Boards Review

Front 1

2 Hypertensive drugs used in pregnancy

Back 1

Methyldopa
Hydralazine

Front 2

Methyldopa major toxicity

Back 2

hemolytic anemia
(positive Coombs test, direct)

Front 3

Methyldopa MOA

Back 3

work on alpha-2 receptors in CNS to decrease sympathetic nervous system output

Front 4

Hydralazine major toxicity

Back 4

Lupus-like syndrome
(anti-histone antibodies)

Also: reflex tachy (CONTRAINDICATED in agina/CAD), salt retention, nausea, headache

Front 5

nitroglycerine/ isosorbide dinitrate decrease what?

Back 5

preload

Front 6

Hydralazine decreases what?

Back 6

Afterload

Front 7

Minoxidil MOA

Back 7

K-channel opener. Hyperpolarizes to relax smooth muscle.

Use in severe hypertension

Front 8

Minoxidil toxicity

Back 8

Similar to hydralazine. Reflex tachy, salt retention, angina, PERICARDIAL EFFUSION

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Rx co-prescribed with Minoxidil and Hydralazine? (2)

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Beta-blocker to prevent reflex tachy

Diuretic to prevent salt retention

Front 10

Rx interaction when diuretics are used in hypertension?

Back 10

Digoxin (via hypokalemia)

Front 11

Nitroprusside toxicity?

Back 11

release cyanide

(direct inhibitor of electron transport. decreases proton gradient causing decreased ATP production)

Used in Hypertension

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Tx of Cyanide poisoning?

Back 12

hydroxocobalamin, nitrite, thiosulfate

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Diazoxide toxicity

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hyperglycemia. (reduces insulin release, hypotension)

used in HT

Front 14

Calcium channel blocker that works mainly on the heart?

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Verapamil

(do not use w/ beta blockers, due to effect on dec. contractility)

Note: can accelerate heart failure due to depression of myocardial contractility

Front 15

Calcium channel blocker that works mainly in the vascular smooth muscle?

Back 15

Nifedipine

(not useful in exertional angina b/c it allows for reflex tachycardia)

Front 16

Verapamil MOA

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block voltage-dependent L-type Ca channels, thereby reducing muscle contractility. (no Ca released from the sarcoplasmic reticulum)

Front 17

Rx given during stress test when patient is incapable of exercise

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Dobutamine (synthetic catecholamine)

Front 18

Partial beta-antagonists that are contraindicated in angina? (2)

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Pindolol and acebutolol

Front 19

Statin MOA

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HMG-CoA reductase inhibitors
(rate-limiting step in cholesterol synthesis. HMG-CoA --> mevalonic acid)

Front 20

Reduction of flushing in niacin use

Back 20

by long-term aspirin use

Front 21

Niacin MOA

Back 21

inhibits lipolysis in adipose tissue, reduces VLDL secretion into circulation

Front 22

Bile acid resin contraindications?
(ie, cholestyramine, colestipol, colesevelam)

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contraindicated in pts. with gallstones

(also, can dec. fat soluble vitamin uptake or bind oral Rx's (ie, digoxin))

Front 23

Lipid-lowering agent that works strongly on triglycerates?

Back 23

Fibrates (-fibrate and gemfibrozil)

(PPAR-alpha receptor agonist. Upregulates LPL --> inc. triglyceride clearance.
Results in:
Increased β-oxidation in the liver
Decreased hepatic triglyceride secretion
Increased lipoprotein lipase activity, and thus increased VLDL clearance
Increased HDL
Increased clearance of remnant particles

Front 24

Firates toxicity?

Back 24

Myositis, increase LFT

Front 25

Ryanodine receptors are coupled with what?

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L-type calcium channels in cell membrane. They are located in the sarcoplasmic reticulum.

Front 26

action of protein kinase A in cardiac cells

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Activated through Beta-1 and G(s).

phosphorylates L-type and Ca channels and phospholamban, both of which increase intracellular Ca during contraction

Front 27

Class 1A antiarrhythmics

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Quinidine, Procainamide, Disopyramide

(The QUeen PROClaims DISO's PYRAMID)

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Prolongation of QT interval by which drugs?

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Class IA and III. Risk of Torsades de Pointes.

Familial Long QT syndrome is from mutation in K-channel.

Front 29

Class I antiarrhythmics decrease what?

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Slope of Phase 0 upstroke and amplitude of action potential

*Also: decrease slope in phase 4.
--> increase time between depolarization.

Front 30

Effect on phase 3 by Class IA, IB, and IC antiarrhythmics?

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IA: elongate (inc AP duration)
IB: shorten (dec AP duration)
IC: no change

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Indication for IA drugs?

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atrial and ventricular arrhythmias, esp:
reentry
ectopic supravenricular
ventricular

Front 32

Indication for IB drugs?

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acute ventricular arrhythmias
(especially post MI)
digitalis-induced arrhythmias

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Indication for IC drugs?

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Last resort for refractory tachyarrhythmias
For patients without structural abnormalities

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Class IB drugs?

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Lidocaine, Mexiletine, Tocainide
(I'd Buy LIDy's MEXIcan Tacos)

Can also include phenytoin

Front 35

Class IC drugs?

Back 35

Flecaninide, encainide, propafenone

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Toxicity of IC?

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Pro-arrhythmic, esp. post MI
significantly prolongs refractory in AV node

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Class II antiarrhythmics?

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Beta-blockers
Propanolol (non-selective)
Esmolol and Metaprolol (cardio selective)
Atenolol
Timolol

Front 38

Actions of Class II?

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decrease cAMP, decrease Ca currents
Suppress abnormal pacemakers by dec phase 4 (AV node very sensitive)
Increase PR interval

Front 39

Toxicities of Class II

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Impotence, exacerbation of asthma/allergic rxns, bradycardia, AV block, CHF, exercise intolerance (inability to inc HR), mask hypoglycemia in diabetics, CNS sleep alterations

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Metaprolol Toxicity?

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dyslipidemia

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Class III antiarrhythmics?

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Soltalol, ibutilide, amiodarone

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Amiodarone Toxicity

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Pulmonary fibrosis, corneal deposits, hepatotoxicity, skin deposits resulting in blue skin (photodermatitis), hypo/hyperthyroidism

Remember to check PFTs LFTs and TFTs when using amiodarone

Note: takes 1-3 weeks to work, not suitable for acute managment

Front 43

Tx of Nodal arrhythmias?

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#1: Adenosine (very short acting)
#2 Class IV: verapamil, diltiazem

(avoid use with class II due to synergistic dec in contractility)

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Action of class IV?

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on nodal cells. dec amplitude and extends length of AP
(ERP is increased, also inc in IA)

Front 45

Causes of AV block?

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Lyme disease, tertiary syphilis, OD of beta-blocker or ca-channel blockers

Front 46

Adenosine MOA

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increase K out of cells --> hyperpolarization and decreased calcium influx

Drug of choice in dx/abolishing AV nodal arrhythmias.

Front 47

Epinephrine reversal with what drugs?

Back 47

With alpha-blockers.
ie, phenoxybenzamine or phentolamine (fyi: irrev, rev)

Normally, non-selective beta and alpha agonist would increase BP. When alpha antagonist is administered, the beta-activation causes a dec in BP due to vasodilatation.

Front 48

Alpha-1 blockers and use

Back 48

Prazosin, terazosin, doxazosin

for HT and urinary retention due to BPH