Cardiology Part 1

Question 1

Alpha - 1

Answer 1

Vascular Smooth Muscle (vasoconstriction), use as an agonist for hypotension. Use as antagonist for hypertension and benign prostatic hyperplasia (BPH)

Question 2

Alpha - 2

Answer 2

CNS synapses (inhibitory effects), agonist use is for hypertension and spasticity while antagonistic has no clinical use

Question 3

Beta - 1

Answer 3

Heart (increased HR and force of contraction),
agonist use for cardiac decompensation and antagonistic use for HTN, arrhythmia, angina pectoris, heart failure, prevention of reinfarction

Question 4

Beta - 2

Answer 4

Lungs (bronchodilation), agonist use to prevent bronchospasms and no clinical use for antagonist

Question 5

Alpha 1 Epinephrine

Answer 5

Topically or Intradermal
Local effects
Control bleeding
Intravenously
Vasoconstriction
Hypotension (vasopressor)

Question 6

Beta 1 epinephrine

Answer 6

Intravenously
Myocardium
Cardiac arrest

Question 7

Beta 2 epinephrine

Answer 7

Inhalation/IM
Target lungs
Anti-Asthmatic / Anaphylaxis

Question 8

Midodrine

Answer 8

Alpha-1 agonist -> vasoconstriction of vascular smooth muscle, used for OH and prevention of hypotension, well tolerated

Question 9

Orthostatic Hypotension

Answer 9

Also known as postural hypotension
Abnormal drop in BP when changing positions
-≥20 mm Hg systolic and/or≥10 mm Hg diastolic
Due to delayed/inadequate baroreceptor reflex

Risk factors:
Age >60, Parkinson’s disease, medications

Question 10

Diuretics

Answer 10

MOA: Increase renal excretion of water and sodium, decreased plasma volume
↓ Blood volume =↓ SV =↓ CO

3 groups based on where they act in nephron:
-Thiazides(First line therapy)
-Loop
-Potassium-sparing

Question 11

Diuretics: Adverse Effects

Answer 11

electrolyte imbalances, increased urination, orthostatic hypotension

Question 12

Sympatholytics

Answer 12

In general work to decrease sympathetic drive
Classified based on where they work:
-Beta blockers
-Alpha blockers
-Centrally acting agents

Question 13

Beta-blockers

Answer 13

MOA: Bind toβ receptors in heart/lung blocking binding of catecholamines

↓Contractility =↓SV = ↓ CO
↓HR = ↓CO

Adjunct therapy – need compelling indication – not first line

Question 14

Cardioselective beta blockers

Answer 14

Atenolol
Metoprolol
Nebivolol (Bystolic)

Question 15

Mixed alpha/beta beta blockers

Answer 15

Carvedilol
Labetalol

Question 16

Nonselective beta blockers

Answer 16

Propranolol

Question 17

Beta-blockers adverse effects

Answer 17

Generally well-tolerated, after adjusting to ADE
Bronchoconstriction
Orthostatic hypotension
Mask hypoglycemia
Exercise intolerance

Question 18

Alpha blockers

Answer 18

MOA: Bind to α1 receptorson vascular smooth muscle, blocking binding of catecholamines
↓Vasoconstriction =↓ TPR
Adjunct therapy

Question 19

Alpha Blockers: Adverse Effects

Answer 19

Reflex tachycardia (Caution in patients with cardiac disease)
Orthostatic hypotension (Take at night to lower risk)
Dizziness

Question 20

Centrally Acting Agents

Answer 20

MOA: Alpha 2 agonist: Stimulate α2 receptors in brainstem which decreases sympathetic activity

↓HR/SV = ↓ CO
Adjunct therapy
Exception: methyldopa in pregnancy

Question 21

Centrally Acting Agents: Adverse Effects

Answer 21

Dry mouth
Dizziness
Sedation
Rebound hypertension/tachycardia with abrupt withdrawal
-Due to rebound sympathetic activity

Question 22

Vasodilators

Answer 22

MOA: Vasodilate the peripheral vasculature directly at cell
IncreasedcGMP = ↓contractility of smooth muscle cells =↓TPR
Adjunct therapy

Question 23

Vasodilators: Adverse Effects

Answer 23

Reflex tachycardia
-Baroreceptor reflex compensation
Orthostatic hypotension
-Warm pool will worsen

Question 24

Angiotensin Converting Enzyme Inhibitors (ACE-I)

Answer 24

Lisinopril
Ramipril
Benazepril
Captopril

Question 25

Angiotensin II Receptor Blockers (ARBs)

Answer 25

Losartan Olmesartan (Benicar) Valsartan (Diovan)

Question 26

RAS Inhibitors MOA

Answer 26

↓Fluid/Sodium Retention = ↓SV = ↓CO ↓Angiotensin II = ↓Vasoconstriction = ↓TPR First line therapy (ACE inhibitors/ARBs)

Question 27

ACE-I/ARBs: Adverse Effects

Answer 27

Generally well-tolerated Hyperkalemia Dry cough (ACE-I) Angioedema (ACE-I) Kidney injury 

Question 28

CCBs MOA

Answer 28

Blocks calcium entry into vascular smooth muscle, First line therapy Vasculature: ↓SVR  Vasodilation Heart: ↓HR/SV = ↓CO

Question 29

CCBs Adverse effects

Answer 29

Peripheral edema Orthostatic hypotension Reflex tachycardia (dihydropyridine only)

Question 30

CCB (dihydropyridine)

Answer 30

Amlodipine Nifedipine Nicardipine

Question 31

CCB (nondihydropyridine)

Answer 31

Diltiazem Verapamil