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1
Q 
IA class antiarrhytmics?
What channels block? 
3 drugs
A

Na channel blockers

Quinidine, Procainamide, Disopyramide

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2
Q

Adverse effects of IA antiarrhemics

A

Cinchonism (tinnitus) quanidine
SLE-like syndrome (procainamide)
HF (disopyramide)

Thrombocytopenia
Forsakes de pointes (⬆️QT)

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3
Q

Phase O in fast response fibers ?

A

Na channels open

Na enters cell - depolarization

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4
Q

Phase O in slow response fibers

A

No appreciable Na current

Depolarization depends on Ca channels

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5
Q

What do Ia antiarrhytmic drugs do to K?

A

Block - prolong repolarization

As well as Na block

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6
Q

Quinidine block what receptors? Channels?

A

Na
K a bit
M (muscarinic): ⬆️HR ⬆️AV conduction
May cause vasodilation alpha-block - reflex tachycardia

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7
Q

Drug interactions of quinidine?

A

⬆️toxicity of digoxin

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8
Q

Lupus causing drugs?

A

Hydralazine
Isoniazid
Procainamide

HIP

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9
Q

Ib antiarrhythmia drugs?
What channels block?
Ap duration?

A

Weak Na block
Lidocaine
Mexiletine

⬇️Ap duration

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10
Q

Ib antiarrhetmyc drugs use when ?
Ap duration?
Diastolic duration?
HR?

A

Use only in hospital
Post-MI (best!), open heart surgery

Only for VA
Lidocaine - IV
Mexiletine - oral
Non-prophylactic

⬇️Ap
⬆️Diastole
⬇️HR

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11
Q

Side effects of Ib antiarrhetmics?

A 
CNS toxicity (seizures, depression or stimulation)
Carfiovascular depression
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12
Q 
Ic antiarrhetmics?
Mechanism? 
Ap?
ERP?
Contraindications?
A

Flecainide
Propafenone
(Fries, please)

STRONG Na channels block (especially His-Purkinje)
No or little effect on Ap duration

Flecainide - bad reputation!
⬆️mortality in post-MI and in VT use
Good for atrial arrithmias

Proarrhytmic (promotes arrhythmia) in post MI, VA
Contraindicated in ischemic, structural ❤️ diseases

Good for SVT (including AF)

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13
Q

How Procainamide metabolized?

A

Metabolized via N-acetyltransferase to N-acetyl Procainamide (NAPA) -prolongs AP duration

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14
Q 
II class of antiarrhetmyc? 
6 drugs 
Mechanism?
A

B-blockers

Metoprolol
Propranolol 
Esmolol
Atenolol.                       -lol 😂
Timolol
Carvedilol

B-receptors activation - ⬆️ cAMP
B-blockers prevent activation - ⬇️cAMP, ⬇️Ca current
⬇️abnormal pacemakers by ⬇️slope of 4 phase

⬆️PR

⬇️AV (!) SV activity

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15
Q

Use of b-blockers?

A

SVT
Prophylaxis post MI

V and control of A fibrillation, A flutter
Because b receptors are all over the ❤️

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16
Q

Adverse effects of B-bl?
Metoprolol?
Propranolol?

A 
Impotence 
⬆️COPD, Astma
HF
Bradycardia 
AV block
Sedation
Metoprolol - dyslipidemia 
Propranolol - exacerbate vasospasm in vasospastic angina
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17
Q

B-by overdose? WhT to do?

A

Saline ( NaCl with water - изотонических раствор)
Atropine
Glucagon

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18
Q 
III class of antiarrhetmyc?
Mechanism?
4 drugs?
A

K channel blockers

⬆️Ap duration
⬆️ERP
⬆️QT
Slowing 3 phase - repolarization

AIDS:

Amiodarone
Ibutilide
Dofetilide
Sotalol

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19
Q

Clinical use of III class antiarrhetmyc

A

AF, AFlutter, VT (amiodarone, sotalol)
Life threatening ventricular arrhythmias

Amiodarone the smartest - mimic I, II, III, IV classes - blocks Ma, K, Ca, B- adrenoreceptors

⬆️APD ⬆️ERP in all cardiac tissues

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20
Q

Side effects of III antiarrhetmyc?

A 
Pulmonary fibrosis (amyodarone)
Smurf skin (iodine contain) - blue skin
Photo toxicity
Hepatic necrosis
Thyroid disfunction
Torsada (sotalole) - excessive b-blockade
(Sotalol - nonselectove b-bl)
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21
Q

What check while using amiodarone?

A

PFT, LFT, TFT

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22
Q

Which classes of antiarrhetmyc don’t use in long QT syndrome?

A

1A
III

POTASSIUM CHANNEL BLOCKERS

Tricyclic antidepressants
Antipsychotic (thioridazine)

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23
Q

How to treat Torsades?

A

Discontinue drug that prolong QT
Correct hypokalemia
Correct hypomagnesemia

Give magnesium or defibrillate

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24
Q

Treatment of A Fibrilation

A

Ventricular rate control: b-bl, CCB, digoxin

Anticoagulants

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25
Pulmonary fibrosis what 3 drugs can cause ?
Amiodarone Bleomycin Busolfen
26
Which drug instead of amiodarone use to avoid blue skin?
Dronedarone
27
Thioridazine? Group? When avoid?
Antipsychotic | Long QT
28
``` IV class antiarrhetmyc? Mechanism? 2 drugs? ```
Ca-Chanel blockers Verapamil Diltiazem Block slow cardiac Ca Channels ⬇️conduction velocity ⬆️ERP ⬆️PR interval Prolonged repolarization ⬇️ 4, 0 Inhibit Ca influx in AV nose
29
Use of IV antiarrhetmyc?
SVT Rate control in AF PREVENT nodal arrhythmias
30
Side effects of IV antiarrhetmyc?
``` Constipation (verapamil) AV block Dizziness Flushing Hypotension HF Edema ```
31
Drug interaction IV antiarrhetmyc
Verapamil displace digoxin AV block with b-blockers, digoxin
32
Other antiarrhetmycs? | 4
Adenosine Magnesium Ivabradine Digoxin
33
Adenosine mechanism of action? Duration of action? When to use?
⬆️K out of cell Hyperpolarizing the cell Decrease AV node conduction Duration - short, 15sec Use in SVT
34
What’s activated of adenosine receptors cause? Where are they?
Cause Gi-coupled ⬇️ in cAMP | ⬇️ SA AV activity
35
Side effects of adenosine?
Flushing, sedation, dyspnea
36
Drugs interaction? | Antagonized by...?
``` By methylxanthines ( theophylline, caffeine) Effects of adenosine blunted ⬇️ ```
37
Adenosine is drug of choose ...?
PSVT
38
Magnesium use?
Torsades | Digoxin toxicity
39
Ivabradine mechanism?
IVabradine prolongs slow depolarization (IV) | By selective inhibitions of funny sodium channels
40
Use of Ivabradine?
Chronic stable angina in those who can’t take b-bl | HF with reduced EF (HFrEF)
41
Adverse effects of ivabradine
Visual brightness (luminous phenomena) Hypertension Bradycardia
42
What drugs control HR?
B-bl, Ca cb
43
What to use in SVT? | How describe SVT?
II, IV, adenosine, digoxin >150 GRS narrows P deformation
44
Drugs for VT? | Describe VT?
I, III VT >120 Wide QRS >140ms patients feel skipping beats Ventricles contracts more often than Atrias
45
Saved By Pharm Class
I - Sodium II - b-bl III - potassium IV - Calcium
46
If patient had ⬆️ ventricular response to stress, activity what to use?
Need for long usage ⬇️sympathetic B-bl - propranolol
47
Drugs for essential HT
Thiazides diuretics ACEI ARB (angiotensin II receptors blockers) Dihydropiridine Ca cb
48
HT with HF treatment?
``` Diuretics ACEI ARB B-bl Aldosterone antagonists (spironolactone, epelerenone, canrenone) ```
49
HT with DM
``` ACEI ARB Ca cb Thiazides B-bl ```
50
HT with Asthma
ARB Ca cb Thiazides Cardioselective b-bl
51
HT with CKD
ACEI | ARB
52
HT with dyslipidemia
A-blockers Ca cb ACEI ARB
53
HT in post MI
B-bl | Useful in preventing second MI
54
What anti HT ⬆️ lipids?
Thiazides | B-bl
55
HT in pregnancy
Hydralazine - preeclampsia (new HT) Labetalole also good for both Methyldopa - drug of choice Nifedipine He Likes My Neonate
56
B blockers contraindications
``` Asthma AV block Bronchitis Emphysema Diabetic CARDIOGENIC SHOCK ```
57
Amiodarone? | Amlodipon?
Amlodipin - -dipines; CCBs | Amiodarone - K cb
58
CCBs mechanism of ⬇️BP
Block voltage-dependent L-type of Ca channels of ❤️ and smooth muscles = ⬇️ intracellular Ca => ⬇️CO(verapamil, diltiaz), ⬇️TPR (all) = ⬇️ muscle contractility
59
Use of CCBs?
Dihydropyridines (no nimodipine): HT, angina, Raynaud Phenomenon Nimidopine: subarachnoid hemorrhage Nicardipin, clividipine: HT urgency or emergency Verapamil/ diltiazem: HT, angina AF, AFlutter Arrhythmias: verapamil, diltiazem
60
Adverse effects of CCBs
Reflex tachycardia Gingival hyperplasia Constipation (ver) Hyperprolactinemia (verapamil )
61
Pulmonary HT treatment | 3 drugs
Bosentan - endoteline receptor blockers- vasodilation Prostacyclin (PG2): Epoprostenol Sildenafil: inhibit V PDE, ⬆️cGMP, pulmonary artery relaxation
62
Pregnancy HT drugs? | HLMN
Hydralazine Labetalol Methyldopa Nifedipine
63
Slidenafil?
V type PDE inhibition ⬆️cGMP Pulmonary artery HT
64
Tamsulosin
Only in BPH , not useful in HTN
65
Drug for: HT + BPH BPH
Prazozin | Tamsulozine
66
Arteriolar specific anti hypertensive drugs?
Hydralazine K blockers Ca blockers
67
Ventilations dilators anti hypertension drugs?
Nitrates
68
Orthostatic hypotension
From ventilations dilation - mainly from a1 blockage or ⬇️sympathetic tone A1 - nonselective, but very powerful vein effect
69
Cyanide poisoning: 2 drugs
Hydroxocobalamin + sodium thiosulfate
70
Hypertensive emergency 5
``` Labetalol Clevidipine Fenoldopam Nicardipine Nitroprusside ```
71
cGMP cAMP What drugs to use?
⬆️cGMP - smooth muscle relaxation by nitrates, nitroprusside, hydralazine ⬇️cAMP - heart ❤️ ⬇️activity of AV SA nodes
72
Hypertensive emergency Ca drugs
Nicardipine, clevidipine
73
Hypertensive emergency drugs
Nicardipine Clevidipine Labetalol Fenoldopam Nitroprusside
74
Cyanid toxicity can be caused by what drug?
Nitroprusside
75
RanolaIazine Mechanism Use. Adverse
Inhibit late onward of Na => ⬇️diastolic was tension and O2 consumption Does not change HR, BP Angina refractory to other drugs Conztipation, dizziness, nausea
76
Sacubitril
Neprilysin inhibitor Prevents degranulation of natriuretic peptide, angiotensin II, substance P => ⬆️vasodilation, ⬇️ exstracellular fluid volume Use with Valsartan (ARB) for HFrEF Cough dizziness hypertension and Hyperkalemia Contraindicated with ACEI inhibitors do you do angioedema
77
Blurry yellow vision
Digoxin
78
Digoxin tissue binding sites and ⬇️its clearance
Verapamil Amiodarone Quinidine
79
Antidote for digoxin toxicity
Slowly normalize K Cardiac pacer Anti-digoxin Fab fragments Mg
80
Decstrocardia in what pathology
Kartagener syndrome - culinary dyskinesia | Defect in Left-right dynein - dextrocardia
81
Drug induced long QT
``` AntiArrhytmic (Ia, III) AntiBiotic (macrolids) AntiCychotic (haloperidol) AntiDepressant (TCA) AntiEmetics (ondansetron) ```
82
Congenital long QT interval pathologies (2)
Romano-Ward syndrome - AD, no deafness | Jervell and Lange- Nielsen syndrome - AR, sensorineural deafness
83
Brugada syndrome
``` AD Asian male Pseudo R bundle branch block, ⬆️ST in V1-V3 Risk of VT VA and SCD Prevent SCD with ICD ```
84
Wolff-Parkinson White s
``` Ventricular preexcitation syndrome Fast accessory conduction pathway from A to V , bypass the rate-slowing AV node V begin to depolarize early Widened QRS ⬇️PR Delta wave ``` May cause SVT
85
AF
No discrete P between irregular QRS Irregular H beat Risk: HTN, CAD, holiday ❤️ syndrome Can cause thromboembolism, stroke Anticoagulants, rhythm and Hr control, or cardioversion
86
A flutter
Saw tooth R1=R2=R3... Treat like AF Catheter ablation
87
VF
Erratic rhythm with no identifying waves. Can be fatal Need IMMEDIATE CPR and defibrillate
88
I degree AV block
PR > 200 msec | No treatment
89
Second degree AV block
PR1
90
Third degree AV block
A and V beat independently P=P GRS=GRS PG=/ PG A rate > V rate Pacemaker Lyme disease
91
Lime disease | What’s with ❤️
Can cause third degree AV block
92
B type natriuretic peptide | Atrial natriuretic
From Ventricular myocytes in response to ⬆️tension ANP - from atrial myocytes in response to ⬆️BV and Atrial P Act via cGMP vasodilation, ⬇️Na reabsorbtion B type - linger half life BNP - bliss test for HF Nesiritid - recombinant form to treat HF
93
Cushing reflex
In ⬆️ intracranial P: triad: bradycardia ⬆️BP respiratory depression These all are physiological nerves system response to ⬆️intracranial pressure
94
Tetralogy of Fallot mnemonic
``` Pulmonary stenosis R ventricular hypertrophy Overriding aorda VSD e ```
95
Lithium explosire of pregnant - ❤️?
Ebstein anomaly Tricuspid valve down in RV “Atrializing” ventricle
96
Eisenmenger syndrome | Ebstein anomaly
Uncorrected L toR becomes R to L Displacement of TV
97
Turner syndrome what with ❤️
Coarctation of aorta | Bicuspid aortic valve
98
Brachial femoral delay
Different pulse on upper and lower extremities | In coarctation
99
Marfan syndrome ❤️?
MVP Thor’s is aortic aneurysms Dissection Aortic regurgitation
100
Infant of diabetic mother ❤️?
Transposition of great vessels | VSD
101
Williams syndrome ❤️
Supravalvular aortic stenosis
102
22q11 syndrome ❤️
DiGeorge Truncus arteriosus Fallot
103
2 hypertension what diseases
``` Fibromuscular dysplasia (string of beads renal artery) 1 hyper aldosteronism Atherosclerotic renal artery stenosis ```
104
Xanthelasmas composed of what ?
Lipid-laden histiocytes
105
Mönckeberg sclerosis
``` Medial calcific sclerosis Affect medial size arteries Vascular stiffening without obstruction Pipestime appearance on Xray Intima not involved Does not effect Q ```
106
Dilated cardiomyopathy inheriting | WhT Gene?
TTN Gene, encoding the Sarcomeric protein titin
107
Doxorubicin what with ❤️
Dilated cardiomyopathy
108
What infections cause dilated cardiomyopathy
Coxsackie B virus | Chagas’ disease
109
What systemic conditions cause dilated cardiomyopathy
Hemochromatosis Sarcoidosis Thyrotoxicosis Wet beriberi
110
Takotsubo cardiomyopathy
Broken ❤️syndrome | Stress cardiomyopathy
111
Friedreich ataxia? | ❤️?
``` Difficulty walking. Loss of sensation in arms, legs Impaired speech Starts 5-15 years ❤️ - hypertrophic cardiomyopathy ```
112
Löffler endocarditis
Associate with hyper eosinophilic syndrome | Hydrology- eosinophilic infiltrates in myocardium
113
Restrictive / infiltrative cardiomyopathy what cause?
Puppy LEASH ``` Postradiation fibrosis Loffler endocarditis Endocardial fibroelastosis Amyloidosis Sarcoidosis Hemochromatosis ```
114
Back triad
Cardiac tamponade Hypertension distended neck veins distant heart sound
115
Pulsus paradoxus
⬇️ in amplitude of systolic blood pressure by > 10 During inspiration Pea COAT Constrictive pericarditis Obstructive pulmonary disease (Croup, Asthma, COPD, OSA, cardiac Tamponade)
116
Symptoms of bacterial endocarditis
FROM JANE with ❤️ Fever Roth spots (eye - white on retina surrounded by hemorrhage) Osler nodes (ouchy raised lesions on the fingers or toe pads) Janeway lesions (small painless Erythematos lesions on palm or sole) Anemia Nail-bed hemorrhage Emboli
117
Is culture is negative while bacterial endocarditis what culture is most likely to be
Coxiella burnetii | Bartonella
118
S bovis
Colon cancer
119
On prosthetic walls bacterial endocarditis what culture is most likely to be
S epidermidis
120
Native valves bacterial endocarditis maybe do you to which organisms
``` HÁČEK HAEMOPHILUS Aggregatibacter (actinobaccilus) Cardiobacterium Eikenella Kingella ```
121
Major criteria of rheumatic fever
``` J❤️NES Joint - migratory polyarthritis ❤️carditis Nodules in skin subcutaneous Erythema marginatum (evanescent rash with ring margin) Sydenham chorea ```
122
Aschoff bodies
Granuloma with giant cells in romantic fever
123
Anitschow cells
Enlarged macrophages with ovoid wavy road like nucleus
124
Blood test in rheumatic fever
⬆️ASO antistreptol | ⬆️anti-DNase B titers
125
Appearance of aorta in 3 syphilis
Tree bark - calcification and vasa vasorum disrupt | Can result in aneurysm of ascending A, aortic arch, A insufficiency
126
Treatment for acute pericarditis
NSAIDs Colchicine Glucocorticoid Dialysis - uremia
127
Tuberous sclerosis
May cause no cancerous tumors in brain kidneys heart liver eyes lung skin
128
Rhabdomyomas
In children Benign Hamartomatous growths
129
Myxomas
Adults IL-6 production symptoms (⬆️t, weight loss) Tumor plop early diastole sound Gelatinous material, myxoma cells immersed in glycosaminoglycans
130
Kussmaul sign
⬆️ in JVP in inspiration instead of ⬇️ May be seen with constrictive pericarditis, restrictive cardiomyopathy, right heart failure, massive pulmonary embolism, right atrium or ventricular tumors
131
Osler Weber Rendu syndrome
Hereditary hemorrhagic telangiectasia AD Twlangiectasias on skin, mucus M, recurrent epistaxis, skin discoloration, arteriovebous malformations, GI bleeding, hematuria
132
Large vessel vasculitis
Giant (temporal) arteritis | Takayasu arteritis
133
Medium vessel vasculitis
``` Buerger d (thromboangiitis obliterans) Kawasaki (mucocutaneus lymph nodes syndrome) Polyarteritis nodosa ```
134
Kawasaki
``` Conjunctivitis Rash Erythema Adenopathy Mucous membranes - strawberry tongue, dry lips ```
135
Kawasaki treatment
IV immunoglobulin | Aspirin
136
What can cause polyarteritis nodosa
Hepatitis type B
137
Polyarthritis nodosa treatment
Corticosteroids | Cyclophosphamide
138
For the arthritis nodosum what’s wrong with Renal
Renal micro aneurysm - string of pearls
139
Small vessels vasculitis
Becker syndrome Cutaneous small vessels vasculitis Eosinophilic geanulomatosis with polyangiitis (churg-strauss) Granulomatosis with Polyangiitis (Wegenera) Immunoglobulin a vasculitis Microscopic polyangiitis Mixed cryoglobulinemia

Pharma (3 decks)

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