Cardiovascular Pharmacology Quiz

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Questions and Answers

What characterizes stable angina pectoris?

Intermittent severe pain induced by exercise

Pain that only occurs at night

Stable pain that is relieved by rest or oxygen (correct)

Constant pain with no relation to activity

What is a key feature of unstable angina pectoris?

Pain is longer in duration and may not be relieved by rest (correct)

Pain is always accompanied by a drop in blood pressure

Pain duration is short and occurs during sleep only

Pain is typically short-lived and easily relieved

What distinguishes NSTEMI from unstable angina?

NSTEMI presents with a lack of cardiac enzymes

NSTEMI has no associated ECG changes

NSTEMI indicates minor myocardial ischemia only

NSTEMI shows elevated cardiac enzymes compared to unstable angina (correct)

What is a characteristic of STEMI?

It is characterized by elevation of ST segments on ECGs Signup and view all the answers

Which of the following is used in the management of unstable angina and NSTEMI?

Aspirin Signup and view all the answers

What is the primary function of anticoagulants like heparin?

To slow down the body's clot formation process. Signup and view all the answers

Which drug is classified as a fibrinolytic?

Tenecteplase Signup and view all the answers

What happens when Clopidogrel is added to Aspirin?

It decreases the risk of major ischemic events by 1/3. Signup and view all the answers

In which scenario are fibrinolytics typically used?

For acute STEMI within 6 hours of symptom onset. Signup and view all the answers

What is the primary goal of using heparin in conjunction with Tenecteplase?

To prevent fibrin formation. Signup and view all the answers

What are the main diseases of the cardiovascular system mentioned?

Acute Coronary Syndrome, Congestive heart failure, Cardiac arrythmias, Hypertension emergencies Signup and view all the answers

Which drug is categorized as a fibrinolytic?

Tenecteplase Signup and view all the answers

Which symptoms are commonly reported by patients with heart failure?

Fatigue and weakness Signup and view all the answers

What distinguishes antiplatelets from anticoagulants?

Antiplatelets work on blood cells while anticoagulants work on plasma proteins. Signup and view all the answers

What condition can produce symptoms similar to congestive heart failure?

Chronic obstructive pulmonary disease (COPD) Signup and view all the answers

What is the role of the conduction system in the heart?

It conducts nerve impulses throughout the heart. Signup and view all the answers

What is NOT a medication used for the management of chronic heart failure?

Antibiotics Signup and view all the answers

Which component is not included in the drug review for cardiac emergencies at the paramedic level?

Beta Blockers Signup and view all the answers

Which type of guidelines should be followed for CHF management?

International Liaison Committee on Resuscitation guidelines Signup and view all the answers

How does Acute Coronary Syndrome (ACS) begin?

With an early inflammatory response caused by cholesterol. Signup and view all the answers

What symptom indicates a need for oxygen in patients with heart failure?

Respiratory distress Signup and view all the answers

Which of the following best describes hypertension complications?

They can lead to organ damage and increase the risk of heart disease. Signup and view all the answers

What is the primary function of beta blockers in cardiac management?

Lower blood pressure and reduce heart workload. Signup and view all the answers

What is considered the gold standard drug for treating angina?

Sublingual nitroglycerin Signup and view all the answers

What can happen if nitroglycerin is administered to a patient taking phosphodiesterase inhibitors?

Intractable hypotension Signup and view all the answers

What is the primary effect of Morphine Sulfate in cardiac care?

Reduces myocardial oxygen demand Signup and view all the answers

Which method is the preferred reperfusion therapy in STEMI treatment when available?

Primary Percutaneous Coronary Intervention (PPCI) Signup and view all the answers

What is a common pathophysiological cause of STEMI?

Vasospasm of a coronary artery Signup and view all the answers

What is one of the key components of the MONA protocol in STEMI management?

Morphine Signup and view all the answers

What effect does glyceryl trinitrate (Nitroglycerin) have on the heart?

Decreases systemic vascular resistance Signup and view all the answers

What is a critical consideration before administering nitroglycerin?

Medication history regarding phosphodiesterase inhibitors Signup and view all the answers

What is the action of antiplatelet medications like aspirin in STEMI management?

Prevent clot formation by inhibiting platelet aggregation Signup and view all the answers

What is a key indication for pharmacologic reperfusion therapy in STEMI patients?

Onset of symptoms within the last 6 hours Signup and view all the answers

Which of the following conditions may lead to the development of congestive heart failure (CHF)?

Cardiac valve disease Signup and view all the answers

What is a common symptom of congestive heart failure?

Shortness of breath from pulmonary edema Signup and view all the answers

Which of the following statements about heart failure onset is true?

It can occur acutely after a myocardial infarction. Signup and view all the answers

What percentage of people over the age of 65 typically display symptoms consistent with congestive heart failure?

6% to 10% Signup and view all the answers

What is pulmonary edema in the context of congestive heart failure?

Fluid accumulation in the lungs Signup and view all the answers

Which medications are CHF patients likely to require?

Multiple medications for long-term therapy Signup and view all the answers

Which of the following factors is least likely to be associated with an increased risk of CHF?

High physical activity Signup and view all the answers

CHF can result from which of the following cardiovascular disorders?

Ischemic heart disease Signup and view all the answers

Study Notes

EHS 202 Pharmacology in EMS - Cardiac Drugs

Course title: Pharmacology in EMS
Course code: EHS 202
Topic: Cardiac Drugs Part 1
Date: 10/2/2024

Learning Objectives

Students will be able to describe and understand the pharmacological management of patients with acute coronary syndromes.
Students will be able to differentiate between antiplatelets, anticoagulants, and fibrinolytics.
Students will be able to explain the pharmacological management of patients with cardiac arrhythmias.
Students will be able to discuss and understand hypertension and associated complications, including those presenting with seizures.
Students will be able to differentiate between percutaneous coronary intervention (PCI) and fibrinolytics.

Functional Components of the Heart

Myocardium: Cardiac muscle fibers in four chambers (two atria and two ventricles).
Conduction system: Specialized tissue conducting nerve impulses (SA node, AV node, bundle of His, bundle branches, and Purkinje fibers).
Nerve supply: Branches from sympathetic and parasympathetic divisions regulating heart rate and contraction force.

Main Diseases of the Cardiovascular System

Acute Coronary Syndrome (ACS)
Congestive heart failure
Cardiac arrhythmias
Hypertension emergencies

Drug Review for Cardiac Emergencies

Oxygen
Nitroglycerin
Aspirin
Morphine sulfate
Fentanyl
Acetylsalicylic acid
Clopidogrel
Epinephrine
Atropine
Amiodarone
Beta-blockers (not for paramedic use)
ACE inhibitors (not for paramedic use)
Tenecteplase (fibrinolytic)
Heparin
Nifedipine (not for paramedic use)

Acute Coronary Syndrome (ACS)

ACS: A progression of ischemic heart disease from angina to acute myocardial infarction.
Begins with early plaque formation in arteries.
Inflammatory response triggers cholesterol buildup.
Plaque rupture causing thrombus formation and obstructing blood flow.
Stable angina: Chest pain from insufficient oxygen supply to heart tissue, relieved with rest.
Unstable angina: More severe, longer-lasting pain, not relieved by rest.
Unsable angina can lead to myocardial infarction (USA).
Myocardial infarction: Partial or complete blockage of the arteries supplying the heart.
UA: Occurs when partially occluding thrombus produces ischemia.
UA pain: Longer duration, may not be relieved by rest or medication, requires immediate attention.
Non-ST-segment elevation myocardial infarction (NSTEMI): Ischemia effects myocardium, no ST segment elevation on ECG. NSTEMI has elevated cardiac enzymes.
Indicates necrosis of cardiac tissue.
ST-segment elevation myocardial infarction (STEMI): Actual infarction of cardiac tissue secondary to oxygen deprivation. Causes cell death and ST segment elevation on ECG.

Unstable Angina and NSTEMI Management

Aspirin
Morphine sulfate
Nitroglycerin (effective, safe, easily administered; sublingual nitroglycerin considered gold standard; before administering, determine if patient taking phosphodiesterase inhibitor medications; assess ECG for right ventricular infarction; patients dependent on adequate preload may decompensate.)

Glyceryl Trinitrate (Nitroglycerin)

Produces vasodilation and dilates veins. Reduces cardiac preload and workload.
Improves blood flow to ischemic myocardium.
Decreases myocardial oxygen demand.

Morphine Sulfate

Commonly used for pain relief.
Relieves pulmonary congestion via vasodilation.
Lowers myocardial oxygen demand and anxiety reduction.
Respiratory depressant.

ST-Segment Myocardial Infarction (STEMI)

Pathophysiology of STEMI: Complete blockage of an artery by a ruptured plaque and thrombus formation.
Decreased blood flow can result from vasospasm.
Cocaine abuse can cause STEMI.
If not reversed, infarction will occur, leading to cell death.

STEMI Management

Appropriate prehospital care includes: Starting oxygen, initiating IV, placing patient on cardiac monitor.
Administering oxygen, aspirin, nitroglycerin (GTN), morphine sulfate.
Remember MONA (Morphine, Oxygen, Nitrates, Aspirin).
Reperfusion therapy is also indicated in STEMI treatment: Pharmacologic reperfusion (fibrinolytics like Tenecteplase), primary percutaneous coronary intervention (PPCI).

Antiplatelets, Anticoagulants, Fibrinolytics

Antiplatelets: Prevent blood cell clumping (aspirin, clopidogrel).
Anticoagulants: Slow clot formation (heparin, warfarin).
Fibrinolytics: Break down clots (streptokinase, tenecteplase, alteplase).

Antiplatelets

Aspirin: Antiplatelet medication. Prevents platelets from adhering to each other.
Clopidogrel: Inhibits platelet aggregation. Used with aspirin to reduce ischemic events.

Anticoagulants

Heparin: Prevents fibrin formation and platelet activation; administered with tenecteplase.

Fibrinolytics

Used for acute STEMI within 6 hours of symptom onset when PCI is not readily available. Tenecteplase activates fibrinolytic system breaking up intravascular thrombi/emboli.
Thrombolysis checklist needed prior to tenecteplase administration.

Congestive Heart Failure (CHF)

A cardiovascular disorder.
Prevalence increases with age.
CHF patients often take multiple medications.
Providers must be familiar with medications for long-term therapy and exacerbations, including pulmonary edema.
Heart failure may result from: Ischemic heart disease, diabetes mellitus, hypertension, and heart valve disease.

CHF Management

Follow international resuscitation guidelines (AHA or ERC).
Patients take medications for long-term systolic/diastolic hypertension control, lipid disorders, and thyroid disorders. Angiotensin-converting enzyme (ACE) inhibitors.
Oxygen: Supplemental oxygen for significant respiratory distress or low oxygen saturation.
Non-invasive positive pressure ventilation: For patients with profound respiratory distress.
Common medications: Nitroglycerin, furosemide, morphine sulfate.

Furosemide

Increases urine output by decreasing water absorption in the kidneys.
Increases urine production, decreasing intravascular volume.
Loop diuretic, often more effective than other diuretics.
Initial dose: 20-40 mg IV push.
Takes approximately 20 minutes to be effective.

Some Other Medications Used for Long-Term Management of CHF

Digoxin
ACE inhibitors
Beta-blockers

Cardiac Arrhythmias

Loss or abnormality of cardiac rhythms.
Types: Bradycardia, atrial arrhythmias (sinus tachycardia, supraventricular tachycardia (SVT), atrial fibrillation (AF), atrial flutter), ventricular arrhythmias (ventricular tachycardia (VT), premature ventricular contraction (PVC), ventricular fibrillation (VF), torsades de pointes), and cardiac arrest.

Bradycardia

Heart rate < 60 bpm
Treatment: Ensure airway, supplemental oxygen, cardiac monitoring, IV line.
Medications: Atropine (600 mcg IV, repeating as necessary to 3mg total dose), epinephrine (2-10 mcg/min), dopamine (2-10 mcg/kg/min).
Transcutaneous pacing might be required.

Atrial Arrhythmias

Sinus tachycardia, supraventricular tachycardia (SVT), atrial fibrillation (AF), atrial flutter.

Atrial Arrhythmias Pharmacological Treatment

Sinus tachycardia: Normally a physiologic response.
SVT: Adenosine (6 mg, 12 mg, 12 mg). Calcium channel blockers, beta-blockers.
Atrial fibrillation (AF): Amiodarone (IV; 150 mg/10 min → 1 mg/min infusion for 6 hours), Calcium channel blockers, beta-blockers.
Atrial flutter: Amiodarone (IV; 150 mg/10 min → 1 mg/min infusion for 6 hours), Calcium channel blockers, beta-blockers.

Ventricular Arrhythmias

Ventricular tachycardia, premature ventricular contractions, ventricular fibrillation, Torsades de Pointes.

Ventricular Arrhythmias Pharmacological Treatment

Ventricular tachycardia (VT): Stable VT: Amiodarone (IV, 150 mg/10 min → 1 mg/min infusion for 6 hours), Lidocaine (0.5mg-1mg/kg → infusion 1-4mg/min).
Unstable VT: Synchronized cardioversion.
Ventricular fibrillation (VF): Epinephrine (1:10,000), amiodarone (IV, 300 mg then 150 mg IV, Lidocaine 1-1.5 mg/kg).

Cardiac Arrest

Arrhythmias associated with cardiac arrest: Pulseless electrical activity (PEA), Asystole, Pulseless ventricular tachycardia (VT), Ventricular Fibrillation (VF)
PEA/Asystole: Treat with epinephrine (1 mg IV/IO every 3-5 minutes)
VF: Electrical therapy for most effective treatment.

Hypertension

High blood pressure, the silent killer, often asymptomatic until organ damage.
Types: Essential (no identifiable cause), systolic hypertension.
Dangerous for older adults.
Diagnosis categories: Normal, high-normal, grade 1, 2, 3 hypertension, isolated systolic hypertension, isolated systolic hypertension with widened pulse pressure.

Hypertension with Seizures

Elevated blood pressure with seizure activity.
May be caused by drugs (e.g., cocaine).
Treatment differs from other hypertensive emergencies.

Hypertension with Seizure Management

Diazepam: A benzodiazepine to induce sleep, relieve anxiety, and relax muscle spasm.
Midazolam: A benzodiazepine that promotes relaxation.

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Description

Test your knowledge on stable and unstable angina pectoris, as well as the differences between NSTEMI and STEMI. This quiz covers key drug utilizations and management strategies for these cardiac conditions. Perfect for students studying pharmacology or medicine.