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Cardiopulm > 3 - Cardiovascular Medications > Flashcards

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

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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

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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)

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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

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5
Q

what is the beta blocker suffix?

A

“lol”

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6
Q

Beta blockers reduces B-receptor binding sites of what neurotransmitters?

A

epinephrine and norepinephrine

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7
Q

B1 selective BB causes what?

A

decrease HR and myocardial contractility

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8
Q

B2 selective BB causes what?

A

bronchoconstriction and vasoconstriction

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9
Q

Nonselective BB are NOT indicated for individuals with ____ or ____.

A

PVD or COPD

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10
Q

BB are clinically indicated for what diseases?

A

hypertension
ischemic heart disease
heart failure
arrhythmias

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11
Q

Side effects of beta blockers?

A
  1. sedation: fatigue, depression
  2. thrombocytopenia
  3. may mask symptoms of hypoglycemia
  4. reduced thermoregulatory response: overheating
  5. some older, selective beta blockers may promote hypoglycemia
  6. smooth mm spasm: bronchospasm and cold extremities
  7. exaggerated cardiac responses: bradycardia, orthostatic hypotension, heart block, excess negative inotropic effect
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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

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13
Q

Calcium channel blockers have very few side effects other than what?

A

negative inotropic effects

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14
Q

Calcium channel blocker suffix?

A

“pine”

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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
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16
Q

Calcium channel blockers influence both myocardial O2 ___ and ___-

A

supply and demand

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17
Q

Calcium channel blockers reduces O2 demand which reduces intracellular ___, slows ___ and ___of contraction

A

Ca+
HR
strength

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18
Q

Nitrates are clinically indicated for?

A

hypertension
ischemic heart disease: angina
heart failure

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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)

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20
Q

___: chest pain related to ischemia of the myocardium

A

angina

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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

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22
Q

nitrates tend to have “___” within the name of the drug

A

nitr

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23
Q

Side effects to nitrates?

A
  1. hypotension
  2. dizziness
  3. reflex tachycardia
  4. flushing of skin nausea/vomiting
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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
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25
Q

Angina: ECG changes
- ST segment ____ shift > .5 mm indicative of ischemia

A

downward

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26
Q

types of angina?

A
  1. stable
  2. unstable
  3. prinzmetals
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27
Q

Stable angina:
- pain free when?
- duration?
- relieved by what?
- patients can reliably predict activities that will provoke discomfort-precipitated by increases in O2 demand

A
  • pain free at rest
  • lasts for several minutes
  • relieved by rest or medication (nitrates)
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28
Q

Unstable angina:
- Onset?
- possible to occur at rest?
- duration?
- signifies?

A
  • onset is unpredictable OR accelerating in frequency, severity or intensity
  • may occur at rest
  • duration > 15 min
  • usually signifies progression of disease
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29
Q

Prinzmetals (variant) angina:
- Occurs when?
- ECG?
- result of ?
- medication?

A
  • occurs at rest, often in early morning
  • ECG shows ST elevation
  • thought to be result of cardiac vasospasm
  • treated with medication (Ca+ channel blockers)
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30
Q

rate pressure product equation? significance?

A

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)

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31
Q

what should rate pressure product never go over?

A

10,000

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32
Q

what medication is clinically indicated for blood clots formation in the coronary artery at the time of plaque rupture?

A

thrombolytic agents

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33
Q

what medication facilitates the conversion of plasminogen to plasmin?

A

thrombolytic agents

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34
Q

patients with clinical evidence of thrombus formation should be treated immediately via thrombolytics within ___ minutes

A

30

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35
Q

thrombolytic agents: overall goal is to keep total ischemic time to < ____ minutes from tome of symptoms to re-perfusion

A

120

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36
Q

Thrombolytic agent side effects:
- ventricular ___ due to rapid reperfusion
- excessive ___
- hemorrhagic CVA
- GI bleeding
- GU bleeding

A

arrhythmias
bleeding: HI resistance training, shaving, venopunctures

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37
Q

what medication is clinically indicated for primary and secondary preventative measure to prevent thrombus formation?

A

anti-platelets

38
Q

what medication decreases platelet adherence at site of injury?

A

anti-platelet agents

39
Q

what medication is clinically indicated for prevention of blood clots, prevent an emboli, inhibit the production of the hormone thrombin?

A

anticoagulants

40
Q

For ___, the timeframe for safe exercise varies based on the type of medication

A

anticoagulants

41
Q

3 commonly used anticoagulants?

A
  1. pradaxa
  2. xarelto
  3. eliquis
42
Q

diuretics are clinically indicated for what diseases?

A

hypertension
heart failure

43
Q

Diuretics work by:

  • decreasing circulating ___ ___
  • improves ventricular ___-___ relationship
  • reduces cardiac ___
  • promotes ___ and electrolyte balance which decreases reabsorption of water and Na+ at the kidneys
A

blood volume (preload)
length-tension: improve cardiac contractility
demad
diuresis

44
Q

diuretics suffix?

A

“ide”

45
Q

location of action for most potent diuretics?

A

loop of henle

46
Q

what type of diuretics work at proximal tubules?

A

carbonic anyhyrase inhibitors (mild)

47
Q

what type of diuretics work on collecting tubules and ducts?

A

K+ sparring (mild)

48
Q

what type of diuretics may cause hypokalemia and glucose intolerance?

A

thiazides (moderate)

49
Q

Caution with aerobic exercise on diuretics due to ___ and ___-

A

hypotension (due to fluid loss)
arrhythmias (due to K+ loss)

50
Q

Medication used to lower blood sugar for Type II diabetics and has cardioprotective effects/lowers hospitalizations due to heart failure?

A

Sodium-glucose transporter inhibitors

51
Q

3 common examples of sodium glucose transporter inhibitors?

A
  1. invokana
  2. farxiga
  3. jardiance
52
Q

Side effects of sodium glucose transporter inhibitors?

A
  1. hypoglycemia
  2. hypotension
  3. UTI’s
  4. diabetic ketoacidosis with normal to slightly elevated blood glucose
53
Q

Drugs affecting Renin-angiotensin-aldosterone system are clinically indicated for?

A
  1. hypertension
  2. heart failure

can be considered as: vasodilators and anti-hypertensives

54
Q

what do ACE inhibitors prevent?

A

conversion of angiotensin I to angiotension II

55
Q

angiotension II causes:
- systemic _____
- renal water and sodium ___
- ____ stimulation

A

vasoconstriction
retention
aldosterone

56
Q

ACE inhibitors suffix?

A

“ril”

57
Q

Angiotensin receptor blockers (ARBs) mechanism of action?

A

limits the effects of angiotensin II at the vasoreceptors of the arterial beds

58
Q

ARBs suffix?

A

“sartan”

59
Q

what should your cardiac patients never eat?

A

grapefruits

60
Q

brand name of combo ARB and neprolysin inhibitor?

A

entresto

61
Q

Neprolysin inhibitor:
- reduces abnormal remodeling
- promote ____
- vaso____
- __ excretion/___ retention

A

diuresis
vasodilation
Na excretion/K retention

62
Q

Side effects of ARBs and ACE inhibitors:
- ___tension
- light headedness
- dizziness
- ____ (life threatening)
- hyper____
- persistent dry cough

A

hypotension
angioedema (large swollen tongue)
hyperkalemia

63
Q

ALDOSTERONE ANTAGONISTS:
- example?
- results: ____ renal fluid and Na retention, acts a mild diuretic, ___ renal excretion of Na
- side effects?

A
  • example: spironolactone
  • decreased, increased
  • possible hyperkalemia, orthostatic hypotension
64
Q

what are positive inotropes clinically indicated for?

A

heart failure

positive inotropes: increase myocardial contractility

65
Q

3 classes of drug to increase myocardial contractility? (positive inotropes)

A
  1. cardiac glycosides
  2. sympathomimetics
  3. phosphodiesterase inhibitors
66
Q

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
A

dilated
atrial

Ca+

chronotrophy (decreases HR)

67
Q

positive inotropes: cardiac glycosides: two main drugs?

A
  1. digitalis
  2. digoxin: shorter half-life (reduced toxicity) as compared to digitalis
68
Q

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

A

110

69
Q

positive inotropes: _____
- indicated for parenteral use for acutely compromised heart failure patient to improve CO in the critical care setting

A

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
Q

3 types of sympathomimetics?

A
  • selective:B1
  • nonselective B1 and B2
  • dopamine
71
Q

which type of sympathomimetic?
- stimulates influx of Ca+ into the myocardium to increase contractility
- increase SA and AV node firing and conduction

A

selective:B1

72
Q

what kind of sympathomimetic?
- increases contractility (B1) and reduces afterload due to vasodilation (B2)

A

nonselective B1 and B2

73
Q

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

A

dopamine

74
Q

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
A

phosphodiesterase inhibitors

75
Q

vasodilators are clinically indicated for what 3 things?

A
  1. hypertension
  2. heart failure
  3. ischemic heart disease
76
Q

VASODILATORS:
- decreases vascular resistance: via ___ mm relaxion, effective for ____ hypertension
- what 3 meds?

A

smooth, systolic

  1. Ca+ channel blockers
  2. ACE inhibitor
  3. nitrates
77
Q

arterial vasodilators reduce cardiac ____

A

afterload

78
Q

venodilators (venous vasodilators) reduce cardiac ___ and effective for ____ hypertension

A

preload, diastolic

79
Q

vasodilators: alpha adrenergic antagonists:
- used manage ___ and not heart failure
- side effects?

A

hypertension
reflex tachycardia, compensatory increase in blood volume

80
Q

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

A

nipride

81
Q

VASODILATORS: MORPHINE
- decreases pre-load via ____
- mild arterial vasodilation
- reduces anxiety and effort associated with severe heart failure

A

venodilation

82
Q

side effect of vasodilatos?

A

compensatory sympathetic activation:
- tachycardia
- vasoconstriction
- increased aldosterone
- elevated plasma renin

83
Q

ANTIARRHYTHMICS: CLASS I: XYLOCAINE

  • clinically indicated for?
A

ventricular and supraventricular tachycardia
atrial fibrillation

84
Q

ANTIARRHYTHICS: CLASS I: XYLOCAINE
- reduces influx of ___ into cell with blocks AP

A

Na+

85
Q

ANTIARRHYTHMICS: CLASS II: B BLOCKERS
- clinically indicated for?

A

ventricular and supraventricular arrhythmia post MI and exercise

86
Q

ANTIARRHYTHMICS: CLASS II: B BLOCKERS
- blocks ___ excitation of the heart to control heart rhythm

A

sympathetic

87
Q

ANTIARRHYTHMICS: CLASS III: CORDARONE
- clinically indicated for?

A

ventricular and supraventricular tachycardia

88
Q

ANTIARRHYTHMICS: CLASS III: CORDARONE
- makes myocardial cells ___ responsive to stimulation

A

less

89
Q

ANTIARRHYTHMICS: CLASS IV: CALCIUM CHANNEL BLOCKERS
- blocks slow ___ channels
- ____ pacemaker activity of depolarized cells

A

Ca+
decreases

  • prolongs refractory period
90
Q

patients who receive ___ or _____ in combination iwth antiarrhythmic drugs are at risk of prolonged QT interval and tosades de pointes

A

hydroxychloroquine, azithromycin

Cardiopulm (3 decks)

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