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54 Cards in this Set
- Front
- Back
ACE inhibitors/ARBs decrease preload or afterload?
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both
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drugs used to decrease oxygen demand in pt. with heart attack
(3) |
beta blockers
ACE inhibitors/ARBs (dec. afterload) Nitrate to reduce preload |
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3 states that increase viscosity of blood
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polycythemia vera
Multiple Myeloma hereditary spherocytosis |
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2 conditions that decrease aortic dicrotic notch
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marfan's, syphilis
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S3 heart sound
normal in (2) abnormal in (4) |
rapid ventricular filling
children, preggos dilated cardiomyopathy CHF mitral regurgitation R-->L shunts (ASD,VSD) |
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S4 heart sound when (4)
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hypertrophic cardiomyopathy
chronic HTN with LVH aortic stenosis after MI |
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QRS complex associated concurrently with what heart action
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mitral valve closure
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what causes paradoxical splitting? wide splitting?
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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) |
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ventricular Action potential depolarization occurs at stage
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0 (zero)
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what 2 antiarrhymthic classes act on nodal cells?
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calcium channel blockers (lengthen upstroke)
beta blockers (lengthen phase 4) |
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what drug used for Wolf-Parkinson White, what is side effect
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procainamide, SLE-like syndrome
amiodarone can also be used |
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Quinidine side effects (3)
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cinchonism
thrombocytopenia torsades de pointes |
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Main side effects of amiodarone (4)
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check PFTs, LFTs, TFTs
pulmonary fibrosis hepatotoxicity hypo/hyperthyroidism (is 40% iodine by weight) also photosensitivity |
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sotalol is what drug class
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K+ channel blocker
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2 populations to avoid Calcium channel blockers in
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CHF patients and AV block patients
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adenosine mech, use, blocked by what drug?
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mech- blocks K+ channels, which decreases intracellular calcium
abolishing SVT (will temporarily stop heart) theophylline |
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torsades de points and digoxin toxicity can both be helped by giving
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Mg2+
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pneumonic for jugular venous pressure parts
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At Charles's Crossing, Vehicles Yield
a,c,v are peaks |
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squatting increases
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Afterload
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anything that prolongs what can lead to torsades de pointes? treatment?
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long QT
magnesium |
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2 methods to control chronic afib?
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rate control: use digoxin, calcium channel blockers, or beta blockers
rhythm control: use sotalol or amiodarone (potassium channel blockers) with warfarin if acute, cardiovert |
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where is angiotensinogen produced?
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in liver
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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 |
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carotid receptors send blood volume status information by what nerve?
aortic receptors? |
carotid- glossopharyngeal
aortic- vagus both transmit to medulla |
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hypertension with bradycardia and respiratory depression is what?
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cushing reflex
indicates raised intracranial pressure |
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do peripheral or central chemoreceptors sense both CO2 and O2?
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peripheral carotid and aortic chemoreceptors sense when O2 is below 60 mmHg
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what does adenosine do to coronary arteries
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dilates, because body sees it as depleted energy (ATP with no phosphate)
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how does nitroglycerin help with angina?
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dilates veins which decreases preload which decreases myocardial 02 demand
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lymphatic blockage causes edema by changing what starling force?
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increasing intersitial oncotic pressure
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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) |
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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) |
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how does LPS cause smooth muscle vasodilation and what is the endothelial counterpart
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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 |
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3 substances that act on myosin light chain kinase to relax smooth muscle
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calcium channel blockers
inc. cAMP beta 2 receptor stimulation by epi prostaglandin E2 |
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what drugs are shown to decrease mortality in CHF (4)
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ACE inhibitor/ARBs
beta blockers K+ sparing diuretics loop diuretics |
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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 |
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minoxidil mech, use
2 side effects |
opens potassium channels to hyperpolarize smooth muscles
for severe HTN causes hypertrichosis (hair growth), reflex tachycardia |
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lab abnormality contraindication for ACE inhibitors/ARBs
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hyperkalemia
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does Nitroprusside act on veins or arterioles
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acts on both! increases cGMP via NO release like nitrates, but unlike nitrates also has action on arterioles
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smooth muscle migration in atherosclerosis involves what 2 factors
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TGF-B and PDGF
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Ezetimibe
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blocks cholesterol absorption at small intestine brush border (lowers LDL)
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what lipid lowering drug inhibits 7 alpha hydroxylase?
side effects (3) |
fibrates
myositis and LFT increase (like statins), cholesterol gallstones (like cholestyramine) |
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what lipid component do omega-3 fatty acids decrease?
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decrease TGs
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what is potential problem of very high TGs?
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a cause of pancreatitis
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treatment of prinzmetal's variant
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dihydropyridine calcium channel blocker (like nifedipine)
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3 changes seen in MI for ECG
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ST segment elevation
Q wave appears T wave becomes inverted |
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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 |
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clopidogral and ticlopidine mechanism
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IRREVERSIBLY inhibit ADP receptors on platelets
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which drug given for MI can cause tinnitus
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aspirin
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Dilated Cardiomyopathy causes (7)
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Cocksackie B virus
Doxorubicin peripartum cardiomyopathy chronic alcohol abuse wet beri beri chagas chronic cocaine use |
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most common cause of myocarditis in US
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cocksackie virus
(will show lymphocytes with necrosis) |
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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 |
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most common arrhythmia of digoxin? treatment?
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bradycardia (by stimulating parasympathetic innervation)
give atropine |
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how is digoxin cleared?
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by kidney (so must decrease if renal impairment)
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antifreeze is toxic to what?
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nephrotoxic (makes calcium oxalate crystals)
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