Cardiovascular System Drugs Flashcards

A patient taking a statin develops severe muscle pain and dark urine. Which condition is most likely, and what is the primary concern?

Answer: Myalgia leading to myopathy; risk of rhabdomyolysis and acute kidney injury

Severe myalgia with dark urine suggests statin-induced rhabdomyolysis, where myoglobin released from lysed muscle cells can precipitate in renal tubules causing AKI.

Clopidogrel is a prodrug that requires hepatic activation by which enzyme system?

Answer: CYP2C19

Clopidogrel is bioactivated predominantly by CYP2C19; poor metabolizers of CYP2C19 have reduced platelet inhibition and worse cardiovascular outcomes.

Which drug used for chronic heart failure blocks mineralocorticoid receptors and reduces mortality but requires monitoring for hyperkalemia?

Answer: Spironolactone

Spironolactone is a mineralocorticoid receptor antagonist (aldosterone blocker) proven to reduce mortality in heart failure with reduced ejection fraction, but it elevates serum potassium.

Nitrates relieve angina primarily by reducing myocardial oxygen demand through which hemodynamic mechanism?

Answer: Decreasing preload by dilating venous capacitance vessels

Nitrates primarily dilate venous capacitance vessels, reducing venous return (preload) and thereby decreasing left ventricular wall tension and myocardial oxygen demand.

Which PCSK9 inhibitor is administered as a subcutaneous injection every 2 weeks and significantly reduces LDL cholesterol in statin-intolerant patients?

Answer: Alirocumab

Alirocumab (Praluent) is a PCSK9 monoclonal antibody given every 2 weeks (or monthly at higher dose) that prevents LDL receptor degradation, markedly lowering LDL.

Beta-blockers are contraindicated in which type of angina because they can worsen coronary vasospasm?

Answer: Prinzmetal (variant) angina

In Prinzmetal angina, beta-blockade leaves alpha-adrenergic vasoconstrictive tone unopposed, potentially worsening coronary vasospasm; calcium channel blockers are preferred.

Dabigatran (a direct thrombin inhibitor) differs from warfarin in that it:

Answer: Has a specific reversal agent (idarucizumab)

Dabigatran can be rapidly reversed by idarucizumab (Praxbind), a monoclonal antibody fragment that binds dabigatran with high affinity, unlike warfarin's reversal with vitamin K/FFP.