Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NPLEX II TIA > Cardiovascular & Intro to Blood Chemistry > Flashcards

Cardiovascular & Intro to Blood Chemistry Flashcards

1
Q

Which marker is more likely to rise during early MI; ALT or AST?

A

AST; “A sick heart can beat f-AST”

L is for Liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

CPK elevation indicates what?

A
  • often done to document acute MI; after 12 hours but before 24 hours
  • CPK-MB can also be elevated with PE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When is LDH released by cells?

A

Increased amounts of hypoxic metabolism; reduces lactate back to pyruvate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is your first step after an elevated LDH?

A

Fractionate the LDH; multiple conditions with tissue damage cause elevated LDH and you need to differentiate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What LDL isoenzyme ratio is seen in MI?

A

LDH-1 > LDH 2
(in normal states, LDH-1 is lower)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How to differentiate liver dz from cardio pathology utilizing LDH isoenzymes?

A

in liver dz LDH < AST & ALT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

LDH may be up to 50x normal in what pathology?

A

pernicious anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What LDH isoenzyme is increased in muscle disease?

A

LDH-5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Increased levels of homocysteine may indicate what?

A

increased myocardial risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the most common cause of elevated ammonia (NH3) levels?

A

severe liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what would be markers consistent with methylation defects?

A

elevated MCV
low reticulocyte
hyper segmented neutrophils (5+)
high MMA
<200pg/mL B12 (can aso be low in pernicious anemia and alcoholism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

normal folate levels

A

200-640 ng/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

folate is decreased in which conditions

A

megaloblastic anemia and alcoholism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

folate is increased in which conditions

A

acute renal failure
liver dz
non fasting status (plasma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Apoprotein A1 vs B vs lipoprotein a

A

A1: >140, associated with HDL, higher = better
B: 70-110, associated with LDL; higher = more myocardial risk
a: indicateds CAD risk; <30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hyperlipidemia Genotypes (2 most common)

A

IV: most common
- chol 200+
- HDL = low, LDL = high
- TG > chol

II: second most common
- chol > 200
- TG normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does a higher level of LDL associate with inflammation?

A

LDL carry oxidants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Higher triglycerides carry an association with what other type of pathology

A

insulin - sugar biochemistry disorders (can’t burn fats and sugars at same time; if sugars are blocking transporter after carb ingestion, TG get released into blood)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

HMG-coA reductase inhibitors are what commonly used drug? how does blocking HMG-coA reductase cause a clinical effect?

A

statins; blocking the mevalonic to cholesterol pathway (also blocks coQ10 so need to replenish)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Adverse effects of statins

A

GI distress
headache
dizziness
abdominal cramps
rash
liver toxicity
rhabdomyaloysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

pre-prescribing and monitoring considerations for statins

A

check AST and ALT prior to rx and at 6 weeks post rx

monitor liver function

rx with 75-100 mg coq10 minimum

discontinue if pt has muscle pain concomitant to RX - EVEN if LFTs are normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

simvastatin MOA

A

HMG CoA reductase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

atorvastatin MOA

A

HMG CoA reductase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lipitor/Atorvastatin typical and max dose

A

10-20 mg qd (in severe cases 40mg)

max dose 80 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Questran is what type of drug? What other name is it known by?

A

Cholestyramine; bile sequesterant used for hyperlipidemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Cholestyramine/questran MOA

A

combines with bile acid to form an insoluble compound that is excreted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Cholestyramine/questran adverse effects

A

constipation
fecal impaction
abominal pain
nausea
def of fat soluble vitamins (reduces absorption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What vitamin can be used as a lipid lowering agent? What is the MOA?

A

niacin; stimulates hepatic lipid metabolism; lowers TC/LDL/TG, raises HDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

niacin adverse effects

A

niacin flush
rash
GI distress
liver toxicity (give with vit C to avoid hepatic effect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

which form of niacin is more hepatotoxic?

A

slow release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

dosing of niacin for hyperlipidemia

A

alone or with low dose statin
1500-2000mg daily
rx with vit c and high potency B complex (gram per gram)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

drugs that end in -fibrate are what type of drug? how are they dosed?

A

fibrates; TG lowering drugs
48-145 mg qd, max dose 145 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is lovaza?

A

high dose estherized omega 3 - 4 grams daily

TG lowering; alone or with statins in high/very high TG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Classifications of BP/HTN

A
  • normal: <120 AND <80
  • preHTN: 120-139 OR 80-89
  • stage 1: 140-159 OR 90-99
  • stage 2: 160+ OR 100+

systolic goes by 20 mmHg jumps, diastolic by 10 mmHg jumps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

top causes of secondary HTN

A

renal artery stenosis
chronic renal dz
primary hyperaldosteronism
thyroid dz
pheochromocytoma
preeclampsia
aortic coarctation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

basic tests for HTN evaluation

A
  • urine for protein, blood, glucose, and microscopic exam
  • hemoglobin or hematocrit; leukocyte ct
  • serum potassium
  • serum calcium, phosphate
  • serum creatinine or BUN
  • fasting glucose
  • total, HDL, and LDL cholesterol; TGss
  • ECG
  • TSH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are first line pharmaceuticals for HTN?

A

diuretics and beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

diuretics MOA

A

loop diuretics: affects the thick asc loop of henle (inhibits Na re-absorption)

thiazide diuretics: affects dital tubule/CD (Na reabsorption/excretion, Na-Cl cotrasnporter)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

where do carbonic anhydrase inibibitors act?

A

proximal tubule of nephron and blocks HCO3 reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what diuretics are potassium wasting?

A

chlorothiazide (HCTZ)
furosemide (lasix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

chlorothiazide MOA

A

inhibits sodium and chloride re-absorption in distal tubule = decrease GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

furosemide MOA

A

loop diuretic; inhibits sodium and chloride reabsorption in the loop of henle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

diuretic uses

A

HTN, edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what adverse effects do thiazide and loop diuretics have in common?

A

hypokalemia (potassium wasting)
hyperglycemia
oliguria
anuria
GI disturbance
hypercalcemia
hyperuricemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

adverse effects unique to thiazide diuretics

A

renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

adverse effects unique to loop diuretics/furosemide

A

ototoxicity
hypovolemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

CI thiazide diuretics

A

hypersensitivity to thiazide or sulfonamide drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what two diuretics/anti-hypertensives are potassium sparing?

A

triamterene and spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

triamterene MOA and uses

A

potassium sparing diuretic acting on distal tubules

HTN/edema (often used with HCTZ to balance k levels)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

spironolactone MOA and uses

A

aldosterone antagonist

HTN, edema, endocrine uses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

triamterene adverse effects

A

hyperkalemia
nausea/vomiting
diarrhea
may turn urine blue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

spironolactone adverse effects

A

hyperkalemia
breast deformity/tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

list the antihypertensive drugs

A
  • beta blockers (-OLOL)
  • ACE inhibitors (-PRIL)
  • ARBS (-SARTAN)
  • Alpha2 central agonist (clonidine)
  • catecholamine agent (reserpine)
  • CCBs (all the rest)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what antihypertensive drug class ends in -OLOL

A

beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what antihypertensive drug class ends in -PRIL

A

ACE inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what antihypertensive drug class ends in -SARTAN

A

ARBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what antihypertensive drug is an alpha2 central agonist

A

clonidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what antihypertensive drug is a catecholamine agent

A

reserpine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what are the two types/MOA of Beta blockers?

A

Specific, newer B1 adrenergic receptor blockers

Nonspecific, older B1 + B2 adrenergic receptor blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what are the specific B1 blockers?

A

atenolol
metoprolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what are the nonspecific B1& B2 blockers?

A

propanolol
carvediolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

specific B1 blocker uses

A

HTN, angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

specific B1 blocker adverse effects

A

fatigue
vertigo/dizziness
bradycardia
hypotensino
bronchospasm
CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

specific B1 blocker CIs/cautions

A

enhances effects of digitalis

abrupt discontinuation is dangerous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

nonspecific B1 & B2 blocker uses

A

HTN, angina, arrythmias, migraines, essential tremors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

nonspecific B1 & B2 blocker adverse effects

A

fatigue
bradycardia
hypotension
nausea/vomiting
diarrhea
CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

nonspecific B1 & B2 blocker CIs/cautions

A

abrupt discontinuation is dangerous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is a general guideline on if a drug may require a tapering schedule?

A

if it has a significant suppresive effect on physiology; rebound sx or bronchospasm may occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

types of ca channel blockers

A

verapamil
diltiazem
amlodipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

CCBs uses

A

angina, HTN
afib/flutter (-zems)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

CCB (-ils) adverse effects

A

constipation
hypotension
dizziness
edema
nausea
CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

CCB (-zems) adverse effects

A

headache
edema
dizziness
arryhtmias
CHF
nausea
constipation
rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

CCB (-pines) adverse effects

A

dizzinesss
CHF
MI
edema
headache
weakness
nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

CCB CI/cautions

A

AVOID IN CHF (AE), pregnancy

ils/zems: increased levels with cimetidine

-pines: capsule passed in stool, medicine released in gut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

angiotensin agents are all potassium-___

A

sparing (downstream block of aldosterone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

ACE-is names

A

lisinopril
ramipril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

ACE-is uses

A

HTN
HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

ACE-is adverse effects

A

dry persistent cough
hyperkalemia
angioedema
tachycardia
hypotension
urticaria
rash
renal dysfunction
headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

ACE-is CI

A

pregnancy (potential effect on fetal lungs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

ARBs drug names

A

valsartan
irbesartan
losartan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

ARBs MOA

A

blockage of ang-2 receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

ARBs uses

A

HTN in those with ACE intolerance due to cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

ARBs adverse effects

A

hypotension
renal dysfunction
hyperkalemia (reabs Hcl, excretes K)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

clonidine MOA / uses

A

stimulates alpha 2 adrenoreceptors in brain stem ; emergency BP lowering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

reserpine/rauwolfia MOA

A

peripheral anti-adrenergic; depletes catecholamines tores in PNS (and maybe CNS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

reserpine/rauwolfia adverse effects

A

drowsiness
sedation
nervousness
depression
dec HR
nasal congestion
nausea/diarrhea
PS predominance
DEPRESSION/SUICIDALITY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

**

reserpine/rauwolfia CI/cautions

A

do NOT administer MAO inhibitors and reserpine within 2 weeks of each other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

standard dose of reserpine

A

.1- .25 mg qd to bid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

The cause of heart failure is the area that the heart is ____. The sx are ___.

A

The cause of heart failure is the area that the heart is pumping into. The sx are the area drained into the side of heart.

right heart (causes: pulm, left heart; sx: JVD)
left heart (causes: CAD, sys HTN; sx: pulm edema/HTN, rhonchi)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

classification of CHF

A

A: RFs
B1: left ventricular dysfunction
B2: mild limitations, fatigue, dyspnea with normal activities
C: moderate limitations, sx with ADL
D: severe, sx at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

sx of CHF

A

dyspnea on exertion
paroxysmal nocturnal dyspnea
orthopnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

diagnostic tool used in CHF

A

echocardiogram
- distinguishes systolic and diastolic dysfunction
- identifies underlying valve disease or ischemic heart damage
- quantifies CHF severity
- assess chamber sidze, EF, wall thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

adaptive mechanisms in CHF

A
  • ventricular dilation > inc diastolic pressure and PE (L HF) and/or systemic edema (R HF)
  • reduced kidney blood flow > inc salt/water retention > inc blood volume > inc HBP > inc afterload
  • symp stimulation > peripheral tissue blood to heart > inc BP
  • tachycardia and inc contractility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

left CHF sx

A

DOE
chronic dry cough
fatigue
teachycardia, cardiac asthma, rust sputum, rales, displaced apical impulse, nocturia, pallor, low BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

right CHF sx

A

fatigue
distended neck veins
pedal/pitting edema
ascites
large liver
triscupid regug
orthopnea
PND

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

pathologies that produce right CHF sx

A

lung dz
pul embolus
volume overload
mitral stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

what is cor pulmonale

A

pulmonary heart dz; right ventricular hypertrophy and eventual failure from pulmonary dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

causes of cor pulmonale

A

COPD
pulm fibrosis or emboli
scleroderma
primary pulm HTN
alveolar hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

cor pulmonale sx

A

chronic cough
exertional dyspnea
wheezing
fatigue
weakness
cyanosis
clubbing
epigastric pulsations
hepatomegaly
polycythemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

what is the ankle brachial index used for?

A

assessing peripheral/vascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

normal achkle-brachial ratio vs PVD

A

> 0.95 is normal
< 0.95 = PVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

if a carotid bruit is heard on examination, what would be your next step?

A

carotid ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

a carotid bruit is indication of what

A

stenosis by atherosclerotic plaque; increased risk of stroke at 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

name the large-vessel vasculitis’

A

giant cell arteritis
takayasu’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

name the medium-vessel vasculitis’

A

polyarteritis nodosa
kawasaki’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

name the small-vessel vasculitis’

A

ANCA associated SV vasculitis
non-ANCA SV vasculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Small vessel vasculitis will often present as what?

A

dermatologic presentation; palpable purura > 24 hours, urticaria

with systemic sx

108
Q

most common etiology of aortic aneuryms

A

atheroma
most are adominal

109
Q

signs/sx aortic aneurysm

A

pain in abdomen or low back
<5 cm asx
pulsatile mass with tenderness and bruit over mass

110
Q

where does aortic dissection occur?

111
Q

what is aortic dissection caused by?

A

a break in the intima allowing blood to flow in a plane between the media and adventitia

112
Q

signs/sx aortic dissection

A

severe chest or neck pain, may radiate to back and later abdomen

peripheral pulses and BP may be unequal

syncope, hemiplegia, paralysis of lower extremities may occur

113
Q

what imaging is best for aortic dissection?

A

CT and transesophageal echocardiography

114
Q

pain that is sharp, constant, and unrelated to movement is typically associated with what pathology?

A

aortic dissection

115
Q

signs/sx of atrial tachycardia/SVT

A

originate at atrial pacemarker at rate of 140-250 / min
QRS narrow but shape normal
common

116
Q

signs/sx of atrial flutter

A

originate at atrial pacemarker at rate of 240-340 / min but some are blocked at AV node; multiple p waves “irregularly irregular”

saw tooth like deflections (flutter waves)

palpitations, sweating, weakness, dizziness, syncope

117
Q

differentiating if extra beats are atrial or ventricular

A

if there is a P wave = extra beat from atria

no P wave, bizarre complexes = ventricular

118
Q

ventricular fibrillation

A

multiple sites in ventricle fire impulses in uncoordinated fashion; terminal

119
Q

presenting sign of heart block

A

sudden onset of syncope

120
Q

what types of murmurs are almost always indicative of heart disease?

A

diastolic murmurs

121
Q

what might a midsystolic murmur indicate?

A

aortic/pulmonic stenosis

122
Q

what might a pansystolic/holosystolic murmur indicate?

A

mitral/tricuspid regurg
VSD

123
Q

what could a diastolic rumble murmur indicate?

A

mitral stenosis

124
Q

what could a decrescendo-immeidate diastolic mumur indicate?

A

aortic regurgitation

125
Q

in what situations would thrombolysis be indicated?

A

arrythmias
prosthetic valves
hypercoaguable (thick) blood: high fibrinogen, dehydration

126
Q

warfarin (coumadin) drug class and MOA

A

anti-thrombotic
vitamin K antagonist (extrinsic 2, 7, 9, 10)

127
Q

warfarin adverse effects

A

prolonged bleeding
hemorrhage
diarrhea
fever

128
Q

warfarin monitoring

A

monitor prothrombin time

129
Q

heparin drug class and MOA

A

anti-thrombotic (usually IV/inpatient)

inhibits clotting factors by binding to antithrombin 3 (AT3) and enhancing thrombin blockade of AT3

129
Q

heparin uses

A

prevention of DVT, embolism, DIC

130
Q

heparin adverse effects

A

hemorrhage, cutaneous necrosis, chills, pruritis, fever

131
Q

heparin CI/caution

A

caution with menstruating people, pts with liver dz, or pts with blood dz

132
Q

clopidogrel and aspirin MOA

A

antithrombics that prevent formation of platelet aggregating substance; thromboxane A2

133
Q

clopidogrel & aspirin uses

A

reduce risk of MI/stroke

134
Q

clopidogrel & aspirin adverse effects

A

salicylism (ASA)
GI distress
bleeding
tinnitus
rash
occult blood

135
Q

preventative aspirin dosing

A

75-162 mg
(avg is one baby aspirin 81 mg)

136
Q

classes of arrythmics

A

Class 1 & 3: specific to antiarrhytmics
class 2 & 4: also anti-hypertensives

137
Q

class 1 antiarrythmics

A

digoxin (glycoside)
lidocaine (blocks Na channels)
flecainide (blocks Na channels)

138
Q

digoxin MOA

A

inhibits sodium/potassium pump to inc intracellular calcium (ca drives the cardiac AP plateau)

139
Q

digoxin adverse effects

A

fatigue
arrthymias
muscular weakness
agitation
blurred vision
anorexia
nausea

140
Q

digoxin cautions

A

monitor blood levels; toxicity may be life threatening, can have flu like sx

yellow halo around vision may develop

monitor K levels (hypokalemia inc digoxin MOA)

141
Q

quinidine MOA

A

dec automaticity, conduction velocity; and prolongs refractory period

has anticholinergic effects

142
Q

quinidine adverse effects

A

arrythmia
nausea/vomiting
diarrhea
cichonism
fever
vertigo
headache

143
Q

quinidine caution/CI

A

prolongs QRS and QT intervals on EKG

144
Q

what is cinchonism?

A

toxicity of quinine and quinidine (cinchona alkaloids) causing meiniers like sx:
- tinnitus and hearing loss
- headache
- nausea
- dizziness/vertigo
- visual changes

145
Q

class II antiarrythmics

A

beta blockers

146
Q

class IV antiarrythmics

147
Q

class III antiarrythmics

A

amiodarone

148
Q

amiodarone MOA

A
  • delay in repolarization
  • prolongation in AP
  • slowing of electricl conduction
  • reduction in SA node fct
  • dec conduction through accessory pathways

K channel blocker

149
Q

amiodarone adverse effects

A

common to have significant side effects

most significant: lung toxicity
hyper/hypothyroid
AV nodal block
bradycardia

rare: liver toxicity

150
Q

CCBs and BBs are used for what purposes within cardiology?

A

anti-hypertensive
anti-arrythmic
anti-anginal

151
Q

signs/sx endocarditis

A

petechiae on palate or conjunctiva on nail beds, splinter hemorrhages

cough, dyspnea, arthralgia, diarrhea, pallor, splenomegaly, abd/flank pain
murmurs

152
Q

dx endocarditis

A

blood cultures are definitive dx tool
echo confirms the vegetations

153
Q

how is ST segment elevation differentiated between an MI and pericarditis?

A

pericarditis: diffuse
MI: regional

154
Q

nitroglycerin relieves chest pain from what condition(s)

A

ONLY angina

155
Q

anti-anginal drugs

A

vasodilators
CCBs, BBs

156
Q

nitroglycerin MOA

A

inc blood supply to heart, dec preload and afterload

157
Q

nitroglycerin adverse effects

A

headache
dizziness
hypotension
tachycardia
bradycardia
rash

158
Q

amyl nitrate uses and MOA

A

anti-anginal: unknown; thought to be dilution of arterial and venous system

antidote for cyanide poisoning

159
Q

NTG acute angina dosing

A

1 SL tablet every 5 mins for 3 doses

160
Q

what other supplements may be used for angina?

A

L-arginine
magnesium glycinate
zinc

161
Q

MI sx occur ____
(constantly, occassionaly, cyclically)

A

cyclically; on a 3-5 min cycle

162
Q

MI workup: cardiac enzyme timeline

A

2-4 hours post MI: tropinin 1 inc
4-6 hours post: CK/MB inc
4-8 hours post: myoglobin inc
6-36 hours post: AST
12-48 hours post: LDH1 > LDH 2

163
Q

Class I antiarrythmics MOA

A

blockade of fast Na channels/delay in ventricular depolarization

164
Q

Class II antiarrythmics MOA

A

delayed atrial > ventricular depolarization

165
Q

Class III antiarrythmics MOA

A

blockade of potassium channels/delayed repolarization

166
Q

Class IV antiarrythmics MOA

A

delayed atrial > ventricular depolarization

167
Q

what type of drug are doxazosin and terazosin?

A

alpha 1 antagonists

168
Q

what drug acts as a sympathomimetic on the CV system? what are its uses?

A

epinephrine (beta agonist); HF, bradycardoa, cardiac stabilization before pacemaker implantation

169
Q

what type of drug is colesevelam? what does it do?

A

bile sequestrant; cholesterol lowering

170
Q

what type of drug is gemfibrozil? what does it do?

A

fibrate; lowers cholesterol/TG

171
Q

what drugs are the vasodilators?

A

hydralazine
nitroglycerin
isosorbide mononitrate

172
Q

potassium chloride uses

A

electrolyte (IV)

173
Q

BBs CI/cautions

A

AVOID in asthma, diabetes
taper d/c to avoid rebound HTN

174
Q

first choice drug class for HTN in pts over 55

A

CCB or thiazide diuretic

175
Q

for a pt under 55 with uncomplicated HTN, what would the first choice drug class be?

176
Q

ARBs CI

177
Q

clonidine AEs

A

vasodilation
dec peripheral resistance (mental depression, swelling of lower limbs/feet)

178
Q

alpha 1 antagonists MOA

A

bind to alpha 1 rec > dec norepi > dec vascular resistance systemically

179
Q

alpha 1 antagonists AEs

A

syncope (first dose)
asthenia
rare priapism or ED

180
Q

alpha 1 antagonists uses

181
Q

adverse effects gemfibrozil

A

inc homocysteine
DVT
SOB
PE
hemopytsis

182
Q

MOA gemfibrozil

A

fibrate; inhibits liver uptake of FFas > inhibits VLDL secretion, may inc HDL

183
Q

digoxin CI

A

BB
CCB
antibiotics
verapamil
amiodarone
quinidine
K wasting diuretics

184
Q

vasodilators AEs

185
Q

hydralazine caution

A

prolonged tx may cause lupus
depletes B6
intensifies hypotension with alcohol/other BP drugs

186
Q

nitroglycerin dosing

A

SL 1 tab every 5 mins, max 3 doses

187
Q

isosorbide mononitrate CI

A

phosphodiesterase inhibitors (sildenafil)

188
Q

potassium chloride caution

A

can cause death due to cardiac AP termination

189
Q

what herbs are used for angina?

A

allium sativa
crataegus oxycantha
leonarus cardiaca

190
Q

what herbs are used for atherosclerosis

A

allium cepa
allium sativum
ginkgo biloba

191
Q

what herbs are used for afib

A

convallaria majalis
leonarus cardiaca

192
Q

what herbs are used for atrial premature beats

A

crataegys oxycantha
leonarus cardiaca

193
Q

what herbs are used for capillary fragility

A

aesculus hippocastanum
arnica montana

194
Q

what herbs are used for CHF

A

convallaria majalis
crataegus oxycantha
digitalis purpura

195
Q

what herbs are used for chronic venous insufficiency

A

aesculus hippocastanum
centella asiatica
hamamelis virginiana
vaccinium myrtillus

196
Q

what herbs are used for edema

A

aesculus hippocastanum
taraxacum officinale

197
Q

what herbs are used for bradycardia

A

glycyrrhiza glabra
rosmarinus officinalis

198
Q

what herbs are used for hypotension

A

convallaria majalis
glycyrrhiza glabra

199
Q

what herbs are used for HTN

A

allium cepa (mild)
allium sativum (mild)
crataegus oxycantha
rauwolfia serpentina (severe)
veratrum viride (severe)

200
Q

what herbs are used for hyperlipidemia/dyslipidemia

A

allium sepa
allium sativum
cynara scolymus

201
Q

what herbs are used for post ischemic stroke recovery

A

ginkgo biloba
rosmarinus officinalis

202
Q

what herbs are used for raynaud’s dz

A

CV stimulants

capsicum frutescens
rosmarinus officinalis
rauwolfia serpentina
zingiber officinale

203
Q

what herbs are used for thrombophlebitis

A

aesculus hippocastanum
hamamelis virginiana

204
Q

what herbs are used for varicose veins

A

venous tonics
aesculus hippocastanum
centella asiatica
vaccinum myrtillus

205
Q

CV tonics

A

crataegus laevigata (hawthorn)
ginkgo bilboa

206
Q

positive inotropes/neg chronotrope herbs

A

convallia majus (lily of the valley)
digitalis purpurea (foxglove)

207
Q

rhythm balancing herbs

A

selenicerus glandiflorus (night blooming cerus/cactus grandiflorus)
leonurus cardiaca (motherwort)

208
Q

hypotensive herbs

A

Coleus forskohlii (coleus) – gentle
Olea europaea (olive)
Rauvolfia serpentina (Indian snakeroot) – potent
Veratrum viride (false hellebore), V. album – dangerous

209
Q

venous tonics

A

Aesculus hippocastanum (horse chestnut) – moderate
Hamamelis virginiana (witch hazel) – gentle
Vaccinium myrtillus (bilberry)

210
Q

Indications for atenolol

A

B1 BB - HTN angina

211
Q

AE atenolol

A

Tiredness, hypotension, bradycardia, cold extremities

212
Q

Interactions atenolol

A

Nitrates/antihypertensives (inc hypotensive effect)
Digoxin (inc bradycardia > inc risk AV block)
DM meds (dec glycemic control)

213
Q

CI atenolol

A

Don’t discontinue abruptly
Bradyardia
Sinus node dysfunction
AV heart block >1
HF
Cardiogenic shock
Preg (cat D)
Caution in DM

214
Q

Drug class/purpose atenolol

A

Beta blocker (b1) - antihypertensive, antianginal

215
Q

Carvedilol drug class/purpose

A

Beta blocker (b1,b2, alpha1) - antihypertensive, adjunct tx for heart failure

216
Q

Work up for ACS/MI

A

ECG - ST-elevation, Q waves, T inversion

CKMB - peaks day 1, lasts 3 days (marker of reinfarction)

troponin - peaks day 1, lasts 2 weeks

217
Q

Etiology, pathophys, presentation of dilated cardiomyopathy

A

4 chamber hypertrophy, unexplained dilation, impaired systolic function

Idiopathic, alcoholism (B1 def), myocarditis, doxorubicin(chemo), cocaine, heroin, glue sniff, peripartum

Mitral/tricuspid regurg
L/R S3 + S4, narrow PP due to dc SV

218
Q

Work up and tx of dilated cardiomyopathy

A

BNP (monitor fluid overload)
ECG - T wave inversion, pathological Qs
CXR - pleural effusion, enlarged heart

Tx: ARBS, BB, aldosterone antagonists, cardiac glycosides, vasodilators, antiarrythmics

219
Q

Etiology, pathophys, presentation of Hypertrophic/obstructive cardiomyopathy

A

Unexplained hypertrophy of ventricles
AD, chromosome 14 missense that codes for cardiac sarcomere proteins

Palpitations, dizziness w/ rapid standing/valsalva, angina w exercise/DOE

Split S2, S4, harsh systolic ejection (C-D) at left sternal border or apex (inc w valsalva)

CAN CAUSE SUDDEN CARDIAC DEATH IN YOUNG ATHLETES

220
Q

Work up and tx for hypertrophic/obstructive cardiomyopathy

A

ECG - prom Q, short P-R
Echo, cardiac MRI - assessing severity

Tx: BB, amiodarone

AVOID DRUGS THAT DEC PRELOAD (DIURETICS) OR INC FORCE OF CONTRACTION (DIGITALIS)

221
Q

Etiology, pathophys, presentation of Restrictive/infiltrative cardiomyopathy

A

Impaired ventricular filling, dec ventricular compliance, normal systolic function (stiffening of heart)

Caused by amyloidosis, sarcoidosis, myocardial fibrosis post surgery, radiation

SOB, exercise intolerance, CHF itch normal LV systolic function, elevated JVP

S3, Mitral/tricuspid regurg if secondary to myocardial dz

222
Q

Work up/tx restrictive/infiltrative cardiomyopathy

A

ECG - low QRS
Ventricular biopsy to determine etiology

Tx underlying dz, diuretics, vasodilators, ACEi, anticoag (if not CI)

223
Q

R CHF etiology/RF, sx

A

Cause: LHF, cor pulmonale (Pulm cause)

Anorexia/GI distress, wt gain, dependent edema, hepatosplenomegaly, inc peripheral venous pressure

S3, rates, JVD, pitting edema

224
Q

R CHF complications

A

Portal HTN, ascites, pleural effusion

225
Q

R CHF work up and tx

A

Nutmeg liver

Tx: digitalis purpurea, convallaria majalis, crataegus OxyCantha

226
Q

L CHF etiology/RF, sx

A

Elevated Pulm capillary wedge pressure, pulmonary congestion

RF: CAD, HTN, DM, cardiomyopathy, valvular heart dz

SOP when supine (orthopnea), paroxysmal nocturnal dyspnea

S3, JVD, rales, crackles, cough, pitting edema, cyanosis

227
Q

L CHF work up, tx

A

HF cells in lungs

tx: same as RHF

228
Q

Most common etiology of subacute endocarditis

A

Strep viridans in CHD or pre-existing valvular heart disease

229
Q

Most common etiology of acute endocarditis

A

Staph aureus, secondary infxn occurring elsewhere in body

** high mortality rate

230
Q

Etiology pericarditis

A

Idiopathic
Viral (coxsackie B)
Bacterial (staph A, strep pneumo, TB)
Fungal (histoplasmosis, blastomycosis)
Post MI d/t inflammation

231
Q

Dx and tx pericarditis

A

Chest pain, friction rub, ST elevation/PR depression

Tx: pericardiocentesis, NSAIDS

232
Q

Etiology, dx, presentation, tx of rheumatic heart disease

A

Group A BH strep

Carditis, polyarthritis, chorea, subQ nodules, erythema mariginatum (JONES)

Tx: penicillin, prednisone

233
Q

Name the difference between the types of Afib

A

Acute: new onset <48 hours
Paroxysmal: recurrent <48 hours, converts spon to normal
Permanent: cannot be converted

234
Q

Afib sx, work up, tx

A

Irregularly irregular HR, often sx but can cause palpitations, weakness, SOB

Inc stroke risk

ECG - irregular R-R, narrow QRS, no organized P waves

Tx: rate, rhythm, stroke prevention. Anticoag, BB, CCB, digitalis, amiodarone, convallaria majalis, leonurus cardiaca

235
Q

Briefly describe budd chiari syndrome

A

IVC or hepatic vein blocked > abdominal pain, hepatomegaly, ascites

236
Q

DVT tx

A

Coumarin, Vit K antagonists

237
Q

Sx and complications of embolism

A

Pain, numbness, NO pulse below blockage, muscle spasm

Complications: PE, gangrene

238
Q

Describe etiology and tx of Thromboangiitis obliterans

A

“Buergers dz”
Inflammation and necrosis of BV > tissue ischemia / infarction in hands/feet

Highly associated with smoking

Tx: corticosteroids, immunosuppressants, smoking cessation

239
Q

Sx and work up PAD

A

Pain in legs when walking and relieved by rest (intermittent claudication), cyanosis of LEs, ulcer formation (toe tips, top of feet, lat malleolus), hair loss on legs

Work up: ABI

240
Q

Tx atherosclerosis

A

Avoid RF (diet)
Smoking cessation
Inc physical activity
Aspirin (antiplatelet)
ACEI/ARB
Allium cepa/sativum
Ginkgo biloba

241
Q

What is hypovolemic shock?

A

Dec blood volume > shock (hemorrhage, burns, heavy sweating, diarrhea, vomiting, meds, vasodilation)

Dec BP, compensatory tachycardia, oliguria, confusion, pale/clammy skin

242
Q

Presentation, etiology, and RF aortic aneurysm

A

Dilation of aorta due to atherosclerosis, Marfans, vasculitis, infections (syphilis, fungal), bicuspid aortic valve, AAA most common

RF: smoking, HTN, fhx, >70, M

243
Q

orthostatic hypotension is a drop of ____ SBP and ____ DBP

244
Q

Types of heart block

A

First degree - normal or pathological; slowed A>V signals, regular R/R, asx (long PR, remains constant)

Second (mobitz 1 - wenckebach) - progressive PR and dropped beat

Second (mobitz 2) - poor prog; fixed PR and dropped beat, multiple irregular P waves

Third - EMERGENCY - ventricles creating own signals with no input from atria. No relationship between P waves and QRS

245
Q

PAC pathophys/tx

A

Common in healthy pt, asx

Tx: BB if palpitations
Crataegus oxycantha
Leonurus cardiaca

246
Q

PVC pathphys, work up, tx

A

Heart beat initiated in ventricles by purkinje fibers instead of SA node

Can be in healthy hearts or dec oxygen to myocardium, alcohol, drugs, smoking, cardiomyopathy, Mg or K def, stress, lack of sleep

QRS >120 msec

Tx: BB/CCB if palpitations, electrolytes

247
Q

super ventricular tachycardia pathophys/sx

A

Rapid HR (100-300) originates in AV node or within atria, returns to normal after time/tx

Unclear cause; conduction, digoxin, COPD, pneumonia, Wolff Parkinson’s white, theophylline

Sx: palpitations, pounding pulse, syncope, dizziness, SOB, chest discomfort, narrow QRS

248
Q

Super ventricular tachycardia tx

A

Valsalva, carotid massage, adenosine

249
Q

Vtach

A

V tach: wide, regular QRS, abnormal P waves.

3 consecutive VPB = v tach

Sustained >30 s = EMERGENCY

250
Q

Vfib

A

EMERGENCY
Ventricular quivering, most common arrythmia in cardiac arrest

Erratic ECG, no identifiable waves

251
Q

Etiology and tx of aortic stenosis

A

Atherosclerosis, bicuspid valve, rheumatic dz

Valve replacement

252
Q

Etiology and tx of Pulmonic stenosis

A

Congenital

Balloon valvuloplasty

253
Q

Etiology and tx of Tricuspid regurgitation

A

Dilation RV, infective endocarditis, RF, congenital

254
Q

Etiology and tx of Mitral regurg

A

most common valvular dz!
MVP, infective endocarditis, marfans

255
Q

What is distinct about the murmur of MVP?

A

Mid systolic click

256
Q

Etiology and tx of Aortic regurg

A

Congenital bicuspid valve, syphilis, marfans, SLR, CT dz, trauma, infective endocarditis

tx: ACEs delay need for valve replacement

257
Q

Etiology of Pulm regurg

A

Pulm HTN, RF, infective endocarditis, surgical repair tetralogy of fallot

258
Q

Etiology and murmur of mitral stenosis

A

Rheumatic cause
High pitched opening snap at apex

259
Q

Etiology of tricuspid stenosis

A

Rheumatic dz

260
Q

AST is increased in what conditions?

A

early MI, viral hepatitis, fatty liver

261
Q

AST > ALT in what condition(s)

A

alcoholic hepatitis

262
Q

GGT is increased in what condition(s)

A

obstruction to bile flow
alcoholism

if GGT and ALP both inc = liver cholestasis

263
Q

if ALP&raquo_space;> ALT rule out

A

bone disease

264
Q

hypoalbuminemia is indicative of

A

cirrhosis; albumen is made in the liver

NPLEX II TIA (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions