Block Five Flashcards
Cardiovascular Drugs
Define inotropic and chronotropic effects.
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- Describe the cardiac stimulants’ mode of action and adverse effects and routes of administration.
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- Describe drug interactions and monitoring details required for digoxin and be able to state the antidote for digoxin.
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- Describe the peripheral vasodilators’ mode of action and adverse effects.
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- Describe the formulations and storage properties of the nitrates.
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- Understand the clinical application of adrenaline and dopamine for cardiac insufficiency.
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A drug has a positive inotropic and positive chronotropic effect. What does this mean?
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What type of inotropic and chronotropic effect does the
B-agonists have?
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When adrenaline is used, bronchodilation and pupil
dilation can occur. Why do these adverse effects occur?
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With constant dosing of digoxin it would take more than
a week to reach steady state level. Why?
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If the therapeutic effects are required more quickly what would the dosing regimen be?
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Therapeutic drug monitoring is important for this drug.
Why?
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What is the inotropic and chronotropic effect of digoxin
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Why do these digoxin adverse effects occur?
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How are glyceryl trinitrate products administered? Explain.
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What is a common adverse effect of nitrates that occurs early in the course of administration? How is the adverse effect treated?
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Write True or False for the following statements.
If digoxin is given with diuretics, the serum K+ should be
monitored.
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Glyceryl Trinitrate is given to relieve angina rapidly.
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Dopamine has a negative inotropic effect
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Adrenaline is a positive chronotrope.
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Adverse effects associated with GTN are facial flushing and headaches.
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Digoxin is a negative inotrope and positive chronotrope.
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Dopamine given at different doses, low, moderate and high will have the same effect.
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- Why must the potassium levels be monitored when a person is taking digoxin?
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Digoxin is a narrow therapeutic index drug. What is the importance of this statement?
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Describe modes of action and adverse effects of the adrenergic antagonists and their clinical applications.
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Describe modes of action, adverse effects, selectivity, drug interactions and clinical application of the calcium channel blockers.
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Describe why beta-blockers and calcium channel blockers should not be discontinued quickly.
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Describe the inotropic and chronotropic effects of the alpha-, betaadrenergic and calcium channel antagonists.
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Describe mode of action, adverse effects and therapeutic use of labetalol.
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What are the inotropic and chronotropic effects of betablockers?
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What are the advantages and disadvantages of propranolol being a non-selective adrenoreceptor blocker?
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What are the inotropic and chronotropic effects of calcium channel blockers?
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What could be the effects of this interaction?
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Write True or False to the following statements:
Calcium channel blockers are negative inotropes and negative
chronotropes.
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Write True or False to the following statements:
B-blockers are negative inotropes and negative chronotropes.
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Write True or False to the following statements:
B-blockers can be used to reduce the severity and frequency of angina attacks.
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Abrupt withdrawal of calcium channel blockers in antihypertensive therapy will not cause any problems.
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If a drug is inotropic what does this mean?
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. Describe the mode of action, adverse effects and clinical applications
of ACE Inhibitors.
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Describe mode of action, adverse effects and clinical applications of Angiotensin II Inhibitors.
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Describe the mode of action, adverse effects and clinical applications of diuretics
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Write True or False for the following: ACE inhibitors work by binding to angiotension II receptors.
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Write True or False for the following: ACE inhibitors improve the life expectancy of patients with CHF.
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Write True or False for the following: Hyperkalaemia is a common adverse effect of thiazides and loop
diuretics.
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Write True or False for the following: An unproductive cough is an adverse effect of ACE inhibitors.
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Write True or False for the following: Angiotensin II receptor antagonists are the diuretic of choice for
CHF.
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Write True or False for the following: Hyponatraemia is a common adverse effect of potassium sparing
diuretics.
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Write True or False for the following: A diabetic may become hyperglycaemic when on thiazides.
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Write True or False for the following: Diuretics should not be taken at night.
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Mr Dandy is taking digoxin and frusemide. What problems could occur
with this drug combination?
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Angiotensin II binds to what receptor?
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When angiotensin II binds to AT1 what happens?
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When angiotensin II binds to AT2 what happens?
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What makes Angiotensin II Inhibitors exciting is their lack of \adverse effects. Is this true?
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Angiotensin II receptor antagonists selectively block AT1 receptor. Why is this effective in hypertension management?
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Describe and contrast the mechanisms of action of heparin, oral anticoagulants, antiplatelet drugs and thrombolytic drugs.
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Explain the clinical application of these drugs.
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Describe the key problems associated with their usage and identify relevant safety measures and key drugs that may cause drug-drug interactions..
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Identify the antidotes for the anticoagulant drugs
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What foods are high in Vitamin K? Hint: section 1.5.
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Explain why drugs that will increase the activity of the
liver metabolising enzymes will decrease the therapeutic
effect of warfarin.
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Go to medsafe website and look up dabigatran. What
type of drug is it? What therapeutic
applications/indications? What care considerations are
associated with its use?
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Go to medsafe website and look up clopidogrel. What type of drug is it? What therapeutic applications/indications? What care considerations are associated with its use?
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What is the treatment for a person with a second
myocardial infarction after being treated with
streptokinase on a previous occasion?
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Go to Medsafe website and look up tenecteplase. What type of drug is it? What therapeutic applications/indications? What care considerations are associated with its use?
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Compare the actions of heparin and tPA with respect to blood clots.
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Compare the actions of heparin and warfarin with respect to their
anticoagulant effect.
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Why may a patient be given both heparin and coumadin?
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What is the main adverse effect associated with usage of anticoagulants? What are the key strategies following from this with regard to clinical management?
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What is the antidote for heparin?
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What is the antidote for Warfarin?
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Oral anticoagulants are known to interact with:
(a) aspirin
(b) alcohol
(c) tegretol
(d) a, b and c
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Indications of excess anticoagulant include:
(a) haematuria and tarry dark stools
(b) headaches and depression
(c) hypertension and tachycardia
(d) all of the above.
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Why can large doses of Vitamin K cause resistance to warfarin for
several days?
(b) Give some clinical applications for warfarin.
(c) Will conditions like cirrhosis of the liver alter warfarin response?
(d) Is warfarin teratogenic?
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Describe the mode of action, adverse effects and care considerations of the HMG-CoA Reductase Inhibitors (Statins).
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Describe the mode of action, adverse effects and care considerations of cholesterol absorption inhibitors.
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Describe the mode of action, adverse effects and care considerations of fibrates.
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Identify clinical applications of lipid lowering drugs.
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What is the lipid profile and normal reference ranges?
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What is the ‘bad’ cholesterol and ‘good’ cholesterol?
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Remember a person with heart problems will be on a number of drugs. So your task is to identify potential drug interactions with Statins.
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Identify what conditions Statins, fibrates and cholesterol
absorption inhibitors can be used to treat.
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Briefly describe the therapeutic strategy for treatment of congestive heart failure (CHF) and angina pectoris.
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Describe the main group of drugs used in treatment of CHF and angina, their mode of action and adverse effects associated with each group of drug.
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Define positive and negative inotropic and chronotropic effects and give drug examples.
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What is the Pathophysiology of Congestive Heart Failure
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What are the therapeutic goals for congestive heart failure
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What are the drugs used to active the therapeutic goals for congestive heart failure
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What is the pathophysiology of angina pectoris
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what are the therapeutic goals for angina pectoris
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what drugs are used to achieve the therapeutic goals for angina pectoris
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What is the mode of action of a loop diurectic
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why is a loop diuretic used in the treatment of heart failure
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What are the common adverse effects of the loop diuretic
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What is the mode of action of an ace inhibitor
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why is a ace inhibitor used in the treatment of heart failure
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What are the common adverse effects of an ace inhibitor
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What is the mode of action of an cardiac glycoside
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why is a cardiac glycoside used in the treatment of heart failure
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What are the common adverse effects of a cardiac glycoside
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Some of the cardiovascular drugs are inotropic agents or chronotropic agents.
Give an example of a drug that is negative inotrope and a drug that is a positive chronotrope and explain what that means.
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3) Mr Jacobs, a 65 year old man, has congestive heart failure and is discharged from the hospital with the following drug regime: digoxin and frusemide. What education would you provide for Mr Jacobs to enable him to take his medication safely and accurately?
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What is the role of peripheral vasodilators in the treatment of angina
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What is the mode of action for peripheral vasodilators
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What is the role of B-adrenergic antagonists in the treatment of angina
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What is the mode of action for B-adrenergic antagonists
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What is the role of calcium channel blockers in the treatment of angina
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what is the mode of action of a calcium channel blocker
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a) When are the nitrates used in the treatment of angina?
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b) Isosorbide mononitrate can be administered orally. GTN cannot. Why?
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c) Why are facial flushing, headaches and reflex tachycardia commonly observed after
administration of nitrates in angina therapy?
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Calcium channel blockers should be used with caution in combination with b-blockers. Why?
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Nifedipine can be used for other therapeutic indications. Name some
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A 6-month old baby weighing 7kg is ordered digoxin IV as stat dose. The initial recommended dose of digoxin is 15 µg/kg stat. Digoxin is available as 50 µg/2 mL ampoule.
a) What amount can safely be given as an initial dose?
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A 6-month old baby weighing 7kg is ordered digoxin IV as stat dose. The initial recommended dose of digoxin is 15 µg/kg stat. Digoxin is available as 50 µg/2 mL ampoule.
b) How many mLs would need to be given?
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When you look at your infusions at the commencement of the shift you have 50 mg GTN diluted in 100 ml 5% dextrose solution running at 4 mL/hr via a volumetric pump.
Calculate the dose in mcg/min.
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Mr Sione, a 57 year old man, develops a deep vein thrombosis after discharge from
hospital where he has recently had a cholecystectomy.
a) Should he be admitted to hospital?
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Mr Sione, a 57 year old man, develops a deep vein thrombosis after discharge from
hospital where he has recently had a cholecystectomy.
What drug should he receive initially?
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How is the drug administered?
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Explain the function of the drug and it’s mode of action.
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What drug a person receive for long-term management of a deep vein thrombosis/cholecystectomy?
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How does this drug work?
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Mr Sione is fond of milk and decides to try a milk product from the supermarket called “Anlene”. This milk product is a functional food and contains Vitamin K. Will Mr Sione be OK drinking this product? Explain your answer.
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Sreptokinase is administered to a patient with a suspected myocardial infarction as the ECG shows an elevated ST segment.
Why would this drug be important in the treatment for MI?
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What is the mode of action of Stretokinase
converts plasminogen into plasmin
What adverse reaction can occur when streptokinase is used?
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A nurse flushed a triple central venous catheter (an IV with three ports). According to hospital policy, the nurse was to flush each port with 10 mL of normal saline followed by 2 mL of heparin flush solution in the concentration of 100 units/mL. The nurse mistakenly picked up a vial of heparin containing heparin 10,000 units/mL. Without checking the label, she prepared the solution for all three ports.
How much heparin did the patient receive and compare this to how much the patient
should receive?
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What is the potential outcome of the ‘flushing’ that the nurse has done?
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What should be done to help the patient?
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The normal adult heparin dosage is 20,000-40,000 units per 24 hours. The doctor has ordered Heparin IV to be infused at 850 U/hour. Is this dosage safe?
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Mrs Lau, a 76-year-old woman was hospitalised 2 weeks ago with a non-ST-elevation myocardial infarction (NSTEMI) and had a bare-metal stent placed in an obstructed coronary artery. Her blood pressure remained high at 145/91 mmHg and her blood lipid profile is problematic.
total cholesterol (TC) = 8.5 mmol/L,
low-density lipoprotein cholesterol (LDL-C) = 4.5 mmol/L,
high-density lipoprotein cholesterol (HDL-C) = 2.0 mmol/L,
triglycerides (TGs) = 8.0 mmol/L,
a) In addition to medication to control Mrs Lau’s blood pressure, what drug treatment could improve her lipid profile?
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Should blood lipids be monitored as part of routine clinical follow-up?
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What treatment options could be considered if Mrs Lau’s LDL-cholesterol and risk ratio of TC/HDL-C remain above the recommended target levels?
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