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54 Cards in this Set

  • Front
  • Back
ACE inhibitors/ARBs decrease preload or afterload?
both
drugs used to decrease oxygen demand in pt. with heart attack

(3)
beta blockers

ACE inhibitors/ARBs (dec. afterload)

Nitrate to reduce preload
3 states that increase viscosity of blood
polycythemia vera
Multiple Myeloma
hereditary spherocytosis
2 conditions that decrease aortic dicrotic notch
marfan's, syphilis
S3 heart sound
normal in (2)
abnormal in (4)
rapid ventricular filling

children, preggos

dilated cardiomyopathy
CHF
mitral regurgitation
R-->L shunts (ASD,VSD)
S4 heart sound when (4)
hypertrophic cardiomyopathy
chronic HTN with LVH
aortic stenosis
after MI
QRS complex associated concurrently with what heart action
mitral valve closure
what causes paradoxical splitting? wide splitting?
paradoxical- things that delay LV emptying, so normal A then P closing is reversed (aotic stenosis, LBBB)

wide splitting (on expiration as well) - things that delay right ventricle emptying (RBBB, pulmonic stenosis)
ventricular Action potential depolarization occurs at stage
0 (zero)
what 2 antiarrhymthic classes act on nodal cells?
calcium channel blockers (lengthen upstroke)

beta blockers (lengthen phase 4)
what drug used for Wolf-Parkinson White, what is side effect
procainamide, SLE-like syndrome

amiodarone can also be used
Quinidine side effects (3)
cinchonism
thrombocytopenia
torsades de pointes
Main side effects of amiodarone (4)
check PFTs, LFTs, TFTs

pulmonary fibrosis
hepatotoxicity
hypo/hyperthyroidism (is 40% iodine by weight)

also photosensitivity
sotalol is what drug class
K+ channel blocker
2 populations to avoid Calcium channel blockers in
CHF patients and AV block patients
adenosine mech, use, blocked by what drug?
mech- blocks K+ channels, which decreases intracellular calcium

abolishing SVT (will temporarily stop heart)

theophylline
torsades de points and digoxin toxicity can both be helped by giving
Mg2+
pneumonic for jugular venous pressure parts
At Charles's Crossing, Vehicles Yield

a,c,v are peaks
squatting increases
Afterload
anything that prolongs what can lead to torsades de pointes? treatment?
long QT

magnesium
2 methods to control chronic afib?
rate control: use digoxin, calcium channel blockers, or beta blockers

rhythm control: use sotalol or amiodarone (potassium channel blockers)

with warfarin

if acute, cardiovert
where is angiotensinogen produced?
in liver
baroreceptors:
where do we sense decrease in blood pressure?
where do we sense increase in blood pressure?

increase or decrease in baroreceptor firing with hypotension?
decrease: ONLY IN CAROTID SINUS BARORECEPTOR

increase: seen in both carotid and aortic baroreceptors

hypotension- decreased firing
carotid receptors send blood volume status information by what nerve?

aortic receptors?
carotid- glossopharyngeal

aortic- vagus

both transmit to medulla
hypertension with bradycardia and respiratory depression is what?
cushing reflex

indicates raised intracranial pressure
do peripheral or central chemoreceptors sense both CO2 and O2?
peripheral carotid and aortic chemoreceptors sense when O2 is below 60 mmHg
what does adenosine do to coronary arteries
dilates, because body sees it as depleted energy (ATP with no phosphate)
how does nitroglycerin help with angina?
dilates veins which decreases preload which decreases myocardial 02 demand
lymphatic blockage causes edema by changing what starling force?
increasing intersitial oncotic pressure
smooth muscle cells

myosin light chain kinase is activated by what?

inhibited by what?
activated by calcium-bound calmodulin

inhibited by cAMP (from beta 2 receptor stimulation by epi, and prostaglandin E2)
what enzyme causes smooth muscle relaxation by dephosphorylating myosin?

what are 4 stimulators?
myosin phosphatase

from increased cGMP levels

increased cGMP- from viagra, NO (endothelial cells, nitrates, LPS)
how does LPS cause smooth muscle vasodilation and what is the endothelial counterpart
LPS stimulates iNOS which converts L-arginine to NO

endothelial cells have cNOS which also converts L-arginine to NO, but stimulation is calcium influx

remember, calcium influx in smooth muscle cells causes contraction, but calcium influx in endothelial cells causes production of NO which diffuses and causes relaxation
3 substances that act on myosin light chain kinase to relax smooth muscle
calcium channel blockers

inc. cAMP
beta 2 receptor stimulation by epi
prostaglandin E2
what drugs are shown to decrease mortality in CHF (4)
ACE inhibitor/ARBs
beta blockers
K+ sparing diuretics
loop diuretics
Hydralazine mech
safe to use in who
what complication and population it is not safe to use in?
increases cGMP to dilate arterioles

safe to use in pregnancy

can cause compensatory tachycardia, so not safe to use in pts with CAD/angina
minoxidil mech, use
2 side effects
opens potassium channels to hyperpolarize smooth muscles

for severe HTN

causes hypertrichosis (hair growth), reflex tachycardia
lab abnormality contraindication for ACE inhibitors/ARBs
hyperkalemia
does Nitroprusside act on veins or arterioles
acts on both! increases cGMP via NO release like nitrates, but unlike nitrates also has action on arterioles
smooth muscle migration in atherosclerosis involves what 2 factors
TGF-B and PDGF
Ezetimibe
blocks cholesterol absorption at small intestine brush border (lowers LDL)
what lipid lowering drug inhibits 7 alpha hydroxylase?

side effects (3)
fibrates

myositis and LFT increase (like statins), cholesterol gallstones (like cholestyramine)
what lipid component do omega-3 fatty acids decrease?
decrease TGs
what is potential problem of very high TGs?
a cause of pancreatitis
treatment of prinzmetal's variant
dihydropyridine calcium channel blocker (like nifedipine)
3 changes seen in MI for ECG
ST segment elevation
Q wave appears
T wave becomes inverted
what is very first cardiac enzyme change seen in MI?
what enzyme useful for diagnosing reinfarction on top of MI?
first- myoglobin (non-specific, but 2-3 hours, before troponin that starts at about 4)

CK-MB useful for recurrent MI
clopidogral and ticlopidine mechanism
IRREVERSIBLY inhibit ADP receptors on platelets
which drug given for MI can cause tinnitus
aspirin
Dilated Cardiomyopathy causes (7)
Cocksackie B virus
Doxorubicin
peripartum cardiomyopathy
chronic alcohol abuse
wet beri beri
chagas
chronic cocaine use
most common cause of myocarditis in US
cocksackie virus

(will show lymphocytes with necrosis)
2 inherited causes of hypertophic cardiomyopathy?

what is the problem?
Friedrich's ataxia

familial

heart too big, causes mitral valve leaflet outflow obstruction

also too thick, can't perfuse which causes death
most common arrhythmia of digoxin? treatment?
bradycardia (by stimulating parasympathetic innervation)

give atropine
how is digoxin cleared?
by kidney (so must decrease if renal impairment)
antifreeze is toxic to what?
nephrotoxic (makes calcium oxalate crystals)