Cardiac Glycosides, Antianginals, and Antidysrhythmics

Question 1

normal value of ANP

Answer 1

20-77

Question 2

more sensitive than ANP for diagnosing HF

Answer 2

BNP

Question 3

normal range for BNP

Answer 3

less than 100 pg/mL

Question 4

nonpharm measures to treat HF

Answer 4

2 g/day of salt
decrease alcohol intake
limit fluid intake
avoid smoking
lose weight
decrease sat fat
mild exercise (walking, biking)

Question 5

agents used in HF

Answer 5

glycosides, phosphodiesterase inhibitors, vasodilators, ACE inhibitors, ARBs, diuretics, spironolactone, nesiritide, some beta blockers

Question 6

cardiac glycoside

Answer 6

digoxin

Question 6

3 effects of digitalis on the heart

Answer 6

positive inotropic (increase contractility)

negative chronotropic (decrease HR)

negative dromotropic (decreases conduction of heart cells)

Question 7

cardiac glycosides are also used to correct what

Answer 7

a-fib and a-flutter

accomplished by negatove chronotropic and negative dromotropic effects

Question 8

therapeutic serum lvl for dig for dysrhythmias

Answer 8

0.8-2.0 ng/mL

Question 9

therapeutic serum lvl for dig for HF

Answer 9

0.5-1.0 ng/mL

Question 10

symptoms of dig toxicity

Answer 10

anorexia, diarrhea, N/V, bradycardia, dysrhythmias, headaches, malaise, blurred vision, visual illusions (white, green, or yellow halos around objects), confusion, and delirium

older adults more at risk

Question 11

antidote for dig

Answer 11

digoxin-immune Fab (digibind)

Question 12

what increases the effect of digoxin at its myocardial cell site of action, resulting in dig toxicity

Answer 12

hypokalemia (low K+)

Question 13

what can interact with dig

Answer 13

diuretic, cortisone (hypokalemia), and antacids (decrease absorption)

Question 14

this drug group inhibits the enzyme PDE, which promotes a positive inotropic response and vasodilation

Answer 14

phosphodiesterase inhibitors

Question 15

a phosphodiesterase inhibitor (admin IV no longer than 48-72 hrs)

need to be on EKG bc dysrhythmias may result

Answer 15

milrinone lactate (high alert)

Question 16

decrease venous blood return to the heart and result in a decrease in cardiac filling, ventricular stretching (preload), and oxygen demand on the heart

Answer 16

vasodilators

Question 17

dilate venules and arteriole, which improves renal blood flow and decreases blood fluid volume

Answer 17

ACE inhibitors

-pril

Question 18

for pts who cannot tolerate ACE inhibitors

Answer 18

ARBs

-sartan

Question 19

first-line drug treatment in reducing fluid volume

Answer 19

diuretics

Question 20

potassium sparing diuretic

Answer 20

spironolactone

Question 21

an ANP that inhibits ADH by increasing sodium loss; effect is achieved by promoting vasodilation, natriuresis, and diuresis

Answer 21

nesiritide

Question 22

a combo of hydralazine (for BP) and isosorbide dinitrate (a dilator) has been approved to treat HF especially in who

Answer 22

african americans

Question 23

new med that regulates vascular tone and contraindicated in pregnancy

Answer 23

vericiguat

Question 24

a condition of acute cardiac pain caused by inadequate blood flow to the myocardium due to either plaque occlusions within or spasms of the coronary arteries

Answer 24

angina pectoris

Question 25

types of angina

Answer 25

classic (stable)- predictable with stress or exertion unstable (preinfarction)- frequently with progressive severity, unpredictable variant (prinzmetal)- during rest caused by vessel spasm

Question 26

types of antianginal drugs

Answer 26

nitrates, beta blockers, and CCBs

Question 27

first agents used to relieve angina generalized vasodilation and can cause hypotension

Answer 27

nitrates decreases preload and afterload

Question 28

used for variant angina

Answer 28

nitrates and CCBs

Question 29

side effects of nitrates

Answer 29

headaches, hypotension, dizziness, flushing, weakness, faintness taper dose to prevent myocardial ischemia reflex tachycardia if given too rapidly

Question 30

decrease the effects of the sympathetic nervous system by blocking the action of the catecholamines, epi and norepi, thereby decreasing the heart rate and blood pressure

Answer 30

beta blockers

Question 31

selective beta 1 blocker (cardioselective)

Answer 31

atenolol and metoprolol (A BEAM)

Question 32

nonselective beta blocker side effects

Answer 32

bronchospasm, agitation, dizziness, drowsiness, confusion, cool extremities, and ED (with propranolol)

Question 33

relax coronary artery spasm and relax peripheral arterioles, decreasing cardiac oxygen demand. negative inotropic and decrease afterload, and peripheral resistence, and they reduce the workload of the heart which decreases the need for oxygen

Answer 33

CCBs check LFTs calcium activates myocardial contraction, increasing the workload of the heart and the need for more oxygen

Question 34

side effects of CCBs

Answer 34

headache, hypotension, dizziness, and flushing of skin reflex tachycardia can occur as a result of hypotension check LFTs

Question 35

what IV med can decrease the effects of heparin

Answer 35

nitro

Question 36

defined as any deviation from the normal rate or pattern of the heartbeat rates that are too slow, too fast, or irregular

Answer 36

cardiac dysrhythmia

Question 37

4 classes of antidysrhythmics

Answer 37

I sodium channel blockers II beta blockers III drugs that prolong repolarization IV CCBs

Question 38

slow conduction and prolong repolarization (quinidine, procainamide, disopyramide)

Answer 38

Class IA

Question 39

slow conduction and shorten repolarization (lidocaine, mexiletine HCl)

Answer 39

Class IB

Question 40

prolong conduction with little to no effect on repolarization (flecainide)

Answer 40

Class IC

Question 41

reduce calcium entry decrease conduction velocity, automaticity, and recovery time (refractory period)

Answer 41

Class II beta blockers

Question 42

prolong repolarization during ventricular dysrhythmias prolong action potential duration

Answer 42

Class III (emergency treatment of ventricular dysrhythmias) (amiodarone)

Question 43

block calcium influx slow conduction velocity decrease myocardial contractility (negative inotropic) increase refraction in AV node

Answer 43

Class IV CCBs

Question 44

all antidysrhythmic drugs are potentially _____

Answer 44

prodysrhythmic