Which ion has higher concentration outside the cell that drives an electrical and concentration gradient inwards?

True or False: Electrical gradients oppose some inward movement of ions in depolarization

Cell membranes have a voltage sensor which places Amino Acid gates in the channel to shunt any further influx of Na+, what will occur after this shunting?

True or False: Calcium influx maintains active depolarization and prolongs it and maintains a more negative membrane potential

When K+ channels open in Phase 3, what happens to the mV inside the cell?

Which type of atrial arrhythmia is actually in rhythm but shows rapid beating of atria?

What is the difference between Ventricular Tachycardia and VTach Torsades de Pointes

What is usually an origin of arrhythmias?

Fast action potential sites are different than nodal cell action potential sites. How does Phase 4 differ in a nodal cell vs Fast AP site?

Afterdepolarization primarily happens in the (Nodal or Myocytes) and occurs in the middle of (repolarization / depolarization)

What are early and late afterdepolarizations caused by?

Blocking Ca2+ channels during long QT still prolongs refractory but without the risk of what?

Reentry is another origin of arrhythmias, this happens when action potential is uni-directional and will circle back around and trigger another depolarization despite normal AP signals still coming from the SA node. This is due to what?

Which of the following are goals for anti-arrhythmic drugs?

Which anti-arrhythmic drug class delays repolarization

Which anti-arrhythmics act on action potential in the nodal cells?

Which anti-arrythmics affect action potential in mycardium and purkinje cells?

The important thing about sodium channel blockers is that their action works more on (normal / depolarized ) cells to block channels and increase refractory period

True or False: The effective refractory period is the length of time a cell cannot receive any new action potential which action potential duration falls within. If you lengthen the ERP with drugs like sodium channel blockers, you also increase the APD

Which subset of Class 1 sodium channel blockers can also increase ADP along with ERP due to their modest K+ blocking effects allowing for longer depolarization periods

Which Class 1A drugs are metabolized by CYP2D6

Which Class 1A drug is also metabolized by N-Acetyltransferases and can cause NAPA metabolite induced K+channel blockage

Which Class 1A drugs can cause Torsades?

Which Class 1A drug has a strong negative inotropic effect which can worsen heart failure

True or False: Lidocaine is only available IV but Mexiletine is available PO

Class 1B drugs can cause neurologic issues like seizures, sedation due to what?

Lidocaine is very highly selective for cells that are depolarized (sick) which make it ideal for what types of situations?

The CAST/CASH trials showed what major contraindications for use of Flecainide and Propafenone due to pro-arrhythmic potential and negative inotropic effects?

CCBs and BBs in nodal cells slow down the depolarization and slows down the heart rate until the threshold potential is reached which will (increase or decrease) pacemaker activity

CCBs work predominately on the (SA node or AV node) to slow conduction while Beta Blockers decrease both

True or False: Class III K+ blockers will prolong APD as well as ERP

Amiodarone, a Class III drug, is special as it has effects on what ?

Amiodarone is most commonly used to treat post-op arrhythmias and (monomorphic or polymorphic) VTach

Amiodarone can cause what endocrine disorder and is problematic due to long half life up to 6 months

Which K+ channel blocker can exacerbate Heart failure particularly in HFpEF?

Adenosine is a very fast acting anti-arrhythmic for AV nodal conduction and not as commonly used, what is the MOA and extra effects?

True or False: Demand Angina is also chronic stable angina, which only occurs upon increased exertion which increases demand.

Which types of angina are considered Supply angina where blood and O2 supply may be shunted or cutoff?

Which angina drugs decrease O2 demand but also increase O2 supply

Which class of Angina drugs increase NO and increase cGMP which vasodilates and relaxes

Which are the primary effects of Nitrates?

Which nitrate products are subject to high first pass metabolism that decreases bioavailability

What is a major contraindication/DDI while using Nitrate drugs for angina?

Ivabradine is an If pacemaker inhibitor of the funny current in nodal cells. It is a mixed Na+ and K+ blocker. If the cells are more depolarized, which Ion channel effect will predominate?

Ivabradine is a (negative or positive or no effect) inotrope and a (negative, positive, or no effect) chronotrope

Ranolazine is a pFOx inhibitor which switches fuel preference in the heart from _____ to ______ for more efficient ATP production with less O2 use

In order for Ranolazine to be used as a pFOx inhibitor instead of a Na+ blocker/negative inotrope, what dose needs to be used

What are the therapeutic goals for CHF?

Digoxin will block the Na/K ATPase and (increase or decrease) intracellular Na+ which also causes a block in Ca/Na exchange to (increase or decrease) intracellular Ca2+

Digoxin causes increased intracellular calcium which stimulates more contractile proteins. Is this a positive or negative inotropic effect

The electrical effects of Digoxin from Na/K ATPase inhibition, this causes depolarization (more positive charge) in all cells this can lead to a (increase or decrease) in SA automaticity and slow AV node conduction. It may instead cause myocytes to have automaticity to fire more Action potentials and potentially cause arrhythmias

Which electrolytes need to be monitored closely with Digoxin use?

Increasing levels of which electrolytes can help reverse effects of digoxin toxicity?

Which diuretic can be problematic or potentiating toxicity with Digoxin use due to increasing Ca2+ levels but excreting all other electrolytes?

In patients over 50, is SBP or DBP more important as a CVD risk factor?

Select all the events that are increased 2-4x for chronic hypertension?

Which of the following are short term mechanisms to regulate blood pressure

What are the requirements for measuring BP in office?

What is Osler's sign for pseudohypertension

Which of the following is considered Stage 1 Hypertension?

What did the reformed 2017 HTN guidelines of BP staging do to the amount of people affected?

Which of the following are secondary causes of hypertension

Which are clinical manifestations of Target organ damage of hypertension

If a patient with hypertension has no clinical CVD and 10 year ASCVD risk of <10% what is their blood pressure goal and what is the initial primary treatment of their blood pressure

What did the SPRINT trial find about intensive treatment of blood pressure to a goal of <120/80 vs standard goal <140/80

Which of the following medications can be initiated as monotherapy in a patient with Stage 1 hypertension and a ASCVD risk score >10%

Which of the following should be monitored 1-2x per year on a patient with HTN

True or False: All 4 main classes (ACE/ARB/CCB/Diuretics) show treatment benefits of lowering morbidity and mortality after 1 year of treatment

True or False: If a patient is on a HTN medication at mid-dose range with highest efficacy but still not at goal, adding onto therapy is recommended

Which of the following are coexisting conditions with HTN that are compelling indications to initiate drug treatment

What are the drugs of choice to start in a patient who has Diabetes and HTN

If a patient has CAD/PAD and HTN what would be the drugs of choice to initiate?

True or False: Thiazide type diuretics are most beneficial in hypertension due to synergy with other drugs and longer acting diuresis compared to Loops

Thiazide diuretics inhibit the Na/Cl pump in the distal tubule leading to increased urinary excretion of Na+ and H2O, after 4-8 weeks on this therapy what happens to Volume contraction?

After initiation of therapy of a thiazide diuretic, what are some immediate effects?

What are some primary differences between HCTZ and Chlorthalidone

While using a diuretic, a patient on a high sodium diet can experience what effects?

Increased aldosterone production in the body can cause hypokalemia and hypomagnesemia, which are factors that can directly produce what in the heart?

True or False: Spironolactone K+ sparing diuretic is useful as monotherapy in resistant hypertension

If a patient is using an ACEi, NSAIDS, and spironolactone but they also have renal insufficiency, what effect would be closely monitored

Which loop diuretic has the highest bioavailability and the longest half life?

What criteria would call for a loop diuretic to be added onto therapy in a hypertensive patient?

Is ventricular pressure highest during systole or diastole?

The S1 sound lub signifies what within the heart?

S2 sounds like a dub, and signifies what?

A wave of depolarization travels towards an electrode on the skin, this reflects into what on an EKG graph?

What does the P wave signify on an EKG

True or False: The QRS complex is the action of Purkinje fibers and myocardial cells depolarizing

True or False: The QT interval is the time of ventricular depolarization to repolarization

True or False: The V1 chest lead will show the strongest amplitude and activity on the EKG

Atrial Fibrillation on an EKG will cause a disappearance of which wave due to many atrial foci firing at rapid irregular rates?

If a patient has significant left ventricular hypertrophy, the impulse has more myocardium to travel through to contract. Will there be an increased or decreased QRS amplitude showing on the V1-6 chest leads?

Changes in the ST segments above or below the isoelectric baseline such as an inverted T wave could indicate what?

An exercise stress test is used to increase myocardial oxygen demand and provoke ischemia, a positive exercise test would most likely have what type of change on an ECG?

An echocardiogram is used to visualize valve structure and wall motion, what is this test used to assess?

If a patient has normal left ventricular wall thickness on an echocardiogram, but the right ventricle wall has some recorded thickness, what could this represent?

Technetium-99m Cardiolite is a tracer used to assess what?

Angiography and Catheterization are both Gold standard diagnostic tests for which disease state?

True or False: Intravascular ultrasound uses catheter technology inserted into coronary arteries and can find information on diameter, circumference, plaque volume or stenosis of arteries

True or False: ACEinhibitors and Beta blockers work synergistically due to BB decreasing Renin production from the kidneys

Which of the following are selective beta 1 blockers?

A patient who has Sleep apnea, uses alcohol frequently, and CAD would benefit from which drug due to having increased sympathetic tone

True or False: BBs like Carvedilol, labetolol, metoprolol are highly lipophilic and undergo extensive first pass metabolism which makes their Bioavailability variably low

ACE inhibitors can increase hypotensive response in CHF due to what?

When should you monitor serum creatinine and K+ levels after initiation of an ACE?

Non-dihydropyridine CCBs (increase or decrease) conduction through AV node which helps for rate control in atrial fibrillation

CCBs are negative inotropes which are contraindicated in CHF, particularly HFrEF. Which disease states are they useful in?

What is the biggest issue when abruptly stopping an Alpha-2 agonist?

What are some disadvantages to using direct vasodilators?

If you have a patient age 70 who is phenotypically older with frailty, they live in a nursing home, and have several comorbid conditions. Would you use intensive BP goal of <120/80?

Which of the following can be some secondary causes of hypertension in hypertensive emergencies?

What is the maximum amount of blood pressure reduction that should be done in the first hour after admitting the patient in a hypertensive emergency?

What are some tests to evaluate TOD in hypertensive emergencies?

True or False: Rapidly correcting blood pressure emergencies more than 25% in the first hour can cause MI ischemia, stroke, and AKI

Which of the following CCBs can have the longest onset and may not be the best for correcting emergent BP

Which of the following are short acting antihypertensives that could be used for a short time in hypertensive urgency?

If a patient has evidence of an aortic dissection, pheochromocytoma, or eclampsia, what would their systolic BP goal be in the first hour?

Which are preferred agents in a patient with hypertensive emergency but have acute renal failure?

Which of the following would you NOT use in CAD if a patient had a hypertensive emergency?

If you needed to use an antihypertensive for acute use and not have long duration of action, which of the following could be used?

Which would be good in hypertensive emergency of a person with acute ischemic stroke/CAD?

Which would you use IV for a patient with acute heart failure?

If a patient is being treated for an aortic dissection, which agent would you use first before combination?

Which should not be used in renal artery stenosis?

Which should be used with caution in Aortic Stenosis patients while trying to reduce BP?

What is starting dose of Sodium Nitroprusside?

What's starting dose of Nitroglycerin?

What is the starting dose of Hydralazine?

What is starting dose of Fenoldopam?

What is the starting dose of nicardipine?

A patient comes in with fatigue, hypotension, cold extremities, and some confusion with known heart failure. Which type of ADHF does this patient have?

Increased JVD, Rales, and ascites would be symptoms of which ADHF?

A patient's pulmonary wedge pressure is an indicator of Left Atrial pressure and preload, Cardiac Index is the cardiac output by BSA. If a patient has Stage 3: reduced CI but normal WP what does this mean

If a patient has Stage 4 hemodynamics are cold and wet meaning poor perfusion CI and high wedge pressure volume overload. Which treatments would you give this patient?

True or False: In ADHF, starting a diuretic if a patient's home PO Lasix is 80mg you would start an IV bolus Q12hours 80mg Lasix at baseline

True or False: If patient hasn't urinated 6 hours after IV bolus dose of Lasix, the dose should be doubled and given BID

True or False: If a patient has inadequate urine output (<1L) after hitting 200mg IV bolus, they should be put on a continuous infusion 10-40mg/hr

If a patient is maxed out on IV bolus Lasix and on continuous infusion and need more urine output, they can be started on PO 5mg Metolazone thiazide for extra synergistic diuresis

True or False: Studies show no difference in urine output on IV chlorothiazide vs PO metolazone but Metolazone has a slower onset but is cheaper than IV Diuril

A patient has been maxed out on IV loop diuretics, metolazone thiazide but have minimal urine output. What should be done next?

Which Nitrate vasodilator can cause a coronary steal and cause more ischemia?

Which of the following are positive inotropes

When do you add on a positive inotrope in ADHF?

When would you use dobutamine B1/2 agonist over milrinone PDE3 inhibitor in a patient who has low blood pressure, low cardiac output, and poor perfusion?

True or False: The OPTIME-CHF trial found there is a survival/mortality benefit in positive inotrope use

Which short term mechanical support can support the most volume of the body?

True or False: A Beta Blocker in a patient with ADHF can be continued in the hospital if the patient is hemodynamically stable, but should not be initiated until after volume status or hemodynamics have corrected