CV Pharm

Question 1

contrast hypertensive urgency & hypertensive emergency

Answer 1

hypertensive urgency has NO associated acute end organ damage, vs. hypertensive emergency which does

Question 2

what is the term for both hypertensive urgencies & emergencies?

Answer 2

hypertensive crisis

Question 3

term for: when bp is uncontrolled depite the use of 3+ antihypertensive drugs, one of which is a diuretic

Answer 3

resistant HTN

Question 4

risk factors for resistance HTN?

Answer 4

older age, obesity, chronic kidney disease, diabetes, obstructive sleep apnea, high salt diet, Af Am race, females (post menopause)

Question 5

common causes of secondary HTN?

Answer 5

renal parenchymal disease, obstructive sleep apnea, renal artery stenosis, primary aldosteronism

Question 6

ppl with resistance HTN are expected to have high or low fluid levels?

Answer 6

expect to be fluid overloaded

inadequate diuretic use is top cause of tx resistance

Question 7

what is the preferred diuretic for Resistant HTN?

Answer 7

chlorthalidone

Question 8

which drugs can be used to tx HTN in pregnancy?

Answer 8

Methyl dopa, labetalol, nifedipine, hydralazine, metoprolol

Question 9

what is the safest antihypertensive drug for pregnant women?

Answer 9

methyldopa

Question 10

what antihypertensives need to be avoided in pregnant women?

Answer 10

diuretics, atenolol, nitroprusside,

ACE inhibitors, angiotensin receptor antagonists

Question 11

what is anginal pain caused by?

Answer 11

release of bradykinin & adenosine onto nociceptive afferents

Question 12

downside of using organic nitrates?

Answer 12

can only be used in acute setting–>tolerance develops early

Question 13

how to combat nitrate tolerance

Answer 13

use dosing regimens that allow for nitrate free of low nitrate concentration for several hrs/day
during window without nitrate, can cover with other drugs (beta blockers, vasodilators, etc)

Question 14

the ability for a cell to initiate an AP

Answer 14

automaticity

Question 15

the ability of a cell to receive and transmit an AP

Answer 15

conductivity

Question 16

the ability of a cell to receive and transmit an AO

Answer 16

dromotropism

Question 17

what maintains the plateau of the AP?

Answer 17

the late INa channels

Question 18

the ERP/APD ratio is important for what?

Answer 18

propagation of abnormal impulses

Question 19

lower ERP/APD ratio indicates what?

Answer 19

it will be easier for tissue to be depolarized by abnormal imppulses

Question 20

what are some things that could create marked prolongatino of the cardiac AP?

Answer 20

slow HR, hypokalemia

Question 21

what cell type are early after depolarizatios most readily induced?

Answer 21

purkinje cells

Question 22

what do early after repolaizations result in?

Answer 22

torsade de pointe

Question 23

delayed after-depolarization occurs under what sort of conditions?

Answer 23

Ca overload

ie. MI, adrenergic stress, digitalis intox, HF

Question 24

what happens in delayed after depolarization?

Answer 24

if DAD reaches threshold, a secondary triggered beat or beats may occur
normal upstroke followed by abnormal depolarization * secondary upstroke

Question 25

what is teh most common cause of paroxysmal regular narrow complex tachy?

Answer 25

AV nodal reentrant tachycardia (AVNRT)

Question 26

what class of antiarrhytmics is good for use in digitalis & MI induced arryhtmia?

Answer 26

class 1b

Question 27

why is there an early reoccurence of arryhtmias after amiodarone is discontinued?

Answer 27

all tissues are saturated, there is a rapid redistribution out of the myocardium-->responsible for early reoccurrence

Question 28

is binding to L-type Ca channel alpha subunit by Ca-channel blockers a complete blockage?

Answer 28

no, it is an incomplete blockage

Question 29

what is the most metabolically active section of the nephron?

Answer 29

1. proximal convoluted tubule | 2. thick ascending limb (2nd most)

Question 30

why is cirrhosis a contraindication for use of acetazolamide?

Answer 30

induced alkalinizatino of urine will decr urinary excretion of NH4-->may contribute to hyperammonemia, hepatic encephalopathy

Question 31

role of thizaides in tx of nephrogenic diabetes insipidis?

Answer 31

1. incr renal Na reabsorption 2. recovery of Aquaporin 2 abundance 3. recovery of NCC, ENaC

Question 32

how does spironolactone prevent LV remodeling & cardiac fibrosis?

Answer 32

inhibits MMP, inhibits protein kinase C

Question 33

how does spirinolactone prevent sudden cardiac death?

Answer 33

improve HR variability, reduce QT dispersion, reduce early morning risk in HR in HF patients, prevents hypokalemia

Question 34

what are the hemodynamic effects of spirinolactone?

Answer 34

bp reduction | modest diuresis, natriuresis

Question 35

what are the vascular effects of spirinolactone?

Answer 35

``` decr vascular NADPH oxidase activity reduce the generation of reactive oxygen species reverse endothelial dysfunction increase nitric oxide bioactivity retard the thrombotic response to injury ```

Question 36

what are the best agents to use in ppl with previous MI (to prevent risk of sudden cardiac death?

Answer 36

beta blockers

Question 37

what is anginal pain mostly due to?

Answer 37

release of bradykinind + adenosine onto nocioceptive afferents

Question 38

anginal pain

Answer 38

rest or unstable angina

Question 39

anginal pain >30 min, shortness of breath, weakness, N/V

Answer 39

acute MI

Question 40

GTN & ISDN are prescribed as what sort of tx for angina?

Answer 40

prophylactic tx

Question 41

which of the organic nitrates has a phasic release formulation?

Answer 41

ISMN

Question 42

how to calculate CO?

Answer 42

SV x HR

Question 43

frank starling mechanism

Answer 43

greater preload = greater contractility

Question 44

describe anrep

Answer 44

if you incr the afterload acutely, can trigger incr in contractilty

Question 45

describe bowditch

Answer 45

relationship b/w hr & contractility

Question 46

how to calculate corrected QT interval?

Answer 46

QT/sq root of R to R interval