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214202 > Block Five > Flashcards

Block Five Flashcards

Cardiovascular Drugs

1
Q

Define inotropic and chronotropic effects.

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2
Q
  1. Describe the cardiac stimulants’ mode of action and adverse effects and routes of administration.
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3
Q
  1. Describe drug interactions and monitoring details required for digoxin and be able to state the antidote for digoxin.
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4
Q
  1. Describe the peripheral vasodilators’ mode of action and adverse effects.
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5
Q
  1. Describe the formulations and storage properties of the nitrates.
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6
Q
  1. Understand the clinical application of adrenaline and dopamine for cardiac insufficiency.
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7
Q

A drug has a positive inotropic and positive chronotropic effect. What does this mean?

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8
Q

What type of inotropic and chronotropic effect does the

B-agonists have?

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9
Q

When adrenaline is used, bronchodilation and pupil

dilation can occur. Why do these adverse effects occur?

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10
Q

With constant dosing of digoxin it would take more than

a week to reach steady state level. Why?

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11
Q

If the therapeutic effects are required more quickly what would the dosing regimen be?

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12
Q

Therapeutic drug monitoring is important for this drug.

Why?

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13
Q

What is the inotropic and chronotropic effect of digoxin

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14
Q

Why do these digoxin adverse effects occur?

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15
Q

How are glyceryl trinitrate products administered? Explain.

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16
Q

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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17
Q

Write True or False for the following statements.
If digoxin is given with diuretics, the serum K+ should be
monitored.

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18
Q

Glyceryl Trinitrate is given to relieve angina rapidly.

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19
Q

Dopamine has a negative inotropic effect

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20
Q

Adrenaline is a positive chronotrope.

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21
Q

Adverse effects associated with GTN are facial flushing and headaches.

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22
Q

Digoxin is a negative inotrope and positive chronotrope.

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23
Q

Dopamine given at different doses, low, moderate and high will have the same effect.

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24
Q
  1. Why must the potassium levels be monitored when a person is taking digoxin?
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25
Q

Digoxin is a narrow therapeutic index drug. What is the importance of this statement?

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26
Q

Describe modes of action and adverse effects of the adrenergic antagonists and their clinical applications.

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27
Q

Describe modes of action, adverse effects, selectivity, drug interactions and clinical application of the calcium channel blockers.

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28
Q

Describe why beta-blockers and calcium channel blockers should not be discontinued quickly.

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29
Q

Describe the inotropic and chronotropic effects of the alpha-, betaadrenergic and calcium channel antagonists.

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30
Q

Describe mode of action, adverse effects and therapeutic use of labetalol.

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31
Q

What are the inotropic and chronotropic effects of betablockers?

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32
Q

What are the advantages and disadvantages of propranolol being a non-selective adrenoreceptor blocker?

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33
Q

What are the inotropic and chronotropic effects of calcium channel blockers?

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34
Q

What could be the effects of this interaction?

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35
Q

Write True or False to the following statements:
Calcium channel blockers are negative inotropes and negative
chronotropes.

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36
Q

Write True or False to the following statements:

B-blockers are negative inotropes and negative chronotropes.

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37
Q

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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38
Q

Abrupt withdrawal of calcium channel blockers in antihypertensive therapy will not cause any problems.

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39
Q

If a drug is inotropic what does this mean?

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40
Q

. Describe the mode of action, adverse effects and clinical applications
of ACE Inhibitors.

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41
Q

Describe mode of action, adverse effects and clinical applications of Angiotensin II Inhibitors.

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42
Q

Describe the mode of action, adverse effects and clinical applications of diuretics

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43
Q

Write True or False for the following: ACE inhibitors work by binding to angiotension II receptors.

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44
Q

Write True or False for the following: ACE inhibitors improve the life expectancy of patients with CHF.

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45
Q

Write True or False for the following: Hyperkalaemia is a common adverse effect of thiazides and loop
diuretics.

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46
Q

Write True or False for the following: An unproductive cough is an adverse effect of ACE inhibitors.

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47
Q

Write True or False for the following: Angiotensin II receptor antagonists are the diuretic of choice for
CHF.

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48
Q

Write True or False for the following: Hyponatraemia is a common adverse effect of potassium sparing
diuretics.

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49
Q

Write True or False for the following: A diabetic may become hyperglycaemic when on thiazides.

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50
Q

Write True or False for the following: Diuretics should not be taken at night.

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51
Q

Mr Dandy is taking digoxin and frusemide. What problems could occur
with this drug combination?

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52
Q

Angiotensin II binds to what receptor?

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53
Q

When angiotensin II binds to AT1 what happens?

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54
Q

When angiotensin II binds to AT2 what happens?

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55
Q

What makes Angiotensin II Inhibitors exciting is their lack of \adverse effects. Is this true?

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56
Q

Angiotensin II receptor antagonists selectively block AT1 receptor. Why is this effective in hypertension management?

A

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57
Q

Describe and contrast the mechanisms of action of heparin, oral anticoagulants, antiplatelet drugs and thrombolytic drugs.

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58
Q

Explain the clinical application of these drugs.

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59
Q

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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60
Q

Identify the antidotes for the anticoagulant drugs

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61
Q

What foods are high in Vitamin K? Hint: section 1.5.

A

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62
Q

Explain why drugs that will increase the activity of the
liver metabolising enzymes will decrease the therapeutic
effect of warfarin.

A

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63
Q

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?

A

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64
Q

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?

A

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65
Q

What is the treatment for a person with a second
myocardial infarction after being treated with
streptokinase on a previous occasion?

A

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66
Q

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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67
Q

Compare the actions of heparin and tPA with respect to blood clots.

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68
Q

Compare the actions of heparin and warfarin with respect to their
anticoagulant effect.

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69
Q

Why may a patient be given both heparin and coumadin?

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70
Q

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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71
Q

What is the antidote for heparin?

A

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72
Q

What is the antidote for Warfarin?

A

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73
Q

Oral anticoagulants are known to interact with:

(a) aspirin
(b) alcohol
(c) tegretol
(d) a, b and c

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74
Q

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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75
Q

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?

A

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76
Q

Describe the mode of action, adverse effects and care considerations of the HMG-CoA Reductase Inhibitors (Statins).

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77
Q

Describe the mode of action, adverse effects and care considerations of cholesterol absorption inhibitors.

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78
Q

Describe the mode of action, adverse effects and care considerations of fibrates.

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79
Q

Identify clinical applications of lipid lowering drugs.

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80
Q

What is the lipid profile and normal reference ranges?

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81
Q

What is the ‘bad’ cholesterol and ‘good’ cholesterol?

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82
Q

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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83
Q

Identify what conditions Statins, fibrates and cholesterol

absorption inhibitors can be used to treat.

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84
Q

Briefly describe the therapeutic strategy for treatment of congestive heart failure (CHF) and angina pectoris.

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85
Q

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.

A

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86
Q

Define positive and negative inotropic and chronotropic effects and give drug examples.

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87
Q

What is the Pathophysiology of Congestive Heart Failure

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88
Q

What are the therapeutic goals for congestive heart failure

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89
Q

What are the drugs used to active the therapeutic goals for congestive heart failure

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90
Q

What is the pathophysiology of angina pectoris

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91
Q

what are the therapeutic goals for angina pectoris

A

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92
Q

what drugs are used to achieve the therapeutic goals for angina pectoris

A

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93
Q

What is the mode of action of a loop diurectic

A

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94
Q

why is a loop diuretic used in the treatment of heart failure

A

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95
Q

What are the common adverse effects of the loop diuretic

A

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96
Q

What is the mode of action of an ace inhibitor

A

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97
Q

why is a ace inhibitor used in the treatment of heart failure

A

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98
Q

What are the common adverse effects of an ace inhibitor

A

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99
Q

What is the mode of action of an cardiac glycoside

A

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100
Q

why is a cardiac glycoside used in the treatment of heart failure

A

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101
Q

What are the common adverse effects of a cardiac glycoside

A

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102
Q

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.

A

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103
Q

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?

A

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104
Q

What is the role of peripheral vasodilators in the treatment of angina

A

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105
Q

What is the mode of action for peripheral vasodilators

A

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106
Q

What is the role of B-adrenergic antagonists in the treatment of angina

A

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107
Q

What is the mode of action for B-adrenergic antagonists

A

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108
Q

What is the role of calcium channel blockers in the treatment of angina

A

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109
Q

what is the mode of action of a calcium channel blocker

A

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110
Q

a) When are the nitrates used in the treatment of angina?

A

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111
Q

b) Isosorbide mononitrate can be administered orally. GTN cannot. Why?

A

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112
Q

c) Why are facial flushing, headaches and reflex tachycardia commonly observed after
administration of nitrates in angina therapy?

A

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113
Q

Calcium channel blockers should be used with caution in combination with b-blockers. Why?

A

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114
Q

Nifedipine can be used for other therapeutic indications. Name some

A

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115
Q

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?

A

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116
Q

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?

A

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117
Q

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.

A

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118
Q

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?

A

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119
Q

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?

A

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120
Q

How is the drug administered?

A

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121
Q

Explain the function of the drug and it’s mode of action.

A

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122
Q

What drug a person receive for long-term management of a deep vein thrombosis/cholecystectomy?

A

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123
Q

How does this drug work?

A

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124
Q

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.

A

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125
Q

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?

A

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126
Q

What is the mode of action of Stretokinase

A

converts plasminogen into plasmin

127
Q

What adverse reaction can occur when streptokinase is used?

A

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128
Q

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?

A

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129
Q

What is the potential outcome of the ‘flushing’ that the nurse has done?

A

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130
Q

What should be done to help the patient?

A

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131
Q

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?

A

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132
Q

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?

A

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133
Q

Should blood lipids be monitored as part of routine clinical follow-up?

A

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134
Q

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?

A

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214202 (6 decks)

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