Cardio 2

Front 1

2 antiplatelet agents

Back 1

Aspirin and Clopidogrel

Front 2

2 drugs for peripheral arterial disease

Back 2

Cilostazol and Pentoxifylline

Front 3

Mechanism of action for Cilostazol

Back 3

Inhibits phosphodiesterase type III - increases cAMP in platelets and vasculature - decrease platelet aggregation and vasodilation

Front 4

Mechanism of action for Pentoxifylline

Back 4

Increases erythrocyte flexibility and decreases plasma fibrinogen - increases tissue oxygenation

Front 5

First line for Peripheral Arterial disease

Back 5

Cilostazol

Front 6

What kind of vasodilators might be used to treat Raynaud's disease

Back 6

CCB, alpha blockers, nitrates, ACEI

Front 7

What does endothelin do?

Back 7

Vasoconstriction and increase in smooth muscle proliferation

Front 8

In pulmonary arterial hypertension you have an increase in? and a decrease in? with smooth muscle dysfunction.

Back 8

Increase in Endothelin; decrease in Prostacyclin and Nitric Oxide

Front 9

What does prostacylin and nitric oxide do?

Back 9

Vasodilate, inhibit platelet aggregation, inhibit smooth muscle proliferation

Front 10

Epoprostenol

Back 10

Prostacyclin Analogue - IV

Front 11

Treprostinil

Back 11

Prostacyclin Analogue - IV or inhalation

Front 12

Iloprost

Back 12

Prostacyclin Analogue - inhalation

Front 13

Bosentan

Back 13

Endothelin Receptor Antagonist - blocks both A and B

Front 14

Ambrisentan

Back 14

Endothelin receptor antagonist - blocks just A

Front 15

Sildenafil

Back 15

Phosphodiesterase type 5 inhibitor

Front 16

Tadalafil

Back 16

Phosphodiesterase type 5 inhibitor

Front 17

Beta blockers used for heart failure

Back 17

Sustained release Metoprolol, Bisoprolol, Carvedilol

Front 18

Inamrinone

Back 18

Phosphodiesterase inhibitor (increases cAMP)

Front 19

Milrinone

Back 19

Phosphodiesterase inhibitor (increases cAMP)

Front 20

Nesiritide

Back 20

BNP - activates guanylyl cyclase - increases cGMP - dilates arteries and veins

Front 21

What to use with a life threatening digoxin toxicity?

Back 21

Digibind - Digoxin immune Fab

Front 22

2 drugs that can give you gynecomastia

Back 22

Spironolactone and Digoxin

Front 23

Class IA antiarrhythmic drugs

Back 23

Quinidine, Procainamide, and Disopyramide

Front 24

Quinidine

Back 24

Class IA - Blocks Na and K channels- works on all types of arrhythmias

Front 25

Adverse effects of Quinidine

Back 25

Cinchonism: headache, tinnitus, hearing loss, dizziness, confusion, disturbed vision; Torsades de pointes; 30-50% have nausea

Front 26

Quinidine can have an initial increase in ventricular rate by:

Back 26

Inhibiting vagal effect on the heart; slows conduction of reentry circuit but increases AV conduction

Front 27

Cinchonism

Back 27

Think Quinidine; headache, tinnitus, dizziness, hearing loss, confusion, disturbed vision

Front 28

Procainamide is just like Disopyramide except:

Back 28

Less antimuscarinic effect, short half life (so used IV!), Lupus like syndrome, ganglionic blocker

Front 29

Disopyramide is just like Procainamide execept:

Back 29

More antimuscarinic effect, negative inotropic effect (don't want ot use with HF)

Front 30

Procainamide is the same as quinidine except:

Back 30

Less effective at suppressing abnormal ectopic pacemaker activity, less antimuscarinic activity, does not block alpha receptors

Front 31

ACLS says that procainamide is a good drug for:

Back 31

Ventricular fibrillation or pulseless ventricular tachycardia; not a drug of choice for chronic use

Front 32

Antiarrhythmic drug that can give you a Lupus-like syndrome:

Back 32

Procainamide

Front 33

Procainamide can cause hypotension because:

Back 33

It is a ganglionic blocker

Front 34

Disopyramide is just like Quinidine except:

Back 34

More marked antimuscarinic effect, no alpha blocking activity

Front 35

Disopyramide has more of an antimuscarinic effect so you can expect side effects to be:

Back 35

Urinary retention and dry mouth

Front 36

Antiarrhythmic Class IB

Back 36

Lidocaine and Mexiletine

Front 37

Lidocaine

Back 37

Class IB: blocks fast Na channels (very fast recovery from block) - greatest effect on depolarized/ischemic Purkinje and Ventricular tissue

Front 38

Although Lidocaine does not block K channels it does:

Back 38

Shortens action potential duration and effective refractory period

Front 39

Is Lidocaine taken orally or via IV?

Back 39

IV only so not used chronically

Front 40

Is Quinidine taken orally or via IV?

Back 40

Not used IV due to hypotensive effects - just orally

Front 41

Is Procainamide taken orally or via IV?

Back 41

Short half life so IV

Front 42

ACLS recommends that Lidocaine be taken with:

Back 42

Acute Ventricular tachycardia or fibrillation - not used chronically due to being an IV drug

Front 43

Lidocaine can be used as a local anesthetic so adverse effects when taken IV include:

Back 43

CNS issues; paresthesia, tremor, nausea, hearing disturbances, slurred speech, convulsions

Front 44

Mexiletine

Back 44

Class IB - just like Lidocaine but can be taken orally so can be used chronically

Front 45

Antiarrhythmic Class IC

Back 45

Flecainide and Propafenone

Front 46

Is Flecainide taken orally or IV?

Back 46

Both Class IC's (flecainide and propafenone) are taken orally

Front 47

Both Class IC's (flecainide and propafenone) are contraindicated:

Back 47

Post-MI - for patient's without structural abnormalities

Front 48

Propafenone is just like Flecainide except:

Back 48

Propafenone is also a beta blocker

Front 49

Beta blockers are especially good at preventing arrhythmias triggered by:

Back 49

Excess catacholamines

Front 50

K Channel Blockers (Class III)

Back 50

Amiodarone, Dronedarone, Sotalol, Ibutilide, Dofetilide

Front 51

Amiodarone

Back 51

K Channel Blockers (Class III) - blocks K, Na, weak Ca, alpha, and beta blocker - very lipid soluble

Front 52

Dronedarone

Back 52

K Channel Blockers (Class III)

Front 53

Sotalol

Back 53

K Channel Blockers (Class III) - Blocks K and non-selective beta blocker

Front 54

Ibutilide

Back 54

K Channel Blockers (Class III) - IV only

Front 55

Dofetilide

Back 55

K Channel Blockers (Class III)

Front 56

Adverse effects include microdeposits in the cornea, photosensitivity, and bluish-gray coloration of the skin

Back 56

Amiodarone (K Blocker - Class III)

Front 57

Things to be on the look out for when taking Amiodarone

Back 57

pulmonary fibrosis, hepatotoxicity, and hypo/hyperthyroidism

Front 58

Why is Amiodarone so lipid soluble?

Back 58

Amiodarone is 40% iodine by weight

Front 59

The FDA requires that a medication guide be given to patients that are prescribed this:

Back 59

Amiodarone

Front 60

Dronedarone and Amiodarone are similar except that:

Back 60

Dronedarone has no iodine - thus is potentially less toxic (still has black box warning)

Front 61

Adverse effects of Sotalol

Back 61

Torsades de pointes, excessive B-block (fatigue, sinus bradycardia, dyspnea)

Front 62

Do you take Ibutilide orally or by IV?

Back 62

By IV

Front 63

Antiarrhythmic Calcium Channel blockers

Back 63

(Class IV) - Verapamil and Diltiazem

Front 64

Adenosine mechanism of action

Back 64

Adenosine increases K out of the cell thus hyperpolarizing - also decreases Ca influx thus decreasing nodal conduction velocity and increasing refractoriness

Front 65

What cardiac drugs are notable for causing AV block?

Back 65

Adenosine, B-blocker, CCB, Digoxin

Front 66

Is Adenosine given orally or by IV?

Back 66

rapid IV bolus - half life of 10 seconds

Front 67

Adenosine adverse effects:

Back 67

Transient asystole, dyspnea (don't give to asthmatics), chest pain, facial flushing

Front 68

Magnessium Sulfate

Back 68

Effective in torsades de pointes and digoxin toxicity

Front 69

Only effective with AV nodal reentry or WPW, not effective for atrial flutter/fibrillation, or ventricular tachycardia

Back 69

Adenosine

Front 70

Prevent arrhythmias triggered by excess catecholamines; reduces sudden cardiac death in post-MI patients

Back 70

B-blockers (Class II)

Front 71

Which arteries does cilostazol mainly vasodilate by increasing cAMP?

Back 71

Femoral arteries

Front 72

No limitation of physical activity. Ordinary physical activity does not cause undue dyspnea or fatigue, chest pain, or near syncope

Back 72

Class I

Front 73

Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity causes undue dyspnea or fatigue, chest pain, or near syncope.

Back 73

Class II

Front 74

Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes undue dyspnea or fatigue, chest pain, or near syncope.

Back 74

Class III

Front 75

Inability to carry out any physical activity without symptoms. Signs of right heart failure. Dyspnea and/or fatigue may be present even at rest. Discomfort is increased by any physical activity.

Back 75

Class IV

Front 76

Phosphodiesterase type III inhibitor

Back 76

Cilostazol

Front 77

First line drugs for Pulmonary Arterial Hypertension

Back 77

Calcium Channel Blockers - first have to have the acute vasoreactivity test

Front 78

What would be a postive acute vasoreactivity test?

Back 78

A fall in mean pulmonary arterial pressure by 10; or a mPAP of less than 40 with unchanged or increased cardiac output

Front 79

Adverse effects of Bosentan

Back 79

Hepatotoxicity, anemia, possible teratogen, decrease concentration of some drugs such as hormonal contraceptives

Front 80

Nonarteritic ischemic optic neuropathy (NAION)

Back 80

Very rare adverse effect of Phosphodiesterase Type 5 inhibitors (afils)

Front 81

An increase in preload with heart failure will do what?

Back 81

Since the Frank-Starling curve is relatively flat in a patient with HF, an increase in preload will cause no further increase in CO but will exacerbate pulmonary edema

Front 82

Drugs to use in someone with Stage A heart failure (high risk)

Back 82

ACE Inhibitors

Front 83

Drugs to use for someone with Stage B heart failure (no symptoms just structural)

Back 83

ACE-I and B-blockers

Front 84

Drugs to use for someone with Stage C heart failure (symptoms)

Back 84

ACE-I, B-blockers, diuretic

Front 85

Increased extracellular K will do what on Digoxin activity?

Back 85

Reduce - Also Hypokalemia increase the toxicity of Digoxin

Front 86

In Stage D of heart failure you want to increase myocardial contractility with these drugs:

Back 86

Dobutamine, Dopamine, Phosphodiesterase Inhibitors (Inamrinone, Milrinone)

Front 87

Drug useful in increasing the force of contraction without increasing HR - used in Stage D heart failure

Back 87

Dobutamine

Front 88

Adverse effect of Inamrinone (Phosphodiesterase inhibitor)

Back 88

Thrombocytopenia