Phar 444 Exam #3

Front 1

is warfarin a prodrug?

Back 1

no

Front 2

a combination product that is only used for ischemic stroke prevention?

Back 2

aggrenox

25 mg instant release aspirin

200 mg extended release dipyridamole

Front 3

aspirin MOA?

Back 3

irreversible acetylation of serine #529 residue of COX

Front 4

constitutive activity, cytoprotective to GI tract, inhibits thromboxane A2 synthesis are characteristics of?

Back 4

COX-1

Front 5

inducible with inflammation describes?

Back 5

COX-2

Front 6

↓ gastric mucosal barrier, ↓ Prostaglandin Synthesis, ↓ Mucus/Bicarbonate Secretion, ↓ Gastric Cellular Energy, ↓ Submucosal Blood Flow, ↓ Mucosal ATP, ↓ Cell Turnover, ↓ Platelet Function (Irreversible via inhibition ofCOX-1) are all examples of?

Back 6

GI tract toxicity associated with aspirin use

Front 7

relationship between aspirin dose and admission for ulcer bleeding?

Back 7

proportional

Front 8

aspirin loading dose?

Back 8

160-365 mg/day

Front 9

aspirin maintenance dose?

Back 9

75-160 mg/day

Front 10

AHA/ACC aspirin recommendations?

Back 10

men only, diabetes, intermediate risk (>10%/10 years), no bleeding risk

Front 11

European Society of Cardiology aspirin recommendations?

Back 11

no aspirin

Front 12

primary aspirin intervention?

Back 12

75-160 mg/day

Front 13

dipyridamole

Back 13

oral antiplatelet

Front 14

sulfinpyrazone

Back 14

oral antiplatelet

Front 15

secondary aspirin intervention?

Back 15

160-365 mg stat. plain, chewed

Front 16

when is secondary aspirin intervention warranted?

Back 16

acute MI, ischemic stroke

Front 17

GI tract bleeding is a toxicity commonly related to which antiplatelet medication?

Back 17

aspirin

Front 18

two types of aspirin sensitivity?

Back 18

immune and non-immune

Front 19

aspirin risk for those 21 yo or less?

Back 19

Reye's syndrome

Front 20

aspirin's effect on the kidneys?

Back 20

nephropathy

Front 21

kidney issues associated with analgesics?

Back 21

papillary necrosis, decreased GFR

Front 22

rhinorrhea, nasal congestion, cough/wheezing, hives/rash/urticaria are all signs of?

Back 22

aspirin sensitivity

Front 23

asthmatics, those with nasal polyps (especially multiple), chronic urticariacs, those with angioedema, those who have had previous anaphylaxis due to any medication are all at increased risk for?

Back 23

aspirin hypersensitivity

Front 24

T/F: aspirin increases the incidence of CHD in high-risk adults?

Back 24

false, decreases

Front 25

T/F: aspirin increases the incidence of GI bleeding?

Back 25

true

Front 26

T/F: aspirin may increase the incidence of hemorrhagic strokes?

Back 26

true

Front 27

platelet therapy regimen for patients with acute coronary syndrome (unstable angina, NSTEMI, STEMI)?

Back 27

aspirin + 1 or more other antiplatelets

Front 28

platelet therapy regimen for patients with stents (bare metal, drug-eluting, biodegradable)?

Back 28

aspirin + 1 or more other antiplatelets

Front 29

ticlopidine

Back 29

1st gen antiplatelet

P2Y12 inhibitor

Front 30

clopidogrel

Back 30

2nd gen antiplatelet

P2Y12 inhibitor

Front 31

prasugrel

Back 31

3rd gen antiplatelet

P2Y12 inhibitor

Front 32

which antiplatelet drug is a cyclopentyltriazolopyrimidine?

Back 32

ticagrelor

P2Y12 inhibitor

Front 33

which antiplatelet drug is FDA approved for treatment of BOTH ACS and prevention of acute CV events following an MI, stroke, or peripheral arterial disease?

Back 33

clopidogrel

Front 34

which P2Y12 inhibitor exhibits reversible binding to its receptor target?

Back 34

ticagrelor

Front 35

which P2Y12 inhibitor is mostly cleared fecally rather than renally?

Back 35

ticagrelor

Front 36

which P2Y12 inhibitor exhibits significant drug interactions or genetic polymorphisms?

Back 36

ticlopidine

Front 37

P2Y12 inhibitor MOA?

Back 37

irreversible (except ticagrelor) inhibition of ADP activation site on platelets?

Front 38

which is faster onset: clopidogrel or ticlopidine?

Back 38

clopidogrel (hours)

ticlopidine (days)

Front 39

which antiplatelet medication has a boxed warning regarding neutropenia/agranulocytosis, thrombocytopenia as thrombotic thrombocytopenia purpura, and aplastic anemia?

Back 39

ticlopidine

Front 40

which is more potent: clopidogrel or ticlopidine?

Back 40

clopidogrel

Front 41

clopidogrel dosing?

Back 41

75 mg/day

300-600 mg/day loading dose

Front 42

ticlopidine dosing?

Back 42

250 mg BID with meals

Front 43

which drug is an irreversible thienopyridine P2Y12 inhibitor?

Back 43

prasugrel

Front 44

prasugrel dosing?

Back 44

loading dose (bolus): 40-60 mg

maintenance dose: 5-15 mg/day

Front 45

prasugrel indication?

Back 45

ACS patients contemplating PCI

Front 46

for which antiplatelet drug are the following claims made: more consistent and thorough platelet inhibition, faster, 32% increase in severe or major bleeding?

Back 46

prasugrel

Front 47

how is prasugrel activated?

Back 47

via a 1-step metabolism to the active compound (mostly CYP 3A4)

Front 48

prasugrel best responders?

Back 48

males, stented patients, diabetics, less than 65 yo, ClCr > 60 ml/min

Front 49

prasugrel not beneficial or detrimental to?

Back 49

strokes/transient ischemic attacks, < 65 kg, > 75 yo

Front 50

antiplatelet affected most by polymorphism?

Back 50

clopidogrel

Front 51

antiplatelet affected least by polymorphism?

Back 51

prasugrel

Front 52

bleeding tendency higher with clopidogrel or prasugrel?

Back 52

prasugrel

Front 53

which drug commonly interacts with clopidogrel and reduces its conversion to its active metabolite?

Back 53

omeprazole

PPI

Front 54

ticagrelor dosing?

Back 54

180 mg loading dose

90 mg BID maintenance dose

Front 55

typical of dosing of antiplatelets?

Back 55

loading dose followed by maintenance doses

Front 56

ticagrelor vs. clopidogrel: lower death rate?

Back 56

ticagrelor

Front 57

how can platelet aggregation be tested in vitro?

Back 57

electrical impedence, light (platelet aggregometry)

Front 58

ADP binding to platelets triggers?

Back 58

aggregation

Front 59

this drug exhibits efficacy without bleeding, is reversible within 48hours, works faster, has a greater % of inhibition, and is more consistent than clopidogrel?

Back 59

ticagrelor

Front 60

dyspnea, asymptomatic ventricular pauses, no use of aspirin at greater than 100 mg/day are all concerns with?

Back 60

ticagrelor

Front 61

elinogrel dosing?

Back 61

10-60 mg po or iv

reversible

Front 62

vorapaxar and atopaxar are both?

Back 62

PAR-1 inhibitors

Front 63

which drug is a synthetic analog of himbacine, the Australian magnolia?

Back 63

vorapaxar

Front 64

vorapaxar dosing?

Back 64

10-40 mg PO loading dose

0.5-2.5 mg/day PO maintenance dose

Front 65

vorapaxar half life?

Back 65

really long 159-311 hours

Front 66

vorapaxar MOA?

Back 66

inhibition of PAR-1 to prevent platelet activation

Front 67

indicated for intermittent claudication, pain in calf, peripheral arterial disease?

Back 67

cilostazol

Front 68

cilostazol dosing?

Back 68

100 mg BID

separate from meals (30 min before, 2 hours after)

Front 69

cilostazol MOA?

Back 69

PDE 3 inhition > increase in cAMP

can cause tachycardia

Front 70

cilostazol contraindication?

Back 70

chronic heart failure

Front 71

abciximab

Back 71

GP IIb/IIIa inhibitor

parenteral antiplatelet

for ACS with PCI

Front 72

eptifibatide

Back 72

GP IIb/IIIa inhibitor

parenteral antiplatelet

for ACS

Front 73

tirofiban

Back 73

GP IIb/IIIa inhibitor

parenteral antiplatelet

for ACS

Front 74

apcitide

Back 74

GP IIb/IIIa inhibitor

for acute DVT

Front 75

when are GP IIb\IIIa inhibitors given to people with ACS?

Back 75

not with fibrinolytics, before diagnostic angiography, immediately after PCI

Front 76

GP IIb\IIIa inhibitors most effective in those with?

Back 76

high troponin, recurrent ischemia, diabetics

Front 77

anticoagulants that can be used concurrently with GP IIb\IIIa inhibitors?

Back 77

UFH, enoxaparin, fondaparinux, bivalrudin

Front 78

absolute contraindication to use of GP IIb\IIIa inhibitors?

Back 78

current bleeding

Front 79

beraprost

Back 79

prostacyclin derivative

oral

Front 80

epoprostenol

Back 80

prostacyclin derivative

Front 81

treprostinil

Back 81

prostacyclin derivative

Front 82

prostacyclin derivative effects?

Back 82

vasodilation (pulmonary HTN), prevents platelet aggregation, anti-proliferative to vascular smooth muscle

Front 83

prostacyclin indications?

Back 83

early stage primary pulmonary HTN

early stage PVD

Front 84

diarrhea, jaw pain, headaches, and flushing are all very common side effects associated with?

Back 84

prostacyclin derivatives

Front 85

thrombolytics WITHOUT fibrin specificity?

Back 85

streptokinase

anistreplase

Front 86

thrombolytics WITH fibrin specificity?

Back 86

urokinase, alteplase, reteplase, lanoteplase, tenecteplase

Front 87

responsible for activated plasminogen to plasmin?

Back 87

t-PA

Front 88

optimal plasminogen to plasmin conversion time in the event of an ischemic stroke?

Back 88

3 hours

Front 89

optimal plasminogen to plasmin conversion time in the event of an MI?

Back 89

6 hours

Front 90

optimal plasminogen to plasmin conversion time in the event of a catheter occlusion?

Back 90

24 hours

Front 91

which thrombolytic drug exhibits antigenicity?

Back 91

streptokinase

Front 92

which thrombolytic drug activates plasmin indirectly?

Back 92

streptokinase

Front 93

which thrombolytic drug exhibits resistance to plasminogen activator inhibitor?

Back 93

tenecteplase

Front 94

which thrombolytic drugs are indicated for STEMI?

Back 94

streptokinase, alteplase, reteplase, tenecteplase

Front 95

which thrombolytic drug is indicated for STEMI, ischemic stroke, pulmonary embolism, and central venous access device?

Back 95

alteplase

Front 96

cheaper, more antigenic, higher lytic state describes which type of thrombolytic drugs?

Back 96

fibrin non-specific

Front 97

costlier, quicker and more thorough onset, less bleeding tendency describes which type of thrombolytic drugs?

Back 97

fibrin specific

Front 98

which antiplatelet medication has weight based dosing?

Back 98

tenecteplase

Front 99

fibrinolytic enzyme derived from the venom of agkistrodon contortix?

Back 99

fibrolase

Front 100

alfimprase

Back 100

direct fibrinolytic derived from snakes

Front 101

direct fibrinolytic, not plasminogen dependent, can lyse large clots in 1-4 hours, lytic activity confined to site of drug delivery, not inactivated by PAI-1, no systemic lytic state at clinically relevant doses, potentially less bleeding?

Back 101

alfimeprase

Front 102

epsilon-aminocaproic acid

Back 102

thrombolytic antagonist

binds to fibrin sites of plasmin

Front 103

tranexamic acid

Back 103

thrombolytic antagonist

binds to fibrin sites of plasmin

Front 104

aprotinin

Back 104

thrombolytic antagonist

broad spectrum protease inhibition

Front 105

drug used to treat heavy menstrual periods?

Back 105

tranexamic acid

Front 106

which drug was recently found to double the risk of kidney failure and cause other serious adverse events, including stroke and heart attack?

Back 106

aprotinin

thrombolytic antagonist

Front 107

atherosclerosis or coronary arteries, vasospasm, plaque rupture, platelet activation and aggregation, thrombogenesis, coronary artery occlusion (complete and partial) are all involved in the pathogenesis of?

Back 107

acute MI

Front 108

unexplained fatigue, sleep disturbances, shortness of breath are precursor symptoms of?

Back 108

acute MI

Front 109

shortness of breath, very tired, unusual fatigue, pain or discomfort centered high in thechest, weakness, shoulder blade/back pain, nausea, hot, flushed, dizziness, pain or discomfort in the left arm,shoulder, and jaw, coldsweat are symptoms of?

Back 109

acute MI

Front 110

differential diagnosis: chestpain or pressure may diffuse and radiate to shoulders, neck, jaw, and arms, pain lasts > 20 minutes and is often accompanied by nausea, dyspnea, or diaphoresis, ST elevations >2 mm, ECGchanges and elevated cardiac enzymes?

Back 110

acute MI

Front 111

differential diagnosis: chestpressure or heaviness that may radiate, usually induced by activity andrelieved by rest or nitrates, often has cardiac history and may have ECGChanges (Q-waves, ST, T changes)?

Back 111

unstable angina

Front 112

differential diagnosis: painis often sharp in nature, involves multiple locations, and is reproduced withpalpation or respiratory movement, heatoften provides relief, consider traumatic causes?

Back 112

costochondritis pain

Front 113

differential diagnosis: mayhave mid-chest pressure and often accompanied with coughing, acid taste in throat, or a choking sensation, usually postprandial and relievedwith antacids, H2 blockers, or proton pump inhibitors, be aware that nitratescan also relieve this pain and can makedifferentiation with angina difficult?

Back 113

GERD, esophagitis, and esophageal spasm

Front 114

differential diagnosis: sharpchest pain, dyspnea, cough, and sometimes splinting, consider pleural effusionif patient has diminished breath sounds, dullness to percussion, and decreasedtactile fremitus, chest x-ray will assist diagnosis?

Back 114

pleurisy and pleural effusion

Front 115

differential diagnosis: chestpain is usually sharp, retrosternal with sudden onset, it can radiate to trapezialridge, there may be a fever, pericardial friction rub, and arrhythmias such asSVT, ECG may have ST elevations or changes in multiple leads?

Back 115

pericarditis

Front 116

differential diagnosis: chesttightness or pressure may be accompanied by nervousness, tachycardia,tachypnea, nausea, diaphoresis, dizziness, and restlessness, ECG, CXR, andlaboratory findings should be negative, therefore a diagnosis can be made through ruling out more serious finding?

Back 116

anxiety and panic attack

Front 117

LOCATE acronym?

Back 117

location, onset and duration, characteristics, associated symptoms, treatment, eliminates/aggravates

Front 118

CHA2DS2-VASc, high homocysteine, high VEGF, high CRP, high TNF are all predictors of?

Back 118

stroke

Front 119

CHADS2-VASc meaning?

Back 119

congestive heart failure, hypertension (sys > 160 mmHg), age > 75 yo, diabetes, prior transient ischemic attack or stroke (2 points), vascular disease, age 65-74 years, sex category

Front 120

time is tissue when it comes to?

Back 120

ischemic strokes

Front 121

AST acronym for responding to acute ischemic strokes?

Back 121

assessment, stabilize, transport (3 to 4.5 hours for total, pre-hospital, door to needle 90 minutes max)

Front 122

assessment portion of acute ischemic stroke response?

Back 122

history and circumstances, 5 suddens, FAST

Front 123

5 suddens of ischemic stroke?

Back 123

weakness, speech impairment, visual changes, dizziness, severe headache

Front 124

FAST acronym for stroke?

Back 124

face drooping, arm weakness, speech difficulty, time to call 911

Front 125

SCAB acronym?

Back 125

stabilization, circulation, breathing, airway

Front 126

the Glasgow Coma, NIHSS, Canadian Neurological Scale, and LA or Cincinnati Stroke Scales are all?

Back 126

stroke severity scoring systems

Front 127

door-to-needle goals?

Back 127

90 minutes max

imaging, comprehensive blood work, severity scoring

Front 128

common problems encountered with victims of stroke?

Back 128

hyperglycemia, hyperthermia, hypertension

Front 129

when should TPA fibrinolysis NOT be used in stroke patients?

Back 129

if BP > 185/110

Front 130

quick, objective, easy way to to assess CNS function?

Back 130

GCS

Front 131

O2 greater than 94%, intravascular TPA, prophylaxis of DVT with anti-thrombotics, endartectomy if TPA contraindicated, stenting in larger cerebral vessels are all treatments for?

Back 131

acute ischemic stroke

Front 132

typical patient characteristic when it comes to ACS?

Back 132

middle aged male, elderly, diabetic, prior history or family history of CAD, CVA, PVD (angina, TIAs, intermittent claudication, erectile dysfunction)

Front 133

rapid ER verification of MI?

Back 133

12-lead ECG

Front 134

delayed ER verification of MI?

Back 134

cardiac enzyme profiles

Front 135

can cardiac enzyme/protein profiles tell us whether a heart attack was STEMI or non-STEMI?

Back 135

no

Front 136

what is indicated by high troponin?

Back 136

recent heart attack

Front 137

how are thrombolytics used in the case of an in-hospital acute MI?

Back 137

within 6 hours of onset

Front 138

how are thrombolytics used in the case of an in-hospital ischemic or thrombotic stroke?

Back 138

within 3 hours

alteplase is the only one that is FDA approved

Front 139

what thrombolytic is used in cases of ischemic or thrombotic strokes that occur in the hospital?

Back 139

alteplase

Front 140

what are surgical alternatives to acute MIs that occur in the hospital?

Back 140

PCTL angioplasty and CABG

Front 141

shortcomings with balloon angioplasty?

Back 141

restenosis, embolization, rupture of blood vessel, infections, can't alleviate blockage

Front 142

type of stent that is used in most coronary arteries?

Back 142

balloon expandable stent

Front 143

type of stent that is used in most carotid applications?

Back 143

self-expanding stent

Front 144

triggers a healing response that could narrow the vessel after a stent has been placed?

Back 144

cracked plaque

Front 145

what sort of stent is used to prevent restenosis due to cracked plaque?

Back 145

drug-eluting stent

Front 146

thrombosis 0-24 hours after stent implantation is known as?

Back 146

acute stent thrombosis

Front 147

thrombosis 24 hours to 30 days after stent implantation is known as?

Back 147

subacute stent thrombosis

Front 148

thrombosis 30 days to one year after stent implantation is known as?

Back 148

late stent thrombosis

Front 149

thrombosis one year after stent implantation is known as?

Back 149

very late stent thrombosis

Front 150

what are drug eluting stents made of?

Back 150

cobalt chromium or stainless steel

Front 151

sirolimus, paclitaxel, everolimus, and zotarolimus are all?

Back 151

anti-proliferative agents that are used in drug eluting stents

Front 152

stent characteristics, APT associations, angioplasty-related factors, lesion-related factors, and medical comorbidities are all factors for?

Back 152

higher rates of stent thrombosis

Front 153

stent used in BPH?

Back 153

Spanner stent

Front 154

oxygen rate for ACS?

Back 154

2-4 liters per minute

Front 155

potent analgesics used in treatment of ACS?

Back 155

morphine, oxycodone, oxymorphone

morphine is vasodilatory

Front 156

potent diuretics used in treatment of ACS?

Back 156

furosemide

Front 157

cardiac off-loaders used in treatment of ACS?

Back 157

nitroglycerin, nitroprusside

also antiplatelet activity

Front 158

stool softener considerations when treating ACS?

Back 158

avoid valsalva maneuver and reflexive CV changes

Front 159

low dose beta blockers are used in ACS patients except those with?

Back 159

cardiogenic shock, brittle COPD, poorly controlled diabetes

Front 160

fibrinolytics, GP IIb/IIIa inhibitors, and antithrombins are all medications used in acute treatment of?

Back 160

acute coronary syndromes

Front 161

antiplatelets, beta blockers, statins, and ACE inhibitors are all medications used in?

Back 161

outpatient treatment of acute coronary syndromes

Front 162

cardioselective beta-blockers?

Back 162

bisoprolol, metoprolol

Front 163

noncardioselective beta-blockers?

Back 163

carvedilol

Front 164

perindopril

Back 164

long acting ACE inhibitor (antihypertensive)

Front 165

complex clinical syndrome from any structural/functional cardiac disorder that impairs the ability of the ventricles to fill with or eject blood, other symptoms include: dyspnea, fatigue, and fluid retention?

Back 165

heart failure

Front 166

ventricles enlarge but fail in?

Back 166

systolic failure

Front 167

ventricles can't relax in?

Back 167

diastolic failure

Front 168

factors that contribute to diastolic, systolic, and total heart failure?

Back 168

increasing age

increasing weight (BMI)

increasing A1C/hyperglycemia

increasing blood pressure

Front 169

reduced ejection fraction, enlarged heart, neuroendocrine activation, increased ventricular arrhythmias, and shortened life expectancy are all manifestations of?

Back 169

congestive heart failure

Front 170

need to add in "deducing strokes" slide from first lecture

Back 170

need to add in "deducing strokes" slide from first lecture

Front 171

weakness, easy fatigue, slowed mentation, cardiac cachexia are signs and symptoms of?

Back 171

low cardiac output heart failure

Front 172

nocturia, cardiomegaly with tachycardia, cyanosis, and DOT (dyspnea, orthopnea, tachypnea) are signs and symptoms of?

Back 172

congestive heart failure

Front 173

who is at risk for HF?

Back 173

previous MI survivor, poorly controlled HTN with hypertrophy, DM, abnormal ECG (esp. resting), chronic tachycardia, obesity, heart murmurs, established CAD

Front 174

what are the ABD's of CHF intervention?

Back 174

aspirin

blockers

diet

diuretics

dilators

digoxin or digitalis

Front 175

which drug has a favorable safety profile in elderly heart failure patients?

Back 175

nebivolol

Front 176

which drug is indicated for the treatment of stable chronic heart failure (NYHA class II-III) in addition to standard therapy to reduce mortality or cardiovascular hospitalizations?

Back 176

nebivolol

Front 177

nebivolol shares pharmacological properties common to which two other drugs?

Back 177

metoprolol (beta-1 selectivity)

carvedilol (vasodilatory properties)

Front 178

NYHA class I?

Back 178

no limitation at ordinary activities

Front 179

NYHA class II?

Back 179

slight limitation at ordinary activities

Front 180

NYHA class III?

Back 180

marked limitation at ordinary activities

Front 181

NYHA class IV?

Back 181

always symptomatic, even at rest

Front 182

what heart failure categorizations replaced the old NYHA categories?

Back 182

ACC/AHA

Front 183

ACC/AHA stage A?

Back 183

at-risk for HF, no overt damage/symptoms

Front 184

ACC/AHA stage B?

Back 184

structural damage w/o symptoms

Front 185

ACC/AHA stage C?

Back 185

structural damage with prior/current symptoms

Front 186

ACC/AHA stage D?

Back 186

refractory HF with hospitalizations

Front 187

which drug is approved in 71 countries but not yet in the US for treatment of HF?

Back 187

nebivolol

Front 188

objectives for CHF patients?

Back 188

cure/prolong survival, make pt. asymptomatic and comfortable, increase the NYHA classification (closer to class I?), decrease the # of hospitalizations

Front 189

CHF intervention lifestyle changes?

Back 189

limit activity to capacity, reduce weight toward ideal, BMI reduction, control risk factors for atherosclerosis, restrict salt moderately (<3.8 grams, <1.5 grams is better), restrict water (1.5 L/day)

Front 190

which type of diuretic is preferred in CHF if it is effective?

Back 190

thiazides

Front 191

GFR for normal renal function?

Back 191

120 ml/min

Front 192

GFR for slightly impaired renal function?

Back 192

60 ml/min

Front 193

GFR for moderately impaired renal function?

Back 193

30 ml/min

Front 194

GFR for severely impaired renal function?

Back 194

15 ml/min or less

Front 195

which type of diuretic is wanted for someone with CHF and a GFR of > 30 ml/min?

Back 195

thiazide diuretic

Front 196

which type of diuretic is wanted for someone with CHF and a GFR or </= 30 ml/min?

Back 196

loop diuretic

Front 197

HCTZ (often in combos), chlorothiazide, bendroflumethazide, methyclothiazide, and polythiazide are all?

Back 197

thiazide diuretics

Front 198

chlorthalidone, indapamide, metolazone, quinethazone are all?

Back 198

thiazide-like diuretics

Front 199

which drugs are used as add on therapy to improve CHF?

Back 199

spironolactone, eplerenone

Front 200

moderately potent, inhibits NaCl (distal convoluted tubule), safe with respect to volume depletion and electrolyte imbalance, HF patients may not respond describes?

Back 200

thiazide therapy of CHF

Front 201

what are the potential thiazide toxicities?

Back 201

hyperlipidemia

hyperglycemia

hyperuricemia

hypercalcemia

hypokalemia (low potassium)

hyponatremia

hypomagnesiemia

hypovolemia

photosensitivity in sunlight

Front 202

which thiazide toxicity differentiates it from loop diuretics?

Back 202

hypercalcemia

Front 203

furosemide, bumetanide, torsemide, and ethacrynic acid are all?

Back 203

loop diuretics

Front 204

which loop diuretic is the poorest choice for treatment of CHF?

Back 204

ethacrynic acid

Front 205

what are the peripheral effects of ADH?

Back 205

vasoconstriction, fluid retention, ACTH release

Front 206

what are the central effects of ADH?

Back 206

learning and memory, social behaviors, autonomic functions

Front 207

ADH is regulated by?

Back 207

osmoreceptors and baroreceptors

Front 208

in regards to ADH, which is more potent: volume or osmotic pressure?

Back 208

volume

Front 209

conivaptan, tolvaptan, mozavaptan, lixivaptan, and satavaptan are all?

Back 209

vasopressin receptor antagonists

Front 210

what effect do the vaptans have?

Back 210

decreased platelet aggregation, decreased pressure, improvement/correction of hyponatremia

Front 211

what type of receptor is the vasopressin receptor?

Back 211

GPCR

Front 212

V1a receptor activity in cardiomyocytes at low levels of vasopressin?

Back 212

+ inotropy or force

Front 213

V1a receptor activity in cardiomyocytes at high levels of vasopressin?

Back 213

- inotropy b/c coronary vasoconstriction

Front 214

V1b receptor is responsible for?

Back 214

ACTH release from the pituitary

is found in the pancreatic Langerhans cells and kidneys

Front 215

adenylyl cyclase with aquaporin-2 to surface as "water pore", free water retention, collecting tubules of nephrons describes which receptor?

Back 215

V2

Front 216

hyponatremia level?

Back 216

= 136-138 mEq/L

Front 217

what is euvolemic hyponatremia?

Back 217

increase in total body water with constant sodium

Front 218

what is SIADH?

Back 218

syndrome of inappropriate ADH secretion

Front 219

causes of SIADH?

Back 219

head injuries, stress, drugs

Front 220

hypervolemic hyponatremia?

Back 220

same sodium levels, greater total body water

Front 221

causes of hypervolemic hyponatremia?

Back 221

cirrhosis, heart failure

Front 222

eplerenone

Back 222

mineralocorticoid receptor antagonist

Front 223

pathologic effects of aldosterone?

Back 223

inhibits nitric oxide synthesis, increases inflammation and reactive fibrosis, inhibits sympathetic responses, stimulates cardiomyocyte apoptosis

Front 224

increased vascular compliance, re-establishHR variability, increased fibrinolysis, resensitizationof baroreceptors, decreased platelet activation, reduced vascular inflammation, reduced vascular remodeling, reduced ventricular fibrosis, hypertrophy, and remodeling are all benefits of?

Back 224

aldosterone inhibitors

Front 225

which MR inhibitor's absorption is increased with food?

Back 225

spironolactone

Front 226

which MR inhibitor has a longer half-life: eplerenone or spironolactone?

Back 226

eplerenone

Front 227

problems associated with MR inhibitor class of drugs?

Back 227

hyperkalemia, gynecomastia, breast pain, drug interactions (inhibition of CYP 3A4)

Front 228

MR receptor antagonist dosing is based on?

Back 228

observed concentration of K

Front 229

MR receptor antagonist contraindications?

Back 229

SCr > 2.5 mg/dL and/or GFR <30 ml/min

Front 230

drug classes associated with photosensitization?

Back 230

anti's, diuretics, hormones, herbs (St. John's Wort)

Front 231

which drug is approved to prevent progression of TIAs to thrombotic strokes?

Back 231

ramipril

Front 232

effects of ACE inhibitors?

Back 232

decreased central and peripheral vasoconstriction, decreased aldosterone production (systemic), decreased release of ADH, decreased vascular and cardiac growth promotion or remodeling

Front 233

neutropenia, angioedema, proteinuria, fetotoxic and teratogenic are severe toxicities of which drug class?

Back 233

ACE inhibitors

Front 234

which two drug classes improve survivability in those with CHF?

Back 234

diuretics and ACE inhibitors

Front 235

which ACE inhibitor CANNOT be taken with meals?

Back 235

captopril

Front 236

all of the ACE inhibitors are prodrugs except?

Back 236

captopril and lisinopril

Front 237

Dr. Smith's favorite ACE inhibitor?

Back 237

fosinopril

Front 238

which ACE inhibitor exhibits long action (once daily dosing = increased compliance, lesser reflex changes), and balanced elimination?

Back 238

fosinopril

Front 239

what two drugs make up BiDil?

Back 239

isosorbide dinitrate and hydralazine

Front 240

how is BiDil used in the treatment of heart failure?

Back 240

as an adjunct

Front 241

which ARBs are indicated on-label for heart failure?

Back 241

valsartan and candesartan(?)

Front 242

omapatrilat MOA?

Back 242

inhibition of ACE, inhibition of neutral endopeptidase (inhibits degradation of ANP which is vasodilatory)

Front 243

omapatrilat uses?

Back 243

HTN, CHF

Front 244

side effects of omapatrilat?

Back 244

angioedema

Front 245

new dual inhibitor that leads to BP reduction, cardioprotection, nephroprotection and has little associated angioedema as far as we know?

Back 245

ilepatril

Front 246

which recently introduced drug is indicated for class II to IV heart failure with reduced ejection fraction?

Back 246

sacubitril/valsartan (Entresto)

not used in severe renal/hepatic impairment

Front 247

levosimendan

Back 247

calcium sensitizer (inotropy) + potassium channel opener (vasodilation)

Front 248

which has a longer half-life: digoxin or digitoxin?

Back 248

digitoxin

Front 249

effects of digitalis?

Back 249

increased force of contraction

delayed conduction through AV node

decreased rate of contraction

Front 250

which drug is used for heart failure with atrial tachycardias?

Back 250

digitalis

Front 251

anorexia, N/V, diarrhea, visual changes, neurologic changes, and gynecomastia are all symptoms of?

Back 251

digitalis intoxication

Front 252

most common cardiotoxicities?

Back 252

dysrythmia, heart block

Front 253

Back 253

ECG with digitalis

Front 254

Back 254

bradycardia due to digitalis toxicity

Front 255

Back 255

first degree AV block due to digitalis

Front 256

Back 256

second degree AV block type 1

Front 257

Back 257

second degree AV block type 2

Front 258

Back 258

third degree AV block

Front 259

Back 259

ventricular tachycardia

Front 260

Back 260

TDP

Front 261

350-440 msec QT interval classification?

Back 261

normal

Front 262

450-500 msec QT interval classification?

Back 262

potential concern

Front 263

> 500 msec QT interval classification?

Back 263

very great risk

Front 264

Back 264

bigeminy

Front 265

Back 265

v. fib

Front 266

what to do in cases of mild digitalis intoxication?

Back 266

withhold doses until therapeutic/low therapeutic range is achieved, correct electrolytes/pH (low K/Mg, high Ca)

Front 267

digoxin therapeutic range?

Back 267

0.5 - 2.0 ng/ml

Front 268

digitoxin therapeutic range?

Back 268

10-25 ng/ml

Front 269

what to do in cases of moderate digitalis intoxication?

Back 269

same for mild + phenytoin/lidocaine for ventricular dysrhythmias

Front 270

what to do in cases of severe digitalis intoxication?

Back 270

DigiBind or DigiFab

Front 271

# vials of DigiBind?

Back 271

total digitalis in body (mg) / 0.6 mg/vial

Front 272

# vials of DigiFab?

Back 272

total digitalis in body (mg) / 0.5 mg/vial

Front 273

empirical dosing regimen for treating digitalis toxicity?

Back 273

10 vials, monitor ECG, repeat after 12-24 hours if symptomatic

Front 274

ancillary medications used to treat digitalis toxicity?

Back 274

low dose beta blockers

carvedilol, metoprolol, bisoprolol

Front 275

patients with CHF, those who take statins, those who have familial hypercholesterolemia, and >/= 65 years of age need?

Back 275

CoQ10 - ubiquinone

Front 276

sources of ubiquinone?

Back 276

oily fish, organ meats, whole grains

Front 277

medications used for acute decompensation of CHF (acute worsening)?

Back 277

inodilators (amrinone, milrinone)

inotropes (dobutamine, dopamine)

Front 278

toxicities associated with inodilators?

Back 278

thrombocytopenia, hepatotoxicity, GI tract disturbances

Front 279

problems associated with beta-1 agonists

Back 279

proarrhythmic, short-acting, tachyphylaxis, IV admin required

Front 280

novel agent used in the treatment of acute decompensated CHF?

Back 280

nesiritide (human, B-type natriuretic peptide)

vasodilation

natriuresis/diuresis

decreased RAAS activation

Front 281

toxicity associated with nesiritide?

Back 281

short term, severe hypotension

long term renal toxicity with increased mortality

Front 282

used to predict mortality of patients with HF?

Back 282

triage BNP test & NT-pro-BNP

Front 283

diagnosis when BNP < 100 pg/ml and NT-proBNP is < 300 pg/ml?

Back 283

HF very improbable 2%

Front 284

diagnosis when BNP 100-400 pg/ml and NT-proBNP is > 300 but < 1800 pg/ml?

Back 284

ECHO needed to diagnose

Front 285

diagnosis when BNP > 500 pg/ml and NT-proBNP is > 1800 pg/ml?

Back 285

HF very probably 95%

Front 286

false positives with BNP tests are common in?

Back 286

females, african americans and hispanics, anemiacs, renal diseases

Front 287

false negatives with BNP tests are common in?

Back 287

those with obesity

Front 288

which drugs carry a black box warning for causing or exacerbating CHF in some patients?

Back 288

thiazolidinediones

tioglitazone, rosiglitazone, pioglitazone

Front 289

which diabetes drug is associated with hepatotoxicity?

Back 289

tioglitazone

Front 290

which diabetes drug is associated with cardiovascular disease?

Back 290

rosiglitazone

Front 291

which diabetes drug is associated with bladder cancer?

Back 291

pioglitazone

Front 292

cardiac transplantations, left ventricular assist devices, cardiomyoplasty, ventricular remodeling (the Batista technique) are all?

Back 292

advancing heart failure treatment techniques

Front 293

Jarvik 7, CardioWest, and AbioCor are all?

Back 293

FDA-approved artificial hearts

Front 294

mydicar

Back 294

gene replacement of SERCA2A (removes Ca from cardiomyocyte back into SR)

employs adeno-associated viral vector to get into the cardiomyocytes

1 time infusion into coronary arteries

phase II CUPID study

Front 295

ixmyelocel-T

Back 295

patient specific, expanded multicellular therapy manufactured from the patient's own bone marrow

works by increasing repair of damaged heart tissue