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Step 1 2019 First Aid Flashcards > Cardio - FA Pharm p312 -319 > Flashcards

Cardio - FA Pharm p312 -319 Flashcards

1
Q

HTN with HF - rx?

A

Diuretics, ACE inhibitors/ARBs, β-blockers (compensated HF), aldosterone antagonists.

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2
Q

Which Rx are protective vs DB nephropathy?

A

ACEI/ARBs

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3
Q

What rx do you avoid in a pt with HTN and asthma

A

Avoid nonselective β-blockers to prevent β2-receptor–induced bronchoconstriction.

Avoid ACE inhibitors to prevent confusion between drug or asthma-related cough

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4
Q

Name 4 dihydropyridine CCB

A

Amlodipine, Nimodipine, Nifedipine, Clevidipine

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5
Q

Which CCB assoc with reflex tachy?

A

Dihydropydrine CCB (“dipines”)

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6
Q

Which CCB act primarily on the heart?

A

Non dihydropyridines - Verapamil, Diltiazem

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7
Q

Which CCB is used in subarach hemorrhage?

A

Nimodipine - only one that crosses BBB

Nimo - like dory in Nemo, head doesnt work right

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8
Q

CCB DOC in HTN emergency?

A

Clevidipine (Clever in an emergency)

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9
Q

Which CCB can cause hyper PRL?

A

VeRaPamiL (PRL in the word, sort of)

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10
Q

Why is hydralazine freq coadmin with BB?

A

to prevent reflex tachy

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11
Q

SE of Hydralazine

A

reflex tachy, fluid retention, headache, angina, SLE-like syndrome

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12
Q

How to Tx a HTN emergency?

A

Treat with clevidipine, fenoldopam, labetalol, nicardipine, or nitroprusside.

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13
Q

`

A
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14
Q

Which cardiac parameter is decreased with nitrates?

A

preload (venous VD >> art VD)

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15
Q

Which cardiac drug is a dopamine D1-R agonist?

A

Fenoldopam

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16
Q

Which cardiac drug is associated with cyanide tox? Tx for it?

A

Nitroprusside; Nitrates and thiosulfate (Any nitrate works for CN- poisoning bc will inc metHgb, which will then bind CN-)

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17
Q

4 cardiac Rx used in HTN + pregnancy?

A

Hydralazine, Labetalol, MethylDopa, Nifedipine

Hypertensive Moms Love Nifedipine

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18
Q

Which cardiac parameter is decreased with Hydralazine?

A

afterload (art VD>> venous VD)

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19
Q

Which cardiac Rx will increase cGMP?

A

Nitroprusside, Nitrates –> both inc NO

Hydralazine

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20
Q

In Angina therapy, which Rx will increase ejection time?

A

BB

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21
Q

Which BB are to be used with caution in angina?

A

Pindolol and acebutalol - bc they are partial B agonists, and so will have SNS (+)’n –> inc cardiac work and O2 demand

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22
Q

Why does heart rate inc with the use of nitrates in angina?

A

reflex

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23
Q

What is the goal of antianginal therapy?

A

Goal is reduction of myocardial O2 consumption (MVO2) by dec 1 or more of the determinants of MVO2: end-diastolic volume, BP, HR, contractility.

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24
Q

Which BB are to be used with caution in angina?

A

Pindolol and acebutolol are partial β-agonists

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25
Q

Ranolazine MoA

A

Inhibits the late phase of sodium current thereby reducing diastolic wall tension and oxygen consumption

Ra - Na - late zine blocks late Na channels

used in refractory angina

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26
Q

Which cardiac parameters is not affected by Ranolazine?

A

it doesn’t affect HR or BP

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27
Q

MoA of Milrinone?

A

Selective PDE-3 inhibitor.
In cardiomyocytes: inc cAMP accumulation –> inc Ca2+ influx –> inotropy and chronotropy.

In vascular smooth muscle: Inc cAMP accumulation –> inhibition of MLCK activity –> general vasodilation

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28
Q

Use and SE of Milrinone

A

Used short term in acute decompensated HF
SE/ Arrythmia, hypotension

29
Q

MoA of Sacubitril?

A

Prevents degradation of natriuretic peptides, angiotensin II, and substance P by neprilysin;

inc vasodilation, dec ECF volume.

30
Q

When is Sacubitril used?

A

Used in combination with an ARB (valsartan) for treatment of HFrEF.

31
Q

SE of Sacubitril?

A

Hypotension, hyperkalemia, cough, dizziness

32
Q

Why is sacubitril CI with ACEIs?

A

can also cause angioedema

33
Q

Why are nitrates CI with sildenafil? - bonus Q

A

Both inc cGMP –> orthostatic hypotension

34
Q

Which lipid lowering agent upregulates LPL?

A

Fibrates - gemfibrozil, clofibrate, bezafibrate

35
Q

Which lipid lowering agent exacerabates gout?

A

Niacin - causes hyperuricemia

36
Q

Which lipid lowering agent inhibits hormone sensitive lipase?

A

Niacin

37
Q

Bleeding is potential side effect of which lipid lowering agent?

A

Bile acid resins - due to dec absorption of other drugs, like warfarin, and fat sol vitamins (uworld Q)

38
Q

Bonus Q - what Tx for Statin induced rhabdomyolysis?

A

mannitol

39
Q

What kidney pathology is associated with statins?

A

Acute tubular necrosis ( break down of musc –> Mgb can plug up kidney –> oxidative damage)

40
Q

GI discomfort - which lipid lowering agent?

A

Bile acid resins

41
Q

What drug blocks chol absorption at SI brush border?

A

ezetimibe

42
Q

Which Drug is an antisense oligonucleotide vs apoB100 mRNA?

A

Mipomersen

43
Q

Digoxin has a secondary effect on heart rate, separate from contractility - what is it? Mech?

A

Dec HR by stimulating CN X

44
Q

Why does digoxin require a loading dose?

A

Bc has a long half life will take a long time to get to steady state.

45
Q

Lower dose of digoxin in patients with which comorbidities?

A

renal failure bc dec excretion - digoxin is renally cleared.

46
Q

Name 4 drugs that can increase Digoxin Tox - Why?

A

Verapamil, Amiodarone, Quinidine, Propafenone - bc they displace digoxin from tissue binding sites

VAQuum uP Digoxin

47
Q

Digoxin tox antidote

A

anti digoxin Fab fragments, Mg2+, slowly normalize K+ (using insulin, kayexalate, hemodialysis)

48
Q

Class I anti-arr Rx overall affect which phase of the cardiac cycle?

A

phase 0

49
Q

What can increase the chances of toxicity of all class I drugs?

A

Hyperkalemia

50
Q

Which anti-arr Rx increase AP duration?

A

Class III (K ch blockers) and Class Ia (block open active Na channels)

51
Q

Adenosine affects which phase of cardiac cycle? Mech of action?

A

phase 4; Inc K+ efflux –> hyperpol and dec Ca current, dec AV node conduction

52
Q

`Adenosine is used for what disease?

A

diagnosing, terminating forms of SvT

53
Q

Which drugs will blunt the affect of Adenosine?

A

Theophylline, Caffeine

54
Q

SE of Adenosine

A

flushing, hypotension, chest pain, sense of impending doom, bronchospasm

55
Q

`Mg2+ is used in what diseases?

A

torsades de pointes and digoxin toxicity.

(and pre-eclampsia)

56
Q

`MoA of Ivabradine

A

IVabradine prolongs slow depolarization (phase “IV”) by selectively inhibiting “funny” sodium channels (If).

57
Q

Ivabradine is used for what diseases? SE?

A

Chronic stable angina in patients who cannot take β-blockers. Chronic HFrEF. (HF with reduced ejection fraction)

Luminous phenomena/visual brightness, hypertension, bradycardia.

58
Q

Which Anti-arr Rx is associated with gingival hyperplasia ?

A

Verapamil

59
Q

Which Anti-arr Rx is associated with “sense of impending doom” as Tox?

A

Adenosine

60
Q

Which Anti-Arr Rx will increase PR interval?

A

BB, CCB

61
Q

Drug associated with headache, tinnitus?

A

Quinidine (Cinchonism)

62
Q

Anti Arr Rx that can lead to reversible SLE like syndrome?

A

Procainamide

63
Q

Best class for post MI?

A

Class Ib - block the inactivated Na channel, tissue post MI is hypoxic, closer to depol, and Na ch is in the inactivated state

64
Q

Which Anti arr rx is assoc with difficulty breathing, skin and eye issues?

A

Amiodarone - SE// pulm fibrosis, hyper/hypothyroidism, corneal deposits, blue/grey skin

65
Q

Which anti Arr rx is a BB that also blocks K channels?

A

Sotalol

66
Q

Which anti Arr rx is CI post MI?

A

Any Class Ic - Flecainide, Proparenone - can be pro-arrythmic

67
Q

with which anti-Arr Rx will you have to do CBCs?

A

Class Ia (thrombocytopenia )

68
Q

Anti -Arr Rx that prolong QT?

A

Class Ia and III - will lead to Torsades

Disopyramide, ibutilide, Dofetilide, Sotalol, Quinidine, Procainamide

69
Q
A

Step 1 2019 First Aid Flashcards (63 decks)

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