Cardio - FA Pharm p312 -319

Question 1

HTN with HF - rx?

Answer 1

Diuretics, ACE inhibitors/ARBs, β-blockers (compensated HF), aldosterone antagonists.

Question 2

Which Rx are protective vs DB nephropathy?

Answer 2

ACEI/ARBs

Question 3

What rx do you avoid in a pt with HTN and asthma

Answer 3

Avoid nonselective β-blockers to prevent β2-receptor–induced bronchoconstriction.

Avoid ACE inhibitors to prevent confusion between drug or asthma-related cough

Question 4

Name 4 dihydropyridine CCB

Answer 4

Amlodipine, Nimodipine, Nifedipine, Clevidipine

Question 5

Which CCB assoc with reflex tachy?

Answer 5

Dihydropydrine CCB (“dipines”)

Question 6

Which CCB act primarily on the heart?

Answer 6

Non dihydropyridines - Verapamil, Diltiazem

Question 7

Which CCB is used in subarach hemorrhage?

Answer 7

Nimodipine - only one that crosses BBB

Nimo - like dory in Nemo, head doesnt work right

Question 8

CCB DOC in HTN emergency?

Answer 8

Clevidipine (Clever in an emergency)

Question 9

Which CCB can cause hyper PRL?

Answer 9

VeRaPamiL (PRL in the word, sort of)

Question 10

Why is hydralazine freq coadmin with BB?

Answer 10

to prevent reflex tachy

Question 11

SE of Hydralazine

Answer 11

reflex tachy, fluid retention, headache, angina, SLE-like syndrome

Question 12

How to Tx a HTN emergency?

Answer 12

Treat with clevidipine, fenoldopam, labetalol, nicardipine, or nitroprusside.

Question 13

`

Question 14

Which cardiac parameter is decreased with nitrates?

Answer 14

preload (venous VD >> art VD)

Question 15

Which cardiac drug is a dopamine D1-R agonist?

Answer 15

Fenoldopam

Question 16

Which cardiac drug is associated with cyanide tox? Tx for it?

Answer 16

Nitroprusside; Nitrates and thiosulfate (Any nitrate works for CN- poisoning bc will inc metHgb, which will then bind CN-)

Question 17

4 cardiac Rx used in HTN + pregnancy?

Answer 17

Hydralazine, Labetalol, MethylDopa, Nifedipine

Hypertensive Moms Love Nifedipine

Question 18

Which cardiac parameter is decreased with Hydralazine?

Answer 18

afterload (art VD>> venous VD)

Question 19

Which cardiac Rx will increase cGMP?

Answer 19

Nitroprusside, Nitrates –> both inc NO

Hydralazine

Question 20

In Angina therapy, which Rx will increase ejection time?

Answer 20

BB

Question 21

Which BB are to be used with caution in angina?

Answer 21

Pindolol and acebutalol - bc they are partial B agonists, and so will have SNS (+)’n –> inc cardiac work and O2 demand

Question 22

Why does heart rate inc with the use of nitrates in angina?

Answer 22

reflex

Question 23

What is the goal of antianginal therapy?

Answer 23

Goal is reduction of myocardial O2 consumption (MVO2) by dec 1 or more of the determinants of MVO2: end-diastolic volume, BP, HR, contractility.

Question 24

Which BB are to be used with caution in angina?

Answer 24

Pindolol and acebutolol are partial β-agonists

Question 25

Ranolazine MoA

Answer 25

Inhibits the late phase of sodium current thereby reducing diastolic wall tension and oxygen consumption Ra - Na - late zine blocks late Na channels used in refractory angina

Question 26

Which cardiac parameters is not affected by Ranolazine?

Answer 26

it doesn't affect HR or BP

Question 27

MoA of Milrinone?

Answer 27

Selective PDE-3 inhibitor. In cardiomyocytes: inc cAMP accumulation --\> inc Ca2+ influx --\> inotropy and chronotropy. In vascular smooth muscle: Inc cAMP accumulation --\> inhibition of MLCK activity --\> general vasodilation

Question 28

Use and SE of Milrinone

Answer 28

Used short term in acute decompensated HF SE/ Arrythmia, hypotension

Question 29

MoA of Sacubitril?

Answer 29

Prevents degradation of natriuretic peptides, angiotensin II, and substance P by neprilysin; inc vasodilation, dec ECF volume.

Question 30

When is Sacubitril used?

Answer 30

Used in combination with an ARB (valsartan) for treatment of HFrEF.

Question 31

SE of Sacubitril?

Answer 31

Hypotension, hyperkalemia, cough, dizziness

Question 32

Why is sacubitril CI with ACEIs?

Answer 32

can also cause angioedema

Question 33

Why are nitrates CI with sildenafil? - bonus Q

Answer 33

Both inc cGMP --\> orthostatic hypotension

Question 34

Which lipid lowering agent upregulates LPL?

Answer 34

Fibrates - gemfibrozil, clofibrate, bezafibrate

Question 35

Which lipid lowering agent exacerabates gout?

Answer 35

Niacin - causes hyperuricemia

Question 36

Which lipid lowering agent inhibits hormone sensitive lipase?

Answer 36

Niacin

Question 37

Bleeding is potential side effect of which lipid lowering agent?

Answer 37

Bile acid resins - due to dec absorption of other drugs, like warfarin, and fat sol vitamins (uworld Q)

Question 38

Bonus Q - what Tx for Statin induced rhabdomyolysis?

Answer 38

mannitol

Question 39

What kidney pathology is associated with statins?

Answer 39

Acute tubular necrosis ( break down of musc --\> Mgb can plug up kidney --\> oxidative damage)

Question 40

GI discomfort - which lipid lowering agent?

Answer 40

Bile acid resins

Question 41

What drug blocks chol absorption at SI brush border?

Answer 41

ezetimibe

Question 42

Which Drug is an antisense oligonucleotide vs apoB100 mRNA?

Answer 42

Mipomersen

Question 43

Digoxin has a secondary effect on heart rate, separate from contractility - what is it? Mech?

Answer 43

Dec HR by stimulating CN X

Question 44

Why does digoxin require a loading dose?

Answer 44

Bc has a long half life will take a long time to get to steady state.

Question 45

Lower dose of digoxin in patients with which comorbidities?

Answer 45

renal failure bc dec excretion - digoxin is renally cleared.

Question 46

Name 4 drugs that can increase Digoxin Tox - Why?

Answer 46

Verapamil, Amiodarone, Quinidine, Propafenone - bc they displace digoxin from tissue binding sites VAQuum uP Digoxin

Question 47

Digoxin tox antidote

Answer 47

anti digoxin Fab fragments, Mg2+, slowly normalize K+ (using insulin, kayexalate, hemodialysis)

Question 48

Class I anti-arr Rx overall affect which phase of the cardiac cycle?

Answer 48

phase 0

Question 49

What can increase the chances of toxicity of all class I drugs?

Answer 49

Hyperkalemia

Question 50

Which anti-arr Rx increase AP duration?

Answer 50

Class III (K ch blockers) and Class Ia (block open active Na channels)

Question 51

Adenosine affects which phase of cardiac cycle? Mech of action?

Answer 51

phase 4; Inc K+ efflux --\> hyperpol and dec Ca current, dec AV node conduction

Question 52

`Adenosine is used for what disease?

Answer 52

diagnosing, terminating forms of SvT

Question 53

Which drugs will blunt the affect of Adenosine?

Answer 53

Theophylline, Caffeine

Question 54

SE of Adenosine

Answer 54

flushing, hypotension, chest pain, sense of impending doom, bronchospasm

Question 55

`Mg2+ is used in what diseases?

Answer 55

torsades de pointes and digoxin toxicity. (and pre-eclampsia)

Question 56

`MoA of Ivabradine

Answer 56

IVabradine prolongs slow depolarization (phase “IV”) by selectively inhibiting “funny” sodium channels (If).

Question 57

Ivabradine is used for what diseases? SE?

Answer 57

Chronic stable angina in patients who cannot take β-blockers. Chronic HFrEF. (HF with reduced ejection fraction) Luminous phenomena/visual brightness, hypertension, bradycardia.

Question 58

Which Anti-arr Rx is associated with gingival hyperplasia ?

Answer 58

Verapamil

Question 59

Which Anti-arr Rx is associated with "sense of impending doom" as Tox?

Answer 59

Adenosine

Question 60

Which Anti-Arr Rx will increase PR interval?

Answer 60

BB, CCB

Question 61

Drug associated with headache, tinnitus?

Answer 61

Quinidine (Cinchonism)

Question 62

Anti Arr Rx that can lead to reversible SLE like syndrome?

Answer 62

Procainamide

Question 63

Best class for post MI?

Answer 63

Class Ib - block the inactivated Na channel, tissue post MI is hypoxic, closer to depol, and Na ch is in the inactivated state

Question 64

Which Anti arr rx is assoc with difficulty breathing, skin and eye issues?

Answer 64

Amiodarone - SE// pulm fibrosis, hyper/hypothyroidism, corneal deposits, blue/grey skin

Question 65

Which anti Arr rx is a BB that also blocks K channels?

Answer 65

Sotalol

Question 66

Which anti Arr rx is CI post MI?

Answer 66

Any Class Ic - Flecainide, Proparenone - can be pro-arrythmic

Question 67

with which anti-Arr Rx will you have to do CBCs?

Answer 67

Class Ia (thrombocytopenia )

Question 68

Anti -Arr Rx that prolong QT?

Answer 68

Class Ia and III - will lead to Torsades Disopyramide, ibutilide, Dofetilide, Sotalol, Quinidine, Procainamide