PNN - CARDIO Review Questions
what are some drug classes that can increase BP? - ✔️✔️estrogen
corticosteroidss
NSAIDs
all adrenergics
migraine meds (triptans & ergots --> constriction)
ADHD amphetamines, and other stimulants
OTC/herbs: ephedra, ma huang, licorice, bitter orange, decongestants
Epigen
Tacrolimus, Cyclosporine
What is the BP goal for patients with CAD? - ✔️✔️< 130/80 per ACC-AHA
What is the BP goal for patients with CHF? - ✔️✔️< 130/80, preferably < 120/80 per
ACC-AHA
When do we worry about hyperglycemia in patients taking thiazide/loop diuretics? -
✔️✔️If potassium levels are normal, hyperglycemia is not a concern.
what are cardiovascular risk factors? - ✔️✔️HTN
smoking
dyslipidemia
DM
microalbuminuria, or GFR < 60
age (> 55 for men, 65 for women)
family hx
obesity (BMI > 30 obese)
physical inactivity
Where in the nephron does acetazolamide work? - ✔️✔️proximal convoluted tubule
Where does mannitol work in the nephron? - ✔️✔️right after acetazolamide in the PCT,
also in the thin descending limb of the loop of henle.
Where do vaptans work in the nephron? - ✔️✔️in the collecting duct
where do thiazides work in the nephron? - ✔️✔️distal convoluted tubule
Where do Loops work in the nephron? - ✔️✔️In the thick ascending limb of the loop of
henle
What are some CI to use of NTG? - ✔️✔️SBP < 90
Use of PDE5-I within last 24-48 hours
,What are some CI to use of beta-blockers? - ✔️✔️SBP < 90
hx of asthma/COPD
Raynaud's
in setting of MI due to cocaine overdose (BB may increase vasospasm)
What are some CI to use of ASA? - ✔️✔️hypersensitivity rxn; salicylate allergy
peptic ulcer disease
Describe renal dosing for DA when utilized for shock? - ✔️✔️1-2 mcg/kg/min = "renal"
dosing (dilation of renal artery)
2-10 mcg/kg/min = beta-1 activity (+ chronotrope and inotrope)
10-20 mcg/kg/min = alpha-1 activity (vasoconstriction)
Where do ADH antagonists work in the nephron? - ✔️✔️DCT + Collecting ducts
Where do K-sparing diuretics work on the nephron? - ✔️✔️DCT + collecting ducts
For every unit of insulin that enters the cell (along with glucose) we also need
potassium. If potassium levels are low, even if there is insulin, glucose will not enter the
cell (Resulting in increased plasma concentration of glucose). only a concern when
potassium levels fall below normal (3.5)
What drug interactions do we watch out for with Thiazides? - ✔️✔️lithium toxicity --
associated with low Na
Digoxin toxicity -- associated with low K
allopurinol hypersensitivity rxn
additive risk of electrolyte disturbance with loops or other drugs with diuretic effect
What other medications, aside from thiazides, can increase uric acid? - ✔️✔️Loops.
Niacin. Low dose ASA. Ethambutol. Pyrazinamide.
Which classes of antihypertensives can potentially increase lipids? - ✔️✔️Thiazides.
Loops. Beta blockers.
CCBs and ACEI/ARBs do not affect lipids.
Cautions with thiazides. What disease states or conditions do we use caution when
using thiazides? - ✔️✔️DM (but only when K is below normal)
gout/kidney stones (due to ability to increase UA)
, renal failure (thiazides are not effective when CrCl < 30, except metolazone)
dyslipidemia
sulfa allergy (all loops/diuretics except edecrin have sulfa)
hyponatremia
sexual dysfunction
are thiazides safe to use in pregnancy - ✔️✔️pregnancy category B
What are loop diuretics indicated for? - ✔️✔️Edema
HTN (in renal patients)
hypercalcemia
Name the thiazide diuretics (2) - ✔️✔️hydrochlorothiazide (Microzide)
Chlorthiazide (Diuril)
Name the thiazide-like diuretics (3) - ✔️✔️chlorthalidone
Indapamide (Lozol)
Metolazone (Zaroxolyn)
Name the Loop diuretics (4) - ✔️✔️Bumetanide (Bumex)
Ethacrynic Acid (Edecrin)
Furosemide (Lasix)
Torsemide (Demedex)
What's unique about Edecrin in regards to the other loops? - ✔️✔️It causes the most
ototoxicity.
Its the only loop diuretic without sulfa.
What are the side effects associated with loop diuretics? - ✔️✔️same electrolyte
disturbances seen with thiazides:
decrease: Na, K, Mg
Increase: uric acid, lipids, glucose** (if hypo-k)
except! decreases Ca (used to treat hypercalcemia)
others: ototoxicity, Lupus, rash/photosensitivity
What are the side effects associated with K-sparing diuretics? - ✔️✔️Hyperkalemia
hyponatremia
rash
headache
spironolactone: gynecomastia
what are some drug classes that can increase BP? - ✔️✔️estrogen
corticosteroidss
NSAIDs
all adrenergics
migraine meds (triptans & ergots --> constriction)
ADHD amphetamines, and other stimulants
OTC/herbs: ephedra, ma huang, licorice, bitter orange, decongestants
Epigen
Tacrolimus, Cyclosporine
What is the BP goal for patients with CAD? - ✔️✔️< 130/80 per ACC-AHA
What is the BP goal for patients with CHF? - ✔️✔️< 130/80, preferably < 120/80 per
ACC-AHA
When do we worry about hyperglycemia in patients taking thiazide/loop diuretics? -
✔️✔️If potassium levels are normal, hyperglycemia is not a concern.
what are cardiovascular risk factors? - ✔️✔️HTN
smoking
dyslipidemia
DM
microalbuminuria, or GFR < 60
age (> 55 for men, 65 for women)
family hx
obesity (BMI > 30 obese)
physical inactivity
Where in the nephron does acetazolamide work? - ✔️✔️proximal convoluted tubule
Where does mannitol work in the nephron? - ✔️✔️right after acetazolamide in the PCT,
also in the thin descending limb of the loop of henle.
Where do vaptans work in the nephron? - ✔️✔️in the collecting duct
where do thiazides work in the nephron? - ✔️✔️distal convoluted tubule
Where do Loops work in the nephron? - ✔️✔️In the thick ascending limb of the loop of
henle
What are some CI to use of NTG? - ✔️✔️SBP < 90
Use of PDE5-I within last 24-48 hours
,What are some CI to use of beta-blockers? - ✔️✔️SBP < 90
hx of asthma/COPD
Raynaud's
in setting of MI due to cocaine overdose (BB may increase vasospasm)
What are some CI to use of ASA? - ✔️✔️hypersensitivity rxn; salicylate allergy
peptic ulcer disease
Describe renal dosing for DA when utilized for shock? - ✔️✔️1-2 mcg/kg/min = "renal"
dosing (dilation of renal artery)
2-10 mcg/kg/min = beta-1 activity (+ chronotrope and inotrope)
10-20 mcg/kg/min = alpha-1 activity (vasoconstriction)
Where do ADH antagonists work in the nephron? - ✔️✔️DCT + Collecting ducts
Where do K-sparing diuretics work on the nephron? - ✔️✔️DCT + collecting ducts
For every unit of insulin that enters the cell (along with glucose) we also need
potassium. If potassium levels are low, even if there is insulin, glucose will not enter the
cell (Resulting in increased plasma concentration of glucose). only a concern when
potassium levels fall below normal (3.5)
What drug interactions do we watch out for with Thiazides? - ✔️✔️lithium toxicity --
associated with low Na
Digoxin toxicity -- associated with low K
allopurinol hypersensitivity rxn
additive risk of electrolyte disturbance with loops or other drugs with diuretic effect
What other medications, aside from thiazides, can increase uric acid? - ✔️✔️Loops.
Niacin. Low dose ASA. Ethambutol. Pyrazinamide.
Which classes of antihypertensives can potentially increase lipids? - ✔️✔️Thiazides.
Loops. Beta blockers.
CCBs and ACEI/ARBs do not affect lipids.
Cautions with thiazides. What disease states or conditions do we use caution when
using thiazides? - ✔️✔️DM (but only when K is below normal)
gout/kidney stones (due to ability to increase UA)
, renal failure (thiazides are not effective when CrCl < 30, except metolazone)
dyslipidemia
sulfa allergy (all loops/diuretics except edecrin have sulfa)
hyponatremia
sexual dysfunction
are thiazides safe to use in pregnancy - ✔️✔️pregnancy category B
What are loop diuretics indicated for? - ✔️✔️Edema
HTN (in renal patients)
hypercalcemia
Name the thiazide diuretics (2) - ✔️✔️hydrochlorothiazide (Microzide)
Chlorthiazide (Diuril)
Name the thiazide-like diuretics (3) - ✔️✔️chlorthalidone
Indapamide (Lozol)
Metolazone (Zaroxolyn)
Name the Loop diuretics (4) - ✔️✔️Bumetanide (Bumex)
Ethacrynic Acid (Edecrin)
Furosemide (Lasix)
Torsemide (Demedex)
What's unique about Edecrin in regards to the other loops? - ✔️✔️It causes the most
ototoxicity.
Its the only loop diuretic without sulfa.
What are the side effects associated with loop diuretics? - ✔️✔️same electrolyte
disturbances seen with thiazides:
decrease: Na, K, Mg
Increase: uric acid, lipids, glucose** (if hypo-k)
except! decreases Ca (used to treat hypercalcemia)
others: ototoxicity, Lupus, rash/photosensitivity
What are the side effects associated with K-sparing diuretics? - ✔️✔️Hyperkalemia
hyponatremia
rash
headache
spironolactone: gynecomastia
