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Board Review-Internal Medicine > Cardiology Drugs > Flashcards

Cardiology Drugs Flashcards

1
Q

Drug for narrow complex PSVT

A

Adenosine

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2
Q

drug for pulseless VT/VF or to stabilize VT or AF it is also proarrhythmic

A

Amiodarone

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3
Q

Beta blockers are used for:

A

SVT, MI

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4
Q

Calcium channel blockers help control

A

SVT

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5
Q

Use dobutamine, dopamine, epi and norepi for

A

bradycardia, hypotension and asystole

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6
Q

A proarrhythmic drug used for SVT

A

digoxin

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7
Q

proarrhythmic drug used for ventricular tachycard

A

lidocaine and procainamide (which can also be used for SVT

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8
Q

Emergency med for pulseless VT/VF

A

vasopressin

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9
Q

Drug to use with caution in wide complex PSVT

A

adenosine– do not use at all in poison or drug induced arrest

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10
Q

Procainamide +amiodarone can lead to

A

QT prolongation

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11
Q

Adenosine

A

for narrow complex PSVT, may cause ischemia, bronchoconstriction, increased ICP .
dont use in wide complex tachycardia or drug or poison induced arrest

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12
Q

Amiodarone

A

for pulseless VT/VF, stable VT of unknown origin AF rate control.
SE: AV block, hypotension, proarrhythmia
CI: QT prolongation

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13
Q

Atropine

A

Sinus brady, type IIa AVB, asystole
SE: tachycardia, ischemia
CI: hypothermic brady, type II (infranodal) AVB or new 3rd degree AVB with wide QRS

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14
Q

Beta blockers

A

use for MI, SVT
SE: bronchospasm, hypotension, bradycardia, worsening heart failure
CI: brady cardia or 2nd or 3rd degree AV block

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15
Q

Calcium Channel blocker

A

SVT
SE: AV block, hypotension, bradycardia, worsened CHF
CI: WPW, ventricular arrhythmia, also using beta blocker

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16
Q

catecholamines

A

use for bradycardia, hypotension, asystole
SE: Hypertension, tachycardia, ischemia, arrhythmia, hyptension
CI: evolving MI, use only after volume resussitation, SBP <100 and signs of shock dont use dobutamine

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17
Q

Digoxin

A 
SVT
SE: proarrhythmia
CI: hypokalemia, hypercalemia or hypomagnesemia
defibrillation
WPW, AV block
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18
Q

Lidocaine

A

ventricular tachyarrhthmias
SE: proarrhythmia, seizure, heart failure
CI: prophylaxis after MI, liver dysfunction or CHF, evolving MI

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19
Q

Procainamide

A

Vent (but not Torsades) and SVT
SE: proarrhythmia (torsade), hypotension, worsening CHF
CI: low magnesium or potassium, MI, hypotension (infuse slowly) polymorphic VT

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20
Q

Vasopressin

A

pulseless VT/VF, vasodilitory shock
SE: bradycardia, ischemia
CI: CAD

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21
Q

Aldosterone antagonist side effects

A

hyperkalemia, esp if renally impaired, gynecomastia

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22
Q

ACE-I side effects

A

angioedema, renal failure, hypotension, hyperkalemia, hepatitis, neutropenia, cough, rash, taste disturbance

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23
Q

ARBs side effects

A

rare angioedema, hepatitis, headache, dizziness, fatigue

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24
Q

beta blocker side effects

A

bronchospasm, hypotension, bradycardia, CHF, CNS effects (lipophilic agents may lead to depression, psychosis, dizziness, weakness, fatigue, dreams, insomnia) GI effects, reduced PV perfusion, impotence, hypo or hyperglycemia

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25
Q

calcium channel antagonist side effects

A

hypotension, bradycardia, worsening hof CHF, dizziness, flushing, peripheral edema, constipation, postural hypotension, taste disturbance

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26
Q

centrally acting blood pressure lowering agent side effects

A

withdrawal hypertension, hypotension, hepatitis (methyldopa), bradycardia (clonidine), frequent CNS effects, gi effects, sexual dysfunction, xerostomia (clonidine)

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27
Q

clopidogrel side effects

A

idiopathic thrombocytopenic purpura, GI effects

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28
Q

digoxin

A

heart block, ectopic arrhythmia, ventricular extra beats, ventricular tachycardia, PSVT, GI” effects, CNS effects (drowsiness, confusion, dizziness, vision abnormalities)

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29
Q

Direct thrombin inhibitors names

A

lepirudin, argatroban, bivalirudin

30
Q

Direct thrombin inhibitor side effects

A

bleeding without antidote, allergic reaction and antibody formation (lepirudin)

31
Q

Fondaparinux side effects

A

bleeding risk, renal impairment

32
Q

hydralazine side effects

A

hypotension, hepatitis, neuropathy, flushing, GI effects

33
Q

LMWH side effects

A

bleeding, heparin induced thrombocytopenia

34
Q

LMWH names

A

enoxaparin, dalteparin

35
Q

loop diuretic side effects

A

dehydration, hypokalemia, hyponatremia, pancreatitis, jaundice, deafness, thrombocytopenia, serious skin disorders, dizziness, gout

36
Q

Nesiritide (Natrecor) side effects

A

hypotension, headache, renal impairment, increased mortality

37
Q

Nitrate side effects

A

syncope, TIA, headache flushing, palpitations, peripheral edema

38
Q

Potassium Sparing Diuretics side effects

A

hyperkalemia, dehydration, GI effects, CNS effects, rashes, gynecomastia and breast tenderness

39
Q

Ranolazine (Ranexa) side effects

A

Prolonged QT interval (low risk of Torsades de pointes

40
Q

Thiazide diuretic side effects

A

dehydration, rare thrombocytopenia, cholestatic jaundice, pancreatitis, hepatic encephalopathy (if cirrhosis), dizziness, gout, hyperglycemia, orthostasis, hypokalemia, hypermagnesemia, hypercalcemia, GI effects

41
Q

Warfarin side effects

A

Abnormal bleeding, rare necrosis or gangrene of skin, “purple toe syndrome” (cholesterol microembolizations) osteoporosis

42
Q

Amiodarone drug interactions

A

typically INCREASES level of other drugs including cyclosporin, dignoxin,k dofetilide, phenytoin (but may also decrease!), procainamide, quinidine, simvastatin (not recommended to give more than 20mg with amiodarone due to risk of myopathy), warfarin

43
Q

Digoxin drug interactions

A

several drugs increase serum digoxin levels: amiodarone, propafenone, quinidine, verapamil

44
Q

Dolfetilide drug interactions

A

Risk of Torsades de pointes with amiodarone (no amiodarone for 3 months!) cimetidine, class 1&II antiarrythmic agents, hydrochlorothiazid, detoconazole, megestrol, prochlorperazine, trimethoprim, verapamile, ziprasidone

45
Q

Proprafenone drug interactions

A

increases level or effect of: digoxin, metoprolol, warfarin

46
Q

Ranolazine (Ranexa) drug interactions

A

CYP3A inhibitors (azole antifungals, clarithromycin, diltiazem, erythromycin, protease inhibitors, verapamil, grapefruit, QTc prolonging drugs (class I and II antiarrhythmics)

47
Q

CYP3A inhibitors:

A

azole antifungals, clarithromycin, diltiazem, erythromycin, protease inhibitors, verapamil, grapefruit, QTc prolonging drugs (class I and II antiarrhythmics

48
Q

Warfarin drug interactions

A

Increases effect or risk of bleeding: acetaminophen, amiodarone, azole antifungals, glycoprotein IIb/IIIa inhibitors (abciximab, eptifibatide, tirofiban (ReoPro, Integrilin, aggrastat)
metronidazole, propafenone, thrombolytics, trimethoprim/sulfmethoxazole
Decreases effect: Rifampin,cholestyramine (use colestipol)

49
Q

What is Kussmaul Sign?

A

Increased JVP with inspiration –constrictive pericarditis

50
Q

What is a loud first heart sound associated with?

A

(? opening) aortic valve; hyperdynamic left ventricular function OR snapping SHUT of the mitral valve with force

51
Q

What is a soft first heart sound associated with?

A

aortic valve; left ventricular dysfunction and a long PR interval

52
Q

What is Hypertrophic Cardiomyopathy characterized by?

A

dynamic outflow obstruction; worse with dehydration, exercise, position, or decreased venous return. (therefore murmur is loudest with valsalva, softer with squat or handgrip)

53
Q

Which maneuvers decrease venous return?

A

hand grip and squat

54
Q

which maneuvers increase venous return?

A

Valsalva

55
Q

Which murmurs get softer with the Valsalva?

A

aortic valve stenosis, pulmonary valve stenosis and mitral valve regurgitaion.

56
Q

A distinguishing sound of mitral valve prolapse.

A

systolic click

57
Q

A distinguishing sound of pulmonary valve stenosis

A

opening click that gets softer on inspiration. It is the only right sided sound that gets softer with inspiration. (this is caused by the premature opening of the pulmonary valve with inspiratory increase in flow to the right ventricle)

58
Q

Description of the murmur of Aortic Stenosis

A

sustained apical impulse, vibration over the right upper sternal border, grade 4/6 murmur that is late peaking and a single second heart sound.

59
Q

Description of the cardiac findings of Hypertrophic Cardiomyopathye with outflow obstruction

A

sustained apical pulse, brisk carotid pulsations, Normal JVP. grade 3/6 systolic murmur best herd in the 2nd interspace, RSB and radiating to the neck, there is a fourth heart sound. Valsalva is LOUDER.

60
Q

Which heart sound is pathological in the ill, but not in the healthy?

A

3rd heart sound. May represent heart failure or early rapid filling of the left ventricle

61
Q

What causes a 3rd heart sound?

A

early rapid filling of the lateral ventricle (in healthy young and/or pregnant patients) or high filling pressure associated with heart failure in most adults

62
Q

What causes a 4th heart sound?

A

stiff left ventricle from HTN or other causes

63
Q

When do we operate in mitral regurg?

A

Asymptomatic or Symptomatic, EF<60% has worse prognosis, Left ventricular end-diastolic dimension is more than 45mm

64
Q

Cardiac exam of mitral stenosis (severe)

A

first heart sound is loud (or soft), second heart sound is physiologically split with a loud pulmonary component. The apical impulse is tapping, nondisplaced and discrete. There is a high-pitched, early diastolic snapping sound heard at the apex and a long, low-pitched diastolic rumbling murmur heard best with a beel in the LLD. There is sternal lift and JVP is 10cm.

65
Q

Signs of Left atrial fluid overload (mitral stenosis or others)

A

increased JVP, sternal lift and increased pulmonary component of the 2nd heart sound. (usually you will also find pulmonary HTN)

66
Q

What does a short interval from second heart sound to opening snap mean?

A

aortic valve opening to the opening snap of the mitral valve is shortened in mitral stenosis due to the increased pressure in the atrium.

67
Q

In less severe mitral stenosis, what does the regurgitant murmur sound like?

A

holosystolic beginning withthe first heart sound. As the mitral stenosis worsens the pressure in the left atrium increases and the regurg murmur is shorter.

68
Q

Which murmurs are suggestive of aortic valve disease?

A

blowing diastolic murmur and systolic ejection murmur.

69
Q

What EKG findings might you get with Mitral Stenosis

A

Left Atrial enlargement (usually), Right ventricle and atrial enlargement if pulmonary hypertension.

70
Q

Common cause of rupture of the papillary muscle

A

MI

71
Q

Common cause of rupture of the mitral chordae

A

a complication of long-standing mitral valve prolapse due to myxomatous degneration

72
Q

Rheumatic fever causes which valular problem?

A

Mitral stenosis, typically appears in the 30s with mild symptoms, then inthe 40s with A fib.

Board Review-Internal Medicine (4 decks)

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