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Questions and Answers
Which mood stabilizer has a wider therapeutic window and faster onset than lithium?
Which mood stabilizer has a wider therapeutic window and faster onset than lithium?
Which mood stabilizer is not effective in acute mania but is used for maintenance therapy?
Which mood stabilizer is not effective in acute mania but is used for maintenance therapy?
Which adverse effect is associated with lithium treatment?
Which adverse effect is associated with lithium treatment?
Which drug is most likely to cause a switch to mania when used as an antidepressant in bipolar patients?
Which drug is most likely to cause a switch to mania when used as an antidepressant in bipolar patients?
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Which type of psychosis is characterized by positive, negative, and cognitive symptoms?
Which type of psychosis is characterized by positive, negative, and cognitive symptoms?
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Which second messenger signaling is depleted with chronic lithium treatment?
Which second messenger signaling is depleted with chronic lithium treatment?
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Which mood stabilizer may act through increasing GABA levels and is associated with hepatic problems?
Which mood stabilizer may act through increasing GABA levels and is associated with hepatic problems?
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Which mood stabilizer is associated with aplastic anemia and agranulocytosis?
Which mood stabilizer is associated with aplastic anemia and agranulocytosis?
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Which drug is used to control acute mania in bipolar patients before possibly adding benzodiazepines and lithium?
Which drug is used to control acute mania in bipolar patients before possibly adding benzodiazepines and lithium?
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Which class of drugs is recommended to start before using antidepressants in bipolar disorder?
Which class of drugs is recommended to start before using antidepressants in bipolar disorder?
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Which side effect is associated with central adrenergic agonists such as clonidine and methyldopa?
Which side effect is associated with central adrenergic agonists such as clonidine and methyldopa?
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What is a precaution associated with the use of drugs for hypertensive crisis?
What is a precaution associated with the use of drugs for hypertensive crisis?
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Which drug is a D1 receptor agonist and increases renal blood flow despite its hypotensive effect?
Which drug is a D1 receptor agonist and increases renal blood flow despite its hypotensive effect?
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What is a notable adverse effect associated with methyldopa?
What is a notable adverse effect associated with methyldopa?
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Which drug is considered a pro-drug and is not first-line in hypertension treatment?
Which drug is considered a pro-drug and is not first-line in hypertension treatment?
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What is a side effect associated with central adrenergic agonists like clonidine and methyldopa?
What is a side effect associated with central adrenergic agonists like clonidine and methyldopa?
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Which drug is used to control acute hypertensive crisis?
Which drug is used to control acute hypertensive crisis?
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What is a notable side effect of reserpine?
What is a notable side effect of reserpine?
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What is a notable adverse effect associated with the use of drugs for hypertensive crisis?
What is a notable adverse effect associated with the use of drugs for hypertensive crisis?
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Which drug reduces sympathetic outflow from brainstem sites and stimulates alpha2 receptors?
Which drug reduces sympathetic outflow from brainstem sites and stimulates alpha2 receptors?
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Which drug increases inward calcium flux in the heart and cAMP levels, leading to improved hemodynamics?
Which drug increases inward calcium flux in the heart and cAMP levels, leading to improved hemodynamics?
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Which drug is indicated for short-term support of cardiac output in advanced heart failure?
Which drug is indicated for short-term support of cardiac output in advanced heart failure?
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Which drug has agonist effects at beta1 and dopamine1 receptors, and is used for short-term therapy to increase splanchnic and renal blood flow?
Which drug has agonist effects at beta1 and dopamine1 receptors, and is used for short-term therapy to increase splanchnic and renal blood flow?
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Which drug is usually the drug of choice in the treatment of acute decompensated heart failure?
Which drug is usually the drug of choice in the treatment of acute decompensated heart failure?
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Which drug is a phosphodiesterase inhibitor with a short half-life and is indicated for short-term therapy through parenteral administration?
Which drug is a phosphodiesterase inhibitor with a short half-life and is indicated for short-term therapy through parenteral administration?
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Which of the following is a possible extra-cardiac effect and toxicity of digitalis glycosides?
Which of the following is a possible extra-cardiac effect and toxicity of digitalis glycosides?
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Which drug is used for short-term therapy through parenteral administration and has a role in increasing splanchnic and renal blood flow?
Which drug is used for short-term therapy through parenteral administration and has a role in increasing splanchnic and renal blood flow?
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Which drug increases Ca++ concentrations and actin-myosin interaction to enhance myocardial contractility?
Which drug increases Ca++ concentrations and actin-myosin interaction to enhance myocardial contractility?
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Which drug slows the sinus rate and has effects on the AV node?
Which drug slows the sinus rate and has effects on the AV node?
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Which drug is an inotropic drug with agonist effects at beta1 and dopamine1 receptors?
Which drug is an inotropic drug with agonist effects at beta1 and dopamine1 receptors?
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Which factor Xa inhibitor is eliminated 66% via metabolism in the liver and 33% unchanged drug in the urine?
Which factor Xa inhibitor is eliminated 66% via metabolism in the liver and 33% unchanged drug in the urine?
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Which thrombin inhibitor is produced by medicinal leeches and now available as a recombinant protein?
Which thrombin inhibitor is produced by medicinal leeches and now available as a recombinant protein?
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Which thrombolytic agent is a nonenzymatic activator of plasminogen extracted from hemolytic streptococci?
Which thrombolytic agent is a nonenzymatic activator of plasminogen extracted from hemolytic streptococci?
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Which thrombolytic agent has a shorter half-life than alteplase and diffuses more freely into clots?
Which thrombolytic agent has a shorter half-life than alteplase and diffuses more freely into clots?
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Which thrombolytic agent is produced by genetic engineering and has a half-life of 3 minutes?
Which thrombolytic agent is produced by genetic engineering and has a half-life of 3 minutes?
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Which antibody fragment binds free and thrombin-bound dabigatran and neutralizes its activity?
Which antibody fragment binds free and thrombin-bound dabigatran and neutralizes its activity?
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Which thrombolytic agent is indicated for use in patients with thrombosis related to heparin-induced thrombocytopenia (HIT) and during coronary angioplasty?
Which thrombolytic agent is indicated for use in patients with thrombosis related to heparin-induced thrombocytopenia (HIT) and during coronary angioplasty?
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Which thrombolytic agent has much higher activity against fibrinogen bound to clots than free fibrinogen in circulation?
Which thrombolytic agent has much higher activity against fibrinogen bound to clots than free fibrinogen in circulation?
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Which thrombolytic agent is an activator of endogenous fibrinolysis without causing uncontrolled bleeding?
Which thrombolytic agent is an activator of endogenous fibrinolysis without causing uncontrolled bleeding?
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Which direct Xa inhibitor is metabolized by the CYP450 system in the liver and excreted by renal and GI system?
Which direct Xa inhibitor is metabolized by the CYP450 system in the liver and excreted by renal and GI system?
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Which of the following is a therapeutic objective of antianginal therapy?
Which of the following is a therapeutic objective of antianginal therapy?
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Which drug is a sodium channel antagonist used in angina?
Which drug is a sodium channel antagonist used in angina?
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Which type of angina is characterized by frequent angina at rest and transient ST segment elevation during angina?
Which type of angina is characterized by frequent angina at rest and transient ST segment elevation during angina?
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Which medication is the mainstay for acute prophylaxis and treatment of single attacks of angina?
Which medication is the mainstay for acute prophylaxis and treatment of single attacks of angina?
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Which medication is a sodium current antagonist and does not impact heart rate and blood pressure, but improves metabolism of the ischemic myocardial cells?
Which medication is a sodium current antagonist and does not impact heart rate and blood pressure, but improves metabolism of the ischemic myocardial cells?
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Which antiplatelet agent has clearly demonstrated reduction in mortality in patients with unstable angina and reduces the incidence of myocardial infarction (MI) and death?
Which antiplatelet agent has clearly demonstrated reduction in mortality in patients with unstable angina and reduces the incidence of myocardial infarction (MI) and death?
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Which medication is a funny current antagonist that reduces heart rate?
Which medication is a funny current antagonist that reduces heart rate?
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Which therapeutic objective for angina involves preventing the occurrence of symptoms?
Which therapeutic objective for angina involves preventing the occurrence of symptoms?
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What are the determinants of myocardial oxygen supply and demand?
What are the determinants of myocardial oxygen supply and demand?
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What are the therapeutic indications for nitrates?
What are the therapeutic indications for nitrates?
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Which of the following drugs is classified as a Class III antiarrhythmic agent?
Which of the following drugs is classified as a Class III antiarrhythmic agent?
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In which type of myocardial cells does the rate of depolarization occur slowly?
In which type of myocardial cells does the rate of depolarization occur slowly?
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Which of the following drugs is a sodium channel antagonist used in the treatment of angina?
Which of the following drugs is a sodium channel antagonist used in the treatment of angina?
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Which major ionic species is involved in the depolarization of slow response cells in the myocardium?
Which major ionic species is involved in the depolarization of slow response cells in the myocardium?
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Which antiarrhythmic drug is known for its ability to enhance depolarization in slow response cells?
Which antiarrhythmic drug is known for its ability to enhance depolarization in slow response cells?
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Which class of antiarrhythmic drugs primarily acts by decreasing diastolic depolarization?
Which class of antiarrhythmic drugs primarily acts by decreasing diastolic depolarization?
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Which drug is a potent K$^+$ channel blocker with modest Na$^+$ channel blocking properties and is used for all arrhythmias (V Tach)?
Which drug is a potent K$^+$ channel blocker with modest Na$^+$ channel blocking properties and is used for all arrhythmias (V Tach)?
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Which drug primarily acts on slow response cells (SA & AV node) and depresses phase 4 depolarization, Vmax, and conduction velocity?
Which drug primarily acts on slow response cells (SA & AV node) and depresses phase 4 depolarization, Vmax, and conduction velocity?
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Which drug is indicated for supraventricular tachycardia, activates K$^+$ channels to reduce effective refractory period, and blocks Ca$^{2+}$ channels at the AV node?
Which drug is indicated for supraventricular tachycardia, activates K$^+$ channels to reduce effective refractory period, and blocks Ca$^{2+}$ channels at the AV node?
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Which of the following drugs has the major side effects of negative chronotropic effect, negative inotropic effect, and hypotension?
Which of the following drugs has the major side effects of negative chronotropic effect, negative inotropic effect, and hypotension?
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Study Notes
Inotropic Effects of Digitalis Glycosides
- Digitalis glycosides, like digoxin, enhance myocardial contractility by increasing Ca++ concentrations and actin-myosin interaction
- They have mechanical effects on the heart, such as increased inotropic and dromotropic effects, and decreased duration of systole
- They also have electrical effects, such as slowing the sinus rate and indirect and direct effects on the AV node
- Digitalis glycosides can cause extra-cardiac effects and toxicity, including GI symptoms, mental symptoms, and vision disturbances
- Milrinone, a phosphodiesterase inhibitor, increases inward calcium flux in the heart and cAMP levels, leading to improved hemodynamics
- Milrinone has a short half-life and is indicated for short-term therapy through parenteral administration
- Dobutamine, an inotropic drug, increases cardiac output and is used for short-term support of cardiac output in advanced heart failure
- Dopamine, another inotropic drug, has agonist effects at beta1 and dopamine1 receptors, and is used for short-term therapy to increase splanchnic and renal blood flow
- In the treatment of acute decompensated heart failure, adrenergic agents like dobutamine are usually the drug of choice
- The text also mentions other drugs used in the treatment of heart failure, such as PDE inhibitors, vasodilators, diuretics, and morphine
- It highlights new treatments for heart failure, including Corlanor and the PARADIGM-HF trial, as well as the use of Entresto™ (sacubitril and valsartan) and its mechanism of action
- The text discusses neprilysin inhibition, its effects on vasoactive peptides, and its role in cardiovascular physiology
Coronary Artery Disease and Angina Summary
- Coronary circulation is limited due to vasodilator reserve
- Angina can be induced by large-vessel vasospasm, known as Prinzmetal’s Angina
- Unstable angina can be caused by additional artery block, clot, or plaque rupture
- Therapeutic objectives for angina include acute and chronic prophylaxis and prophylactic approaches
- Determinants of myocardial oxygen supply and demand include oxygen demand and supply factors
- Organic nitrates like nitroglycerin have pharmacodynamic effects that relax vascular smooth muscle
- Nitrates have therapeutic indications for angina, congestive heart failure, and after myocardial infarction
- Nitrates have adverse effects and limitations including headaches, dizziness, orthostatic hypotension, and tolerance
- Sildenafil interacts with nitrates to enhance vascular effects and is contraindicated with nitrates
- Nitrate therapy in chronic stable angina includes short-acting and long-acting preparations with limitations
- Beta-blockers are used in anginal therapy to decrease heart rate and contractility
- Calcium channel blockers have beneficial effects in angina through various mechanisms and are used in monotherapy and combination therapy
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Description
This quiz covers the inotropic effects of digitalis glycosides like digoxin, as well as other drugs used in the treatment of heart failure, such as Milrinone, Dobutamine, and Dopamine. It also summarizes aspects of coronary artery disease and angina, including therapeutic objectives, determinants of myocardial oxygen supply and demand, the use of nitrates and sildenafil, as well as the role of beta-blockers and calcium channel blockers.
