Test three

Question 1

What do ACE inhibitors do?

Answer 1

relax veins and arteries to lower blood pressure
they do this by stopping angiotensin II production
Also prevent or reverse pathological changes in heart and blood vessels

Question 2

common side effect vs adverse effects of ace inhibitors

Answer 2

cough bc increased bradykinin

first dose hypotension
teratogenic
angioedema –> fucks up airway

Question 3

ARBs

Answer 3

less effective than ACEis, but work similarly
also block aldosterone
no cough

Question 4

ARB side effects

Answer 4

Low bp
Other (fatigue, dizzy, headache)
Swelling
Allergic rxn
Raised K
Teratogenic
AKI (drops perfusion)
Nasal congestion

Question 5

Who should you NOT give CCBs to?

Answer 5

HF patients

Question 6

Where do CCBs work?
-which conditions are they good for?

Answer 6

heart and blood vessels (not so much veins)
reduce work
good for angina and afib

Question 7

How do CCBs work?

Answer 7

decrease AV conduction
slow HR and force of contraction
reduce afterload
increase coronary perfusion

Question 8

examples of CCBs

Answer 8

verapamil and diltiazem

Nifedipine is a hard core one

Question 9

How to identify CCB OD

Answer 9

dizzy, headache, nausea, face flushing

EKG

Question 10

How do vasodilators reduce cardiac workload?

Answer 10

act on arteries to reduce afterload

act on veins to reduce preload

Question 11

Adverse side effect of vasodilators

Answer 11

reflex tachycardia –> increases O2 demand

Question 12

examples of vasodilators

Answer 12

hydrazaline

Sodium nitroprusside
-fast acting drip for emergencies
-can cause cyanide poisoning

Question 13

Treatment choices in order for htn

Answer 13

lifestyle mod, diuretic, vasodilator, ACEi, BB, CCB

Question 14

Why shouldn’t you use salt substitutes if htn?

Answer 14

they usually contain K which activates the RAAS

Question 15

Which drug classes are prohibited in pregnant ppl with htn?

Answer 15

ACEi, ARBs, DRIs

(use BBs instead)

Question 16

Nitrates use for angina

Answer 16

dilate everything
don’t mix with ED meds
tablets dissolve (no first pass effect)
take off at night

Question 17

stable vs unstable angina

Answer 17

stable= predictable (e.g. after exercise)
unstable = random –> happens at rest

Question 18

Anti-ischemia therapy

Answer 18

MONA (morphine, O2, Nitroglycerine, aspirin)

also BBs and ACEis

Question 19

if a patient is on aspirin and they come in with GI bleed and their platelet is normal, do they need more platelets?

Answer 19

yes –> js bc platelets are there doesn’t mean they’re working

aspirin deactivates them

Question 20

side effects of BBs (why aren’t ppl complient?)

Answer 20

ED, weird dreams, depression, fatigue

Question 21

anticoagulants vs antiplatelets vs thrombolytics

Answer 21

1. disrupt coagulation cascade, suppressing fibrin (heparin)
2. inhibit platelet aggregation (aspirin)
3. promote lysis of fibrin

Question 22

heparin vs LMWH

Answer 22

both are made from animals and act on platelets and thrombin

LMWH works slower –> once dailly –> longer half life
heparin works super fast –> small half life

both bad for renal patients bc kidney excretion

Question 23

Warfarin

Answer 23

anticoagulant
Super variable –> gotta get labs done all the time
Vit K antagonist
Takes forever to kick in, so you gotta start with enoxaparin

Question 24

Antidotes for heparin and warfarin

Answer 24

heparin: protamine sulfate (also platelet infusion)

warfarin: Vit K or fresh frozen plasma

Question 25

goal INR for anticoagulant therapy?

Answer 25

2-3

Question 26

Direct thrombin inhibitors
-example

Answer 26

Dabigatran and bivalirudin

take once a day and its not affected by lifestyle
No antidote though

Question 27

What do tPAs do and when should you use them?

Answer 27

break down clots
only use in emergencies (MI, stroke, massive PE)

Question 28

What’s the only type of isotonic soln

Answer 28

plasmalight

Question 29

Lets talk ab K and how it gets fucked up

Answer 29

K gets fucked up if you pee too much (kidneys regulate it)
insulin helps remedy hyperkalemia (give sugar with it)
K a/w acidosis
give 10 meq/100cc/hr

Question 30

Lets talk ab Mg and how it gets fucked up

Answer 30

diarrhea and alcoholism cause low Mg
kidney pts and L&D usually have high Mg
Mg relaxes muscles (that’s why it’s used in preeclampsia)

Question 31

2 major things that htn causes

Answer 31

HF and afib

Question 32

diuretics help w/ preload or afterload?
how about RAAS inhibitors?

Answer 32

preload
afterload

Question 33

Digoxin and Cardiac glycosides

Answer 33

-inotropes
-digoxin has super narrow therapeutic range and long half life (1.5 days)
adverse effects are dysrhythmias