10/02

Question 1

beta 1 and 2 __________ cyclic AMP and acetylcholine _______ cyclic AMP

Answer 1

increases
decreases

Question 2

cyclic AMP activates

Answer 2

protein kinase A

Question 3

protein kinase A binds to the ______ which then releases _______. This in turn increases the force of ________

Answer 3

sarcoplasmic reticulum
calcium
contraction

Question 4

in pacemaker cells, the role of norepinephrine is to

Answer 4

increase the heart rate and increase the force of contraction

Question 5

acetylcholine ____ the rate and force of a heart beat

Answer 5

decreases

Question 6

in the underlying endothelial cells of the vasculature, we have norepinephrine being released and it binds to alpha 1 and to some extent to alpha 2. What is the effect?

Answer 6

alpha 1gq increases IP3= contraction

alpha 2inhibitory deceases cyclic AMP= contraction

Question 7

if we give an alpha 2 agonist in the setting of HTN, it is primarily going to work by _______

Answer 7

stimulating parasympathetic outflow and inhibiting the sympathetic outflow

Question 8

what is an alpha 2 antagonist that is not used clinically? This drug works on which neuron?

Answer 8

yohimbine
the presynaptic neuron to increase blood pressure by blocking the negative feedback loop

Question 9

what can, over time, lead to things like arrhythmias, heart failure, and cardiac death?

Answer 9

scar tissue on the heart from things like MI’s. cardiac myocytes don’t proliferate

Question 10

what are non cardiac related heart failure examples?

Answer 10

graves disease
beriberi- thiamine deficiency

Question 11

when do we start using the word “congestive” when talking about heart failure?

Answer 11

when fluid starts leaving the heart and going into the lungs or into the periphery

Question 12

How are the heart walls in systolic failure

Answer 12

thin

Question 13

How are the heart walls in diastolic failure

Answer 13

thick

Question 14

systolic heart failure reduces cardiac ________. This is more acute or chronic?

Answer 14

function
acute

Question 15

diastolic heart failure reduces cardiac ________. This is more acute or chronic?

Answer 15

filling
chronic

Question 16

what is the most common precipitating factor for heart failure?

Answer 16

coronary artery disease

Question 17

what is the first and last line of defense in systolic heart failure?

Answer 17

first: diuretic
last: inotropic drugs

Question 18

what are the 4 factors that affect cardiac performance?

Answer 18

preload
afterload
contractility
heart rate

Question 19

what is blood pressure largely determined by?

Answer 19

the contraction of the left ventricle

Question 20

in the heart, the more stretch we have, the more

Answer 20

forceable the contraction there will be

Question 21

what is preload?

Answer 21

the measure of stretch of the heart

Question 22

what is the blood that’s left in the heart after every systole called?

Answer 22

end systolic volume

Question 23

what contributes to end diastolic volume?

Answer 23

passive filling
atrial contraction
end systolic volume

Question 24

left ventricle ESV equation

Answer 24

passive filling (65mL)+atrial contraction (25mL)= ESV 50mL

Question 25

Stroke volume = what minus what?

Answer 25

EDV-ESV

Question 26

what is the normal end diastolic range?

Answer 26

4-12mmHg

Question 27

what contributes to altered preload?

Answer 27

increase in EDV, increase in blood volume or increase in venous tone

Question 28

What can reduce preload?

Answer 28

salt restriction diruetics venodilation

Question 29

what is afterload?

Answer 29

BP. the force the heart has to pump against

Question 30

what leads to diastolic heart failure?

Answer 30

increased afterload

Question 31

as output decreases, the body increases

Answer 31

afterload which decreases output

Question 32

what may be more useful for long-term treatment of heart failure?

Answer 32

non-cardiac targets ACE inhibitors ARB's Aldosterone receptor antagonists vasodilators

Question 33

List the steps of heart muscle contraction

Answer 33

AP depolarizes the cell trigger Ca++ comes in and binds to the Ryr receptors Ryr opens on the sarcoplasmic reticulum releasing stored Ca++ Ca++ bathes the troponin tryptomysin complex which dissociates from actin. actin then can interact with myosin. With the help of ATP we have contraction. to reset SERCA pumps Ca++ back into the SR trigger Ca++ is exchanged via the Na+/Ca++ exchanger (3Na+1Ca++) Na+/Ca++ pump (3Na+2K+)

Question 34

How does Digoxin work?

Answer 34

it blocks the Na+/K+ pump. More Na+ in the cell= the Na+/Ca++ exchanger stops working= more Ca++ in the cell= more Ca++ release from the SR=increased inotropy

Question 35

what is another name for the Na+/Ca++ exchanger in pharm

Answer 35

Na+/Ca++ antiporter

Question 36

digitalis increases the _____ of the heart

Answer 36

force of contraction

Question 37

where does digitalis come from?

Answer 37

foxglove plant

Question 38

Why is digoxin so dangerous?

Answer 38

it has a very narrow therapeutic index, it causes arrhythmias

Question 39

what is the only oral positive inotropic agent for heart failure?

Answer 39

digoxin

Question 40

what are the electrical effects of digoxin?

Answer 40

Increases PR decreases QT

Question 41

What is the EKG characteristic of digoxin therapy?

Answer 41

a downward "schwoop" between the S and T. Called the digitalis effect compared to the mustache of famous painter Salvador Dali

Question 42

What is the Therapeutic index of Digoxin?

Answer 42

2

Question 43

What are the little depolarizations that happen before we are out of the absolute refractory period?

Answer 43

early or delayed after depolarizations. Can lead to Vtach or Vfib

Question 44

Digoxin is a ___________ of potassium

Answer 44

competitive inhibitor

Question 45

How does Digoxin induce arrhythmias?

Answer 45

Hypercalcemia d/t it blocking the Na+/K+ pump Hypomagnesium, not sure how

Question 46

what is the IV positive inotrope?

Answer 46

milrinone only one available in the US

Question 47

What does Milrinone target?

Answer 47

PDE3- normally this degrades cAMP to AMP= relaxation. Milrinone blocks it so there's increased cAMP=increased force of contraction

Question 48

What does PDE stand for?

Answer 48

phosphodiesterase

Question 49

beta one selective agonists have an effect on the heart, but do not effect the ______

Answer 49

blood pressure

Question 50

what drugs are more widely used compared to Digoxin for their positive inotropic effects? What class of drug are these?

Answer 50

Dopamine Dobutamine (most widely used) beta adrenergic stimulants

Question 51

What drugs reduce compensatory responses to failure by decreasing afterload?

Answer 51

ACE ARBs

Question 52

How do vasodilators help in heart failure?

Answer 52

decreases preload and afterload

Question 53

What drug is never indicated for acute heart failure, but can be added to the patient's ACE and ARBS regimens for chronic heart failure, and why?

Answer 53

Beta Blockers this reduces the stress on the heart by decreasing the HR and decreasing the force of contraction

Question 54

meds to avoid in heart failure

Answer 54

NSAIDS Thiazolidinediones Metformin

Question 55

What is stage A heart failure?

Answer 55

high risk with no symptoms- lifestyle changes

Question 56

What is stage B heart failure?

Answer 56

structural heart disease, no symptoms- start on ACE

Question 57

What is stage C heart failure?

Answer 57

structural disease with symptoms- start on ACE and B blockers

Question 58

What is stage D heart failure?

Answer 58

refractory symptoms requiring special intervention- Digoxin,Transplantation, ventricular assistive device, CABG

Question 59

IV treatment for Acute heart failure

Answer 59

diuretics dobutamine vasodilators