Angina, Hyperlipidemia, Shock Flashcards by Sarah Gillen

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

acute pancreatitis

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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

afterload

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widely used dihydropyridine calcium channel blocker

amlodipine

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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

angina pectoris

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

antibiotics

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

arterial

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

atorvastatin

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adrenergic receptor population blocked by atenolol

beta1

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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

beta blockers

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

between beats

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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

bile acid sequestrants

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among the adverse CNS effects some experience when using beta blockers

bizarre dreams

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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

blood pressure

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among the adverse effects of beta-blockers on the heart

bradycardia

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

CCB

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

cholesterol

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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

cholestyramine

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

chylomicrons

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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

cold

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

colesevelam

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

colestipol

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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

collateral

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

conduction

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

constipation

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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

contractility

determined by diastolic blood pressure and coronary vascular resistance

coronary blood flow

administering low doses of these improves shock reversal

corticosteroids

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

crystalloid fluid

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

diltiazem

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)

dipine

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

dopamine

predictable side effect of dihydropyridine calcium channel blockers

edema

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

emergency

name give to the circulation in which statins are largely confined

enterohepatic

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

epinephrine

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

exercise

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

ezetimibe

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

fenofibrate

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

fibrates

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

fingers

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

flushing

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

gemfibrozil

can be severe with niacin use to modify plasma lipid levels

GI distress

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

HDL

a determinant of cardiac work, decreased by beta blockers

heart rate

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

hepatotoxicity

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

hyperglycemia

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

hypertriglyceridemia

type of scheduling required for transdermal nitroglycerin patches to minimize tolerance

intermittent

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

LDL

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

liver injury

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

L-type

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

metoprolol

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

muscle pain

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

niacin

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

nifedipine

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

nitroglycerin

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

nitroprusside

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)

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

norepinephrine

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

omega 3

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

organ failure

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

organic nitrates

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

oxygen demand

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

oxygen supply

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

PCSK9

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

pindolol

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

pravastatin

absolute contraindication for statins

pregnancy

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

preload

prototypical nonselective beta-blocker

propranolol

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

ranolazine

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

reflex tachycardia

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

renin

unlike skeletal muscle, cardiac muscle cannot do this

rest

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

rhabdomyolysis

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

risk factors

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

short half-life

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

sildenafil

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

sodium

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

soluble

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

statins

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

subendocardial

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

sublingual

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

third

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

tolerance

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

transdermal

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

type IIb

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

urgency

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

vascular steal

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

vasodilatation

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

vasopressin

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

vasospastic

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

verapamil

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

VLDL

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

wall tension

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

warm

a potential adverse respiratory effect of beta blockers

wheezing