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Flashcards in Pharmacology Deck (141):
1

Antiarrhythmics (AA) causing increased QT interval

quinidine and procainamide (IA) AND AND disopyramide, amiodarone, sotalol, dofetilide

2

Antibiotics causing increased QT interval

azithromycin, clarithromycin, erythromycin (macrolides) AND trimethoprim-sulfamethoxazole, ketoconazole AND pentamidine, some flouroquinolones, mefloquine

3

Amiodarone (Cordarone), bretylium, ibutilide and sotalol (Betapace®) are class... antiarrhythmic drugs.

class III antiarrhythmic

4

Cough headache, ice-pick headache syndrome, chronic paroxysmal hemicrania and other syndromes such as effort migraine, coital headache, and hemicrania continua respond to ...

indomethacin

5

Macrolides are…

ACE: azithromycin, clarithromycin, erythromycin

6

… and … are diuretics that competitively inhibit the mineralocorticoid (aldosterone) receptor.

Spironolactone / eplerenone

7

Pleuresy is often the presenting symptom in … induced by procainamide, hydralazine, minocycline, diltiazem and other Rx.

SLE

8

Lidocaine, tocainide are class... antiarrhythmic drugs.

IB

9

The ... drugs act by modulating or closing the sodium channels, thereby inhibiting phase 0 depolarization.

class I antiarrhythmic

10

Drugs causing metabolic coma are ..., ... and ....

benzodiazepines AND barbiturates AND opioids

11

Flecainide (Tambocor™), propafenone (Rythmol) are class... antiarrhythmic drugs.

IC

12

... block the potassium channels, thereby prolonging repolarization and the duration of the action potential and the refractory period, manifested on the surface ECG by prolongation of the QT interval.

Class III antiarrhythmics

13

As a general rule, any herbs starting with the letter “G” should raise concern about possible …

Bleeding disorders

14

… root or extract taken in high doses may interact with antihypertensives and cause hypertension by allowing endogenous cortisol to act as a mineralocorticoid.

Licorice

15

Intravenous … is the single most effective intervention for the management of TCA cardiovascular toxicity, because it can reverse QRS prolongation, ventricular arrhythmias, and hypotension.

sodium bicarbonate

16

There are multiple, mostly nonspecific manifestations of …: fatigue, blurred vision, disturbed color perception, anorexia, nausea, vomiting, diarrhea, abdominal pain, headache, dizziness, confusion, delirium, and occasionally hallucinations

digitalis toxicity

17

Concomitant ingestion of … (food) and certain dihydropyridine calcium channel blockers may elevate the plasma concentration of the latter, possibly leading to hypotension

grapefruit juice

18

… used as a sedative, it can lead to dermatitis, hallucinations, SOB, liver toxicity.

Kava-kava

19

… may be the most frequent adverse reaction to herbal remedies (Jin Bu Huan, Ma-Huang, germander, valerian, mistletoe, skullcap, chaparral leaf, comfrey), and herbal teas containing toxic alkaloids, pennyroyal oil, and kava.

Hepatotoxicity

20

Hypertension, hypotension, tachycardia, ventricular arrhythmias, cardiac arrest are all side effects of this antidote …

Naloxone

21

The presenting signs of a … overdose include cardiac arrhythmias, hypotension, and anticholinergic signs (hyperthermia, flushing, dilated pupils, intestinal ileus, urinary retention, and sinus tachycardia)

TCA

22

Toxic levels of… (eg, tricyclic antidepressants, antipsychotic medication, benzodiazepines) can result in CNS excitation, which may lead to confusion, delirium, hallucinations, and seizures. Some patients develop hyperpyrexia, cardiac arrhythmias, coma, a

anticholinergic agents

23

Diuretics, especially HCTZ, are notorius for inducing or precipitating... (GI condition).

constipation

24

... has shown some efficacy in patients with nonorganic erectile dysfunction, but not in one with organic causes.

Yohimbine

25

... (antimalarial drug) is contraindicated in patients with cardiac conduction disease.

Mefloquine

26

A rise in INR at 48 hours after the first dose implies ... (condition), due to either other drugs or a problem with the cytochrome P-450 system.

high sensitivity to warfarin

27

Regular ... Rx is an absolute contraindication to sildenafil use because of hypotensive effect potentiation.

nitrate

28

... complications are significantly increased in patients who are receiving activated protein C (dotrecogin alfa).

Bleeding

29

ACEI and ARBs should be discontinued in the ... trimesters because of fetal complications.

2nd and 3rd

30

... are the most potent anti-retroviral drugs and most commonly studied for long-term follow-up when taken together with two NRTI.

Protease inhibitors (PI)

31

ABx ... (side effect) should not be used in patients receiving class IA or III antiarrhythmic agents.

prolonging the QTc interval (fluoroqui, macro)

32

The 8 mg dexamethasone suppression test differentiates between pituitary and ectopic ACTH production, in the latter cortisol is...

not suppressed.

33

After large dose steroids, patients should receive stress doses steroids for... (duration)

one year.

34

... (2 oral hypoglycemic drugs) may cause fluid retention and weight gain and are contraindicated in severe CHF patients.

Pioglitazone (Actos) and Rosiglitazone (Avandia)

35

Insulin can not be combined with Pioglitazone (Actos) and Rosiglitazone (Avandia) due to...

increased risk for fluid retention with CHF.

36

Beta-blockers selectivity (or cardioselectivity) refers to the ability of a drug to preferentially block the...

beta-1 receptors.

37

BP that contraindicates for t-PA use is...

SBP>185 or DBP>110.

38

Advanced age is... in t-PA administration for ischemic stroke.

not a contraindication

39

The relatively cardioselective agents are:

atenolol or metoprolol.

40

Nonselective beta blockers can cause worsening of symptoms of severe peripheral vascular disease or Raynaud's phenomenon but usually not in milder disease, with mild to moderate intermittent claudication. ... are probably preferable in such patients.

Cardioselective beta blockers

41

The prototype nonselective beta-blocker is...

Propranolol

42

Toxic myopathy can be caused by... (class drugs).

statins

43

ABx known to cause... are: Bactrim, rifampicin, vancomycin, cephalotin and linezolid.

thrombocytopenia

44

Heparin, quinidine, quinine and valproic acid can all cause... (blood dyscrasia).

thrombocytopenia.

45

Adding warfarin to ASA and clopidogrel combination increases the risk of bleeding ... times.

5

46

In cardiogenic shock from anaphilactoid reaction to contrast agent, epinephrine should be administered in doses of ...micrograms.

10

47

In cardiogenic shock from anaphilactoid reaction to contrast agent, epinephrine should be administered every ...

minute.

48

In cardiogenic shock from anaphilactoid reaction to contrast agent, epinephrine should be administered in a concentration of ...

1:10,000.

49

These drugs can modestly lower Lp(a) levels: ...

niacin and fibric acids.

50

Platelet transfusion cannot be used for 2b3a reversal in drugs with high drug : receptor ratio such as ...

eptifibatide (Integrilin) and tirofiban (Aggrastat). (100:1)

51

Platelet transfusion can be used for 2b3a reversal in drugs with low drug : receptor ratio such as ...

abciximab. (1.5:1), despite being irreversible.

52

Metformin-induced lactic acidosis is fatal in ... % of the cases.

50

53

Among paclitaxel and sirolimus, only ... has an anti-inflammatory effect.

sirolimus

54

... high affinity for the beta-2 adrenergic receptor causes vasodilation and a decrease in MAP, therefore its utility in hypotensive patients is limited to situations in which hypotension results from bradycardia.

Isoproterenol’s

55

... is primarily an inotropic and chronotropic agent rather than a vasopressor. It acts upon beta-1 adrenergic receptors and, unlike dobutamine, has a prominent chronotropic effect.

Isoproterenol (Isuprel®)

56

In patients during the initial management of AMI who have a contraindication to…, coronary angiography is class IIa indication when performed in a timely fashion by individuals skilled in the procedure and supported by experienced personnel in an appropri

fibrinolytic therapy

57

Lidocaine has this neurological side-effect...

seizures.

58

The antianginal therapy of choice in patients with HTN is... (2 classes).

beta-blockers and nondihydropyridines (verapamil and diltiazem)

59

The short-acting dihydropyridine is...

nifedipine.

60

The CAPTURE trial showed benefit in using... in patients with refractory unstable angina in need for intervention only in those with elevated troponin values.

abciximab (Reopro)

61

The... are potent vasodilators (type of CC blockers) that have little or no negative effect upon cardiac contractility or conduction.

dihydropyridines

62

The therapy for variant angina consists of... and has excellent response.

nitrates and calcium blockers

63

The three coronary vasodilator compounds used in humans to achieve maximal arteriolar dilatation are...

dipyridamole, papaverine, and adenosine.

64

The most common side effects of calcium blockers are...

facial flushing and HA.

65

... are contraindicated in patients with PVD and resting leg pain, but can be used in intermittent claudication.

Beta blockers

66

The following calcium blockers are contraindicated in stable angina patients with... (valvulopathy): nifedipine (Adalat® CC; Nifedical™ XL; Procardia®; Procardia XL®), amlodipine (Norvasc®), nisoldopine (Sular®) and felodipine (Plendil®).

AS

67

The longer-acting dihydropyridines with... depressant activity are felodipine, isradipine, nicardipine, nifedipine, and nisoldopine.

little cardiac

68

The antianginal therapy of choice in patients with bradycardia and HAVB are... (2 classes).

long acting dihydropyridines (felodipine, isradipine, nicardipine, nifedipine, and nisoldipine) and long acting nitrates

69

Individuals with... should not be given Viagra as there is always a chance of receiving nitrates in the ER/hospital setting.

chronic stable angina

70

DIG trial showed digitalis reduced the re-admissions to the hospital for worsening CHF by... %, with the greatest benefit in patients with more severe symptoms and decreased EF.

28

71

Concomitant quinidine, amiodarone, verapamil or propafenone administration with... (antiarrhythmic) requires a decrease of 50% in its dose.

digoxin

72

... (drug, dose) was preferable for secondary prevention after stroke or TIA in patients with intracranial arterial stenoses in a study of 569 patients.

Aspirin (650 mg twice daily)

73

Doxorubicin therapy should not be initiated in patients who have a baseline EF...

<30%.

74

... ’s predominant effect is vasoconstrictor with little change in cardiac output.

Norepinephrine

75

The antidote for dipyridamole (Persantine) is...

IV aminophylline.

76

..., a selective alpha1-adrenergic agonist may be a good choice in shock when there is an increased risk for tachyarrhythmias.

Phenylephrine (Neosynephrine)

77

The immediate two meds used in acute aortic dissection to reduce the arterial pressure are...

nitroprusside and propranolol/labetalol.

78

Laboratory monitoring of... (antithrombotic) is recommended in renal insufficiency, morbid obesity, and pregnancy.

LMWH (e.g. Lovenox)

79

Patients should avoid concurrent use of... (ABx) and CYP3A inhibitors (e.g., diltiazem, verapamil) due to increased risk for SCD (sudden cardiac death).

erythromycin

80

Monitoring LMWH (Lovenox) is done by measuring... at 3-4 hours after an injection.

peak anti-Xa levels

81

Quinidine causes a twofold increase in... levels due to decrease renal elimination and displacement from tissue-binding sites.

digoxin

82

When methyldopa or a beta-blocker is ineffective in controlling BP during pregnancy,... is largely used.

nifedipine

83

Quinidine sulfate has these ECG side-effects:

prolongs QRS and QTc.

84

Antiarrhythmic agents with predominantly class ... action (potassium channel blockers) are the most effective antiarrhythmic therapy for SV and ventricular tachyarrhythmias.

III

85

If overt hypothyroidism occurs with amiodarone therapy, amiodarone... and thyroid hormone replacement started.

can be continued

86

Agents with class... antiarrhythmic effects (calcium channel blockers) are useful for reentry rhythms involving the AVN and for slowing ventricular response to AF/Flut.

IV

87

Large doses of quinidine can cause...: blurred vision, tinnitus, hearing loss, visual disturbances, HA, confusion, delirium and psychosis.

chinchonism

88

If overt hyperthyroidism occurs with amiodarone therapy, amiodarone... and anti-thyroid agents started.

has to be stopped

89

... is the only ACEI available in IV form.

Enalaprilat

90

Procainamide has this troublesome reaction in some patients: … (arthralgias, fever, hepatomegaly and pleurisy).

drug-induced LES

91

... is not only an antiarrhythmic agent, but also a peripheral and coronary vasodilator and an effective antianginal agent.

Amiodarone

92

One large RCT in people already receiving diuretics and ACEIs found that... reduced the proportion of people admitted to hospital for worsening heart failure at 37 months compared with placebo, but found no significant difference between groups in mortali

digoxin

93

The statins cause a decrease in the atherosclerotic plaque lipids and inflammation and increase the plaque... content.

collagen

94

Activation of alpha-1 adrenergic receptors, located in the vascular walls, induces significant...

vasoconstriction.

95

... has purely alpha-adrenergic agonist activity and therefore results in vasoconstriction with minimal cardiac inotropy or chronotropy.

Phenylephrine (Neosynephrine®)

96

At doses of 1 to 2 mcg/kg per minute, dopamine acts predominantly on... in the renal, mesenteric, cerebral, and coronary beds, resulting in selective vasodilation.

dopamine-1 receptors

97

An accelerated junctional rhythm commonly is a complication of... toxicity.

digitalis

98

Dopamine receptors are present in the renal, splanchnic (mesenteric), coronary, and cerebral vascular beds; stimulation of these receptors leads to...

vasodilation.

99

At doses >10 mcg/kg per minute, the predominant effect of dopamine is to stimulate... receptors and produce vasoconstriction with an increased SVR.

alpha-adrenergic

100

... receptors are most common in the heart, and mediate increases in inotropy and chronotropy with minimal vasoconstriction.

Beta-1 adrenergic

101

Stimulation of beta-2 adrenergic receptors in blood vessels induces...

vasodilation.

102

Dobutamine increases... by beta-1 adrenergic receptor activation.

cardiac output (increases inotropy and chronotropy and reduces left ventricular filling pressure)

103

Dobutamine acts also upon beta-2 adrenergic receptors and thus...

induces vasodilation and can cause hypotension.

104

... acts on both alpha-1 and beta-1 adrenergic receptors, thus producing potent vasoconstriction as well as a less pronounced increase in cardiac output.

Norepinephrine (Levophed®)

105

At 5 to 10 mcg/kg per minute, dopamine also stimulates... receptors and increases cardiac output, predominantly by increasing stroke volume with variable effects on heart rate.

beta-1 adrenergic

106

Class... agents should not be used in patients with EF<35% owing to the high risk of proarrhythmia.

I - Ia (quinidine and procainamide), Ib (lidocaine), and Ic (propafenone)

107

... is contraindicated in patients with acute heparin-induced thrombocytopenia, at least until after the administration of danaparoid or thrombin inhibitors.

Warfarin

108

Warfarin does not have a fully therapeutic effect until the factor X and II levels decline in... days.

5 to 7. A prothrombin time INR of ~ 2.0 on 2 consecutive days helps ensure that factor X and II levels have had time to decrease to appropriate levels.

109

Because of one report indicating an increased incidence of major birth defects in newborns exposed to ... during the first trimester, the use of verapamil is preferred when a calcium antagonist is indicated.

diltiazem

110

... (HIV drug class) therapy contraindicates the use of simvastatin (Zocor®) and alternatives as atorvastatin, and pravastatin should be entertained.

Protease inhibitors

111

In severe cases of aspirin toxicity with altered mental status, pulmonary edema, cerebral edema, or renal failure,... is needed.

hemodialysis

112

Patients who adhere to a vegan diet (no meat products) should be given... supplementation.

oral vitamin B12

113

One non-systematic review found that... (event) is more common in people of advanced age and low body weight, those with hypertension on admission, and those given tissue plasminogen activator rather than another thrombolytic agent.

intracranial hemorrhage

114

... (cholesterol drug) causes insulin resistance and may worsen hyperglycemia in patients with DM.

Nicotinic acid (Niacin)

115

The first line therapy (antidote) for cocaine intoxication are... (class drugs)

benzodiazepines (lorazepam IV/IM).

116

The most common initial symptoms of... (gas) intoxication are nausea, headache and dizziness.

carbon monoxide

117

The antidote for amphetamines is...

benzodiazepines.

118

The antidote for arsenic, mercury, gold or lead is...

BAL (dimercaprol).

119

The antidote for benzodiazepines is...

flumazenil.

120

The antidotes for beta-blockers and calcium-channel blockers are...

glucagon, calcium chloride and ventricular pacing.

121

The antidotes for... are blood alkalinization and alpha-agonists (Phenylephrine).

TCAs

122

The antidote for heparin is...

protamine sulfate.

123

The antidote for iron is...

deferoxamine.

124

... is the preferred drug to decrease pain for procedures due to its rapid onset and resolution.

Fenthanyl (Duragesic®)

125

... is the preferred drug to decrease anxiety for procedures due to its rapid onset and resolution.

midazolam (Versed®)

126

... is used to calm agitated delirium after reversible causes have been identified and treated.

Haloperidol (Antipsychotic, a butyrophenone)

127

The clinical clues to... are coma, hypotension, cardiac irritability and profound anion gap metabolic acidosis in the setting of adequate fluid resuscitation and oxygen administration.

cyanide intoxication

128

Combustion of natural fabrics (wool and silk) is known to produce...

hydrogen cyanide gas.

129

The therapy for cyanide intoxication is...

IV sodium thiosulfate.

130

... in using a MDI (metered dose inhaler) is the main cause of therapy failure.

Poor technique

131

Adding these drugs... to the treatment of acute COPD exacerbations has been shown to allow faster recory of FEV1, improve oxygenation and decrease the number of treatment failures.

corticosteroids

132

The cornerstone of therapy in sarcoidosis is daily... for 6-12 months.

corticosteroids

133

Bosentan is an... useful in stable NYHA III and IV patients with pulmonary hypertension.

endothelin receptor antagonist

134

Patients taking beta-blockers may develop refractory anaphylaxis (persistent hypotension and bradycardia) and should be treated with...

glucagon for its non-beta-inotropic effect.

135

In adult patients not responding to traditional therapy for shock,... (drug) should be used.

vasopressin

136

Cholinergic effects of... receptor stimulation produce salivation, lacrimation, diarrhea, and potentially lethal bronchorrhea or bronchospasm.

muscarinic

137

... is rarely associated with positive dsDNA and the complement level is usually normal, but antihistone antibodies are positive in 95% of cases.

Drug-induced lupus

138

... a glucose-lowering drug used commonly in patients with type 2 diabetes, may result in small amounts of weight loss.

Metformin,

139

Renin-angiotensin inhibitors, angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), are associated with hyperkalemia in about ...% of patients

10

140

In older patients taking ACE inhibitors and ARBs, TMP/SMX use was associated with excess risk for sudden death — presumably from trimethoprim-induced...

hyperkalemia

141

In patients older than 80, ...use was associated with higher odds of general pain

statin