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Wolff Pharmacology Review > Angina, Hyperlipidemia, Shock > Flashcards

Angina, Hyperlipidemia, Shock Flashcards

1
Q

now the major concern with hypertriglyceridemia, levels need to be very high (e.g., > 1000 mg/dL)

A

acute pancreatitis

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2
Q

a function of diastolic blood pressure, it refers to the pressure that must be generated in the left ventricle before blood begins to exit and can be decreased by arterial vasodilatation

A

afterload

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3
Q

widely used dihydropyridine calcium channel blocker

A

amlodipine

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4
Q

pain felt when there is a mismatch between oxygen supply and oxygen demand in the heart, can be worsened by the abrupt withdrawal of beta blockers

A

angina pectoris

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5
Q

evidence supports prompt administration to broad-spectrum agents for cases of septic shock

A

antibiotics

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6
Q

side of the circulation in which calcium channel blockers exert their vasodilatory effects to influence afterload with little to no effect on preload

A

arterial

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7
Q

best selling drug ever drug because of its ability to lower plasma cholesterol levels, now available as a generic

A

atorvastatin

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8
Q

adrenergic receptor population blocked by atenolol

A

beta1

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9
Q

class of drugs that is not useful for vasospastic angina, but can decrease frequency of angina attacks, reduce nitroglycerin consumption and increase exercise tolerance in those with frequent attacks of angina due to stress, physical activity due to the activities of daily living

A

beta blockers

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10
Q

time during which heart receives majority of its blood flow, using drugs to increase it decreases myocardial ischemia

A

between beats

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11
Q

drug class known for its ability to cause severe constipation, bleeding hemorrhoids, and flatulence, and to interfere with the absorption of fat soluble vitamins and various other drugs

A

bile acid sequestrants

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12
Q

among the adverse CNS effects some experience when using beta blockers

A

bizarre dreams

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13
Q

trauma, brain injury, adrenal tumors, coarctation of the aorta, renal artery stenosis and excessive salt intake in somebody with untreated primary hypertension are reasons this can quickly increase to life-threatening levels

A

blood pressure

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14
Q

among the adverse effects of beta-blockers on the heart

A

bradycardia

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15
Q

abbreviation for a drug class that has a rare but known complication of gingival hyperplasia

A

CCB

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16
Q

blockade of its synthesis in the liver by statins causes the liver to take up more LDL from the systemic circulation

A

cholesterol

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17
Q

a bile-acid sequestrant, several grams of this gritty powder must be consumed per day to lower plasma cholesterol levels; drug class has minimal effect on triglyceride and HDL levels

A

cholestyramine

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18
Q

deliver the triglycerides in the diet to the myocytes, adipocytes and liver

A

chylomicrons

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19
Q

refers to phase of septic shock in which profound hypotension and hypoperfusion lead to cold mottled skin with petechiae, initially in feet, that slowly progresses upward to cause irreversible multi-system organ failure

A

cold

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20
Q

a newer, better tolerated but more expensive alternative to colestipol or cholestyramine

A

colesevelam

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21
Q

a bile-acid sequestrant, it lowers plasma cholesterol levels by carrying bile into the toilet, thus forcing the liver to synthesize more from cholesterol

A

colestipol

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22
Q

refers to a “back roads” blood vessel that can help deliver blood flow to ischemic regions of the heart, these capabilities can increase over time and can be augmented with some antianginal drugs

A

collateral

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23
Q

increases in AV node as a consequence of beta1-receptor-mediated sympathetic tone

A

conduction

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24
Q

caused by the ability of verapamil to interfere with the pulsatile/peristaltic actions of the GI tract

A

constipation

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25
Q

refers to the “oomph” generated by the interactions between actin and myosin in the cardiomyocytes for a given degree of preload and afterload, decreased by beta blockers and by the direct actions of calcium channel blockers

A

contractility

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26
Q

determined by diastolic blood pressure and coronary vascular resistance

A

coronary blood flow

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27
Q

administering low doses of these improves shock reversal

A

corticosteroids

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28
Q

typically all that is required to treat all but the most severe cases of hypovolemic shock

A

crystalloid fluid

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29
Q

a benzothiazepine calcium channel blocker, its effects are rather intermediate between verapamil and the dihydropyridines, especially useful as a class II antiarrhythmic drug

A

diltiazem

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30
Q

ending of a drug name that suggests it is a member of the dihydropyridine class of calcium channel blockers that binds to calcium channels that are inactivated, as happens more often in blood vessels with stable levels of tone (or spasm)

A

dipine

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31
Q

used to treat cardiogenic shock, low doses do not preserve renal function as was once thought

A

dopamine

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32
Q

predictable side effect of dihydropyridine calcium channel blockers

A

edema

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33
Q

hypertensive ____, refers to elevated blood pressure (e.g., SAP > 1808 or DAP > 120) that is damaging organs

A

emergency

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34
Q

name give to the circulation in which statins are largely confined

A

enterohepatic

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35
Q

drug of choice for anaphylactic shock since it reverses bronchoconstriction, also acceptable first choice for septic shock

A

epinephrine

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36
Q

it is good for you, but will not lower your LDL levels

A

exercise

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37
Q

generally well tolerated drug that lowers plasma cholesterol levels by inhibiting NPC1L1, a transport molecule in the GI epithelium responsible for absorption of dietary cholesterol and plant sterols

A

ezetimibe

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38
Q

a drug administered to lower plasma triglycerides, member of a drug class associated with an increased risk for gallstones

A

fenofibrate

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39
Q

generally well tolerated class of drugs that is best at lowering triglyceride levels, benefits of doing this are called into question by a recent trial suggesting statins were responsible for all benefits seen in diabetic patients with hypertriglyceridemia

A

fibrates

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40
Q

among the body parts that can become cold with beta blocker use

A

fingers

41
Q

intense and associated with the use of niacin for hyperlipidemia, can be minimized by using and NSAID and/or taking extended-release niacin

A

flushing

42
Q

a drug administered to lower plasma triglycerides, exerts its effect by interacting with PPAR-alpha

A

gemfibrozil

43
Q

can be severe with niacin use to modify plasma lipid levels

A

GI distress

44
Q

the lipoproteins that function as peripheral cholesterol scavengers, considered low if < 40 mg/dL

A

HDL

45
Q

a determinant of cardiac work, decreased by beta blockers

A

heart rate

46
Q

niacin is among the drugs that can cause this, with dark urine, clay-colored stools and jaundice

A

hepatotoxicity

47
Q

among the troubling complications associated with the use of niacin for lipid abnormalities

A

hyperglycemia

48
Q

very common in the general population due to its association with common conditions such as obesity, pregnancy and diabetes mellitus

A

hypertriglyceridemia

49
Q

type of scheduling required for transdermal nitroglycerin patches to minimize tolerance

A

intermittent

50
Q

the cholesterol rich lipoprotein, its oxidation and deposition in the vascular tissues is thought to contribute to atherosclerosis; optimal value is < 100 mg/dL, considered high if > 160 mg/dL

A

LDL

51
Q

seen in 0.5-2% of patients using statins, the reason serum transaminase levels are monitored

A

liver injury

52
Q

functional name assigned to the voltage-gated calcium channels blocked by calcium channel blockers

A

L-type

53
Q

cardioselective beta-blocker, now sold in extended release formulation as Toprol XL

A

metoprolol

54
Q

a relatively common adverse effect of statins, risk is increased by combining with niacin or fibrates

A

muscle pain

55
Q

best drug for raising plasma HDL levels, also lowers LDL and VLDL; data for recent clinical trials indicates that its beneficial effects on those values does not translate into reductions in mortality

A

niacin

56
Q

prototypical dihydropyridine calcium channel blocker, typically combined with a beta-blocker when treating angina since it increases heart rate when used by itself

A

nifedipine

57
Q

routinely utilized as necessary for prompt relief of angina symptoms or angina prophylaxis due to its ability to preferentially (but not exclusively) dilate the venous circulation to decrease preload

A

nitroglycerin

58
Q

short half-life drug that increase cGMP levels in both arteries and veins to cause a mixed vascular relaxation, a drug of choice for hypertensive emergencies because the infusion rate can be adjusted to quickly fine tune the desired blood pressure response

A

nitroprusside

59
Q

abbreviation for nitric oxide, the gas released by endothelial cells that diffuses into the underlying vascular smooth muscles cells to cause vasodilatation (i.e., EDRF)

A

NO

60
Q

arguably the drug of choice for treating cardiogenic shock and septic shock

A

norepinephrine

61
Q

the type of fatty acids contained in fish oil, FDA approved to help lower very high triglyceride levels

A

omega 3

62
Q

likely consequence of lowering blood pressure too far too fast in a hypertensive emergency superimposed on top of chronic high blood pressure

A

organ failure

63
Q

class of drugs that preferentially dilates veins to increase venous capacitance and thereby decrease cardiac preload

A

organic nitrates

64
Q

inability to meet this is responsible for the myocardial ischemia caused by atherosclerosis in the coronary blood vessels (i.e., “chronic stable”), influenced by myocardial contractibility, heart rate and wall tension

A

oxygen demand

65
Q

unstable and variant (Prinzmetal) forms of myocardial ischemia cause angina pain due to its disruption

A

oxygen supply

66
Q

target of a new exciting class of drugs capable of lowering plasma cholesterol levels ~70% by preventing LDL-receptor breakdown along with LDL in liver; i.e., recycled to cell surface to capture more LDL

A

PCSK9

67
Q

example of a beta blocker with “intrinsic sympathomimetic activity”, means it is a partial agonist that will produce a minimal amount of beta mediated response; specific uses are limited, but test fodder and may have utility when patient is at risk for heart block nevertheless needs a drug to suppress heart rate

A

pindolol

68
Q

less efficacious than atorvastatin, but arguably a better choice due to lower risk of adverse effects when combined with a fibrate to treat mixed hyperlipidemia

A

pravastatin

69
Q

absolute contraindication for statins

A

pregnancy

70
Q

refers to how much blood is in the ventricles at the end of diastole, influenced by venous vascular tone, blood volume and skeletal muscle compression of veins with their one-way valves that direct blood flow back toward the heart

A

preload

71
Q

prototypical nonselective beta-blocker

A

propranolol

72
Q

a drug that has been shown to be beneficial in treating angina despite no significant effect on blood pressure, heart rate, or rate-pressure product; can be added to other anti-anginal therapies

A

ranolazine

73
Q

occurs when drug-induced decreases in preload and/or afterload cause a fall in blood pressure

A

reflex tachycardia

74
Q

its secretion by the renal afferent arterioles is increased by beta1-adrenergic receptor stimulation and results in the formation of a vasoconstrictor hormone

A

renin

75
Q

unlike skeletal muscle, cardiac muscle cannot do this

A

rest

76
Q

rare but potentially fatal complication of statin use, often shows up on exams as urinalysis positive for hemoglobin (which is actually myoglobin) but with no red blood cells

A

rhabdomyolysis

77
Q

age (> 45 male, > 55 female), family history, hypertension and cigarette smoking are among these for coronary artery disease

A

risk factors

78
Q

CCB clevidipine, D1 agonist fenoldopam and beta-blocker esmolol are particularly suited for treating hypertensive emergencies because of this

A

short half-life

79
Q

phosphodiesterase type V inhibitor used for erectile dysfunction that can cause severe hypotension in patients using organic nitrates to treat angina pectoris

A

sildenafil

80
Q

blockade of a pathological late current of this cation is thought to be the mechanism of action for ranolazine; facilitates relaxation of the myocardium during diastole

A

sodium

81
Q

form of guanylate cyclase responsible for nitric oxide-induced cGMP formation

A

soluble

82
Q

generally well-tolerated class of drugs that blocks HMG-CoA reductase, solid evidence that it reduces cardiovascular morbidity and mortality

A

statins

83
Q

region of the myocardium in which blood flow is increased when preload is decreased

A

subendocardial

84
Q

preferred route for nitroglycerin administration for acute angina attacks, bypasses first-pass effect

A

sublingual

85
Q

by the time a person has taken this nitroglycerin pill at 5 min intervals for anginal pain, they need to get to ED ASAP since likely a myocardial infarction

A

third

86
Q

refers to need for increasing amounts of drug (e.g., nitroglycerin) to get the same effect, a function of the dose and frequency of drug administration

A

tolerance

87
Q

route for nitroglycerin administration that has slow onset with long duration, suitable for prophylaxis against frequent anginal attacks

A

transdermal

88
Q

also known as combined hyperlipidemia in which there are elevations of both LDL and VLDL, common

A

type IIb

89
Q

hypertensive ______ refers to SAP > 180 mm Hg or DAP > 110 mm Hg, but no associated organ damage, requires treatment optimization but generally not hospitalization

A

urgency

90
Q

refers to the decrease in post-obstruction blood flow that is seen when other blood vessels are dilated

A

vascular steal

91
Q

underlies the severe headaches, facial flushing, hypotension, etc., that are side effects of nitroglycerin use

A

vasodilatation

92
Q

vasoactive peptide hormone from posterior pituitary, a second line vasopressor for treating shock

A

vasopressin

93
Q

form of angina that benefits from calcium channel blockers and organic nitrates but generally not from beta blockers or ranolazine

A

vasospastic

94
Q

phenylalkylamine calcium channel blocker that exerts its effects preferentially on the beating heart because its ability to block the channels is frequency/use dependent, decreases heart rate and exerts negative inotropic effects

A

verapamil

95
Q

the triglyceride-rich lipoprotein made by the liver, normally < 150 mg/dL; hepatic production is decreased by niacin

A

VLDL

96
Q

to generate or maintain a given pressure, increases dramatically as radius of chamber increases; mathematically defined by LaPlace

A

wall tension

97
Q

refers to initial phase of septic shock in which increased cardiac output due to decreased peripheral resistance and plasma volume is lost into “third spaces” ; large amounts of crystalloid fluid are required to maintain cardiac filling

A

warm

98
Q

a potential adverse respiratory effect of beta blockers

A

wheezing

Wolff Pharmacology Review (12 decks)

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