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Step 1 Pharm > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Diuretics, ACE inhibitors (cause for COUGH), angiotensin II receptor blockers (ARBs), calcium channel blockers

A

Essential Hypertension

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2
Q

Diuretics, ACE inhibitors, angiotensin II receptor blockers, beta-blockers, K+-sparring agents

A

CHF

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3
Q

ACE inhibitors, angiotensin II receptor blockers, diuretics, calcium channel blockers, beta-blockers, alpha-blockers

A

Diabetes mellitus

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4
Q

Use them cautiously in decompensated CHF

Contraindicated in cardiogenic shock

A

Beta-blockers

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5
Q

They are protective against diabetic neuropathy

A

ACE inhibitors

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6
Q

Block voltage-dependent L-type calcium channels

cardiac and smooth muscle

HTN, angina, arrhythmias, Prinzmetal’s angina, Raynaud’s

Cardiac depression, AV block, peripheral edema, flushing, dizziness, constipation

A

Calcium channel blockers

Nifedipine, verapamil, diltiazem, amlodipine

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7
Q

Tissue where:

amlodipine = nifedipine > diltiazem > verapamil

A

Vascular smooth muscle

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8
Q

Tissue where:

verapamil > diltiazem > amlodipine = nifedipine

A

Heart muscle

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9
Q

Causes smooth muscle relaxation due to increased cGMP

Arterioles > veins

(afterload reduction)

Severe HTN, CHF

1st line: HTN in pregnancy

Compensatory tachycardia, fluid retention, nausea, headache, angina, lupus-like syndrome

A

Hydralazine

Add methyldopa for HTN in pregnancy

Add beta-blocker to prevent reflex tachycardia

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10
Q

Direct release of NO increases cGMP

Malignant HTN

S.E. Cyanide toxicity at large doses

A

Nitroprusside

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11
Q

D1 receptor agonist

coronary, peripheral, renal, splanchnic vasodilation

Decreases BP (vasodilation) so used for Malignant HTN via

Increases Na+ loss

A

Fenoldopam

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12
Q

Nitroprusside, nicardipine, clevidipine, labetalol, fenoldopam

A

Malignant HTN

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13
Q

Release NO in smooth muscle

Increases cGMP

Veins >> arteries

(decreased preload)

Angina, pulmonary edema

Reflex tachycardia, hypotension, flushing, headache, Monday disease

A

Nitroglycerin,

Isosorbide dinitrate

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14
Q

Dizziness, tachycardia (reflec to NO dilation effects), headache

Loss of tolerance over weekend

Develop tolerance during work week

A

Monday disease

Due to nitroglycerin reexposure at beginning of work week.

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15
Q

These are determinants of what?

End-diastolic volume, blood pressure, heart rate, contractility, ejection time

A

Myocardial O2 consumption

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16
Q

Contraindicated in angina

(2)

A

Partial beta-agonists

Pindolol, acebutolol

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17
Q

Which Calcium Channel Blocker (CCB) is similar to:

Nitrates

and

beta-blockers

A

Nifedipine - nitrates

and

Verapamil - beta-blockers

18
Q

Effects of nitrates:

EDV

BP

Contractility

HR

Ejection time

MVO2

A

EDV - decrease

BP - decrease

Contractility - increase (reflex)

HR - increase (reflex)

Ejection time - decrease

MVO2 - decrease

19
Q

Effects of beta-blockers:

EDV

BP

Contractility

HR

Ejection time

MVO2

A

EDV - increase

BP - decrease

Contractility - decrease

HR - decrease

Ejection time - increase

MVO2 - decrease

20
Q

Combined nitrates and beta-blockers reduce what?

(3)

A

BP, HR, MVO2 (greatly)

21
Q

Inhibit conversion of HMG-CoA to mevalonate

Greatly reduces LDL

Slightly increases HDL

Hepatotoxicity, rhabdomyolysis (muscle breakdown)

A

HMG-CoA reductase inhibitors

Lovastatin, pravastatin, simvastatin, atorvastatin, rosuvastatin

22
Q

Reduces hepatic VLDL secretion

Inhibits lipolysis in adipose tissue

Greatly increases HDL

Decrases LDL

Red, flushed face, hyperglycemia, hyperuricemia

A

Niacin

(Vit B3)

Flushing reduced by aspirin

Hyperglycemia may cause acanthosis nigricans

23
Q

Prevent intestinal reabsorption of bile acids

(Liver uses cholesterol to make more bile)

Decreases LDL

Bad taste, GI discomfort, malabsorption of fat-soluble vitamins, cholesterol gallstones

A

Bile acid resins

Cholestyramine, colestipol, colesevelam

24
Q

Prevents cholesterol reabsorption

at small intestine brush border

Decreases LDL

Rare hepatotoxicity, diarrhea

A

Cholesterol absorption blockers

Ezetimibe

25
Q

Upregulates lipoprotein lipase (LPL)

(Increases triglyceride clearance)

Greatly reduces triglycerides

Myositis, hepatotoxicity, cholesterol gallstones

A

Fibrates

Gemfibrozil, clofibrate, bezafibrate, fenofibrate

26
Q

Inhibits Na+/K+ ATPase

indirectly inhibits Na+/Ca2+ antiport

increases Ca2+ in cells (positive inotropy)

Stimulates vagus nerve to decrease HR

CHF, atrial fibrillation

A

Cardiac glycosides

Digoxin

CHF - increases contractility

A fib - decreases conduction at AV, depresses SA

27
Q

Drug causes

Increased PR interval, decreased QT, ST scooping, T-wave inversion, arrhythmia, AV block

Can lead to hyperkalemia

Exceted in urine

Renal failure, hypokalemia (allows binding), quinidine (displaces from tissue binding sites):

Increase toxicity

28
Q

Nausea, vomiting, diarrhea, blurry yellow vision

(Cholinergic effects)

Treatment for OD?

A

Digoxin

Normalize K+, lidocaine, cardiac pacer, anti-dig Fab fragments, MG2+

29
Q

Local anesthetics

Slow or block conduction

Decrease slope of phase 0

Increase threshold for firing in abnormal pacemaker cells

Hyperkalemia increases toxicity

A

Class I antiarrhythmics

Na+ channel blockers

30
Q

Increases:

AP duration, effective refractory period, QT interval

For both atrial and ventricular arrhythmias

esp reentrant and ectopic SVT, VT

Thrombocytopenia, torsades de pointes

A

Class IA : “PRO QUIN DI”

Quinidine, procainamide, disopyramide

Quin - cinchonism, headaches, tinnitus

Pro - reversible SLE syndrome

Diso - heart failure

31
Q

Decreases:

AP duration

Preferentially affects ischemic/depolarized Purkinje and ventricular tissue

Acute ventricular arrhythmias (post-MI), digitalis induced arrhythmias

CNS stimulation/depression, cardiovascular depression

A

_Class IB: _“I‘d Buy Liddy’s funny (Pheny) Mexican Tacos”

Lidocaine, Mexiletine, Tocainide

32
Q

No effect on AP duration

V-tach that progresses to V-fib, intractible SVT

Prolongs refractory period in AV node

Contraindicated with structural abnormalities, MI

Proarrhythmic

A

Class IC: “For Pushing Extasy”

Flecainide, propafenone

33
Q

Class 1 A, IB and IC (Na+ blockers)

Mneumonic:

A

“Police Department Questions (Class 1A-AP increases)- The Little Man (Class 1B-AP decreases) - For Pushing Extasy (Class 1C-No change in AP)”

34
Q

Decreases cAMP, Ca2+ current in SA, AV nodes

Decreased nodal activity, esp AV node (inc. PR)

Decreases phase 4 in abnormal pacemakers

V-tach, SVT

Slows ventricular rate in A-fib and A-flutter

Impotence, bradycardia, AV block, CHF, CNS depression

A

Class II: Beta-blockers

Metoprolol, propranolol, esmolol, atenolol, timolol

Metoprolol- dyslipidemia (Tx: glucagon)

Propranolol- vasospasm in Prinzmetal’s angina

Esmolol- very short acting

35
Q

Which class II antiarrhythmic can exarcerbate

vasospasm in Prinzmetal’s angina?

A

Propranolol

36
Q

Increases AP duration, QT interval

Increases effective refractory period

Used when other antiarrhythmics fail

A

Class III: K+ channel blockers

Amiodarone, ibutilide, dofetilide, sotalol

(AIDS)

37
Q

Toxicity of:

Sotalol, Ibutilide

A

Sotalol - torsades de pointes, excessive beta-block

Ibutilide - torsades de pointes

38
Q

Toxicity of:

Amiodarone

Which function tests?

Why does it have class I, II, III and IV effects?

A

Pulmonary fibrosis, hepatotoxicity, hypo/hyperthyroidism

Corneal, skin deposits, photodermatitis

neurologic effects, constipation

bradycardia, heart block, CHF

Check PFTs, LFTs, TFTs

40% iodine by weight

Amiodarone alters the lipid membrane

39
Q

Decreases conduction velocity

Increases effective refractory period, PR interval

Prevents nodal arrhythmias (SVT)

Constipation, flushing, edema, CHF, AV block, sinus node depression

A

Class IV: Ca2+ channel blockers

Verapamil, diltiazem

40
Q

Increases K+ outflow

Hyperpolarizes cell, decreases Ca2+ in

(Na+/Ca2+ antiport)

Abolishes SVT (first line)

Very short acting (15 seconds)

Flushing, hypotension, chest pain

What blocks all effects? (2)

A

Adenosine

Effects blocked by theophylline and caffeine

41
Q

For torsades de pointes, digoxin toxicity

Step 1 Pharm (19 decks)

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