physiology of the heart

Question 1

what is a U wave

Answer 1

this is purkinje repolarization after the T wave. due to hypokalemia

Question 2

J wave

Answer 2

this is a separate wave within the ST segment that has to due with hypothermia or hypocalcemia.

Question 3

when to use thiazides

Answer 3

moderate to mild HTN. since they are in the middle for potentcy

Question 4

when to use loops

Answer 4

HTN crisis, CHF, cirrhosis, renal dysfucntion

Question 5

what to watch out for with diuretics

Answer 5

HSR to thiazides, volume depletion, hypokalemia, hypomagnesemia, glucose intolerance, lipid profile, ototoxic, erectile dysfunction,

Question 6

caution for potassium sparing

Answer 6

gynecomastia in men, breast pain, menstrual irregularities, hyperkalemia. do not use in renal failure, diabetes, or when using ACEi and ARBs.

Question 7

list of potassium sparing diuretics

Answer 7

amiloride, triemterine, spironolactone.

Question 8

mechanism of ACEi

Answer 8

blocks ACE from converting angiotensin I to angiotensin II also inhibits the breakdown of bradykinin.

Question 9

mechanism for ARBS

Answer 9

inhibits angiotensin II from binding to its receptor and stops the release of aldosterone and vasodilator

Question 10

side effects of ACEi and ARBs

Answer 10

cough (not ARBs), hypotension, decreased renal function, angioedema.

Question 11

when are ACEi and ARBs contraindicatred

Answer 11

renal artery stenosis, hyperkalemia, caution in renal failure, pregnancy

Question 12

what else do ACEi and ARBs do?

Answer 12

benefit chronic renal failure (NOT ACUTE) congestive HF, LV remodeling, LVH, may even reduce risk of diabetes.

Question 13

what do CCBs do?

Answer 13

they inhibit the Ca influx for vascular sooth muscle thus decrease TPR.

Question 14

what are the two classes of CCBs

Answer 14

dihyropyridines and non dipine

Question 15

what are the two dipine used

Answer 15

amlodipine and nifedipine

Question 16

what are the two nondipines

Answer 16

diltiazem and verapamil

Question 17

what else to CCB do?

Answer 17

good for raynauds, antianginal

Question 18

when treating angina with dipine what do we watch out for?

Answer 18

reflex tachy and worsening angina

Question 19

what is the main reason to use a beta blocker for HTN

Answer 19

to reduce cardiac output.

Question 20

what secondary reasons do we use b blockers for

Answer 20

to decrease the release of renin

Question 21

side effects for beta blockers

Answer 21

decreased exercise tolerance, bronchospasm, bradycardia, CHF due to negative inotropy, mask symptoms of hypoglycemia, depression, worsening PVD

Question 22

why use metoprolol and atenolol

Answer 22

because they have cardiogenic selectivity and not broncho interference. if asthma and need a beta blocker use a selective like metoprolol and atenolol

Question 23

why use carvedilol, esmolol and labetolol

Answer 23

these are used for HTN urgency or acute coronary syndromes. because they have additional sympathomimetic activity and can drastically lower BP.

Question 24

what is the main use for esmolol

Answer 24

AV nodal blocking. it is unique due to its short half life.

Question 25

alpha blockers mechanism

Answer 25

reduces vascular resistance.

Question 26

aphla blockers examples

Answer 26

terazosin and doxazosin

Question 27

SE of alpha blockers

Answer 27

orthostatic hypertension, fkuid retention, worse angina

Question 28

even though they are clearly outdated, why use alpha blockers at all

Answer 28

because they can aid in BPH

Question 29

examples of systemic vasodilators

Answer 29

hydralazine and minoxidil

Question 30

mechanism of hydralazine and minoxidil

Answer 30

they are vasodilators by relaxing smooth muscle of arterioles

Question 31

when to use hydralazine and minoxidil

Answer 31

in CHF and HTN. also used in refractory HTN.

Question 32

central acting sympathoplegic

Answer 32

these are alpha 2 agonists that reduce sympathetic outflow from the brainstem. the decreased sympathetic tone also reduces release of renin

Question 33

examples of central sympathp

Answer 33

clonidine, methyldopa, guanabenz

Question 34

when to use methyl dopa

Answer 34

during pregnancy

Question 35

SE of the central acting

Answer 35

sedation, dry mouth, rebound HTN. fatigue, orthostatic hypotension, depression.

Question 36

what are ganglion blockers

Answer 36

adrenergic neuron blocking agents. pharma sympathectomy.

Question 37

examples of ganglion blockers? 2

Answer 37

guanethidine and reserpine.

Question 38

SE of the ganglion blockers

Answer 38

sedation, parkinson, mental status changes

Question 39

aspirin uses

Answer 39

CAD.

Question 40

what is aspirin mechanism

Answer 40

irreversible inhibition of COX enzymes. blocking prostaglandin and thromboxane synthesis

Question 41

ticlopidine what is it and when to use it?

Answer 41

this an alternative to aspirin for treating CAD. it is a thienopyridine derivative that inhibits platelet aggregation by ADP. decreases fibrinogen and thus blood viscosity

Question 42

SE of ticlopidine

Answer 42

neutropenia and TTP

Question 43

clopidogrel what is it and when to use it

Answer 43

alternative to aspirin, it is a thienopyridine derivative with a greater anitthrombotic activity than ticlopidine. selectively inhbits the ADP platelet receptor.

Question 44

prasugrel what is it and when

Answer 44

this is another anti platelet alternative to aspirin. same family.

Question 45

who can we use prasugrel on?

Answer 45

<75 years of age, greater than 60kg, no history of stroke of TIA

Question 46

dipyridamole

Answer 46

pyrimido-pyrimidine derivative. increases cAMP inhibits PDE, activates adenylyl cyclase limited use due to exercise induced ischemia

Question 47

cilostazol

Answer 47

another alternative to aspirin for anti platelet. quinilone derivative that inhibits PDE. increases cAMP leading to inhibition of platelet aggregation.

Question 48

which beta blockers do we use in CAD

Answer 48

beta 1 selective or cardioselective

Question 49

which are beta 1 selective

Answer 49

metoprolol, atenolol, bisoprolol

Question 50

when not to use Beta blockers

Answer 50

bradycardia, AV block, sick sinus syndrome, unstable LVF, asthma, severe depression, peripheral vascular disease.

Question 51

SE of beta

Answer 51

sedation, fatigue, decreased exercise tolerance. lethargy, insomnia, claudication worse, impotence

Question 52

contra for nitrates

Answer 52

hypotension, aortic stenosis, hypertrophic cardiomyopathy, use of PDE to treat erectile dysfunction

Question 53

SE to nitrates

Answer 53

tolerance. HA, hypotension.

Question 54

digoxin when to use it

Answer 54

use for HF. it stimulates the heart.

Question 55

what is the mechanism for digoxin

Answer 55

it inhibits the Na/k ATPase. this allows for calcium to come into the heart cell giving the heart an increased force of contraction due to the calcium.

Question 56

what does digoxin do for the heart in CHF?

Answer 56

it increases CO, LVEF, exercise tolerance, natriuresis, vagal tone, and decreases LVEDP, NE, RAAS, and neural-hormonal activity.

Question 57

why is use of digoxin waining

Answer 57

due to the narrow therapeutic window. can be toxic and proarrhthmigenic

Question 58

what is dobutamine and when do we use it

Answer 58

we use it in heart failure. it is a direct beta agonist

Question 59

what are the downfalls od dobutamine

Answer 59

tolerance develops within 48 hrs.

Question 60

what is milrinone and when do we use it

Answer 60

it is a PDEi that increases contractility and relaxation. we use it in HF. there is no tolerance up to 72 hours.