Pharm Test 5

Front 1

pacemaker of heart

Back 1

SA node

Front 2

impulses travel form SA node to...

Back 2

AV node

Front 3

impulses then travel from AV node to...

Back 3

Bundle of His

Front 4

fast potentials occur in these three...

Back 4

His-Purkinje system, atrial muscle, and ventricular muscle

Front 5

from Bundle of His to...

Back 5

left and right bundle branches

Front 6

from left and right bundle branches to...

Back 6

Purkinje fibers

Front 7

_____ charged ions cover inner surface of heart cells

Back 7

negatively charged ions

Front 8

________ charged ions come in an out of cell to polarized, depolarize

Back 8

positiely charged ions

Front 9

phase 0 fast potential

Back 9

influx of sodium, rapid depolarization

Front 10

phase 1 fast potential

Back 10

rapid partial repolarization

Front 11

phase 2 fast potential

Back 11

stable, calcium enters cell for contraction, DOES NOT INFLUENCE RHYTHM, just contractility

Front 12

phase 3 fast potential

Back 12

rapid repolarization, potassium extrusion, delay of this prolongs action potential duration and effective refractory period

Front 13

phase 4 fast potential

Back 13

stable or spontaneous depolarization via self excitation (automaticity), becoming it's own pacemaker anywhere in heart - aka dysrhythmias

Front 14

phase 0 slow potential

Back 14

slow influx of calcium

Front 15

phase 1 of slow potential

Back 15

non existant

Front 16

phase 2 and 3 slow potential

Back 16

insignificant

Front 17

phase 4 slow potential

Back 17

spontaneous depolarization of SA and AV node

Front 18

how does SA node work?

Back 18

spontaneous depolarization of SA node faster than all other spontaneous depolarizations, so it usually discharges first and determines heart rate

Front 19

excessive discharge of __________ neurons that innervate SA node can cause sinus tachycardia

Back 19

sympathetic neurons

Front 20

excessive ______________/____________ discharge can cause sinus bradychardia

Back 20

vagal / parasympathetic

Front 21

EKG letters?

Back 21

P QRS T

Front 22

p wave?

Back 22

depolarization of atria

Front 23

qrs?

Back 23

depolarization of ventricles

Front 24

t wave?

Back 24

repolarization of ventricles

Front 25

long PR interval?

Back 25

delayed AV node conduction

Front 26

long QT interval?

Back 26

delayed ventricular repolarization

Front 27

digoxin depresses the ______ segment of ekg

Back 27

ST segment

Front 28

first degree atrioventriular block?

Back 28

conduction through AV node delayed

Front 29

2nd degree AV block?

Back 29

conduction through AV node partial

Front 30

3rd degree AV block?

Back 30

nothing gets through AV node

Front 31

reentrant dysrhtymias?

Back 31

self sustaining circuit when one brance of Purkinje fibers blocked

Front 32

2 types of tachycardias

Back 32

supraventricular and ventricular tachycardias

Front 33

which tachycardia worst for heart pump?

Back 33

ventrucular tachycardia

Front 34

treatment for supraventrucular tachycardia?

Back 34

block AV node conduction instead of eliminating dysrhythmias

Front 35

treatment of ventruclar dysrhythmias?

Back 35

eliminate dysrhythmias

Front 36

all dysrhythmia meds__________

Back 36

are prodysrhythmias (worsten dysrhythmias)

Front 37

class 1 antidysrhythmics?

Back 37

block sodium channels, thus blocking phase 0 fast potentials in His-Purkinje, atria, and ventricles

Front 38

class 1 antidysrhythmics _____________ QRS complex by slowing ventricular conduction

Back 38

widens

Front 39

quinidine is class _____

Back 39

class 1a

Front 40

quinidine action

Back 40

blocks sodium channels and delayes ventricular repolarization, so widens QRS and widens QT

Front 41

side effects of quinidine?

Back 41

diarrhea and GI symptoms

Front 42

warning signs of quinidine induced dysrhythmia

Back 42

widening of QRS by 50% or more

widening of QT by too much

Front 43

quinidine ____________ digoxin level

Back 43

raises

Front 44

lidocaine class______

Back 44

1b agent

Front 45

class 1b (digoxin) action

Back 45

accelerate repolarization, gets rid of ST segment to do this

Front 46

lidocaine only for ___________ dysthythmias

Back 46

ventricular, not for supraventricular

Front 47

lidocaine undergoes _______________

Back 47

rapid inactivation by liver, so continuous IV infusion

Front 48

propranolol and other class II drugs?

Back 48

beta blockers, block beta1 receptors blocking calcium

Front 49

action of class II beta blockers?

Back 49

weakens sympathetic stimulation of heart thus decreasing SA nodal automaticity, AV conduction, and myocardial contractility

Front 50

decreased AV conduction means ________ on EKG

Back 50

widens PR interval

Front 51

good for supraventricular tachycardias

Back 51

propranolol, beta blockers. block calcium used for phase 0 depolarization of slow potentialin SA node

Front 52

class III antidysrhythmics blocks _______

Back 52

potassium channels used during repolarization of fast potential in phase 3 fast potential.

Front 53

class III, potassium channel blockers action on EKG

Back 53

porlong action potential duration, refractory period, widen QT interval

Front 54

name one class III agent

Back 54

amiodarone

Front 55

amiodarone effective against

Back 55

atrial and ventricular dysrhythmias but lots of side effects

Front 56

4 side effects of class III amiodarone

Back 56

lungs, eyes, liver, thyroid

Front 57

donedarone (class iii) doubles risk of death in patients with _______

Back 57

heart failure, atrial fibrillation

Front 58

class IV antidysrhythmics

Back 58

calcium channel blockers - Verapamil and diltiazem

Front 59

action of verapamil and diltiazem?

Back 59

slow ventricilar rate in A Fib

terminate SVT caused by AV reentrant circuit

suppress AV nodal conduction

Front 60

drug of choice for paroxysmal SVT?

Back 60

adenosine

Front 61

route for adenosine?

Back 61

IV bolus

Front 62

quinidine assessment (3)

Back 62

ekg, liver function, BP

Front 63

quinidine contraindicated for (4)

Back 63

cinchona allergy, heart block, digoxin, QRS/QT

Front 64

quinidine take with?

Back 64

meals

Front 65

quinidine side effects (5)

Back 65

diarrhea, cinchonism, cardiotoxicity, arterial embolism, digoxin

Front 66

plasma levels of quinidine

Back 66

2-5 mcg/mL

Front 67

quinidine for?

Back 67

atrial and ventricular dysthythmias

Front 68

procainamide?

Back 68

ventricular and supraventricular dysrhythmias, very toxic

Front 69

procainamide assess (5)

Back 69

ekg, cbc (blood), liver, kidney, BP

Front 70

procainamide contra (3)

Back 70

lupus, av block 2nd+, allergy

Front 71

procainamide admin (2)

Back 71

evenly spaced time, 3 hours between route change

Front 72

procainamide plasma level

Back 72

3-10 mcg/mL

Front 73

procainamide side effects (4)

Back 73

lupus like syndrome (SLE), blood count, QRS / PR, arterial embolism

Front 74

lidocaine for

Back 74

ventricular dysrhythmias

Front 75

lidocaine assess (2)

Back 75

ekg, bp

Front 76

lidocaine contra (3)

Back 76

stokes-adams, wolff-parkinson-white, AV/SA block

Front 77

lidocaine admin

Back 77

IV with 5% dextrose in water

IM - deltoid (IM rare)

Front 78

lidocaine plasma level

Back 78

1.5-5 mcg/mL

Front 79

side effects of lidocaine (2)

Back 79

seizures, respiratory

Front 80

amiodarone for (3) (not safe)

Back 80

a fib, v fib, AV nodal reentrant tachycardia

Front 81

amiodarone assess (8)

Back 81

ekg, eyes, chest x ray, potassium, magnesium, thyroid, pulmonary, liver

Front 82

amiodarone contra (3)

Back 82

sinus node, AV block, pregnant

Front 83

amiodarone side effects (7)

Back 83

pulmonary, heart failure, liver, thyroid, pregnant, eyes, sunscreen

Front 84

amiodarone interactions (3)

Back 84

grapefuit juice, diuretics, everything, CYP3A4

Front 85

lipoproteins that contain this apolipoprotein transport cholesterol and/or TG (triglycerides) from liver to peripheral tissues

Back 85

apolipoprotein B-100

Front 86

lipoproteins that contain this apolipoprotein transport cholestrol from peripheral tissues back to liver

Back 86

apolipoproteins A-I and A-II

Front 87

VLDL?

Back 87

very low density lipoprotein

Front 88

LDL

Back 88

low density lipoprotein

Front 89

HDL

Back 89

high density lipoprotein

Front 90

ASCVD?

Back 90

arteriosclerotic vascular disease

Front 91

elevatoin of _____ cholesterol increase risk of ASCVD

Back 91

LDL

Front 92

______ cholestrol, transports cholestrol back into liver

Back 92

HDL

Front 93

atherogenosis

Back 93

chronic inflammatory process, LDL's beneath arterial endothelium which is then oxidized

Front 94

cholesterol screening?

Back 94

every 5 years after age 20

Front 95

treat of LDL based on?

Back 95

10 year risk of major coronary event

Front 96

2 criteria for highest risk group?

Back 96

already have ASCVD

diabetes

Front 97

diet first choice, meds are _____

Back 97

lifelong

Front 98

drugs for LDL?

Back 98

statins, HMG-CoA reductase inhibitors

Front 99

statins action:

Back 99

increase LDL receptors on hepatocytes (liver cells)

Front 100

four statins that are metabolized by CYP3A4 and thus their levels can be increased in presence of CYP3A4 inhibitor (antibiotics, etc)

Back 100

atorva, fluva, lova, simva

Front 101

side effect of statins

Back 101

liver damage, myopathy (derease muscle tissue)

elevated ALT and AST for liver

elevated creatine kinase for muscle

Front 102

statin drug assessment

Back 102

liver function test (liver enzyme test, ALT and AST)

creatine kinase

Front 103

Niacin?

Back 103

can lower LDL / TG and increase HDL but has side effects

Front 104

niacin side effects (2)

Back 104

flushed face - use aspirin or ibuprofen

liver damage

Front 105

bile acid sequestrant (colesevelam)

Back 105

prevent reabsorption of bile acids in intestine, GI side effects

Front 106

name one bile aid sequestrant

Back 106

colesevelam

Front 107

admin for colesevelam

Back 107

1 hour before or after other drugs (bile sequestrant for cholesterol)

Front 108

name of nicotinic acid?

Back 108

niacin

Front 109

name of one statin

Back 109

lovastatin

Front 110

ezetimibe? (2)

Back 110

lowers LDL in small intestine

muscle injury

Front 111

one fibric acid derivative (fibrate) and what for and side effect

Back 111

gemfibrozil for TG, muscle injury

Front 112

cholestyramine?

Back 112

is questran, old bild acid sequestrant for cholestrol, GI issues

Front 113

risk factors of ASCVD (5)

Back 113

smoking, age, hx of ASCVD, HDL < 40mg/dL, hypertension

Front 114

cholestrol diet? (2)

Back 114

cholestrol less than 200 mg/day

saturated fat less than 7%

Front 115

statins contraindicated (2)

Back 115

hepatitis, pregnant

Front 116

lovastatin admin

Back 116

evening meal

Front 117

niacin contra (2)

Back 117

liver, gout

Front 118

niacin admin

Back 118

with meals

Front 119

niacin side effects (4)

Back 119

flushing, hepatotoxiity, hyperglycemia, hyperuricemia

Front 120

cholestyramine and colesevelam admin

Back 120

for these bile acid sequestrants:

fibroud pulpy fruit or apple sauce to counter impaction and esophageal irriation

Front 121

special note on rosuvastatin?

Back 121

asian, turns into double in blood

Front 122

gemfibrozil special note

Back 122

warfarin enhances by this fibrate used for TG and higher HDL

Front 123

gemfibrozil SE (3)

Back 123

gallstones, myopathy (esp with statins), liver disease

Front 124

gemfibrozil admin

Back 124

30 min before or after food for this TG cholestrol med

Front 125

cause of anginal pain

Back 125

not enough oxygen for cardiac oxygen demand

Front 126

determine cardiac oxygen demand: (4)

Back 126

heart rate, contractility, preload, afterload

Front 127

three types of angina pectoris

Back 127

chronic stable

variant (vasospastic)

unstable

Front 128

cause of stable chronic angina

Back 128

coronary artery atherosclerosis

Front 129

cause of variant angina

Back 129

coronary vasospasm

Front 130

goal for stable chronic angina

Back 130

reduce oxygen demand

Front 131

goal for variant angina

Back 131

increase oxygen supply

Front 132

action of nitroglycerin for stable chronic angina

Back 132

dilates veins, decreasing venous return, decreasing preload, decreasing o2 demand

Front 133

action of nitroglycerin for variant angina

Back 133

relaxes coronary vasospasm, increasing oxygen supply

Front 134

nitroglycerin route

Back 134

sublingual or patch

Front 135

nitroglycerin SE (3)

Back 135

headache, orthostatic hypotension, reflex tachycardia

Front 136

what to use for nitroglycerin induced tachycardia: (3)

Back 136

beta blocker, verapamil, or diltiazem (-pine ccb will affect heart rhythm)

Front 137

nitroglycerin admin note:

Back 137

must take off patch for 8 hours every 24 hours to avoid tolerance (sulfhydryl depletion)

Front 138

adverse nitroglycerin (2)

Back 138

no sildenafil (viagra), or PDE5 inhibitors

Front 139

beta blocker as primary med for stable angina action:

Back 139

decreate oxygen demand by decreaing heart rate and contractility, fixed schedule only

Front 140

CCB action as primary med for stable angina:(2)

Back 140

decrease afterload

reduce heart rate / contractility

Front 141

CCB action as primary med for variant angina (1)

Back 141

increase oxygen supply by relaxing coronary artery spasm

Front 142

if CCB combined with beta blocker, use this CCB

Back 142

nifedipine

Front 143

ranolazine use and action

Back 143

along with beta blocker, nitrate, or ccb

helps heart generate energy more efficiently

Front 144

for MI and death use: (2)

Back 144

antiplatelet (aspirin, clopidogrel)

cholesterol lowering drug

Front 145

hemostasis steps (2)

Back 145

platelet plug, coagulation (fibrin)

Front 146

two steps before fibrin for coagulation forms

Back 146

factor Xa > thrombin > fibrin

Front 147

__________degrades fribrin meshworks of clots

Back 147

plasmin

Front 148

____ a blood clot formed within a blood vessel or atria of heart

Back 148

thrombus

Front 149

arterial thrombi made of (2)

Back 149

platelet plug, fibrin

Front 150

venous thrombi made of (1)

Back 150

fibrin (later rbc and other get stuck on it)

Front 151

two antiplatelet drugs

Back 151

aspirin, clopidogrel

Front 152

two anticoagulants (anti fibrin)

Back 152

heparin, warfarin

Front 153

arterial thrombi best treated by

Back 153

antiplatelet (aspirin, clopidogrel)

Front 154

venous thrombi best treated by

Back 154

anticoagulants (heparin, warfarin)

Front 155

trade name of clopidogrel?

Back 155

plavix, antiplatelet

Front 156

heparin action

Back 156

helps antithrombin destroy thrombin and factor Xa which form fibrin (coagulant)

Front 157

antidote to heparin

Back 157

protamine sulfate

Front 158

thrombocytopenia?

Back 158

low platelets

Front 159

heparin monitered by

Back 159

aPTT

Front 160

normal aPTT

Back 160

40 seconds

Front 161

target aPTT with heparin

Back 161

60-80 seconds

1.5x to 2x

Front 162

LMW heparins bind to _______ preferentially as anticoagulant

Back 162

to factor Xa

Front 163

LMW heparins bioavailbility high because

Back 163

don't bind to random unecessary plasma proteins and tissues

Front 164

name two LMW heparins:

Back 164

enoxaparin,

tinzaparin

Front 165

benefit of LMW heparin

Back 165

specific binding means we know the level so safe for home without constant testing

Front 166

warfarin action for anticoagulation

Back 166

prevents activation of vitamin K

oral

Front 167

warfarin route

Back 167

oral

Front 168

heparin route

Back 168

sub cut

IV

Front 169

warfarin used for (2)

Back 169

VTE (venous thromboembolism)

stroke and embolism in a fib

Front 170

warfarin monitored using PT expressed as

Back 170

INR

Front 171

target INR for warfarin patients

Back 171

2 to 3

Front 172

genetic bleeding risk with warfarin (2)

Back 172

CYP2C9

VKORC1

Front 173

warfarin antidote

Back 173

vitamin K

Front 174

warfarin drug interactoins

Back 174

avoid all drugs

Front 175

oral anticoagulant (newer than warfarin)

Back 175

dabigatran

Front 176

aspirin action as antiplatelet

Back 176

inhibition of cyclooxygenase

Front 177

aspirin for (3)

Back 177

MI, angina, stroke

Front 178

aspirin dose

Back 178

80-325 mg/day

Front 179

clopidogrel (plavix) action as antiplatelet

Back 179

blocks p2Y-12ADP receptors on platelet

Front 180

clopidogrel pharmokinetics

Back 180

prodrug, needs conversion with help of enzyme CYP2C19

Front 181

one thrombolytics (clot destruction) med

Back 181

tPA, alteplase aka fibrinolytic

Front 182

action of thrombolytics drugs

Back 182

covert plasminogen to plasmin which degrades fibrin matrix of thrombi

Front 183

thrombolytics drug use

Back 183

started early, 4-6 hours after MI

Front 184

thrombolitic drug alteplase (tPA) risk

Back 184

intracranial hemorrhage, bleeding

Front 185

fibrinolysis contraindicated for STEMI when (4)

Back 185

s bp over 180, face trauma, intracranial hemorrhage, pregnant

Front 186

routine therapy for suspected STEMI (3)

Back 186

oxygen, morphine, nitroglycerin

Front 187

lower risk of second MI with (4)

Back 187

beta blocker

ACE or ARB

antiplatelet or warfarin

statin

Front 188

average bleeding time

Back 188

1-9 min