Cardio Pharm

Question 1

which lipid-lowering agent has best effect on HDL?

Answer 1

niacin (side effects: flushing which is dec’d by aspirin or longterm use)

Question 2

which statin is NOT metabolized by P450 system?

Answer 2

pravastatin

Question 3

which lipid lowering agent causes a slight increase in TG?

Answer 3

bile acid resins (cholestyramine, colestipol)

Question 4

which lipid loweirng agents have biggest lowering effect on TGs?

Answer 4

fibrates”–gemfibrozil, clofibrate, bezafibrate, fenofibrate”

Question 5

which lipid lowering agents work by decreasing production of VLDL?

Answer 5

niacin

Question 6

which lipid lowering agents work by stimulating LPL/enhancing rate of catabolism of VLDL?

Answer 6

fibrates (gemfribrozil, clofibrate, bezafibrate, fenofibrate)

Question 7

which class of lipid lowering agents is safest and what is the effect?

Answer 7

cholesterol absorption blockers (ezetimibe). only decreases LDL. no effect on HDL or TGs

Question 8

which antihypertensive can cause a positive Coombs test?

Answer 8

methyldopa (cental acting alpha agonist, safe for preggers)

Question 9

which CCB should NOT be used for arrhythmias?

Answer 9

nifedipine

Question 10

MOA of nitroglycerin

Answer 10

vasodilate by releasing NO in smooth muscle–> increase in cGMP and smooth muscle relaxation; dilates veins» arteries

Question 11

which heart drug has Monday dz” as a toxicity”

Answer 11

(tolerance during the work week and loss of tolerance over weekend-> tachycardia, dizzinesss, headache); nitroglycerin

Question 12

what diuretics should go with digoxin?

Answer 12

spironolactone/K+ sparers b/c hypokalemia potentiates dig toxicity

Question 13

what increases toxicities of digoxin

Answer 13

renal failure, hypokalemia, quinidine (dec’d clearance, displaces dig from tissue binding sites)

Question 14

antidote to digoxin toxicity

Answer 14

slowly normalize K+, lidocaine, cardiac pacer, anti-dig Fab fragments

Question 15

compare the class I antiarr in terms of effect on AP duration

Answer 15

IA (Na, intermediate acting)–increase duration; IB (Na, fast acting)–decrease duration; IC (Na, slow acting)–no change in AP

Question 16

usefulness of IA antiarr?

Answer 16

(quinidine, amiodarone, procainamide, disopyramide) affect both ATRIAL and VENTRICULAR s, esp reenrant and ectopic tachycardias

Question 17

which antiarrhythmics useful in acute ventricular arrhytmias, esp post MI?

Answer 17

IB (lidocaine, mexiletine, tocainide)

Question 18

drug of choice in diagnosing/abolishing AV nodal arrhythmias

Answer 18

adenosine (maybe cause flushing)

Question 19

which antiarr contraindicated post-MI?

Answer 19

class IC (flecainide, encainide, propafenone)

Question 20

when use class IC antiarr?

Answer 20

usually only as last resort in refractory tachyarrhythmias

Question 21

which antiarr only work on AV and SA nodes?

Answer 21

class II (beta blockers)

Question 22

which antiarr can cause dyslipidemia?

Answer 22

metoprolol (class II)

Question 23

amiodarone toxicities

Answer 23

pulmonary fibrosis, hepatotoxicity, thyroidisms, corneal deposits, photodermatitis, neurologic effects, constipation; check PFTs, LFTs, TFTs!!!

Question 24

use of class IV antiarr?

Answer 24

(nondihydropyridine CCBs; verpamil, diltiazem); primarily affect AV nodal cells–> good for prevention of nodal arrhythmias

Question 25

antiarrhythmic effect of K+?

Answer 25

depresses ectopic pacemakers, esp in digoxin toxicity

Question 26

what lipid lowering agent causes flushing ?

what is the flushing mediated by?

Answer 26

niacin

prostaglandins

Question 27

what are the side effects of niacin?

Answer 27

red flushed face (can be decreased by aspirin)

hyperglycemia

hyperuricemia (exacerbates gout)

Question 28

what lipid lowering agents cause muscle problems?

Answer 28

Statins (rhabdomyolysis) and Fibrates (myositis)

Question 29

Which lipid lowering agents cause gall stones?

Answer 29

fibrates and bile acids

Question 30

what two agents would you use for hypertriglyceridemia?

Answer 30

niacin and fibrates

Question 31

If you use a statin what protiens increase in production?

Answer 31

LDL receptors

Question 32

whats the MOA of niacin?

Answer 32

inhibits lipolysis in adipose tissue and reduces hepatic VLDL secretion into circulation

Question 33

what increases HDL?

Answer 33

NIACIN THE MOST

and statins and fibrates a little too