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MCQ ON CARDIOLOGY I

PAH

Which of these may be used for management of pulmonary arterial hypertension? Calcium channel blockers Prostacyclins Bosentan All of the above---------------

Use of sildenafil is contraindicated with: Amyl nitrate Isosorbide dinitrate Nitroglycerine All of the above------------

Which of these prostacyclin is active when administered orally? Iloprost-------------Epoprostenol Sodium Beraprost Treprostinil

Safe antihypertensive drugs in pregnancy include: i.) ii.) iii.) iv.) v.) Furosemide Hydralazine Methyldopa Diazoxide Hydrochlorothiazide

RJ is a 47-year-old man with a past medical history of sickle cell disease, severely depressed right ventricular systolic function, who has been newly diagnosed with primary pulmonary hypertension on right heart catheterization. He has a positive response to adenosine vasodilator challenge during catheterization. His pulmonary artery systolic pressure is 60 mm Hg. He is in functional class III. His current medications include: warfarin 10 mg daily, metoprolol 25 mg twice daily, furosemide 20 mg twice daily, hydroxyurea 500 mg daily, and risperidone 4 mg at bedtime. His heart rate is 67 beats/minute and blood pressure is 118/57 mm Hg. Which medication should RJ be initiated on to prevent mortality and progression of his pulmonary hypertension? (A) epoprostenol 2 ng/kg/minute (B) diltiazem 240 mg daily (C) bosentan 62.5 mg PO twice daily (D) inhaled iloprost 2.5 mcg x1, then 5 mcg/inhalation through nebulizer 69 times daily
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In patients with an acute vasodilator response to challenge during right heart catheterization, they should receive a calcium channel blocker to prevent mortality. In this patient, metoprolol may require dosage reduction or substitution with an ACE inhibitor to allow adequate blood pressure and heart rate for diltiazem therapy. Alternatively, amlodipine could be utilized if the patient has to remain on metoprolol but his heart rate cannot tolerate both diltiazem and metoprolol together. All alternative vasodilators should be reserved for patients who do not respond adequately to a vasodilator challenge during catheterization or who are failing calcium channel blocker therapy. Epoprostenol should be reserved for those in functional class IV to prevent mortality and also should be reserved as an alternative to patients who do not respond to or are failing calcium channel blockers.

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Blood Pressure in a 28 y.o. of 200s+/130s+ mm/Hg. He has acute on chronic renal failure (BUN/Creatinine 46/4.7 from 30/2.8 mg/dl) and schistocytes. If the hypertensive emergency was discovered earlier which agent below would have been the most appropriate therapy? A.) hydralazine parenterally B.) clonidine loading C.) fenoldopam D.) nitroprusside E.) nitroglycerin

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There are several antihypertensive agents available including esmolol, nicardipine, labetalol, and fenoldopam. While sodium nitroprusside is a rapid-acting and potent antihypertensive agent, it may be associated with significant toxicity and should therefore be used in select circumstances at a dose not to exceed 2 g/kg/min. The appropriate therapeutic approach of each patient will depend on the clinical presentation of the patient. Agents such as nifedipine and hydralazine should be abandoned because these agents are associated with significant toxicities and/or side effect profile.

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The Arrhythmias

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Dr. S's grandfather is a 81 YO male who is admitted with ECG showing wide comples tachycardia. PMH is significant for MI 2 months ago and valvular heart disese. Which drug(s) would be contraindicated for him?

a). sotalol b). Propafenone c). disopyramide d). amiodarone e). B and C

B and C Propafenone and disopyramide are class Ic and Ia drugs, respectively and are contraindicated in heart disease.

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ADHF

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GOOD LUCK

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