Lipoprotein Drugs
Colestipol, cholestyramine, and colesevelam belong to this drug class.
What is bile acid-binding resins (BABRs)?
*Cole or chole in latin means bile, and bile is made from cholesterol. A cholecystectomy is the surgical removal of the gallbladder where bile is stored.
What is angina, syncope, dyspnea?
*Angina due to LVH and epicardinal coronary artery ischemia. Syncope upon exertion due to poor cardiac output to compensate. Dyspnea due to upstream pulmonary HTN.
Stage II HTN would be categorized by these BP readings.
What is SBP >140 mmHg or DBP >90 mmHg?
What is Warfarin?
This drug class is considered to be the most potent but NOT the best antihypertensive diuretic.
This drug has the longest half life of the statin class. This drug inhibits HMG-CoA reductase, the rate limiting step of cholesterol synthesis.
What is Rosuvastatin (19 hours)?
A 43 year-old woman presents to the ED with cutaneous flushing and hepatomegaly. She has also been experiencing heavy bouts of diarrhea and nausea. Urinalysis positive for elevated 5-HIAA. Excised tricuspid valve revealed excessive fibrosis. Name the condition.
What is carcinoid heart disease (syndrome)?
A 38 year-old female presents to clinic with elevated levels of BP. CT renal angiogram revealed alternating regions of thickened media of the renal artery. The patient likely has...
What is fibromuscular dysplasia?
Rivaroxaban inhibits factor Xa in the clotting cascade which is associated with this clotting factor conversion.
What is prothrombin to thrombin?
*Rivaroxaban has "xa" in the name to help you remember what it does.
Lisinopril, enalapril, and fosinopril all are considered to be ACE inhibitors. Patients with renal artery stenosis are at risk of developing THIS pathology if they take ACE inhibitors.
What is renal failure?
*Renal artery stenosis already make it difficult for perfusion of the glomeruli of the kidney. To compensate, the kidneys activate RAAS to keep perfusion normalized. ACE inhibitors would impari this safety mechanism.
A patient with elevated cholesterol, triglycerides, and low HDL was prescribed Niacin to help with these serum issues. An incorrect adjunctive drug (pair) would be...
What are fibrates (Gemfibrozil, Fenofibrate)?
*This is because both drugs severely impact triglyceride levels, and this would cause adverse effects.
A 47 year-old man with right upper quadrant fullness and difficulty breathing. Positive history of multiple streptococcal infections as a child. Upon auscultation, you hear an "opening snap" followed by a decrescendo murmur. ECG revealed atrial fibrillation.
What is Mitral Stenosis?
*Molecular mimicry of M protein in streptococcal organisms and cardiac myosin produces autoantibodies post infection. Rheumatic Heart Disease (Fever).
A newborn presents to the clinic with his parents. Parents are concerned because you can see his pulse rebounding through his upper extremities. CT revealed narrowing of the descending aorta just distal to the subclavian.
What is aortic coarctation?
What is Clopidogrel or Prasugrel?
*Look for the suffix "grel" for these antiplatelet drugs.
A patient is started on a beta blocker, an alpha-2 agonist, and an alpha-1 antagonist. The two INCORRECT management of hypertension methods listed here include:
1. What is starting sympatholytics as first line?
2. What is using the same drug class?
*First line is typically not a sympatholytic and you always use different HTN meds never of the same class for combinations.
Acceptable combos: ACE-I/ARB +CCB, ACE-I/ARB + Thiazide, etc.
A patient with a gain of function PCSK9 gene mutation has led to a hypercholesterolemia state. First line statins have had minimal effect, the next drug of choice best for this patient is...
What is PCSK9 inhibitor (alirocumab, evolocumab)?
*"Mabs" are drugs that mimic antibodies, and are not specific to this class of drug.
A 68 year-old female presents to the ED with chest fullness, hemoptysis, and dyspnea. She is afraid she might be having an MI because she previously had one a month ago. Upon auscultation, you hear a murmur that lasts the entire duration during systole at the apex.
What is Mitral Regurgitation?
*Mitral valve prolapse due to recent MI and papillary muscle infarct.
Distressed 32 year-old man presents to the clinic for a wellness checkup. He has no prior history of HTN but positive for hyperlipidemia. His BP reads 128/76. The most likely etiology of the patients BP values are...
What is White Coat Hypertension?
*Elevated BP is Systolic 120 - 129 mm Hg and diastolic <80 mm Hg
Your patient presents with a pulmonary embolism. He was treated with heparin and alteplase (fibrinolytic drug). The patient is now suffering from Heparin Induced Thrombocytopenia Type II. This heparin inactivating compound would be given...
What is Protamine Sulfate?
*Heparin is a (-) charge and protamine sulfate is (+) charge, thus binds and inactivates it.
58 year-old male with a positive history of heart failure is being treated for hypertension. You want to start him on a calcium channel blocker. You would avoid this type of CCB with this patient...
What is Nondihydropyridines (Non-DHPs)?
*Non-DHPs like verapamil and diltizem have BOTH vascular and cardiac effects. Avoid with patients that have heart problems.
"Vytorin" is this drug combination: one being a drug that activates within the brush border of the small intestine, and the other drug affects the rate limiting step of cholesterol synthesis in the liver.
What is Ezetimibe and Simvastatin?
Name the murmurs based on auscultations.
1. Holosystolic at apex
2. Systolic harsh crescendo-decrescendo at right upper sternal border
3. Diastolic 'opening-snap' decrescendo
4. Diastolic decrescendo with 'water-hammer pulses' or 'hyper-dynamic pulses'
1. What is Mitral Regurgitation?
2. What is Aortic Stenosis?
3. What is Mitral Stenosis?
4. What is Aortic Regurgitation?
Labs from a patient with HTN revealed low plasma renin and elevated ACTH (adrenocorticotrophic hormone). CT revealed bilateral adrenal hyperplasia. Patient's HTN is secondarily caused by this condition.
What is primary aldosteronism?
*Retention of sodium, brings in water into the vasculature which raises blood volume and HTN.
What is fibrinolytic drug (alteplase, reteplase, tenecteplase)?
*The suffix "plase" clues you in on fibrinolytic drugs.
A pregnant mother is prescribed an antihypertensive medication. She cannot take an ACE inhibitor or an angiotensin receptor antagonist (ARB) due to their teratogenic effects. She was likely prescribed these medications (Only need one).
What is Hydralazine, Labetalol, Methyldopa, Nifedipine?
*Labetalol is DOC but others are safe as well for adjunctive therapy. Remember He Likes My Neonate (Hydralazine, Labetalol, Methyldopa, Nifedipine).