gold usmle: cardio pharm

Question 1

Digoxin

Answer 1

↓ AV nodal conduction/ inh. Na/K/Atpase = inc. Ca conc. in heart cells = inc. contraction force

Question 2

Diltiazem

Answer 2

Txt black men. Txt AV nodal re entrance

Question 3

Quinidine

Answer 3

↓ AV nodal conduction. Cinchonism. Anticholinergic= aggravate MG. Hypotension= α block

Question 4

Verapamil

Answer 4

↓ AV nodal conduction. ↓ BP. Negative inotrope= no CHF use

Question 5

Propranolol

Answer 5

↓ AV nodal conduction. ↓ BP. Negative inotrope(= β block) Aggravates Asthma and Diabetes Melitus via β2 block.

Question 6

Diazoxide

Answer 6

Balanced vasodilator.

Question 7

Niroprusside

Answer 7

Balanced vasodilator. Unloads heart. ↑s cyanide= pre-txt w/ thiosulfate. Txt Acute HTN’v Crisis

Question 8

Reserpine

Answer 8

Txt severe & resistant HTN. Depletes CA. See stuffy nose. No to pts w/ peptic ulcers.

Question 9

Dobutamine

Answer 9

At high doses β2(+) offsets α1 = β1 ↑ CO w/o systemic vascular resistance

Question 10

Dopamine

Answer 10

At low doses Txt Shock= dilates renal and mesenteric aa= maintain urine output

Question 11

Esmolol

Answer 11

Short acting β(-)

Question 12

Captopril

Answer 12

Balanced vasodilator. Txt Outpt. CHF see dry cough(bradykinin induced)

Question 13

Digoxin

Answer 13

Txt CHF & Atrial Flutter - inotropic - ↓ K+ levels= dig. Toxicity

Question 14

Dig. Toxicity

Answer 14

Fatal ventricular arrhythmias w/ sever AV block

Question 15

Quinidine

Answer 15

ClassIa anti arrhythmic. Moderate Na Ch. Block

Question 16

Lidocaine

Answer 16

ClassIb anit arrhythmic. Normalizes conduction. Txt initial MI= control arrhythmias

Question 17

Flecanide

Answer 17

ClassIc anti arrhythmic. Marked conduction slowing

Question 18

Amiodarone

Answer 18

Long t1/2= need potent doses to obtain desired level for action. See blue skin, ocular deposits, Pulmonary Fibrosis.

Question 19

NE

Answer 19

↑ AV nodal conduction via β1. Metoprolol(-) β1

Question 20

Ach

Answer 20

↓ AV nodal conduction via M receptor. Atorpine(-) M-r

Question 21

Atenolol

Answer 21

Controls catecholamine induced arrhythmias

Question 22

Bretylium

Answer 22

Txt Malignant Ventricular Arrhythmias but causes passing catecholamine release that can aggravate arrhythmias
briefly

Question 23

Nimodipine

Answer 23

Txt Acute subarachnoid hemorrhage by preventing post hemorrhagic vasospasm

Question 24

Atropine

Answer 24

↓ excess vagal tone as seen in Sinus Bradycardia

Question 25

Nitrates

Answer 25

↓ preload= venous pooling. ↓ MVO2= reflex tachy. ↑ ventr work= dec O2 demand

Question 26

Propranolol

Answer 26

Blocks reflex tachy but causes excess brady= ↑ diastole time= ↑ EDV

Question 27

Verapamil

Answer 27

↑ O2 supply via ↓ in vasospasm Txt Prinzmetal’s variant angina

Question 28

Aspirin

Answer 28

Prevents arterial platelet adhesion (not DVThrombi). Inactivates COX= ↓ platelet production of TxA2, a potent vasoconstictor

Question 29

Warfarin

Answer 29

(-)Vit. K dependent gamma carboxylation of clotting factors= anticoagulation state

Question 30

Heparin

Answer 30

Dependent on Antithrombin III activation

Question 31

TPA

Answer 31

Binds to fibrin clots & activates plasminogen on the spot. Short t1/2, given IV. 32. Does not discriminate b/t fibrin-based clots= bleeding & stroke complications arise

Question 32

Streptokinase

Answer 32

From bacteria= allergies arise. Can see excess bleeding in post-op pts.

Question 33

Urokinase

Answer 33

Human source. ↑ plasmin. Can see excess bleeding in post-op pts.

Question 34

Colestipol

Answer 34

Bile acid sequestrants. Interrupt bile acid reabsorption= ↑↑ LDL uptake. Cholestyramine same MOA.

Question 35

Lovastatin

Answer 35

HMGCoA reductase(-)= ↑ LDL-r synthesis. Pravastatin/ Mevastatin same MOA.

Question 36

Losartan

Answer 36

↓ Aldosterone. ↑ Renin 2-3x’s

Question 37

Diazoxide

Answer 37

Txt insulinomas. Not balanced vasodilator= onlt dilates arterial smooth muscle

Question 38

Clonidine

Answer 38

Central α2(+). ↓ TPR via ↓ symapthetic effect

Question 39

Methyldopa

Answer 39

Central α2(+). (++) Coombs= Hemolytic anemia

Question 40

Phenytoin

Answer 40

ClassIb. Reverses mild AV block due to digitoxin toxicity

Question 41

Procainamide

Answer 41

ClassIa. SLE like syndrome.

Question 42

Indopamide

Answer 42

Only Thiazide that will have no effect on cholesterol levels

Question 43

Thiazides

Answer 43

Older black men w/ HTN due to ↑ Renin.

Question 44

β(-)

Answer 44

Young white men w/o asthma (cause bronchospasm)

Question 45

ACEIs

Answer 45

(-) change AI ! AII. (-) Bradykinin inactivation. Captopril/ Enalapril 47. Cause renal failure = use w/ caution in the elderly

Question 46

Epinephrine

Answer 46

↑ contraction rate & force via β1. 49. ↑ systolic but ↓ diastolic BP. 50. ↓ peripheral resistance via β2 vasodilaiton

Question 47

Norepi.

Answer 47

↑ heart rate and ↑ systolic and diastolic BP | 52. ↑ peripheral blood vessel resistance

Question 48

Methyldopa

Answer 48

DOC for pregnancy induced HTN

Question 49

Quinidine pre-txt

Answer 49

Atrial arrhythmia pretxt w/ a drug that will ↓ ventricular response: Dig.;β(-); Ca Ch.(-)

Question 50

ClassII

Answer 50

β(-) ↓risk fo reinfarction & sudden death following MI

Question 51

“Gray man”

Answer 51

Amiodarone: ClassIII antiarrhythmia

Question 52

Beperidil

Answer 52

Ca Ch(-). Limited clinical use due to Torsades de Pointes

Question 53

ACEIs

Answer 53

Vasodilate renal efferents > than afferent arterioles: ↓GFR & Filtration pressure 59. ↓ Diabetic renal failure progression

Question 54

Adenosine

Answer 54

Its receptor is blocked by Methylxanthines (ie… Theophyline) | 61. Favored for the Txt of Reentrant Supra Ventricular Tachycardia

Question 55

Enoxaparin

Answer 55

Low molecular weight heparin = Oral anticoagulant

Question 56

Isoproterenol

Answer 56

↑HR & ↓MAP

Question 57

Variant angina

Answer 57

Use Ca Ch. (-)r ie… Nifedipine

Question 58

Contraindicated in | CHF

Answer 58

β (-)r = you don’t want to ↓ the heart’s pumping strength