Physiology
The QRS portion of an ECG constitutes ventricle ____ and atrial ____.
What is ventricle contraction and atrial relaxation?
This functional group results in a major rash for patients on captopril.
What is sulfhydryl group?
Name the beta blockers that are best for heart failure with reduced ejection fraction.
What are bisoprolol, metoprolol succinate, and carvedilol?
These statins are metabolized by CYP2C9.
What are fluvastatin, pitavastatin, and rosuvastatin?
The defining characteristic that differentiates between severe hypertension and hypertensive emergency is ___.
What is evidence of acute target organ damage?
BARRKH: Brain, Arteries, Retina, Respiratory, Kidneys, and Heart
State the correct blood flow through the heart, starting with deoxygenated blood coming in from the body.
What is superior/inferior vena cava → right atrium → tricuspid valve → right ventricle → pulmonary valve → pulmonary arteries → pulmonary veins → left atrium → mitral/bicuspid valve → left ventricle → aortic valve → aorta?
___ is a ___ (type of antihypertensive drug) that has a increased risk of gynecomastia due to its ___ structure.
What is spironolactone is a mineralocorticoid receptor/aldosterone antagonist that has an increased risk of gynecomastia due to its lactone ring structure?
If a patient has had a stroke previously, then these antihypertensive classes are indicated.
What are thiazides, ACE inhibitors, and ARBs?
State which nonstatin options are most applicable for each benefit group.
1. Patient has had a recent myocardial infarction.
2. Patient with chronic T2DM has a PREVENT-ASCVD 10 year risk score of 18%.
3. Patient has a PREVENT-ASCVD 10 year risk score of 9%.
1. What are bempedoic acid, ezetimibe, and/or PCSK9 mAb?
2. What are bempedoic acid, ezetimibe, and/or PCSK9 mAb?
3. What are bempedoic acid and/or ezetimibe?
What is oral (severe HTN)? What is IV (hypertensive emergency)?
During activation of platelets, these internal receptors are externalized onto the cell's surface to allow for binding to fibrinogen and later aggregation.
What are glycoprotein IIb/IIIa receptors (GPIIb/IIIa)?
1. These beta blockers are renally excreted.
2. This beta blocker has high lipophilicity, crosses the BBB, and results in CNS side effects (e.g. CNS depression).
3. This beta blocker is eliminated very quickly through these types of enzymes.
1. What are atneolol, bisoprolol, nadolol, and sotalol?
2. What is propranolol?
3. What is esmolol and RBC esterases?
What is overlapping the two administrations?
Day 1: 100% PO / Apply patch
Day 2: 50% PO / Continue patch
Day 3: 25% PO / Continue patch
Day 4: DC PO / Continue patch
What is preventing hypertensive crisis/rebound hypertension?
The way to differentiate between mild and moderate to severe statin-attributed muscle symptoms (SAMS) is through these primary symptoms. Management includes the following and routine monitoring of CK ___ recommended.
What is muscle aches for mild SAMS and general weakness for moderate to severe SAMS?
Mild SAMS: continue statin therapy and reassess, but DC statin if sxs worsen or persist or become intolerable
Moderate to severe SAMS: DC statin, check CK if severe sxs appear, and check BMP for renal function if urine is dark
Routine monitoring of CK is not recommended.
___ toxicity is heavily associated with the rapid, vasodilator Nitropress.
What is cyanide and thiocyanate?
The factors, in order, that are involved in the intrinsic pathway of the coagulation cascade include:
What are Factors XII (12), XI (11), IX (9), and X (10)?
*Factor X (10) converts to Factor Xa (10a) which converts prothrombin/Factor II (2) to thrombin/Factor IIa (2a)
Chronic exposure to ___ diuretics over time results in a lower maximum pharmacological response in sodium and water excretion, as a result of increased sodium reabsorption in the ___ portion of the nephron due to the ___.
What is loop diuretics over time result in a lower maximum pharmacological response in sodium and water excretion, as a result of increased sodium reabsorption in the distal portion of the nephron due to the Braking Phenomenon (chronic adaptation)?
I would like to initiate a patient on minoxidil today. I should include a ___ and a ___ in their drug regimen to help lower sodium and water ___, along with reflex ___cardia. I would also expect to see ___ as a side effect of minoxidil.
What is a diuretic and a beta blocker to help lower sodium and water retention, along with reflex tachycardia? What is hypertrichosis/hirsutism?
A patient who's currently pregnant needs to be initiated on a nonstatin agent. Give an example of a nonstatin agent that should be avoided and an example of one that is safe.
Bonus question: Which beta blocker is best for this patient if she develops pre-eclampsia?
What are PCSK9 inhibitors, ezetimibe, evinacumab, bempedoic acid, niacin, and fibrates (avoid)? What are BAS and omega-3 fatty acids (safe)?
Bonus: What is labetalol?
Name the fluid/electorlyte/general imbalances associated with these drugs:
1. Thiazide diuretics
2. Loop diuretics
3. K+ sparing diuretics
1. THIAZIDE: What are hyponatremia, hypokalemia, hypomagnesemia, hyperchloremia, hypercalcemia, hyperuricemia (worsens gout), hyperglycemia, and hyperlipidemia?
2. LOOP: What are hypovolemia, hypokalemia, hypomagnesemia, hypocalcemia, and hyperuricemia (worsens gout)?
3. K+ SPARING: What is hyperkalemia?
A 70 y/o patient, BM, is taking atenolol 50 mg PO qd for hypertension. Atenolol is a _____ β__ blocker and it _____ heart rate, contractility, automaticity, and conduction velocity.
What is cardioselective β1 blocker and what is decreases heart rate, contractility, automaticity, and conduction velocity?
Two patients come into the clinic. One is taking a nicardipine. The other is taking verapamil.
1. This medication of the two has greater cardiac effect on myocytes and nodes. The patient mentions this medication helps lower their heart rate.
2. This medication of the two has greater effect (i.e. vasodilation) on peripheral arteries. The patient mentions this medication helps to lower their blood pressure (through decrease in SVR).
3. This medication has great effect on coronary arteries.
1. What is verapamil (non-DHP CCB)?
2. What is nicardipine (DHP CCB)?
3. What is both nicardipine and verapamil (DHP and non-DHP CCBs)?
A 65 year old patient has an office BP of 158/93 mmHg and is already on enalapril, nifedipine, and hydrochlorothiazide. They are also currently taking Claritin D and prednisone for a "bad cold" they currently have. They on occasion drink 2 cups of a day when they're especially tired, and drink a glass of wine a day per week. They do not have any other comorbidites. The next best step is to...
What is DC/minimize interfering substances? Limit usage of pseudoephedrine (Claritin D) and prednisone. If applicable, can switch prednisone oral to an inhaled or topical formation. Avoid more than 1 cup of coffee a day and avoid/limit alcohol intake. If BP is still uncontrolled, the patient has resistant hypertension and needs to maximize diuretic Tx and/or add another agent?
A 73 year old patient has an elevated lipid panel and a comorbidity of CKD Stage 3b. They have not yet had an ASCVD event, but they are at high risk of it. Their LDL today is 186 mg/dL. They should be initiated on a ___ intensity statin with or without ___.
What is moderate intensity statin with or without ezetimibe?
59 year old patient is potentially on an α1 selective antagonist for HTN and BPH. Of the available options, ___ and ___ would be best in targeting both disease states.
What is terazosin and doxazosin?
They inhibit α1A receptors in genitourinary smooth muscles along with vascular α1 receptors. They have a more pronounced vasodilator effect in arterial resistance vessels than venous ones, so peripheral resistance drops, vasodilation increases, and BP lowers.