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CPR II > Week 2 (Exam 1) > Flashcards

Week 2 (Exam 1) Flashcards

1
Q

Who would you avoid giving Flecainide to?

A

Patients with preexisting ventricular tachyarrhythmias
Patients with previous MI
Patients with Ventricular Ectopic Rhythms

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2
Q

Nicardipine MOA

A

Slow Calcium entry blocker into Cardiac/SM

Does not change serum [Ca]

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3
Q

STEMI vs NSTEMI etiology

A

STEMI is complete occlusion of coronary vessel

NSTEMI is partial occlusion or complete w/ collateral circulation

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4
Q

Sotalol Clinical Use and Adverse Effects

A

Class 2 and Class 3 activities
Treats life-threatening ventricular arrhythmias
Maintains sinus rhythm for patients with A Fib
Adverse: Cardiac Depression, Torsade

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5
Q

Pt has postive stress test

A

Proceed to invasive coronary angiography

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6
Q

Adenosine MOA

A

Activates Gi-Coupled GPCR A1 Adenosine Channel
Enhances K+ Current and Inhibits Ca and Funny
Causes Hyperpolarization and suppression of APs
Inhibits AV conduction and Increased Refractory Period

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7
Q

4 drugs commonly used to treat Aortic Dissection

A

Labetalol, Esmolol, Nitroprusside, Nitrocardipine

b-Blockers

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8
Q

Dofetilide Clinical Use

A

Class 3 drug that maintains sinus rhythm after cardioversion in patients with A Fib

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9
Q

What happens if you combine Digitalis Glycosides?

A

Increased Bradycardia

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10
Q

Uses for Nitroprusside

A

Immediate lowering of blood pressure
Reduces bleeding during surgery
Treats Acute Congestive Heart Failure

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11
Q

Benazepril

A

Ace Inhibitor for HTN

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12
Q

Captopril MOA

A

ACE Inhibitor

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13
Q

Acute Pericarditis Treatment

A

NSAIDs (Indomethacin) and Colchicine (for 3 mos)

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14
Q

Carvedilol MOA

A

A- and (non-selective) B-Blocker

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15
Q

Amiodarone Clinical Use and MOA

A

Class 3 Agent
Blocks K+ Channels and Prolongs QT and APD uniformly
Blocks Inactivated Na+ Channels (and some Ca+)
Adrenolytic (causes bradycardia)
Used for V Tach and A Fib

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16
Q

Adverse Effects of Class 4 Drugs

A

Verapamil can make you constipated

Cardiac stuff: AV Block, -Inotropy, SA arrest, hypotension

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17
Q

What side effect are old people especially susceptible to when taking Esmolol?

A

Bradycardia (dosage reductions might be necessary)

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18
Q

Do not use Nitroprusside:

A

For Compensatory Hypertension

In its without enough brain blood, near death, b12 deficient, anemic, renal diseased, hypovolemic

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19
Q

Bisoprolol MOA

A

B1-Selective b-Blocker

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20
Q

Where are the cells in the heart that feature Fast Action Potential?

A

Atrial and Ventricular Cardiac Myocytes

Purkinje Fibers

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21
Q

Indications for Bisoprolol

A

Angina, A Fib / Flutter, HF, HPTN

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22
Q

How are Class 1c and Class 3 agents used for cardioversion / rhythm control in A Fib?

A

1C: Na block reduces retrograde conduction
2: K block keeps cells in their refractory period

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23
Q

Posterior Heart MI Leads and Artery

A

Leads: V1, V2, V3 Tall R and Depressed ST
70% Right Dom (PDA from RCA)
10% Left Dom (PDA from LCx)
20% Codominant (PDA from RCA and LCx)

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24
Q

Indications for Losartan

A

Treat HTN, to Lower BP in its above 6 years old
Reduce Risk of Stroke
Diabetic Nephropathy withy high creatine, proteinuria

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25
Q

Spironolactone MOA

A

Aldosterone Antagonist

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26
Q

Contraindications of Spironolactone

A

Hypokalemia
Addison’s
Concomintant use of Eplerenone

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27
Q

Verapamil and Diltiazem Clinical Use and MOA

A

The Class 4 Agents
Ends and Prevents Paroxysmal Supreventricular Tach
Controls Ventricular Rate in A Fib and Flutter

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28
Q

Contraindication for Stress ECG

A

Patients with baseline ECG abnormalities

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29
Q

Labetalol Adverse Effects

A

Dizziness, Scalp Tingling, Lightheadedness, Headache, GI, Stuffy Nose

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30
Q

Disopyramide MOA and Effects

A

1A Antiarrhythmic with antimuscarinic effects
Good with Recurrent Ventricular Arrhythmias
QT prolongation, Torsade
Negative Inotropy, causing heart failure
Atropine-like symptoms

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31
Q

Black Box warning for ACE Inhibitors / Angiotensin II receptor Blockers

A

Fetal Toxicity, Death

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32
Q

Most myocarditis patients present with one of 3 patterns…

A

New Onset or Worsening Heart Failure
Cardiac Conduction Abnormalities
Acute Myocardial Infarction

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33
Q

5 Drugs for PSVT episode prevention

A

Ca Blockers: Verapamil and Diltiazem

b-Blockers: Metoprolol, Atenolol, Propranolol

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34
Q

Septal Heart MI Leads and Artery

A

Leads V1 and V2

LAD

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35
Q

Labetalol MOA

A

Decreases Peripheral Vascular Resistance

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36
Q

What is Benazepril closest to pharmacologically?

A

Fosinopril and Quinapril

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37
Q

NSTEMI ECG Crtieria

A

ST Depression 0.5mm or higher in 2 contiguous leads

T Wave Inversions more than 1mm in two with prominent R waves or R/S ratio more than 1

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38
Q

What 3 drugs would you use for Maintenance of Sinus Rhythm in A Fib patients with structural disease?

A

Sotalol
Amiodarone
Dofetilide

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39
Q

Adverse Effects of Procainamide

A

QT prolongation, Torsade de Pointe, Syncope

SLE, Hypotension

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40
Q

MOA of Benazepril

A

ACE inhibitor (Competes for Angiotensin I so it doesn’t cover to Angiotensin II)

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41
Q

What happens if you combine Nitroglycerin with Labetalol?

A

Additional Antihypertensive Effects

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42
Q

Caution nitroprusside use with patients:

A

with high Cyanide/Thiocyanate ratio (Congenital Leber’s Optic Atrophy, Tobacco Amblyopia)
with Acute Congestive Heart Failure
with Hepatic Impairment
with Head Trauma

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43
Q

1C anti arrhythmic MOA

A

Block NA channels and certain K Channels

Do Not Prolong AP, Just QRS

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44
Q

Esmolol MOA

A

Class 2 Anti-Arrhythmic
Competitively blocks b1 Adrenergics
Controls rapid heartbeats and high BP surrounding surgery or medical procedures

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45
Q

Cyanide (and Thiocyanate)

A

From breakdown of Sodium Nitroprusside, and following binding of oxyhemoglobin,
(also produces NO and Methaemoglibin)

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46
Q

What has a super potent effect when combined with Lisinopril?

A

Thiazide Diuretics: Exponential

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47
Q

Definitive Diagnosis of Myocarditis

A

Endomyocardial Biopsy

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48
Q

3 Black Box Warnings of Nitroprusside

A

Hypotension (ischemic injury, death)
Cyanide Toxicity
No Direct Inject (Dilute before infusion)

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49
Q

Dressler Syndrome

A

Pericarditis (immune-based) weeks to months after an MI

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50
Q

Inferior Heart MI Leads and Artery

A

Leads II III and aVF

RCA

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51
Q

Drug interactions with Furosemide

A

Makes Aminoglycosides (especially with impaired renal function) more Ototoxic

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52
Q

3 components of Angina Pectoris

A

Substernal chest pain or discomfort
Provoked by exertion or emotional stress
Relieved by rest and/or Nitroglycerin

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53
Q

Torsade etiology

A

Impaired K channels cause prolonged repolarization

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54
Q

Ibutilide Clinical Use and Adverse Effects

A

Class 3 Antiarrhythmic
Blocks rapid part of delayed rectifier K+ current
Restores sinus rhythm in A Fib
Adverse: QT prolongation, Ventricular Arrhythmias

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55
Q

Esmolol Clinical Use and MOA

A

rapid b1-blocker used in supra ventricular arrhythmias and those associated with myocardial infarction.
Used as adjunct to general anesthesia

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56
Q

Enalapril MOA

A

ACE Inhibitor

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57
Q

Nicardipine Metabolism

A

CYP3A4 Substrate

P-GP (MDR1) Substrate

58
Q 
Acute Chest Pain or Discomfort
Dyspnea
N/V
Diaphoresis
Fatigue
A

Acute Coronary Syndrome

59
Q

1B Antiarrhythmic MOA

A

Block Sodium Channels Only

May Shorten AP

60
Q

Class 4 Drug MOA

A

Block L-Type Ca+ Channels in pacemaker cells
Decrease phase 0 slope
Increase L-type Ca channel threshold potential

61
Q

Labetalol Warnings and Precautions

A

Hepatic Injury
Cardiac Failure
Non-Allergic Bronchospasm

62
Q

Nitroprusside Metabolism

A

1 Nitroprusside + 1 Hemoglobin -> 1 cyan-methoglobin + 4 CN- ions
Thiosulfate reacts with cyanide, then leaves via urine as thiocyanate

63
Q

Why is hydroxychloroquine and Azithromycin dangerous to give everyone for COVID?

A

They cause QT prolongation and/or Torsade

2+ drugs causing QT combines cause Torsade and Fatal Ventricular Arrhythmias

64
Q

New Cardiac Murmur in Embolic Disease (CVA)

A

Non-Bacterial Thrombotic Endocarditis (Marantic)

Often seen with Malignancy, often found on autopsy

65
Q

Uh oh, you need to treat someone for cyanide poisoning after you gave them too much sodium nitroprusside. What do?

A

Give Sodium Thiosulfate: Increases rate of toxic cyanide processing

66
Q

Why do b-blockers decrease Phase 0 of action potentials

A

Acts on Funny and T-Type Ca Channels

67
Q

Treatment and management of stable angina

A

External Enhanced CounterPulsations (EECP) therapy

68
Q

What drug do you use for Oral Anticoagulation in patients with A Fib and mechanical heart valves?

A

Warfarin

69
Q

Class 1A Anti-arrhythmic MOA

A

Block Na: Reduces Phase 0 Slope, Prolongs QRS

Block K: Prolong AP, Prolong QT

70
Q

Suspect an aortic Dissection? Order…

A

CT Angiography

71
Q

What counseling point would you be sure to make with a patient starting Lisinopril?

A

Don’t take NSAIDs

72
Q

Adverse Effects of Adenosine

A

SOB, Bronchoconstricution, Chest Burn, AV Block, Hypotension

73
Q

Contraindications for Captopril

A

Sulfur Allergy
Angioedema
Aortic Stenosis

74
Q

Indications for Furosemide

A

Treatment of Edema associated with CHF, Cirrhosis, Renal Disease
Pulmonary Edema

75
Q

What is responsible for the refractory period?

A

Voltage gated K+ channels

76
Q

Nitroprusside MOA

A

NO: activates Guanylate Cyclase on Vascular SM,
Increasing intracellular cGMP, activating PKG, activating Phosphates, activating Myosin Light chains involved in muscle contraction, VASODILATION

77
Q

Enalapril Indications

A

Diabetic Neuropathy
Stroke Prevention
CHF, Proteinurea, HPTN

78
Q

Methaglobinemia as a side effect

A

From Nitroprusside

79
Q

Adverse Effects of Esmolol

A

Bronchial Asthma
Bradycardia / hypotension
Cardiogenic shock, cardiac failure
Fetal Bradycardia in Pregnancy (even after stopped)
Extravasation
Hyperkalemia (especially with renal impairment)

80
Q

What 5 drugs would you use for Maintenance of Sinus Rhythm in A Fib patients with minimal heart disease?

A 
Flecainide
Propafenone
Sotalol
Amiodarone
Dofetilide
81
Q

Labetalol Contraindications

A

Overt Cardiac Failure
Greater than First Degree Heart Block
Severe Bradycardia

82
Q

Contraindications for Carvedilol

A

Bronchial Asthma
AV Block
Severe Bradycardia
Hepatic Impairment

83
Q

Oral Anticoagulation in patients with A Fib and no mechanical heart valves

A

Dabigatran, Rivaroxaban, Edoxaban, Apixaban, Warfarin

84
Q

Warnings associated with Carvedilol

A

Worse CAD upon cessation
Non-Allergic Bronchospasm
Masking Hypoglycemia, worsening Hyperglycemia

85
Q

1st, 2nd, 3rd line treatments for Stable Angina Pectoris

A
  1. Aspirin, Betablocker, Nitro, Statin
  2. Increase b-Blocker, Add Ca Channel Blocker
  3. Optimize BB and Ca Blocker, Consider Ranolazine
86
Q

Propafenone Clinical Use and MOA

A

1C Antiarrhythmic + some B-Blocking
For Supraventricular Arrhythmias w/out structural dz
Similar possible exacerbation as with Flecainide

87
Q

Indications for Spironolactone

A

HF, Reduced Ejection Fraction, HPTN
Edema
Primary Hyperaldosteronism

88
Q

Nicardipine to patients with b-Blockers

A

Titrate Slowly

89
Q

Nicardipine interactions with Cyclosporine and Tacrolimus

A

Concomitant use increases plasma [cyclosporine or tacrolimus] because nicardapine inhibits hepatic microsomal enzymes (CYP3A4)

90
Q

Why does the threshold of an AP get increased with b-blockers?

A

Effects L-Type Ca Channels

91
Q

What happens if you have a STEMI patient at a Non-PCI capable hospital?

A

Transferwithin 120 Minutes OR:

Give Thrombolytics within 30 minutes, then transfer

92
Q

Propanalol Clinical Use and MOA

A 
B Blocker (Class 2)
For Stress/Thyroid Storm Arrhythmias, A Fib / Flutter, Paroxysmal Supraventricular Arrhythmias, MI Arrhythmias
93
Q

Distribution of labetalol

A

Crosses Placenta

Found in breast milk

94
Q

4 Cardiac Tamponade Signs

A

Pericardial Friction Rub
Absent Y Descent on Jugular Veinous Waveforms, Pulsus Paradoxus
Hypotension + JVD + Muffled Heart Sounds

95
Q

Clinical use of Adenosine

A

Conversion to sinus Rhythm in Paroxysmal Supaventricular Tach (IV)

96
Q

Indications for Benazepril

A

HTN and Heart Failure Management

97
Q

Metabolism of Labetalol

A

Conjugated to Glucuronide Metabolites, Ester Linkage Hydrolysis
55 - 60% is found in urine within first 24 hours of dosing
Crosses the Placenta

98
Q

4 signs of Constrictive Pericarditis

A 
JVD (Prominent x and y descents on waveform)
Pulsus Paradoxus
Kussmaul Sign (JVP doesn't decrease with inspiration)
Pericardial Knock (cessation of ventricular filling)
99
Q

What cardioversion drugs would you only use with a left ventricular ejection fraction 40% or higher?

A

Flecainide and Propafenone

100
Q

Flecainide Clinical Use and MOA

A

1C Antiarrhythmic
Used in normal hearts with supra ventricular arrhythmias
Exacerbation in certain patients

101
Q

Metoprolol MOA

A

B-1 Selective (cardioselective) Blocker

102
Q

What should you try to avoid when giving Nicardipine to patients who sustained an acute cerebral infarct or hemorrhage?

A

Systemic Hypotension

103
Q

Fosinopril Indications

A

CHF, HTPN, Proteinurea

Does Not Contain Sulfhydryl

104
Q

Mexiletine Clinical Use and MOA

A

1B Antiarrhythmic (oral lidocaine, basically)
Good on Ventricular arrhythmias, neuropathy
Tremor, blurred vision, nausea, lethargy

105
Q

Quinidine MOA and Adverse Effects

A

1A Antiarrhythmic
Tachycardia from hypotension, QT prolongation, Torsade
GI effects
Tinnitus / hearing loss / delirium / vision disturbances
Thrombocytopenia, hepatitis, fever

106
Q

EKG findings of Paroxysmal Supraventricular Tach (PSVT)

A

Narrow QRS, P Wave Inverted or Hidden by QRS

107
Q

Adverse Reactions to Captopril

A

Abdominal Pain
Agranulocytosis
Alopecia
Anaphylactoid Rxns

108
Q

Drug interactions with Spironolactone

A

Hyperkalemics: Hyperkalemia
Lithium: Toxicity
NSAIDs: Reduces effect of Aldosterone

109
Q

ST elevation of 2mm or more, or New LBBB

A

This pt has a STEMI

110
Q

Indications for Valsasrtan

A

HTN, to lower BP, Etc

111
Q

Captopril Indications

A

HTN, CHF

112
Q

Adverse Effects of amiodarone

A 
AV Block and Bradycardia
Fatal Pulmonary Fibrosis
Hepatitis
Photodermatitis
Hypo/er-Thyroidism: failed thyroxine to triiodothyronine
113
Q

Nicardipide interactions with Cimetidine

A

Increases Plasma [Nicardipine]

114
Q

contraindications of beta-blockers

A

Asthma, Peripheral Vascular Disease, Raynaud’s, Type 1 Diabetics on Insulin, Bradyarrhythmias and AV conduction abnormalities, severe depression of cardiac function

115
Q

Acute vs Subacute Infective Endocarditis

A

Acute: Staph Aureus on Normal Heart Valves
Subacute: On Damaged Heart Valves, Fatal above 6 wks

116
Q

Contraindications for Furosemide

A

Anuria, Hx Hypersensitivity

117
Q

Dual Antiplatelet Therapy

A

ASA and P2Y12 Inhibitor

118
Q

Procainamide Clinical Use and MOA

A

Class 1A Antiarrhythmic along with SA / AV depression

Effective with sustained V Tach and MI arrhythmias

119
Q

Beck’s Triad

A

Hypotension + JVD + Muffled Heart Sounds

This is Cardiac Tamponade

120
Q

What happens if you combine Labetalol with Tricyclics?

A

Tremor

121
Q

Half life of Esmolol

A

9 minutes

122
Q

Who should you use caution with regarding Labetalol?

A

Nursing mothers: a small amount is excreted in milk
Pregnancy: faster metabolism of it
Geriatrics: Lower elimination

123
Q

Classifications of Angina based on its 3 components

A

Typical: All 3 components
Atypical: 2/3
Non-Angina Chest Pain: 1

124
Q

Lateral Heart MI Leads and Artery

A

Leads V5, V6 or I, AVL

LCx

125
Q

Novel / Non-traditional risk factors for CAD

A

CKD
Proteinuria
Inflammatory States (HIV, RA, Psoriasis)

126
Q

Nicardipine Contraindications

A

PATIENTS WITH ADVANCED AORTIC STENOSIS

127
Q

Class 3 Drug MOA

A

Prolongs APD and QT uniformly

128
Q

Lidocaine Clinical Use and MOA

A 
1B Antiarrhythmic (IV only)
Good on V Tach in acute myocardial ischemia 
Least toxic of all class 1s, maybe hypotension or neuro
129
Q

Risk factors for young people having an Aortic Dissection

A

Marfan syndrome (or other CT disorders)
Syphilis
Cocaine or Meth
Trauma

130
Q

Acute medical management of Aortic Dissection

A

Anti-Impulse Therapy to lower HR below 120

131
Q

Nicardipine use in patients with Angina

A

Can worsen it with chronic oral therapy

can be induced in >1% of CAD patients

132
Q

Pain pattern of Acute PEricarditis

A

Worse lying flat and relieved by sitting up and leaning forward

133
Q

Anterior Heart MI Leads and Artery

A

Leads V2, V3, V4

LAD

134
Q

Caution in using Nicardipine with patients who:

A

Have Heart Failure (-inotropic effects)
have Impaired Liver Function (where its metabolized)
have Impaired Renal Function (titrate gradually!)
are Geriatric

135
Q

What are the two Angiotensin II blockers?

A

Valsartan and Losartan

136
Q

What is blocked by b-blockers?

A

Epinephrine

137
Q

Captopril Monitoring Parameters

A

BP
BUN
Na, K

138
Q

What drug do you want to avoid in combination with Esmolol?

A

IV calcium channel blockers

139
Q

Treat a hemodynamically stable Torsade de Pointe

A

Tx electrolyte abnormalities
Magnesium sulfate IV regardless of levels
Transveous Temporary Pacemaker or Isoproterenol IV

140
Q

Black Box warning for Benazepril

A

Fetal Toxicity

CPR II (8 decks)

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