cardiac pharm

Question 1

Nifedipine

Answer 1

Ca2+ channel blocker

Vs HTN/Angina

AV block, flushing, constipation

Question 2

Verapimil/Diltiazem

Answer 2

Ca2+ channel blocker

Vs HTN/angina

Toxicity: AV block, flushing, constipation

Question 3

What calcium channel blocker is most effective in the heart?

What is most effective vs vascular smooth muscle?

Answer 3

Heart - Verapimil most effective. Amlodipine least effective

Vascular smooth muscle = Amlodipine/Nifedipine strongest, verapimil least effective

Question 4

Hydralizine

Answer 4

Increases cGMP -> Arteriolar dilation > Venodilation

Vs HTN in pregnancy

Given with B blocker to prevent reflex tachycardia

Toxicity: Reflex tachycardia, Lupus like syndrome, Fluid retention

Question 5

Nitroprusside

Answer 5

Increases cGMP via release of NO

Veno and vaso dilator

Decreases preload and afterload

Toxicity: Cyanide toxicity

Question 6

Fenoldopam

Answer 6

Dopamine D1 agonist, vasodilation

Decreases BP and increases Natriuresis

Question 7

Nitroglycerin

Answer 7

Increases cGMP -> Dilates veins more than arteries

Used vs angina or edema

Toxicity: Reflex tachycardia, hypotension, flushing, Tolerance development that quickly is lost and results in side effects on reexposure

Question 8

Statins

Answer 8

Decrease LDL

Inhibit HMG CoA to mevalonate (cholesterol precursor)

Toxicity: Hepatotoxic

Question 9

Niacin (Vitamin B3)

Answer 9

Increases HDL

Reduces VLDL secretion

Toxicity: Red flushed face, hyperglycemia, hyperuricemia

Question 10

Cholestyramine/colestipol

Answer 10

Decrease LDL

Decrease absorption of bile, liver must use cholesterol to make more

Toxicity: GI pain, decreased absorption of fat soluble vitamins

Question 11

Ezetimibe

Answer 11

Decreased LDL reabsorption at intestine brush border

Increase diarrhea (toxicity)

Question 12

Gemfibrozil/fenofibrate

Answer 12

Decreased Triglycerides

Increased Triglyceride clearance

Question 13

Digoxin

Answer 13

Glycoside -> Inhibits Na+/K+ ATPase

inhibits Na+/Ca2+ exchanger

vs CHF/atrial fibrillation

Toxicity: Blurry yellow vision, AV block, hypokalemia

Toxicity antidote: K+, lidocaine

Question 14

Class IA antiarrhythmics

Answer 14

Quinidine
Disopyramide
Procainimide

Question 15

Quinidine

Answer 15

CLass IA Na+ blocker

Inc AP duration and inc refractory period

Toxicity: Cinchonism -> tinnitus

Question 16

Disopyramide

Answer 16

Class IA Na+ blocker

Inc. AP duration and inc refractory period

Toxicity: torsades de pointes

Question 17

Procainimide

Answer 17

Class IA Na+ blocker

Inc. AP duration and inc refractory period

Toxicity: Lupus like syndrome

Question 18

Class IB

Answer 18

Lidocaine, Mexilitine, Tocainide

Best post MI

Question 19

Lidocaine

Answer 19

Class IB Na+ blocker

Dec AP duration

Toxicity: CNS/CV depression

Question 20

Mexilitine

Answer 20

Class IB Na+ blocker

Dec AP duration

Toxicity: CNS/CV depression

Question 21

Tocainide

Answer 21

Class IB Na+ blocker

Dec AP duration

Toxicity: CNS/CV depression

Question 22

Class IC

Answer 22

Flecainide, Propafenone

Containdicated post MI or with structural heart disease

Question 23

Flecainide

Answer 23

Class IC Na+ blocker

Vs Vtach

Toxicity: Arrythmia post MI

Question 24

Propafenone

Answer 24

Class IC Na+ blocker

Vs Vtach

Toxicity: Arrythmia post MI

Question 25

B blockers

Answer 25

Dec Nodal activity, dec Ca2+, dec slop of phase 4 AV node - Inc. PR Esmolol short acting Class II antiarrythmics Toxicity: Impotence, vasospasm, dyslipidemia

Question 26

Metoprolol toxicity

Answer 26

Dyslipidemia

Question 27

Propanolol toxicity

Answer 27

Coronary vasospasm in prinzmetal angina

Question 28

K+ blockers

Answer 28

Amiodarone, Ibutilide, Dofetilide, Sotalol Class III antiarrythmic

Question 29

Amiodarone

Answer 29

Class III antiarrythmic K+ blocker Inc AP duration, Inc QT interval Toxicity: Pulmonary fibrosis, blue gray skin, photodermatitis, constipation, hepatotoxicity Alters lipid membrane Check PFT, LFT, TFT

Question 30

Ibutilide

Answer 30

Class III K+ blocker Inc AP duration Toxicity: torsades de pointes

Question 31

Dofetilide

Answer 31

Class III K+ blocker Inc AP duration

Question 32

Sotalol

Answer 32

Class III K+ blocker Inc AP duration Toxicity: Torsades de pointes

Question 33

Verapimil/Diltiazem

Answer 33

Class IV Ca2+ blockers Inc PR interval, Dec conduction velocity Toxicity: Constipation, CHF

Question 34

Drug of choice vs supraventricular tachycardia

Answer 34

Adenosine

Question 35

Antidote vs torsades

Answer 35

Mg2+