Kaplan

Question 1

What does the relatively high resting potential of the slow response fiber indicate?

Answer 1

They can fire AP by themselves

Question 2

What ions are responsible for the AP of slow response fiber?

Answer 2

Slow Ca current and then delayed K current

Question 3

How are Na/Ca/K channels and pacemaker current in slow response fiber affected with beta 1 receptor? what about M2?

Answer 3

Gs open Na/Ca channel and close K channel for AP/steepen pacemaker current/Gi does the opposite—>flatten the pacemaker current

Question 4

What is the m and h gate of Na channel?

Answer 4

M is the activation gate

H is the inactivation gate—>responsible for refractory period

Question 5

What do class Ia/b/c Na channel blockers block?

Answer 5

Ia—>block activated form of Na channel (both m and h gate are opened)
Ib—>block inactivated form (m open, h closes)—>prevent the channel from going back to be activated and firing
Ic—>block resting

Question 6

Which class of Na channel is used for arrhythmic post MI?

Answer 6

Class Ib

Question 7

Na is reabsorbed the most in what part of the nephron? and what follows it?

Answer 7

Proximal tubule/bicarb, Cl and water

Question 8

What is the permeability of thin descending limb?

Answer 8

Water reabsorption w/o solutes reabsoption

Question 9

Diuretics causes ___ and ___?

Answer 9

Hypokalemia and alkalosis

Question 10

Osmotic diuretics work on what part of the nephron and mainly which part?

Answer 10

the entire tubule/mainly on proximal tubule

Question 11

Carbonic anhydrase inhibitor increase ___ and ___ con. inside of the lumen?

Answer 11

Na and HCO3-

Question 12

What symptoms carbonic anhydrase inhibitor treat regarding acute mountain sickness?

Answer 12

1. Respiratory alkalosis caused by hyperventilation

2. Edema caused by increase hydrostatic pressure from hypoxic vasoconstriction

Question 13

How does renal stone happens with carbonic anhydrase?

Answer 13

Increase urine pH

Question 14

Loop diuretics causes hypo___?

Answer 14

hypo every single ions!

Question 15

For treating HTN, loop diuretics vaso___ by increasing ___? what drug can cancel this effect?

Answer 15

vasodilate/increasing prostaglandin/NSAIDs

Question 16

Why is sulfonamide common in drugs and what drugs have sulfur in them? (watch for allergic reactions)

Answer 16

Sulfur containing drugs are lipid soluble and binds to protein/all the sulf- and thio- drugs have sulfur in them—>as well as carbonic anhydrase inhibitor, loop diuretics except for ethacrynic acid

Question 17

Weak acid diuretic drugs (thiazide) that is secreted in the proximal tubule competes with ___? which causes ___?

Answer 17

Urinate/hyperuricemia (contraindicates in pt with gout)

Question 18

Thiazide causes hypo/hypercalcemia? that as a result treats ___?

Answer 18

Hypercalcemia/nephrolithiasis (Ca stone)

Question 19

Thiazide causes ___ release and should be avoided with ___ pts?

Answer 19

Insulin resistance—>hyperglycemia/hyperlipidemia/diabetes mellitus pts
Turn borderline diabetics into full blown diabetics

Question 20

Diuretics causes drop of __ and __? but eventually ___ returns to normal?

Answer 20

BP and CO/CO

Question 21

Which is more potent, ACEI or ARB?

Answer 21

ACEI (due to inhibition of the breakdown of bradykinin)

Question 22

Why do use ACEI for chronic kidney disease?

Answer 22

e.g. HTN causes kidney failure—>kill a lot of glomeruli—>the remaining glomeruli compensate and over work—>RAS is activated—>further kidney damage and more glomeruli die—>if block RAS with ACEI—>kidney function decrease but eventually plateau (prevent burnout)

Question 23

With a drug that decrease symp tone to decrease BP, you would expect to see?

Answer 23

No reflex tachy/orthostatic HoTN/increase parasymp

Question 24

Alpha 2 receptor is G_ coupled?

Answer 24

Gi

Question 25

Alpha 2 agonist drugs for HTN would interact with what other drugs?

Answer 25

TCA

Question 26

Reserpine causes severe?

Answer 26

Depression

Question 27

Beta blocker would decrease ___ so it is contraindicated in pt with high ___?

Answer 27

Lipolysis--->increase lipid in blood/lipid

Question 28

What are the 2 groups of HTN drugs that do not have reflex tachycardia?

Answer 28

Alpha 2 agonist/beta blockers

Question 29

What are the 2 drugs for HTN in during pregnancy?

Answer 29

Methyldopa/hydralazine

Question 30

Long term use of minoxidil induces?

Answer 30

Diabetes

Question 31

Which one has stronger vasodilating effect, dihydropridine or non-dihydropyridine?

Answer 31

Dihydropyridine

Question 32

What drugs causes gingival hyperplasia?

Answer 32

Dihydropyridine

Question 33

ACEI/ARB causes hyper or hypokalemia?

Answer 33

Hyperkalemia (lack of aldosterone)

Question 34

Use ACEI/ARB for pt with renal stenosis will induce?

Answer 34

Acute renal failure

Question 35

What would class Ia anti arrhythmic drugs do to phase 0 and the AP?

Answer 35

Decrease the slope of phase 0/prolonged AP

Question 36

What is causing Quinidine's pro arrhythmia effect?

Answer 36

M and Alpha blockade---->tachycardia

Question 37

Hyper or hypokalemia would worsen LQT?

Answer 37

Hyperkalemia

Question 38

What are the 4 drugs that cause SLE like syndrome?

Answer 38

Hydrazine/procainamide/isoniazid/methydopa

Question 39

How does thiazide treat nephrogenic diabetes insipidus?

Answer 39

Increase aldosterone release in distal tubule and increase water reabsorption

Question 40

What does class Ib drug do to the AP?

Answer 40

decreases the duration of AP

Question 41

Beta blocker for anti arrhythmia work on ___ and ___ node and promote ___?

Answer 41

SA and AV node/parasymp

Question 42

What does beta blocker do to the pacemaker AP?

Answer 42

Decrease the slope of phase 4--->takes longer for it to achieve another AP

Question 43

What drugs causes pul fibrosis?

Answer 43

Amiodarone/bleomycin

Question 44

Class IV anti arrhythmic drugs work on ___ and ___ in the heart? and what does do to the pacemaker AP?

Answer 44

SA and AV node/decrease phase 0

Question 45

You need to give ___ before you give quinidine?

Answer 45

Digoxin

Question 46

What is the mechanism of adenosine?

Answer 46

Gi coupled--->decrease cAMP--->decrease AV and SA node activity

Question 47

Carvedilo/labetolol/ACEI/ARB/spironolactone are used for?

Answer 47

Interfere with negative cardiac remodeling--->increase survival of CHF

Question 48

Digoxin is used for? and how does it work?

Answer 48

Increase contractility--->increase CO in CHF pts and also for SVT/inhibit Na/K pump--->increase intracellular Na and Ca leve

Question 49

What does milrinone do?

Answer 49

Increase contractility for heart failure pts

Question 50

What is the side effect of Digoxin?

Answer 50

Cardiac arrhythmia

Question 51

Digoxin interact with ___ to increase toxicity?

Answer 51

Diuretics (hypokalemia)

Question 52

What anti arrhythmic drugs treat SVT?

Answer 52

Class II and IV/adenosine/Digoxin

Question 53

What to give for WPW pts?

Answer 53

Class Ia and III

Question 54

How does nitrite work?

Answer 54

Venodilate at smooth muscle cell of the large veins--->decrease preload--->decrease cardiac work and O2 demand

Question 55

Difference in mechanism of dihydropyridine and non dihydropyridine?

Answer 55

Non di---->work on heart--->decrease contractility | di--->coronary vasodilator

Question 56

Don't use beta blocker for ___ angina?

Answer 56

Vasospastic (printzmetal)

Question 57

How does cAMP cause smooth muscle relaxation?

Answer 57

cAMP phosphorylates (inactivate) myosin light chain kinase

Question 58

High cholesterol causes low ___ receptor on hepatocyte? which results in?

Answer 58

LDL (liver don't need more fat anymore)/the formation of plaque

Question 59

What is the mechanism of statin?

Answer 59

Inhibit HMG-CoA--->decrease liver cholesterol--->increase LDL receptor--->decrease plasma LDL Also decrease TG

Question 60

Statin should not be used with gemfibrozil because?

Answer 60

Increased risk for rhadomyolysis

Question 61

Bile aid sequestrants are contraindicated in hyperTG pts because?

Answer 61

It forces liver to take up LDL and then produces more VLDL--->causes hyperTG

Question 62

What can you give to counter the side effect of niacin?

Answer 62

Aspirin

Question 63

Asthma is under the category of ___? and it is characteristics of ?

Answer 63

COPD/bronchospasm

Question 64

What to give for acute and chronic asthmatic response?

Answer 64

Acute--->bronchodilator | Chronic--->anti-inflammatory

Question 65

What are the 3 factors that causes bronchoconstriction?

Answer 65

ACh/Adenosine/leukotriene

Question 66

What mediates bronchodilation? what kind of drugs can achieve these?

Answer 66

Increase cAMP and cGMP/Beta 2 agonist and phosphodiesterase inhibitor

Question 67

What is the side effect for beta 2 agonist for asthma?

Answer 67

Epi like effect--->fight or flight (anxiety and what not)/eventually go away

Question 68

What is the drug of choice for pt on beta blocker that experience bronchospasm?

Answer 68

Ipratropium

Question 69

What is status asthmaticus?

Answer 69

Acute asthma over 60 mins

Question 70

What else is cromoglycate and nedocromil used for?

Answer 70

Seasonal allergy

Question 71

Should we treat HTN in women more conservatively or aggressively?

Answer 71

Aggressively

Question 72

How does ACEI prevent kidney failure and diabetic nephropathy? and what do you expect to see at the beginning of the treatment?

Answer 72

ACEI decrease GFR purposely to reduce hyperfiltration-->eventually level off/increase in creatine due to decrease in GFR

Question 73

What is the first line treatment for HTN in general?

Answer 73

ACEI/diuretics

Question 74

Why thiazide is use the most for diuretics for HTN?

Answer 74

Long acting

Question 75

When do you use loop instead of thiazide for HTN?

Answer 75

When GFR is

Question 76

What should you consider when giving diuretics to athletes?

Answer 76

It dehydrate ppl, lowers CO and make people feel fatigue

Question 77

Thiazide might push people on the edge of being ___ to be ___?

Answer 77

Diabetics

Question 78

Beta blockers causes ___ unawareness

Answer 78

Hypoglycemic (caution to use with diabetics) | Beta blockers raise serum glucose

Question 79

HTN pt with CAD, give?

Answer 79

CCB

Question 80

Di or non-di are good for chronic kidney disease?

Answer 80

Non-di

Question 81

Beta blocker can worsen?

Answer 81

Asthma

Question 82

Does beta block increase or decrease serum lipid?

Answer 82

Increase

Question 83

What are beta blockers with sympathomimetic activity?

Answer 83

Partial agonist of beta receptors (less effective)

Question 84

EAD is worsen by high or low HR/long or short QT interval?

Answer 84

Low HR and long QT interval

Question 85

Mobitz type I AV block response to?

Answer 85

Anti parasymp (atropine)

Question 86

What to give pt with diastolic CHF?

Answer 86

Nitrite/diuretics

Question 87

What are the 3 beta blockers that decrease morbidity in HF?

Answer 87

Carvediolol/metoprolol/bisoprolol

Question 88

What is the side effect of nitrite besides HoTN?

Answer 88

Headache

Question 89

If a HF pt cant get ACEI or ARB, give what?

Answer 89

Hydralazine or nitrite