Cardiac Pharm

Question 1

What are the two main problems that can cause heart failure?

Answer 1

1. Heart cant fill with enough blood

2. Heart cant pump with enough force

Question 2

T/F: In diastolic heart failure, the heart cannot pump enough blood out of the ventricles due to weakened heart muscles.

Answer 2

False

Diastolic - stiff muscle cant relax, heart doesn’t fill

Systolic - weakened heart cant pump, not enough blood pumped out

Question 3

T/F: Diastole = filling, systole = pumping

Answer 3

True

Question 4

What class of heart failure involves symptoms at rest?

Answer 4

Class IV (severe)

Question 5

How does cardiac muscle differ from skeletal muscle?

Answer 5

Ca++ influx activates ryanodine receptors on sarc reticulum leading to more Ca++ release

Things happen more slowly to allow heart to fill

Question 6

__________ alter the force or energy of muscular contractions.

Answer 6

Inotropic drugs

Negative - weaken the force

Positive - increase the strength

Question 7

_____________ may change the heart rate by affecting nerves controlling the heart, or by changing the rhythm produced by the SA node.

Answer 7

Chronotropic drugs

Positive - increase HR

Negative - decrease HR

Question 8

Cardiac glycosides, B-adrenergic receptor agonists, and bipyridines are all _______________ used to treat CHF.

Answer 8

Positive inotropic drugs

Question 9

How does digoxin work?

Answer 9

It is a cardiac glycoside - blocks Na/K ATPase

Internal Na increases -> slows down removal of Ca from the cell

Question 10

T/F: Diuretics (mainly loop) are the mainstay in CHF treatment.

Answer 10

True

Question 11

T/F: B1-adrenergic receptor agonists are the first line of defense against CHF.

Answer 11

False

Question 12

T/F: Bipyridines are safe drugs to treat CHF.

Answer 12

False

They are available but not favored for treatments

Question 13

T/F: All beta-blockers are good for treating CHF.

Answer 13

False

Only some, mechanisms not really known

Question 14

Along with their role in helping fluid retention, ___________ can also have some other positive effects on CHF.

Answer 14

diuretics

Question 15

____________ are shown to help in supplementation to other meds especially in the A.A. Population.

Answer 15

Vasodilators

Question 16

What is the difference between a stable and unstable angina?

Answer 16

Stable - fixed plaque

Unstable - unstable plaque, could throw a clot

Question 17

What is the result of taking nitrates/nitrites?

Answer 17

Prodrugs that spontaneously produce nitric oxide

Question 18

What is the end result of nitrous oxide release?

Answer 18

Relaxation of smooth muscle -> vasodilation -> more blood to the heart

Question 19

What is the most common adverse effects of nitroglycerin?

Answer 19

Vasodilation causes headaches

Question 20

T/F: The use of viagra with nitroglycerin is contraindicationed.

Answer 20

True

Will cause extreme hypotension

Question 21

What is the rationale for using beta blockers or calcium channel blockers to treat angina?

Answer 21

Lower cardiac output so the heart doesn’t need as much oxygen

Question 22

What are the three types of drugs used to treat angina pectoris?

Answer 22

1. Nitrates - vasodilation
2. Calcium blockers - vasodilation and cardiac depressants
3. Beta-blockers - cardiac depressants

Question 23

__________ coordinate cardiac muscle contraction.

Answer 23

Electrical signals

Question 24

Basically, the sum total of action potentials traveling through the heart creates the _________.

Answer 24

EKG

Question 25

The electrical signal starts at the _________, and travels through the __________.

Answer 25

SA node; AV node

Question 26

What is an atrioventricular block?

Answer 26

A type of arrhythmia where the conduction between atria and ventricles is blocked/slowed

Question 27

What is the diagnostic tool for a primary AV block?

Answer 27

PR interval lengthened beyond 0.2 seconds

Question 28

What constitutes a 3rd degree AV block?

Answer 28

Impulse from SA node does not reach ventricles

Question 29

How would an atrial fibrillation look on an EKG?

Answer 29

Tiny irregular fibrillation between heart beats and beats are erratic

Question 30

What are the four classes of anti-arrhythmic drugs?

Answer 30

Class I - block Na+ channel Class II - Beta blockers Class III - prolong action potential and prolong refractory period Class IV - Ca+ channel antagonists

Question 31

Why is dosage so important for anti-arrhythmia drugs?

Answer 31

Obviously can’t stop or make drastic changes to heart function - just tweak

Question 32

T/F: Beta blockers can diminish both Na and Ca currents

Answer 32

True

Question 33

What will be the effect of blocking the K+ channel?

Answer 33

Prolonged ventricular action potential

Question 34

What phase of the action potential will class I drugs affect?

Answer 34

Phase 0 They will block Na+ channels thus altering the depolarization speed

Question 35

What phase of the action potential will class II drugs act on?

Answer 35

Phase 4 Beta-blockers prolong AV conduction

Question 36

Which phase of the action potential do class III compounds affect?

Answer 36

Phase 3 K+ channel blockers slow down repolarization

Question 37

What phase of the action potential do class IV drugs act on?

Answer 37

Phase 2 Ca+ channel blockers slow conduction by increasing the refractory period