Drugs Flashcards
(131 cards)
1
Q
ramipril
A
ACEi; treats hypertension
2
Q
abciximab
A
(GP IIb/IIIa inhibitor)
Platelet aggregation inhibitor mainly used during and after coronary artery procedures like angioplasty
3
Q
Patients with aortic regurgitation may benefit from which long-acting vasodilators?
Acute aortic regurg: endocarditis, dissection, trauma
Chronic: rheumatic heart disease, prior endocarditis
–loud S3, short diastolic murmur–
A
Nifedipine XL
or other long acting calcium channel blockers
4
Q
Torsades de pointes treatment? UNstable
(anti-psychotic agents that can cause it: thioridazine, pimozide, droperidol, and ziprasidone)
can also be caused by HYPOcalcemia
A
cardioversion
5
Q
What type of STEMI is the use of nitroglycerin relatively contraindicated for?
A
Inferior ST elevation (II, III, aVF)
–these may be indicative of a right ventricular infarct which are preload dependent and can lead to a precipitous drop in blood pressure
6
Q
chlorthalidone
A
thiazide diuretic; hypertension
7
Q
Carvedilol
A
Beta-blocker; Dilated cardiomyopathy (heart failure)
8
Q
Which class of common over the counter drugs can worsen heart failure?
A
NSAIDs
(e.g. ibuprofen)
9
Q
What is the treatment of hemodynamically UNstable ventricular tachycardia?
A
Electrical cardioversion
10
Q
Wolff-Parkinson-White + tachycardia + hemodynamically UNstable treatment?
10
A
Cardioversion
11
Q
Sinus bradycardia
A
Atropine
12
Q
nicardipine
A
calcium channel blocker; vasodilator
used to treat chronic stable angina, hypertension, and Raynaud’s phenomenon
**more selective for cerebral and coronary vessels**
13
Q
Flecainide
A
anti-arrhythmic drug
–supraventricular tachycardia
–ventricular tachycardia
NOT RELATED TO ACUTE ISCHEMIA
14
Q
Alendronate
A
biphosphonate that acts as an osteoclast inhibitor to inhibit bone resorption
15
Q
What common drug class reduces cardiac contractility?
A
beta-blockers
16
Q
Pulseless electrical activity treatment?
A
chest compressions
Causes:
- Hypovolemia
- Hypoxia
- Hypothermia
- Hyperkalemia
- Tension pneumothorax
- Thrombus (PE, MI)
- Toxicologic
- Tamponade
17
Q
Capture beats and fushion beats confirm the diagnosis of which cardiac dysrhythmia?
A
Ventricular tachycardia
18
Q
What antipsychotic drug has a black blox warning for the development of pericarditis and myocarditis?
A
Clozapine
19
Q
Salmeterol
A
long-acting beta-2 agonist; bronchospasm and COPD
20
Q
Ibuprofen
A
NSAID
21
Q
metaproterenol
A
Beta-2 agonist
acute management of asthmatic bronchospasm
22
Q
A common side effect of calcium channel blockers is pedal edema; what can be added to the patient’s regimen to offset this?
Calcium channel blockers:
- Amlodipine
- Felodipine
- Nicardipine
- Isradipine
- Nifedipine
- Diltiazem
- Verapamil
A
Edema side effect can be lessened by adding an ACEi or ARB to patient’s regimen
23
Q
Sinus bradycardia + hemodynamically UNstable
A
atropine
24
Q
Cardiomegaly, Kerley B Lines, effusions
with exertional dyspnea, orthopnea, paroxysmal noctural dyspnea, pitting edema and S3 heart sound
A
Acute decompensated heart failiure
- BiPAP
- Nitroglycerin
- Furosemide
- Hypotension, no shock: dobutamine
- Hypotension, yes shock: norepinephrine
25
What is the treatment of choice in antidromic, atrioventricular reciprocating tachycardia in a hemodynamically **STABLE** patient?
25
procainamide
| (WPW syndrone)
26
Wolff-Parkinson-White + tachycardia + hemodynamically **STABLE**
treatment?
1. Vagal maneuver first; then
2. Adenosine
27
isradipine
Calcium channel blocker
PINE
28
esmolol
short-acting beta blocker; hypertension in setting of aortic dissection
29
ST elevations V3, V4
Anterior
Left anterior Descending (LAD)
30
In patients with myocardial infarction, which three drugs have been shown to decrease mortality?
Aspirin, beta-blockers, ACEi
31
furosemide
diuretic; used in acute decompensated heart failure
32
Pregnancy induced hypertension tx?
i.e. first choice for control of hypertension in pregnancy
Methyldopa (centrally acting alpha agonist)
33
What is the most commonly used first line agent to treat hypertension?
Thiazide diuretics, like hydrochlorothiazide or chlorthalidone
34
What is the initial treatment for a STEMI in leads II, III, and aVF?
Intravenous hydration
Inferior leads; may be right ventricular infarct which is preload dependent
Right coronary artery
Also, aspirin
NITROGLYCERIN IS CONTRAINDICATED
35
Which class of medications are CONTRAINDICATED with cocaine related chest pain?
Beta-blockers; can cause unopposed alpha effects leading to worsening symptoms and blood pressure
36
Bisoprolol
Beta-blocker; Dilated cardiomyopathy (heart failure)
37
Ketorolac
(toradol) NSAID (poor anti-inflammatory effects, but good for analgesic)
38
Hypertensive emergency tx
(hypertension with acute end-organ system injury)
1. Reduce MAP 25% in first hour;
2. Normalize BP over next 8-24 hours;
3. Treatment: labetalol (first), nicardipine (second)
labetalol=short-acting beta blocker and alpha blocker
nicardipine=calcium channel blocker; vasodilator
39
Which medications are contraindicated in Wolff Parkinson White syndrome?
A--adenosine
B-- beta-blockers
C-- calcium channel blockers
D-- digoxin
why? slows AV nodal conduction
40
Young patient +dizziness+palpitations+ hyperthyroidism/caffeine/drugs
Paroxysmal Supreventricular Tachycardia (PSVT) caused by reentrant conduction pathway (conduction reentry)
tx: reduction of offending agent, can also treat with vagal maneuvers
Hemodynamically stable: can use adenosine or calcium channel blocker
Hemodynamically unsable: cardioversion
41
losartan
ARB (angiotensin receptor blocker); blood pressure
42
Verapamil
calcium channel blocker; hypertension
Edema side effect can be lessened by adding an ACEi or ARB to patient's regimen
43
Acute decompensated heart failure (hypotension; no signs of shock)
1. BiPAP
2. Nitroglycerin
3. Furosemide
4. **Add:** dobutamine
44
Acute decompensated heart failure (hypotension; yes signs of shock)
1. BiPAP
2. Nitroglycerin
3. Furosemide
4. **Add:** norepinephrine
45
What is the INR range in a patient taking warfarin for atrial fibrillation?
INR range is 2-3
46
Prednisone
Corticosteroid with anti-inflammatory properties
47
Adenosine
atrioventricular (AV) nodal blocker; used for supraventricular trachycardias
48
Temporal (giant cell) arteritis treatment?
high-dose steroids
dx: temporal artery biopsy
--monocular vision loss, jaw claudication, headache, women \>50
ESR\>50
49
What is indicated for the treatment of unstable tachydysrhythmias, including certain supraventricular dysrhythmias as well as monomorphic ventricular tachycardia
Synchronized cardioversion (200J)
50
phentolamine
IV ; used for hypertensive emergency due to pheochromocytoma
alpha-blocker which can be used to block the catecholamine effects of a pheochromocytoma
51
Acute rheumatic fever treatment
(diffuse inflammation of the heart following an infection with group A beta-hemolytic streptococcal infection)
Treat with:
1. NSAIDS
2. antibiotics: penicillin V or penicillin G or amoxicillin
52
Nifedipine
calcium channel blocker
PINE
53
which bile acid sequestrant medication can lower A1C by 0.5% in patients with type 2 diabetes and dyslipidemia?
colesevelam
54
Reteplase
Fibrinolytic agent; used to treat ST-elevation myocardial infarctions when catheterization lab is not readily available
55
Diltiazem
calcium channel blocker; used in tachydysrhythias
56
Deep Vein Thrombosis
IV heparin and switch to warfarin
57
Which class of medications should be given initially for acute pulmonary edema?
nitrates
58
dipyridamole
Vasodilator and blood thinners; used to treat TIA
59
nitroprusside
vasodilator
60
Timolol
Beta-Blocker; glaucoma
61
Mitral stenosis requires what treatment?
Result of rheumatic heart disease
--antibiotic prophylaxis for procedures prone to bacteremia--
\*\*loud S1, opening snap, low-pitched, rumbling diastolic apical murmur, best with left lateral decubitus position\*\*
62
enalapril
ACEi; blood pressure
63
ST elevations I, aVL, V5, V6,
lateral
Left circumflex
64
Cor Pulmonale treatment
right heart catheterization
HTN+ RVH (right ventricular hypertrophy)
most common chronic cause: COPD
most common acute cause: PE
65
Hypertension and aortic dissection; treatment of choice?
In patients with aortic dissection, what is the recommended blood pressure goal?
Negative ionotropes (short-acting beta blockers) labetalol, esmolol, and propranolol
Systolic 110 mm Hg
66
What is the role of beta-adrenergic blocking agents in acute myocardial infarction?
Beta-adrenergic blockers given within 24 hours of presentation reduce the risk of developing ventricular dysrhythias
67
Felodipine
Calcium channel blocker
PINE
68
Which virus is most responsible for pericarditis?
coxsackie
69
ST elevation; patient is being prepared for transfer to the interventional cardiac unit for primary percuntaneous cardiac reperfusion
--Already given oxygen, nitroglycerin, and aspirin
What else do you give this patient?
abciximab
(GP IIb/IIIa inhibitor)
Platelet aggregation inhibitor
70
Hypertension + COPD+ cardiact arrythmyia
Multifocal atrial tachycardia (MAT)
treat with calcium channel blockers
71
Hydralazine
peripheral vasodilator;
often added to methyldopa for refractory cases of pregnant hypertension
72
Metoprolol
Beta-blocker; Dilated cardiomyopathy (heart failure) and hypertension
73
Ranolazine
Anti-angina medication that is used ONLY AFTER calcium channel blockers, beta-blockers, and nitrates have failed to control angina
74
What drug is safe to administer in a patient with a wide complex irregular tachycardia?
procainamide
75
What are some common electrolyte abnormalities associated with hydrochlorothiazide?
1. **HYPO**kalemia
2. **HYPO**natremia
3. **HYPO**magnesemia
4. **_hyper_**calcemia
Hypo: MagNaK
Hyper: Ca
76
Torsades de pointes treatment? **STABLE**
(anti-psychotic agents that can cause it: thioridazine, pimozide, droperidol, and ziprasidone)
can also be caused by **HYPO**calcemia
IV magnesium sulfate
77
What is the best treatment for first degree heart block?
no treatment is necessary
78
Procainamide
antiarrhythmic; used in tachydysrhythmias
--supraventricular tachycardia
--ventricular tachycardia
79
Methyldopa
(centrally acting alpha agonist)
first choice for control of hypertension in pregnancy
80
Nitrate therapy works by which mechanisms?
reducing both preload and afterload
81
witnessed ventricular fibrillation
immediate defibrillation with 200 joules biphasic (360 joules monophasic)
82
amlodipine
calcium channel blocker; blood pressure and angina
83
Community acquired pneumonia treatment
ceftriaxone and azithromycin
84
Hypotension and aortic dissection; fluid of choice?
Crystalloids
85
Torsades de pointes treatment? **_PULSELESS_**
(anti-psychotic agents that can cause it: thioridazine, pimozide, droperidol, and ziprasidone)
can also be caused by **HYPO**calcemia
defibrillation
86
Pain
Pallor
Paresthesias
Pulselessness
Paralysis
Poikilothermia
Arterial thrmboembolism
Most common source=left heart
Most common site= femoral artery bifurcation
87
labetalol
short-acting beta blocker and alpha blocker;
hypertension in setting of aortic dissection
Malignant hypertension
hypertension in pregnancy (after Methyldopa)
88
Acute decompensated heart failure (no hypotension)
1. BiPAP
2. Nitroglycerin
3. Furosemide
89
Low-output heart failure treatment
Systolic dysfunction-- EF \<40%
(causes: ischemic heart disease, HTN, cardiomyopathy, valvular heart dx)
O2, BiPAP, nitrates, furosemide
90
Hemodynamically stable ventricular tachycardia
procainamide
amiodarone
(if refractory-synchronized cardioversion)
bidirectional ventricular tachycardia indicates digoxin toxicity
91
hydrochlorothiazide
thiazide diuretic; hypertension
92
Transient ischemic attack treatment
administer aspirin and dipyridamole; admit to stroke unit
if allergic to aspirin: clopidogrel
93
varicose veins
| (lower leg edema, dilated veins)
compression stockings
94
patient vignette with artherosclerosis+new murmur described as mid-systloic murmur heard best at the second intercostal space near right sternal border; decreases with isometric handgrip and Valsalva maneuvers
"crescendo-decrescendo"
paradoxically split S2, S4 gallop
aortic stenosis
95
Clopidogrel
platelet P2Y12 receptor blocker (antiplatelet therapy)
96
ventricular fibrillation unwitnessed
CPR for 2 minutes, then defibrillation
97
ST elevations in V4R and V5R
Right ventricular
CONTRAINDICATED: nitrates
This is preload dependent--\> fluids!!
98
Which medication is used in the treatment of hemodynamically stable atrial fibrillation with concomitant Wolff-Parkinson-White syndrome?
(pre-excied atrial fibrillation)
Ibutilide, an anti-arrhythmic drug (prolongs refractoriness of AV node)
99
What medication is recommened for the treatment of atrial dysrhythmias associated with hyperthroidism?
propranolol
100
Which calcium channel blocker has the greatest effect on the AV node?
verapamil
101
Which drug used for the treatment of heart failure has been shown to reduce hospitalizations, but has no effect on mortality?
Digoxin
102
which beta-blocker is contraindicated in prinzmetal's angina?
propranolol
103
what class of medications may help improve palpitations from mitral valve prolapse?
beta-blockers
104
What is the treatment of choice for Prinzmetal angina?
Calcium channel blockers and nitrates
105
Tachycardia (stable narrow-complex supraventricular tachycardia)
treatment?
Adenosine
106
What is the mainstay of treatment for hypertrophic cardiomyopathy?
Management: long-term beta-blocker therapy. Can also use calcium channel blockers.
CONTRAINDICATED: positive inotropes and nitrates
107
ST elevations V1, V2
Septal
Left anterior Descending (LAD)
108
Infectious endocarditis: IV drug use (staph aureus)
Vancomycin and ceftriaxone
Vancomycin= glycopeptide antibiotic
ceftriaxone= cephalosporin antibiotic
109
which electroly abnormality can cause increased blood pressure?
hypercalcemia
110
When should nitrates be avoided?
1. Systolic \<90 mm Hg
2. HR \< 50/min
3. HR\>100/min
4. Right ventricular infarction (inferior with leads II, III, aVF)
5. Patient who took phosphodiesterase inhibitor (erectile dysfunction) in last 24 hours
6. Hypertrophic cardiomyopathy
7. Severe aortic stenosis
111
Acute pericarditis
NSAID (ibuprofen, naproxen)
Also: Colchicine and corticosteroids if refractory
112
Calcitonin
lower serum calcium concentration by inhibiting calcium absorption by the intestines, inhibiting osteoclast activity in bones, and inhibits renal tubular cell reabsorption of calcium (allowing it to be excreted via urine)
113
ST depressions in V1, V2, large R waves
Posterior
114
Wolff-Parkinson-White DEFINITIVE treatment
radiofrequency ablation of bundle of kent
115
Naproxen
NSAID
116
Infliximab
anti-tumor necrosis factor alpha antibody used in treatment of autoimmune dx
117
propranolol
short-acting beta blocker; hypertension in setting of aortic dissection
118
Mitral valve prolapse
(inherited with symptoms of anxiety, panic attacks, palpitations, exercise intolerance, syncope, etc)
MVP=apical mid-systolic click which may or may not be followed by a late-systolic murmur
Aysmptomatic: reassurance and serial echocardiograms
Symptomatic: beta-blockers, counseled on caffeine, alcohol, and tobacco abstinence, and given 24 hr cardiac monitor
119
What is the first-line agent for reduction of triglycerides?
A fibrate, such as gemfibrozil
120
Patient develops angioedema to aspirin, but you are concerned for acute coronary syndrome. which medication do you administer?
clopidogrel
binds to the platelet adenosine diphosphate (ADP) receptor to irreversibly inhibit activation and aggregation for the life of the platelet
121
Increase in creatinine levels of a patient who recently started an ACEi. why?
Do ACEis cause HYPERkalemia or HYPOkalemia? why?
ACE i blocks the conversion of angiotensin I to angiotensin II and thus decreases glomerula blood flow
HYPERkalemia; reduction of aldosterone secretion
122
Dilated cardiomyopathy (heart failure)
Bisoprolol, carvedilol, and metoprolol
123
dobutamine
inotropic;
## Footnote
Short-term (\<48 hr) management of heart failure caused by depressed contractility from organic heart disease or surgical procedures.
Stimulates beta1 (myocardial)-adrenergic receptors with relatively minor effect on heart rate or peripheral blood vessels.
Therapeutic Effect(s):
Increased cardiac output without significantly increased heart rate.
124
Which antihypertensive agent is preferable for a hypertensive emergency caused by a PHEOCHROMOCYTOMA?
IV phentolamine;
alpha-blocker which can be used to block the catecholamine effects of a pheochromocytoma
125
which medications are associated with periodic sinus arrest?
digitalis, procainamide, quinidine
126
Pulseless ventricular tachycardia?
defibrillation
127
Sinus bradycardia + hemodynamically **STABLE**
monitored closely
128
For managing blood pressure, which two classes of medications should NOT be used together?
ACEis and ARBs
129
ST elevations in II, III, aVF
inferior
Right coronary artery (right dominant)
Left circumflex (left dominant)
130
Which diabetic medications should be avoided in heart failure?
1. Thiazolidinediones (pioglitazone and rosiglitazone)
2. Metformin: risk of lactic acidosis
131
lisinopril
ACEi
