UW revision med drugs BAB and HCM

Question 1

BAB. Mechanism?

Answer 1

Excessive adrenergic blockage –> decreased intracellular cAMP.

Question 2

BAB. beta1 blockage mediated effects? 2

Answer 2

Cardiac supression with bradycardia and hypotension.
Confusion due to cerebral hypoperfusion

Question 3

BAB. beta1 blockage neuro symptom?

Answer 3

Confusion due to cerebral hypoperfusion

Question 4

BAB. Beta 2 blockage mediated effect? 3

Answer 4

Bronchospasm
Hypoglycemia (impaired gluconeogenesis/glycogenolysis)
Confusion and seizures due to hypoglycemia

Question 4

BAB. Beta 2 blockage mediated effect on glucose?

Answer 4

Hypoglycemia (impaired gluconeogenesis/glycogenolysis)

Question 5

BAB. Beta 2 blockage mediated effect on neuro?

Answer 5

Confusion and seizures due to hypoglycemia

Question 6

BAB. Diagnosis? 2

Answer 6

ECG = sinus node dysfunction, AV blockage
Consistent clinical presentation (DRUG LEVELS NOT USEFUL)

Question 7

BAB. Tx. Hypotension?

Answer 7

Iv fluids

Question 8

BAB. Tx. Bradycardia?

Answer 8

Atropine

Question 9

BAB. Tx to counteract toxicity?

Answer 9

GLUCAGON!!!! (incr. intracellular cAMP)

Gali buti case, kad gavo skysciu ir atropino - ner efekto, ka toliau?

Question 10

BAB Other Tx. Sometimes given to incr. BP?

Contractility?

Answer 10

Calcium gluconate

Insulin and glucose (incr. contractility)
Lipid emulsion therapy (in regional anesthesia) - binds lipid soluble medications in blood stream.

Question 11

BAB auscultation finding, that most likely will not present with other toxicities?

Answer 11

bilateral wheezing (due to bronchoconstriction)

Question 12

(A) Hypertrophic cardiomyopathy.
Asymptomatic. next step?

Answer 12

Routine clinical motinoring

Question 13

(A) Hypertrophic cardiomyopathy.
Symptomatic (dyspnea, angina). next step? 2

Answer 13

BAB or nondihydroCCB

Question 14

(A) Hypertrophic cardiomyopathy.
Symptomatic (dyspnea, angina).
IF high risk for SCD (prior syncope or VT, family history). Next step?

Answer 14

ICD placement

Question 15

(A) Hypertrophic cardiomyopathy.
Symptomatic (dyspnea, angina).
IF Atrial fib.
Next step?

Answer 15

Rate or rhythm control and anticoagulation

Question 16

(A) Hypertrophic cardiomyopathy.
Refractory symptoms –> Significant LVOT obtruction. Next step?

Answer 16

Septal ablation or surgical myectomy

Question 17

(A) Hypertrophic cardiomyopathy.
Refractory symptoms –> Nonobstructive. Next step?

Answer 17

Cardiac transplantation

Question 18

Hypertrophic cardiomyopathy. If has symptoms, give BAB. Two effects on heart?

Answer 18

Negative chronotropy and negative inotropy

Question 19

Hypertrophic cardiomyopathy. BAB.
Negative chronotropy effect?

Answer 19

Slows HR to increase LV fillin time and increase LVEDV

Question 20

Hypertrophic cardiomyopathy. BAB.
Negative inotropy effect?

Answer 20

decr. myocardial contractility to increase LV end systolic volume (ie baseline LV volume in increased)

Question 21

Hypertrophic cardiomyopathy. nondihydro-CCB has similar effect to BAB, can be added for additional benefit.

Answer 21

Increasing LV volume to decrease LVOT obstruction (two ways = negative chronotropy and inotropy)