1 Flashcards
1
Q
Drug that causes hypertrichosis
A
Minoxidil
2
Q
Drug given with nitrates to Black pt
A
Hydralazine
3
Q
Direct Acting Vasodilators
A
Hydralazine, Minoxidil, Nitroprusside and Fendolapam
4
Q
Drug given with caution for Coronary artery diseases because of increase in sympathetic flow
A
Hydralazine
5
Q
Hydralazine causes 2 side effects
A
Tachycardia and SLE
6
Q
Good for patients with hypertension and high creatinine
A
Hydralazine
7
Q
Acts on potassium channel by making the smooth cell more permeable and for it to hyperpolarize and relax
A
Minoxidil
8
Q
Minoxidil is primarily used for
A
Severe or refractory hypertension
9
Q
2 vasodilators that causes increase in sympathetic flow
A
Hydralazine and minoxidil
10
Q
Given IV and causes peak in 30s- used in emergency hypertension
A
Sodium nitroprusside
11
Q
Blurred vision, disorientation and nausea
A
Sodium nitroprusside
12
Q
Cannot be administered in glucoma patients
A
Fenoldopam
13
Q
Given IV and has rapid onset of 15mins for 50% max effect
A
Fenoldopam
14
Q
This drug works on Dopamin D1 receptor and works through cAMP dependent pathway
A
Fenoldopam
15
Q
This drugs unlike other antihypertensives maintains or enhances kidney functions
A
Fenoldopam
16
Q
Nitrates are used for
A
Angina, Acute coronary syndrome and Heart failure
17
Q
This drug develops tachyphylaxis (tolerance) with prolonged use
A
Nitrates
18
Q
This drug works by inhibiting PDE3
A
Milirone
19
Q
This drug works by inhibiting PDE5
A
Sildenafil
20
Q
This drug increases cGMP level and causes vasodilation
A
Sildenafil, Nitrates
21
Q
This drug decreases right side filling without affecting systemic arterial pressure
A
Nitrates
22
Q
This causes paradoxical split sound
A
Aortic stenosis or left bundle branch block (LBBB),
23
Q
splitting does not vary with inspiration “fixed split S2” is due to
A
ASD
24
Q
Split S2 sound during inspiration is
A
normal
25
Drug given for acute angina
sublingual nitroglycerin
26
Drug given for CAD
Long acting nitrate
27
Drug given for pulmonary arterial hypertension
Sildenafil
28
Drug cannot be administrated with sildenafil
nitrates
29
Calcium channel blockers that decrease the contractility and heart rate
Verapamil and Diltiazem
30
Uses for Ca channel blocker
Angina, Coronary artery spasm, Hypertension , SVT arrhythmias
31
Which type of calcium channel is the targt of current calcium channel blockers and what is this responsible for in action potential
L type, calcum entry that maintains phase2 of the action potential
32
Differences between nondihydropyridines from dihydropyridines
dihydropyridines do not have ionotrophic effect
33
Adnergic drug you need to worry about rebound
Clonidine
34
alpha2 agonists
clonidine, alpha-methyldopa, Guanebez
35
Non selective alpha antagonists
doxazosin, prazosin, terazosin, phentolamine, phenoxybenzamine
36
beta blockers
carvedilol, propanolol, metoprolol, Esmolol, Labetolol
37
selective peripheral alpha blockers are used for
benign prostatic hypertrophy, hyertension
38
Non selective alpha blockage side effects
Postural hypotension, reflex tachycardia, arrhythmias
39
Name all the antiplatelets
Cox inhibitors, Dipyramidole, ADP receptor inhibitor, GP IIb/ IIIa
40
Irreversible antiplatelet drug
Aspirin
41
At low dose, ASA inhibits vs at high dose
TXA2 vs TXA2 and PGI2
42
Unknown mechanism of action but likely to be through increase in cAMP
Dipyramidole
43
Drug whose effect is actually better at lower doses for antiplatelet function
ASA
44
Drug used for restenosis following cardiac intervention
GP IIb/IIIa
45
Drug that causes thrombocytopenia
GP IIb/IIIIa, heparin
46
Drug that is too potent to use for long term
GP IIb/IIIa
47
Drug where transfused platelets will also be inactivated
ADP receptor inhibitor
48
Drug without reversing agents
ADP receptor inhibitor, Factor Xa inhibitors
49
ADP receptors inhibitors are used for
Unstable angina, STEMI, NSTEMI, stroke
50
Drug especially dangerous with surgery and causes thrmobotic thrombocytopenic purpura
ticlopidine
51
Drug that causes neutropenia
Ticlopidine
52
Fully reversible with protamine
unfractionated heparin
53
Drug that act to potentiate antithrombin III
heparin
54
Name all the anticoagulant therapies (5)
heparin, warfarin, LMW heparin, Factor Xa inhibitors, Direct thrmobin inhibitors
55
Drug with minimal to no drug or food interactions in the class of anticoagulant therapy
Rivaroxaban, Apixaban, Edoxaban, Dabigatran
56
LMWH is used for
VTE prophylaxis VTE treatment, Acute coronayr syndrome
57
Drug with antidote as vitamin K
warfarin
58
Drug that causes thyroid problem, blue discoloration, increase in shortness of breath
Amiodarone
59
Drug for a fib in hypertrophic cardiomyopathy
Disopyramide
60
Drug not recommended fr daily therapy in pt with uncomplicated MI with drug eluting stent
Nitrate
61
Diuretic that does not primarily benefit the HF through kideney
Spironolactone
62
Not beneficial for pt with congested HF
Verapamil
63
Not beneficial for pt with HF
Digoxin
64
Which ion electrolyte imbalance causes Torsade and fainting spells due to cardiac diuretic therapy
Hypomagnesia
65
Pt with leg swelling and constipitation
Calcium channel blocker
66
Diuretic used to for acute Pul edema bc reduces effect on venous return to heart
Furosemide
67
Ineffective drug for pt with known CAD with syncopy and VT
Diltiazem
68
Highest incidence of drug drug and drug food interactions
Warfarin
69
medication has not been shown to improve survival in heart failure patients but makes them feel better
Furosemide
70
What should you give to pT with WPW in ER with palpitation BP of 110/70 HR irregularly irregular at 220bpm
Procainimide
71
Drug combinations that can cause hyperkalemia
Spirolactone + ACEi
72
Nausea, vomiting and yellow vision with PVC
Digoxin
73
Hypokalemia causing diuretic
Furosemide
74
Hypocalcimia causes XXX changes in EKG
QT elongation
75
Hypercalcimia causes XXX changes in EKG
QT shortening
76
What changes are seen with Digoxin in EKG
depressed ST and mild PR elongation
77
What changes are seen with hyperkalemia
Tall peaked T wave
78
Waht changes are seen with severe hyperkalemia
Flattened p wave and wide QRS
79
What changes are seen with hypokalemia
ST depression, flattened T wave and prominent U wave
80
Marfan's syndrom
ruptured proximal aorta due to dissection
81
drug that inhibits VLDL secretion from liver
Omega 3
82
Drug that increases uric acid level
HCTZ
83
Survival benefits shown with ICD
Pts with HF and ejection fraction less than 35%
84
Drug that causes long QT syndrome
Sotalol
85
Sotalol can cause in EKG
Torsades
86
Congentil heart defect that requires patent ductus arteriosus for survival
Pulmonary atresia
87
Infant with HLHS is most likely to have miss...
femoral pulses
88
Doxorubicin SE
causes cardiomyopathy- progressive and deteriorating course
89
Drug that increases the level of HDL
Niacin, Nicotinic acid
90
Paroxysmal SVT treatment
Cardioversion
91
Drug to terminate PSVT
Adenosine, Ca channel blockers or beta blockers
92
Arrhythmia where delta wave is present
AVRT
93
Conduction time in SA node
<200ms
94
Conduction time in His purkinje system
<100ms
95
physcial exam of AS
Pulsus parvus et tardus, carotid upstroke delayed, S4, Reduced A2, Paradoxical splitting of S2, Harsh systolic murmur
96
Pulsus paradoxus
Temponade or pericarditis
97
Pulsus parvus et tardus
AS
98
Reduced A2
As
99
delayed carotid upstroke
AS
100
Benign Prostatic hypertension
peripheral Alpha blocker
101
Side effect of alpha blocker
Bradycardia and orthostatic HPN
102
Refractory HF
Nesiritide
103
Drug that doesn't work with low GFR
Thiazide
104
SE of Thiazide
Glucose intolerance
105
SE of milirone
arrhythmia
106
SE of verapamil
bradycardia
107
People who cannot get ACEi
prenant people
108
ARB SE
Hyperkalemia
109
Drug that causes neurologic CNs confusion and dizziness
Lidocaine and Mexiletine
110
Hypertrophic cardiomyopathy especially Afib
Disopyramide
111
Cardiac defect in Trisomy 21
AV canal defect
112
Cardiac anomaly in Marfan
Aortic Root aneurysm/rupture
113
Holt Oram cardiac anomaly
ASD, conduction anomalies
114
DiGeorge (22q11) cardiac defects
Conotruncal defects- truncus arteriosus, TOF
115
Sudden death in young athlete
Cardiomyopathy
116
What is wrong with Long QT 1 and 2
loss of function K channel
117
Brugada
SCN5A mutation in men, VF during sleep
118
What is wrong with Long QT3
Gain of fn Na channel
119
What is the trigger of Long QT3
sleep
120
What is the trigger of Long QT2
Auditory stimuli during rest
121
What is the trigger of Long QT1
Exercise and emotion
122
Treatment for Long QT1
No excersice and Beta blockers
123
Treatment for Long QT2
Avoid Hypo K
124
Treatment for Long QT3
Mexilitine, Flecainide, Defib
125
Overuse of statin SE
Rabdomyolysis and myopathy
126
Catacholaminergic Polymorphic VT
exercise/stress, 30% mortality by 30yo, Ryanod
| ine/Calsequestrin muta
127
HCTZ is contraindicated in
renal insufficiency- high creatinine level
128
Marfan's syndrome
Aortic anneurysm and mitral valve prolaps
129
Systolic diastolic Continuous murmur in babies
patent ductus arteriosus (PDA)
130
SE of lidocaine
Seizures, neurological symptoms
131
Drug that causes hives
ACEi
132
Drug that treats hypertension and headaches simultaneously
metoprolol
133
Risk factors for SCD
family history of SCD, history of ventricular tachycardia by
| ambulatory monitoring, history of syncope, septal thickness>30 mm, drop in BP with exercise
134
3 factors that determine O2 demand
Heart rate, Contractility and Wall tension
135
Treatment for sudden cardiac death
antiarrhythmic drugs and ICD
136
highest cause of Sudden cardiac death
CAD
137
best risk predictor of SCD based on positive predictive value/specificity especially in CAD
Left ventricular dysfunction
138
Myocardial Oxygen supply determined by
Diastolic Perfusion Pressure
Coronary Vascular Resistance
Oxygen Carrying Capacity
139
How do coronary arteries increase their oxygen intake?
Incresae blood flow, already at max oxygen removal from blood
140
What determines the risk of mortality in Acute coronary syndrome
Troponin and infarct size
141
5 Endogenous protective mechanism from forming thrombosis
1. Antithrombin to heparin like protein
2. Thromobomoduline +thrombin - activate Protein C and S which inhibit Factor 8 and 5
3. Fibrin activate TPA to make plasmin from plasminogen
4. NO and PGI2
5. Tissue factor ihbitior inhibit 7 and 10
142
factors that determine whether plaque will rupture or not
1. Lipid content
2. macrophage content
3. Smooth muscle content
4. Thin fibrous cap
5. Collagen synthesis/degradation
143
Factors that are made macrophages in the plaque that prones it to rupture
```
Matrix Metalloproteinases
–Collagenase
–Stromelysin
–Gelatinase
–Elastase
Tissue Factor
CRP
Myeloperoxidase
```
144
All platelet activation pathway lead to
GP IIb/IIIa
145
Effect of ADP and Thromboxane on platelet
aggregates
146
Effect of Oxygen in blood vessels
Vasoconstricts
147
Effects of TXA2 and serotonin in blood vessels
Vasocontricts
148
TIMI risk factors
1. Age
2. Previous history of CAD
3. ASA in last 7 days
4. ST deviation
5. More than 2 events in last 24hr?
6. Elevated cardiac markers
7. >3 CAD risk factors? (HTN, DM, Smoking)
149
7 Pharm for CAD- angina and NSTEMI
1. Aspirin
2. ACEi
3. Nitrates
4. B-blockers
5. Statin
6. ADP antagonists
7. high risk on Bivalirudin or unfract heparin
150
Q waves only persists in which CAD
STEMI
151
MI in V1 and V2
Proximal LAD
152
MI in V2 -V4
LAD
153
MI in V5-6 and I, aVL
Circumflex
154
MI in V1-V6
Proximal LAD
155
MI in II, III, aVF
Right coronary, inferior leads
156
MI mirror image in V1 and V2
Posterior deescending
157
MI reversed chested leads in rV3-rV4
Right coronary- RV infarct
158
Prognosis in acute MI
LVEF and arrhythmias
159
STEMI tx
1. Reperfuse in cath lab (PCI)
| 2. Fibronolytic
160
Disadvantages of Fibrinolysis
Reocclusiong, reinfacrtion, initial occluded artery remains, ICH, Mortality ceiling
161
Tx for recent MI asymptiomatic with EF>40
Antiplatelet
beta blocker
ACEi
Statin
162
Tx for recent MI asymptiomatic with EF<40
Antiplatelet
beta blocker
ACEi
Statin
163
Tx for recent MI symptiomatic with EF<40
```
Antiplatelet
Carvedilol
ACEi
Statin
eplerenone- monitor K level
```
164
Secondary prevention of MI
Stop smoking
Excercise
No NSAIDs
Get influenza vaccines
165
Most common form of arrhythmic death in acute MI
V. Fib
| primary has good survival but secondary not so good
166
CHF MI treatment
Lasix, nitrates,ACEi
167
Indications for IABP
Cardiogenic shock, VSD, MR
168
Other cardiac problems due to MI
1. VSD
2. papillary rupture- MR
3. Myocardial rupture
4. LV anuerysm
5. Pericarditis
6. TE
169
Pericarditis Post infarct
Give aspirin
| Don't give heparin or coumadin- danger of tamponade
170
Right heart failure solution
Volume expansion!
171
Clinical ppt of pericarditis chest pain
Sharp, stabbing, pleuritic with inspiration being worse, positional,
dypsnea, fever
172
Duration of pericarditis vs MI
hours to days in pericarditis and mins in MI
173
ST segment elecation in MI vs in pericarditis
convex in MI and widspread concave in pericarditis
174
Pericarditis heart sound
Left sternal border with diaphragm, pt leans forward- high pitched scratchy sound
175
EKG of pericarditis
ST elevation diffuse
PR depression
Diffuse T wave inversion
176
Types of pericardial effusion
Inflammatory, non inflammatory serous effusion, chylous effusion, trauma
177
Clinical ppt of pericardial effusion
dull left chest discomfort
178
Physical exam of pericardial effusion
Friction rub, Ewart sign- dullness to percussion of lung, distant or muffled heart sound
179
Pericardial effusion tx
Pericardiocentesis or underlying causes
180
Cardiac tamponade
distolic presure in each chamber becomes elevated and equal to pericardial presure, compression results in impairment of venous return and filling, decreased stroke volume and CO
181
3 factors that determine the development of cardiac tamponade
Volume, rate of fluid acculmulation, compliance
182
Physical exam of tamponade- Beck's triad
Jugular venous distension,
Quite heart sound
systemic hypotension
Pulsus paradoxus
183
Temponade tx
Volume resuscitation
Pericardiocentesis
Surgical pericardiostomy
184
Most common cause of constrictive pericarditis outside US
TB
185
EKG of QRS in temponade
varies because heart swings
186
Physical exam of constritive pericarditis
Kussmaul's sign
rapid Y descent
Early diastolic pericardial knock
187
Constrictive pericarditis treatment
Surgical pericardiectomy
188
2 major system regulating blood pressure
1. autonomic
| 2. RAAS
189
Main problem with restrictive cardiomyopathy
filling
190
Reversible cardiomyopathy
Infiltrative- hemochromatosis, sarcoidsis, ischemic with viable myocardium, inflammatory etc
191
Causes of myocarditis
Coxsakie virus etc, sarcoidosis, giant cell myocarditis, drug induced, bacteria, fungus or parasite, rhemuatic fever, etc
192
Giant cell myocarditis
rapidly progress to heart failure and arrhythmias, 20% have another autoimmune diseases
193
Hypersenstivity Myocarditis
eosinophils!
194
Aschoff body
Rhematic fever!
195
Hemochromatosis
AR inheritance, increased intestinal iron absorption, Fe storage in heart
196
Hemosiderosis
Transfusion pt, Fe storage in heart
