A patient is diagnosed with essential hypertension. He wants to know his treatment options. What medication(s) can you offer him?
Thiazide diuretics, ACE inhibitors, angiotensin II receptor blockers, dihydropyridine Ca2+ channel blockers
A patient on procainamide for an arrhythmia develops a facial rash and joint pains. She has antihistone antibodies. What is the diagnosis?
Reversible SLE-like syndrome
Because it can increase contractility, digoxin is used to treat what condition? What other condition does it treat? How?
Heart failure (↑contractility); atrial fibrillation; digoxin ↓atrioventricular node conduction and depresses the sinoatrial node
Which β-blocker is extremely short acting?
Esmolol
Which calcium channel blockers are most selective for vascular smooth muscle? Which one agent is most cardioselective?
Nifedipine or amlodipine (dihydropyridines); verapamil
A 35-year-old man has a low-density lipoprotein of 200 mg/dL. Which drug class would have the most powerful LDL-lowering effect?
HMG-CoA reductase inhibitors (statins) have the strongest reducing effect of all of the lipid-lowering drugs
A patient on amiodarone is frustrated with monthly testing that is required. What lab(s) are being tested in this patient?
Pulmonary function tests, liver function tests, and thyroid function tests must be checked regularly when on amiodarone
What is the mechanism by which pharmacologic treatments can reduce angina?
Reduce myocardial oxygen consumption by decreasing one or more of end-diastolic volume, BP, HR, contractility
A 55-year-old man develops severe chest pain after walking up a hill. He puts a pill under his tongue that stops the pain. How does it work?
Nitrates release nitric oxide in smooth muscle (↑cGMP/smooth muscle relaxation), causing vasodilation (veins &62;> arteries) and ↓preload
Name some medications that can be used to treat a hypertensive emergency.
Nitroprusside, nicardipine, clevidipine, fenoldopam, labetalol
What is the mechanism of action of the first-line antiarrhythmic for diagnosing and treating supraventricular tachycardia?
Adenosine increases the amount of K+ flowing out of cells, leading to hyperpolarization of the cell and decreased intracellular Ca2+ (ICa)
Which does hydralazine reduce: afterload or preload? Which vessels does it dilate more: veins or arterioles?
Afterload; arterioles
A 64-year-old woman takes verapamil for an arrhythmia. Which cardiac myocytes does this class of medication affect?
Class IV antiarrhythmics (Ca2+ channel blockers) ↓AV node pacemaker cells' conduction velocity and ↑ERP/PR interval
Which antiarrhythmics belong to class III?
Potassium channel blockers, such as Amiodarone, Ibutilide, Dofetilide, Sotalol (AIDS)
Which two antiarrhythmic drugs belong to class IV?
Diltiazem and verapamil, which prevent nodal arrhythmias (e.g., supraventricular tachycardia) and offer rate control in atrial fibrillation
Hydralazine causes smooth muscle relaxation by increasing concentrations of which substance in endothelial cells?
cGMP
A 70-year-old woman starts a new drug for atrial fibrillation and develops GI upset. What other symptoms may be present? What causes them?
Nausea/vomiting, blurry yellow vision, arrhythmias/AV block; the drug (digoxin) has a cholinergic effect as it stimulates vagus nerve (↓HR)
Which pharmacologic agents are used to treat hypertension in patients with congestive heart failure?
Diuretics, ACE inhibitors/ARBs, β-blockers (compensated HF), aldosterone antagonists
Quinidine causes symptoms of headache and tinnitus, which are collectively known as what?
Cinchonism, which can occur with all quinine derivatives
Which antiarrhythmics belong in class II?
β-blockers such as propranolol, esmolol, timolol, metoprolol, atenolol, and carvedilol
Which ion is infused for the treatment of torsades de pointes and digoxin toxicity?
Mg2+
Nitroprusside is a ____ (short/long)-acting drug that increases which substance via direct release of nitric oxide?
Short; cGMp
A patient cannot take statins due to side effects. What other drugs can lower his low-density lipoprotein levels?
Niacin (vitamin B3), bile acid resins, ezetimibe, fibrates (although all reduce LDL less effectively than do statins)
What are the clinical indications for the use of dihydropyridine calcium channel blockers, other than nimodipine and clevidipine?
Hypertension, angina (including Prinzmetal angina), Raynaud phenomenon
Among the calcium channel blockers, which acts similarly to a β-blocker?
Verapamil
What are the three main indications for the use of nitrates (nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)?
Angina, pulmonary edema, and acute coronary syndrome
In what circumstance is a β-blocker contraindicated in a heart failure patient?
In cardiogenic shock, and moreover, β-blockers must be used with caution in decompensated HF
What vision complaint can occur with digoxin use?
Blurry yellow vision (also from cholinergic effects of stimulating the vagus nerve)—think van Gogh
A man has side effects from hydralazine. What autoimmune complication might this mimic? Is he likely to have fluid retention or excretion?
Systemic lupus erythematosus; fluid retention
Adenosine is infused into a patient with supraventricular tachycardia. For how long do you expect this drug to be active in the patient?
Adenosine is a short-acting (about 15 seconds) drug
