CVS

Question 1

Cholestyramine

1. mechanism
2. adverse effects

Answer 1

Cholestyramine
1. mechanism: inhibit bile acid cholesterol reabsorption.
(increases TG)
2. adverse effects: GI upset, reduce absorption of fat soluble vitamins

Question 2

statins

1. mechanism
2. adverse effects

Answer 2

statins (the only shown to reduce CAD mortality)

1. mechanism: inhibit HMG-CoA reductase
2. adverse effects: myopathy, hepatotoxic

Question 3

Gemfibrozil

1. mechanism
2. adverse effects

Answer 3

Gemfibrozil (reduce TG alot, reduce VLDL)

1. mechanism: activates PPAR-a to upregulate LPL to degrade TG ， reduce hepatic VLDL synthesis
2. adverse effects: gallstones (inhibit cholesterol 7a-hydroxylase), myopathy

Question 4

Niacin

1. mechanism
2. adverse effects

Answer 4

Niacin (reduce VLDL, increase HDL)

1. mechanism: inhibits lipolysis in adipose tissue, reduce VLDL synthesis
2. adverse effects: nice raisin (red , sweet, sour)

Question 5

Alirocumab

1. mechanism
2. adverse effects

Answer 5

Alirocumab (reduce LDL alot)

1. mechanism: PCSK9 inhibitors (deactivate LDL receptor degradation)
2. adverse effects: myalgia, neurocognitive sx

Question 6

Ezetimide

1. mechanism
2. adverse effects

Answer 6

Ezetimide

1. mechanism: inhibits cholesterol absorption at brush border of small intestines
2. adverse effects: diarrhea

Question 7

Which anti-arrhythmics drug is contraindicated in structural/ ischemic heart disease? Which drug should it be replaced with?

Answer 7

Class 1C (flecainide, propafenone) replaced with Class 1B (lidocaine, phenytoin, mexiiletine) (with weaker binding strength)

Question 8

Which anti-arrhythmics drug is contraindicated in pts high risk of torsades de pointes? Why

Answer 8

Class 1A (procainamide, quinidine, disopyramide), Class 3 (amiodarone, Ibutilide, dofetilide, Sotalol). Prolong QT

Question 9

Which part of electrical conduction does each class of anti arrhythmic drug does it effect?

Answer 9

1A: sodium (longer AP) less sloppier slope 0
1B: sodium (shorter AP) less sloppier slope 0
1C: sodium (same AP) less sloppier slope 0

2: beta blocker (SA node, AV node activity, longer PR interval) slope 4 of nodal cells
3: potassium (longer QT interval, longer AP) slope 3
4: Calcium (slow down AV node conduction incl depolar & repolar, longer PR interval) prolong slope 1 & 3 of nodal cells

Question 10

Mechanism of adenosine

Answer 10

Increase K+ out of cell (hyperpolarize), blocks calcium channel (slow down AV node conduction)

Question 11

Mechanism of digoxin

Answer 11

block Na/K ATP-ase. Stimulates vagus nerve. Positive inotropy

Question 12

List 4 changes in aging heart

Answer 12

1. decreased LV chamber apex-to-base dimension
2. sigmoid shape ventricular septum
3. myocardial atrophy with collagen deposits
4. brownish lipofuscin pigment in cardiomyocytes