Cardiovascular & Renal PSA

Question 1

Adenosine is used 1st line management of _____________

Answer 1

SVT

Question 2

Adenosine is an __________ of adenosine receptors on cell surfaces

Answer 2

Agonist

Question 3

Adenosine activities the ____________ receptors in the heart

Answer 3

G coupled protein receptors

Question 4

_____________ transiently slows the sinus rate, conduction velocity, and increases the AV node refractoriness

Answer 4

Adenosine

Question 5

(Adenosine MOA) Increasing refractoriness in the AV node breaks the _______________

Answer 5

Re-entry circuit

Question 6

Breaking the re-entry circuit allows for normal _____________ from the ___ node to resume control of heart rate.

Answer 6

Depolarisation
SA NODE

Question 7

Important adverse side effects of adenosine include b_______, b________, and a sense of ‘__________’

Answer 7

Bradycardia - sometimes even asystole!
Breathlessness
Impending doom

Question 8

You should not administer adenosine to patients with h__________, c___________, d_______ HF

Answer 8

Hypotension
Coronary ischaemia
Decompensated HF

Question 9

________ blocks cellular uptake of adenosine, which prolongs and potentiates it’s affect. In this case the dose of adenosine should be ________

Answer 9

Dipyridamole
Half the dose!

Question 10

T________, A________ and C________ are competitive antagonists of adenosine receptors and reduce its effect. So they make require _________ doses

Answer 10

Theophylline
Aminophylline
Caffeine
higher doses

Question 11

Adenosine is always given ___ route. Initial dose is normally ______

Answer 11

IV 6mg (once only)
Higher doses required in selected cases

Question 12

There are 3 common indications for aldosterone antagonist what are they?

Answer 12

1. Ascites & oedema
2. Chronic HF
3. Primary hyperaldosteronism

Question 13

What are the two aldosterone antagonists you need to know about (think K sparing):

Answer 13

Spironolactone
Epleronone

Question 14

Aldosterone is a _________ that is produced in the ___________

Answer 14

Mineralcorticoid
Adrenal cortex

Question 15

Aldosterone acts on __________ receptors in the _______ of the kidney

Answer 15

Mineralocortioid receptors
Distal tubules

Question 16

________ increases the activity of epithelial sodium channels (ENaC) , which increases the re absorption of sodium and water

Answer 16

Aldosterone

Question 17

Aldosterone antagonists (spironolactone) inhibits the effect of aldosterone by ________ binding to the aldosterone receptor.

Answer 17

Competitively

Question 18

Spironolactone increases _______ & _______ excretion and ________ retention

Answer 18

Sodium and water excretion
Potassium retention

Question 19

Important adverse effects of Aldosterone antagonists is __________ which can lead to _________, _________, ____________

Answer 19

Hyperkalaemia
Muscle weakness
Arrhythmias
Cardiac arrest

Question 20

Adverse affect of spironolactone is __________

Answer 20

Gynaecomastia

Question 21

Liver impairment, jaundice and Steven Johnson syndrome can be adverse side effects of ___________

Answer 21

Aldosterone antagonists (spironolactone)

Question 22

_________________ are contraindicated in patients with hyperkalaemia, severe renal impairment, Addisons disease.

Answer 22

Aldosterone antagonists (spironolactone)

Question 23

Aldosterone antagonists can cross the _______ and appear in _______ so should be avoided in pregnancy and postpartum

Answer 23

Placenta
Breast mil

Question 24

Aldosterone antagonists should not be combined with ____________

Answer 24

Potassium supplements

Question 25

Aldosterone antagonists are prescribed as _______ preparations

Answer 25

Oral

Question 26

Epleronone is only indicated for _______________

Answer 26

Heart failure

Question 27

Typical starting dose of **Spironolactone** is _______daily for Ascites, compared to _____daily for heart failure

Answer 27

100mg 25mg

Question 28

Alpha blockers can use used as an add on treatment for _____________

Answer 28

Resistant hypertension

Question 29

The main alpha blocker used in cardiology is _______

Answer 29

Doxazosin

Question 30

Alpha blockers are highly selective for __________

Answer 30

Alpha1 adrenoreceptors

Question 31

Alpha blockers (doxazosin) causes __________ and drop in BP

Answer 31

Vasodilation

Question 32

Important adverse side effects of **alpha blockers** include: P____________, D_______ and S________

Answer 32

Postural hypotension Dizziness Syncope

Question 33

Alpha blockers should not be used in patients with existing _________

Answer 33

Postural hypotension

Question 34

________ is used in the management of tachyarrhythmias

Answer 34

Amiodarone

Question 35

There’s are 5 main tachyarrhythmias that amiodarone is used for, what are they?

Answer 35

A.fib Atrial flutter SVT VT Refractory VF

Question 36

**Amiodarone** has effects on myocardial cells, including blockade of ____, ____, and ____ channels and **antagonism** of __ and _____________ receptors.

Answer 36

Na+ , K+ and Ca2+ Alpha and beta adrenergic receptors

Question 37

Amiodarone infers with ____ node conduction, which reduces _________

Answer 37

AV node Ventricular rate

Question 38

In SVT, Amiodarone affects the ___ node which may break the _______ circuuit and restore sinus rhythm.

Answer 38

AV NODE Re-entry circuit

Question 39

Amiodarone causes relatively little ___________, although it can cause _______ in IV infusion

Answer 39

Myocardial depression Hypotension

Question 40

When taken chronically _________ has many side effects, a number of which are serious; pneumonitis, bradycardia, AV block, hepatitis, skin hypersensitivity, and grey discolouration

Answer 40

Amiodarone

Question 41

Due to its iodine content (_______) can cause thyroid abnormalities

Answer 41

AmIOdarone

Question 42

Amiodarone should be avoided in patients with _______, ______, and ______

Answer 42

Severe hypotension Heart block Active thyroid disease

Question 43

In cardiac arrest give ______ Amiodarone

Answer 43

300mg IV

Question 44

**Amiodarone** is given via _______ route

Answer 44

IV - VIA CENTRAL LINE

Question 45

**Adrenaline** is a potent ______ of a1, a2, b1,b2 adrenoreceptors

Answer 45

Agonist

Question 46

Adrenaline is an agonist for __ , __, __, __

Answer 46

A1, A2, b1, b2

Question 48

In cardiac arrest adrenaline is given after the _____ shock

Answer 48

3rd

Question 49

ARBs are generally used when ACEi are not tolerated due to ______

Answer 49

Cough

Question 50

Cardiac indications for ARBs are 1.______, 2. _______, 3.________

Answer 50

Hypertension Chronic HF Ischaemic heart disease

Question 51

ARBs block the action of _________ on the ____ receptor

Answer 51

Angiotensin 2 on the AT1 receptor

Question 52

Angiotensin 2 is a _________ and stimulates _______ secretion

Answer 52

Vasoconstrictor and stimulates aldosterone secretion

Question 53

Blocking angiotensin 2 **(ARB)** reduces the ____________ (_______) which lowers BP

Answer 53

Peripheral vascular resistance (afterload)

Question 54

ARBS reduce aldosterone level which promotes ___ and ___ excretion; this can help reduce venous return (_______) which is beneficial in heart failure

Answer 54

Na+ and water Preload

Question 55

The two most important side effects of ARBs are ___________ & __________

Answer 55

Hypotension Hyperkalaemia

Question 56

ARBs should be avoided in (4)

Answer 56

Renal artery stenosis AKI Pregnancy Breastfeeding

Question 57

Drug interaction; avoid prescribing ARB with any ___________

Answer 57

K+ elevating drugs

Question 58

Common ARB chosen in heart failure in ___________ at _____ mg daily

Answer 58

Losartan 12.5

Question 59

Common indications for beta blockers are .. (5)

Answer 59

IHD Heart failure AF SVT HYPERTENSION

Question 60

Nitrates are indicated for _______ and ________

Answer 60

Angina and HTN

Question 61

What are the contraindications for nitrates _______ & ________

Answer 61

Aortic stenosis Hypovolaemia

Question 62

Side effects of nitrates are _______ & _______

Answer 62

Hypotension Tachycardia

Question 63

Atropine is indicated for _________ , usual dose is _______

Answer 63

Bradycardia 500mg IV

Question 64

Atropine inhibits ____________ receptors (MOA = ________)

Answer 64

Inhibits muscarinic receptors Anticholinergic

Question 65

Contraindications of **atropine** are __________ & ____________

Answer 65

Acute angle glaucoma GI obstruction

Question 67

What are the general anticholinergic side effects? ((9)

Answer 67

Dry eyes, blurred vision 👀 Dry mouth 🫦 Constipation 💩 Confusion and drowsiness 😴 Increased heart rate ❤️ Skin flushing ☺️

Question 68

Digoxin is usually indicated in _______ & _______

Answer 68

Atrial flutter & atrial fibrillation

Question 69

**Digoxin** reduces _____ node firing by increasing ___ & ___

Answer 69

SA node firing Ca2+ & Na+

Question 70

Contraindications for digoxin include (4)

Answer 70

Constructive pericarditis HOCUM Heart block SVT

Question 71

Stains are indicated for __________

Answer 71

Hypercholesterol

Question 72

Statins are contraindicated in __________ & ____________ use

Answer 72

Pregnancy Macrolide

Question 73

Side effects of statins (4)

Answer 73

Asthma GI upset Myalgia Thrombocytopenia

Question 74

The 5H’s reversible causes of cardiac arrest

Answer 74

Hypovolaemia H+ acidosis Hypothermia Hypo/ Hyperkalaemia Hypoxia

Question 76

Nitrates mode of action reduce _____ and therefore cause _________

Answer 76

Reduce Ca2+ Cause vasodilation