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Patho 1 > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Drugs used for stable angina relief

A

Nitrates, beta blockers, Ca channel blockers, Ranolazine

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2
Q

Drugs for stable angina reduction

A

Lipid lowering, aspirin or clopidrogrel

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3
Q

Drugs for improving stable angina

A

ACEs or ARBs

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4
Q

Nitroglycerin class, indications, MOA

A
  • nitrates
  • angina
  • Dilate veins, which dec preload and takes pressure off heart (dilates all vessels, big and small, esp veins)
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5
Q

Nitrates NC

A
  • tolerance can occur quickly - only use with actual angina or know you will have it (prophylactic for exercise)
  • if take once and doesn’t help, don’t take another
  • can take Tylenol for HA but often doesn’t last long
  • risk for hypo/dizzy
  • no relief in 5 min - 911 (but also take another, don’t exceed 3)
  • IV form - glass bottle and special tubing (severe HA and tachy)
  • severe hypotension with sildenafil, antiHTN, alc
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6
Q

Nitrostat

A
  • nitrates
  • ACTIVE ANGINA
  • sublingual; use every 5 min x3
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7
Q

Nitrates SE

A
  • R/t vasodilation - HA, hypotension/dizzy, reflex tachy (compensate)
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8
Q

Transderm-Nitro

A
  • short-acting nitro
  • chest or thigh
  • rotate site
  • hairless site
  • on in morning, off at night
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9
Q

Nitro-bid (2%)

A
  • short acting nitro
  • 1-2 inches to chest or thigh area
  • cover with piece of paper
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10
Q

Isosorbide

A
  • long acting nitrate
  • PREVENTION
  • only long acting
  • taper to prevent inc pain from coronary artery vasospasm
  • not for current pain and can take
  • SPECIAL SE: VASOSPASM
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11
Q

Ranolazine class, MOA

A

Antianginal agent
- Helps myocardium generate energy more efficiently; unknown

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12
Q

Ranolazine SE and NC

A
  • HA, dizzy, nausea, constipation
  • only PO
  • can PROLONG QT INTERVAL (risk for other lethal dysrhythmia)
  • careful with liver/kidney fail
  • CYP 340 inhibitor (avoid grapefruit and other inhibitors)
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13
Q

sacubitril/valsartan class, MOA

A
  • Angiotensin receptor-Neprilysin inhibitor (ARNI)
  • Dec preload and afterload, suppress aldosterone, which helps with cardiac remodeling
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14
Q

Ppl with HF are often on…

A
  • ACE, ARB, or ARNI
  • beta blocker
  • mineralcorticoid rec antagonist
  • SLGT2 inhibitor
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15
Q

sacubitril/valsartan SE and NC

A
  • Hypotension, hyperkalemia, cough (ACE)
  • highest dose possible
  • ARNI best bc have Nepriysin inhibit but pricy
  • ARBs might be tolerated better
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16
Q

Which drug is a mineral corticoid receptor antagonist and how does it work?

A

Spironolactone - suppresses Na/H2O retention and offloads the LV

17
Q

Carvedilol class, MOA

A
  • Beta and alpha blockade
  • Protects against SNS activation (neurohormonal) and dysrhythmia, reverse cardiac remodeling
18
Q

Carvedilol SE and NC

A
  • Lethargy, fatigue, dec BP, bradycardia, can exacerbate lung issues, fluid retention, worsening HF
  • wean when discontinuing the med to avoid CVD event, - watch asthma patients,
  • no give with HR <60 or SBP<100
19
Q

Dapagliflozin class, MOA

A
  • SLPG2 inhibitor
  • Not well known; helps with vent unloading thru natriuresis/osmotic diuresis w/o actually depleting volume like most diuretics; may affect cardiac metab and bioenergetics (NOT TOO IMPORTANT TO KNOW)
20
Q

Dapaglifozan NC

A
  • no ESRD or severe kidney
  • oral
  • dec readmission, mort and morb
21
Q

Diuretics w/ HF

A
  • LOOP is first line
  • vol overload
  • oral or IV
  • SE - hypokalemia, hypotension, digoxin tox
  • no survival benefit, just helps sx
22
Q

Digitalis class and MOA

A
  • Cardiac glycosides - inotropic drug
  • Inhibit Na/K ATP pump in cardiac cell which causes Ca to collect in heart which inc contractility; inc BF to kidneys and dec sympathetic action to dec HR
  • Second line bc inc risk dysrhythmias
23
Q

Digitalis SE and NC

A
  • Cardiac dysrthymias (A fib, A flutter), digitalis tox,
  • high risk tox - age, women, combo drugs like diuretics
  • monitor levels (weekly INR)
  • dec dose
  • supplemental K bc inc risk tox with low K (higher risk with diuretics)
  • take apical pulse full minute before and hold<60
  • antidote for tox is Digibind (only if severe)
24
Q

What is the other inotropic drug that we see?

A

Sympathomimetics like dopamine and dobutamine

25
Q

Amiodarone class, indications, MOA

A
  • Antidysrthmic
  • Help bring out a fib and vent dysrhtmia
  • Prolong AP duration and effective refractors period in all cardiac tissues; blocks alpha and beta adrenergic rec in SNS
26
Q

Digitalis tox sx

A
  • brady, HA, dizzy, confusion, Nausea, visual disturbances (blurry, yellow vision)
27
Q

Amio SE and NC

A
  • Many adverse (75% have)- thyroid alterations corneal microdeposits - light sensitivity, dry eye, visual halo; can cause pulm tox (fatal sometimes)
    • IV or PO
  • very lipidphyllic - gets conc in adipose tissue
  • may not see for pt with iodine allergies
  • BLACK BOX - pulm tox, hepatotox, pro-arythmic fx (new rhythm)
  • intx with Digoxin (tox) and warfarin (can GREATLY inc INR)
  • v long half life - can take 2-3M for SE to leave
  • CI with severe brady or heart blocks
28
Q

Atropine class, indications, and MOA

A
  • Antichol and antimuscarinic
  • sinus brady
  • Poisons the vagus nerve, inhib postganglionic ACh rec and direct vagolytic action
29
Q

Atropine SE and NC

A
  • ACh - Xerostomia, blurry vision, photophobia, tachy, flushing, hot skin
  • only for symptomatic (don’t use if they talking) and VAGALLY INDUCED brady
  • does not work on sick hearts
  • IVP (1mg q3-5, 3mg MAX)
  • only work ¼ ppl
  • NEED ON TELE
30
Q

Adenosine MOA and indications

A
  • SVT, PSVT, sinus tach
  • Slows the conduction of time thru AV node
31
Q

Adenosine SE and NC

A
  • v short half life (may need multiple doses)
  • cause short burst asystole (flat line)
  • only IV (6mg IVP, can give another 12mg if not converted, can give 3rd 12 mg if needed)
  • always follow with flush (rapid or 2 normal)
  • given with stopcoc
  • needs AED pads on
32
Q

Dofetilide (Tikosyn) class, indications, and MOA

A
  • Antidysrhythmic
  • A fib, a flutter to stay in sinus rhythm (maintenance)
  • Selectively blocking rapid cardiac ion channel carrying K currents
33
Q

Dofetilide (Tikosyn) SE and NC

A
  • High risk of Torasades (polymorphic V tach - deadly - CPR) and SVT, HA, dizzy, chest pain
  • always start in hospital on tele (ECG)
  • don’t give for long QT or other drugs that may prolong QT
34
Q

Why is warfarin given for cardiac probs

A

Given in conjunction with rhythm problems like a-fib or a-flutter to dec risk of stroke

Patho 1 (30 decks)

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