CVPR Cardiovascular pharmacology

Question 1

Primary HTN AKA

Answer 1

Essential hypertension

Question 2

Drugs to treat primary hypertension

4 listed

Answer 2

• Thiazide diuretics
• ACE inhibitors
• Angiotensin II receptor blockers (ARBs)
• Dihydropyridine Ca channel blockers

Question 3

Drugs to treat hypertension with HF

5 listed

Answer 3

• Diuretics
• ACE inhibitors
• ARBs
• Β-blockers cautiously in decompensated HF
• Aldosterone antagonists

Question 4

Β-blockers in HF

Answer 4

Β-blockers must be used cautiously in decompensated HF and are contraindicated in cardiogenic shock

Question 5

Β-blockers in cardiogenic shock

Answer 5

Contraindicated in cardiogenic shock

Question 6

HF and ARBs

Answer 6

May be combined with the neprilysin inhibitor Sacubitril

Question 7

Drugs to treat hypertension with diabetes mellitus

5 listed

Answer 7

• ACE inhibitors
• ARBs
• Ca channel blockers
• Thiazide diuretics
• Selective β-blockers

Question 8

ARBs and ACE inhibitors and diabetes

Answer 8

ARBs and ACE inhibitors are protective against diabetic nephropathy

Question 9

Drugs to treat hypertension with asthma

Answer 9

• ARBs
• Ca channel blockers
• Thiazide diuretics
• Selective β-blockers

Question 10

Β-blockers and asthma

Answer 10

Avoid nonselective β-blockers to prevent the blockade of β2-receptor-induced bronchodilation

Question 11

ACE inhibitors and asthma

Answer 11

Avoid ACE inhibitors to prevent confusion between drug or asthma-related cough

Question 12

Drugs to treat HTN in pregnancy

4 listed

Answer 12

• Hydralazine
• Labetalol
• Methyldopa
• Nifedipine

Question 13

Nmeumonic for drugs to treat HTN in pregnancy

Answer 13

He likes My Neonate

Question 14

Classes of Ca channel blockers

Answer 14

• Dihydropyridines
• Non-dihydropyridines

Question 15

Dihydropyridines site of action

Answer 15

Vascular smooth muscle

Question 16

Non-dihydropyridines site action

Answer 16

Act on heart

Question 17

List of dihydropyridines

5 listed

Answer 17

• Amlodipine
• clevidipine
• nicardipine
• nifedipine
• nimodipine

(dihydropyridines act on smooth muscle)

Question 18

List of non-dihydropyridines

Answer 18

• Diltiazem
• Verapamil

Question 19

Mechanism of action dihydropyridines

Answer 19

Block voltage-dependent L-type Ca channels of cardiac and smooth muscle → ↓ muscle contractility

Question 20

Ca channel blockers affinity

Answer 20

• Vascular smooth muscle: amlodipine = nifedipine > diltiazem > verapamil
• Heart: verapamil > diltiazem > amlodipine = nifedipine
• Verapamil = ventricle

Question 21

Clinical uses of dihydropyridine (except nimodipine)

3 listed

Answer 21

• HTN
• Angina (including prinzmetal)
• Raynaud phenomenon

Question 22

Clinical uses of nimodipine

Answer 22

Subarachnoid hemorrhage (prevents cerebral vasospasm)

Question 23

Clinical uses of nicardipine and clevidipine

Answer 23

Hypertensive urgency or emergency

Question 24

Clinical use of non-dihydropyridines

Answer 24

• HTN
• Angina
• Atrial fibrillation/flutter

Question 25

Adverse effects of non-dihydropyridines

Answer 25

* Cardiac depression * AV block * Hyperprolactinemia * Constipation * Gingival hyperplasia

Question 26

Adverse effects of dihydropyridines

Answer 26

* Peripheral edema * Flushing * Dizziness

Question 27

What is hyperprolactinemia?

Answer 27

Hyperprolactinemia is a condition in which a person has higher-than-normal levels of the hormone prolactin in the blood. The main function of prolactin is to stimulate breast milk production after childbirth, so high prolactin levels are normal in pregnancy

Question 28

Hydralazine mechanism

Answer 28

↑cGMP → smooth muscle relaxation Vasodilates arterioles \> veins Afterload reduction

Question 29

Clinical use of hydralazine

Answer 29

Severe HTN (particularly acute) HF (with organic nitrate) Frequently coadministered with a β-blocker to prevent reflex tachycardia

Question 30

Hydralazine and pregnancy

Answer 30

Safe to use during pregnancy

Question 31

Adverse effects of hydralazine 5 listed

Answer 31

* Compensatory tachycardia (contraindicated in angina/CAD) * Fluid retention * Headache * SLE-like syndrome

Question 32

Drugs to treat HTN emergency

Answer 32

* Clevidipine * Fenoldopam * Lebetalol * Nicardipine * Nitroprusside

Question 33

Nitroprusside mechanism of action

Answer 33

Short-acting ↑cGMP via direct release of NO

Question 34

Fenoldopam mechanism of action

Answer 34

* Dopamine D1 receptor agonist * Causes coronary, peripheral, renal and splanchnic vasodilation * Resulting in ↓BP and ↑natriuresis

Question 35

Fenoldopam clinical uses

Answer 35

* HTN emergency * Also used postoperatively as an antihypertensive

Question 36

Adverse effects of Fenoldopam

Answer 36

Can cause hypotension and tachycardia

Question 37

List of nitrates

Answer 37

* Nitroglycerin * Isosorbide dinitrate * Isosorbide mononitrate

Question 38

Nitrates mechanism of action

Answer 38

Vasodilate by ↑NO in vascular smooth muscle → ↑cGMP causing smooth muscle relaxation Dilates veins \>\> arteries ↓ preload

Question 39

Clinical use of nitrates 3 listed

Answer 39

Angina Acute coronary syndrome Pulmonary edema

Question 40

Adverse effects of nitrates

Answer 40

* Reflex tachycardia (treat with β-blockers) * Hypotension * Flushing * Headache * "Monday disease"

Question 41

Treatment of reflex tachycardia caused by nitrates

Answer 41

Treat with β-blockers

Question 42

What is "Monday disease"?

Answer 42

Development of tolerance for the vasodilating action during the work week and loss of tolerance over the weekend resulting in tachycardia, dizziness, headache upon rexposure

Question 43

Nitrates contraindications

Answer 43

Right ventricular infarction

Question 44

What is the goal of antianginal therapy

Answer 44

Goal is reduction of myocardial O2 consumption (MVO2) by ↓ 1 or more of the determinants of MVO2

Question 45

What are the determinants of MVO2?

Answer 45

* End-diastolic volume * BP * HR * Contractility

Question 46

Nitrates effect on end-diastolic volume

Answer 46

↓

Question 47

β-blockers effect on end-diastolic volume

Answer 47

No effect or ↑

Question 48

Nitrates + β-blockers effect on end-diastolic volume

Answer 48

No effect or ↓

Question 49

Nitrates effect on BP

Answer 49

↓

Question 50

β-blockers effect on BP

Answer 50

↓

Question 51

Nitrates + β-blockers effect on BP

Answer 51

↓

Question 52

dihydropyridines for Hypertensive urgency or emergency

Answer 52

nicardipine and clevidipine

Question 53

Hydralazine contraindications

Answer 53

contraindicated in angina/CAD

Question 54

Nitroprusside adverse effects

Answer 54

can cause cyanide toxicity