ACUTE Cardiovascular

Question 1

Which meds are vasopressors:

Answer 1

• Norepinephrine
  
  • Epinephrine
  • Phenylephrine
  • Vasopressin
  • Dopamine (at higher doses)
  • Midodrine (oral alpha-1 agonist for step-down weaning)

Question 2

Which meds cause tachycardia

Answer 2

• Epinephrine
  
  • Dopamine
  • Dobutamine
  • Hydralazine
  • Isoproterenol
  • Nitroprusside (reflex)

Question 3

Which meds DO NOT cause tachycardia

Answer 3

• Phenylephrine (may actually cause reflex bradycardia)
  
  • Vasopressin
  • Beta-blockers (e.g., Metoprolol)
  • Non-DHP CCBs (e.g., Diltiazem)

Question 4

Which meds result in increased CO

Answer 4

• Milrinone
  
  • Dobutamine
  • Dopamine
  • Epinephrine
  • Digoxin
  • Norepinephrine (modestly)

Question 5

Which meds increase myocyte contractility

Answer 5

(Positive inotropes)
* Digoxin
* Dobutamine
* Epinephrine
* Milrinone
* Levosimendan (calcium sensitizer)

Question 6

Which meds prolong QT intervals

Answer 6

• Class Ia (e.g., Quinidine, Procainamide)
  
  • Class III (e.g., Amiodarone, Sotalol, Dofetilide)
  • Risk of Torsades de Pointes

Question 7

Which meds would benefit patient with cardiogenic shock

Answer 7

• Milrinone (esp. if on beta-blocker)
  
  • Dobutamine
  • Norepinephrine (if hypotensive too)

Question 8

Which medications are indicated for primary management of acute decompensated heart failure

Answer 8

• Milrinone
  
  • Loop diuretics (e.g., Furosemide)
  • Nitroglycerin (if hypertensive with pulmonary edema)

Question 9

Which medications are not indicated for primary management of acute decompensated heart failure

Answer 9

• Phenylephrine (increases afterload)
  
  • Non-DHP CCBs (e.g., Diltiazem)
  • Nifedipine (DHP CCB)

Question 10

Which meds you’d recommend for patient who has asthma with an underlying arrhythmia

Answer 10

• Avoid beta-blockers (esp. nonselective)
  
  • Use Non-DHP CCBs (e.g., Diltiazem or Verapamil) cautiously (unless HFrEF)
  • Digoxin can also help with rate control in Afib

Question 11

Which meds used to treat junctional tachycardia

Answer 11

• Beta-blockers (if no contraindications)
  
  • Non-DHP CCBs: verapamil, diltiazem
  • Amiodarone (in more severe/unstable cases)

Question 12

Chronic Afib treatment with decreased CO

Answer 12

• Digoxin
  
  • Beta-blockers (e.g., Metoprolol)
  • Amiodarone (for rhythm control)
  • Avoid Non-DHP CCBs if HFrEF

Question 13

Class III antiarrhythmic agents: potassium channel blockers

Answer 13

Amiodarone
Dofetilide : strict QT monitoring, oral only
Ibutilide: IV only, rapid cardioversion in afib/flutter
Sotalol: nonselective B-blocker + K channel blocker
* Dronedarone: like amid, rapid conversion afib/flutter

Question 14

Positive Lusitropic

Answer 14

myocardial relaxation (e.g., beta-agonists ↑ lusitropy)

Question 15

Bathmotropic

Answer 15

: excitability (threshold potential, not a common clinical term)

Question 16

Dromotropic

Answer 16

conduction velocity (e.g., beta-blockers ↓ it)

Question 17

Chronotropic

Answer 17

heart rate (e.g., epinephrine ↑, beta-blockers ↓)

Question 18

RAAS System Summary

Answer 18

1. ↓ perfusion → Renin release
   
   2. Renin → Angiotensin I → (via ACE) → Angiotensin II
   3. Angiotensin II → vasoconstriction + aldosterone release
   4. Aldosterone → Na⁺/water retention → ↑ BP

Question 19

midodrine

Answer 19

MOA: alpha agonist
Indications: orthostatic hypotension
Contraindications: supine HTN

Question 20

milrinone

Answer 20

MOA: PDE3 inhibitor> increases cardiac contractility, decreased vascular resistance
Indications: low output HF (works independently of beta receptors)
Contraindications: risk of arrhythmias, hypotension, HF exacerbation, renal failure

Question 21

digoxin

Answer 21

MOA: Na⁺/K⁺ ATPase inhibitor> less Na exchange = more Ca in cells = increased contractility
Indications: afib, HFrEF
Contraindications: renal dosing, risk of toxicity

Question 22

carvedilol

Answer 22

MOA: β/α-blocker
Indications: HFrEF
Contraindications: asthma, bradycardia

Question 23

nitroglycerin

Answer 23

MOA: NO donor> balanced arterial and venous dilation
Indications: angina, pulmonary edema, preload reduction
Contraindications: headache, tolerance

Question 24

ARBS

Answer 24

MOA: block AT1 receptors> prevent vasoconstriction and aldosterone release
Indications: HF, HTN
Contraindications: hyperkalemia, pregnancy

Question 25

nitroprusside

Answer 25

MOA: NO donor Indications: rapid BP control Contraindications:cyanide toxicity,

Question 26

Calcium sensitizer: levosimendan

Answer 26

not FDA approved, less arrhythmia risk

Question 27

BB and acute coronary syndrome

Answer 27

MOA: decrease HR, decrease O2 demand Indications: fib, post MI, HFrEF Contraindications: avoid in acute decompensated heart failure and asthma

Question 28

digibind

Answer 28

MOA: binds to dig and excreted in urine Indications: toxicity Contraindications: hypokalemia

Question 29

dopamine

Answer 29

MOA: improve SV and CO, increase arterial BP Indications: dose dependent effects Contraindications: arrhythmia risk

Question 30

Contraindications of non DHP calcium channel blocker

Answer 30

* HFrEF * Bradycardia * 2nd/3rd degree AV block

Question 31

Which med to use for weaning stable patient from IV pressers

Answer 31

Midodrine PO TID during daytime (ideal for step-down from norepinephrine)

Question 32

Appropriate vasodilation for initial management of HTN with pulmonary edema

Answer 32

Nitroglycerin (venodilator → ↓ preload)

Question 33

Signs of dig toxicity

Answer 33

*N/V, visual disturbances (yellow-green halos), confusion, arrhythmias, bradycardia

Question 34

Indications of use for class 1B antiarrhythmics

Answer 34

* Ventricular arrhythmias, especially post-MI * Examples: Lidocaine, Mexiletine

Question 35

Which antiarrhythmic puts you at the greatest risk of torsades

Answer 35

* Class Ia (Quinidine, Procainamide) * Class III (Dofetilide, Sotalol)

Question 36

Which receptors are responsible for increasing systemic blood pressure while on vasopressin

Answer 36

V1 receptor: vasoconstriction → ↑ systemic BP

Question 37

Contraindications for ACE and ARBs

Answer 37

* Pregnancy * Hyperkalemia * Bilateral renal artery stenosis * Severe renal dysfunction

Question 38

SE of chronic amiodarone therapy

Answer 38

* Pulmonary fibrosis * Hepatotoxicity * Thyroid dysfunction * Blue-gray skin * Corneal deposits * Bradycardia

Question 39

Which vasodilator puts you at risk cyanide toxicity

Answer 39

Nitroprusside

Question 40

BEERs criteria and why avoid hydralazine in elderly

Answer 40

Risk of orthostatic hypotension * Unpredictable half-life * Reflex tachycardia * Risk of falls

Question 41

Whats special about sotalol

Answer 41

* Beta-blocker + Class III (K⁺ blocker) * Dual antiarrhythmic effect * QT prolongation risk

Question 42

Contraindications for 1C agents

Answer 42

* Structural heart disease * Post-MI * Heart failure

Question 43

Diuretic classes and their side effects

Answer 43

Loop, SE ototoxicity, decrease K &Ca Thiazide: HCTZ, SE high Ca, high glucose, high uric acid K sparing, spironolactone, increased K, gynecomastia

Question 44

Best drug for hypertension emergency in pregnancy is

Answer 44

Labetalol (IV), Hydralazine (also used but not preferred due to unpredictable response)