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Dr. Omar's Deck of Secret Knowledge > Pharm: Cardiac Drugs > Flashcards

Pharm: Cardiac Drugs Flashcards

1
Q

MOA of Methyldopa. Side effect?

A

Methyldopa is a centrally acting a2-agonist which reduces cardiac output or vascular resistance.

May cause hemolytic anemia

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2
Q

A cheese lover on MAO inhibitor experienced a hypertensive crisis. How did this happen?

A

Large amounts of tyramine in cheese may cause release of large amounts of neurotransmitters. Tyramine normally had low bioavailability because of its metabolism by MAO.

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3
Q

Beta blocker with direct vasodilator action

A

Nebivolol

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4
Q

What is the MOA of the ff vasodilators:

  1. Hydralazine
  2. Verapamil
  3. Fenoldopam
  4. Minoxidil
A
  1. Release of NO from drug or endothelium
  2. Reduction of Ca influx via L-type channels
  3. Activation of dopamine D1 receptors
  4. Hyperpolarization due to opening of K channels
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5
Q

Anti hypertensive used topically in the treatment of baldness

A

Minoxidil

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6
Q

Thiazides derivative that lacks diuretic effects; given as an anti hypertensive because it causes hyper polarization and relaxation of smooth muscles

A

Diazoxide

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7
Q

Inhibits renin’s action on its substrate, angiotensinogen. What are its major toxicities?

A

Aliskiren.

Headache and diarrhea

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8
Q

Recent evidence suggest that the MOA of ranolazine as an anti-anginal drug is related to:

A

Inhibition of late Na current

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9
Q

5 mechanisms/drug classes for sympathiplegic control of blood pressure.

A

1) baroreceptor sensitizing agents
2) CNS sympathetic outflow blockers
3) ganglion blockers
4) nerve terminal blockers
5) adrenergic blockers

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10
Q

What loop diuretic has no sulfa group?

A

Ethacrynic acid

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11
Q

What is the most potent loop diuretic?

A

Bumetanide. Also does not need to be bound to albumin.

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12
Q

Gravest side effect of reserpine

A

Severe psychiatric depression with suicidal ideations

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13
Q

Feared side effects of alpha 1 selective blockers

A

1st dose orthostatic hypertension

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14
Q

Feared side effect of methyldopa

A

Immunologic mediated hemolytic anemia (+) Coombs test.

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15
Q

What beta blocker is used to treat pheochromocytoma?

A

Labetalol

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16
Q

Aside from blocking sympathetic effects on the heart, what is the other mechanism of action of beta blockers?

A

Decreases renin release

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17
Q

What are the common causes of drug induced lupus?

A

Hydralazine
Isoniazid
Procainamide
Penicillamine

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18
Q

What vasodilators are specific for arterioles?

A

Hydralazine
Minodixil
Nitroprusside

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19
Q

Marker for drug induced lupus

A

Antihistone 95% sensitive

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20
Q

What CCB causes gingival hyperplasia?

A

Nifedipine
Cyclosporine
Phenytoin
Verapamil

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21
Q

Which CCB is preferential for cardiac L-type calcium channels?

A

Non-dihydropyridines

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22
Q

What is the dopamine agonist that increases renal blood flow by dilating afferent and efferent arterioles?

A

Fenoldepam

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23
Q

What are 2 mechanisms by which ACEI protect diabetic kidneys?

A

ACEIs inhibit albumin excretion and slowdown progression to macroalbuminuria.

Secondary effect: decrease compensatory hypertrophy of nephrons

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24
Q

Vasodilator used in the treatment of insulinomas

A

Diazoxide

Decreases insulin release from islet of Langerhans

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25
Q

What vasodilator is known to cause coronary steal syndrome?

A

Nitroprusside.

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26
Q

According to ALLHAT and NKF-ADA, what drugs should be given to patients with DM? Provided they still have good kidney function, CKD 2.

A

Diuretic, BB, ACEI or ARB, CCB, aldosterone antagonist

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27
Q

Vasospastic angina is responsible for how many % of anginal cases?

A

10%

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28
Q

Mechanism of action of pFOX inhibitors?

A

Shifts fatty acid metabolism to more efficient glucose use in cardiac muscle.

29
Q

Give an example of a 3-KAT inhibitor.

A

Trimetazidine. Shifts fatty acid to glucose metabolism in cardiac cells

30
Q

Cause of nitrate induced headaches?

A

Meningeal artery vasodilation

31
Q

Rapid infusion of nifedipine cause cardiotoxicity by what mechanism?

A

Rapid vasodilation > significant lowered BP > increased sympa outflow > increased HR > increased myocardial O2 demand

32
Q

What drug in the treatment of cyanide toxicity forms a less toxic and easily excretable metabolite?
What is the metabolite?

A

IV sodium thiosulfate

Thiocyanate

33
Q

Inhaled amyl nitrite and sodium nitrates cause?

A

Methemoglobinemia, which has increase affinity for cyanide

34
Q

After how long does or develop a tolerance to nitroglycerin transdermal patches?

A

8-10 hours

35
Q

Rare toxic effect of diltiazem that primarily affects the extremities.

A

Raynaud’s phenomenon

36
Q

What drugs causes Raynaud’s phenomenon?

A

Diltiazem, some beta blockers, chemotherapeutic drugs, smoking

37
Q

What drug class when combined with beta blockers has decreased side effects?

A

Nitrates

38
Q

ECG findings in digitalis toxicity

A

1) most common: bradycardia
2) scooped out ST segment
3) prolonged PR interval

More specific:

4) bidirectional vent. Tachycardia
5) atrial fibrillation with slow ventricular rate
6) atrial tachycardia with a block

39
Q

What drug used in acute treatment of heart failure increase mortality when used for chronic HF?

A

Phophodiesterase inhibitors

40
Q

What drug significantly improves functional status in CHF but not prolong life?

A

Digoxin

41
Q

Drug of choice in the treatment of digitalis toxicity?

A

Lidocaine

42
Q

What diuretics has significant long term benefits in HF?

A

Spironolactone and epleronone

43
Q

What drugs have been shown to have survival benefits for HF?

A

ACEIs
beta blockers
Aldosterone antagonists

44
Q

Give the Singh-Vaughan Classification of antiarrhythmics:

A

1) Na channel blockers
2) Beta blockers
3) potassium channel blockers
4) CCBs

45
Q

Most selective class 1 antiarrhythmic for ischemic tissue.

A

1B

Lidocaine, tocainide, mexiletine

46
Q

What antiarrhyhtmic has the deadly side effect of agranulocytosis?

A

Tocainide

47
Q

What class 1 antiarrhythmic is used to treat malaria

A

Quinidine

48
Q

Quinidine’s unique side effect among the antiarrhythmics?

A

ITP

49
Q

Treatment for class 1A overdose with arryhythmia?

A

Sodium lactate

50
Q

Last resort antiarrhytmic known to have a proarrhythmic effect?

A

Flecainide

51
Q

Ideal treatment for Wolf-parkinson-white?

A

Procainamide or Amiodarone.

Don’t forget cardioversion is the best option!

52
Q

What 2 class 3 drugs also have class 2 effects?

A

Amiodarone and sotalol

53
Q

What class of antiarrhythmics is characterized by prolongation of the action potential?

A 
Class 3 & (minor class 1A)
Caused by blockade of Ik channels that are responsible for repolarization thereby increasing effective refractory period.
54
Q

Amiodarone like drug with less side effects used for the treatment of atrial flutter?

A

Dronedarone

55
Q

What drug leaves microcrystalline deposits on the skin and cornea?

A

Amiodarone

56
Q

Why are dihydropyridines not used as antiarrhythmics?

A

They evoke a compensatory sympathetic response that facilitates arryhythmia rather than terminating them.

57
Q

Transient chest pain is a notable side effect of adenosine, why?

A

It causes mild to moderate bronchoconstriction

58
Q

What diuretic group does not act on the luminal side?

A

Aldosterone receptor antagonists

59
Q

What drug blocks the excretion of weak acids and bases at the PCT

A

Probenecid

60
Q

What causes hep enceph in patients receiving acetazplamide?

A

Acetazolamide causes alkalinization of urine due to decreased bicarbonate reabsorption. This prevents ammonia from turning to ammonium. Ammonia is more easily reabsorbed.

61
Q

Parathyroid hormone shares several renal effects with what diuretic?

A

Thiazides diuretics

62
Q

What diuretic mimics the effect of gitelman syndrome?

A

Thiazide diuretics

63
Q

What diuretic mimics bartter syndrome?

A

Loop diuretics

Only for type 1 Bartter syndrome

64
Q

What diuretics cause acidosis?

A

Acetazolamide by decreased bicarbonate reabsorption

Spironolactone by decreased H+ secretion

65
Q

What drugs cause hypochloremic, hypokalemic metabolic alkalosis?

A

Thiazides and Loop D’s.

66
Q

Drug of choice for central diabetes insipidus

A

Desmopressin

67
Q

Drug of choice for nephrogenic DI?

A

Thiazides

68
Q

Drug used for Von Willebrands disease?

A

Desmopressin

69
Q

MAO inhibitors were once used for HPB because they caused formation of this false neurotransmitter in postganglionic neuron terminals which had very low efficacy.

A

Octopamine

Dr. Omar's Deck of Secret Knowledge (57 decks)

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