CPJE 2023 Clinical: Cardiovascular PDF

CPJE 2023 Clinical: Cardiovascular Study CPJE 2023 Clinical: Cardiovascular 8 studiers today Leave the first rating Students also viewed CPJE Brand/Generics/indication (up... 714 terms CPJE 2023 Brand-Generics Kinesiology final study guide 667 terms Raka_M Preview Vaccines 42 terms shabi...

CPJE 2023 Clinical: Cardiovascular Study CPJE 2023 Clinical: Cardiovascular 8 studiers today Leave the first rating Students also viewed CPJE Brand/Generics/indication (up... 714 terms CPJE 2023 Brand-Generics Kinesiology final study guide 667 terms Raka_M Preview Vaccines 42 terms shabibi16 Preview emileegracezuker123 52 terms Preview Terms in this set (96) TG^^^ Constipation; Cramping Side effects of BAS Other: stomach pain, bloating, farting Most of GI issues can be reduced by drinking lots of water and fiber Which niacin product is: Best tolerated = ER (NIASPAN) - best tolerate Most flushing = IR (NIACOR) - most flushing Most hepaottoxic: SR/CR (SLO-NIACIN) -most hepatotoxic Which fenofibrate brand names need to be taken w/ Fenoglide meals? Lipofen Which BAS product has NO DDI? At what dose does niacin cause risk for rhabdo? Colesevelam (WELCHOL) > or = 1 gram/day or if used with statin Cholestyramine (Prevalite, Questran) Which BAS product can cause tooth problems? tooth discoloration, enamel erosion, or tooth decay Which BAS product is C/I in bowel obstructino? Colesevelam (Welcol) ACEi: 36 hour washout When starting entresto, how to wash out ACE/ARB? ARB: no washout needed Long acting nitrates require _____ hours of drug-free interval 10-12 hours to avoid tolerance which Class 3 anti-arrhythmics should be avoided in patients w/ HF? Sotalol Dronedarone (only in patients w/ episode of ADHF) Samlenn11 which Class 1 anti-arrhythmics should be avoided in CPJE 2023 Clinical: Cardiovascular 1C: Flecainide & Propafenone patients w/ HF? Lipid Emulsion What are unique side effects of clevedipine ^^^^TG High infection risk (max time after puncture = 12 hours) STATIN: **** the LIGHT Which statins should be taken at night? Simvastatin Fluvastatin Lovastatin Simvastatin & Lovastatin: Max dose w/ Amiodarone Simvastatin & Lovastatin: Max dose w/ Amlodipine Simva: 20mg Lova: 40mg Simva: 20mg Lova: no interaction Very strong interaction Simvastatin & Lovastatin: Max dose with non-DHP CCB Simva: 10mg Lova: 20mg Moderate Intensity Statin: Atorva 10-20 Rosu 5-10 Atorva -------------------------------------------------------------- Rosu Prava 40-80 -------------------------------------------------------------- Fluva 40 BID Prava Lova 40 Fluva Simva 20-40 Lova Pita 2-4 Simva Pita 10% Potassium Chloride: ____ meq/____mL Digoxin tpx range (HF vs AFIB) 10% KCl = 20 meq/15 ml HF: 0.5 - 0.9 AFIB: 0.5 - 2 CINCHONISM -Tinnitus Describe quinidine overdose -Hearing Loss -Blurry vision -Delerium Which P2Y12 inhibitor is C/I in patients w/ hx of ICH? Which P2Y12 inhibitor is C/I in patients w/ hx of stroke/TIA How long to hold P2Y12 inhibitors prior to surgery Which anti-arrthymic causes metallic taste disturbance? Before giving alteplase for stroke, BP must be < Ticagrelor (brillinta) Prasugrel (Effient) Clopigorel/Ticagrelor = 5 days Prasugrel = 7 days Propafenone (Class 1C) <185/110 CPJE 2023 Clinical: Cardiovascular Beta Blockers (reflex tachy) Which HTN drugs should NOT be stopped abruptly? Clonidine/Guanfacine/Methyldopa (reflex HTN) Which beta blockers need to be WITH FOOD? All metoprolol products All carvedilol products Coreg (IR) <85 kg = 25mg BID Target HF dose: Coreg > 85kg = 50mg BID Coreg (ER): 80mg daily Target HF Dose: Metoprolol Succinate Metoprolol Succinate: 200mg daily Target HF Dose: Bisoprolol Bisoprolol: 10mg daily Target HF dose: Captopril Captopril: 50mg TID Target HF dose Enalapril & Quinapril Target HF dose: Lisinopril & Ramipril Target HF dose: Losartan and Valsartan Enalapril: 20mg BID Quinapril: 20mg BID Lisinopril: 40mg daily Ramipril: 10mg daily Losartan: 150mg daily Valsartan: 160mg BID Quinidine & Mexiletene: take with food Class 1 antiarrhythmics: food recommendations: Disopyramide & Procainamide: Empty Stomach Quinidine: BBW Procanaimide: BBW Which Class 1A anti-arrthymics have anticholinergic Increased mortality Thrombocytopenia Agranulocytosis Long term use leads to ANA --> DILE Quinidine and disopyramidine properties (1) Amiodarone Which antiarrthymics need medguide? (Hint: 3) (2) Dronedarone (3) Dofetilide (TIKOSYN) Amiodarone: food recommendation Take with food and with lots of water (to avoid constipation) Thyroid What 3 major things to monitor with amiodarone? Liver Lungs Which antiarrthymics can only be initiated in the hospital Sotalol with continuous EKG monitoring? Dofetilide (3 days minimum) CPJE 2023 Clinical: Cardiovascular Dronedarone can cause failure of which organs? Liver (typically in first 6 months) --> true w/ amio too Lung (pulm fibrosis and pneumonitis) --> true w/ amio too Kidney (ARF) --> DOES NOT occur with amio **although does not effect thyroid function** Hyper and hypo thyroid (hypo more common) Vision impairment List the side effects associated with amiodarone Blue skin discoloration --> photosensitivity Peripheral neuropathy Hypotension/Bradycardia (more so with IV formula) Liver toxicity Lung toxicity What are the black box warnings with amiodarone? Thyroid toxicity (hyper/hypo) (does not cause renal toxicity like dronedarone) During ACS, it is recommended to use CHEWABLE aspirin. Chew it What if you only have EC? Anti-angina: First line is typically beta blockers which are Amlodipine only!!! contraindicated in Prinzmetal's angina. What is first line in this case? Which isosorbide mononitrate formulations are BID vs Ismo, Monoket (IR) --> BID dosing DAILY dosing? Imdur (ER) --> Daily dosing -Ismo -Monoket -Imdur Which isosorbide dinitrate formulations are BID/TID vs BID/DAILY dosing? -Isordil Isordil (IR) --> BID/TID Dilatrate (SR) --> BID/daily Note that dinitarate has extensive first past metabolism that mononitrate does not, which is -Dilatrate why the dosing is different QT prolongation Side effects w/ Ranolazine (Ranexa) Dizziness Constipation headache flushing Side effects with SL nitroglycerin? burning or stinging in mouth hypotension dizziness --> avoid alcohol Heart failure: what is preference, ACE, ARB vs ARNI? ARNI > ACE > ARB Fatigue/Dizziness Besides bradycardia, what are side effects of beta Depression blockers? Impotence/Erectile Dysfunction Weight gain Gynocomastia happens in 10% of men on spironolactone -> what is alternative in s/o heart failure? MRA option: Spironolactone or EPLRENONE CPJE 2023 Clinical: Cardiovascular What are side effects of BiDil? Headache DILE Dizziness Reflex tachy from hydralazine In general, what is the most common side effect of nitrates HEADACHES (short or long acting) that patients complain about? QT Prolongation (like ranexa) What are side effects of Ivabradine (CORLANOR) HR: Bradycardia add on therapy for HF BP: Hypertension phosphenes --> FLASHES OF LIGHT Ivabradine vs Ranolazine: indication? When would you consider adding Vericiguat (Verquvo) in Ivabradine: heart failure (reduced morbidity) Ranolazine: Angina Maxed out on other agents and high NP levels patients with heart failure? Which HF agent is very teratogenic and requires baseline Vericiguat (Verquvo) pregnancy test? Flecanaide and propefenone Sotalol and dronendarone (only if hx of ADHF) What agents are considered HARMFUL for patients with Pioglitazone and rosiglitazone HF? Saxagliptin and alogliptin !!!! NSAIDS !!!!! !!! non-DHP CCB !!! What are options for high potency statin? Which statins are HYDROPHILIC and thus have low risk of muscle issues? Atorva 40-80 Rosu 20-40 Rosuvastatin and Pravastatin (The rest of lipophillic) How can niacin impact BMP? Food recommendation with niacin formulations?: Increased uric acid (can cause gout) Increase blood glucose All niacin products are take with food (to reduce flushing) IR: Niacor ER: Niaspan CR/SR: Slo-Niacin Take ASA 325mg or ibuprofen 200mg (30-60 minutes before dose) Take with food How to avoid flushing after taking dose of niacin? Avoid spicy food, alcohol, hot beverage Avoid hot shower after dose Convert to ER Niaspan Which lipid-lowering drugs is associated with increased Niacin uric acid levels and gout attacks? Bempedoic acid Can niacin be used with statins? CPJE 2023 Clinical: Cardiovascular Which class of lipid-lowering drug needs medguide? Technically yes, but will have increased risk of myopathy. FENOFIBRATE! (gemfibrozil + fenofibrate) Renal disease When are fibrates contraindicated? Liver disease (including primary biliary cirhhosis) Gallbladder disease Gemfibrozil vs Fenofibrate: food recommendations Gemfibrozil vs Fenofibrate: myopathy risk Gemfibrozil: 30 minutes before breakfast and dinner Fenofibrate: FENOGLIDE and LIPOFEN only need to be taken with food All fibrates have myopathy risk, but it is very HIGH with gemfibrozil (do not use gemfibrozil with statins or ezetimibe) Statins Which lipid lowering drugs have risk for myopathy/rhabdo? Ezetimibe (okay to use w/ statins) Niacin (increased risk with statins) Fibrates (increased risk with statins, particularly gemfibrozil) Ethacrynic acid should not be used with which class of AMINOGLYCOSIDES (apparently EA will reduce effect???) antibiotics? What electrolyte profile do THZ and LOOP diuretics have Reduced: K, Na in common: Increased: glucose, uric acid, TG, Cholesterol Calcium! What electrolyte profile do THZ and LOOP diuretics differ? Thz: increased Ca Loop: decreased Ca Can K-sparing diuretics be used in pregnancy? ACE/ARB are contraindicated in what two populations K-sparing diuretics are CONTRAINDICATED if CrCL < ____ NO! Contraindicated! (1) pregnancy (2) Patients with B/L Renal Stenosis CrCL < 30 *Diabetes (use with caution) --> can mask hypo *Asthma/COPD (use with caution) --> use B1 selective beta blockers should be used with caution (or contraindicated) in what populations? *Raynauds (cold extremities) Contraindicated in: -Heart Block -HR < 60 Thiazide & Beta Blockers Which anti-HTN drugs can cause erectile dysfunction (More common w/ thiazides) CPJE 2023 Clinical: Cardiovascular DHP (amlodipine) -Reflex tachy -Headache What are side effect differences between DHP vs nonDHP CCB -Peripheral edema Non-DHP (Dilt, Verapamil) -Constipation (more w/ verapamil) Both can cause gingival hyperplasia, although more common with Non-DHP Which Nifedipine brand names products can leave ghost Adalat CC (Nifedipine) shell? ANTICHOLINERGIC -Dry mouth What are side effects of A2 agonists (clonidine, -Fatigue guanfacine, methyldopa)? -Dizzy/somnolent -constipation -Erectile dysfunction What is the effect on HR by A2 agonists (clonidine, bradycardia guanfacine, methyldopa)? First line = methyldopa and labetolol What are options for HTN treatment in pregnancy? Second line = Hydralazine, nifedipine, BB In patients post-MI, when should you consider adding LVEF < 40% ACEi/ARB? Thrombocytopenia What are side effects of G2B/3A blockers? Bleeding Hypotension Which G2B/3A blocker does NOT need renal dose Abciximab (REOPRO) --> its a mab :) adjustment Which G2B/3A blocker needs to be protected from light? Eptifibatide (Integrilin) Clopidogrel Which P2Y12 inhibitors are prodrugs? Prasugrel Ticlopidine Which P2Y12 inhibitor needs to be taken WITH FOOD? Ticlodipine What is unique side effect of ticlodipine? Risk of neutropenia and hematopoietic Which P2Y12 inhibitors need medguide? ALL OF THEM! Which HF drug can cause phosphenes (flashes of light)? Which Verapamil brand name can leave ghost shell? Ivabradine (Corlanor) Covera (Verapamil)