CV Exam (review, shuffled) Flashcards
Optimal HDL level in men? Women?
Men: >40
Women: >50
Read everything important about IgA Vasculitis.
- Formerly Henoch-Schonlein Purpura
- IgA complex deposition –> complement activation
- *Mostly affects children
- *Recent antecedent infection common (usually upper respiratory tract- IgA protects mucosal sites)
- P/w palpable purpura in buttocks/legs, GI pain/bleeding, hematuria (IgA nephropathy)
- Self-limited, may recur. Steroids for severe tx.
What enzyme is upregulated with use of bile acid-binding resins?
Cholesterol 7alpha-hydroxylase
rate-limiting step of bile acid synthesis
Name another vasodilator we need to know besides nitropresside and hydralazine.
Minoxidil (if other drugs are resistant)
Pts w/what dz’s should not take mannitol?
- CHF
- Renal failure (chronic)
- Pulmonary edema (extracts water from cells)
Name the drug classes that can be used in the treatment of CHRONIC CHF.
- Diuretics (except CA-inhibitors/mannitol)
- ACEIs/ARBs
- BBs
- Digoxin
What types of angina are Nitrates used in? CCBs?
BBs?
All 3
All 3
Stable and unstable (not variant)
What is SREBP?
TS factor activated by statin’s action, which increases LDL-receptor expression (binds B100)
What is PPAR-alpha? (give detail)
Fibrates are ligands for the PPAR-alpha receptor. Leads to:
A. Decreased ApoC3/increased LPL expression –> increased FA oxidation –> decreased VLDL synthesis –> increased VLDL clearance.
B. Increased apoA1 expression –> increased HDL production.
Which statins are affected by CYP3A4 inducers/inhibitors?
LSA:
Lovastatin, sivastatin, atorvastatin
PCSK9 inhibitors’ effects on % reductions/increases of serum lipids:
v LDL (> 50%)
Causes of dilated cardiomyopathy?
ABCCCD Alcohol abuse Beriberi (wet) Coxsackie B viral myocarditis Cocaine abuse (chronic) Chagas disease Doxorubicin
(+hemochromatosis, sarcoidosis, peripartum)
- Which loop diuretic is 40x more potent than furosemide, but has a shorter T1/2?
- Which has a longer T1/2?
- Bumetanide
2. Torsemide
Name 3 drugs safe to use during pregnancy to treat HTN.
Alpha-methyl DOPA
Beta-blockers
Hydralazine
Ivabradine: MoA? Indications? Toxicity? Contraindications?
- Blocks If current in SA nodal fibers. (starts w/letter “I”) Prevents exercise-induced myocardial ischemia.
- Chronic stable angina
- Bradycardia; heart block; luminous phenomenon
- Sick Sinus Syndrome; use with non-dihydropyridine CCBs
- Which CA inhibitor is ~ 30x more potent than acetazolamide?
- About 5x more potent than acetazolamide?
- Topical preparation for ocular use–avoids systemic effects?
- Dichlorphenamide
- Methazolamide
- Dorzolamide
What drug class is DOC for uncomplicated (mild-mod) HTN?
Diuretics (along w/lifestyle mods)
Which statin is unaffected by CYP450 metabolism?
Pravastatin
When are 2 combined HTN drugs recommended, numerically?
When BP >20/10 over
What are the killer chest pains?
- ACS
- Tension PTX
- PE
- Dissecting aneurysm
What is ANCA?
Explain the 2 types
Anti-neutrophil cytoplasmic antibody
- ABs directed against neutrophilic granules (mostly against enzymes)
pANCA: anti-myeloperoxidase
cANCA: anti-proteinase 3
- ANCA formation induced by drugs or cross-reactive microbial antigen (autoimmune, infections, malignancies).
ANCA binds these cells, further activating. ANCA activated neutrophils –> release lytic granules and ROS–> vascular dmg.
What drug class might you combine with a vaso- and arterio-dilators to reduce the reflex tachycardia?
Beta-blockers
ranges for desirable, borderline, and high cholesterol?
- Desirable: < 200
- Borderline: 200-240
- High: > 240
Read everything important about Granulomatosis w/Polyangiitis.
- Formerly Wegener’s Granulomatosis (“c”)
- Nectrotizing, granulomatous
- Commonly involves *nasopharynx, lungs, kidneys (“C”)
- Classic: middle-aged male w/sinusitis/nasopharyngeal ulcer, hemoptysis, bil. nodular lung infiltrates, and hematuria due to rapid progressing glomerulonephritis (can become crescentic- obliterates glumerulus)
- *c-ANCA (correlates w/dz activity)
- Also a/w saddle-nose deformity, mononeuritis multiplex, necrotizing scleritis, palpable purpura, orbital pseudotumor, etc., arthritis
- Tx: corticosteroids w/cyclophosphamide, relapses common (“c”)
List the non-pharmacological therapies for CHRONIC CHF.
- Surgical therapy–revascularization for ischemic heart dz–valve repair/replacement for valvular heart dz–aneurysmectomy
- LVADs (bridge to transplant or destination therapy)
- Biventricular pacing: cardiac resynchronization therapy (CRT) +/- implantable cardiac defibrillators (ICDs)
- Cardiac transplantation
Stress tests are ___% sensitive, maybe ___% specific
60
80
Patients taking short-acting nifedipine, diltiazem or verapamil were 1.6 times more
likely to have __________. (dz)
MI
Which ACEI allows for once daily dosing?
Which has a shorter T1/2?
Which has a longer T1/2?
Lisinopril
Captopril
Enalapril
What is the pathology of MVP?
Unknown
- Usually asymptomatic
Explain furosemide pharmacokinetics.
Half-life is short (1-1.5 hrs) so duration is only 2-3 hrs. Renal secretion mechanism; organic acid transporter.
In hypertensive emergency, you only wan to lower BP 25-30% in the first 24 hrs. What 2 dz’s are exceptions?
- Dissecting Aneurysm: rapidly (20mins) lowered to 100-120 mmHg
- Acute phase of ischemic stroke: reperfusion candidates
Is a non-dihydropyradine w/a beta-blocker a good or bad combo?
Bad (conduction disturbances)
- “Use w/caution”
Which statins are affected by CYP2C9 inducers/inhibitors?
FR
Fluvastatin, rosuvastatin
What is NCPL1?
Membrane protein that mediates intestinal cholesterol absorption, inhibited by ezetimibe.
What is the major side effect of lomitapide and mipomerson?
Hepatotoxicity.