Cardio Pharmacology I

Question 1

B-blockers must be used with caution in what and are contraindicated in what?

Answer 1

decompensated heart failure

contraindicated in cardiogenic shock

Question 2

what drugs are protective against diabetic nephropathy?

Answer 2

ACE inhibitors/ARBs

Question 3

What drugs can be used for hypertension in pregnancy? (4)

Answer 3

Hydralazine, labetalol, methyldopa, nifedipine

Question 4

Amlodipine and the other ‘dipines’ have what mechanism of action?

Answer 4

Block voltage-dependent L-type calcium channels of cardiac and smooth muscle -> decreasing muscle contractility

Question 5

difference between dihydropyridines and non-dihydropyridines?

Answer 5

dihydropyridines act on vascular smooth muscle

non-dihydropyridines act on heart

Question 6

name the non-dihydropyridines

Answer 6

diltiazem, verapamil

Question 7

amlodipine = nifedipine > diltiazem > verapamil in regards to what function?

Answer 7

action on vascular smooth muscle

Question 8

verapamil > diltiazem > amlodipine = nifedipine in regards to what function?

Answer 8

action on heart

Question 9

which calcium channel blocker can be used for subarachnoid hemorrhage (prevents cerebral vasospasm)?

Answer 9

Nimodipine

Question 10

which calcium channel blocker can be used for hypertensive urgency or emergency?

Answer 10

Clevidipine

Question 11

Dihydropyridines can be use for what indications? (3)

Answer 11

hypertension, angina (including Prinzmetal), Raynaud phenomenon.

Question 12

which dihydropyridine cannot be used for their normal indications?

Answer 12

Nimodipine

Question 13

Non-dihydropyridines can be used for what indications? (3)

Answer 13

hypertension, angina, atrial fibrillation/flutter.

Question 14

Adverse effects of cardiac depression, AV block, hyperprolactinemia, constipation are associated with what class of drugs?

Answer 14

Non-dihydropyridine CCB

Question 15

Adverse effects of peripheral edema, ushing, dizziness, gingival hyperplasia are associated with what class of drugs?

Answer 15

Dihydropyridine CCB

Question 16

Mechanism of Hydralazine?

Answer 16

increases cGMP -> smooth muscle relaxation. Vasodilates arterioles > veins; afterload reduction.

Question 17

Why is hydralazine frequently co-administered with a B-blocker?

Answer 17

to prevent reflex tachycardia.

Question 18

What are the indications for Hydralazine? (3)

Answer 18

Severe hypertension (particularly acute), HF. 
hypertension in pregnancy.

Question 19

What do you coadminister hydralazine with for HF?

Answer 19

organic nitrates

Question 20

What are the contraindications for Hydralazine and why? (2)

Answer 20

Angina and CAD

compensatory tachycardia

Question 21

What cardiac drug is known to cause drug-induced Lupus like syndrome?

Answer 21

Hydralazine

Question 22

clevidipine, fenoldopam, labetalol, nicardipine, nitroprusside can all be used in what scenario?

Answer 22

Hypertensive Emergency

Question 23

Mechanism of Nitroprusside?

Answer 23

Short acting; cGMP via direct release of NO

Question 24

Adverse effect of Nitroprusside?

Answer 24

Can cause cyanide toxicity (releases cyanide)

Question 25

What cardiac drug used in hypertensive emergency is a D1 receptor agonist?

Answer 25

Fenoldopam

Question 26

What cardiac drug is used postoperatively as an antihypertensive?

Answer 26

Fenoldopam

Question 27

What is the effect of Fenoldopam on the body?

Answer 27

coronary, peripheral, renal, and splanchnic vasodilation. | decreases BP and increases natriuresis.

Question 28

Mechanism of Nitrates?

Answer 28

Vasodilator by increasing NO in vascular smooth muscle -> increase in cGMP and smooth muscle relaxation. Dilate veins >> arteries. decreases preload.

Question 29

What are the indications for Nitrates?

Answer 29

Angina, acute coronary syndrome, pulmonary edema.

Question 30

What is Monday disease and it occurs with what drug class?

Answer 30

Nitrates industrial exposure: development of tolerance for the vasodilating action during the work week and loss of tolerance over the weekend -> tachycardia, dizziness, headache upon reexposure.

Question 31

What is the goal of anti-anginal therapy?

Answer 31

reduction of myocardial O2 consumption (MVO2)

Question 32

What are the determinants of MVO2 targeted in anti-anginal therapy? (4)

Answer 32

end-diastolic volume, BP, HR, contractility

Question 33

What B-blockers are contraindicated in angina?

Answer 33

Pindolol and acebutolol—partial β-agonists contraindicated in angina.

Question 34

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

Answer 34

Ranolazine

Question 35

How does Ranolazine effect heart rate and contractility?

Answer 35

Does not affect heart rate or contractility

Question 36

What drug do you use for angina refractory to all other medications?

Answer 36

Ranolazine

Question 37

What drug has the side effects of constipation, dizziness, headache, nausea, QT prolongation?

Answer 37

Ranolazine

Question 38

Mechanism of Statins?

Answer 38

Inhibit conversion of HMG- CoA to mevalonate, a cholesterol precursor

Question 39

Statins decrease mortality in what patients?

Answer 39

CAD patients

Question 40

Toxicity of Statins?

Answer 40

Hepatotoxicity/Hepatitis (increases LFTs), myopathy

Question 41

when are statins more susceptible to causing myopathy?

Answer 41

especially when used with fibrates or niacin

Question 42

What enzyme do statins inhibit?

Answer 42

HMG-CoA Reductase

Question 43

How do statins change LDL, HDL, and TG levels?

Answer 43

decreases LDL a lot increases HDL decreases TG

Question 44

Name the bile acid resins (3)

Answer 44

Cholestyramine, colestipol, colesnvelam | start with "Coles"

Question 45

What drugs prevent intestinal reabsorption of bile acids making the liver use cholesterol to make more?

Answer 45

Cholestyramine, colestipol, colesnvelam | Bile acid resins

Question 46

What drugs decrease the absorption of other drugs and decrease the absorption of fat-soluble vitamins?

Answer 46

Cholestyramine, colestipol, colesnvelam | Bile acid resins

Question 47

How do bile acid resins change LDL, HDL, and TG levels?

Answer 47

decreases LDL a lot slightly increases HDL slightly increases TG

Question 48

What drug prevents cholesterol absorption at small intestine brush border?

Answer 48

Ezetimibe

Question 49

What adverse effects does Ezetimibe have?

Answer 49

Rare LFTs, diarrhea

Question 50

How does Ezetimibe change LDL, HDL, and TG levels?

Answer 50

decreases LDL a lot | no change in HDL and TG

Question 51

Name the Fibrates (3)

Answer 51

Gemfibrozil, bezafibrate, fenofibrate | "fibr" in the middle

Question 52

What group of drugs upregulate LPL -> increases TG clearance?

Answer 52

Fibrates

Question 53

What group of drugs activates PPAR-α to induce HDL synthesis?

Answer 53

Fibrates

Question 54

What are the adverse effects of Fibrates?

Answer 54

Myopathy (risk with statins), cholesterol gallstones, hepatitis

Question 55

How do Fibrates change LDL, HDL, and TG levels?

Answer 55

decrease LDL increase HDL decrease TG a lot

Question 56

What vitamin is Niacin?

Answer 56

B3

Question 57

Mechanism of Niacin (B3)? (2)

Answer 57

Inhibits lipolysis (hormone- sensitive lipase) in adipose tissue; reduces hepatic VLDL synthesis

Question 58

What lipid lowering drug causes a red, flushed face?

Answer 58

Niacin

Question 59

WHICH adverse effect OF WHAT lipid lowering drug is decreased by NSAIDs or long-term use?

Answer 59

red, flushed face adverse effect of Niacin (B3)

Question 60

What lipid lowering agent causes hyperglycemia and hyperuricemia?

Answer 60

Niacin (B3)

Question 61

How does Niacin change LDL, HDL, and TG levels?

Answer 61

decreases LDL a lot increases HDL a lot decreases TG

Question 62

Digoxin directly inhibits what?

Answer 62

Na+/K+ ATPase

Question 63

Digoxin indirectly inhibits what?

Answer 63

Na+/Ca++ exchanger

Question 64

What is the net effect of digoxin's inhibition of the transporters?

Answer 64

increased Ca++ concentration inside the myocyte -> positive inotropy (contractility)

Question 65

How does Digoxin increase cardiac contractility? | detailed explanation

Answer 65

by inhibition of the gradient formed by the Na/K ATPase, Ca++ is no longer released from cell -> accumulation of Ca++. This causes the SR to have Ca++-dependent Ca++ release, which then increases Troponin C binding Ca++ -> increased cardiac contraction

Question 66

Why does Digoxin cause a decrease in HR?

Answer 66

stimulates Vagus Nerve

Question 67

indication for Digoxin use?

Answer 67

HF and atrial fibrillation

Question 68

Explain why Digoxin works for its two indications

Answer 68

HF - increases contractility, helps the heart pump | Atrial Fib - decreases conduction at AV node and depresses SA node

Question 69

what type of adverse reactions are seen with Digoxin?

Answer 69

cholinergic - due to vagus nerve stimulation

Question 70

What odd side effect occurs with digoxin? (think Van Gogh)

Answer 70

blurry yellow vision

Question 71

What electrolyte disorder can be caused by digoxin?

Answer 71

Can lead to hyperkalemia, which indicates poor prognosis.

Question 72

Why does renal failure predispose someone to digoxin toxicity?

Answer 72

decreases excretion

Question 73

Why does hypokalemia predispose someone to digoxin toxicity?

Answer 73

no competition for digoxin binding at K+-binding site on Na+/K+ ATPase

Question 74

What drugs that displace digoxin from tissue-binding sites, and decreased clearance

Answer 74

verapamil, amiodarone, quinidine

Question 75

What are the antidotes for digoxin toxicity? (4)

Answer 75

Slowly normalize K+, cardiac pacer, anti-digoxin Fab fragments, Mg2+