Cardiac

Question 1

A 45-year-old man presents to the ED with blurry vision and headache. His blood pressure is 190/130 mmHg. How could you treat?

Answer 1

Nitroprusside, nicardipine, clevidipine, fenoldopam, or labetalol

Question 2

What are the three indications for NO

Answer 2

Angina, pulmonary edema, and acute coronary syndrome

Question 3

What are the calcium blockers?

Answer 3

dihydropyridines: amlodipine, clevidipine, nicardipine, nifedipine, nimodipine –> vascular SM
nondihydropyridines: verapamil, diltiazem

Question 4

Fenoldapam MOA? use?

Answer 4

D1 agonist - severely vasodilates - dec BP

-used in hypertensive emergency

Question 5

What are the clinical indications for the use of dihydropyridine calcium channel blockers?

Answer 5

For all but nimodipine = hypertension, angina (including Prinzmetal), Raynaud phenomenon;

for nimodipine = subarachnoid hemorrhages

Question 6

When cant you use hydralazine?

Answer 6

CAD and angina- compensatory tachy

Question 7

A 40-year-old woman with chronic hypertension has a positive pregnancy test. What is the first-line hypertensive therapy for her?

Answer 7

Hydralazine with methyldopa

Question 8

How can the reflex tachycardia that is associated with hydralazine be prevented?

Answer 8

By administering hydralazine with a β-blocker

Question 9

Which two β-blockers are contraindicated in angina and why?

Answer 9

Pindolol and acebutolol, as they are partial β-agonists and can increase myocardial oxygen consumption

Question 10

What drugs are proven to improve survival in CHF?

Answer 10

ACEIS/ARBS, carvedilol, spironolactone

Question 11

What are the s/e of the CCBs?

Answer 11

all: cardiac depression, peripheral edema, flushing, gingival hyperplasia
nondihydros: AV block, verapamil - constipation, hyperprolactinemia

Question 12

MOA hydralazine?

Answer 12

vasodilates arterioles > veins - dec afterload

inc cGMP

Question 13

What is a s/e you worry about with hydralazine?

Answer 13

lupus like syndrome - dec acetylation

Question 14

MOA of nitrates

Answer 14

inc cGMP - vasodilate veins» arteries - dec preload

Question 15

What is monday disease?

Answer 15

some people develop a tolerance for the vasodilating action of NO

Question 16

What are the main meds used in angina?

Answer 16

Beta blockers - exertional - reduce contractility, dec HR
nitrates - dec preload and ejection time, inc HR - reflex
combined of both: dec BP, MVO2

nefedipine - vasospasm
nitrates

Question 17

Which drugs dec LDL

Answer 17

statins> bile acid resins =ezetimibe= niacin > fibrates

Question 18

which drugs inc HDL

Answer 18

all but ezetimibe - niacin does the most

Question 19

which drug decreases TGs the most - why?

Answer 19

fibrates

Question 20

Which drug inc TGs?

Answer 20

bile acid resins

Question 21

Which cholesterol lowering agents can cause myopathy?

Answer 21

statins when combined with fibrates or niacin

Question 22

Which drugs prevent cholsterol reabsorption at small intestine brush border?

Answer 22

ezetimibe

Question 23

which drug upregulates LPL - inc TG clearance and activates PPAR-a to induce HDL synthesis?

Answer 23

fibrates

gemfibrozil, clofibrate, bezafibrate, fenofibrate

Question 24

How does niacin work?

Answer 24

inhibits lipolysis

reduces hepatic VLDL synthesis

Question 25

What are the s/e of niacin

Answer 25

red flushed face - use NSAIDs or just wait it out
hyperglycemia
hyperuricemia

Question 26

What are the indications for digoxin?

Answer 26

CHF - inc contractility

atrial fib - dec conduction at AV node, depresses SA

Question 27

MOA of digoxin

Answer 27

inhibition of Na/k ATPase
inc ca2+ - positive inotropy
stimulates vagus nerve - dec HR
(cholinergic s/e)

Question 28

What vision complaint can occur with digoxin use?

Answer 28

Blurry yellow vision (also from cholinergic effects of stimulating the vagus nerve)—think van Gogh

Question 29

Which lipid-lowering agent causes the greatest increase in high-density lipoprotein (HDL) levels? Which agents cause a more modest increase?

Answer 29

Niacin causes the greatest increase in HDL; statins and fibrates have a moderate effect on HDL, & bile acid resins increase it slightly

Question 30

What medications dec digoxin clearance by displacing it from tissue binding sites? what can happen?

Answer 30

verapamil, amiodarone, quinidine

Long PR, short QT, ST scooping, T-wave inversions, arrhythmias;

Question 31

What indicates poor prognosis with digoxin?

Answer 31

hyperkalemia

Question 32

What should you measure before treating someone with digoxin?

Answer 32

creatinine levels

K+ levels - hypokalemia allows more digoxin to bind

Question 33

what are the first line drugs for hypertriglyceridemia

Answer 33

fibrates

Question 34

what drugs inc TGs

Answer 34

bile acid resins

Question 35

which agents inc hepatic cholesterol synthesis

Answer 35

bile acid resins

fibrates

Question 36

What is the order of sodium blocking in class I antiarrythmics? why does this occur

Answer 36

1c> 1a>1B

class IC displays the most use dependence - cause a delay in conduction speed that is out of proportion to prolongation of refractory period

sodium blocking effects intensify as the HR inc due to less time btwn APs for the medication for dissociate from the receptor

Question 37

which drugs have an affinity for ischemic myocardium

Answer 37

IB - lidocaine, mexiletine, tocainide

Question 38

what do class 3 antiarrythmics do

Answer 38

block potassium channels and prolong repolarization

Question 39

which class exhibits reverse use dependence and what does this mean

Answer 39

class III - activate K + channels - the slower the heart rate the more QTC is prolonged