Pharmacology-- Cardiology

Question 1

Digoxin

Answer 1

Dec. AV nodal conduction. Inhibits Na/K ATPase= inc. Ca concentration in heart cells = inc. contraction force
Tx: CHF and atrial flutter. Negative inotropic
Decreased K+ levels cause digoxin toxicity (tx w Digoxin immune Fab

Question 2

Diltiazem

Answer 2

Non-DHP Calcium channel blocker
Tx: black men
Tx: AV nodal re-entrance

Question 3

Quinidine

Answer 3

Blockfast inward Na current (INa). – use dep block
Dec. AV nodal conduciton. Cinchonism (quinine OD, bc quinine stereoisomer). Anticholinergic= aggravates MG. Hypotension= alpha block

Question 4

Verapamil

Answer 4

L-type Ca channel blocker
Dec AV nodal conduction, Dec BP. Negative inotrope= no CHF use
Inc O2 supply via dec. vasospasm. Tx: Prinzmetal’s angina

Question 5

Propranolol

Answer 5

Nonselective beta blocker
Dec AV nodal conduction, dec BP Negative inotrope (B block). Aggravates asthma and DM via B2 block.
Blocks reflex tachy but causes excess bray= Inc diastole time= Inc EDV

Question 6

Diazoxide

Answer 6

Balanced vasodilator– K-channel activator, leads to muscle relaxation

Question 7

Nitroprusside

Answer 7

Balanced vasodilator. Unloads heart. Inc. cyanide= pre-tx w/ thiosulfate.
Tx: acute HTN crisis, dyspnea

Question 8

Reserpine

Answer 8

Tx: severe and resistant HTN
Depletes Ca, See suffy nose. Not for pt.s w peptic ulcers
Mech: irreversibly blocks the vesicular monoamine transporter (VMAT).[4] This normally transports free Ne, 5HT, DA from the cytoplasm of the presynaptic nerve terminal into storage vesicles for subsequent release

Question 9

Dobutamine

Answer 9

Primary mech: direct B1 stim. At high doses Beta2 offsets alpha1= beta1. Inc CO w/o systemic vascular resistance

Question 10

Dopamine

Answer 10

At low doses: tx of shock = dilates renal and mesenteric arteries= maintain urine output

Question 11

Esmolol

Answer 11

short acting beta antagonist

Question 12

Captopril

Answer 12

ACE inhibitor. Balanced vasodilator. Tx: outpatient CHF. Dry cough (bradykinen excess induced)

Question 13

Quinidine - mech

Answer 13

Class Ia anti-arrhythmic. Moderate Na channel block

Question 14

Digoxin toxicity

Answer 14

Fatal ventricular arrhythmias w/ severe AV block

Tx w digoxin immune Fab (Digibind)

Question 15

Lidocaine

Answer 15

ClassIB anti-arrhythmic. Normalizes conduction. Tx: inital MI to control arrhythmias

Question 16

Flecanide

Answer 16

Class IC anti-arrhythmic (Na). Marked conduction slowing

Question 17

Amiodarone

Answer 17

Long t1/2. Need potent doses to obtain desired level for action. Side effeects: blue skin, ocular deposits, pulm. fibrosis

Question 18

NE

Answer 18

Inc AV nodal conduction via B1.

Metoprolol is B1 blocker

Question 19

ACh

Answer 19

Dec. AV nodal conduction via M receptor.

Atropine is a muscarinic antagonist

Question 20

Atenolol

Answer 20

selective beta1 receptor antagonist

Controls catecholamine induced arrhythmias

Question 21

Bretylium

Answer 21

Class III anti-arrhythmic, blocks K channels

Tx: Malignant ventricular arrhythmias but cause catecholamine release that can aggravate arrhythmias briefly

Question 22

Nimodipine

Answer 22

DHP-Ca channel blocker, selective for cerebral vasculature

Tx: acute subarachnoid hemorrhage by preventing post hemorrhagic vasospasm

Question 23

Atropine

Answer 23

Competitive Ach Musc receptor antagonist (thus blocks PS action)
Dec excess vagal tone as seen in sinus bradycardia

Question 24

Nitrates

Answer 24

Decrease preload= Venous pooling, Dec MVO2=reflex tachy, Inc ventricular work= dec O2 demand

Question 25

Aspirin

Answer 25

Prevents arterial platelet adhesion (NOT DVT thrombi) . Irreversibly inactivates COX= Dec. platelet production of Txa 2, a potent vasoconstrictor

Question 26

Warfarin

Answer 26

Decreases vit-K dep. gamma-carboxylation of clotting factors= anticoagulation state

Question 27

Heparin

Answer 27

Activates Antithrombin III | --Only IV

Question 28

tPA

Answer 28

Binds to fibrin clots and activates plasminogen on the spot. Short t1/2, given IV. Dose not discriminate between fibrin-ased clots= bleeding/stroke risk

Question 29

Streptokinase

Answer 29

Binds and activates plasminogen (fibrinolytic). Used for some MI and PE Bacteria derived so allergy risk high. Can see excess bleeding in pt.s post-op

Question 30

Urokinase

Answer 30

aka uPA. Plasminogen activator (fibrinolytic) Human source. Can see excess bleeding in pt.s post-op bc of inc plasmin

Question 31

Colestipol

Answer 31

Bile acid sequestrant. Interrupt bile acid reabsorption= Big inc in LDL uptake. Cholestyramine has same MOA

Question 32

Lovastatin

Answer 32

(a statin) HMG-coA reducatase inhibitor.Leads to inc. LDL-receptor synth. Provastatin/mevastatin have same MOA

Question 33

Losartan

Answer 33

Angiotensin II receptor antagonist. Decresease aldosterone, inc renin 2-3x. Similar effects to ACE inhibition but no cough side effects

Question 34

Diazoxide

Answer 34

Tx insulinomas. Only dilates arterial smooth muscle, not venous

Question 35

Clonidine

Answer 35

Central alpha2 adrenergic agonist. Dec TPR via dec. sympathetic effects

Question 36

Methyldopa

Answer 36

Central alpha2 receptor iagonist. | ??? Positive Coombs--> hemolytic anemia

Question 37

Quinidine Pre-tx

Answer 37

Atrial arrhythmia pretx w a drug that will dec ventricular response such as: digozxin, beta blocker, Ca channel blocker

Question 38

Class II--??

Answer 38

Beta blocker dec. risk for reinfarction & sudden death following MI

Question 39

"Gray man"

Answer 39

Amiodarone side effect--- class III antiarrhythmic--- skin discolors w extended use, see it in fair skinned ppl more

Question 40

Beperidil

Answer 40

Ca channel blocker. Limited clinical use due to Torsades de Pointes

Question 41

ACEIs

Answer 41

Vasodilate renal efferents > renal afferents. Dec. GFR and filtration pressure. Thus dec. Diabetic renal failure progression

Question 42

Adenosine

Answer 42

Adenosine receptor blocked by methylxanthines (e.g. theophyline). Favored for tx of reentrant supra ventricular tachy

Question 43

Enoxaparin

Answer 43

Low molec weight heparin (LMWH)= oral anticoagulant

Question 44

Isoproterenol

Answer 44

Inc HR and Dec MAP

Question 45

Variant angina

Answer 45

Prinzmetal...use Ca Channel receptor blocker like Nifedipine to dec. spasm

Question 46

Contraindicated in CHF

Answer 46

Beta receptor antagonists. Don't want to dec. heart's contractility.