Hypertension, CHF, Diuretics, Arrhythmias, Obesity Drugs

Question 1

Acute Systolic CHF

Answer 1

Loop diuretic (relieve congestion) + Nitroglycerin (reduce preload) + O2

Question 2

Adenosine

Answer 2

activates A1 receptor in AV node, opens K+ channel to hyperpolarize and reduce automaticity, slow conduction and increase refractory period in AV node; terminate AVNRT, AVRT. (first line is carotid sinus massage)

Question 3

Lorcaserine

Answer 3

5-HT2 receptor agonist, promotes satiety via hypothalamus; obesity, SE: serotonin syndrome if used with SSRI

Question 4

Orlistat

Answer 4

GI lipase inhibitor; obesity, SE: diarrhea

Question 5

Chlorthalidone, hydrocholorothiazide

Answer 5

Thiazide diuretic- inhibits NaCl cotransport in DCT, also arterial vasodilation; hypertension (first line for black, >60yo), also for mild chronic systolic CHF, SE: hypokalemia

Question 6

Atenolol, metoprolol

Answer 6

Bb- reduce chronotropy and intropy, reduce remodeling; hypertension (second-line), also for chronic diastolic CHF- SE: exercise intolerance, sexual dysfunction, blunt recognition of hypoglycemia, bronchoconstriction

Question 7

Dofetilide, ibutilide

Answer 7

Class III K+ channel blocker (ibutilide also enhances slow Na+ current); terminate acute AFib, flutter, tachycardia, SE: VT

Question 8

Sotalol

Answer 8

Class II Bb- non-selective B antagonist and blocks K+ channels, slow conduction through AV node and inhibit repolarization, respectively; cardiac tachyarrhythmia, SE: VT

Question 9

Furosemide

Answer 9

Loop diuretic, inhibits NKCC2 cotransporter in TAL, produces NO/prostaglandin to vasodilate (relieves congestion); acute systolic CHF, chronic systolic/diastolic CHF, SE: hypokalemia, urine out of control

Question 10

Carvedilol

Answer 10

Bb, a1B antagonist- reduce CO by reducing chronotropy + inotropy + PR by blocking sympathetic vasoconstriction, reverse cardiac remodeling; hypertension (second-line for people with diabetes/hyperlipidemia), chronic systolic CHF, SE: exercise intolerance, sexual dysfunction, blunt recognition of hypoglycemia, bronchoconstriction

Question 11

Bb (for arrhythmia)

Answer 11

Class II B1 +/- B2 antagonist- slow conduction through AV node and increase refractory period; rate control; SE: you know it already

Question 12

Candesartan, lorsartan

Answer 12

AT1 receptor antagonist- blocks angiotensin II, reduces remodeling; hypertension (first line for <60yo), chronic systolic CHF, SE: hyperkalemia, teratogenesis

Question 13

Hydralazine + Isosorbide dinitrate

Answer 13

source of NO and inhibits ROS, reverse remodeling; chronic systolic CHF in AA only

Question 14

Triamterene, amiloride

Answer 14

K+ sparing diuretic- blocks Na+ channels in CD; prevent hypokalemia during diuretic therapy

Question 15

Prazosin

Answer 15

a1 antagonist, reduces PR by blocking sympathetic vasoconstriction; hypertension (second-line for people with hypercholesterolemia or BPH), SE: ortho hypotension

Question 16

Digoxin-induced VT

Answer 16

Adjust dose/Ab/MgSO4

Question 17

Procainamide

Answer 17

Class IA Na+ channel blocker (intermediate affinity) and also blocks K+ channels; terminate acute AFib and monomorphic ventricular tachycardia

Question 18

Verapamil, diltiazem (for arrhythmia)

Answer 18

Class III L-type Ca++ channel blocker- slow conduction and increase refractory period in AV node; rate control, SE: excessive cardiac depression

Question 19

Chronic Systolic CHF

Answer 19

Symptomatic (DDD- digoxin, diuretic, vasodilator) + anti-remodeling (ACEi + ARB + Bb + aldosterone antagonist + Ibavradine if HR >70-75, isosorbide dinitrate/hydralazine for AA)

Question 20

Bupropion + Naltrexone

Answer 20

Anoretic anti-depressant, inhibits DA uptake and partial 5-HT1a agonist activity, DA stimulates POMC neurons to release a-MSH. Naltrexone is a mu opioid receptor antagonist, blocks reward pathways that motivate; obesity, SE: HA and sleep disturbance

Question 21

Lidocaine

Answer 21

Class IB Na+ channel blocker (low affinity), slow conduction and increase refractory period in ventricles; terminate acute ventricular tachyarrhythymia

Question 22

Propafenone/flecainide

Answer 22

Class IC Na+ channel blocker (high affinity) and blocks K+ and Ca+ channels; terminates AFib, prevents everything else SVT

Question 23

Monomorphic VT

Answer 23

electrical shock/procainamide/Bb

Question 24

Nebivolol

Answer 24

Bb, B1 antagonist which increases NO availability, reduces chronotropy + inotropy + resistance; hypertension in people who can’t tolerate other Bb SE: blunts recognition of hypoglycemia, bronchoconstriction

Question 25

Torsades

Answer 25

MgSO4, Bb

Question 26

Sacubitril

Answer 26

converted to sacubitrilat by esterases, which inhibits neprilysin, thus raising BNP, vasodilation, diuresis, stops RAAS; acute systolic CHF, SE: cough and angioedema

Question 27

Diastolic CHF

Answer 27

Diuretic (relieve congestion) + Bb (increase filling by slowing HR) + CCB (vasodilates and relaxes cardiac muscle to increase filling, reduces afterload) + ACEi/ARB (just for vasodilation)

Question 28

Sacubitril + valsartan (Entresto)

Answer 28

Neprilysin inhibitor + ARB, chronic systolic CHF, SE: cough, angioedema, teratogenesis

Question 29

Lisinopril, enalapril, captopril

Answer 29

ACEi- reduces PR by reducing angiotensin II and aldosterone (Lisinopril- reduce remodeling); hypertension (first line for <60yo), and chronic systolic CHF, SE: cough, angioedema, hyperkalemia, teratogenesis

Question 30

Mannitol

Answer 30

Increases osmolarity of ECF and washes out CC multiplier; rapid elimination of toxins, cerebral edema, acute angle closure glaucoma, CF (powdered)

Question 31

Phentermine + Topiramate

Answer 31

Reuptake inhibitor of NE, 5-HT, and DA, inhibits MAO enzymes, increases leptin and suppresses NPY; obesity, SE: addiction, topiramate is CA inhibitor and changes taste of carbonated stuff

Question 32

Amlodipine, nifedipine

Answer 32

CCB- blocks vascular L-type Ca++ channels and stabilizes inactivated state, reduce PR; hypertension (first line for black, >60 yo), SE: edema, GERD

Question 33

Magnesium Sulfate

Answer 33

Decreases ACh in motor nerve terminals and slows SA node impulse formation and prolonging conduction time; torsades and digoxin (polymorphic VT)

Question 34

Digoxin

Answer 34

Na+/K+ ATPase inhibitor, increases Na+ for Na+/Ca++ exchanger; systolic CHF, SE: VT and Torsades

Question 35

Amiodarone, Dronedarone

Answer 35

Class III K+ channel blocker, some Na+ Ca++ activity; prevent cardiac tachyarrhythmias, SE: VT

Question 36

Nitroglycerin

Answer 36

Source of NO, dilates veins > large arteries, reduce myocardial O2 demand; acute systolic and diastolic CHF, SE: headache, hypotension

Question 37

Ivabradine

Answer 37

HCN4 inhibitor, reduces HR; chronic systolic CHF

Question 38

Spironolactone, eplerenone

Answer 38

K+ sparing diuretic- aldosterone receptor (MR) antagonists- reverse remodeling by aldosterone; chronic systolic CHF, SE: hyperkalemia

Question 39

Digoxin (for arrrhtyhmia)

Answer 39

increases vagus nerve activity, reduces HR and slow conduction and increase refractory period in AV node; rate control (together with Bb or CCB) SE: VT