Cardiac Glycosides, Antianginals, and Antidysrhythmics Flashcards
Occurs when the heart muscle does not pump blood as well as it should
Congestive heart failure
Drugs that inhibit the sodium-potassium pump, which results in an increase in intracellular sodium
Cardiac glycosides
Action that increased myocardial contraction stroke volume
Inotropic
An action that decreases conduction of heart cells
Dromotropic
Cardiac dysrhythmia with rapid uncoordinated contractions of the atrial myocardium
Atrial fibrillation
Medicines that relieve the symptoms of angina pectoris
Antianginal drugs
Peripheral vascular resistance
Afterload
Agents used for the treatment of stable and variant angina pectoris, certain dysrhythmias, and hypertension
Calcium channel blockers
The first agents used to relieve angina
Nitrates
Amount of blood in the ventricles of the heart at the end of diastole
Preload
Lack of blood supply to the heart muscle
Myocardial Ischemia
Drugs that restore the cardiac rhythm to normal
Antidysrrhythmic drugs
Any deviation from the normal rate or pattern of the heartbeat
Cardiac dysrhythmia (arrhythmia)
Return of cell membrane potential to resting after depolarization
Repolarization
When sodium and calcium enter the cardiac cell and myocardial contraction occurs
Depolarization
Drugs that decrease the effects of the sympathetic nervous system by blocking the action of the catecholamines, epinephrine, and norepinephrine - caused a decrease in heart rate and blood pressure
Beta blockers
Nonpharmacological treatment for heart failure includes:
Limiting salt to <2g/day (1 tsp). Limiting alcohol to 1 drink/day or less. Restricting fluid intake. Quitting smoking. Decreasing saturated fat intake. Mild exercise.
Which lab is typically used to diagnose HF?
Brain natriuretic peptide (BNP)
How do cardiac glycosides affect heart function?
- Positive inotropic (increase myocardial contractility)
- Negative chronotropic (decrease heart rate)
- Negative dromotropic (decrease conduction)
- Increase stroke volume (increase cardiac output)
What is the therapeutic level of Digoxin?
0.8-2.0 ng/mL
What are the symptoms of digoxin toxicity?
Nausea, vomiting, diarrhea, blurred vision, green or yellow halo, headache, confusion, delirium, bradycardia, PVCs, cardiac dysrhythmias
What medication can we give for Digoxin toxicity?
Digoxin immune fab
True or False: Hypokalemia will increase the likelihood of digoxin toxicity.
True
Drugs that interact with digoxin include:
Diuretics, cortisone, and antacids
Milrinone lactate (Primacor) is an example of a:
Phosphodiesterase inhibitor
Phosphodiesterase inhibitors work by:
- Causing a positive inotropic effect. 2. Increasing stroke volume. 3. Promoting vasodilation
What effects do vasodilators and arteriolar dilators have on preload and afterload?
Vasodilators decrease preload. Arteriolar dilators decrease afterload.
Besides cardiac glycosides and phosphodiesterase inhibitors, what other drugs do we use to treat HF?
ACE inhibitors, ARBs, Diuretics, and Beta Blockers
What are the different types of angina?
Classic (stable), Unstable (preinfarction), and Variant (Prinzmetal, vasospastic)
Describe class angina
Occurs with predictable stress or exertion
Describe unstable angina
Occurs frequently with progressive severity unrelated to activity; unpredictable
Describe variant angina
Occurs during rest; caused by vasospasm
What are nonpharmacological ways to control angina?
Avoiding heavy meals, smoking, extreme weather changes, strenuous exercise, emotional upset, and alcohol.
How do nitrates work?
They promote vasodilation and decrease preload and afterload.
What are the most common side effects of nitrates?
Headache and hypotension
Why do we usually give nitro sublingual?
Due to its extensive 1st pass metabolism
How do beta blockers help heart failure?
Decrease force of myocardial contraction and heart rate, which decreases the workload of the heart.
Are atenolol and metoprolol selective or nonselective beta blockers?
Selective
Verapamil, nifedipine, and diltiazem are examples of:
Calcium channel blockers
How do calcium channel blockers affect the heart?
They relax coronary arteries, cause a negative inotropic effect, thus reducing cardiac workload and oxygen demand.
Which calcium channel blocker is most likely to cause hypotension?
Nifedipine
What patient education should be provided regarding administration of nitroglycerin?
Take sublingual nitro if chest pain occurs per prescribers instructions. Take the first dose while sitting or lying down. If chest pain is not relieved, call 911.
The 4 classes of antidysrhythmic drugs are:
- Sodium channel blockers
- Beta blockers
- Drugs that prolong repolarization
- Calcium channel blockers
Quinidine, Flecainamide, lidocaine, and procainamide are examples of:
Sodium channel blockers
Amiodarone is an example of:
A drug that prolongs repolarization
Which 2 types of drugs used to treat dysrhythmias have similar effects on the heart?
Beta blockers and calcium channel blockers
