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Pharm - Amy > Cardiac Agents > Flashcards

Cardiac Agents Flashcards

1
Q

types of antianginal drugs (3)

A
  • nitrates
  • beta-blockers
  • calcium channel blockers
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2
Q

Nitroglycerin action (2)

A
  • reduces myocardial oxygen demand (decreases preload and afterload)
  • increases cGMP (second messenger within cells) → smooth muscle relaxation and vasodilation
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3
Q

Nitroglycerin uses

A

variant and classic angina

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4
Q

sublingual nitroglycerin

A
  • most common
  • readily absorbed into bloodstream, bypasses first-pass effect
  • decomposes in heat/light - keep in original container
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5
Q

IV nitroglycerin

A
  • titrated to relieve angina or manage acute congestive heart failure exacerbation
  • dilute in D5W
  • use glass infusion bottles, non-polyvinyl tubing
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6
Q

topical nitroglycerin

A
  • apply on chest or thigh
  • ointment
  • transdermal patch - pre-measured, more precise
  • don’t touch with fingers
  • don’t place in are of cardioverter-defibrillator paddle placement
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7
Q

Nitroglycerin side effects (5)

A
  • headache – most common
  • decreased blood pressure, dizziness, lightheadedness
  • rebound effect of myocardial ischemia if ointment/patch is not tapered
  • reflex tachycardia if given too rapidly
  • circulatory collapse - life-threatening
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8
Q

nitroglycerin has enhanced hypotensive effect if given with (4):

A
  • beta blockers
  • calcium channel blockers
  • antihypertensives
  • alcohol
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9
Q

IV nitroglycerin + heparin interaction

A

decreases effects of heparin

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10
Q

beta blocker action

A
  • blocks beta receptor sites → decreases effects of sympathetic nervous system by blocking action of catecholamines (epinephrine, norepinephrine)
  • decreases heart rate and blood pressure
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11
Q

beta blocker uses (3)

A
  • antianginal
  • antihypertensive
  • antidysrhythmic
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12
Q

beta blocker contraindications (5)

A
  • low heart rate or blood pressure
  • 2nd or 3rd degree AV block
  • sinus bradycardia
  • late-stage heart failure
  • diabetes mellitus - masks hypoglycemia (esp. selective beta blockers)
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13
Q

nonselective beta blocker example

A

Propranolol (Inderal)

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14
Q

nonselective beta blocker adverse reactions (2)

A
  • bronchoconstriction

- impotence/erectile dysfunction

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15
Q

nonselective beta blocker contraindication

A

patients with constrictive lung diseases (asthma, COPD)

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16
Q

selective beta blocker examples (2)

A
  • Metoprolol (Lopressor)

- Atenolol (Tenormin)

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17
Q

selective beta blocker (Metoprolol) side effects (9)

A
  • dizziness
  • diarrhea
  • nasal stuffiness
  • impotence, decreased libido
  • depression
  • mental changes
  • bradycardia, heart block
  • thrombocytopenia
  • agranulocytosis
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18
Q

calcium channel blockers action

A

inhibits calcium ion from entering calcium ion channels into vascular smooth muscle and myocardium → smooth muscle relaxation and coronary vasodilation

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19
Q

calcium channel blockers uses (3)

A
  • classic and variant angina
  • chronic hypertension
  • some dysrhythmias
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20
Q

calcium channel blockers side effects (6)

A
  • headache
  • hypotension (esp. Nifedipine)
  • dizziness
  • flushing
  • reflex tachycardia due to decreased BP
  • peripheral and pulmonary edema
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21
Q

calcium channel blockers examples (2)

A
  • Nifedipine (Procardia)

- Amlodipine (Norvasc)

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22
Q

Nifedipine

A
  • trade: Procardia
  • most potent calcium channel blocker
  • can cause profound hypotension
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23
Q

Amlodipine

A
  • trade: Norvasc

- newer calcium channel blocker

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24
Q

Amlodipine side effects (6)

A
  • peripheral/ankle edema
  • headache
  • flushing
  • dizziness
  • fatigue
  • bradycardia
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25
Q

Amlodipine adverse reactions (4)

A
  • hypotension
  • angina
  • angioedema
  • heart block
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26
Q

Amlodipine + grapefruit juice interaction

A

reduces presystemic clearance of drug, increases in bioavailability

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27
Q

African-Americans respond well to:

A
  • alpha-1 blocker and calcium channel blocker antihypertensives
  • diuretics as initial therapy
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28
Q

African-Americans do not respond well to:

A

beta-blocker and ACE inhibitor antihypertensives

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29
Q

1st line of treatment for hypertension

A

diuretics

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30
Q

Asians are sensitive to:

A

beta-blockers and other antihypertensives - twice as sensitive than Caucasians

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31
Q

types of antihypertensives (8)

A
  • diuretics
  • beta blockers
  • alpha-2 agonists
  • alpha adrenergic blockers
  • ACE inhibitors
  • angiotensin II receptor blockers (ARBs)
  • direct renin inhibitors
  • calcium channel blockers
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32
Q

diuretics action

A

promotes sodium and water depletion → decrease volume

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33
Q

Furosemide

A
  • trade: Lasix
  • most common diuretic
  • a loop diuretic
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34
Q

Furosemide action

A

inhibits exchange of chloride, sodium, and potassium in the loop of Henle

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35
Q

Furosemide side effects (3)

A
  • nausea
  • diarrhea
  • electrolyte imbalances - hypokalemia
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36
Q

ACE inhibitors action

A
  • inhibits angiotensin-converting enzyme (ACE)
  • inhibits formation of angiotensin II – a vasoconstrictor
  • blocks release of aldosterone → sodium excretion, potassium retention
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37
Q

ACE inhibitors uses (2)

A
  • primarily for hypertension

- also: heart failure

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38
Q

ACE inhibitors side effects (11)

A
  • constant irritated dry cough
  • hypotension
  • dizziness
  • rash
  • taste disturbance
  • hyperkalemia – risk for dysrhythmia
  • tachycardia
  • impotence
  • intestinal angioedema
  • agranulocytosis
  • anaphylactoid reaction
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39
Q

hold antihypertensive if systolic BP is less than ___

A

90 mmHg

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40
Q

if BP is greater than ____, treat immediately or within days

A

180/110 mmHg

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41
Q

if BP is greater than ____, treat immediately

A

210/120 mmHg

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42
Q

types of antihyperlipidemics (5)

A
  • bile-acid sequestrants
  • fibrates (fibric acid)
  • nicotinic acid
  • cholesterol absorption inhibitors
  • HMG-CoA reductase inhibitors (statins)
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43
Q

bile-acid sequestrants action

A

reduces LDL cholesterol levels by binding with bile acids in the intestine

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44
Q

bile-acid sequestrants side effects (3)

A
  • constipation
  • flatulence
  • cramping
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45
Q

fibrates action (2)

A
  • breaks down lipoprotein from tissues and removes them from plasma
  • decreases synthesis of triglycerides
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46
Q

fribrates should not be taken with:

A

anticoagulants - compete for protein sites

47
Q

monitor ____ when taking fibrates

A

INR

48
Q

nicotinic acid action (3)

A
  • inhibits release of free fatty acids from adipose tissues
  • promotes triglyceride removal from plasma
  • increases HDL
49
Q

cholesterol absorption inhibitors action

A
  • acts in the small intestine to inhibit cholesterol absorption
  • must be combined with a statin for optimum effect
50
Q

statins action (2)

A
  • inhibits enzyme HMG-CoA reductase in cholesterol biosynthesis → decreases cholesterol
  • slightly increases HDL and decreases LDL
51
Q

HMG-CoA reductase

A

precursor for cholesterol synthesis, controls last step in cholesterol production

52
Q

Atorvastatin contraindications (2)

A
  • active liver disease

- pregnancy

53
Q

Atorvastatin - use with caution in:

A
  • history of liver disease
  • increased alcohol ingestion
  • trauma
  • severe metabolic endocrine disorders
  • uncontrolled seizures
54
Q

Atorvastatin side effects (7)

A
  • headache
  • rash
  • pruritus
  • diarrhea, constipation
  • sinusitis
  • pharyngitis
  • leg cramps
55
Q

Atorvastatin adverse reactions (4)

A
  • rhabdomyolysis: breakdown of myoglobin from muscles → kidney damage
  • myalgia (muscle aches)
  • photosensitivity
  • cataracts
56
Q

Atorvastatin + digoxin interaction

A

increases digoxin level

57
Q

Atorvastatin + oral contraceptives interaction

A

increases contraceptive level

58
Q

Atorvastatin + macrolide antibiotics interaction

A

increased effects

59
Q

Atorvastatin + antifungals interaction

A

increased effects

60
Q

Atorvastatin + antacids interaction

A

decreased effects

61
Q

Atorvastatin + propranolol interaction

A

decreased effects

62
Q

HMG-CoA reductase inhibitor (statin) example

A

Atorvastatin (Lipitor)

63
Q

labs for antilipidemics (3)

A
  • liver function tests/liver enzymes
  • CPK (creatinine phosphokinase)
  • lipid profile
64
Q

antilipidemics - total cholesterol goal

A

less than 200 mg/dL in 8-12 weeks

65
Q

antilipidemics - HDL goal

A

45-60 mg/dL

66
Q

antilipidemics - LDL goal

A

less than 100 mg/dL

67
Q

antilipidemics - triglycerides goal

A

less than 150 mg/dL

68
Q

Procainamide

A
  • trade: Pronestyl, Procan SR
  • class 1 antidysrhythmic
  • converted by liver into NAPA, active compound
69
Q

Procainamide action (3)

A
  • depresses phase 0 of action potential (prevents sodium from entering cell) → slow conduction, prolonged repolarization/relaxation
  • decreases automaticity and likelihood of ectopic foci
  • decreases conduction velocity in cardiac tissues
70
Q

phase 0 of action potential

A

rapid depolarization (contraction) initiated by rapid influx of sodium into cell

71
Q

Procainamide uses

A
  • wide variety of ventricular and atrial dysrhythmias

- paroxysmal atrial tachycardia, supraventricular dysrhythmia

72
Q

Procainamide dose-related side effects (6)

A
  • anorexia
  • dizziness
  • drowsiness
  • heart blocks
  • hypotension
  • CHF
73
Q

Procainamide long-term therapy effects (2)

A
  • Lupus-like syndrome with rash and small joint pain

- pericarditis with tamponade

74
Q

Procainamide adverse reactions (3)

A
  • hypotension
  • marked slowing of conduction - bradycardia
  • Torsade de pointes - form of V. tach, may evolve to V. fib
75
Q

Amiodarone

A
  • trade: Cordarone

- class III antidysrhythmic

76
Q

Amiodarone action

A
  • unclear mechanism
  • blocks potassium and slows upward movement of potassium during phase 3 of action potential → prolongs repolarization, slows rate and conduction of heart
77
Q

Amiodarone use

A

maintenance and treatment - ventricular tachycardia/fibrillation, atrial flutter/fibrillation

78
Q

Amiodarone side effects (5)

A
  • nausea/vomiting, GI distress
  • dizziness
  • hypotension
  • arrhythmia
  • decreased HR - can lead to 2nd, 3rd degree heart block
79
Q

Amiodarone adverse reactions (7)

A
  • hypo/hyperthyroidism - similar structure to thyroid hormone
  • corneal microdeposits
  • hepatic dysfunction
  • pulmonary fibrosis - with long-term use
  • peripheral neuropathy
  • proximal muscle weakness
  • blue-grey hyperpigmentation of skin
80
Q

Amiodarone + class I antidysrhythmics interaction

A

increases blood levels

81
Q

Amiodarone + warfarin interaction

A

increased blood levels

82
Q

Amiodarone + fluoroquinolones, macrolides, azole antifungals interaction

A

increased risk for QT prolongation

83
Q

Amiodarone + grapefruit juice interaction

A

grapefruit juice inhibits enzymes in GI tract that metabolize amiodarone - risk for toxicity

84
Q

types of anticoagulant (6)

A
  • heparin
  • low molecular weight heparin
  • warfarin
  • antiplatelet
  • direct-acting thrombin inhibitors
  • factor Xa inhibitors
85
Q

heparin action

A

inhibits thrombin → prevents conversion of fibrinogen to fibrin

86
Q

heparin use

A

prevent thromboembolic states (DVT, pulmonary embolism, evolving stroke, disseminated intravascular coagulation (DIC), atrial fibrillation/flutter, MI, valve replacements, etc.)

87
Q

subQ heparin

A

for DVT prophylaxis

88
Q

IV heparin

A

for acute treatment of thrombosis (MI, PE)

89
Q

heparin side effects

A

itching, burning, ecchymosis (discoloration/brusing) at injection site

90
Q

heparin adverse reactions (2)

A
  • heparin-induced thrombocytopenia (HIT)

- bleeding

91
Q

heparin-induced thrombocytopenia (HIT)

A
  • allergic reaction, immune-mediated response to heparin
  • platelet factor IV binds to heparin, combined with IgG → immune complex → binds to circulating platelets → reduces platelet level, causes thrombosis
92
Q

heparin effects are increased with (4):

A

aspirin, NSAIDs, thrombolytics, probenecid

93
Q

heparin antidote

A

protamine sulfate

94
Q

lab to monitor with heparin treatment

A

aPTT - 5-15 minutes after dose + in 2-8 hours

95
Q

low molecular weight heparin action

A

binds with antithrombin to accelerate the rate at which antithrombin inhibits factor Xa and thrombin

96
Q

low molecular weight heparin antidote

A

protamine sulfate

97
Q

low molecular weight heparin compared to unfractioned heparin

A
  • similar use
  • more stable response
  • less risk for bleeding, thrombocytopenia
  • doesn’t require frequent aPTT monitoring
  • alf-life is 2-4 times that of heparin
98
Q

warfarin action

A

inhibits hepatic synthesis of coagulation factors dependent on vitamin K (factors II, VII, IX, X)

99
Q

warfarin uses

A
  • prevent thromboembolic conditions

- blood clots primarily in the veins, but works in arteries too

100
Q

warfarin side effects (5)

A
  • anorexia
  • diarrhea
  • abdominal cramps
  • rash
  • fever
101
Q

warfarin adverse effects

A
  • increased AST, ALT (liver enzymes)

- bleeding

102
Q

warfarin antidotes

A
  • vitamin K - will manufacture clotting factors

- fresh frozen plasma (FFP) - clotting factors in plasma

103
Q

aspirin action

A

inhibits platelet aggregation by interfering with thromboxane A2

104
Q

aspirin uses (5)

A
  • MI - bite and chew
  • CVA - treatment or prophylaxis
  • CAD prophylaxis
  • may be used within 48 hours of stroke
  • recommended before and after endarterectomy
105
Q

aspirin side effects (2)

A
  • tinnitus

- bleeding

106
Q

aspirin adverse effects (7)

A
  • nausea
  • dyspepsia
  • heartburn
  • GI bleed
  • toxicity
  • headache
  • anaphylactoid reaction
107
Q

Plavix action

A

prevents platelet aggregation by blocking adenosine diphosphate from binding to platelet receptor

108
Q

Plavix use

A

for patients allergic to aspirin

109
Q

direct-acting thrombin inhibitors action

A

directly inhibits thrombin from converting fibrinogen to fibrin

110
Q

direct-acting thrombin inhibitors uses (3)

A
  • HIT
  • unstable angina
  • angioplasty
111
Q

direct-acting thrombin inhibitors contraindication

A

liver failure

112
Q

labs to monitor in warfarin treatment

A

prothrombin time, INR

113
Q

anticoagulants contraindications (7)

A
  • bleeding disorders
  • peptic ulcer
  • severe hepatic or renal disease
  • hemophilia
  • CVA
  • eye, brain, or spinal injury
  • risk for injury from fall
114
Q

herbal therapies that increase bleeding with warfarin (3)

A

ginko, garlic, ginseng

Pharm - Amy (3 decks)

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