Cardiovascular Exam Ii

Front 1

This receptor is located in vascular smooth muscle and causes vasoconstriction

Back 1

Alpha1

Front 2

This receptor is located in presynaptic adrenergic nerve terminals and vascular smooth muscle and causes inhibition of NE release and vasoconstriction

Back 2

Alpha2

Front 3

This receptor is located in heart and causes increase in heart rate, increase in contractility and increase in speed of AV node conduction

Back 3

Beta1 receptors

Front 4

This receptor is located in JG cells in kidney and causes renin release

Back 4

Beta1

Front 5

Activation of this receptor in presynaptic adrenergic nerve terminals causes increase in NE release

Back 5

Beta1

Front 6

Activation of this receptor in adipose tissue causes lipolysis

Back 6

Beta1

Front 7

This receptor is located in vascular smooth muscle and causes vasodilation, in bronchial smooth muscle causing bronchodilation and in liver stimulating glycogenolysis, also in skeletal muscle vascular bed causing vasodilation

Back 7

Beta2

Front 8

This receptor is located in renal blood vessels and causes vasodilation

Back 8

D1

Front 9

Sympathomimetic drugs are used for treatment of _

Back 9

Hypotension
Shock
Acute heart failure

Front 10

Sympatholytics are used for treatment of _

Back 10

Hypertension
Angina pectoris
Cardiac arrhythmias
CHF

Front 11

This drug is used for resuscitation from cardiac arrest and anaphylactic shock - IV - whats the mechanism?

What would be common adverse effects?

Back 11

Epinephrine

Increase inotropic and chronotropic effects plus alpha mediated vasoconstriction

Tachycardia (most common) and HTN crisis

Front 12

Which drugs increase effect of epinephrine

Back 12

Cocaine
TCA
MAO inhibitors
Thyroid hormones

Front 13

This drug stimulates alpha1, alpha2, beta 1 receptors and has relatively little effect on beta 2 - only indicated for cardiac arrest and hypotensive states

Back 13

NE

Front 14

This drug stimulates beta 1 and beta 2 receptors and is used in AV block, bradycardia and emergency situations ( in anticipation of inserting cardiac pacemaker)

Back 14

Isoproterenol

Front 15

D1 agonist used for severe hypertension

Back 15

Fenoldopam

Front 16

At low dose (less than 2 micrograms) dopamine binds which receptor and whats its action

Back 16

D1 receptor --> mesenteric and renal artery dilation (facilitates diuresis)

Front 17

At medium dose (2-10) micrograms dopamine binds what receptor and whats the action

Back 17

Beta 1 receptor --> inotropic effect, severe CHF

Front 18

At high dose (over 10 micrograms) dopamine binds what receptor and whats the action

Back 18

Alpha 1 receptor --> peripheral vasoconstriction, hypotensive state (shock)

Front 19

Synthetic beta 1 agonist, can activate alpha 1 receptors, increases CO with little or no effect on HR (selectively activates myocytes), only used IV for heart failure

Back 19

IV dobutamine

Front 20

Dopamine and dobutamine are used for treatment of _

Back 20

Acute CHF

Front 21

Name 3 alpha 1 agonists

Back 21

Phenylephrine
Methoxamine
Midodrine (prodrug)

Front 22

Clinical use of phenylephrine and methoxamine

Back 22

Hypotensive emergencies - preserve cerebral and coronary flow, also used to maintain BP during anesthesia

Front 23

This alpha 1 agonist is used for posture hypotension

Back 23

Midodrine

Front 24

This drug releases NE and is a mixed beta/alpha agonist, causes mild CNS stimulation and has potential for abuse although form of it is used as OTC decongestant

Back 24

Ephedrine

Front 25

Name 2 alpha 2 agonists

Back 25

Clonidine
Alpha methyldopa

Front 26

Which drugs bind to receptors in CV control centers of CNS and decrease sympathetic outflow from the brain

Back 26

Alpha 2 agonists - clonidine, alpha methyldopa

Front 27

This drug is indicated for hypertension, it is very lipid soluble and also available as transdermal patch, alpha 2 agonist

Back 27

Clonidine

Front 28

This prodrug is indicated for pregnancy related HTN and is an alpha 2 agonist

What are the potential side effects

Back 28

Alpha methyldopa

Positive Coombs test - complicated cross matching of blood, can cause hemolytic anemia

Potential for serious hepatotoxicity

Front 29

What are the major side effects of alpha 2 agonists

Back 29

Sedation in 50% of patients, sexual dysfunction in males, nausea, dizziness and sleep disturbances, dose related withdrawal

Front 30

What is the main precaution in clonidine

Back 30

DO NOT WITHDRAW SUDDENLY --> can cause rebound HTN

Front 31

Name alpha 1 selective blockers

Back 31

Prazosin
Doxazosin
Terazosin

Front 32

Name non-selective alpha blockers

Back 32

Phenoxybenzamine

Phentolamine

Front 33

What is the main indication for use of alpha 1 blockers

Back 33

Hypertension - decrease sympathetic tone of arteries and veins - decrease TPR

Front 34

What are the adverse effects of alpha 1 blockers

Back 34

MILD TACHYCARDIA (reflex tachycardia)
1st dose hypotension
Salt and water retention

Front 35

Irreversible nonselective alpha blocker which is indicated for treatment of pheochromocytoma (pre op)

Back 35

Phenoxybenzamine

Front 36

Competitive reversible non selective alpha blocker, prevents hypotension during surgical excision of pheochromocytoma, also used for diagnostic purposes

Back 36

Phentolamine

Front 37

Name non selective beta blockers

Back 37

Propranolol
Timolol
Pindolol

Front 38

Prototype non selective beta blocker, highly lipid soluble, high 1st pass effect - used for HTN, angina, arrhytmias, MI, aortic dissection, hypertrophic cardiomyopathy

Back 38

Propranolol

Front 39

Name beta 1 selective blockers

Back 39

Atenolol
Metoprolol
Esmolol

Front 40

Multiple large studies indicate long term use of _ in patients who have had MI prolongs survival

Back 40

Propranolol
Timolol
Metoprolol

Front 41

Adverse effects of beta 1 blockade

Back 41

Bradycardia
Decreased CO
AV block
Can precipitate heart failure
Arrhythmias
Sodium water retention
Rebound cardiac excitation if discontinued suddenly
May worsen peripheral vascular disease

Front 42

Adverse effects of beta 2 blockade

Back 42

Bronchoconstriction
Inhibition of glycogenolysis - detrimental for diabetics
Masks tachycardia
Vasoconstriction

Front 43

Name two alpha/beta blockers

Back 43

Labetalol

Carvedilol

Front 44

This drug depletes sympathetic neurons of NE, prevents NE from vesicular packaging - decreases HR, CO, vasodilation --> decreases BP

Back 44

Reserpine

Front 45

What is THE MOST SERIOUS side effect of reserpine that limits its use

Back 45

DEPRESSION (can lead to SUICIDE)

Front 46

This drug is transported into membrane of sympathetic nerve terminals by the uptake 1 system and prevents release of NE in response to AP's

What is the main side effect

Back 46

Guanethidine

Orthostatic hypotension

Front 47

Ganglionic blocker that has rare use in treatment of essential hypertension in patients refractory to other antihypertensives

Back 47

Mecamylamine

Front 48

Name class of drugs

First line treatment of HTN through Na excretion and fluid volume reduction

What are the adverse effects

Back 48

Diuretics

Hypokalemia, volume depletion

Front 49

3 classes of Ca channel blockers with examples

Back 49

Benzothiazepines - DILTIAZEM

Phenylalkylamines - VERAPAMIL

Dihydropyridine - NIFEDIPINE

Front 50

Name class of drug

First or second line drugs, selective inhibitors of L type Ca channel, work through natriuresis

Back 50

Ca channel blockers

Front 51

Side effects of Ca channels blockers

Back 51

Cardiac arrest
Bradycardia
AV block
Constipation
Edema (peripheral)

Front 52

MOA of Diltiazem

Back 52

Negative inotropic effect and decreased AV node conduction

Front 53

Ca channel blocker recommended in LVH, diastolic dysfunction and/or arrhythmias

Back 53

Diltiazem

Front 54

Diltiazem interacts with what other drug?

Back 54

Cyclosporine

Front 55

Ca channel blocker of choice in CHF

Back 55

Nifedipine

Front 56

This Ca channel blocker is smooth muscle selective, adjunctive to beta blocker or ACE inhibitor

Back 56

Nifedipine

Front 57

Nifedipine interacts with _

Back 57

Grapefruit juice

Front 58

Adverse effect of nifedipine

Back 58

Acute MI

Front 59

Verapamil is contraindicated in _

Back 59

Heart block and CHF

Front 60

Adverse effect of Verapamil

Back 60

Constipation

Front 61

This direct vasodilator is indicated in pregnancy related HTN and HF with ACE inhibitors intolerance, severe HTN

Back 61

Hydralazine

Front 62

Side effects of hydralazine

Back 62

Headache
Nausea
Anorexia
Palpitation
Sweating
Flushing
Lupus like fever

Front 63

This direct vasodilator opens K channels in smooth muscle membrane and is indicated in case of refractory HTN

Back 63

Minoxidil

Front 64

Side effect of Minoxidil

Back 64

Hirsutism in women

Front 65

MOA of sodium nitroprusside

Back 65

Direct and indirect stimulation of guanylyl cyclase

Front 66

Side effects of sodium nitroprusside

Back 66

Decreased BP
Cyanide accumulation
Metabolic acidosis
Arrhythmia

Front 67

Indications for sodium nitroprusside

Back 67

Pheochromocytoma (in operation)

Front 68

This direct vasodilator increases K conductance in smooth muscle - indicated occasionaly in hypertensive emergencies and hypoglycemia

Back 68

Diazoxide

Front 69

Adverse effects of diazoxide

Back 69

Excessive hypertension
Renal salt and water retention

Front 70

D1 agonist that is indicated for post op HTN and HTN emergencies

What is the contraindication?

Back 70

Glaucoma

Fenoldopam

Front 71

Third line drugs for HTN indicated for conocomitant BPH, adjunct to ACE inhibitors or CCB for resistant hypertension

What is the toxicity?

Back 71

Alpha 1 blockers - prazosin, doxazosin, terazosin

Fluid retention, tachycardia, fatigue, ORTHOSTATIC HYPOTENSION

Front 72

Contraindication for alpha methyldopa

Back 72

Depression

Front 73

Side effects alpha methyldopa

Back 73

Sedation
Nightmares
Depression
Vertigo
Lactation

Front 74

This drug is indicated for labile hypertension needing multiple drugs, mainstay in hypertensive urgencies
What is the toxicity it can cause?

Back 74

Clonidine

Dry mouth

Withdrawal syndrome

Front 75

Which anti HTN drug causes delayed or retrograde ejaculation

Back 75

Guanethidine

Front 76

Which drugs decrease TPR with no tachycardia, indicated in pre operative management of pheochromocytoma, chronic kidney disease, HTN emergencies and clonidine withdrawal

What are the side effects

Back 76

Carvedilol and Labetalol - combined alpha and beta blockers

SE --> Heart block, heart failure, bronchospasm, postural hypertension

Front 77

This class of drugs is indicated in concomitant heart failure and angina and high renin hypertension - decrease CO and inhibit renin production

Back 77

Beta blockers

Front 78

2 contraindications for beta blockers

Back 78

Concomitant asthma + insulin dependent diabetes

Front 79

Side effects of beta blockers

Back 79

Bradycardia
Asthma
Increase triglycerides
Depression

Front 80

Patient has concomitant asthma, ischemic heart disease and cardiac arrhythmias - which anti HTN would you give

Back 80

Metoprolol (atenolol, esmolol) - cardioselective beta blockers

Front 81

Side effects of beta 1 blockers

Back 81

Bradycardia
Heart block
Asthmatic symptoms at high doses

Front 82

Patient has HTN, concomitant migraines, esential tremors and reflex tachycardia - which HTN drug would you give

Back 82

Propranolol (timolol, pindolol, carteolol, nadolol, penbutolol)

Front 83

What are the contraindications non selective beta blockers

Back 83

Bronchospasic pulmonary disease
Insulin dependent diabetes

Front 84

Side effects of non selective beta blockers

Back 84

Bronchospasm
Heart block

Front 85

Name class of drugs which decrease TPR, no reflex sympathetic activation and save in ischemic heart disease

Back 85

ACE inhibitors - enalapril, captopril, fosinopril

Front 86

Patient has HTN and concomitant heart failure, KIDNEY DISEASE and diabetes, also resistant HTN - which anti HTN drug would you give

Back 86

ACE inhibitor

Front 87

ACE inhibitors are contraindicated in ?

Back 87

2nd and 3d trimester of pregnancy