Quick Review Flashcards
Nitrates for IHD
- nitroglycerin
- isosorbide mononitrate
- isosorbide dinitrate
Calcium channel blockers: non - cardio for IHD
- Amlodipine
- Nifedipine
- Nicardipine
*best at vasodilation
Calcium channel blockers: cardio for IHD
- Verapamil
- Diltiazem
*best at decreased contractility, SA node, AV node
Beta blockers for IHD
- Propanolol (antagonist)
- Metoprolol (inverse)
- Nadolol (antagonist)
- Atenolol (antagonist)
Classic v. Variant angina
a. due to occlusion
b. due to vasospasm (prinzmetal)
What drug causes coronary steal syndrome?
Dipyridamole
What drug class are contraindicated in those with elevated intracranial pressure?
nitrates
Pt. presents with severe unstable angina. They have a hx of type 1 diabetes, but it is well controlled with insulin. They also have a history of HTN, but are negative for all respiratory complaints. What beta blocker would you prescribe?
none - type 1 diabetics on insulin is a contraindication
Women presents 24 weeks pregnant to neonatal surgery. What condition is being corrected?
CPAM –> they can get get so big that you get pulmonary hypoplasia
mediastinum shift with the following atelectasis:
a. respiration
b. compression
c. contration
a. toward resorption
b. away
c. idk
what four ways do we get pulmonary edema?
a. increased hydrostatic P (LHF, inc volume, pulmonary v. obstruction)
b. decrease oncotic pressure (liver or renal problem)
c. unknown (altitude, neuo)
d. injury to alveolar wall (bac pneumonia, sepsis, smoke, aspiration)
Stages of ARDS
- Exudative (hyaline, neutrophils, edema)
- Proliferative (fibroblast, early fibrosis)
- Resolution (normal tissue) or Fibrotic (extensive fibrosis)
List of Obstructive Diseases
- asthma
- chronic bronchitis
- emphysema
- bronchiectasis
- pneumoconiosis
List of Restrictive Diseases
- pneumoconiosis
- idiopathic pulmonary fibrosis
- sarcoidosis
- HS pneumonitis
What cells do we see in asthma?
a. atopic: mast, eosinophils, lymphocytes
b. non-atopic: neutrophils, T cells
Why is the hypertrophied heart at risk of ischemia?
the myocytes getting bigger doesn’t mean they’re getting more O2/blood
What causes LV hypertrophy?
- HTN
- ischemic HD
- aortic/mitral valvular diseases
- primary myocardial diseases
When do we see nutmeg liver?
- Right sided HF
NOTCH pathway is associated with what congenital defects?
NOTCH1 –> bicuspid aortic valve
NOTCH 2 and JAG 1 –> Tetralogy of Fallot
What type of coarctation is symptomatic at birth?
- one with a PDA (cyanosis in lower half of body)
* one without isn’t seen until adulthood where you may get leg claudication, hypotension in LE, hypertension in UE
When do we see myocyte hypereosiniphilia?
12-24 hrs after an MI
Where are phase I enzymes located?
lipophilic ER membranes of liver (and other tissues)
Succinycholine and inhalation anesthetics can cause what?
malignant hyperthermia in pts with ryanodine receptor mutations
Individuals with genetic defects in pseudocholinesterase can metabolize _____ at 50% the rate as normal individuals
Succinycholine
CYP inducers
- phenytoin (anticonvulsant)
- ethanol (CYP2E1)
- aromatic hydrocarbons such as benzo[a]pyrene (tobacco smoke),
- rifampin
- phenobarbital and other barbiturates
rasburicasenot be used in patients with deficiency.
G6PD
the common variant, rs4149056 inSLCO1B1, increases systemic exposure of_______ and was identified to have the single strongest association with _____________
simvastatin
simvastatin-induced myopathy
Choline esters have what charge? alkaloids?
a. +
b. -
The net cardiovascular effects of moderate doses of AChE inhibitors is modest Brady/tachycardia, a ____ in cardiac output, and a modest ____ in blood pressure
a. Brady
b. fall
c. increase
a. The tertiary amines are used for their effects on the ___ or ____ (___, ___, ___)
b. The quaternary amines are ___ and elicit their antimuscarinic effects in the ___ (___, ___)
a. eye, CNS, atropine, tropicamide, benztropine
b. charged, periphery, ipratropium, glycopyrrolate
____ is the first drug of choice for symptomatic bradycardia in an advanced cardiac life support (ACLS) setting
atropine
Surgical excision is not recommended in small cell carcinoma when what has happened?
it has spread to the LNs
Apex of lung can cause what problem?
Horner Syndrome –> ptsosis, miosis, anhidrosis
Atypical Carcinoid tumor vs. Carcinoid Tumor
- increased rte of metastasis
- necrosis
- increased mitotic activity
- disordered growth
a. Calretinin distinguishes what two types of cancers?
b. CD34+ and keratin - distinguishes what type of cancer from another?
a. mesothelioma from adencocarcinoma
b. Solitary fibrous tumor from mesothioloma
What causes the following:
a. pigeon breeder’s lung
b. Farmer’s Lung
c. Hot tub Lung
all are HS pneumonitis
a. protein in pigeon poop
b. actinomycetic spores in hay
c. reaction to Mycobacterium avium complex (MAC)
Desquamative Interstitial Pneumonia
tons of macrophages
5-6th decade smokers
Respiratory Bronchiolitis-ILD
- 3-4th decade smokers
- “peribronchiolar” metaplasia
gelatinous material
protein alveolar proteinosis
plexiform lesion, medial hypertrophy
pulmonary HTN
human Metapneumovirus
- affects young, old, and immunocompromised
- causes bronchiolitis, pneumonia
- a paramyxovirus
pumpkin seed
histoplasmosis capsulatum*
*granulomatous response; coin lesions on CXR
ACE Inhibitors should be given to all people with what? unless they are what?
a. LV systolic failure or LV dysfunction without HF
b. not tolerated (try ARB), pregnant, hypotensive, serum creatine >3, hyperkalemic
Unless contraindiateced, carvedilol should be give to what pts? in addition to what?
a. LV systolic dysfunction caused by MI
b. ACE inhibitors
What should you use in a patient with low GFR:
Hydrochlorothiazide or furosemide
furosemide (other doesn’t work in pts with low GFR)
What drug combo works to tx chronic HF in African Americans but not whites?
isosorbide denigrate + hydralazine*
*can cause drug induced lupus
