Exam 2 - D-I Cardio

Question 1

What is a normal QTc?

Answer 1

< 470 men, < 480 women

Question 2

What is abnormal QTc defined as? (2)

Answer 2

500 ms or more, or 60 ms from baseline or more

Question 3

What drugs can cause prolonged QT intervals? (6; A-F)

Answer 3

antiarrhythmics, antibiotics (fluoroquinolones, macrolides), antipsychotics (FGAs), antidepressants (citalopram, TCAs), antiemetics, antifungals

Question 4

What are non-modifiable risk factors for Torsades de Pointes? (4)

Answer 4

> 65, female, genetic predisposition, cardiac disease

Question 5

What are modifiable risk factors for Torsades de Pointes? (4)

Answer 5

diuretic treatment, electrolyte abnormalities, >1 QT-prolonging agent, organ function

Question 6

What should potassium and magnesium levels be maintained at to avoid QT prolongation?

Answer 6

K > 4, Mg > 2

Question 7

What are the treatments for Torsade de Pointes? (4)

Answer 7

discontinue offending agents, magnesium PUSH IF NO PULSE AND INFUSION IF PULSE, transcutaenous pacing, isoproterenol infusion

Question 8

What are alternatives for isoproterenol? (2)

Answer 8

epinephrine, atropine

Question 9

What are the treatments for hemodynamically unstable patients? (2)

Answer 9

cardioversion, defibrillation

Question 10

What drugs can cause HF due to sodium and volume retention? (3)

Answer 10

NSAIDs, steroids, thiazolidinediones

Question 11

What drugs can cause HF due to cardiomyopathy? (3)

Answer 11

chemotherapeutic agents (anthracyclines, alkylating agents), biologics (trastuzumab), alcohol

Question 12

What drugs can cause HF due to negative inotropy? (2)

Answer 12

nDHP CCBs, BBs

Question 13

What is a boxed warning for TZDs?

Answer 13

avoid in patients with NYHA III-IV

Question 14

What are the most common topoisomerase 2B agents that can cause cardiac myocyte death? (2)

Answer 14

daunorubicin, doxorubicin

Question 15

What is a treatment for anthracycline induced cardiomyopathy?

Answer 15

dexrazoxane

Question 16

What are treatment-related risk factors for anthracycline induced cardiomyopathy toxicity? (5)

Answer 16

cumulative doses > 400 mg/m^2, dosing schedules, previous anthracycline therapy, radiation therapy, co-admin of cardiotoxic agents

Question 17

What are patient-related risk factors for anthracycline induced cardiomyopathy toxicity? (4)

Answer 17

age, pre-existing CVD, obesity, smoking

Question 18

To what dose should anthracyclines be limited to to prevent cardiomyopathy?

Answer 18

550 mg/m^2 max

Question 19

By what mechanisms can trastuzumab induce cardiomyopathy? (4)

Answer 19

increased ROS, reduced NOS expression, reduced NO bioavailability, increased angiotensin II

Question 20

What is a boxed warning for trastuzumab?

Answer 20

symptomatic and asymptomatic reductions in LVEF and development of HF

Question 21

When should nDHPs be avoided?

Answer 21

EF < 40%

Question 22

When should BBs be avoided?

Answer 22

acute HF exacerbations

Question 23

What drugs/things can cause increased HR and contractility? (5)

Answer 23

cocaine, B-agonists, sympathomimetics, withdrawal of B-blockers, potent vasodilators

Question 24

What drugs can cause increased coronary resistance (vasospasms)? (2)

Answer 24

cocaine, triptans

Question 25

What drugs can cause coronary artery thrombosis/vasospasms? (5)

Answer 25

cocaine, triptans, OCPs, NSAIDs, estrogens

Question 26

What drugs can cause increased cardiovascular risk? (6)

Answer 26

cocaine, OCPs, NSAIDs, estrogens, HIV agents, rosiglitazone

Question 27

Explain a sympathomimetic crisis?

Answer 27

inhibition of reuptake of NE leading to increased NE concentrations and enhanced alpha-1 mediated vasoconstriction

Question 28

What are the treatments for chest pain in a cocaine-induced MI? (2)

Answer 28

aspirin, benzodiazepines

Question 29

What are the treatments for persistent HTN in a cocaine-induced MI? (2)

Answer 29

benzodiazepines, IV nitroglycerin

Question 30

Explain how COX inhibition can cause MI and stroke? (2)

Answer 30

vascular vasoconstriction and increased platelet aggregation

Question 31

What is a boxed warning for NSAIDs?

Answer 31

may increase risk of CV thrombotic events for those with CVD or at risk

Question 32

What are risk factors for acute MI with NSAIDs? (2)

Answer 32

recent initiation of therapy (within 7 days), higher doses