Pharmacology: Cardiovascular

Question 1

Hydralazine

Answer 1

Incr cGMP

Question 2

Nifedipine

Answer 2

Dihydropyridine
Blocks v-gated L type calcium channels, decr muscle contractility
More selective in heart muscle

Question 3

Amlodipine

Answer 3

Dihydropyridine
Blocks v-gated L type calcium channels, decr muscle contractility
More selective in heart muscle

Question 4

Verapamil

Answer 4

Non-dihydropyridine, Class IV anti-arrhythmic
Blocks v-gated L type calcium channels, decr muscle contractility
More selective in vascular smooth muscle

Question 5

Diltiazem

Answer 5

Non-dihydropyridine, Class IV anti-arrhythmic
Blocks v-gated L type calcium channels, decr muscle contractility
More selective in vascular smooth muscle

Question 6

Which CCB affects vascular smooth muscles more? Heart?

Answer 6

Vascular: dHPs
Nifedipine > diltiazem > verapamil

Heart: non-dHPs
Verapamil > diltiazem > nifedipine

Question 7

Nitroprusside

What toxicity to worry about?

Answer 7

Direct release of NO –> incr cGMP
Short acting
Cyanide toxicity! (Tx: Amyl nitrite, B12, thiosulfate)

Question 8

Fenoldapam

Answer 8

Dopamine D1 receptor agonist

Relaxes renal vascular smooth muscle

Question 9

Diazoxide

Answer 9

K+ channel opener - hyperpolarizes and relaxes vascular smooth muscle

Question 10

Nitroglycerin (PO)

Answer 10

Releases NO --> incr cGMP --> smooth muscle relaxation and vasodilation
Veins >> arterioles
Decrease preload (venous pooling)
SE: Reflex tachy, flushing 
"Monday disease"

Question 11

Isosorbide dinitrate (PO)

Answer 11

Metabolized to isosorbide mononitrate
Releases NO --> incr cGMP --> smooth muscle relaxation and vasodilation
Veins >> arterioles
Decrease preload (venous pooling)
SE: Reflex tachy, flushing 
"Monday disease"

Question 12

Which beta-blockers are contraindicated in treating angina?

Answer 12

Pindolol and acebutolol: are partial beta-agonists

Question 13

Digoxin

Answer 13

Cardiac glycoside

1. Direct inhibition of Na/K ATPase increases intracellular Ca and inotropy
2. Increases PSNS activity by incr vagal tone –> decr HR

Question 14

What can increase Dig toxicity?

Answer 14

1. Renal failure (decr excretion)
2. Hypokalemia (more binding to Na/K channel)
3. Quinidine (decr dig clearance)

Question 15

Treating Dig toxicity

Answer 15

Slowly normalize K, lidocaine, cardiac pacer, anti-dig Fab fragments, Mg2+

Question 16

Pt with CHF and blurry yellow vision. What does his EKG look like?

Answer 16

Dig toxicity.

Incr PR interval, decr QT, scooping, T inversions, possible arrhythmias

Question 17

Nesiritide

Answer 17

Recombinant B-type natriuretic peptide –> incr cGMP –> vasodilation

Question 18

Quinidine

Answer 18

Class IA antiarrhythmic

Question 19

Procainamide

Answer 19

Class IA antiarrhythmic

Question 20

Disopyramide

Answer 20

Class IA antiarrhythmic

Question 21

Lidocaine

Answer 21

Class IB antiarrhythmic

Question 22

Mexiletine

Answer 22

Class IB antiarrhythmic

Question 23

Tocainide

Answer 23

Class IB antiarrhythmic

Question 24

Moricizine

Answer 24

Class IC antiarrhythmic

Question 25

Flecainide

Answer 25

Class IC antiarrhythmic

Question 26

Propafenone

Answer 26

Class IC antiarrhythmic

Question 27

Propranolol

Answer 27

Class II antiarrhythmic

Question 28

Esmolol

Answer 28

Class II antiarrhythmic

Question 29

Metoprolol

Answer 29

Class II antiarrhythmic

Question 30

Atenolol

Answer 30

Class II antiarrhythmic

Question 31

Timolol

Answer 31

Class II antiarrhythmic

Question 32

Ibutilide

Answer 32

Class III antiarrhythmic | K+ channel blocker

Question 33

Sotalol

Answer 33

Class III antiarrhythmic | K+ channel blocker

Question 34

Bretylium

Answer 34

Class III antiarrhythmic | K+ channel blocker

Question 35

Amiodarone

Answer 35

Class III antiarrhythmic K+ channel blocker Check LFTs, PFTs, TFTs Has class I, II, III, and IV effects because it alters the lipid membrane

Question 36

Dofetilide

Answer 36

K+ channel blocker

Question 37

Adenosine

Answer 37

Incr K+ efflux (out of cells) --> hyperpolarizing cell, decr Ca conductance (Na/K ATPase works harder, drives Ca out more via Na/Ca exchange?)

Question 38

What drug blocks the effects of adenosine? How? What is is used for?

Answer 38

Theophylline, a methylxanthine. Used for asthma, COPD. A non-selective adenosine R antagonist, in addition to being a competitive nonselective PDE-inhibitor that increases cAMP -->--> decreasing inflammation

Question 39

Statins

Answer 39

HMG-CoA reductase inhibitors | Decrease LDL cholesterol!

Question 40

Niacin

Answer 40

Inhibit lypolysis, reduces VLDL secretion - Main effect: increases HDL! - SEs: Flushing, hyperglycemia, hyperuricemia

Question 41

Cholestyramine

Answer 41

Bile acid resin - Prevent intestinal reabs of bile so liver must use up CH to make more - Main effect: decr LDL - SE: bad taste! cholesterol gallstones

Question 42

Colestipol

Answer 42

Bile acid resin - Prevent intestinal reabs of bile so liver must use up CH to make more - Main effect: decr LDL - SE: bad taste! cholesterol gallstones

Question 43

Colesevelam

Answer 43

Bile acid resin - Prevent intestinal reabs of bile so liver must use up CH to make more - Main effect: decr LDL - SE: bad taste! cholesterol gallstones

Question 44

Ezetimibe

Answer 44

Cholesterol absorption blocker - Prevent CH reabs at small intestine brush border - Main effect: decr LDL

Question 45

Gemfibrozil

Answer 45

Fibrate - Upregulates LPL and increases TG clearance - Main effect: decrease TG! - SE: Cholesterol gallstones (from increased cholesterol in bile

Question 46

Clofibrate

Answer 46

Fibrate - Upregulates LPL and increases TG clearance - Main effect: decrease TG! - SE: Cholesterol gallstones

Question 47

Benzafibrate

Answer 47

Fibrate - Upregulates LPL and increases TG clearance - Main effect: decrease TG! - SE: Cholesterol gallstones

Question 48

Fenofibrate

Answer 48

Fibrate - Upregulates LPL and increases TG clearance - Main effect: decrease TG! - SE: Cholesterol gallstones

Question 49

Ciprofibrate

Answer 49

Fibrate - Upregulates LPL and increases TG clearance - Main effect: decrease TG! - SE: Cholesterol gallstones

Question 50

The lipid-lowering agents that: 1. Decrease LDL cholesterol 2. Increase HDL cholesterol 3. Decrease TG

Answer 50

1. Statins, bile acid resins, cholesterol absorption blocker (exetimibe) 2. Niacin 3. Fibrates

Question 51

The lipid-lowering agents that: 1. Cause heptatoxicity 2. Cause myopathy/myositis 3. Cuase hyperglycemia 4. Cause cholesterol stones 5. Cause flushing 6. Cause hyperuricemia 7. Taste bad!

Answer 51

1. Statins, fibrates 2. Statins, fibrates 3. Niacin 4. BAS, fibrates 5. Niacin 6. Niacin 7. BAS