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Step 1 USMLE Rx - Cardio > Anti-Anginas / HTN / Blood Thinners > Flashcards

Anti-Anginas / HTN / Blood Thinners Flashcards

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USMLE® Step 1 flashcards
1
Q

Hydralazine

  • A: MOA*
  • B: Indication (3)*
  • C: Adverse Effects (4)*
  • D: Contraindication*
  • D2: _____ can DEC* Hydralazine effectiveness
A

“Hydralazine and Minoxidil make you FAT (+ 1 for Hydralzine)”

A: Arteriole Vasodilator

B:

  • Resistant HTN
  • Pregnancy HTN
  • [Mitral Regurgitation]

C:

  1. Tachycardia
  2. Angina exacerbation
  3. Fluid retention
  4. DILE (Drug-induced Lupus Erythematosus)

D: CAD

D2: NSAIDs can DEC effectiveness

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2
Q

Chlorthalidone

  • A: MOA*
  • B: Indication*
  • C:* Why are Thiazides often used in combination with antiHTN drugs that vasoDilate
A

A: Thiazide diuretic

B: [1st Line - Uncomplicated HTN]

C: Thiazides are often used in combination with antiHTN drugs that vasoDilate in order to counteract Adverse side effects of BP change in presence of vasodilation and volume contraction

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3
Q

Furosemide Indication

A

HTN in Severe Renal Insufficiency

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4
Q

Nifedipine

  • A: MOA (2)*
  • B: Indication (3)*
  • C: Side Effects (2)*
A

A:

  • [mild Ca+ channel blocker]
  • [Selective Vasodilator]

B:

*[1st Line - HTN]

*DM

*Hyperlipidemia

C:

(x) acute reflex tachycardia
(x) Peripheral Edema (from Arterial dilation being > than venous)

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5
Q

Verapamil

  • A: MOA*
  • B: Indication*
  • C: Side Effects (2)*
A

A: [Ca+ channel blocker]

B: [1st Line - HTN]

C:

  • Constipation (from anti-cholinergic effects)
  • Bradycardia
  • has greatest effect on heart out of the Non-dihydropyridines*
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6
Q

Clonidine

  • A: MOA*
  • B: Indication*
  • C: Adverse Effects (4)*
A

A: [Medullary Alpha 2 AGONIST]

B: [2nd Line - HTN]

C:

(x) Sedation
(x) Dry Mouth
(x) Contact Dermatitis with transdermal patch
(x) MUSTH DISCONTINUE SLOWLY TO PREVENT REBOUND HTN

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7
Q

Guanfacine

  • A: MOA*
  • B: Indication*
A

A: [Alpha 2 AGONIST]

B: [2nd Line - HTN]

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8
Q

Methyldopa

  • A: MOA*
  • B: Indication*
  • C: How does it affect Sympathetic Tone? What 3 things does Methyldopa prevent?*
  • D: Side Effect*
A

A: [Alpha 2 AGONIST]

B: Pregnancy HTN

C:

**DEC Sympathetic Tone but also competes for [DOPA Decarboxylase] –> prevents [L-Dopas Therapeutic affects], production of dopamine and [NorEpi/Epi in peripheral nerves]

D: SEDATION

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9
Q

Phenoxybenzamine

  • A: MOA*
  • B: Indication (2)*
  • C: How does this class of drugs work?*
A

A: [General Alpha BLOCKER]

B:

  • Rx for pheochromocytoma before surgery
  • HTN 2º to pheochromocytoma

C: Blocks post-synaptic alpha receptors –> prevents VENOUS constriction

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10
Q

Prazosin

  • A: MOA*
  • B: Indication*
  • C: What are the other 2 Drugs similar to this tht are QD dosing?*
  • D: Side Effects (3)*
A

A: [Alpha 1 BLOCKER]

B: [2nd line - Chronic HTN]

C: [Terazosin / Doxazosin] which are dosed QD and

D:

  • hypOtension (postural and [occurs especially in 1st dose])
  • Beneficial DEC in [LDL/HDL ratio]
  • Fluid Retention
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11
Q

Terazosin

  • A: MOA*
  • B: Indication*
  • C: Drugs in this class have less ______ effects than ______ or __________*
A

A: [Alpha 1 BLOCKER]

B: [2nd line - Chronic HTN]

C: [Alpha 1 BLOCKERS] have [less tachycardia effects] than vasodilators or [general alpha blockers]

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12
Q

Doxazosin

  • A: MOA*
  • B: Indication*
A

A: [Alpha 1 BLOCKER]

B: [2nd line - Chronic HTN]

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13
Q

Nadolol

  • A: MOA*
  • B: Indication (2)*
A

A: [Beta BLOCKER]

B:

  • [Long term angina]
  • HTN
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14
Q

Pindolol

  • A: MOA*
  • B: Indication (2)*
A

A: [Beta-Blocker] with partial agonist activity at both B1 and B2 adrenergic Receptor

B:

  • Chronic HTN
  • [pts with symptomatic bradycardia or postural hypOtension]
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15
Q

Metoprolol

  • A: MOA*
  • B: Indication (2)*
  • C: Side Effects*
A

A: [Lipophilic B1 Blocker] (so may have central sympatholytic effect)

B:

  • HTN
  • Long Term Angina

C: CNS Side Effects - Insomnia

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16
Q

Atenolol

  • A: MOA*
  • B: Indication*
A

A: [Hydrophilic B1 Blocker] = NO CNS SIDE EFFECTS :-)

B: Chronic HTN

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17
Q

Labetolol

  • A: MOA*
  • B: Indication (2)*
A

A: [Mixed alpha and beta BLOCKER tht’s Lipophilic]

B:

  • Chronic HTN
  • [1st choice- Pregnancy HTN]
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18
Q

Carvedilol

  • A: MOA (2)*
  • B: Indication (2)*
A

A:

  • [Mixed alpha and beta Blocker]
  • NO generator (vasodilatory)

B:

*Chronic HTN

*[Compensated CHF]

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19
Q

Minoxidil

  • A: MOA*
  • B: Indication*
  • C: Adverse Effects (3)*
A

A: Arteriole VasoDilator

B: Resistant HTN

C:

  1. Tachycardia
  2. Angina exacerbation
  3. Fluid retention

“Hydralazine and Minoxidil make you FAT”

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20
Q

Nitroprusside

  • A: MOA*
  • B: Indication*
  • C: Adverse Effect*
  • D: How does it affect SV*
A

A: [General VasoDilator] (Arterial AND Venous –> DEC Afterload AND Preload)

B: Acute HTN Crisis

C: can cause cyanide poisoning

D: SV is maintained/unchanged!

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21
Q

Captopril

  • A: MOA*
  • B: Indication*
  • C: Con for this specific Drug*
A

A: [ACEk2 inhibitor]

B: [1st line- Chronic HTN]

C: Requires BID dosing

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22
Q

Enalapril

  • A: MOA*
  • B: Indication (2)*
  • C: Is converted into ______ in liver and has ____ (shorter./ longer) half-life ​*
A

A: [ACEk2 inhibitor]

B:

*[1st line- Chronic HTN]

*Heart Failure

C: Is converted into –> [Active metabolite enalaprilat] in liver and has longer half-life

23
Q

Lisinopril

  • A: MOA*
  • B: Indication*
  • C: Pros for this particular drug (2)*
  • D: Adverse Effects (3)*
A

A: [ACEk2 inhibitor]

B:

*[1st line- Chronic HTN]

C:

  • IS NOT A PRODRUG - and has more predictable onset and [duration of action] than Prodrugs.
  • Longer Half-Life

D:

(x) Hyperkalemia (especially when given w/ [K+ Sparing Diuretics])
(x) Dry cough
(x) Angioedema

D:

24
Q

Losartan

  • A: MOA*
  • B: Indication*
  • C: Side Effects*
  • D: Relation to [ACEk2 inhibitors] (2)*
A

A: [ARB - AT1](AT1 Receptor Blocker)

B: [1st line- Chronic HTN]

C: (x) Hyperkalemia

D: SAME Drug interactions and Contraindications as [ACEk2 inhibitors] but no cough or angioedema

25
Q

[T or F] One of the causes of aFib is Sustained HTN

A

TRUE

26
Q

A: Why do you use a Concomitant beta blocker, [ACEk2 inhibitor], or ARB

B: How does [Beta Blockers] interact with Thiazide Diuretics

C: Which is a better diurectic between [Loop Diuretics] and [Thiazide Diuretics] in normal renal pts? Explain why.

A

A: diminishes K+ loss by blunting the diuretic-induced rise in renin and aldosterone levels

B: INC Hyperlipidemia and Hyperglycemia

C: THIAZIDE DIURETICS! (Loop Diuretics cause rebound Na+ retention so instead, they’re reserved for refractory / [renal insufficiency] /CHF pts)

27
Q

[T or F] Loop Diuretics are often used alone for HTN

A

FALSE!

LOOP DIURETICS ARE NOT USED ALONE!

28
Q

Name the 3 HTN Drugs that are contraindicated with [K+ Sparing Diuretics - SEAT]

A

” ABA HATED her SEAT”

  1. ACEk2 inhibitors
  2. ARBs
  3. Beta Blockers
29
Q

Diltiazem is a _______ [L-type __ channel blocker] that reduces _______ AND _______

B: Side Effect

A

Diltiazem is a NON-Dihydropyridine [L-type Ca+ channel blocker] that reduces [Cardiac Output] AND [Peripheral Resistance]

B: Bradycardia

30
Q

A: Ca+ Channel blocker Relative Contraindication (2)

B: Ca+ Channel Blocker ABSOLUTE CONTRAINDICATION

C: What’s [Ca+ Channel Blocker] relation to MI

A

A: Pts with liver failure or taking [Beta Blockers]

B: Pts with SA/AV Node conduction disturbances

C: Patients taking short-acting [Ca+ channel blockers] were 1.6 times more likely to have MI !

31
Q

A: ______ is given in combination with diuretics and works by disrupting NorEpi vesicular storage.

B: Side Effects (4)

A

A: Reserpine is given in combination with diuretics and works by disrupting NorEpi vesicular storage.

B: Depression / Nasal Congetion / [Potentiates MAOIs] /[HTN crisis]

32
Q

Propranolol

A: MOA

B: Indications (2)

C: Side Effects

A

A: [General Beta Blocker]

B:

  • adjunct to prevent reflex tachycardia from tx with direct vasodilators,
  • compensatory sodium retention with diuretics

C: CNS - dependent side effects

33
Q

There is a class of BETA BLOCKERS that have the ability to VasoDilate. How do they do this? (2)

A
  1. increasing nitric oxide release
  2. blocking 􏰂[alpha adrenergic receptors]
34
Q

Beta Blocker group

Adverse Effects

A: All (6)

B: [General beta blocker]

C: Lipophilic beta blocker] (3)

A

A: BHITHER!

  1. Bradycardia
  2. Impotence sexually
  3. Triglyceride INC
  4. Heart Block
  5. Hyperglycemia (can mask [insulin-induced hypOglycemia] and (Hyperglycemia occurs less with cardioselective Bblockers),
  6. Exercise tolerance DEC (less so with 3rd generation drugs)
  7. Raynaud’s Phenomenon (cold extremities)

B: Bronchospasm

C: Insomnia –> FATIGUE –> Depression

35
Q

A: Why should drugs that interfere with angiotensin II production NOT be given to [2nd/3rd trimester pregnant women]?

B: What other condition is [ACEk2 inhibitors] or ARBs contraindicated with?

C:

Other uses of [ACEk2 inhibitors] include…

  • prolong survival in pts with ______ or [____ dysfunction after MI]
  • preserves ______ function in patients with diabetes
A

A: Ang II is important in fetal renal development

B: Pt with [Bilateral renal stenosis] because their renal perfusion pressure depends mostly on [Angiotensin 2]

C: [ACEk2 inhibitors] do

  • prolong survival in pts with heart failure or [LV dysfunction after MI]
  • preserves renal function in patients with diabetes
36
Q

A: Losartan (ARBs) are less efficacious in patients of ______ descent when used as ______

A2: Which drugs are recommended as 1st line for this descent in Uncomplicated HTN? (2)

B: Why is it Good to administer [Ca+ Channel Blockers + ACEk2 inhibitors]

A

A: Losartan (ARBs) are less efficacious in patients of African descent when used as monotherapy

A2: Instead, Use [Ca+ Channel Blockers] or Diuretics in African Descent pts

B: CCBs can reduce fluid retention

37
Q

A: Which AntiHTN drugs are best safe for DM pts

B: Which AntiHTN drug is actually used for HTN prophylaxis in DM pts

A

A: have few adverse effects on carbohydrate metabolism ​

  • [ACEk2 inhibitors]
  • alpha-blockers,
  • CCBs

B: [ACEk2 inhibitors]

38
Q

A: List the 4 Mechanisms of Anti-Angina tx

B: List Medications for each Mechanism

A
39
Q

Name an equally effective [Anti-Platelet] to ASA

A

[ADP Receptor Blockers]

(Clopidogrel / Prasugrel / Ticlopidine)

40
Q

A: Name the common therapy for [Transient Ischemic Attack] px

B: Side Effect of this drug

A

A: ASA / aspirin –> impairs Platelet Aggregation

B: [GI Bleeding] from DEC prostaglandin-mediated protection

41
Q

FenolDopam

A: MOA

B: Effects (2)

C: What pt demographic benefits most from this drug?

D: Route of Admin

A

A: [Dopamine 1 - Agonist]

B: Arteriolar Dilation of Renal and Splanchnic blood vessels =

  1. INC Renal Perfusion –> INC Natriuresis–> DEC BP
  2. DEC [Systemic Vascular Resistance] –> DEC BP

C: [Hypertensive Emergency Pts WITH concomitant renal insufficiency]

D: IV

42
Q

Bepridil

A: MOA

B: Indication

A

A: Ca+ Channel Blocker

B: 2nd Line Anti-Anginal

43
Q

Which 4 Drug groups improves SURVIVAL in HF pts?

A

“BANA helps HF pts live Loonger”

  1. Beta Blockers (Metoprolol / Carvedilol)
  2. [ACEk2 inhibitors AND ARBs]
  3. Aldosterone Blockers (Spironolactone / Eplerenone)
  4. [Nitrates + Hydralazine]
44
Q

SE of Thiazide Diuretics (8)

B: Which one of these SE is associated with [Muscle Weakness and Rhabdomyolysis]?

A

HyperGLUC & hypOvikn

Hyper…GLYCEMIA / LIPIDEMIA / URICEMIA / CALCEMIA

+

hypO… volemia / [impotence alone] / [kalemia–> metabolic alkalosis] / natremia

B: [hypOkalemia–>metabolic alkalosis]

45
Q

A: Stable Angina Tx (3)

B: Which drug has to be given with something else, and why?

A

A:

  1. Nitrates (NTG)
  2. CCB
  3. Beta Blockers

B: Give Nitrates with Beta Blockers to prevent reflex Tachycardia

46
Q

A: Which 2 Calcium Channel Blockers are more isolated to VasoDilation

B: What are their Side Effects (2)

C: What class of CCB are these?

A

A: [Amlodipine / Nifedipine]

B:

  • Peripheral Edema
  • HA / Dizziness

C: Dihydropyridines

47
Q

A: 3 Characteristics of DILE (Drug Induced Lupus Erythematosus)

B: Which Drugs cause it? (3)

A
  1. Lupus Sx - new onset
  2. (ANA) Anti-Nuclear Antibodies
  3. (AHA) Anti-Histone Antibodies

B: DILE on my HIP!

Hydralazine

Isoniazid

Procainamide

48
Q

Does Isosorbide Dinitrate have HIGH or low bioavailability? Why or why not?

A

loooow bioavailability

2° to Intense [Hepatic First Pass Metabolism] = Requires High Oral Dose

49
Q

A: Which 3 compounds have the ability to stimulate eNOS2 in the [Capillary Endothelial Cell] by INC ____

B: Which Amino Acid does eNOS2 use to create NO?

A

A: [Shear Stress / ACh / Bradykinin] all INC Ca+ in the [Capillary Endothelial Cell] —> Stimulates eNOS2–> NO –> VasoDilation

50
Q

Loop Diuretics

Side Effects (8)

A

“Going in a Loop? DUNK and MOVM”

hypOKalemia (linked to hyperglycemia)

hypOMagnesemia

hypONatremia

Volume Contraction in serum***

HyperUricemia –> Gout

Metabolic alkalosis

Ototoxicity (reversible)

Diarrhea (ethacrynic acid)

51
Q

A: Severe SE of [Mannitol (Osmotic Diuretic)]

B: How does this happen?

C: What condition may this be helpful in

A

A: Pulmonary Edema –> ARDS

B: INC plasma & fluid osmolality extracts water from [interstitial space] –> vascular space/tubular lumen. Too much fluid in vascular space –> Pulmonary Edema –> ARDS

C: Cerebral Edema (Mannitol may reduce Intracranial pressure)

52
Q

Carbonic Anhydrase Inhibitors

A: Indications (5)

B: What renal Secretory pump do they use?

A

“[Carbonic Anhyrase Inhibitors] are Mega HUGE like Mountains”

  1. Glaucoma - reduces intraocular pressure
  2. “Mountain Altitude sickness” (treats by DEC serum pH–>DEC HgB affinity for O2–> [INC Tissue O2 Delivery])
  3. [Urine pH] INCREASE in cystinuria
  4. [HypOkalemic periodic paralysis] (will require Dietary K+)
  5. Epilepsy adjunct tx

B: [Organic Acid (MATE) Transporter]

53
Q

Thiazides

Indications (6)

A

“Thiazide drink is a Happy CIDER”

Hypertension.

Edema 2º to CHF,

Cirrhosis,

Renal disease.

[Idiopathic Hypercalcuric Renal Calculi]

[Diabetes Insipidus-nephrogenic] (prevents further urine dilution from taking place in DCT)

54
Q

Thiazides

A: Site of Action (2)

B: Condition that prevents Thiazides from being used? What’s the [Thiazide Family] Exception?

A

“Thiazide drink is a Happy CIDER”

A: [Early DCT] and [cortical thick aLOH]

B: [Severe Renal Insufficiency] —> use [Metolazone Quinazoline] since it is the strongest of [Thiazide Family]

Step 1 USMLE Rx - Cardio (5 decks)

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