Cardiac Drugs

Question 1

Thiazide Diuretics

Answer 1

Hydrochlorothiazide, Chlorthalidone
Hypertension and heart failure
Inhibits reabsorption of sodium and chloride from distal tubules in kidneys
Reduce peripheral resistance
Decrease preload

Question 2

Thiazide Diuretic Adverse Effects and Considerations

Answer 2

Hypokalemia
Raise glucose levels
Exacerbation of gout (increases uric acid)
Electrolyte imbalances (calcium)
Orthostasis
Avoid: in renal failure, digoxin toxicity, decrease effect of diabetic meds (check BG), lithium toxicity. No NSAIDS

Question 3

ACE Inhibitors

Answer 3

Captopril (-pril)
Hypertension, Heart Failure, Diabetes, Post MI
Inhibits angiotensin-2 production. Interfering with RAAS.
Increases bradykinin levels
Decrease vasoconstriction (lower peripheral resistance)
Decrease aldosterone production

Question 4

ACE Inhibitors Adverse Effects and Considerations

Answer 4

Hyperkalemia (suppression of aldosterone)
Dizziness
Cough
Angioedema - Elevated bradykinin
Black box warning - serious fetal abnormalities
Consider - Renal function and potassium, orthostasis, no NSAID’s, empty stomach

Question 5

ARBs

Answer 5

Valsartan (-sartan)
Hypertension, When ACEI cannot be used.
Binds with Angiotensin-2 receptors in vascular smooth muscle and adrenal cortex to stop vasoconstriction and aldosterone production.

Question 6

ARBs Adverse Effects and Considerations

Answer 6

Cough (less than ACE), Hyperkalemia (less than ACE), headaches, dizziness, GI issues, xerostomia, alopecia.
Increase creatinine
Drug interaction with Diltiazem, oral anti-fungal
Consider: Monitor renal function, interacts with CYP450, do not give with ACE, give with or without foods.

Question 7

Calcium Channel Blockers

Answer 7

Hypertension, angina, rate control in AFib, SVT, Raynaud Syndrome
Inhibits movement of calcium into mycardial muscle cells. Block muscle cell contractions.
Decrease cardiac workload (slows contractions and conduction), reduces O2 consumption.
Decrease systemic resistence
Two Types - Dihydropyridine, Non-dihydropyridine

Question 8

Dihydropyridine
Non-Dihydropyridine

Answer 8

Dihydropyridine (-dipine) - Vascular selective, direct effect on vasodilation and less reduction of calcium.
SE - Peripheral Edema, Headache, Flushing, , dizziness, can have increased HR, GI effects
Non-dihydropyridine - Hypertension, angina, dysthymias (AFIB,, SVT)
Negative inotropic effects (weaker contractions), slow AC conduction and SA node
SE - Bradycardia, decreased cardiac output, GI SE, should not be used with heart block
Verapamil, diltiazem

Question 9

Calcium Channel Blockers Considerations

Answer 9

Avoid use in heart failure
Avoid Grapefruit juice - especially with diltiazem
Do not give if HR <60 BPM - call md
Check for orthostasis

Question 10

Beta Blockers

Answer 10

(-olol)
Hypertension (not first line)
Decreased risk of sudden death after MI
All patients after MI
HR reduction in AF
Heart Failure

Block beta, decrease HR, decrease BP, decrease muscle contraction,Increase kidney bloodflow, decrease renin release. SLOWS SNS
Selective Beta 1 (just heart) - Metoprolol
Non selective (both betas, includes smooth tissue) - propranolol

Question 11

Beta Blockers Adverse Effects and Considerations

Answer 11

Fatigue, Depression, sleep issues, bradycardia
Caution use in chronic lung disease (bronchospasms).
May mask Hypoglycemia
Never stop abruptly, sympathetic surge
Considerations: Apical rate above 60.
Orthostasis
Monitor glucose level especially if diabetic

Question 12

Types of Metoprolol

Answer 12

Succinate - Long acting. Daily dose
Used in heart failure and hypertension
Tartrate - Short acting,
Used post MI, Rate control in arrhythmias
Can be given IV