and change atenolol to bisoprolol for a 68-year-old male with a history of angina who had an MI last month and has heart failure with reduced ejection fraction
• Enalapril is safe to use in a patient taking ranolazine.
• If a patient's angina is previously well-controlled with once-daily isosorbide mononitrate but is occurring more frequently during early morning hours, continue once-daily administration but advise the patient to take this medication in the evening
• A common direct or reflex effect of nitroglycerin includes an increased cardiac force
• A common effect that may occur due to the mechanism of nitroglycerin is a headache due to meningeal vasodilation
• Nitroglycerin sublingual tablets or spray should be prescribed to all anginal patients to treat an acute attack
• Block of exercise-induced tachycardia is the most probable mechanism of action in angina if a β blocker is used for prophylaxis in a patient treated with nitroglycerin.
• Orthostatic hypotension is an adverse effect that nitroglycerin and prazosin have in common
• Isosorbide dinitrate is a drug that often causes tachycardia
• Nitroglycerin is relatively contraindicated because of migraines in a 45-year-old woman with hyperlipidemia and frequent migraine headaches who develops angina of effort
• Calcium channel blockers and β blockers taken together result in additive effects on cardiac force in patients with angina
• Sildenafil interacts with nitroglycerin by inhibiting the metabolism of cGMP causing potentially severe hypotension

Antiarrhythmics

• Metoprolol should be used to prevent life-threatening arrythmias that can occur post-myocardial infarction
• Isosorbide mononitrate is most likely to cause methemoglobinemia which is marked shortness of breath, and hypotension.
• Suppression of arrhythmias resulting from a reentry focus is most likely to occur if the drug converts a unidirectional block to a bidirectional block
• Disopyramide is most likely the antiarrhythmic being taken when a 57-year-old man who is being treated for an atrial arrhythmia complains of dry mouth, blurred vision, and urinary hesitancy
• Mexiletine is the likely cause of feeling severe upset stomach and heartburn for a 58-year-old woman being treated for chronic suppression of a ventricular arrhythmia after 1 week of therapy
• Metoprolol is appropriate to initiate for rate control as an outpatient for a 78-year-old woman who has been newly diagnosed with atrial fibrillation
• Sodium lactate should be given immediately if a 76-year-old patient with rheumatoid arthritis and chronic heart disease takes an overdose and manifest acute procainamide toxicity with markedly prolonged QRS
• Cinchonism is not considered an adverse effect of amiodarone
• Ventricular tachycardia can be treated with Lidocaine
• Hypertension is a coexisting conditon that allows for initiation of flecainide for rhythm control of atrial fibrillation
• Dronedarone increases the risk of death in patients with permanent atrial fibrillation or symptomatic heart failure
• Hyperkalemia should be avoided to reduce the likelihood of procainamide toxicity in a 76-year-old patient with rheumatoid arthritis and chronic heart disease who is already receiving digoxin, hydrochlorothiazide, and potassium
• Digoxin levels of 1 to 2 ng/mL are desirable in the treatment of atrial fibrillation
• When used as an antiarrhythmic drug, lidocaine typically reduces abnormal automaticity
• Metoprolol should be used to to prevent life-threatening arrhythmias that can occur post-myocardial infarction . - Esmolol is most suitable for a 36-year-old woman with a history of poorly controlled thyrotoxicosis
• Adenosine is the antiarrhythmic of choice in most cases of acute AV nodal tachycardia . - Verapamil is paired with an increased PR interval ECG effect when considering an overdose of antiarrhythmic drug for a 55-year-old
• Lidocaine should be immediately given to a 60-year-old man who comes to the emergency department with severe chest pain. ECG reveals ventricular tachycardia with occasional normal sinus beats
• Diltiazem slows conduction through the AV node and has its primary action directly on L-type calcium channels
• Amiodarone has the longest half-life of all antiarrhythmic drugs

Drugs Affecting Coagulation

• Ticagrelor is a P2Y12 ADP receptor antagonists and reversibly binds the receptor
• Clopidogrel is less likely to cause neutropenia relative to ticlopidine.
• Sulfamethoxazole/trimethoprim will increase the anticoagulant effect of warfarin
• Heart failure with reduced ejection fraction is a disease state in which cilostazol is contraindicated
• Heparin must bind to antithrombin III in order to exert its anticoagulant effect
• Alteplase is considered "fibrin selective" because it rapidly activates plasminogen bound to fibrin
• Hemorrhagic stroke is the most likely adverse drug effect to occur when a fibrinolytic drug is used to treat acute myocardial infarction in a 58-year-old woman with a history of poorly controlled mild hypertension and elevated blood cholesterol.
• Protamine sulfate is most appropriate for reversing the anticoagulant effects of heparin
• The effects of Vitamin K on INR will be noted at 24 hours
• An ACE inhibitor may have increased the risk of developing orolingual angioedema in a 58-year-old man receiving intravenous alteplase treatment for acute stroke
• Reteplase accelerates the conversion of plasminogen to plasmin when attempting to open an occluded artery in a patient with confirmed MI
• Dabigatran is not approved for treatment of a 56 year old man that presents to the ER with complaints of swelling, redness, and pain in his right leg, diagnosed with acute DVT and requires treatment w/ an anticoagulant.
• Alteplase is most likely to improve a 65-year-old man presenting to the emergency dep’t 30 min after onset of stroke (difficulty speaking). Imaging studies ruled out cerebral hemorrhage.
• The recurrence of symptoms of stroke can be treated indefinitely with Warfarin
• Clopidogrel is less likely to cause neutropenia relative to ticlopidine in pt with acute cerebral symptoms, but can not tolerate alteplase.
• Enoxaparin can be used without monitoring the patient's aPTT and has a shorter duration of action in a woman with pain in her left thigh. Duplex ultrasonography indicates the presence of DVT in the affected limb
• Oral vitamin K1 is given to a woman that presents with pain in her left thigh, has DVT and and INR at 7.0. To prevent hemorrhage, the warfarin should be discontinued.
• For severe thrombocytopenia, Lepirudin will be used to avoid unfractionated heparin

Antihypertension

• Enalapril is most likely responsible for a persistent, dry cough.
• Prazosin may cause reflex tachycardia and/or postural hypotension on initial administration.
• Clonidine can precipitate a hypertensive crisis following abrupt cessation of therapy.
• Metoprolol is likely causing being unable to achieve an erection in hypertensive patient being treated with thiazide diuretic for the last 5 years. Over the last 3 months, his diastolic has steadily increased
• Lisinopril and hydrochlorothiazide is a good choice for initial hypertension in a 40-year-old with pressure readings of 163/102 and 165/100 and also diabetic.
• All of the following would be next steps to treat hypertension, except ADD on an ARB.
• Losartan is most responsible for elevated serum potassium when hypertension regimen was modified.
• Felodipine is most likely to cause swelling of the feet that started shortly after treatment Peripheral edema.
• Hydralazine is appropriate during pregnancy
• Lisinopril should be prescribed in combo with a thiazide diuretic for a 50yo with diagnosed HTN
• Captopril is most likely to be contraindicated in pregnancy
• Minoxidil increases the heart rate in a dose dependent manner in a patient admitted to the ER with severe tachycardia after drug overdose.
• Competitively blocks angiotension II concentration in the blood of Essential HTN.
• Alpha receptor blockers most likely will cause postural hypotension and increase risk of falls in elderly
• Incessant cough is manifestation in significant # patients treated with ACE inhibitors
• Fetal damage occurs during pregnancy.
• B is to receive a calcium channel blocker, Verapamil in associated with increased PR interval.
• Prazosin with atenolol shows to increase sympathetic outflow from the CNS
• Nitroprusside is very short acting and acts by releasing nitric oxide

Diuretics

• Furosemide helps pts with pulmonary edema from heart disease

• Acetozolamide helps with mountain climbing

• An alcoholic develops hepatic cirrhosis use Spironolactone . - Hydrochlorothiazide helps patient with kidney stones

• A thiazide responds well to HTN but indicates low of potassium

• Spironolactone is contraindicated in hyperkalemia

• Hydroclorthiazide is causes enlarged breasts in males and causes pain

• Mannitol is the best diuretic to treat increased intracranial pressure from patients with extreme headaches Spironolactone shows to improve blood pressure in resistant hypertension

• A 50-year-old man needs chlorothiazide because history of renal stones

• Long term diuretic use leads to chronic Ototoxicity

• Furosemide plus saline infusion treats hypercalcemia . - Acetazolamide is for glaucoma pt with hyperchloremic metabolic acidosis

Heart Failure

• I-38-year-old has edema,Furosemide=1st line
• 15.An 82-year-old woman has long-standing heat failure; Spironolactone
• Digoxin antibody-Digoxin overdose Carvedilol has shown to prolong heart failure in spite of having neg. inotropic effect on cardiac contractility
• Which drug may heart failure -Ibuprofen
• ACE inhibitors reduce preload = Action of ACE inhibitors on the failing heart
• Losartan - Losartan has an active metabolite
• Betal-blockers improve- By decreasing cardiac remodeling
• increase renin release- by activating norepinephrine- 76 correct A. HFrEF- hydrochlorothiazide, lisinopril, change metoprolol tartrate-metoprolol succinate . correct. D SC short breath. increased pitting edema 5 pound weight gain in last 2 days= Start with Lasix..Correct Spironolactone prevents - Prevents cardiac hypertrophy= B important is to monitor in patients taking digoxin= Potassium
• Increases cardiac contractility- correct answer-B.
• What is most commone adverse associated with fixed hydrozine/isomonitrate answer - C. best documented with cardiac glygosides -D incereased systolic cytoplasm Increased intracellular calcium -84 the answer - B. D Correct Tachycardia dig therapeutic Furosemide would best one with marked pulmonary Dobutamine -physlogically improtant inortopic effect

Hyperlipidemia

• Type I hyper lipoprotein has no drug therapy available. Correct answere =A.

• Lovastatin (inhibiting enzyme 3-hydroxy) correct Answer = D.

• Niaci correct bulding free facts acds

• C holestyramine prevents returns. Correct = c

• Simvistatin

• B Take, levothyroxine and take before

• A Administer aspirin ,3. Correct answere A. niacin,correct level Answer b = niacin.

• Which most increase patient, triglyndeide increase =

• Correct=b:Patients w/renal insufficienty 96 Increased HDL, - 96. The answer is C.

• Which a drug is likely, increase when cholesterol high? 17,

• B. Alanie and aspartase aniosiminotransaminase20) c correct: Decreased gastroabsorptionof cholesterol A. Decreased lipid syntheses 1A1)

Sedatives

• All benzodiazepines have some sedative effects.
• Triazolam is a short acting hypnotic
• Phenobarbital induces respiratory depression, enhanced by consumption of ethanol.
• Lorazepam is for for alcohol withdrawl symptoms
• Zaleplon short acting hynotic, sleep induction compared to maintaince. Correct C.
• Loraazepam has rapid anxiolytic effect. Answe = C.
• Rameon on melatonin, receptroagonis :Doxepin

Antisizures meds

• A. Absence; A 9 yr old boy
• A Child with absence= 9 yearold . A. Ethosumide
• Which best used? D. Lamotrigine
• B considerar lamotrigine, consider beocming pregnant
• . Correct C: Lamogingrine concentrations decrerasing :.Correct answer = B. Fica complex partial
• B bexetiracan: complex partial with breakthrough

Parkinson Medication

• A correct combination: Levodopa, carbidopa, or entacaponew
• C. Carbidopa, peripheral effects diminished by includding A Bromocriptin

Alzheimer's

• Modest memory w/ drugs
• C Dopaenrgeric
• D Memantine a gluatame and esterase
• A RIVASTIGMINE Patch

Antiimicrobials

• D Riluzole. 7. correct D. C: Teriflunomide. 1.Correct answer - B- Morphine 2 Answer correct C- Hydrocodone

Cell wall inhibitors

• C: Dantomyen- Outpatient treat staph D: RHABDMYOLYSIS- daptomycin- adverse effect
• 101- A correct vancomycin+cefaphine 102 B corrects Piperacilb/tazobactam
• C Aztreonam is correct of beta lactams. 103 104 A is is drug choice beznathine

Meningitis

• C cefetoxine- bext dxrug 106 A correct cefoxition

107. Is not a canidate for Telavinic correct. 108 An 1-y/o with faealis? D. Amoxicillin =correct

• 109 Which is primaary correct D: Tobramycin is correct amoxicillin= correct

A .correct mod B.correct line zolid A-gentamicin long A peniclilin G requires C. erythromycin correct B Correct

• B: Clorampenical is cause of anema in children

D doxyciribin correct D C correct. C B correc b

This lesson covers antianginal drugs, including their uses and side effects. It discusses Prinzmetal angina, nifedipine, atenolol, amlodipine, diltiazem, and ranolazine. It emphasizes referring patients with worsening symptoms to the emergency room.