Antihypertensives, Antianginals, and Heart Failure Drugs

Question 1

What is the blood pressure equation?

Answer 1

Blood pressure=CO x SVR

CO=Cardiac output
SVR= Systemic vascular resistance

Question 2

What is the cardiac output equation?

Answer 2

CO=HR x SV

Question 3

What are some diseases that may cause secondary hypertension?

Answer 3

Diabetes
Stroke
Kidney disease

Question 4

In the ANS, what does the parasympathetic nervous system stimulate? Sympathetic?

Answer 4

Parasympathetic nervous system stimulates smooth muscle, cardiac muscle, glands. (Remember, it uses muscarinic/nicotinic receptors)

Sympathetic nervous system stimulates the heart, blood vessels, skeletal muscles. (Remember, it uses Alpha and Beta receptors)

Question 5

What are the antihypertensive drug catagories?

Answer 5

1) Adrenergic drugs
2) Angiotensin-converting enzyme (ACE) inhibitors
3) Angiotensin 2 receptor blockers (ARBSs)
4) Calcium channel blockers (CCBs)
5) Diuretics
6) Vasodilators
7) Direct renin inhibitors

Question 6

Ace inhibitors and beta blockers are more effective in what group of people?

Answer 6

White people.

Question 7

Calcium channel blockers and diuretics are more effective in what group of people?

Answer 7

African american.

Question 8

What is a first line drug for treatment of hypertension?

Answer 8

Ace Inhibitors (-prils).

Question 9

What are some important considerations and indications for Captopril and Lisinopril?

Answer 9

Captopril and Lisinopril are NOT prodrugs. Meaning they are in their inactive form until metabolized by the liver to an active form.

Unlike other ACE inhibitors that are prodrugs, Captopril and lisinopril can be used if a patient has liver dysfunction.

Question 10

What are the action, uses, and side effects of Calcium Channel Blockers?

Answer 10

This is used frequently due to its low amount of side effects.

Its action is toblock calcium access to cells causing a decrease in contractility and conductivity of the heart, as well as lowers the demand for oxygen.

Its side effects are low BP, bradycardia, may precipitate A-V Block, abdominal discomfort (constipation, nausea), peripheral edema.

Question 11

A patient with type 2 diabetes questions why she was prescibed ACE inhibitor Lisinopril. She doesn’t have Hypertension. How would you explain the reasoning for giving her that medication?

Answer 11

The medication has a protective effect on the kidneys for patients with type 2 diabetes.

In the early stages of diabetes, before they have chronic renal failure, the ace inhibitors, because of where they exert their effect (in the angiotensin converting enzyme) is actually protective due to the lowering of the pressure exerted opon the kidneys. So its given to help prevent CKD from developing as quickly.

Question 12

What are some common uses for Peripheral-acting adrenergic antagonists?

Answer 12

These are used in the treatment of Hypertention and also used for Benign Prosthetic Hypertrophy. 50% of men over 50, and 80% of men over 80 suffer from this condition.

The problem with Alpha receptor antagonists is that they can cause first dose hypotension, so watch for orthostatic hypotension.

Question 13

What do beta-blockers do?

Answer 13

Beta-blockers reduce heart rate and also acts on the periphery blood vessels there by lowering the blood pressure. (Remember beta 1 receptors are selective to the heart) These meds end in -lol

Side effect of the medication is depression, and impotency in men.

Question 14

What are important considerations and indications for ACE Inhibitors?

Answer 14

Used to lower blood pressure.

Adverse effect is impaired taste, headache, non-productive cough, angioedema.

Question 15

What are some important considerations and indications for ARBS?

Answer 15

Used in treating hypertension and treatment of heart failure. It is commonly combined with a diuretic, in fact, there are medications that come as a combined pill.

Its a newer class, and well tolerated with low adverse effects, no dry cough (-sartans).

Question 16

What are the contraindications and indications of Calcium Channel Blockers?

Answer 16

Blocks the binding of calcium through the receptors, causing smooth muscle relaxation.

Blocks the influx of calcium in the myocardial cells as the impulse comes down. This is how it works to slow the heart rate (in cases like RVR).

Question 17

What are important considerations and indications for Diuretics?

Answer 17

They decrease preload and decreases the overall workload of the heart. Thiazide are most commonly used and its first line diuretic treatment typically.

Question 18

What are some important considerations and indications for Vasodilators?

Answer 18

Aprazoline? nitrofuroside? Lower blood pressure.

Question 19

What is Angina Pectoris and what causes it?

Answer 19

AKA chest pain, its caused by a lack of oxygen supply and nutrients in the blood. Its insufficient to meet the demands of the heart so the heart muscle “aches”.

The heart requires a large supply of oxygen.

Question 20

What is ischemia and what causes it?

Answer 20

Ischemia is caused by poor oxygen supply to an organ or tissue.

Ischemic heart diseases are diseases where there’s poor blood supply to the heart muscle. Some diseases are artherosclerosis, coronary artery disease, or myocardial infarction (MI) which is the necrosis or death of cardiac tissue.

Ischemia can potentially be reprofused.

Question 21

What are the types of Angina?

Answer 21

1) Chronic stable angina (AKA classic or effort angina)
2) Unstable angina (AKA preinfarction or crescendo angina)
3) Vasospastic angina (AKA prinzmetal or variant angina)

We use a lot of Nitrates for this, which causes vasodilation which increases perfusion.

The instructions for dealng with angina you are to sit/lie down, take the nitro, and if the pain hasn’t resolved in 5 minutes you need to contact emergency services because they can be suffering from an MI and suffer sudden cardiac death. You can take nitroglycerine every 5 minutes for up to three doses. Be mindful of the blood pressure, taking nitro lowers it more every dose.

Question 22

What are the drugs used to treat Angina?

Answer 22

1) Nitrates/nitrites
2) Beta blockers which are protective due to the fact that they block the catacholemines flowing through the body from binding with the beta receptors of the heart.
3) Calcium channel blockers really good for aspasms, due to it blocking the calcium influx.

Therapeutic objectives
*Minimize the frequency of attacks and decrease the duration and intensity of anginal pain.
*Improve the patient’s functional capacity with as few adverse effects as possible.
*Prevent or delay the worst possible outcome: MI

Question 23

What is a concerning amount of weight gain in a person taking beta-2 blockers and why?

Answer 23

Call your health care provider if you experience a weight gain of 2 pounds or more in 24 hours or 5 pounds or more in 1 week. Worried that the patient is going into fluid overload and can potentially damage the heart.

Question 24

Explain heart failure. What is it, and what causes it?

Answer 24

Heart failure is when the heart is unable to pump blood insufficient amounts from the ventricles to meet the body’s metabolic needs.

The symptoms depend on the cardiac area effected.
1) Systolic dysfunction (which is the most common).
2) Diastolic dysfunction.

The cardiac defects that lead to heart failure include…
1) Myocardial infarction
2) Valve deficiency

Defects outside the heart that can lead to heart failure:
1) Coronary artery disease
2) Pulmonary hypertension
3) Diabetes

Question 25

What is “Pump it, Park it, or Pee it” in regards to heart failure treatment?

Answer 25

We can give medication to:
Pump it medications are positive inotropes, these are medications that increase the force of the contraction.

Park it medications are vasodilators that dilate the vessels that park the fluid out in the periphery.

Pee it medications are diuretics and will cause excretion of the overload of fluids, these fluids are increasing the demand of preload (initial stretching of the cardiac myocytes prior to contraction) within the heart.

Question 26

What are the interventions for treatment of congestive heart failure?

Answer 26

Upright position
Nitrates
Lasix
Oxygen
ACE Inhibitors
Digoxin

Fluids
Afterload
Sodium restriction
Test (dig level, ABGs, potassium level)

Question 27

Explain, in detail, the steps in the conduction system of the heart from SA node to the purkinje fibers…

Answer 27

First the SA node (the natural pacemaker of the heart) fires an electrical stimuli through the myocardial cells of the atria creating a wave contraction that spreads to both atria.

The electrical stimulus eventually reaches the AV node giving enough time for the atria to pump the blood into the ventricals. Once the atria are empty of blood the valves between the atria and the ventricles close.

At this point the atria begin to refill and the electrical stimulus passed through the AV node and Bundle of His to the Bundle branches and Purkinje fibers. This impulse spreads across all cells within the ventricular walls causing them to contract. As the ventricles contract, the right ventricle pumps blood into the pulmonary ARTERY and into the lung and the left ventricle pumps the blood into the Aorta.

Now the ventricles are empty, the artria are full, and the valves between are closed-the SA node will prepare to fire again and the process will repeat, but they must “recharge” first.

The SA node recharges while the atria are refilling.
The AV recharges when the ventricles are refilling.
This way there is no need fora pause in heat function.

Question 28

What are the three stages of a single heartbeat?

Answer 28

1) Atrial depolarization
2) Ventricular depolarization
3) Atria and ventricular repolarization

As the atria repolarizes during the ventricular contraction, there is no wave representing atrial contraction, as its buried in the QRS.

Question 29

What are the drug therapy’s for heart failure?

Answer 29

These are our “pump it, park it, and pee it”

REMEMBER! If its positive, it will have and increasing effect, if its negative it will have a decreasing effect on the heart…

1) Positive inotropic drugs: Inoptropic effects the force or energy of the myocardial contraction; It increases the force of the myocardial contraction. (Digoxin)

2) Positive chronotropic drugs: Chronotropic effects the rate of the heart; It increases the heart rate.

3) Positive dromotropic drugs: Dromotropic effects the cardia conduction of the heart; It accelerates the cardiac conduction.

Question 30

What are the various drug therapy classses that can be used for heart failure?

Answer 30

1) ACE inhibitors
2) Angiotensin 2 receptor blockers
3) Beta blockers
4) Aldosterone antagonists
5) B-type natriuretic peptides
6) Phosphodiesterase inhibitors
7) Cardiac glycosides

Question 31

What is the range for digoxin?

Answer 31

Though it varies it is 0.5-2.0 Nanograms per milliliter

Question 32

What are dysrythmias? What do Antidysrythmics do?

Answer 32

Dysrythmias are any deviation from the normal rhythm of the heart. These erratic beats make the heart irritable and it’s irritable because of the calcium, potassium, and magnesium levels which effects the action potential.

Antidysrythmics are used for the treatment and prevention of disturbances in cardiac rhythm.

Question 33

What are some common dysrythmias?

Answer 33

1) Supraventricular dysrhythmias
2) Ventricular dysrhythmias
3) Ectopic foci
4) Conduction blocks
5) A-fib

You must know how to identify A-fib and V-tach

Question 34

What is preload? What is afterload?

Answer 34

Preload is the volume of blood left in the ventricals at the end of diastole (end diastolic pressure).

Afterload is the resistance left ventricle must overcome to circulate the blood. Increased afgerload means increased cardiac workload.

Question 35

What are the general adverse effects of antidysrhythmics?

Answer 35

ALL antidysrhythmics can cause dysrhythmias!
1) Hypersensitivity reactions
2) Nausea
3) Vomitting
4) Diarrhea
5) Dizziness
6) Blurred vision
7) Headache

Question 36

What are some effects of lidocaine toxicity?

Answer 36

1) Slurred or difficult speech
* Parasthesias
* Numbness of the lips/tongue

2) Altered CNS
* Drowsiness
* Dizziness
* Arrythmias
* Restlessness
* Confusion

3) Muscle twitching
* Tremors

4) Seizures
* Convulsions
* Respiratory depression
* Respiratory and cardiac arrest

Question 37

What are the 5 main emergency drugs?

Answer 37

Oxygen
Lidocaine
Epinephrine
Atropine
Narcan

Question 38

What are some drugs (not classes of drugs) used for bradyardia?

Answer 38

Isoproterenol
Dopamine
Epinephrine
Atropine

Question 39

What drugs and classes effect dysrhythmias in the atria?

Answer 39

Amiodarone
Adenosine
Atropine
Beta blockers
Calcium channel blockers

Question 40

What drugs and classes effect the ventricular dysrhythmias?

Answer 40

Amiodarone
Lidocaine
Epinephrine