Pharmacology (Cardiac) Flashcards
1
Q
The ______ are stretch receptors on the aortic arch and carotid arteries that provide afferent information to the cardiovascular control center (CVCC) about blood pressure.
A
baroreceptor reflex
2
Q
A change in blood pressure signals the carotid and aortic barorecptors which will then signal the Medullary cardiovascular control center (CVCC). Which of the following do parasympathetic neurons target to bring the blood pressure back to homeostasis?
A. SA node
B. Ventricles
C. Veins
D. Arterioles
E. All of the above
A
A. SA node
3
Q
An increase in blood pressure causes an increase in which of the following?
A. Sympathetic system
B. Parasympathetic system
A
B. Parasympathetic system
note: an increase in BP causes an increase in parasympathetic output and a decrease in sympathetic output.
Parasympathetic:
- Increases in parasympathetic output causes a release of more ACh on the muscarinic receptors of the SA node thus decreasing heart rate.
- Decreasing heart rate decreases cardiac output
- Decreasing cardiac output decreases blood pressure
Sympathetic:
- Decreases in sympathetic output signals 3 different receptors:
- Arteriolar smooth muscle (vasodilation causing a decrease in peripheral resistance)
- Ventricular myocardium (decreasing force of contractions)
- SA node (decreasing heart rate)
4
Q
An increase in blood pressure causes an decrease in which of the following?
A. Sympathetic system
B. Parasympathetic system
A
A. Sympathetic system
5
Q
Which of the following uses norepinephrine and ACh?
A. Sympathetic system
B. Parasympathetic system
A
A. Sympathetic system
6
Q
Which of the following uses ONLY ACh?
A. Sympathetic system
B. Parasympathetic system
A
B. Parasympathetic system
7
Q
Which of the following can be found in the cross section of an artery?
A. Inner layer of endothelial cells
B. Connective tissue
C. Smooth muscle
D. All of the above
A
D. All of the above
8
Q
Antihypertensive drugs are aimed at doing all of the following EXCEPT:
A. Reducing cardiac output
B. Increasing plasma volume
C. Reducing peripheral resistance
D. All of the above are targets of antihypertensive drugs
A
B. Increasing plasma volume
Antihypertensive drugs:
- reduce cardiac output
- reduce plasma volume
- reduce peripheral resistance
9
Q
All of the following are “Minor” antihypertensive drugs EXCEPT:
A. Hydralazine
B. Minoxidil
C. Verapamil
D. Guanethidine
E. Clonidine
A
C. Verapamil
note: “minor” antihypertensive drugs are used in combination with other drugs (adjunct)
Verapamil = Ca2+ channel blocker
10
Q
Which of the following is a centrally acting anti-hypertensive drugs that is an alpha2 adrenergic agonist?
A. Hydralazine
B. Minoxidil
C. Verapamil
D. Guanethidine
E. Clonidine
A
E. Clonidine
Clonidine = Centrally acting a2-adrenergic agonist
Hydralazine = peripheral vasodilator
Minoxidil = peripheral vasodilator (Rogaine = hair loss)
Guanethidine = sympathetic antagonist
11
Q
Which of the folloiwng is a sympathetic antagonist?
A. Hydralazine
B. Minoxidil
C. Verapamil
D. Guanethidine
E. Clonidine
A
D. Guanethidine
Clonidine = Centrally acting a2-adrenergic agonist
Hydralazine = peripheral vasodilator
Minoxidil = peripheral vasodilator (Rogaine = hair loss)
Guanethidine = sympathetic antagonist
12
Q
Which of the following is a peripheral vasodilator that is also sold as Rogaine for treating hair loss?
A. Hydralazine
B. Minoxidil
C. Verapamil
D. Guanethidine
E. Clonidine
A
B. Minoxidil
Clonidine = Centrally acting a2-adrenergic agonist
Hydralazine = peripheral vasodilator
Minoxidil = peripheral vasodilator (Rogaine = hair loss)
Guanethidine = sympathetic antagonist
13
Q
Which of the following is a peripheral vasodilator?
(select all that apply)
A. Hydralazine
B. Minoxidil
C. Verapamil
D. Guanethidine
E. Clonidine
A
A. Hydralazine
B. Minoxidil
14
Q
What are the 4 “Major” hypertensive drug categories that go through the RAAS pathway?
A
- ACE inhibitors
- Beta blockers (inhibits renin release)
- Direct renin inhibitors (Aliskiren)
- Angiotensin II blockers
15
Q
Discuss the RAAS pathway:
- What organ produces angiotensinogen?
- A decrease in blood pressure causes _____ cells in what organ to produce Renin?
- What does Renin do?
- What organ produces ACE enzymes?
- What does ACE do?
- ANG II in the plasma signals the adrenal cortex of the kidneys to produce _______.
- Production of the previous hormone causes an increase in ______ reabsorption.
A
RAAS
- Liver produces Angiotensinogen
- Decrease in BP signals JG cells in the kidney to produce renin
- Renin converts angiotensinogen to ANG I
- Lungs produce ACE enzyme
- ACE converts ANG I to ANG II
- ANG II signals the adrenal cortex to increase adolsterone thus increasing Na+ reabsorption
16
Q
What does RAAS stand for?
A
RAAS (Renin-angiotensin-aldosterone-system)
note: Na+ retention doesn’t directly raise low BP, but:
- it leads to increased fluid intake an volume expansion which increases blood volume thus increasing BP
- ANG II has additional effects:
- Activation of brain ANG II receptors causes an increase in vasopressin thus increasing water reabsorption
- ANG II is a potent vasoconstrictor that increases in BP but not blood volume
17
Q
Angiotensin II signals all of the following EXCEPT:
A. Signals the arterioles to vasoconstrict
B. Signals the hypothalamus to increase vasopressin and thirst
C. Signals the adrenal cortex to release aldosterone
D. Signals the arterioles to vasodilate
A
D. Signals the arterioles to vasodilate
18
Q
How do ACE inhibitors lower blood pressure?
A
ACE inhibitors such as lisinopril inhibit the ACE enzyme that converts ANG I to ANG II.
- lower ANG II in circulation decreases hypothalamus stimulation for thirst
- lower ANG II also decreases vasoconstriction
- ANG II receptors in CVCC increase sympathetic output thus increasing cardiac output and vasoconstriction.
- decreasing ANG II decreases all of the above
ACE inhibitors prevent sodium and water resorption by inhibiting aldosterone secretion
19
Q
________ prevent sodium and water resorption by inhibiting the aldosterone system.
A. ACE inhibitors
B. Beta blockers
C. Calcium channel blockers
D. Alpha-1-blockers
A
A. ACE inhibitors
20
Q
A persistent cough is a common side effect of which of the following?
A. ACE inhibitors
B. Beta blockers
C. Calcium channel blockers
D. Alpha-1-blockers
A
A. ACE inhibitors
21
Q
Which of the following are ACE inhibitors:
A. Losartan
B. Metoprolol
C. Doxazosin
D. Nifedipine
E. Lisinopril
A
E. Lisinopril
“prils” = ACE inhibitors
“sartan” = ANG II receptor blockers (ARBs)
“olol” = Beta blockers
“zosin” = Alpha adrenergic receptor antagonist
22
Q
Which of the following are the ACE inhibitors?
A. “prils”
B. “sartan”
C. “olol”
D. “zosin”
A
A. “prils”
“prils” = ACE inhibitors
“sartan” = ANG II receptor blockers (ARBs)
“olol” = Beta blockers
“zosin” = Alpha adrenergic receptor antagonist
23
Q
Which of the following are the Beta blockers?
A. “prils”
B. “sartan”
C. “olol”
D. “zosin”
A
C. “olol”
“prils” = ACE inhibitors
“sartan” = ANG II receptor blockers (ARBs)
“olol” = Beta blockers
“zosin” = Alpha adrenergic receptor antagonist
24
Q
Which of the following are the Alpha adrenergic receptor antagonists?
A. “prils”
B. “sartan”
C. “olol”
D. “zosin”
A
D. “zosin”
“prils” = ACE inhibitors
“sartan” = ANG II receptor blockers (ARBs)
“olol” = Beta blockers
“zosin” = Alpha adrenergic receptor antagonist
25
Which of the following ANG II receptor blockers (ARBs)?
A. "prils"
B. "sartan"
C. "olol"
D. "zosin"
B. "sartan"
"prils" = ACE inhibitors
"sartan" = ANG II receptor blockers (ARBs)
"olol" = Beta blockers
"zosin" = Alpha adrenergic receptor antagonist
26
Which of the following are potent vasodilators that decrease systemic vascular resistance (afterload)?
A. "prils"
B. "sartan"
C. "olol"
D. "zosin"
B. "sartan"
27
Which of the following is alpha-1 selective antagonist to treat hypertention?
A. "prils"
B. "sartan"
C. "olol"
D. "zosin"
D. "zosin"
28
Which of the following **inhibits renin release** causing less activation of the RAAS pathway?
A. "prils"
B. "sartan"
C. "olol"
D. "zosin"
C. "olol"
29
Overall, an increase in ANG II will cause an _______ in blood pressure.
Increase in BP
* ANG II causes vasoconstriction, increase in vasopressin (water retention), increase in thirst and an increase in aldosterone.
* ACE inhibitors inhibit the conversion of ANG I to ANG II thus causing a decrease in ANG II which overall will decrease BP
30
All of the following are true regarding ACE inhibitors "prils" EXCEPT:
A. A persistent cough is a common side effect
B. Possibility of hyperkalemia if taken with K sparing diuretics
C. Can sometimes cause angioneurotic edema
D. All of the above are true
D. All of the above are true
* **Persistent cough** is caused bc ACE also breaks down bradykinin, ACE inhibition leads to increased bradykinin which will cause a persistent cough
31
Discuss Beta-blockers:
* What receptors does it block?
* Does this cause an (increase/decrease) in sympathetic stimulatioin of the heart?
* Does this cause an (increase/decrease) of cardiac output?
* What do Beta-blockers inhibit the release of?
* Inhibition of the answer above causes (more/less) activation of the RAAS pathway?
Beta-blockers
* blocks beta-adrenergicc receptors
* Decreased symptathetic stimulation of the heart
* which decreases cardiac output
* Beta-blockers inhibit the release of renin
* this causes a decrease in the RAAS pathway
note: renin converts angiotensinogen to ANG I which is the first step of the RAAS pathway
32
Discuss Angiotensin II (ANG II) Receptor Blockers (ARBs):
* ARBs are potent (vasodilators/vasoconstrictors)?
* This causes a (increase/decrease) in systemic vascular resistance (afterload)?
* What do ARBs medications usually end in?
Angiotensin II receptor blockers (ARBs)
* ARBs are potent vasodilators
* this causes a decrease in systemic vascular resistance (afterload)
* "sartan" - Losartan, Valsartan
33
Which of the following are the most common type of adrenergic receptor on vascular smooth muscle?
A. alpha1 receptors
B. alpha 2 receptors
C. beta1 receptors
D. beta2 receptors
A. alpha1 receptors
34
Which of the following are found pre-synaptically on the sympathetic nerve termini that are part of the negative feedback pathway (activation leads to less NE release?
A. alpha1 receptors
B. alpha 2 receptors
C. beta1 receptors
D. beta2 receptors
B. alpha 2 receptors
35
Discuss Alpha Adrenergic Receptor Antagonist:
* Discuss the receptor involved
* What do these medication names end in?
* What are the 4 adverse effects?
Alpha Adrenergic Receptor Antagonist
* Cardiovascular system: alpha1 selective antagonist to tx hypertension
* "osin" - Doxazosin, Prazosin, Terazosin
* Adverse effects:
* first dose effect: hypotension, syncope (fainting)
* Tachycardia
* Nasal congestion
* Dry mouth (xerostomia)
36
All of the following are adverse effects of alpha adrenergic receptor antagonist EXCEPT:
A. Persistent cough
B. Dry mouth
C. Nasal congestion
D. Hypotension and syncope (fainting)
A. Persistent cough
ACE inhibitors = Persistent cough
37
Discuss the Centrally acting "Sympatholytics":
* What receptor do these class of drugs target?
* Is it an agonist or antagonist to this receptor?
* Does this cause an (increase/decrease) in sympathetic activity?
* Pre-synaptic receptor that ______ NE release.
* What are the 4 drugs in this class?
* alpha2 agonist will have the same effect as \_\_\_\_\_\_\_.
**_Centrally acting "Sympatholytics"_**
## Footnote
* alpha2 adrenergic agonist
* **decreaes** sympathetic activity
* pre-synaptic receptor that **inhibits** NE release
* **Clonidine, Methyldopa, Guanabenz, Guanfacine**
* **alpha2 agonist have same effect of alpha1 antagonist**
38
All of the following are centrally acting "Sympatholytics" EXCEPT:
A. Clonidine
B. Guanabenz
C. Guanfacine
D. Methyldopa
E. Terazosin
E. Terazosin
Centrally acting "Sympatholytics" = alpha2 agonist
39
\_\_\_\_\_\_\_\_ (blocks both alpha1 and alpha2) not used for hypertension, but is used in dentistry to help reverse local anesthesia (Oraverse).
Phentolamine
40
What is Phentolamine (Oraverse) used for?
Used to reverse local anesthesia in dentistry
41
(T/F)
Alpha2 agonist will have the same effect as alpha1 agonist.
FALSE
Correct statement: **Alpha2 agonist** will have the same effect as **alpha1** **_antagonist_**
42
Discuss Ca2+ channel blockers:
* What are the 3 drugs of this class?
* Which of the 3 drugs is **more cardioselective?**
* How does this effect smooth muscle contraction?
* Does this cause vasodilation or vasoconstriction?
* What does this do to BP?
* What are the 4 adverse effects of Ca2+ blockers?
Ca2+ channel blockers
* Verapamil, Diltiazem, Nifedipine
* Diltiazem is more cardioselective
* Blocks smooth muscle contraction
* leads to vasodilation
* which lowers BP
* Adverse effects:
* **gingival hyperplasia**
* flushing
* headache
* hypotension
43
Which of the following class of drugs is associated with gingival hyperplasia?
A. Alpha adrenergic receptor antagonist
B. ACE inhibitors
C. ARBs
D. Centrally acting "Sympatholytics"
E. Ca2+ channel blockers
E. Ca2+ channel blockers
Ca2+ channel blockers = gingival hyperplasia
ACE inhibitors = persistent cough
Alpha adrenergic receptor antagonist = dry mouth (xerostomia)
44
Which of the following is a **more cardioselective** Ca2+ channel blocker?
A. Verapamil
B. Diltiazem
C. Nifedipine
D. Metropolol
B. Diltiazem
45
What are the 2 other smooth muscle relaxants (vasodilators) that are used as hypertension drugs?
Sildenafil and Nitroprusside
46
What are the 5 hypertensive emergency drugs that are used for rapid vasodilation?
Emergency Hypertensive drugs used for rapid vasodilation
* Nitroglycerine
* Hydralazine
* Labetalol
* Nitroprusside
* Fenoldopam
47
Which of the following is an emergency hypertensive drug that is a **D1 dopamine reeceptor agonist**?
A. Nitroglycerine
B. Nitroprusside
C. Hydralazine
D. Fenoldopam
E. Labetalol
D. Fenoldopam
48
Which of the following is an emergency hypertensive drug that is taken sublingually because of hepatic metabolism?
A. Nitroglycerine
B. Nitroprusside
C. Hydralazine
D. Fenoldopam
E. Labetalol
A. Nitroglycerine
49
Which of the following is an emergency hypertensive drug that is a peripheral vasodilator?
(select all that apply)
A. Nitroglycerine
B. Nitroprusside
C. Hydralazine
D. Fenoldopam
E. Labetalol
B. Nitroprusside
C. Hydralazine
50
Which of the following is a mixed alpha1, beta1 and beta2 blocker used as an emergency hypertensive drug?
A. Nitroglycerine
B. Nitroprusside
C. Hydralazine
D. Fenoldopam
E. Labetalol
E. Labetalol
51
Labetalol blocks all of the following EXCEPT:
A. alpha1 blocker
B. alpha2 blocker
C. beta1 blocker
D. beta2 blocker
B. alpha2 blocker
52
What are the 5 Pulmonary hypertensive drugs?
1. Epoprostenol
2. Bosentan
3. Ambrisentan
4. Sildenafil
5. Tadafil
Epoprosentol = prostacyclin
Bosentan = endothelin receptor antagonist
Ambrisentan = endothelin receptor antagonist
Sildenafil = phosphodiesterase type 5 inhibitor
Tadalafil = phosphodiesterase type 5 inhibitor
53
Which of the following pulmonary hypertensive drugs is a phosphodiesterae type 5 inhibitor
(select all that apply)
A. Epoprostenol
B. Bosentan
C. Ambrisentan
D. Sildenafil
E. Tadalafil
D. Sildenafil
E. Tadalafil
Epoprosentol = prostacyclin
Bosentan = endothelin receptor antagonist
Ambrisentan = endothelin receptor antagonist
Sildenafil = phosphodiesterase type 5 inhibitor
Tadalafil = phosphodiesterase type 5 inhibitor
54
Which of the following pulmonary hypertensive drugs is an endothelin receptor antagonist?
(select all that apply)
A. Epoprostenol
B. Bosentan
C. Ambrisentan
D. Sildenafil
E. Tadalafil
B. Bosentan
C. Ambrisentan
Epoprosentol = prostacyclin
Bosentan = endothelin receptor antagonist
Ambrisentan = endothelin receptor antagonist
Sildenafil = phosphodiesterase type 5 inhibitor
Tadalafil = phosphodiesterase type 5 inhibitor
55
Which of the following pulmonary hypertensive drugs is a prostacyclin (vasodilator, also inhibits platelet activation?
(select all that apply)
A. Epoprostenol
B. Bosentan
C. Ambrisentan
D. Sildenafil
E. Tadalafil
A. Epoprostenol
Epoprosentol = prostacyclin
Bosentan = endothelin receptor antagonist
Ambrisentan = endothelin receptor antagonist
Sildenafil = phosphodiesterase type 5 inhibitor
Tadalafil = phosphodiesterase type 5 inhibitor
56
Discuss dental implications of hypertension drugs:
* Centrally acting drugs cause \_\_\_\_\_.
* ______ can result from centrally acting drugs, alpha blockers, and direct vasodilators.
* ______ can inhibit the antihypertensive effect of ACE inhibitors, beta-blockers, and diuretics.
* Xerostomia is likely caused from which class of hypertensive drugs?
* _______ can cause altered sense of taste.
* ______ cause a persistent cough.
Dental implications:
* Centrally acting drugs cause **sedation** (clonidine)
* **Orthostatic hypotension** can result from centrally acting drugs, alpha blockers, and direct vasodilators
* **NSAIDs** can inhibit the antihypertensive effect of ACE inhibitors, beta-blockers and diuretics
* _Xerostomia_ is likely from **centrally acting drugs**
* **ACE inhibitors** can alter the sense of taste
* **ACE inhibitors** cause persistent cough
57
(T/F)
Beta-2 receptors and M2 receptors affect both timing (heart rate) and the strength of contraction (related to amount of intracellular Ca2+)
False
Correct statement: **Beta-1** and **M2** affect heart rate and strength of contraction
58
What are the 4 classes of "Antiarrhythmic" drugs?
1. Class I = Na+ channel blockers
2. Class II = beta-adrenergic receptor blockers
3. Class III = K+ channel blockers
4. Class IV = Ca2+ channel blockers
59
Which of the following are a **class IV**"Antiarrhythmic" drugs?
A. Na+ channel blockers
B. Beta-adrenergic receptor blockers
C. K+ channel blockers
D. Ca2+ channel blockers
D. Ca2+ channel blockers
Class I = Na+ channel blocker
Class II = Beta-adrenergic receptor blockers
Class III = K+ channel blockers
Class IV = Ca2+ channel blockers
60
Which of the following are a **class II**"Antiarrhythmic" drugs?
A. Na+ channel blockers
B. Ca2+ channel blockers
C. K+ channel blockers
D. Beta-adrenergic receptor blockers
D. Beta-adrenergic receptor blockers
Class I = Na+ channel blocker
Class II = Beta-adrenergic receptor blockers
Class III = K+ channel blockers
Class IV = Ca2+ channel blockers
61
Which of the following are a **class III**"Antiarrhythmic" drugs?
A. K+ channel blockers
B. Ca2+ channel blockers
C. Na+ channel blockers
D. Beta-adrenergic receptor blockers
A. K+ channel blockers
Class I = Na+ channel blocker
Class II = Beta-adrenergic receptor blockers
Class III = K+ channel blockers
Class IV = Ca2+ channel blockers
62
Which of the following are a **class I**"Antiarrhythmic" drugs?
A. K+ channel blockers
B. Ca2+ channel blockers
C. Na+ channel blockers
D. Beta-adrenergic receptor blockers
C. Na+ channel blockers
Class I = Na+ channel blocker
Class II = Beta-adrenergic receptor blockers
Class III = K+ channel blockers
Class IV = Ca2+ channel blockers
63
Which of the following is used to treat atrial fibrillation, tachycardia and ventricular arrhythmias?
A. K+ channel blockers
B. Ca2+ channel blockers
C. Na+ channel blockers
D. Beta-adrenergic receptor blockers
C. Na+ channel blockers
note: class I (Na+ channel blockers) are used to treat atrial fibrillation, tachycardia and ventricular arrhythmias
64
Which of the following class of Na+ channel blockers is a **mild** Na+ channel blocker that results in **shortened repolarization**?
A. Class 1A
B. Class 1B
C. Class 1C
D. All of the above
B. Class 1B
Class 1A = moderate --\> prolonged repolarization
Class 1B = mild ---\> shortened repolarization
Class 1C = marked Na+ blocker
65
Which of the following class of Na+ channel blockers is a **moderate** Na+ channel blocker that results in **prolonged repolarization**?
A. Class 1A
B. Class 1B
C. Class 1C
D. All of the above
A. Class 1A
Class 1A = moderate --\> prolonged repolarization
Class 1B = mild ---\> shortened repolarization
Class 1C = marked Na+ blocker
66
All of the following are true of Class IA Na+ sodium channel blockers EXCEPT:
A. Reduced automacity
B. Decreased conduction velocity
C. Increase refractory period
D. B and C
E. All of the above are true
D. All of the above are true
Class IA = reduced automacity, decreased conduction velocity, increase refractory period
Class IB = reduced automacity
Class IC = reduced automacity and decreaed conduction velocity
67
All of the following are true of Class IB Na+ sodium channel blockers EXCEPT:
A. Reduced automacity
B. Decreased conduction velocity
C. Increase refractory period
D. B and C
E. All of the above are true
D. B and C
Class IA = reduced automacity, decreased conduction velocity, increase refractory period
Class IB = reduced automacity
Class IC = reduced automacity and decreaed conduction velocity
68
All of the following are true of Class IC Na+ sodium channel blockers EXCEPT:
A. Reduced automacity
B. Decreased conduction velocity
C. Increase refractory period
D. B and C
E. All of the above are true
C. Increase refractory period
Class IA = reduced automacity, decreased conduction velocity, increase refractory period
Class IB = reduced automacity
Class IC = reduced automacity and decreaed conduction velocity
69
Which of the following is true of Lidocaine:
A. Reduced automacity at abnormal pacemakers
B. Decreased conduction velocity
C. Increase refractory period
D. B and C
E. All of the above are true
A. Reduced automacity at abnormal pacemakers
Class 1B: Lidocaine
* reduces automacity at abnormal pacemakers
* His-Purkinje system and/or ventricular myocardium
* Can cause convulsions
70
Which of the following is a Class IA Na+ channel blocker?
(select all that apply)
A. Quinidine
B. Procainamide
C. Lidocaine
D. Flecainide
E. Propafenone
A. Quinidine
B. Procainamide
71
Which of the following is a Class IB Na+ channel blocker?
(select all that apply)
A. Quinidine
B. Procainamide
C. Lidocaine
D. Flecainide
E. Propafenone
C. Lidocaine
72
Which of the following is a Class IC Na+ channel blocker?
(select all that apply)
A. Quinidine
B. Procainamide
C. Lidocaine
D. Flecainide
E. Propafenone
D. Flecainide
E. Propafenone
73
Which of the following is a Class IA Na+ channel blocker that can cause **cinchonism**, hypotension, and torsades de pointes?
A. Quinidine
B. Procainamide
C. Lidocaine
D. Flecainide
E. Propafenone
A. Quinidine
74
Which of the following is a Class IA Na+ channel blocker that can cause mental changes, lupus and torsades de pointes?
A. Quinidine
B. Procainamide
C. Lidocaine
D. Flecainide
E. Propafenone
B. Procainamide
75
Which of the following is a Class IC Na+ channel blocker that can cause convulsions, dizziness, blurred vision, cardiac risk with recent myocardial infarction?
A. Quinidine
B. Procainamide
C. Lidocaine
D. Flecainide
E. Propafenone
D. Flecainide
76
Which of the following is a Class IC Na+ channel blocker that can cause chest pain, edema, nausea, altered taste, anxiety and dyspnea?
A. Quinidine
B. Procainamide
C. Lidocaine
D. Flecainide
E. Propafenone
E. Propafenone
77
Which of the following does NOT involve supraventricular?
A. Quinidine
B. Lidocaine
C. Flecainide
D. All of the above
B. Lidocaine
78
Discuss Class IA Na+ channel blockers:
* What are 2 examples of drugs?
* How does it effect each of the following below?
* Automacity
* Conduction velocity
* Refractory period
**_Class IA Na channel blockers_**
* **Quinidine** (cinchonsim- quinine poisoning) and **Procainamide** (metal changes and lupus)
* Increases automacity
* Decreases conduction velocity
* Increases refractory period
* **Increases overall action potential duration**
79
Discuss Class II Beta-adrenergic receptor bockers:
* What does it block and 2 things does that reduce?
* What are the 4 things they treat?
* What are 2 medications?
* Contraindications?
**_Class II Beta-adrenergic receptor blockers_**
* Blocks sympathetic stimulation of heart
* reduces automacity and decreases conduction velocity
* Used to treat hypertension, post myocardial infarction, angina, and to prevent tachyarrhythmias
* **Propanolol** (blocks beta1 and beta2)
* **Esmolol** (only blocks beta1)
* Contraindicatd in asthma
* Can also cause heart block
80
Which of the following blocks both beta1 and beta2 receptors?
A. Propanolol
B. Esmolol
C. Amiodarone
D. Verapamil
A. Propanolol
81
Which of the following blocks **ONLY beta1 receptors**?
A. Propanolol
B. Esmolol
C. Amiodarone
D. Verapamil
B. Esmolol
82
Discuss Class III K+ channel blockers:
* Reduces \_\_\_\_\_\_\_
* above causes ______ ventricular depolarization
* also increases the \_\_\_\_\_\_\_\_
* What are the 3 drug names?
* Which of the 3 drugs has a long half life, needs loading dose and can cause many serious side-effects?
* Which of the 3 drugs has fewer side effects?
Class III K+ channel blockers
* Reduces automacity
* prolongs ventricular depolarization
* increases refractory period
* Amiodarone, Dronedarone and Sotalol
* Amiodarone is a complicated drug w/ a long half life, needs loading dose, can cause serious side-effects:
* pulmonary fibrosis, thyroid abnormalities, skin discoloration, cornea deposits and peripheral neuropathy
* Dronedarone and Sotalol have fewer side effects
83
Which of the following can potentially cause **fatal pulmonary toxicity**, overt **liver disease**, new onset or worsening arrhythmias and may require hospitalization?
A. Metropolol
B. Propanolol
C. Verapamil
D. Amiodarone
D. Amiodarone
Note: Amiodarone has black box warnings for how dangerous it is
84
All of the following are Class III K+ channel blockers EXCEPT:
A. Amiodarone
B. Esmolol
C. Dronedarone
D. Sotalol
B. Esmolol
85
Which of the following is an example of a Class IV Ca2+ channel blocker?
A. Amiodarone
B. Esmolol
C. Dronedarone
D. Sotalol
E. Diltiazem
E. Diltiazem
Class IV Ca2+ channel blockers = Verapamil and Diltiazem
86
Discuss Class IV Ca2+ channel blockers:
* What are they used to treat?
* What are 2 examples of drugs?
* (T/F) can act ONLY on cardiac muscles.
* What 4 things can these drugs cause a decrease in?
* What are 2 adverse effects?
**_Class IV Ca2+ channel blockers_**
* Used to tx: hypertension, angina, and atrial arrythmias
* Drugs: **Verapamil** and **Diltiazem**
* FALSE: can act on BOTH cardiac and smooth muscle
* Decreased automacity
* Decreased contractility
* Decreased conduction velocity in AV node
* Decreased peripheral resistance
* Can cause flushing and AV node conduction defects
87
Which of the following "Anti-dysrhythmic" drugs inhibits rapid depolarization?
A. Beta-agonists
B. Class I
C. Class II
D. Class III
E. Class IV
B. Class I
88
Which of the following "Anti-dysrhythmic" drugs inhibits phase 2 plateau?
A. Beta-agonists
B. Class I
C. Class II
D. Class III
E. Class IV
E. Class IV
89
Which of the following "Anti-dysrhythmic" drugs increases pacemaker potential in phase 4 and increases phase 2 plateau?
A. Beta-agonists
B. Class I
C. Class II
D. Class III
E. Class IV
A. Beta-agonists
90
Which of the following "Anti-dysrhythmic" drugs **inhibits repolarization at phase 3**?
(select all that apply)
A. Beta-agonists
B. Class Ia
C. Class II
D. Class III
E. Class IV
B. Class Ia
D. Class III
Beta-agonist = increase pacemaker potential (phase 4) and increases plateau (phase 2)
Class I = inhibits rapid repolarization (phase 0)
Class II = does the same as beta-agonist
Class III and Class IA = inhibits repolarization
Class IV = inhibits phase 2 plateau
91
Which of the following is **given IV**, usually in advanced cardiac life support situation?
A. Adenosine
B. Verapamil
C. Amiodarone
D. Propanolol
E. Diltiazem
A. Adenosine
92
Which of the following is NOT indicated in Supraventricular?
(select all that apply)
A. Lidocaine
B. Amiodarone
C. Verapamil
D. Adenosine
A. Lidocaine
Lidocaine (class IB) = contraindicated in supraventricular
Amiodarone (class III) = extremely long half life
Verapamil (class IV) = contraindicated in ventricular
Adenosine = contraindicated in ventricular w/ extremely short half life
93
Which of the following is indicated in Supraventricular and Ventricular but has an **extremely long half life**?
(select all that apply)
A. Lidocaine
B. Amiodarone
C. Verapamil
D. Adenosine
B. Amiodarone
Lidocaine (class IB) = contraindicated in supraventricular
Amiodarone (class III) = extremely long half life
Verapamil (class IV) = contraindicated in ventricular
Adenosine = contraindicated in ventricular w/ extremely short half life
94
Which of the following is indicated in Supraventricular but NOT Ventricular and has an extremely **short half life**?
(select all that apply)
A. Lidocaine
B. Amiodarone
C. Verapamil
D. Adenosine
D. Adenosine
Lidocaine (class IB) = contraindicated in supraventricular
Amiodarone (class III) = extremely long half life
Verapamil (class IV) = contraindicated in ventricular
Adenosine = contraindicated in ventricular w/ extremely short half life
95
Which of these compounds is an **aldosterone receptor antagonist**?
A. Enalaprilat
B. Candesartan
C. Chlorrothiazide
D. Torsemide
E. Eplerenone
E. Eplerenone
96
Which of these compounds is an ACE inhibitor?
A. Bumetanide
B. Lisinopril
C. Losartan
D. Furosemide
E. Propanolol
B. Lisinopril
ACE inhibitors = "prils"
97
Which of these compounds is an angiotensin II receptor antagonist?
A. Chlorthiazide
B. Enalaprilat
C. Losartan
D. Furosemide
E. Propanolol
C. Losartan
ACE inihibitors = "prils"
ANG II receptor antagonist = "sartan"
98
Flecainide belongs to which class of Antiarrhythmic drugs?
A. Class I
B. Class II
C. Class III
D. Class IV
E. Class V
A. Class I
Class I = Quinidine, Procainamide, lidocaine, Flecainide, Propafenone
Class II = Propanolol and Esmolol
Class III = Amiodarone, Dronedarone, Sotalol
Class IV = Verapamil and Diltiazem
99
All of the following are Class I Antiarrhythmic drugs EXCEPT:
A. Propanolol
B. Quinidine
C. Procainamide
D. Lidocaine
E. Propafenone
F. Flecainide
A. Propanolol
Class I = Quinidine, Procainamide, lidocaine, Flecainide, Propafenone
Class II = Propanolol and Esmolol
Class III = Amiodarone, Dronedarone, Sotalol
Class IV = Verapamil and Diltiazem
100
Which of the folloiwng is a class II Antiarrhythmic drug?
A. Propanolol
B. Quinidine
C. Procainamide
D. Lidocaine
E. Propafenone
F. Flecainide
A. Propanolol
Class I = Quinidine, Procainamide, lidocaine, Flecainide, Propafenone
Class II = Propanolol and Esmolol
Class III = Amiodarone, Dronedarone, Sotalol
Class IV = Verapamil and Diltiazem
101
Which of the folloiwng is a class II Antiarrhythmic drug?
A. Quinidine
B. Procainamide
C. Esmolol
D. Lidocaine
E. Propafenone
F. Flecainide
C. Esmolol
Class I = Quinidine, Procainamide, lidocaine, Flecainide, Propafenone
Class II = Propanolol and Esmolol
Class III = Amiodarone, Dronedarone, Sotalol
Class IV = Verapamil and Diltiazem
102
All of the following are Class III Antiarrhythmic drugs EXCEPT:
A. Amiodarone
B. Sotalol
C. Propanolol
D. Dronedarone
C. Propanolol
Class I = Quinidine, Procainamide, lidocaine, Flecainide, Propafenone
Class II = Propanolol and Esmolol
Class III = Amiodarone, Dronedarone, Sotalol
Class IV = Verapamil and Diltiazem
103
Which of the following is a Class IV Antiarrhythmic drug?
A. Amiodarone
B. Sotalol
C. Propanolol
D. Dronedarone
E. Diltiazem
E. Diltiazem
Class I = Quinidine, Procainamide, lidocaine, Flecainide, Propafenone
Class II = Propanolol and Esmolol
Class III = Amiodarone, Dronedarone, Sotalol
Class IV = Verapamil and Diltiazem
104
Flecainide belong to which subclass of Antiarrhythmic drugs?
A. Class IA
B. Class IB
C. Class IC
D. Class ID
C. Class IC
Class IA = Quinidine and Procainamide
Class IB = Lidocaine
Class IC = Flecainide and Propafenone
105
Quinidine belong to which subclass of Antiarrhythmic drugs?
A. Class IA
B. Class IB
C. Class IC
D. Class ID
A. Class IA
Class IA = Quinidine and Procainamide
Class IB = Lidocaine
Class IC = Flecainide and Propafenone
106
Procainamide belong to which subclass of Antiarrhythmic drugs?
A. Class IA
B. Class IB
C. Class IC
D. Class ID
A. Class IA
Class IA = Quinidine and Procainamide
Class IB = Lidocaine
Class IC = Flecainide and Propafenone
107
Propafenone belong to which subclass of Antiarrhythmic drugs?
A. Class IA
B. Class IB
C. Class IC
D. Class ID
C. Class IC
Class IA = Quinidine and Procainamide
Class IB = Lidocaine
Class IC = Flecainide and Propafenone
108
Lidocaine belong to which subclass of Antiarrhythmic drugs?
A. Class IA
B. Class IB
C. Class IC
D. Class ID
B. Class IB
Class IA = Quinidine and Procainamide
Class IB = Lidocaine
Class IC = Flecainide and Propafenone
109
Flecainide would NOT be used to treat which of the following?
A. Atrial fibrillation
B. Hypertension
C. Tachycardia
D. Ventricular arrhythmias
B. Hypertension
110
Propanolol can be used to treat all of the following EXCEPT:
A. hypertension
B. post myocardial infarction
C. atrial arrhythmias
D. angina
E. prevent tachyarrhythmias
C. atrial arrhythmias
111
Verapamil are used to treat all of the following EXCEPT:
A. hypertension
B. angina
C. atrial arrhythmias
E. prevent tachyarrhythmias
E. prevent tachyarrhythmias
Class I: tx for atrial fibrillation, tachycardia and ventricular arrhythmias
Class II: tx for hypertension, post myocardial infarction, angina and to prevent tachyarrhythmias
Class IV: hypertension, angina and atrial arrhythmias
112
Amiodarone belongs to which class of Antiarrhythmic drugs?
A. Class I
B. Class II
C. Class III
D. Class IV
E. Class V
C. Class III
113
Verapamil belongs to which class of Antiarrhythmic drugs?
A. Class I
B. Class II
C. Class III
D. Class IV
E. Class V
D. Class IV
114
Verapamil would NOT be used to treat which of the following?
A. Angina
B. Hypertension
C. Atrial arrhythmias
D. Congestive heart failure
D. Congestive heart failure
