Dr. French's Review Sesh

Question 1

What does digoxin do to the cardiac AP in a dangerous overdose?

Answer 1

too much Ca++ is retained and this causes PVCs, V-tach, and V-fib

Question 1

*** DON’T CHOOSE ISOPROTERANOL AS AN ANSWER CHOICE***

Answer 1

just fyi!

Question 2

What can high intracellular Ca++ trigger?

Answer 2

late delayed afterpolarizations

Question 2

Digoxin binds to the same site as ____.

Answer 2

K+

Question 3

What is the most commonly used class III antiarrhythmic drug?

Answer 3

amiodarone

Question 4

The Beta-1 receptor normally mediates _____.

Answer 4

the HR and inotropy

Question 5

The alpha-1 thru AT-1 receptors normally mediate ____.

Answer 5

the preload and afterload

Question 6

How do you treat premature ventricular contractions (PVCs)?

Answer 6

usually none- but maybe a beta blocker

Question 6

*** DON’T CHOOSE NITRIDE AS A CHOICE ON THE EXAM***

Answer 6

just sayin!

Question 7

If K+ goes down in someone’s labs, you could blame the ____ drugs. If K+ goes up, you could attribute it to _____ drug.

Answer 7

down = loop diuretics or thiazides b/c they’re K+ wasting up = aldosterone antagonists b/c they’re K+ sparing (ACE inhibitors and ARBs)

Question 8

What does digoxin do to the cardiac AP in a good, safe dose?

Answer 8

the Na/K pump is blocked, so Ca++ doesn’t leave the cell as much via the NCX exchanger and this increases contractivity and inotropy

Question 10

What does amiodarone do?

Answer 10

it blocks K+ repolarization and phase 0 Na+

Question 10

ACE inhibitors end in ____.

Answer 10

-pril

Question 11

What vasodilator is prescribed? To whom?

Answer 11

hydralazine PLUS isosorbide dinitrate (nitrates) in black pts

Question 11

Name 3 inotropes.

Answer 11

1. dobutamine 2. mirinone 3. digoxin

Question 13

If the tachyarrhythmia is at or above the AV node, use _____ control drugs.

Answer 13

rate

Question 15

Antiarrythmic drugs can either be ____ or ____.

Answer 15

rate control; rhythm control

Question 17

What is the tx for chronic supraventricular tachycardia (SVT)?

Answer 17

slow conduction or catheter ablation

Question 18

In HF, the heart has INCREASED or DECREASED lusitropy?

Answer 18

DECREASED - the heart is stiffer in HF

Question 19

____ is the drug of choice for acute supraventricular tachycardia.

Answer 19

Adenosine

Question 19

What receptor normally mediates the preload?

Answer 19

alpha-1 thru AT1

Question 20

____ (drug) binds to the same site as K+.

Answer 20

Digoxin

Question 22

A long QT interval predisposes you to _____.

Answer 22

Torsades de pointes

Question 23

What does PVC stand for?

Answer 23

premature ventricular contractions

Question 24

What is the most common diuretic?

Answer 24

furosemide

Question 25

When would you add an aldosterone antagonist to therapy?

Answer 25

if LVEF

Question 26

Which RAAS antagonist has antiremodeling effects?

Answer 26

the ACE inhibitors (-prils)

Question 26

What is the maximum K+ level you want your pt to be at?

Answer 26

5

Question 27

What is the tx for V-fib?

Answer 27

defibrillation followed by epi or vasopressin and amiodarone

Question 28

The ARBs end in \_\_\_\_.

Answer 28

sartan

Question 29

What are the 2 types of type 2 AV block?

Answer 29

Mobitz I (progressive increased PR interval until blocked beat Mobitz II (disease in His-Purkinje = more unpredictable and urgent to prevent asystole)

Question 29

What receptor normally mediates the afterload?

Answer 29

alpha-1 thru AT-1

Question 30

What is the tx for chronic v-tach?

Answer 30

ablation and implantable defibrillators

Question 31

What receptor normally mediates the HR?

Answer 31

beta-1

Question 32

How is chronic AV block treated?

Answer 32

NOT with meds- permanent cardiac pacing

Question 34

Which diuretics have more reliable absorption than furosemide?

Answer 34

torsemide and bumetanide

Question 35

Lidocaine is only for \_\_\_\_\_.

Answer 35

ventricular arrhythmias

Question 36

What receptor normally mediates inotropy?

Answer 36

Beta-1

Question 37

If your pt is getting digoxin toxic, what should you do?

Answer 37

1. stop the drug 2. monitor serum K+ and give K+ orally 3. if that doesn't fix it, give IV K+ and antiarrhythmic agents like lidocaine and phenytoin 4. if there's a serious/suicidal OD (K+ is high already), only give the digoxin antibody, Digibind

Question 38

What is AV block?

Answer 38

failure to conduct thru the AV node or below

Question 38

What is sinus tach?

Answer 38

SA node firing at a rate of 100-180 (can be normal)

Question 38

The big difference between ARBs and -prils is that only ACE inhibitors prevent the breakdown of \_\_\_\_\_\_.

Answer 38

bradykinin

Question 40

The big difference between ARBs and -prils is that only ____ prevent the breakdown of bradykinin.

Answer 40

ACE inhibitors

Question 41

A pt with _____ is at much greater risk for digoxin toxicity.

Answer 41

hypokalemia

Question 42

Atropine is used for \_\_\_\_\_\_.

Answer 42

vagally mediated bradycardia

Question 44

What is the tx for Torsades de pointes?

Answer 44

Potassium chloride and MgSO4 (to correct the electrolyte abnormalities)

Question 45

What is the drug treatment for acute v-tach?

Answer 45

class I or III antiarrhythmic (amiodarone)

Question 46

\_\_\_\_\_ (drug) is unique to the ventricles.

Answer 46

Lidocaine

Question 47

How is SA dysfunction treated?

Answer 47

a pacemaker- don't use meds

Question 48

What causes bradyarrhythmias?

Answer 48

sinus node dysfunction (failure to initiate)

Question 49

What is triggered automaticity? What are the 2 types?

Answer 49

site of initiation is outside the SA node; early and late

Question 49

What are the s/s of digoxin tox?

Answer 49

GI disturbances headache visual disturbances

Question 51

The ACE inhibitors and ARBs reduce both ____ and \_\_\_\_\_.

Answer 51

preload; afterload

Question 52

Name 3 beta blockers.

Answer 52

1. carvedilol 2. metroprolol 3. bisprolol

Question 53

What is the only cardiac glycoside we can prescribe?

Answer 53

digoxin

Question 54

AV nodal blockers are the \_\_\_\_\_.

Answer 54

beta blockers

Question 56

What is the tx for sinus tach?

Answer 56

treat the underlying condition

Question 57

What is the tx for acute supraventricular tachycardia (SVT)?

Answer 57

adenosine

Question 59

What is digoxin used for?

Answer 59

to increase systolic function (A-fib) and for symptom improvement (HF)

Question 60

When would you used an ARB instead of an ACE inhibitor?

Answer 60

when the pt can't tolerate the ACE inhibitor (usually b/c of the kinin cough)

Question 61

What are the side effects of ACE inhibitors? Why does this happen?

Answer 61

1. increased plasma K+ (lowered aldosterone) 2. hypotension (vasodilation) 3. kidney damage (GFR failure) 4. chronic dry cough (angioedema and irritation) All b/c of increased Bradykinin \*\*\*\* don't give in pregnancy

Question 62

How can Epi cause arrhythmias?

Answer 62

causes Ca++ overload --\> prolonged afterdepolarizations--\> V tach --\> V fib

Question 63

What is enhanced automaticity?

Answer 63

abnormal initiation at the SA node

Question 64

What is the preferred aldosterone antagonist?

Answer 64

spironolactone (then eplerenone)

Question 65

How is acute AV block treated?

Answer 65

\*\*\*dopamine, epi, atrophine\*\*\*; also shock and transvenous pacing

Question 66

What class of antiarrhythmics are the rhythm controllers?

Answer 66

class I or class III (amiodarone)

Question 67

What is the ECG sign for hyperkalemia?

Answer 67

peaked T wave

Question 68

What are the most common triggers of triggered automaticity (early afterdepolarizations)?

Answer 68

1. slow heart rate 2. low K+ 3. drugs that prolong the action potential duration

Question 69

Rhythm control modifies ______ via the _____ current.

Answer 69

conduction; sodium