USMLE 1 Pharm CV/Resp

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(2) diuretics used for HTN what do both lower as an AE?: Thiazides

Loops

both lower K+
Vasodilator used for severe HTN and CHF AE?: Hydralazine

AE: SLE-like effects
Vasodilator used for emergency HTN situations AE?: Nitroprusside

AE: converts to cyanide
Anti-HTN, anti-anginal and anti-arrhythmic class that works by reducing heart contractility (2) AE: Calcium channel blockers

AE: Cardiac depression; Edema
which of the calcium channel blockers most specific for: Vascular Smooth Muscle: Nifedipine
which of the calcium channel blockers most specific for: Heart muscle: Verapamil
Drug for angina that also is effective against pulmonary edema: Nitroglycerine
what are the (5)* determinants of myocardial oxygen consumption?: BEECH:

BP,
Ejection time,
EDV,
Contractility,
HR
Drug used for CHF and A-fib can cause arrthymias what are the ECG changes? (3): Digoxin

ECG:
Inc PR
Dec QT
T-wave inversion
MOA of digoxin (2) AE?: Inhibit Na/K pump to indirectly inhibit Na/Ca antiport, causing Ca increase inside cell

AE:
Yellow vision; Arrhythmias
(4)* class IA antiarrhythmics: Queen Amy Proclaims Diso's PYRAMID:

Quinidine,
Amiodarone,
Procainamide,
Disopyramide
MOA of class IA Na-channel blockers what type of arrhythmias is it good for?: Inc action potential duration by Inc QRS (QT interval)

Use: Ventricular Arrhythmia
how do the Na-channel blockers affect HR, CO, BP and SV?: Dec HR -> Dec CO -> Dec BP -> Inc SV
(more time to fill)
AE for Quinidine: Cinchonism:

HA, Tinnitus, thrombocytopenia, Torsades de Pointes
why are Procainamide and Disopyamide successful at slowing the QT interval?: both are Amides, which are metabolized in the liver giving NH4 that can be converted to GLU -> GABA
AE for Procainamide: SLE-like effects
DOC for V-Tach: Lidocaine

(b/c it affects ischemic tissues and works quickly; IV only)
what is the class and drug that is the last resort (V-fib) as a Na-channel blocker? when is it contra-indicated?: Class IC: Flecainide

CI:
post-MI (leads to heart stopping)
Na-channel blocker class/drug that decreases Action Potential time: Class IB: Lidocaine
(3) drugs that can block both Na and Ca channels what Dx are they good for?: Procainamide,

Phenytoin,

Quinidine

use: Wolf Parkinson White
Class II antiarrhythmics class and MOA: Beta-blockers

MOA:
Dec cAMP and Ca currents ->
Dec slope of phase 4 and Inc PR interval
(3) AE of Beta-blockers: blocking betas make me SICk:

Sedation,

Impotence,

CV effects (bradycardia, CHF)
B-blocker: Longest acting: Propranolol
B-blocker: Shortest acting: Esmolol
B-blocker: also blocks Alpha-receptors (for Pheos and HTN crisis) (2): Labetalol

Carvedilol
B-blocker: for Miosis: Timolol
B-blocker: also blocks K+ channels: Sotalol
B-blocker: good for patient w/ DM, asthmatics, MI and elderly: Atenolol
(3)* drugs in Class III anti-arrhythmics: BiAS to K-channel blockers:

Bretylium,

Amiodarone,

Sotalol
MOA of K-channel blockers: Inc AP by Inc QT interval
AE of Amiodarone (4): Amy aught to run PFTs, LFTs and TFTs or you'll be BLUE:

Pulmonary fibrosis,
Hepatotoxicity,
Hyper/Hypothyroidism (contains iodine),
turns skin Blue
Class of choice for Atrial arrhythmias MOA: Ca-Channel blockers;

For AV nodal cells, Inc ST segment and Inc PR interval
DOC for Digitalis-induced arrthymias: Phenytoin
drug that inhibits VLDL production, Dec TG and Dec HDL breakdown AE?: Niacin

AE: Flushing
class that increases the production of lipoprotein lipase to Inc breakdown of TG (2) AE?: Fibrates

"-FIBR-" (Gemfibrozil, Fenofibrate)

AE: GI upset, gall stones
contraindication of Bile Acid Sequestrants?: High TG levels...BAS Increases TG
DOC in AV nodal arrhythmias: Adenosine
Antiarrhythmic that depresses ectopic pacemakers (esp digoxin toxicity): Potassium
(3) First generation H1 blockers: Diphenhydramine (Benadryl),

Chlorpheniramine (Chlor-trimeton),

Promethazine (Phenergan)
Clinical uses (3) and AE (3) of First generation H1 blockers: Uses:

Motion sickness
Allergy (hives, itching, nasal),
Sleep aid

AE:
Sedation,
Antimuscarinic,
Anti-alpha-adrenergic
(3) Second generation H1 blockers Use?: Loratadine (Claritin),

Fexofenadine (Allegra),

Centirazine (Zyrtec)

Use: Non-drowsy Allergic rhinitis, Hay fever
Name and MOA of a Nasal Decongestant: Pseudoepherine (Sudafed)

Alpha-agonist leading to vasoconstriction
(2) Cough suppressants: Codeine,

Dextromethophan (DM)
Name and MOA of expectorant: Guaifenesin
(Robitussin)

Inc. respiratory secretions and viscosity
Long acting B2-agonist for Asthma Prophylaxis: Salmeterol
Methylxanthine used for Severe asthma MOA? (2) AE?: Theophylline

Bronchodilator by Inh Phosphodiesterase and Dec cAMP hydrolysis

AE:
Cardiotoxicity;
Neurotoxicity
Drug and MOA of Mast Cell Stabilizers Use?: Cromolyn

causes Mast cells not to release histamine

use: Only for Prophylaxis
what is the most potent anti-inflammatory agent that is effective for mild, moderate and severe asthma (first line for chronic asthma)? MOA?: Glucocorticosteroids

Inh NF-kB transcription factor that induces TNF-alpha, inhibiting formation of PGE and LTE
(2) Adverse effects of Glucocorticoids?: Oral candidiasis,

bone demineralization
Leukotriene effect modulator that inhibits lipoxygenase and leukotriene formation AE?: Zileuton

AE: Hepatotoxicity
(2) Leukotriene effect Modulator that binds the leukotriene receptors Use?: Zafirlukast,

Montelukast

Use: Prophylaxis; mild/moderate asthma
Muscarinic antagonist that prevents bronchoconstriction: Ipratropium
non-specific Beta-agonist that relaxes bronchial smooth muscle AE?: Isoproterenol

AE: tachycardia
What asthma agents deal with an early response (bronchoconstriction)? (4): My BLT:

Muscarinic antagonist,

Beta-agonist,

Leukotriene antagonist,

Theophylline
what asthma agents deal w/ mast cells releasing mediators? (2): Cromolyn,

Steroids
Ganglionic blocker (rarely used) for the rapid reduction of HTN: Trimethaphan
only drug that reduces morbidity and mortality in heart failure: Spironoloactone
drug given IV for severe acute heart failure: Dobutamine
what anti-HTN drug may ilicit a positive Coombs test and hemolytic anemia?: Methyldopa
DOC for variant angina: Nifedipine
what drug interaction w/ Digoxin increases its toxicity?: Thiazides

(Dec K+ -> Inc Dig toxicity)
Anti-anginal Tx that has AE of severe constipation: Verapamil
(2) AE of Adenosine: Burning sensation in chest,

SOB
(2) AE of Dobutamine: Inc HR and BP
HTN medication that has AE of "Loss of taste": ACEi
patient treated w/ anti-arrhythmic that causes recurrent attacks of feeling faint and experiencing episodes of loss of consciousness. what drug?: Quinidine
Cardiac AP drug: affects Phase 4 (3): Digoxin,

Verapamil
(Ca-channel blockers),

Lidocaine
Cardiac AP drug: affects Phase 0 to slow conduction and prolong repolarization: IA drugs

(All class I slow conduction, but only IA prolongs repolarization)
Cardiac AP drug: affects Phase 0 but causes no change in repolarization: Class IC - Flecainide
Cardiac AP drug: blocks Na, Ca and K channels: Amiodarone
Drug that lowers HTN by inhibiting Peptidyl Dipeptidase: ACEi

(at biochemical level)
drug class for CHF that decreases Preload and BV: ACEi
only Drug class that increases the survival rate in CHF: ACEi

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