Cardiovascular

Question 1

Nitroglycerin

Answer 1

Nitrovasodilator, nitric oxide donor
Uses: angina, acute coronary syndrome
Toxicity: tachycardia, orthostatic hypotension, headache
Sublingual for acute angina (rapid onset, short duration), oral for prophylactic (slow onset, longer duration), venodilation at low doses (decreased venous return), arteriodilation at high doses (decreased afterload)

Question 2

Sildenafil

Answer 2

Phosphodiesterase type 5 inhibitor (elevated cGMP levels, vasodilation)
Uses: angina, erectile dysfunction
Toxicity: tachycardia, hypotension, vision disturbances (yellow halos)
Contraindicated with nitrovasodilators, rapid onset with long duration

Question 3

Propranolol

Answer 3

Non-selective beta antagonist (decreased cardiac output, RAAS, O2 demand)
Uses: hypertension, congestive heart failure, angina, arrhythmias
Toxicity: bradycardia, AV block, bronchospasm, CNS sedation
Contraindicated in asthma, also used for performance anxiety and migraine, crosses BBB

Question 4

Metoprolol

Answer 4

Selective beta1 antagonist (decreased cardiac output, RAAS, O2 demand)
Uses: angina, congestive heart failure, hypertension
Toxicity: bradycardia, AV block, CNS sedation
Reduces mortality in heart failure patients, widely used for stage I/II hypertension, crosses BBB

Question 5

Verapamil

Answer 5

Cardioselective L-type Ca2+ channel blocker (decreased force and rate of cardiomyocyte contraction, decrease cardiac output)
Uses: hypertension, angina, arrhythmias
Toxicity: hypotension, excessive cardiac depression, constipation
Strong cardiac blocking effect, weak vascular smooth muscle blocking effect

Question 6

Nifedipine

Answer 6

Vascular selective L-type Ca2+ channel blocker (decreased total peripheral resistance)
Uses: hypertension, prophylactic for angina, arrhythmias
Toxicity: hypotension, flushing, dizziness
Strong vascular smooth muscle blocking effect, weak cardiac blocking effect

Question 7

Ranolazine

Answer 7

Late Na+ channel current modulator (decreased Na+ influx during AP, decreased Ca2+ overload)
Uses: chronic angina
Toxicity: constipation, dizziness
Avoid use in patients with long QT syndrome, drug-drug interactions due to CYP3A4/2D6 metabolism

Question 8

Digoxin

Answer 8

Cardiac glycoside
Na/K ATPase inhibitor (increased intracellular Na+ inhibits Na+/Ca2+ exchanger and more Ca2+ is retained in the cell)
Uses: congestive heart failure, arrhythmias
Toxicity: arrhythmogenic, nausea, malaise, diarrhea, vision problems (yellow halos)
Only approved oral inotropic agent for CHF, increased [Ca2+], increased stroke volume, no net effect on CHF mortality, low therapeutic index

Question 9

Metoprolol

Answer 9

Selective beta1 antagonist (affects cardiac and renal receptors, decreased cardiac remodeling and afterload/TPR)
Uses: congestive heart failure, hypertension
Toxicity: bradycardia, AV block, CNS sedation
Reduces mortality in heart failure patients, used for stage I/II hypertension, less bronchial effects

Question 10

Carvedilol

Answer 10

Mixed alpha1 and beta1 antagonist (decreased afterload/TPR and cardiac remodeling)
Uses: congestive heart failure, hypertension
Toxicity: bradycardia, AV block, CNS sedation, less bronchospasm
Reduces mortality in heart failure patients

Question 11

Captopril

Answer 11

ACE inhibitor
Uses: stage I/II hypertension, congestive heart failure, diabetic renal disease
Admin: oral
Toxicity: bradykinin cough reflex, hyperkalemia, teratogenic
First line therapy for CHF, reduces morbidity and mortality, effective for up to 12 hours

Question 12

Losartan

Answer 12

Angiotensin II type I receptor antagonist (decreased TPR and BP)
Uses: stage I/II hypertension, congestive heart failure
Admin: oral
Toxicity: hyperkalemia, teratogenic, severe hypotension, acute renal failure
No cough reflex, first line therapy for CHF

Question 13

Furosemide

Answer 13

NKCC2 cotransporter inhibitor in thick ascending limb of Henle (loop diuretic)
Uses: edema (due to CHF, cirrhosis, nephrotic syndrome), hypertension, hypercalcemia
Toxicity: hypokalemic metabolic alkalosis, ototoxicity, dehydration
“High ceiling” diuretic, rapid onset of action, enhanced urinary Ca2+ loss

Question 14

Hydrochlorothiazide

Answer 14

NCC cotransporter inhibitor in distal convoluted tubule (thiazide diuretic)
Uses: hypertension, CHF, idiopathic hypercalciuria
Toxicity: hypokalemic metabolic alkalosis, hyponatremia, hyperlipidemia, hyperuricemia, hypercalcemia
“Low ceiling” diuretic, component of many combination therapies

Question 15

Spironolactone

Answer 15

Competitive aldosterone receptor antagonist (K-sparing diuretic)
Uses: hyperaldosteronism, CHF, hypertension
Toxicity: hyperkalemia, endocrine effects (gynecomastia)
Used in combination with loop or thiazides to prevent hypokalemia, eplerenone lacks anti-androgen effects

Question 16

Amrinone

Answer 16

Phosphodiesterase-3 inhibitor (elevated cAMP levels, increased cardiac output, vasodilation)
Uses: acute decompensated heart failure
Admin: IV
Toxicity: arrhythmia
Short duration

Question 17

Dobutamine

Answer 17

Sympathomimetic
Beta1 agonist (increased cardiac output)
Uses: acute decompensated heart failure
Admin: IV
Toxicity: arrhythmia
Short duration, positive inotrope

Question 18

Nitroprusside

Answer 18

Nitrovasodilator, nitric oxide donor
Uses: acute decompensated heart failure
Admin: IV
Toxicity: tachycardia, excessive hypotension
Short duration

Question 19

Hydralazine + isosorbide dinitrate

Answer 19

Hydralazine: vascular K+ channel opener
Isosorbide dinitrate: nitric oxide donor, nitrovasodilator
Uses: congestive heart failure unresponsive to diuretics/ACE-I/ARB, angina
Admin: oral
Toxicity: tachycardia, excessive hypotension, headache
Long duration

Question 20

Amiloride

Answer 20

ENaC Na+ channel inhibitor in cortical collecting duct (K-sparing diuretic)
Uses: congestive heart failure, hypertension, hypokalemia
Toxicity: hyperkalemia

Question 21

Aliskiren

Answer 21

Renin inhibitor (decreased ATII production)
Uses: hypertension secondary to renal failure or diabetes
Toxicity: angioedema, renal impairment

Question 22

Labetalol

Answer 22

Mixed alpha1 and beta1 antagonist (decreased cardiac output and TPR)
Uses: pregnancy-induced hypertension, hypertensive crisis
Toxicity: bradycardia, AV block, CNS sedation
Composed of 4 stereoisomers

Question 23

Prazosin

Answer 23

Alpha1 antagonist (decreased TPR)
Uses: benign prostatic hypertrophy, hypertension
Toxicity: orthostatic hypotension, reflex tachycardia
Used in hypertension patients unresponsive to diuretics/Ca2+ channel blockers

Question 24

Clonidine

Answer 24

Alpha2 agonist (decreased NE release)
Uses: ADHD, hypertension
Toxicity: severe withdrawal, sedation
Penetrates CNS and acts on sympathetic nerve terminal

Question 25

Hydralazine

Answer 25

Nitric oxide mechanism Uses: hypertensive crisis, pregnancy-induced hypertension, heart failure Toxicity: tachycardia, salt and water retention Can cause lupus-like syndrome

Question 26

Ambrisentan

Answer 26

Endothelin-A receptor antagonist (vasodilation) Uses: pulmonary hypertension Toxicity: hepatic impairment, headache 100x selective for endothelin A receptor over endothelin B