Pharm Flashcards by Jordana Gilman

heart: (inward/outward) current: the potassium current, I-K1

outward (contributes most to repolarization of cardiac myocyte after an AP, phase 4)

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heart: (inward/outward) current: the fast sodium current, I-Na

inward (phase 0 of AP)

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heart: (inward/outward) current: the L-type calcium current, I-Ca-L

inward, during plateau phase of AP, phase 2

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heart: (inward/outward) current: the pacemaker current, I-f

inward (funny current–activates with hyperpolarization)

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heart: necessary to initiate electrical activation (functioning pacemaker/autonomic innervation/electrical coupling of myocytes/electromechanical coupling)

functioning pacemaker

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heart: necessary to ensure propagation of electrical activation (functioning pacemaker/autonomic innervation/electrical coupling of myocytes/electromechanical coupling)

excitable myocytes and electrical coupling of myocytes

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heart: necessary to translate electrical activation into mechanical contraction (functioning pacemaker/autonomic innervation/electrical coupling of myocytes/electromechanical coupling)

electromechanical coupling

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heart: (duration of P wave/PR interval/shape of QRS complex/duration of QT interval/degree of QT elevation) reflects rate of atrial activation

duration of P wave

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heart: (duration of P wave/PR interval/shape of QRS complex/duration of QT interval/degree of QT elevation) reflects conduction time from atria to the ventricles

PR interval

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heart: (duration of P wave/PR interval/shape of QRS complex/duration of QT interval/degree of QT elevation) reflects adaptation of myocardial cells to changing HR

duration of QT interval

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heart: (duration of P wave/PR interval/shape of QRS complex/duration of QT interval/degree of QT elevation) reflects sequence and rate of activation of the ventricles

shape of QRS

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heart: (duration of P wave/PR interval/shape of QRS complex/duration of QT interval/degree of QT elevation) indicative of ischemia

degree of QT elevation

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heart: (Na/Ca/K current Kr/transient outward K current/K current Ks) reduces propagation velocity in ventricular myocardium when blocked

Na current

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heart: (Na/Ca/K current Kr/transient outward K current/K current Ks) block of these two currents can shorten the AP without affecting propagation velocity in the ventricular myocardium

calcium and Ks

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heart: (Na/Ca/K current Kr/transient outward K current/K current Ks) these two currents are activated during Phase 1 and 2 and do not affect propagation

transient outward K current I-to and I-Kr

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heart: phase (0/1/2/3/4) due to activation of fast voltage gated Na channels

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heart: phase (0/1/2/3/4) due to inactivation of fast sodium channel current and activation of transient outward K current I-to

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heart: phase (0/1/2/3/4) due to inward calcium channels and outward K channels

2 (plateau)

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heart: phase (0/1/2/3/4) due to outward K channels

3 (final phase of repolarization)

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heart: phase (0/1/2/3/4) due to inward rectifier K current

4 (resting)

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heart: conduction of cardiac impulse is (fastest/slowest) in nodal tissues

slowest (SA and AV nodes)

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heart: conduction of cardiac impulse is (fastest/slowest) in His-Purkinje fibers

fastest

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heart: conduction of cardiac impulse in which cells is intermediate velocity

atrial and ventricular cells

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heart: (increases/decreases) HR: parasympathomimetic agent

decreases (hyperpolarize membrane potential)

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heart: (increases/decreases) HR: less negative threshold potential

decreases (will take longer time to reach threshold)

heart: (increases/decreases) HR: vagal stimulation

decreases (release of ACh, hyperpolarizes membrane potential)

heart: (increases/decreases) HR: increased slope of diastolic depolarization

increases (shorter time to threshold)

heart: (increases/decreases) HR: ACh-esterase inhibitors

decreases (prolong affect of ACh, hyperpolarizes membrane potential)

heart: (desmosomes/intercalated disks/T tubules/Gap junctions/Bundles of Kent) are low resistance pathways that allow the propagation of the impulse

Gap junctions

heart: (desmosomes/intercalated disks/T tubules/Gap junctions/Bundles of Kent) mechanical coupling between cells

desmosomes

heart: (desmosomes/intercalated disks/T tubules/Gap junctions/Bundles of Kent) a membrane specialization between cardiac cells

intercalated disk (comprised of desmosomes and gap junctions)

heart: (desmosomes/intercalated disks/T tubules/Gap junctions/Bundles of Kent) invaginations of the sarcolemmal membrane into the cell interior

T tubules

kidney: (acetazolamide/mannitol/cholothiazide/ tramterene/spironolactone) is a carbonic anhydrase inhibitor which decreases bicarbonate reabsorption in the proximal tubule

acetazolamide

kidney: (HCTZ/amiloride/furosemide/isosorbide/indapamide) would benefit a pt taking Lithium having trouble maintaining fluid balance

amiloride (blocks channel mediated lithium uptake by cells in late distal tubule and collecting duct)

kidney: (thiazide/amiloride/furosemide/isosorbide/indapamide) may be prescribed to mitigate the effect of lithium induced diuresis, but requires an assessment of blood lithium levels

thiazide--due to the increase in proximal tubule lithium reabsorption when prescribing thiazides in patients taking lithium

kidney: (thiazide/amiloride) puts patient at risk for hypokalemia

thiazide

kidney: which nephron segment reabsorbs most of the glomerular filtrate

proximal tubule

kidney: the increase in urine volume caused by osmotic diuretics is attributed to its effect in the ______ (nephron segment)

proximal tubule

kidney: (amiloride/HCTZ/furosemide/acetazolamide/aminophylline): limits ability of kidney to conserve fluid volume and make a hyperosmotic urine

furosemide

kidney: (amiloride/HCTZ/furosemide/acetazolamide/aminophylline) decreases solute reabsorption in the medullary thick ascending limb of the LoH, which decreases the counter-current multiplication of solute concentrations

furosemide

kidney: what is the free water clearance when the ECF is neither contracted nor expanded, and the edema has been corrected?

kidney: (toresemide/metolazone/methazolamide/spironolactone/amiloride/isosorbide) inhibits carbonic anhydrase in the proximal tubule

methazolamide

kidney: (toresemide/metolazone/methazolamide/spironolactone/amiloride/isosorbide) inhibits Na, K, Cl Cotransport in the thick ascending limb of the loop of Henle.

torsemide

kidney: (toresemide/metolazone/methazolamide/spironolactone/amiloride/isosorbide) thiazide like diuretic which inhibits Na, Cl cotransport in the early distal tubule

metolazone

kidney: (toresemide/metolazone/methazolamide/spironolactone/amiloride/isosorbide) inhibits Na channels in the late distal tubule and collecting duct

amiloride

kidney: (hypoventilation/bicarbonate infusion/ketoacidosis/increasing titratable acid excretion/increasing ECF pCO2) promotes increased renal clearance of salicylate

bicarbonate infusion, raises pH of tubular fluid

kidney: intravascular volume = _% of body weight

kidney: The Na, Cl cotransporter in the luminal membrane of the early distal tubule is the target of what type of diuretics

thiazide

kidney: Thiazide and thiazide-like diuretics block sodium reabsorption at which nephron segment

early distal tubule

kidney: what type of diuretic is chlorthalidone

thiazide like

kidney: The countercurrent multiplication of the cortical to medullary ion concentration gradient arises from active solute transport in the (thin/thick) ascending limb of the loop of Henle.

thick

kidney: renal wasting of K in the urine induced by diuretics results from an increase in (Na secretion/K secretion/Na reabsorption/K reabsorption) in the late distal tubule

Na reabsorption

kidney: (lumenal membrane Na/basolateral Na-K-Cl cotransport/basolateral K/basolateral Na-K-ATPase/lumenal membrane K) channels couple increased sodium reabsorption to increased K secretion in the cortical collecting duct

basolateral Na-K-ATPase

kidney: thiazide diuretics decrease free water clearance by (a decrease/an increase) in urine osmolarity

an increase

kidney: (mannitol/HCTZ/furosemide/spironolactone/bumetanide) corrects hypercalciuria

HCTZ. thiazides induce an increase in Ca reabsorption from the tubular fluid

kidney: Most of the sulfonamide diuretics present in the tubular fluid arise from secretion in which part of the nephron

proximal tubule

kidney: (amiloride/torsemide/methazolamide/indapamide/dichlorphenamide) most rapidly contracts ECF volume

torsemide (high ceiling loop diuretic which induces the greatest incrase in urine flow rate)

kidney: percentage of renal plasma flow normally filtered in the glomerulus is __%

20%

kidney: (amiloride/torsemide/methazolamide/indapamide/dichlorphenamide) prevents hypokalemia, is a K sparing diuretic

amiloride

kidney: The (ion-ion) cotransporter in the lumenal membrane of the early distal tubule is the target of thiazide diuretics

Na-Cl

kidney: (amiloride/torsemide/methazolamide/indapamide/dichlorphenamide) is a high ceiling/loop diuretic

torsemide (inhibits Na, K, 2Cl cotransport in thick ascending limb of LoH)

kidney: Amiloride and HCTZ both (decrease/increase) calcium reabsorption in the early and late distal tubule and lower calcium concentration in the urine.

increase (corrects hypercalciuria)

kidney: (bumetanide/indapamide/chlorothiazide/triamterene/torsemide) can cause hyperkalemia because it is a K sparing diuretic

triamterene by decreasing K secretion in the late distal tubule

kidney: lithium may induce nephrogenic diabetes insipidus by an effect on which segment of the nephron

collecting duct (interferes with ADH to increase water permeability)

kidney: (positive/negative) free water clearance is a response to dehydration

negative

kidney: acetazolamide increases the concentration of which anion in the tubular fluid

HCO3-

kidney: patient with renal dz and decreased GFR has a failure to respond to high ceiling diuretics because of (a decrease/an increase) in plasma organic anions, which prevents tubular secretion of diuretic

an increase

kidney: Aldosterone-dependent regulation of Na+ reabsorption occurs in which nephron segment

late distal tubule

kidney: (amiloride/torsemide/methazolamide/indapamide/dichlorphenamide) used to prevent stone formation in the kidney

indapamide (thiazide like diuretic)

kidney: Diuresis is a symptom of uncontrolled diabetes mellitus. This diuresis results primarily from a decrease in fluid and solute reabsorption in which segment of the nephron?

proximal tubule (due to high glucose levels, the filtered load of glucose exceeds the resorptive capacity of the prox tubule)

kidney: High ceiling or loop diurectics induce the largest diuresis by inhibition of solute transport in which nephron segment

the thick ascending loop of Henle

kidney: (amiloride/furosemide/indapamide/chlorothiazide/acetazolamide) induces the largest diuresis in the shortest time, reversing a crisis episode of pulmonary edema

furosemide (high ceiling loop diuretic)

kidney: the urine osmolarity of someone with nephrogenic diabetes insipidus is (very high/very low)

very low (100mOsm/kg H2O) because the collecting ducts are unresponsive to ADH and therefore impermeable to water)

kidney: The kidney functions to maintain ECF osmolality constant while responding to a negative Na+ balance by isosmotically (increasing/decreasing) the ECF volume proportionate to the negative Na+ balance while increasing Na+ reabsorption.

decreasing

kidney: Which nephron segment is constitutively “leaky” and unable to maintain an osmotic gradient?

proximal tubule

kidney: (chlorothiazide/furosemide/spironolactone/triamterene) compromises the kidney's ability to compensate for dehydration

furosemide--inhibits medullary solute reabsorption in the thick ascending LoH. Over time, this decreases the cortico-medullary solute conc gradient and the magnitude of negative free water clearance.

kidney: (mannitol/furosemide/bumetanide/triamterene/HCTZ) compensates for diuretic induced hypokalemia

triamterene, a K sparing diuretic which decreases fractional excretion of K

kidney: (amiloride/mannitol/bumetanide/torsemide/chlorothiazide) increases negative free water clearance in patients taking lithium

amiloride (blocks apical membrane channel in late distal tubule and collecting duct which permits access of lithium intracellularly)

kidney: thiazide diuretics control polyuria from nephrogenic diabetes insipidus by an indirect effect on (corticomedullary solute gradient/LoH solute transport/glomerular filtration/collecting duct solute transport)

glomerular filtration. thiazide decreases ECF volume which induces a decrease in GFR (decrease GFR leads to decreased urine excretion)

kidney: (amiloride/spironolactone/chlorothiazide/acetazolamide/aminophylline) slows the time-dependent renal compensation to ECF volume expansion

chlorothiazide--inhibits solute reabsorption in the diluting segment of the nephron which raises the osmolarity of the tubular fluid and urine, decreasing the positive free water clearance in response to ECF expansion

kidney: (amiloride/spironolactone/HCTZ/mannitol/aminophylline) causes hyponatremia in response to excess fluid consumption

HCTZ--inhibits solute reabsorption in the diluting segment of the nephron, raises the osmolarity of tubular fluid and urine, decreases the positive free water clearance in response to ECF volume expansion --> risk for hyponatremia

``` kidney: A localized increase in intravascular hydrostatic pressure will drive an ECF fluid shift from the (interstitial/intravascular) to the (interstitial/intravascular) space. ```

from the intravascular to the interstitial

kidney: at normal hydrostatic pressure, ECF distribution is __% interstitial and __%intravascular

75% interstitial, 25% intravascular

kidney: Which segment of the nephron causes a reduced fractional excretion of Na+ in response to aldosterone?

late distal tubule and collecting duct

kidney: an elevated level of ADH would result in a (higher/lower) urine osmolarity

higher urine osmolarity (increases reabsorption of water, negative free water clearance)

kidney: (furosemide/chlorothiazide/triamterene/spironolactone/amiloride) is a competitive antagonist of the cytoplasmic aldosterone receptor in the late distal tubule and collecting duct

spironolactone (does not interact with a membrane transport protein)

kidney: (amiloride/spironolactone/chlorothiazide/acetazolamide/aminophylline) prevents mountain sickness, controls intraocular fluid pressure, may cause metabolic acidosis

acetazolamide (carbonic anhydrase inhibitor which blocks bicarb transport in proximal tubule)

diuretics: (increase/decrease) excretion of sodium

increase, by defn (water follows solute) EXCEPT mannitol

diuretics: (carbonic anhydrase inhibitor/loop/thiazide/K sparring) cause acidosis, increased urinary excretion of HCO3-

carbonic anhydrase inhibitor (acetazolamide)

diuretics: (carbonic anhydrase inhibitor/loop/thiazide/K sparring) cause increased calcium excretion, alkalosis

loop (ethacrynic acid, furosemide, torsemide)

diuretics: (carbonic anhydrase inhibitor/loop/thiazide/K sparring) cause decreased Ca excretion, alkalosis

thiazide (HCTZ, indapamide, metolazone)

diuretics: (carbonic anhydrase inhibitor/loop/thiazide/K sparring) cause acidosis with decreased K excretion

K sparring (amiloride, triamterene, spironolactone, eplerenone)

diuretics: (carbonic anhydrase inhibitor/loop/thiazide/K sparring): acetazolamide

CA inhib

diuretics: (carbonic anhydrase inhibitor/loop/thiazide/K sparring) ethacrynic acid

loop

diuretics: (carbonic anhydrase inhibitor/loop/thiazide/K sparring) amiloride, triamterene

K sparring

diuretics: (carbonic anhydrase inhibitor/loop/thiazide/K sparring) spironolactone, eplerenone

K sparring

diuretics: (carbonic anhydrase inhibitor/loop/thiazide/K sparring) indapamide, metolazone

thiazide

antiHTN: if a pt is taking HCTZ already and still has HTN, why is it bad to add furosemide?

best to combine tx from different classes. two diuretics will magnify the side effects of diuretic therapy

antiHTN: (beta blockers/loop diuretics/alpha 1 antagonists/thiazide diuretics) have a neutral or beneficial effect on serum lipids

alpha 1 antagonists (the others may raise serum lipids)

antiHTN: a cardioselective beta blocker has greater affinity for beta (1/2), and this selectivity is (enhanced/lost) at high concentrations

greater affinity for 1 (1 heart, 2 lungs) but selectivity is lost at high concentrations

antiHTN: cardioselective beta blocker WITHOUT intrinsic sympathomimetic activity (metoprolol/acebutolol)

metoprolol. (acebutolol) has intrinsic sympathomimetic activity)

antiHTN: pheochromocytoma, oral contraceptives, renal parenchymal dz and renal vascular stenosis can lead to (primary/secondary) HTN

secondary (primary=essential=cause unknown)

antiHTN: pts with essential HTN may benefit from (hormone replacement tx/decreased sodium intake)

decreased sodium intake and other lifestyle changes (decrease alcohol, stop using OCPs)

antiHTN: ______ is a Zn containing metalloproteinase with two active sites that can break down bradykinin, is found in heart and brain

ACE. most abundant in lung, converts angiotensin I to II

antiHTN: recommended to tx HTN in pregnancy (enalapril/losartan/a-methyldopa/captopril/valsartan)

a-methyldopa

antiHTN: cardioselective beta blockers decrease (resorption of sodium in nephron/peripheral resistance/cardiac output)

cardiac output

antiHTN: (beta 1/beta 2/alpha 1/alpha 2) blocker will reduce vascular resistance by blocking receptors on vascular smooth muscle cells

alpha 1 blocker

antiHTN: _____ decreases blood pressure by interfering with the uptake and storage of biogenic amines resulting in depletion or norepinephrine, dopamine, and serotonin in central and peripheral neurons.

Resperpine

antiHTN: antihypertensive that may aggravate gout (enalapril/nifedipine/carvedilol/HCTZ/doxasosin)

HCTZ (side effect is increased serum uric acid levels)

antiHTN: what does it mean for a beta blocker to have intrinsic sympathomimetic activity (ISA)?

they interact with the beta receptor in a manner that interferes with the actions of endogenous NE but results in stimulation of the adrenergic pathway to varying degrees. Such agents act as competitive inhibitors when endogenous sympathetic activity is high, but act as partial agonist when endogenous sympathetic activity is low.

antiHTN: angiotensin receptor blocker (lisinopril/a-methyldopa/losartan/doxasosin)

losartan

antiHTN: ACE inhibitor (lisinopril/a-methyldopa/losartan/doxasosin)

lisinopril

antiHTN: which TWO drugs are beneficial to pts with diabetes and chronic kidney disease (lisinopril/furosemide/a-methyldopa/losartan/doxasosin)

lisinopril and losartan

antiHTN: which drug is associated with cough (lisinopril/a-methyldopa/losartan/doxasosin)

lisinopril ACEi

antiHTN: what two classes of drugs should you use when someone with HTN also has diabetes and chronic kidney dz?

ACEi and angiotensin receptor blocker

antiHTN: example of an ACEi (propranolol/HCTZ/a-methyldopa/enalapril)

enalapril PRIL (lisinopril)=ACEi

antiHTN: what two types of drugs for HTN can cause harm to a developing fetus

ACEi and angiotensin receptor blockers

antiHTN: what type of antiHTN is contraindicated in a pt with asthma

beta blocker (beta agonists are used to treat asthma)

antiHTN: In patients with bilateral renal artery stenosis, glomerular perfusion pressure is maintained by ____ mediated vasoconstriction of the efferent arterioles.

angiotensin II (therefore, do not give a pt with renal artery stenosis an angiotensin receptor blocker, it could lead to decreased GFR and kidney failure)

antiHTN: in a pt at risk of developing osteoporosis, which drug can increase serum Ca levels (enalapril/nifedipine/HCTZ/carvedilol/doxasosin)

HCTZ

``` antiHTN: Hydralazine and amlodipine can (decrease/increase) proteinuria in chronic kidney dz ```

increase (bad)

antiHTN: beta blockers can (improve/worsen) glycemic control in diabetes mellitus

worsen

antiHTN: which antiHTN used in pregnancy can present with a lupus-like syndrome with joint pain and photosensitivity and anemia (amlodipine/losartan/lisinopril/HCTZ/methyldopa)

methyldopa

antiHTN: which drug can cause dose-related peripheral edema and reflex tachycardia (amlodipine/losartan/lisinopril/HCTZ/methyldopa)

amlodipine

antiHTN: (ACEi's/Ca channel blockers/diuretics/direct vasodilators) have a renoprotective effect due to dilation of the efferent arteriole, thus reducing glomerular hyperfiltration

ACE inhibitors act at the efferent arteriole to decrease vascular resistance (dilate) and therefore, prevent an increase in GFR and hyperfiltration.

asthma: (theophylline/cromolyn/betamethasone/prednisone/ipratropium) reverses bronchoconstriction by blocking vagal stimulation

ipratroipium (anticholinergic)

asthma: (theophylline/cromolyn/betamethasone/prednisone/ipratropium) anticholinergic

iprotropium

asthma: (theophylline/cromolyn/betamethasone/terbutaline/ipratropium) given orally or by IV injection or by suppositories

theophylline (mild to moderate bronchodilator)

asthma: (theophylline/cromolyn/salmeterol/albuterol/ipratropium) prevents asthma attacks but does not reverse asthmatic bronchospasm

cromolyn

asthma: (theophylline/cromolyn/albuterol/prednisone/zileuton) used to reverse acute onset of asthmatic bronchospasm

albuterol (beta 2 agonist)

asthma: albuterol is a beta 2 (antagonist/agonist)

agonist

asthma: (theophylline/cromolyn/albuterol/prednisone/ipratropium) decreases reflex bronchoconstriction caused by inhaled irritants

ipratropium (blocks vagal pathway, mediating reflex bronchoconstriction)

asthma: oral (beta 2 agonist/corticosteroid) has greatest side effects

oral corticosteroid

asthma: (oral/inhaled) corticosteroid has greatest side effects

oral

asthma: albuterol decreases bronchoconstriction by acting on (mast cells/basophils.smooth muscle/microvascular endothelium)

smooth muscle

``` angina: ____ (drug class) increase myocardial O2 consumption (reflex increased in heart rate and contractility), while others tend to decrease myocardial oxygen consumption (decreased preload with consequent decrease in end -diastolic pressure, decreased systolic blood pressure and decreased ventricular volume). ```

nitrates

cardiac: (digoxin/dobutamine/inamrione/dopamine/isoproterenol) inhibits troponin I

digoxin

cardiac: (digoxin/dobutamine/inamrione/dopamine/isoproterenol) blocks alpha 2 receptors

isoproterenol

cardiac: (digoxin/dobutamine/inamrione/dopamine/isoproterenol) inhibits Na-K ATPase

inamrione

cardiac: (digoxin/dobutamine/inamrione/dopamine/isoproterenol) beta 1 receptor agonist, positive inotrope and chronotrope

dobutamine

cardiac: (enalapril/propranolol/isosorbide dinitrate/NE/digoxin) for CHF, reduces dyspnea, pulm edema, and systolic dysfunction by decreasing left ventricular afterload

enalapril (ACEi that selective vasodilates arteries)

cardiac: (enalapril/propranolol/isosorbide dinitrate/NE/digoxin) reduces cardiac output, do not use for CHF

propranolol

cardiac: (enalapril/propranolol/isosorbide dinitrate/NE/digoxin) selective venodilator

isosorbide dinitrate

cardiac: treat diastolic heart failure with (dobutamine/verapamil/digoxin/hydralazine/isosorbide dinitrate)

isosorbide dinitrate--reduces filling pressure without reducing cardiac output

cardiac: (diastolic/systolic) heart failure: dyspnea, near normal ejection fraction

diastolic

cardiac: (diastolic/systolic) heart failure: decreased ejection fraction

systolic

cardiac: (dobutamine/verapamil/digoxin/hydralazine/isosorbide dinitrate) is a calcium channel blocker

verapamil

cardiac: agents with positive inotropic actions (are/are not) indicated if systolic function is normal

are not

cardiac: (dobutamine/verapamil/digoxin/hydralazine/isosorbide dinitrate) is a vasodilator whose major effects occur in the arterial circulation

hydralazine

cardiac: (propranolol/dobutamine/carvedilol/bucindolol/inamrione) (2) third-generation beta blockers

carvedilol and bucindolol

cardiac: (propranolol/dobutamine/carvedilol/aspirin/inamrione) reduces afterload to counteract the negative inotropic properties of adrenergic withdrawal, may even increase cardiac output

carvedilol (third gen beta blocker)

cardiac: (propranolol/dobutamine/carvedilol/aspirin/inamrione) contraindicated in heart failure

propranolol

cardiac: (propranolol/dobutamine/carvedilol/aspirin/inamrione) (2) can only be used for in-hospital treatment of heart failure that is refractory to conventional medication

dobutamine and inamrione

cardiac: ST elevation in normal complexes suggest what?

myocardial ischemia

cardiac: ____ rhythm: a P wave precedes each normal beat

sinus

angina: nitroglycerin action (coronary vasodilation/reduced preload/reduced afterload/coronary vasoconstriction/increased ejection time)

reduced preload (relaxation of smooth muscle, especially in venous circulation)

cardiac: (phenylephrine/clopidogrel/nitroglycerin/metaraminol/isoproteronol) side effect: orthostatic hypotension

nitroglycerin (weakness, syncope, dizziness)

why would you see rapid HR after administration of nitroglycerin?

reflex sympathetic discharge due to a fall in systemic blood pressure

atrial flutter: use digitalis to (slow rate of firing at SA node/slow conduction through AV node/decrease refractory period through AV node/decrease rate of conduction through atrial muscle)

slow conduction through AV node by enhancing its vagal tone and diminishing sympathetic activity, direct inhibitory effect on AV propagation

nitrates in angina pectoris: (increase preload/decrease systolic BP)

decrease systolic BP. may cause reflex increase in HR, ventricular size decrease, peripheral venous pooling

(decreased peripheral resistance/metabolic vasodilation/alpha adrenergic stimulation/release of ACh) causes increase in coronary blood flow during exercise

metab vasodilation

nitroglycerin reduces myocardial oxygen needs by reducing (CO/HR/coronary flow/intramyocardial tension)

intramyocardial tension

three major determinants of myocardial oxygen consumption: systolic wall tension, contractility, and ___

what causes lethargy and weakness in a patient taking furosemide for CHF?

hypokalemia

a patient with CHF being treated with furosemide who has developed hypokalemia should receive which type of diuretic in addition?

K sparring, like triamterene

when digitalis therapy is initiated, serious cardiac arrhythmias may be caused by what element deficiency? (Na/K/Cl/Ca/Zn)

potassium (take care when using diuretics in conjunction with digitalis)

initial treatment of mild CHF (diuretic/Ca channel blocker/phosphodiesterase inhibitor/first gen beta blocker/catecholamine)

diuretic

whenever there is an increase in oxygen demand, the coronary vascular resistance (increases/decreases)

decreases, with a consequent increase in coronary blood flow

angina pectoris: immediate relief (esmolol/nifedipine/propranolol/nitroglycerin/isosorbide dinitrate)

sublingual nitroglycerin

prevents tachycardia induced by a bolus IV injection of nitroglycerin: (propranolol/isoproterenol/phenoxybenzamine/phentolamine/dobutamine)

propranolol--blocks beta receptors in the heart

lipids: what type of drug is colestipol

bile acid sequestrant

lipids: what type of drug is prescribed for children

bile acid sequestrant (safe)

lipids: what type of drug lowers serum cholesterol by inhibiting a sterol transporter in the endothelial cells of the small intestine (PSCSK9 inhib/ezetimibe/HMG CoA Reductase Inhib-statins/bile acid sequestrant/fibrates/niacin)

ezetimibe

lipids: what type of drug is colesevelam (PSCSK9 inhib/ezetimibe/HMG CoA Reductase Inhib-statins/bile acid sequestrant/fibrates/niacin)

bile acid sequestrant

lipids: what type of drug binds to cholesterol and causes its fecal excretion (PSCSK9 inhib/ezetimibe/HMG CoA Reductase Inhib-statins/bile acid sequestrant/fibrates/niacin)

bile acid sequestrant

lipids: what type of drug is bezafibrate

fibrate

lipids: what type of drug stimulates fatty acid oxidation and LPL synthesis

fibrate

lipids: statins (PSCSK9 inhib/ezetimibe/HMG CoA Reductase Inhib/bile acid sequestrant/fibrates/niacin)

HMG CoA Reductase Inhibitor

lipids: ___ inhibits LDL oxidation in arteries, absorbs cholesterol from cell membrane turnover, delivers cholesterol from peripheral tissues to liver

HDL--increased levels decrease risk of CAD

lipids: cholesterol (increases/decreases) activity of HMG CoA reductase

decreases

lipids: cholesterol (inactivates/activates) ACAT - acetyl coA: cholesterol acetyltransferase

activates

lipids: cholesterol (increases/decreases) txn of the LDL receptor gene

decreases

lipids: what type of drug produces its effect by binding to and activating the peroxisome proliferator-activated receptor α (PPARα)? (niacin/fibrate/bile acid sequestrant/statin/ezetimibe)

fibrate (ex. fenofibrate)

lipids: _____ is a nuclear receptor expressed in skeletal muscle, cardiac muscle, hepatocytes, and macrophages, and fibrates work on this receptor

PPAR alpha

lipids: resins have (many/few) side effects and are (rarely/safely) prescribed in combo with statins or ezetimibe

few side effects, safely combined

lipids: a combination of fibrate with a ___ (drug type) is inadvisable due to increased risk of myositis

statin

lipids: 2 resins (nicotinic acid/bezafibrate/cholestyramine/ezetimibe/colesevelam)

cholestyramine and colesevelam

lipids: (nicotinic acid/bezafibrate/cholestyramine/ezetimibe/colesevelam) best agent for increasing HDL-C, lowers triglycerides, and lowers LDL-C by 25%

nicotinic acid

lipids: (nicotinic acid/fibrates/ezetimibe/resins) have no effect on HDL-C levels and can actually increase serum TG's (triglycerides)

resins

lipids: (nicotinic acid/fibrates/ezetimibe/resins) insignificant effects on TGs and HDL-C levels

ezetimibe

lipids: (nicotinic acid/fibrates/ezetimibe/resins) variable effects on LDL-C and modest increases in HDL-C

fibrates

lipids: combination tablet of ezetimibe and ____ is marked because of their complementary mechanistic effects on lowering LDL-C levels

simvastatin (Vytorin)

lipids: first statin studied in humans, but not marketed as a drug (mevastatin/simvastatin)

mevatatin

lipids: how do statins work to lower serum cholesterol levels

increased LDL-receptor gene txn

lipids: statins: (increased/decreased) intracellular cholesterol activates an hepatic protease, which activates a sterol regulatory element binding protein (SREBP), which increases transcription of the LDL-R gene. Increased expression of LDL-R increases hepatocyte absorption of LDL-C, thus producing a fall in serum cholesterol levels.

decreased

antiarrhythmics: cardiac glycoside toxicity induced v tach is likely caused by (increased pacemaker activity/AV node reentry/early after depolarizations/delayed after depolarizations/atrial ectopic focus)

DADs

antiarrhythmics: Increases in diastolic [__ (ion)]i activate a transient inward cation current the produces DADs.

Ca2+

antiarrhythmics: cardiac glycosides (do not affect/affect) normal automatic mechanisms

do not affect, and therefore will not increase pacemaker automaticity or an atrial ectopic focus

antiarrhythmics: early after depolarizations are enhanced by (increased/decreased) QT interval duration

increased

antiarrhythmics: Increasing ___ (ion) currents will suppress EAD formation.

K+

antiarrhythmics: ______ are the primary mechanism for prolonged QT interval arrhythmias and are enhanced by increases in INa or ICa,L and slow heart rates.

early after depolarizations

antiarrhythmics: Mobitz Type (1/2) 2nd degree AV block, or Wenckebach phenomenon, is characterized by a gradually increasing PR interval until a ventricular beat is dropped.

type 1

antiarrhythmics: Which type of cardiac arrhythmia is least likely to require an artificial pacemaker? (sick sinus syndrome/mobitz type II 2nd degree AV block/trifascicular block/3rd degree AV block/Mobitz type I 2nd degree AV block)

mobitz type 1

antiarrhythmics: Mobitz Type I 2nd degree AV block is typically caused by excessive vagal tone and usually responds to _____ (M2 receptor blockade).

atropine

antiarrhythmics: Wolff Parkinson White syndrome (will/will not) be terminated by vagal stimulation

will not--may become worse

antiarrhythmics: v tach (will/will not) be terminated by vagal stimulation

will not

antiarrhythmics: Automatic AV junctional tachycardia may be slowed, but not terminated, by vagal stimulation or ______.

adenosine

antiarrhythmics: which tachycardia is most likely to be terminated by vagal stimulation? (paroxysmal SVT/atrial tach/automatic AV junctional tach/v tach/WPW syndrome tach)

paroxysmal SVT

antiarrhythmics: Atrial tachycardia is usually caused by an | automatic ____ activity and will not be terminated by increased vagal tone.

ectopic

antiarrhythmics: drug of choice for Mobitz type I 2nd degree AV block (quinidine/procainamide/propranolol/verapamil/atropine)

atropine--because Mobitz Type I is caused by excessive vagal tone, so it can be reversed by atropine

antiarrhythmics: 2 drugs that may worsen heart block (quinidine/procainamide/propranolol/verapamil/atropine)

quinidine and procainamide

antiarrhythmics: 2 drugs that further slows AVN conduction in AVN heart block (quinidine/procainamide/propranolol/verapamil/atropine)

propranolol and verapamil

antiarrhythmics: Class (Ia/Ib/Ic/II/III/IV) Na channel blockers

Class I

antiarrhythmics: Class (Ia/Ib/Ic/II/III/IV) quinidine, procainamide, disopyramide

antiarrhythmics: Class (Ia/Ib/Ic/II/III/IV) lidocaine, mexiletine (oral)

antiarrhythmics: Class (Ia/Ib/Ic/II/III/IV) flecainide, propafenone, moricizine

antiarrhythmics: Class (Ia/Ib/Ic/II/III/IV) beta blockers

antiarrhythmics: Class (Ia/Ib/Ic/II non selective/II beta i selective/II fast acting/III/IV) propranolol, carvedilol

non selective II

antiarrhythmics: Class (Ia/Ib/Ic/II non selective/II beta i selective/II fast acting/III/IV) metoprolol, acebutolol

II beta i selective

antiarrhythmics: Class (Ia/Ib/Ic/II non selective/II beta i selective/II fast acting/III/IV) esmolol

fast acting

antiarrhythmics: Class (Ia/Ib/Ic/II non selective/II beta i selective/II fast acting/III/IV) prolong phase 3

III

antiarrhythmics: Class (Ia/Ib/Ic/II non selective/II beta i selective/II fast acting/III/IV) K channel blockers, sotalol

III

antiarrhythmics: Class (Ia/Ib/Ic/II non selective/II beta i selective/II fast acting/III/IV) ibutilide, dofetilide

III

antiarrhythmics: Class (Ia/Ib/Ic/II non selective/II beta i selective/II fast acting/III/IV) amiodarone, dronedarone

III mixed

antiarrhythmics: Class (Ia/Ib/Ic/II non selective/II beta i selective/II fast acting/III/IV) Ca channel blockers

antiarrhythmics: Class (Ia/Ib/Ic/II non selective/II beta i selective/II fast acting/III/IV) phenylalkamines

antiarrhythmics: Class (Ia/Ib/Ic/II non selective/II beta i selective/II fast acting/III/IV) verapamil

IV example of phenylalkamine

antiarrhythmics: Class (Ia/Ib/Ic/II non selective/II beta i selective/II fast acting/III/IV) benzothiazepines

antiarrhythmics: Class (Ia/Ib/Ic/II non selective/II beta i selective/II fast acting/III/IV) diltiazam

IV example of benzothiazepines

antiarrhythmics: Class (Ia/Ib/Ic/II non selective/II beta i selective/II fast acting/III/IV) dihydropyridines

antiarrhythmics: Class (Ia/Ib/Ic/II non selective/II beta i selective/II fast acting/III/IV) nifeidipine, amlodipine, felodipine, isradipine

IV example of dihydropyridines

carhart: contraindicated in seasonal wheezing (atorvastatin/clopidogrel/enalapril/propranolol/valsartan)

propranolol beta blocker contraindicated in asthma

carhart: most important ion in determining the electrophysio changes of myocardial ischmia

extracellular K: greatest impact on the AP

carhart: dipyridamole increases intracellular cAMP and inhibits the uptake/degradation of (NE/renin/AT I/5-HT/adenosine)

adenosine

carhart: dipyridamole inhibits the breakdown of adenosine, which leads to (vasodilation/anti-platelet action)

vasodilation

carhart: dipyridamole increases cAMP, which leads to (vasodilation/anti-platelet action)

anti platelet

carhart: (oxygen therapy/beta blocker) have a positive impact on mortality in acute ST elevation MI

beta blocker. Oxygen has not demonstrated mortality benefits.

carhart: thrombolytic therapy in acute MI with ST elevation (reduces mortality/has no impact on mortality)

reduces mortality. as does aspirin

carhart: BNP levels are measured to assess _____ status

volume

carhart: lactate levels rise with poor _____

perfusion

carhart: __ (ion) levels increase with the use of spironolactone and need to be monitored frequently

K+

carhart: what is the effect of spironolactone used in heart failure on Na and creatinine levels?

the dose used in heart failure therapy does not cause significant diuresis

carhart: (adenosine/endothelin) causes coronary artery dilation

adenosine

carhart: (beta 2 agonists/endothelin) causes smooth muscle contraction and vasoconstriction of coronary arteries

endothelin

carhart: peripheral edema side effect (amlodipine/furosemide/isosorbide mononitrate/metolazone/metoprolol)

amolodipine (15% incidence of this effect)

carhart: dihydropyridine Ca channel blocker (amlodipine/furosemide/isosorbide mononitrate/metolazone/metoprolol)

amlodipine

carhart: (dipyridamole/heparin/clopidogrel/nitroglycerin) has clear anti platelet effects

clopidogrel--thienopyridine derivative

carhart: (dipyridamole/heparin/clopidogrel/nitroglycerin) anticoagulant, works on thrombin (not platelets)

heparin

carhart: (dipyridamole/heparin/clopidogrel/nitroglycerin) secondary anti platelet effects, but is not considered an aspirin alternative

nitroglycerin

carhart: (dipyridamole/heparin/clopidogrel/nitroglycerin) may worsen ischemia

dipyridamole

carhart: four drug classes that have a mortality benefit in pt with stable angina

beta blockers, aspirin, ACEi's, statins

carhart: (sildenafil/quinidine) quality of life drug in pt with stable angina

sildenafil (viagra)

carhart: (sildenafil/quinidine) anti arrhythmic which actually increases risk of death in pt with stable angina

quinidine

carhart: nitrates, Ca channel blockers, ticlopidine improve symptoms in pt with stable angina. what is their effect on mortality?

do not demonstrate a survival benefit

carhart: ACEi's (increase glomerular filtration pressure/block the release of vasopressin)

block the release of vasopressin. (GFR decreases)

``` carhart: thrombolytic contraindications (4) A. Adenocarcinoma of the colon B. Aortic dissection C. Intracranial hemorrhage D. Pregnancy E. Recent facial trauma ```

B. Aortic dissection C. Intracranial hemorrhage D. Pregnancy E. Recent facial trauma

``` carhart: absolute contraindications of thrombolytics (3) B. Aortic dissection C. Intracranial hemorrhage D. Pregnancy E. Recent facial trauma ```

B. Aortic dissection C. Intracranial hemorrhage E. Recent facial trauma

``` carhart: relative contraindication of thrombolytics (1) B. Aortic dissection C. Intracranial hemorrhage D. Pregnancy E. Recent facial trauma ```

pregnancy

carhart: reduced in the setting of heart failure (aldosterone/melatonin/endothelin)

melatonin

carhart: elevated in the setting of heart failure (tumor necrosis factor/melatonin)

TNF

carhart: what should you give instead if captopril is giving a dry cough

ARB (sartan)

carhart: what do statins increase that cause dry cough

bradykinin

carhart: treats CAD by relaxing vascular smooth muscle by increasing intracellular cGMP (isosorbide dinitrate/bisoprolol/enalapril)

isosorbide dinitrate

carhart: isosorbide dinitrate increases intracellular (cAMP/cGMP)

cGMP

carhart: treats CAD by acting on the myocardium (isosorbide dinitrate/bisoprolol/enalapril)

bisoprolol (beta 1 selective)

carhart: verapamil and diltiazem are in what drug class

non dihydropyridine Ca channel blockers

carhart: nondihydropyridine Ca channel blocker (enalapril/bisoprolol/verapamil)

verapamil

carhart: nondihydropyridine Ca channel blocker (isosorbide dinitrate/diltiazem)

diltiazem

carhart: used to treat fluid retention in chronic heart failure (diltiazem/aldactone/nifedipine/furosemide)

furosemide

carhart: 2 vasodilator drugs (diltiazem/aldactone/nifedipine/furosemide)

diltiazem and nifedipine

Pharm Flashcards

(270 cards)