3 - Cardiovascular Medications Flashcards
1
Q
Ischemic heart disease: Goals of pharmacological management
- reestablishment of the balance between myocardial O2 supply and demand which is accomplished by decreased ___ or ___ to reduce O2 demand
- increasing ___ __ size
- removal of ____
- decrease coronary spasm
- increases O2 supply
A
HR or SBP
arterial lumen
thrombus
2
Q
Heart Failure: Goals of Pharmacological Management
- address the underlying contribution to heart failure
- maintain ___
- regulate __ and ___ intake
- decrease ___/____
- increase cardiac ___
- reduce cardiac workload
- decrease _____ stimulation
A
CO
fluid and salt
preload/afterload
contractility
sympathetic
3
Q
Arrhythmias: Goals of pharmacological management
- inhibit abnormal pulse formation and conduction by altering membrane permeability to specific ions
- classified based on the ionic gates they control: which 4?
- location?
A
Na+, K+, Ca+, Cl-
myocardial pacemaker cells (SA, AV)
4
Q
Hypertension: Goals of Pharmacological Management
- reduce ___ ___
- limit ___ nervous system activity to:
- promote arterial and venous ____- reduce ____
- reduce the effects of the renin-angiotensin-aldosterone system at the kidney to: promote vasodilation and reduce fluid volume
A
fluid volume (diuretics)
sympathetic
CO
5
Q
what is the beta blocker suffix?
A
“lol”
6
Q
Beta blockers reduces B-receptor binding sites of what neurotransmitters?
A
epinephrine and norepinephrine
7
Q
B1 selective BB causes what?
A
decrease HR and myocardial contractility
8
Q
B2 selective BB causes what?
A
bronchoconstriction and vasoconstriction
9
Q
Nonselective BB are NOT indicated for individuals with ____ or ____.
A
PVD or COPD
10
Q
BB are clinically indicated for what diseases?
A
hypertension
ischemic heart disease
heart failure
arrhythmias
11
Q
Side effects of beta blockers?
A
- sedation: fatigue, depression
- thrombocytopenia
- may mask symptoms of hypoglycemia
- reduced thermoregulatory response: overheating
- some older, selective beta blockers may promote hypoglycemia
- smooth mm spasm: bronchospasm and cold extremities
- exaggerated cardiac responses: bradycardia, orthostatic hypotension, heart block, excess negative inotropic effect
12
Q
Calcium channel blockers are clinically indicated for what diseases?
A
ischemic heart disease
arrhythmias
BP control
Reduction of re-infarction in patients with non-Q wave infarcts
13
Q
Calcium channel blockers have very few side effects other than what?
A
negative inotropic effects
14
Q
Calcium channel blocker suffix?
A
“pine”
15
Q
Do calcium channel blockers increase or decrease the following variables?
- HR
- O2 demand
- contractility
- vasodilation
- O2 supply to coronary arteries
- BP
A
- decrease HR
- decrease O2 demand
- decrease contractility
- increase vasodilation
- increase O2 supply to coronary arteries
- decrease BP
16
Q
Calcium channel blockers influence both myocardial O2 ___ and ___-
A
supply and demand
17
Q
Calcium channel blockers reduces O2 demand which reduces intracellular ___, slows ___ and ___of contraction
A
Ca+
HR
strength
18
Q
Nitrates are clinically indicated for?
A
hypertension
ischemic heart disease: angina
heart failure
19
Q
Nitrates:
- ____ HR
- reduce blood to heart by dilating veins which reduces ____
- cause heart to contract with ___ force
- ___ BP
A
slows
preload
less
lowers - less resistance in heart to pushing blood from chambers (reduce after-load)
20
Q
___: chest pain related to ischemia of the myocardium
A
angina
21
Q
what is angina caused by?
A
an imbalance in the myocardial oxygen supply and demand
lack of oxygen stimulates pain receptors within the heart
22
Q
nitrates tend to have “___” within the name of the drug
A
nitr
23
Q
Side effects to nitrates?
A
- hypotension
- dizziness
- reflex tachycardia
- flushing of skin nausea/vomiting
24
Q
Ischemic pain patterns? anywhere above what?
A
- may radiate to the shoulder, in between the scapulae, arm, throat or jaw
- anywhere above the umbilicus
25
Angina: ECG changes
- ST segment ____ shift > .5 mm indicative of ischemia
downward
26
types of angina?
1. stable
2. unstable
3. prinzmetals
27
Stable angina:
- pain free when?
- duration?
- relieved by what?
- patients can reliably predict activities that will provoke discomfort-precipitated by increases in O2 demand
- pain free at rest
- lasts for several minutes
- relieved by rest or medication (nitrates)
28
Unstable angina:
- Onset?
- possible to occur at rest?
- duration?
- signifies?
- onset is unpredictable OR accelerating in frequency, severity or intensity
- may occur at rest
- duration > 15 min
- usually signifies progression of disease
29
Prinzmetals (variant) angina:
- Occurs when?
- ECG?
- result of ?
- medication?
- occurs at rest, often in early morning
- ECG shows ST elevation
- thought to be result of cardiac vasospasm
- treated with medication (Ca+ channel blockers)
30
rate pressure product equation? significance?
SBP x HR
if pt is having angina, gives you a measure of how hard to work them in the future (stay below that rate product pressure that produced angina)
31
what should rate pressure product never go over?
10,000
32
what medication is clinically indicated for blood clots formation in the coronary artery at the time of plaque rupture?
thrombolytic agents
33
what medication facilitates the conversion of plasminogen to plasmin?
thrombolytic agents
34
patients with clinical evidence of thrombus formation should be treated immediately via thrombolytics within ___ minutes
30
35
thrombolytic agents: overall goal is to keep total ischemic time to < ____ minutes from tome of symptoms to re-perfusion
120
36
Thrombolytic agent side effects:
- ventricular ___ due to rapid reperfusion
- excessive ___
- hemorrhagic CVA
- GI bleeding
- GU bleeding
arrhythmias
bleeding: HI resistance training, shaving, venopunctures
37
what medication is clinically indicated for primary and secondary preventative measure to prevent thrombus formation?
anti-platelets
38
what medication decreases platelet adherence at site of injury?
anti-platelet agents
39
what medication is clinically indicated for prevention of blood clots, prevent an emboli, inhibit the production of the hormone thrombin?
anticoagulants
40
For ___, the timeframe for safe exercise varies based on the type of medication
anticoagulants
41
3 commonly used anticoagulants?
1. pradaxa
2. xarelto
3. eliquis
42
diuretics are clinically indicated for what diseases?
hypertension
heart failure
43
Diuretics work by:
- decreasing circulating ___ ___
- improves ventricular ___-___ relationship
- reduces cardiac ___
- promotes ___ and electrolyte balance which decreases reabsorption of water and Na+ at the kidneys
blood volume (preload)
length-tension: improve cardiac contractility
demad
diuresis
44
diuretics suffix?
"ide"
45
location of action for most potent diuretics?
loop of henle
46
what type of diuretics work at proximal tubules?
carbonic anyhyrase inhibitors (mild)
47
what type of diuretics work on collecting tubules and ducts?
K+ sparring (mild)
48
what type of diuretics may cause hypokalemia and glucose intolerance?
thiazides (moderate)
49
Caution with aerobic exercise on diuretics due to ___ and ___-
hypotension (due to fluid loss)
arrhythmias (due to K+ loss)
50
Medication used to lower blood sugar for Type II diabetics and has cardioprotective effects/lowers hospitalizations due to heart failure?
Sodium-glucose transporter inhibitors
51
3 common examples of sodium glucose transporter inhibitors?
1. invokana
2. farxiga
3. jardiance
52
Side effects of sodium glucose transporter inhibitors?
1. hypoglycemia
2. hypotension
3. UTI's
4. diabetic ketoacidosis with normal to slightly elevated blood glucose
53
Drugs affecting Renin-angiotensin-aldosterone system are clinically indicated for?
1. hypertension
2. heart failure
can be considered as: vasodilators and anti-hypertensives
54
what do ACE inhibitors prevent?
conversion of angiotensin I to angiotension II
55
angiotension II causes:
- systemic _____
- renal water and sodium ___
- ____ stimulation
vasoconstriction
retention
aldosterone
56
ACE inhibitors suffix?
"ril"
57
Angiotensin receptor blockers (ARBs) mechanism of action?
limits the effects of angiotensin II at the vasoreceptors of the arterial beds
58
ARBs suffix?
"sartan"
59
what should your cardiac patients never eat?
grapefruits
60
brand name of combo ARB and neprolysin inhibitor?
entresto
61
Neprolysin inhibitor:
- reduces abnormal remodeling
- promote ____
- vaso____
- __ excretion/___ retention
diuresis
vasodilation
Na excretion/K retention
62
Side effects of ARBs and ACE inhibitors:
- ___tension
- light headedness
- dizziness
- ____ (life threatening)
- hyper____
- persistent dry cough
hypotension
angioedema (large swollen tongue)
hyperkalemia
63
ALDOSTERONE ANTAGONISTS:
- example?
- results: ____ renal fluid and Na retention, acts a mild diuretic, ___ renal excretion of Na
- side effects?
- example: spironolactone
- decreased, increased
- possible hyperkalemia, orthostatic hypotension
64
what are positive inotropes clinically indicated for?
heart failure
positive inotropes: increase myocardial contractility
65
3 classes of drug to increase myocardial contractility? (positive inotropes)
1. cardiac glycosides
2. sympathomimetics
3. phosphodiesterase inhibitors
66
Positive inotropes: Cardiac glycosides
- indicated especially for:
- ___ cardiomyopathy
- ___ fibrillation
- increases intracellular ____ which increases myocardial contractility
- has negative effects on:
- _____
- dromotrophic: increases conduction delay SA to AV node, increase P-R interval
dilated
atrial
Ca+
chronotrophy (decreases HR)
67
positive inotropes: cardiac glycosides: two main drugs?
1. digitalis
2. digoxin: shorter half-life (reduced toxicity) as compared to digitalis
68
If taking digoxin due to atrial fibrillation:
- patient may have an irregular pulse
- a fib with resting HR > ____ bpm may need to be reassessed by physician
- controls a fib due to increased PR interval
110
69
positive inotropes: _____
- indicated for parenteral use for acutely compromised heart failure patient to improve CO in the critical care setting
sympathomimetics
- drugs mimic the actions of the sympathetic nervous system
- used for a short period of time to minimize the possibility of sympathetic receptor desensitzation
70
3 types of sympathomimetics?
- selective:B1
- nonselective B1 and B2
- dopamine
71
which type of sympathomimetic?
- stimulates influx of Ca+ into the myocardium to increase contractility
- increase SA and AV node firing and conduction
selective:B1
72
what kind of sympathomimetic?
- increases contractility (B1) and reduces afterload due to vasodilation (B2)
nonselective B1 and B2
73
what kind of sympathomimetic?
- used when HF is present with systemic hypotension
- stimulates B1 myocardial, D-1 and alpha vascular receptors to increase:
- CO via increased contractility]
- BP via vascular vasoconstriction
dopamine
74
what positive inotrope?
- indicated for patients with a combination of:
- severe CHF: used short term for pts awaiting transplantation
- used to strengthen myocardial contraction by increasing intracellular Ca, administered by IV, typically good for pts who did not respond well to other positive inotropes
phosphodiesterase inhibitors
75
vasodilators are clinically indicated for what 3 things?
1. hypertension
2. heart failure
3. ischemic heart disease
76
VASODILATORS:
- decreases vascular resistance: via ___ mm relaxion, effective for ____ hypertension
- what 3 meds?
smooth, systolic
1. Ca+ channel blockers
2. ACE inhibitor
3. nitrates
77
arterial vasodilators reduce cardiac ____
afterload
78
venodilators (venous vasodilators) reduce cardiac ___ and effective for ____ hypertension
preload, diastolic
79
vasodilators: alpha adrenergic antagonists:
- used manage ___ and not heart failure
- side effects?
hypertension
reflex tachycardia, compensatory increase in blood volume
80
VASODILATORS: COMBINED ARTERIAL AND VENOUS
- ______: affects vascular beds of both systems
- given parenterally
- rapid onset of action
- effective in treatment of severe heart failure
- increased venous capacitance reduces preload
- decreased arterial resistance reduces afterload
- result is reduced myocardial oxygen demand
nipride
81
VASODILATORS: MORPHINE
- decreases pre-load via ____
- mild arterial vasodilation
- reduces anxiety and effort associated with severe heart failure
venodilation
82
side effect of vasodilatos?
compensatory sympathetic activation:
- tachycardia
- vasoconstriction
- increased aldosterone
- elevated plasma renin
83
ANTIARRHYTHMICS: CLASS I: XYLOCAINE
- clinically indicated for?
ventricular and supraventricular tachycardia
atrial fibrillation
84
ANTIARRHYTHICS: CLASS I: XYLOCAINE
- reduces influx of ___ into cell with blocks AP
Na+
85
ANTIARRHYTHMICS: CLASS II: B BLOCKERS
- clinically indicated for?
ventricular and supraventricular arrhythmia post MI and exercise
86
ANTIARRHYTHMICS: CLASS II: B BLOCKERS
- blocks ___ excitation of the heart to control heart rhythm
sympathetic
87
ANTIARRHYTHMICS: CLASS III: CORDARONE
- clinically indicated for?
ventricular and supraventricular tachycardia
88
ANTIARRHYTHMICS: CLASS III: CORDARONE
- makes myocardial cells ___ responsive to stimulation
less
89
ANTIARRHYTHMICS: CLASS IV: CALCIUM CHANNEL BLOCKERS
- blocks slow ___ channels
- ____ pacemaker activity of depolarized cells
Ca+
decreases
- prolongs refractory period
90
patients who receive ___ or _____ in combination iwth antiarrhythmic drugs are at risk of prolonged QT interval and tosades de pointes
hydroxychloroquine, azithromycin
