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Step 1 2019 First Aid Flashcards > Cardio Conrad Fischer Medquest Pharm > Flashcards

Cardio Conrad Fischer Medquest Pharm Flashcards

1
Q

ACE (-)’rs - target is where in the body?

A

lung

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2
Q

SE of ACEIs

A

cough
hyperkalemia
bradykinin

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3
Q

Use of ACEIs and mech of dec mortality in said disease?

A

HTN

CHF w/ systolic dysfxn (Dec EF) - will (-) LV remodeling + dilation, control afterload

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4
Q

MoA of AGII

A

leads to VC of arterioles –> afterload
This or inc K+ –> (+) rel of aldosterone from ZG “Zona Aldosterona”

Aldos @ prox tubule = retain Na, rel K+

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5
Q

Can you use ACEIs in DB?

A

if just DB alone - NO

DB + HTN/ proteinuria (chronic kidney disease) = YES

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6
Q

Define proteinuria range where ACEIs in DB would be necessary?

A

30-300 mg - microalbuminemia

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7
Q

Sx of Conn Syndrome

A

HTN and dec K+

( bc of retention o f Na and release of K due to aldos)

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8
Q

Mech of dry cough due to ACEIs

A

inc bradykinin –> kallikrein = dry cough

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9
Q

What leads to ACEIs intolerance? Switch to which Rx if this occurs?

A

Bradykinin - causes VD and pro-inflammatory –> angioedema, dry cough

If occurs - give ARBs instead (-sartan)

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10
Q

Bradykinin actions

A

Bradykinin (+) B2R –> dec endothelium dep, inc NO –> angioedema

Inc PGE2/cGMP –> VD, loss of natriuresis

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11
Q

Tx of Angioedema

A

Ecallantide
Icatibant

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12
Q

Which substances/Rx work on Aff art vs eff art of glomerulus?

A

Afferent:

Normally, VD caused by PGI2 & PGE2

(-) NSAIDs (leading to VC)

Efferent:

VC caused by AGII, NE - maintains GFR when renal perfusion dec
ex/ Bilateral renal a stenosis

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13
Q

How to know if swelling is allergic rxn or angioedema?

A

There’s no itching with angioedema

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14
Q

63 yr old female w/ Hx of HTN. Has palpitations, EKG shows Afib w/ HR of 125.

What is next course of action?

A

If < 1d, do nothing

>2 d - long term anticoagulants

If still doesn’t resolve, slow HR w/ BB, CCB, & Digoxin

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15
Q

What are the indications of cardioversion in this pt?

A

If hemodynamically unstable

Sx/ chest pain ( dec perfusion)
SOB (can’t get blood out of lungs)
confusion (dec brain perfusion)
dec BP

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16
Q

Which CCB can be used in this pt?

A

Only verapamil and diltiazem

-dipines can inc HR bc of reflex tachy

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17
Q

Which BB can be used in the Afib pt?

A

usually B1R (-)’rs - metoprolol

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18
Q

What is the target HR to reduce down to?

A

<100

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19
Q

Use of Propranolol

A

Thyroid storm

stage fight

essential tremor

Migraine prophylaxis - BB > 3mo to (-) next attack
portal HTN - dec freq of bleed

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20
Q

CCB like verapamil and diltiazem used for what arrythmias?

A

Can only slow HR if atrial arrythmia, SVT
bc (-) AV node in pathological conditions

if sinus rhythm issue, don’t slow HR

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21
Q

SE of CCB

A

dec BP
constipation ( (-) smooth musc)
peripheral edema (VD)
AV block

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22
Q

SE of BB

A

ED
dyslipidemia
depression (dec NE, Dopamine)

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23
Q

SE of Digoxin

A

INC K+ ( (-) Na/K ATPas)
atrial arrythmia w/ variable block
diarrhea (most common)

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24
Q

If a pt has 2 or more of the following, what Rx do you give?
CHF
HTN
Age > 75
DB
Stroke Hx

A

give anticoagulants
>48 hr, inc risk of clot/embollus

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25
Q

When is warfarin used to (-) stroke?

A

if valvular issues - like valvular Afib

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26
Q

-dipines used for?

A

HTN - will dec mortality, causes VD arterioles
CAD - if can’t use BB, will not dec mortality
pulm HTN - relax heart if hypertrophic cardiomyopathy
(-) vasospasm - Raynauds, SAH, Prinzmetal

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27
Q

What do you give in case of chronic dec in O2 in lungs?

A

chronic hypoxia –> VC lungs. Give O2

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28
Q

Rx of Primary Pulm HTN

A

1) PDE5 (-)’rs = sildenafil, vardenafil, todalafil
2) Bosentan - endoth -R (-)’r
3) PGI2 = VD - Epoprostenol, Iloprost, (-) platelet aggregation

+ R. heart catherization and see what works

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29
Q

MoA and use of Spironolactone & Eplerenone

A

Aldos-R (-)’r - retain Na and excrete K+
use: CHF - dec preload, dec mortality in systolic dysfxn

also anti-androgenic - PCOS, acne, hirsuitism

Ascites - best initial Rx as a diuretic

Adrenal hyperplasia/Aldos producing adenomas

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30
Q

Which Rx dec mortality in CHF?

A

ACEIs, ARBs, BB, and Aldos-R (-)’rs

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31
Q

How to replace mineralocorticoids?

A

Fludrocortisone

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32
Q

SE of Spironolactone/Eplerenone

A

inc K

Spironolactone - gynecomastia

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33
Q
A
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34
Q

Acetazolamide - MoA and use?

A

MoA - (-) HCO3- resorption
Use for mountain sickness, alkalosis

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35
Q

Propranolol use in Pheo - use what first?

A

start with alpha (-)’n - Phenoxybenzamine, Phentolamine, then BB

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36
Q

SE of any BB?

B2 (-)’n ?

A

Any BB - dec HR, BP, Inc K+ ( bc RAAS (-)’n)

B2R (-)’n - bronchospasm, ED, hypoglycemia (glycogen breakdown)

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37
Q

34 yr old female @ ER w/ palpitations
SVT @ 160 bpm, no response to vagal maneuvers (carotid massage)

What Rx to give?

A

Adenosine

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38
Q

MoA of Adenosine

A

Opens K+ channels –> hyperpol
if not responsive to Inc CN X of carotid massage
dec Ca currents, and AV node conduction
slows sinus rate

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39
Q

SE of Adenosine

A

transcient asystole <5s
bronchospasm (if hyper responsive airway)

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40
Q

If SVT not fixed with Adenosine?

A

Digoxin

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41
Q

MoA of Aspirin

A

irreversible acetylates COX

(-) PG (TXA2), (-) plat activation and aggregation

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42
Q

Uses of Aspirin

A
  1. Acute Coronary Syndrome
  2. Stroke/TIA - aspirin or clopidogrel
  3. PAD
  4. dec fever
  5. Inflammatory arthritis - ex/ Jarisch Herxheimer rxn
  6. Esst’l thrombocythemia
  7. Kawasaki
  8. arthritis, gout
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43
Q

In Acute coronary syndrome, MI/unstable angina

post stent, post bypass

Use which Rx?

A

Use 2 Rx

dipyridomole too weak on its own, need aspirin too

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44
Q

In stroke/ TIA, use which Rx?

A

aspirin OR clopidogrel

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45
Q

In essential thrombocytopenia, when to use which rx?

A

if they bleed - use hydroxyurea
if they clot - use aspirin

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46
Q

SE of Aspirin

A
  • bleed (platelet aggregation), esp w/ vWF deficiency
    1 dose can (-) platelet for a week.
  • (-)’n of PGE2 —> peptic ulcers, renal insuff, VCaff
  • asthma –> nasal polyps w/ LT synthesis issues
  • intoxication –> tinnitus (salicylism)
  • In toxic amounts –> metabolic acidosis, destroys mitoch - lactic acidosis.
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47
Q
A
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48
Q

Use of Dipyridamole

A

cardiac stress test for obstruction
should inc flow w/ thallium

combine w/ aspirin for brain - stroke/TIA, periph art disease

49
Q

MoA of Dipyridamole

A 
(-) platelet PDE = Inc cAMP = VD 
(-) (+)'n of platelets
(+) cGMP = VD

PDE normally breaks down cAMP

50
Q

SE of dipyridamole

A

bleed

headache (VD)

51
Q

Ex of ADP-R (-)’r

A

Clopidogrel
Prasugrel
Ticlopidine
Ticogrelor

52
Q

Uses of ADP-R (-)’r

A

1 in heart issues

acute coronary syndrome
stenting

give 1 w/ aspirin

53
Q

Diff between ADP-R (-)’rs

A

Clopidogrel - used only in brain, if aspirin not tolerated.
Ticlopidine - SE/ TTP, neutropenia
Prasugrel - inc efficacy, more bleeding, never used in brain
Ticagrelor - reversible, doesn’t need to be activated.

54
Q

MoA of Cilastazol

A

antiplatelet PDE III (-)’rs - inc cAMP
reversible platelet aggregation
arterial VC

55
Q

Use of PDE (-)’r

A

Periph art disease - VD, esp in femoral bed
Claudication from vascular disease - do dipyridimole stress test

56
Q

SE of PDE (-)’r

A

VD –> dizzy, edema, vertigo, headache
use of aspirin, clopidogrel + exercise

better > pentoxifylline

57
Q

72 yr old pt on ramipril, metoprolol, spironolactine, furosemide, dev dry cough, which Rx to stop?

A

stop ACEIs, used ARBs

58
Q

major SE of ACEIs/ ARBs , how to treat?

A

Inc K+ — use hydralazine + nitrates

59
Q

SE of hydralazine

A

drug induced lupus [(+) ANA]
hypotension

60
Q

Ex of GPIIb/IIIa (-)’rs

A

Abciximab
Tirofiban
Eptifibatide
Lomifiban
Orbofiban

61
Q

Use of GPIIb/IIIa (-)’rs

A

percutaneous coronary interventions

In a cath lab, bc IV only. (-) coronary a from occluding, (-) platelets
in addition to aspirin + clopidogrel

62
Q

Disease with defective GPIIb/IIIa - R?

A

Glanzmann Thrombosthenia

63
Q

SE/ of GPIIb/IIIa (-)’rs

A

bleed, thrombocytopenia

64
Q

MoA of GPIIb/IIIa (-)’rs

A

(-) fibrinogen and vWF binding to receptor on platelet
stops platelets from binding to endothelial lining and to each other

(-) the homeostatic plug (primary clot)

65
Q

Diff between GpIIb/IIIa & GpIb - R? Defective in which diseases?

A

GpIIb/IIIa - helps platelets stick together w/ fibrinogen & vWF
defective in Glanzmann

GpIb - platelet sticks to endothelium vWF,
defective in Bernard Soulier - 1 B

66
Q

vWF def - use what test?

A

In the presence of ristocetin, blood with adequate vWF clots normally. Blood that’s deficient in vWF or has defective vWF won’t clot.

67
Q

ex of Thrombolytics

A

tPA
Anistreplase
Streptokinase
Alteplase
Tenecteplase

68
Q

How soon after stroke/chest pain is thrombolytics useful?

A

w/in 12 hours post chest pain
<3-4 hours for a stroke

69
Q

How much time from door to balloon/angiplasty?

A

90 min, if longer, go to thrombolytics

70
Q

CI of Thrombolytics

A

any risk of bowel/brain bleed - risk of bleeding, cerebral tumor, head trauma, or BP > 110

71
Q

If chest pain and BP > 110, and you correct BP, can you give thrombolytics

A

Yes

72
Q

Does Guaiac pos stool considered CI for thrombolytics

A

No, but black or red stool is CI for thrombolytics

73
Q

MoA of thrombolytics

A

-ase - enzymes that degrade plasminogen –> plasmin

Plasmin degrades fresh fibrin

74
Q

Fibrin is stabilized by

A

soft clot is just fibrin, but is solidified with thrombin, and FXIIII

FXIII - is clot stabilizing factor

75
Q

Sudden SOB w/ clear lung means?

A

PE

76
Q

What lab parameter inc with thrombolytics

A

D-dimer INC
bc fibrin degradation product = d-dimers
(fibrin isotrimer –> 2 D shaped dimers)

77
Q

Digoxin is used in?

A

HF, atrial arrythmia

78
Q

MoA of Digoxin

A

(-) Na/K ATPase -
Na stays in, Ca cant leave cell bc does so with Na/Ca anitport –> Inc Ca (+) ionotropy

79
Q

SE of Digoxin

A

GI (cholinergic) - n/v, diarrhea
arrythmia - atrial tachy w/ variable block
confusion - encephalopathy

INC K+

80
Q

What effect does Digoxin have on BP?

A

no effect on BP, so can be used for HR control

81
Q

What cardiac parameter of CHF does digoxin improve?

A

CO,

82
Q

In case of SVT, how does Digoxin help?

A

will not convert Afib –> sinus, but will slow ventricular rate

83
Q

EKG signs of Afib/flutter?

A

no p waves
irreg irreg R-R intervals

84
Q

Tx of Digoxin tox

A

Digibind (Digoxin antibody)

85
Q

Fondaparinux MoA, when used?

A

FX (-)’r , used if HIT rxn, binds directly to antithrombin III, INC (+)’n to target it

86
Q

Fondaparinux used in what diseases?

A

DVT, PE

(-) DVT in hip and knee replacements

87
Q

Highest rate of DVT seen in what surgery? and why?

A

ankle replacement

longest period of immobility

88
Q

MoA of Amiodarone?

A

class III anti-arrythmics.

(-) K+ channels - prolongs APD, extends refractoriness
also (-) inactivated Na & Ca channels, (-) abnormal automaticity

89
Q

Use of Amiodarone

A
  1. Vtach/ Vfib - used in addition to defibrillator + vasopressors
  2. Afib - maintain sinus rhythm
  3. Prolonged QT syndrome - has BB effect, slowing heart will inc coronary filling –> dec ischemia –> dec all arrythmias
90
Q

SE/ of Amiodarone

A 
pulmonary fibrosis (dec FEV1/FVC)
corneal deposits, blue-grey skin
91
Q

68 female with SOB w/ min exertion from CHF, EF = 28%

which rx provide a mortality benefit?

A

All ACEIs and ARBs

BB - not all of them

Spironolactone/Eplerenone

Hydralazine AND nitrates ( only if both, nitrates on their own do not dec mortality)

92
Q

Which BB provide a mortality benefit in CHF?

A

metoprolol
carvedilol
bisoprolol

93
Q

T or F Ionotropic rx reduce mortality

A

F - Ionotropic Rx do not dec mortality
ex/ Dobutamine
Amrinone/Milrinone

94
Q

When giving BB for CHF, what do you add if ischemia also involved

A

Ranolazine - used in ischemia, CAD

95
Q

MoA of Ranolazine?

A

Na channel (-)’r

(-) Ca overload, leading to ischemia bc inc contraction + O2 consumption

96
Q

What anti-arrythmic rx (-) phase IV

A

IVabradine - inc late INa

97
Q

Pt w/ CAD by stress test, No DB/HTN, no smoking
Inc LDL = 3 mo

What does the pt have? What Rx ?

A

Acute Coronary Syndrome

give Statins

98
Q

What do we give in chronic angina? Which dec mortality the most?

A

statins (best to dec mortality) - esp atorvastatin, rosuvostatin
niacin (dec LDL, inc HDL)
cholestyramine (dec LDL)

99
Q

1 SE of Statin?

A

Liver issues ( measure LFTs)

Rhabdomyositis not as common

100
Q

Normal LDL levels

A

<70-100

Try to get it <100, especially if CAD, or equivalent like disease DB, peripheral art disease, or stroke

<70 if multiple comorbidities

101
Q

At what LDL level do you start statins?

A 
def give statins if LDL \> 130
usually yes if \> 70-100
102
Q

Man with metastatic cancer w/ DVT

Woman w/ metallic heart valve on routine care

Which rx?

A

Warfarin

#1 strongest indicator for warfarin use = metallic heart valve
#2 - valvular Afib
103
Q

MoA of Heparin

A

(+) Antithrombin - (-) all of the clotting cascade, esp IIa, Xa

104
Q

When is IV Heparin the ans?

A

Use IV Heparin for surgical procedure bc of short t1/2

105
Q

What test is used to follow Warfarin use/Heparin use?

A

Warfarin - measure PT/INR 2-3
Heparin - meaure PTT

106
Q

SE of Heparin

A

bleed
HIT (allergic rxn)

107
Q

Mech of HIT , what Rx to switch to?

A

HIT is not dose dep
IgG vs heparin bound platelet factor 4
test for Ab or serotonin related assays
Stop heparin and switch to Fondaparinux

108
Q

Warfarin (-) which factors

A

Factors 2, 7, 9, 10

109
Q

Which anticoags safe in pregnancy

A

heparin, LMWH

all heparins are safe in pregnancy, monitor with PTT

110
Q

32 yr old woman in 3rd trim pregnancy
HTN, edema, proteinuria, pre delivery

67 year old man has torsades post MI, hemodynamically stable

Best rx?

A

MgSO4

will (-) seizure and dec BP in preeclampsia
(-) fetal arrythmia on Torsades

111
Q

How does MgSO4 work?

A

Mg competes for Ca for active sites on smooth m in arterioles and uterine smooth m. Dec smooth m contractions = venodilate

Ventricle cells under catecholamine stress less likely to respond w/ autonomic depol

112
Q

SE of Mg2+

A

musc weakness
loss of reflexes
diarrhea ( why we use milk of Mg) - osmotic retention of fluid

severe - resp paralysis

113
Q

31 year old female at ER w/ palpitations. Short PR interval –> SVT

when given diltiazem/adenosine, pt had vtach

What does this pt have?

A

if diltiazem/ adenosine make it worse - it’s WPW

114
Q

EKG sign of WPW?

A

delta wave, short PR

115
Q

Best initial Rx of WPW?

A

procainamide (Ia)
amiodarone (III)

116
Q

Which Rs is the WRONG ans for WPW

A

Digoxin
CCB
Adenosine

b/c by (-)’g Normal conduction = Inc Abnormal conduction system

117
Q

Why do disopyramide + quinidine do not work as well on WPW?

A

They do not work as well on ventricular arrythmia, exclusively atrial

118
Q

How to definitively treat WPW?

A

cauterize accessory pathway - radiofreq catheter ablation

Step 1 2019 First Aid Flashcards (63 decks)

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