Cardiac Pharm Flashcards
What are the two main problems that can cause heart failure?
- Heart cant fill with enough blood
2. Heart cant pump with enough force
T/F: In diastolic heart failure, the heart cannot pump enough blood out of the ventricles due to weakened heart muscles.
False
Diastolic - stiff muscle cant relax, heart doesn’t fill
Systolic - weakened heart cant pump, not enough blood pumped out
T/F: Diastole = filling, systole = pumping
True
What class of heart failure involves symptoms at rest?
Class IV (severe)
How does cardiac muscle differ from skeletal muscle?
Ca++ influx activates ryanodine receptors on sarc reticulum leading to more Ca++ release
Things happen more slowly to allow heart to fill
__________ alter the force or energy of muscular contractions.
Inotropic drugs
Negative - weaken the force
Positive - increase the strength
_____________ may change the heart rate by affecting nerves controlling the heart, or by changing the rhythm produced by the SA node.
Chronotropic drugs
Positive - increase HR
Negative - decrease HR
Cardiac glycosides, B-adrenergic receptor agonists, and bipyridines are all _______________ used to treat CHF.
Positive inotropic drugs
How does digoxin work?
It is a cardiac glycoside - blocks Na/K ATPase
Internal Na increases -> slows down removal of Ca from the cell
T/F: Diuretics (mainly loop) are the mainstay in CHF treatment.
True
T/F: B1-adrenergic receptor agonists are the first line of defense against CHF.
False
T/F: Bipyridines are safe drugs to treat CHF.
False
They are available but not favored for treatments
T/F: All beta-blockers are good for treating CHF.
False
Only some, mechanisms not really known
Along with their role in helping fluid retention, ___________ can also have some other positive effects on CHF.
diuretics
____________ are shown to help in supplementation to other meds especially in the A.A. Population.
Vasodilators
What is the difference between a stable and unstable angina?
Stable - fixed plaque
Unstable - unstable plaque, could throw a clot
What is the result of taking nitrates/nitrites?
Prodrugs that spontaneously produce nitric oxide
What is the end result of nitrous oxide release?
Relaxation of smooth muscle -> vasodilation -> more blood to the heart
What is the most common adverse effects of nitroglycerin?
Vasodilation causes headaches
T/F: The use of viagra with nitroglycerin is contraindicationed.
True
Will cause extreme hypotension
What is the rationale for using beta blockers or calcium channel blockers to treat angina?
Lower cardiac output so the heart doesn’t need as much oxygen
What are the three types of drugs used to treat angina pectoris?
- Nitrates - vasodilation
- Calcium blockers - vasodilation and cardiac depressants
- Beta-blockers - cardiac depressants
__________ coordinate cardiac muscle contraction.
Electrical signals
Basically, the sum total of action potentials traveling through the heart creates the _________.
EKG
The electrical signal starts at the _________, and travels through the __________.
SA node; AV node
What is an atrioventricular block?
A type of arrhythmia where the conduction between atria and ventricles is blocked/slowed
What is the diagnostic tool for a primary AV block?
PR interval lengthened beyond 0.2 seconds
What constitutes a 3rd degree AV block?
Impulse from SA node does not reach ventricles
How would an atrial fibrillation look on an EKG?
Tiny irregular fibrillation between heart beats and beats are erratic
What are the four classes of anti-arrhythmic drugs?
Class I - block Na+ channel
Class II - Beta blockers
Class III - prolong action potential and prolong refractory period
Class IV - Ca+ channel antagonists
Why is dosage so important for anti-arrhythmia drugs?
Obviously can’t stop or make drastic changes to heart function - just tweak
T/F: Beta blockers can diminish both Na and Ca currents
True
What will be the effect of blocking the K+ channel?
Prolonged ventricular action potential
What phase of the action potential will class I drugs affect?
Phase 0
They will block Na+ channels thus altering the depolarization speed
What phase of the action potential will class II drugs act on?
Phase 4
Beta-blockers prolong AV conduction
Which phase of the action potential do class III compounds affect?
Phase 3
K+ channel blockers slow down repolarization
What phase of the action potential do class IV drugs act on?
Phase 2
Ca+ channel blockers slow conduction by increasing the refractory period
