Cardiovascular

Question 1

Diuretics, ACE inhibitors (cause for COUGH), angiotensin II receptor blockers (ARBs), calcium channel blockers

Answer 1

Essential Hypertension

Question 2

Diuretics, ACE inhibitors, angiotensin II receptor blockers, beta-blockers, K+-sparring agents

Answer 2

CHF

Question 3

ACE inhibitors, angiotensin II receptor blockers, diuretics, calcium channel blockers, beta-blockers, alpha-blockers

Answer 3

Diabetes mellitus

Question 4

Use them cautiously in decompensated CHF

Contraindicated in cardiogenic shock

Answer 4

Beta-blockers

Question 5

They are protective against diabetic neuropathy

Answer 5

ACE inhibitors

Question 6

Block voltage-dependent L-type calcium channels

cardiac and smooth muscle

HTN, angina, arrhythmias, Prinzmetal’s angina, Raynaud’s

Cardiac depression, AV block, peripheral edema, flushing, dizziness, constipation

Answer 6

Calcium channel blockers

Nifedipine, verapamil, diltiazem, amlodipine

Question 7

Tissue where:

amlodipine = nifedipine > diltiazem > verapamil

Answer 7

Vascular smooth muscle

Question 8

Tissue where:

verapamil > diltiazem > amlodipine = nifedipine

Answer 8

Heart muscle

Question 9

Causes smooth muscle relaxation due to increased cGMP

Arterioles > veins

(afterload reduction)

Severe HTN, CHF

1st line: HTN in pregnancy

Compensatory tachycardia, fluid retention, nausea, headache, angina, lupus-like syndrome

Answer 9

Hydralazine

Add methyldopa for HTN in pregnancy

Add beta-blocker to prevent reflex tachycardia

Question 10

Direct release of NO increases cGMP

Malignant HTN

S.E. Cyanide toxicity at large doses

Answer 10

Nitroprusside

Question 11

D1 receptor agonist

coronary, peripheral, renal, splanchnic vasodilation

Decreases BP (vasodilation) so used for Malignant HTN via

Increases Na+ loss

Answer 11

Fenoldopam

Question 12

Nitroprusside, nicardipine, clevidipine, labetalol, fenoldopam

Answer 12

Malignant HTN

Question 13

Release NO in smooth muscle

Increases cGMP

Veins >> arteries

(decreased preload)

Angina, pulmonary edema

Reflex tachycardia, hypotension, flushing, headache, Monday disease

Answer 13

Nitroglycerin,

Isosorbide dinitrate

Question 14

Dizziness, tachycardia (reflec to NO dilation effects), headache

Loss of tolerance over weekend

Develop tolerance during work week

Answer 14

Monday disease

Due to nitroglycerin reexposure at beginning of work week.

Question 15

These are determinants of what?

End-diastolic volume, blood pressure, heart rate, contractility, ejection time

Answer 15

Myocardial O2 consumption

Question 16

Contraindicated in angina

(2)

Answer 16

Partial beta-agonists

Pindolol, acebutolol

Question 17

Which Calcium Channel Blocker (CCB) is similar to:

Nitrates

and

beta-blockers

Answer 17

Nifedipine - nitrates

and

Verapamil - beta-blockers

Question 18

Effects of nitrates:

EDV

BP

Contractility

HR

Ejection time

MVO2

Answer 18

EDV - decrease

BP - decrease

Contractility - increase (reflex)

HR - increase (reflex)

Ejection time - decrease

MVO2 - decrease

Question 19

Effects of beta-blockers:

EDV

BP

Contractility

HR

Ejection time

MVO2

Answer 19

EDV - increase

BP - decrease

Contractility - decrease

HR - decrease

Ejection time - increase

MVO2 - decrease

Question 20

Combined nitrates and beta-blockers reduce what?

(3)

Answer 20

BP, HR, MVO2 (greatly)

Question 21

Inhibit conversion of HMG-CoA to mevalonate

Greatly reduces LDL

Slightly increases HDL

Hepatotoxicity, rhabdomyolysis (muscle breakdown)

Answer 21

HMG-CoA reductase inhibitors

Lovastatin, pravastatin, simvastatin, atorvastatin, rosuvastatin

Question 22

Reduces hepatic VLDL secretion

Inhibits lipolysis in adipose tissue

Greatly increases HDL

Decrases LDL

Red, flushed face, hyperglycemia, hyperuricemia

Answer 22

Niacin

(Vit B3)

Flushing reduced by aspirin

Hyperglycemia may cause acanthosis nigricans

Question 23

Prevent intestinal reabsorption of bile acids

(Liver uses cholesterol to make more bile)

Decreases LDL

Bad taste, GI discomfort, malabsorption of fat-soluble vitamins, cholesterol gallstones

Answer 23

Bile acid resins

Cholestyramine, colestipol, colesevelam

Question 24

Prevents cholesterol reabsorption

at small intestine brush border

Decreases LDL

Rare hepatotoxicity, diarrhea

Answer 24

Cholesterol absorption blockers

Ezetimibe

Question 25

**Upregulates lipoprotein lipase (LPL)** (Increases triglyceride clearance) **Greatly reduces triglycerides** Myositis, hepatotoxicity, cholesterol gallstones

Answer 25

_Fibrates_ **Gemfibrozil, clofibrate, bezafibrate, fenofibrate**

Question 26

**Inhibits Na+/K+ ATPase** **indirectly inhibits Na+/Ca2+ antiport** **increases Ca2+ in cells (positive inotropy)** **Stimulates vagus nerve to decrease HR** CHF, atrial fibrillation

Answer 26

_Cardiac glycosides_ **Digoxin** **CHF - increases contractility** **A fib - decreases conduction at AV, depresses SA**

Question 27

Drug causes **Increased PR interval, decreased QT**, ST scooping, T-wave inversion, arrhythmia, AV block Can lead to hyperkalemia Exceted in urine **Renal failure, hypokalemia (allows binding), quinidine (displaces from tissue binding sites):** **Increase toxicity**

Answer 27

Digoxin

Question 28

**Nausea, vomiting, diarrhea, blurry yellow vision** (Cholinergic effects) Treatment for OD?

Answer 28

Digoxin **Normalize K+, lidocaine, cardiac pacer, anti-dig Fab fragments, MG2+**

Question 29

Local anesthetics **Slow or block conduction** **Decrease slope of phase 0** Increase threshold for firing in abnormal pacemaker cells Hyperkalemia increases toxicity

Answer 29

_Class I antiarrhythmics_ **Na+ channel blockers**

Question 30

Increases: **AP duration, effective refractory period, QT interval** For both atrial and ventricular **arrhythmias** esp reentrant and ectopic SVT, VT **Thrombocytopenia, torsades de pointes**

Answer 30

_Class IA :_ **"PRO QUIN DI"** Quinidine, procainamide, disopyramide **Quin - cinchonism, headaches, tinnitus** **Pro - reversible SLE syndrome** **Diso - heart failure**

Question 31

_Decreases:_ **AP duration** Preferentially affects ischemic/depolarized Purkinje and ventricular tissue **Acute ventricular arrhythmias (_post-MI_), digitalis induced arrhythmias** CNS stimulation/depression, cardiovascular depression

Answer 31

_Class IB: _"**I**'d **B**uy **L**iddy's funny (Pheny) M**ex**ican **Taco**s" **Lidocaine, Mexiletine, Tocainide**

Question 32

**No effect on AP duration** **V-tach that progresses to V-fib, intractible SVT** Prolongs refractory period in AV node **Contraindicated with structural abnormalities, MI** **Proarrhythmic**

Answer 32

_Class IC:_ "**F**or **P**ushing Extasy" **Flecainide, propafenone**

Question 33

Class 1 A, IB and IC (Na+ blockers) Mneumonic:

Answer 33

"**Police Department Questions** (Class 1A-AP increases)- **The Little Man** (Class 1B-AP decreases) - **For Pushing Extasy** (Class 1C-No change in AP)"

Question 34

**Decreases cAMP, Ca2+ current in SA, AV nodes** Decreased nodal activity, esp AV node **(inc. PR)** Decreases phase 4 in abnormal pacemakers **V-tach, SVT** **Slows ventricular rate in A-fib and A-flutter** _Impotence_, bradycardia, AV block, CHF, CNS depression

Answer 34

_Class II:_ Beta-blockers Metoprolol, propranolol, esmolol, atenolol, timolol **Metoprolol- dyslipidemia (Tx: glucagon)** **Propranolol- vasospasm in Prinzmetal's angina** **Esmolol- very short acting**

Question 35

Which class II antiarrhythmic can **exarcerbate** **vasospasm** in Prinzmetal's angina?

Answer 35

**Propranolol**

Question 36

**Increases AP duration, QT interval** **Increases effective refractory period** Used when other antiarrhythmics fail

Answer 36

_Class III:_ K+ channel blockers **Amiodarone, ibutilide, dofetilide, sotalol** **(AIDS)**

Question 37

Toxicity of: **Sotalol, Ibutilide**

Answer 37

Sotalol - **torsades de pointes**, excessive beta-block Ibutilide - torsades de pointes

Question 38

Toxicity of: **Amiodarone** Which function tests? Why does it have class I, II, III and IV effects?

Answer 38

**_Pulmonary fibrosis, hepatotoxicity, hypo/hyperthyroidism_** Corneal, skin deposits, photodermatitis neurologic effects, constipation bradycardia, heart block, CHF _Check PFTs, LFTs, TFTs_ **40% iodine by weight** **Amiodarone alters the lipid membrane**

Question 39

Decreases conduction velocity **Increases effective refractory period, PR interval** Prevents nodal arrhythmias (SVT) Constipation, flushing, edema, CHF, AV block, sinus node depression

Answer 39

_Class IV:_ Ca2+ channel blockers **Verapamil, diltiazem**

Question 40

**Increases K+ outflow** **Hyperpolarizes cell, decreases Ca2+ in** (Na+/Ca2+ antiport) **_Abolishes SVT (first line)_** Very _short acting_ (15 seconds) Flushing, hypotension, chest pain What blocks all effects? (2)

Answer 40

**Adenosine** Effects blocked by _theophylline_ and _caffeine_

Question 41

**For torsades de pointes, digoxin toxicity**

Answer 41

Mg2+