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Flashcards in Cardiovascular- GOOD Deck (59):
1

Four antihypertensives that are safe for use in pregnancy?

-Hydralazine
-Labetalol
-nifedipine
-methyldopa

[H]ow [L]ong [N]ow [M]om must I stay in your belly?

2

Anti-hypertensives that are protective against diabetic nephropathy?

-ACEi/ARBs
--pril --sartan

3

When must B blockers be used with caution?

-decompensated HF
-use w/ extreme caution in cardiogenic shock

4

What reduces mortality in CHF patients?

-ACEi/ARBs

5

Of the following calcium channel blockers, which are dihydropyridines?
Which are non-dihydropyridines?

-verapamil
-nimodipine
-nifedipine
-diltiazem
-amlodipine
-clevidipine
-nicardipine

-verapamil, diltiazem are NON dihydropyridines, all others ending in --dipine are dihydropyradines

6

MOA for CCB's
Difference between dihydropyridines and others?

-block L type calcium channels of cardiac + smooth muscle

-dihydropyridines acts more on vascular smooth muscle, verapamil/ diltiazem more on cardiac muscle

7

In general, when would dihydropyridines be useful? (3)

-hypertension (smooth muscle vasocponstriction), angina (vasoconstriction decreases coronary flow), and Raynaud (vasoconstriction= cold fingers!)

8

List a special use for:
-nimodipine
-clevidipine

-nimodipine: SAH (prevents vasospasm)
-clevidipine: HTN emergency (rapid vasodilation)

9

Verapamil and diltiazem have what ADRS?
-note, we aren't memorizing cardiac depression because that's stupid. These things slow the heart. Duh.

-AV block (also kind of duh but not ALL cardiac depressants do this, usually CCBs or BBers/ digoxin)
-hyperprolactinemia
-constipation

10

ADRs assc with dihydropyridines:
-3 direct semi obvious results of vasodilation
-1 rando

-edema, flushing, dizziness
(all related to vasodilation)
-gingival hyperplasia (note, also see this with phenytoin therapy **)

11

Hydralazine MOA

-^^cGMP
-arteriole more than venous dilation
-not in typically used for essential primary hypertensive treatment, use in preggos, SEVERE htn

12

With what is hydralazine generally administered?

-BBer
-sudden drop in BP will lead to reflex tachycardia otherwise

13

Super important ADR of hydralazine?

-lupus like syndrome
-also see this with: procainamide, isoniazid

14

You have a hypertensive emergency. What do you use?

-HINT: none of the shit patients take to manage chronic HTN. Don't pick simple BBer/ ACE
-[N]o one [c]an [f]**king [L]ive with a BP of 300/200 if you just give them an ACEi!

-nitropprusside, nicardipine
-clevidipine
-fenoldopam
-labetolol (a,B1/2, not simple)

15

Nitroprusside:
MOA
1 important ADR

-^^NO, ^^cGMP
-Cyanide tox

16

Fenoldopam:
-MOA

-D1 agonist

17

Nitrates work alot like nitroprusside. How does it work again?

-^^NO --> ^^ cMGP
-but note: this prefer to dilate VEINS!!!!!

18

Three uses for nitrates. You know two. Promise.

-agina, acute coronary syndrome (told you! youre smart!)
-also... pulm edema

19

Like hydralazine, what should you combine nitrates with?

-BBers, because reflex tachy

20

Whats Monday disease?

-decelopment of tolerance for vasodilation during week --> loss of tolerance over weekend, industial worker comes back to work and gets tachy, dizzy, H/A

21

Anti-anginal therapy:
whats the ultimate goal?

-reduce MVO2 by reducing either EDV, BR, HR, or contractility

22

What in the world is ranolazine

-Inhibits the late phase sodium channel --> reduces diastolic wall tension/ O2 consumption
-no change in HR or contractility

23

When is ranolazine used?

-when HTN is refractory to all other treatment, give them the RAVIOLI (that's what ranolazine looks like), but beware --> QT prolongation!!!!

24

Each of the following agents have the *STRONGEST* affect on which lipid value?
-Statins
-resins
-ezetimibe
-fibrates
-niacin

-Statins: lowers LDL
-resins: lowers LDL
-ezetimibe: lowers LDL
-fibrates: lowers TGs
-niacin: equally lowers LDL and ^^HDL but has bad ADRs, not usually used.

25

Of the three drugs that work primarily by lowering LDL...
-which has NO EFFECT on TGs/HDL?
-which has a NEGATIVE effect on TGs?
-Which has a slightly positive effect on all three parameters?

-ezetimibe: pure LDL reduction
-resins: slightly increase TGs!
-Statin: slightly increased HDL, decreased TGs

Remember the three drugs that mainly work on LDL are: statins, resins, eztimibe

26

Why isn't niacin used often?

-hyperglycemia, hyperuricemia
(most of these patients are borderline diabetic!)
-flushing

27

Fibrates mainly work by lowering ____. What effect do they have on other parameters?

-TGs
-good effect on LDL, HDL
(lowers, raises, respectively)

28

Remind me again, whats the only class that has a NEGATIVE outcome on one of the lipid parameters?

-[R]ESINS [R]AISE T[R]IGLYCERIDES.

**Uworld has asked this to me at least twice. KNOW THIS. **

29

Common name stem for resins? fibrates?

-resins start with chol/col
-fibrates have -fibr in name

30

Which Lipid lowering agent is assc with:

-flushing
-hepatotoxicity
-myopathy
-hyperuricemia, glycemia
-gallstones
-decrease KADE absorption
-diarrhea

-flushing: niacin
-hepatotoxicity: statins
-myopathy: statins, fibrates
-hyperuricemia, glycemia: niacin
-gallstones: fibrates
-decrease KADE absorption: resins
-diarrhea: ezetimibe


(*NOTE: I know most everything "can" cause diarrhea but eztemibe almost ALWAYS does. They actually care about this.)

31

MOA for:
-statins
-resins
-eztemibe

MOA for:
-statins: competitive HMGCRi
-resins: ---I bile acid reabsorption
-eztemibe: --I cholesterol reabsorption

32

MOA for:
-fibrates

^LPL --> ^ TG clearance
^PPARa --> ^ HDL synthesis

Fatties (dyslipidemia patients) Love Pizza
(Fibrates = LPL and PPARa)

33

MOA for:
-niacin

--I hormone sens lipase & lipolysis
--I VLDL synthesis

Niacn [h]as [v]ery bad ADRs
-[h]ormone sens lipase, [V]LDL

34

Why does resin prevention of bile acid reabsorption have anything to do with cholesterol levels?

low bile acid means liver must USE UP CHOLESTEROL to make more.

35

Digoxin MOA:
-for the love of God, know this one.

-Na/K ATPase inhibitor directly
..... then =Na/Ca channel inhibition and ^^ intracellular Ca and ionotropy
-stimulates vagus, lowers HR

36

How does digoxin reverse afib?

-lowers conduction at both AV and SA nodes

37

Digoxin ADRs:
-general
-cardiac
-electrolyte

-general: cholinergic (SLUDEBBB)
-cardiac: AV block-- like BBers, verapamil
-electrolyte: hyperkalemia

38

What electrolyte abnormality predisposes a patient to digoxin tox?

-hypokalemia, more open binding sites for digoxin

39

3 Pharmacologic tx for treating dig tox?
(aside from the obvious cardiac pacer if their heart is out of whack.)

-normalize K+
-anti-dig fragments
-Mg

40

What are the MOAs for the following anti-arrhythmic classes?:
-IA
-IB
-IC

Class one all Na blockers lowering slope of phase 0, state dependent (prefers frequently depolarized tissue)

-IA:^AP/ERP/QT

-IB: lowers AP duration in ischemic or depolarized tissue

-IC: significant drop in ERP (only) of AV node/ accessory tracts (only)

41

All three classes of Na channel block anti-arrhytmics (IA,B,C) decrease the slope of phase 0 depolarization. Which class shows the GREATEST depression?

-class IC
-significantly decreases ERP (only, not AP) of AV node (only, not purkinkes, ventricles)

42

What are the MOAs for the following anti-arrhythmic classes?:
-II
-III
-IV

-II: BBers
-III: K+ Bers
-IV: CCBers

43

What are the class IA anti-arrhythmics?

-the Queen Proclaims Disos Pyramide
-quinidine
-procainamide
-disopyramide

44

What are the class IB anti-arrhythmics?

I'd Buy Liddys Mexican Tacos
-lidocaine
-mexiletine

45

What are the class IC antiarrhymics?

-Can I have Fries Please
-flecainide
-propafenone

46

Of the class I antiarrhythmics, which subclass is assc with the following ADRs?

-CNS stimulation
-proarrhtymic in ischemic, structural disease
-torsade

-CNS stimulation: 1B
-proarrhtymic in ischemic, structural disease: 1C
-torsade: IA

47

Specifically, which type 1 antiarrhythmic causes the following ADR:
-cinchonism
-SLE like syndrome
-heart failure

All class 1A

-cinchonism: quinidine
-SLE like syndrome: procainamide
-heart failure: disopyramide

48

Which class 1 is used in:
-isolated SVTs, like afib?
-post MI V. arrhythmias, dig tox
-A or V arrhythmias, esp. re-entrant, ectopic SVT/VT

-isolated SVTs, like afib?: IC
-post MI V. arrhythmias, dig tox: IB
-A or V arrhythmias, esp. re-entrant, ectopic SVT/VT: IA

49

MG used for what two things?

-torsades, dig tox

50

BBers, specific MOA
-How do they effect pacemaker AP?
-How do they effect EKGs?

-lower cAMP, Ca and SA/AV node activity
-increase PR interval!!! (HAVE HAD THIS QUESTION TWICE.)
-lower slope of phase *4* (THIS TOO!!)


*****KNOW. THIS. CARD. ******

51

Class II use:

-SVTs only, can control v rate in these but does not control V. arrhythmias!

52

When should you never ever give a Bber alone?

-pheos, cocaine
--> unopposed a activity

**note, there are plenty of other BBer effects. We don't have time for memorizing a ten long line card right now. You should be familiar.

53

How to treat BBer OD?

-saline, atropine, glucagon

54

What are the class III antiarrythmics?

-AIDS
-amiodarone
-ibutilide
-dofetilide
-**sotalol (please don't confuse this for a pure BBer, Ive done this more than once...)

55

-Aside from blocking K+ channels, what is the specific MOA for class III?
-What other class is it very similar to?
-Use?

^^ AP, ERP, QT, like class IA
-SVTs, V tach

56

Amiodarone has so many tox effects due to its lipophilicty. To summarize here, and not memorize a list we do not have time for....

tell me, what parameters should you be monitoring if you have a patient on this drug?

-PFT, LFT, TFT
-also don't be shocked if their eyeballs or skin turn grey.

(Questions often ask you what test to monitor *or* why the thyroid is affected. That's because amiodarone is 40% iodine)

57

Adenosine:
-MOA
-Use

-^ K+ out of cells = hyperpolarizing and low Ica current.
-use in SVTs
-works super fast.

58

Class IV:
-aside from blocking Ca channels, what does it do?

-lowers conduction velocity, increases ERP/ PR interval
-SVTs only

59

Which of the anti-arrhythmic classes could handle ventricular arrythmias?

-class IA and III only.