Cardiac Pharm General Flashcards
1
Q
Criteria for normal airway clearance?
A
- Patent airway functional
- mucociliary escalator
- Effective cough
2
Q
Anything that alters airway patency, mucociliary function, strength of the inspiratory or expiratory muscles, or the effectiveness of the cough reflex can do what do airways?
A
Impair airway clearance and cause retention of secretions
3
Q
3 agents that affect HR
A
- Chronotrope
- Inotrope
- Dromotrope
4
Q
Define Chronotrope
A
Agent that affects HR (+/-)
5
Q
Define Inotrope
A
Agent that affect myocardial contraction(+/- contraction strength)
6
Q
Define Dromotrope
A
Agent that affects the rate of conduction(increase or negative conduction velocity)
7
Q
Agents that affect vessel tone/pressure?
A
Vasoactive
Vasopressors
Catecholamine
8
Q
what action do vasoactive agents have?
A
Affect blood vessel tone
(dilation/contraction)
9
Q
What action do vasopressors cause?
A
Agent that causes vasoconstriction (increase SVR)
- used to increase BP
- results in increase in coronary perfusion pressure
10
Q
How do catecholamine agents a act?
A
1 group of similar compounds having sympathomimetic action
11
Q
Define Positive chronotropes
List an example
A
-Have chronotropic affects (epi, norepinephrine, dopamine)
Atropine: a parasympatholytic that can be used for its chronotropic effects (inhibits allowing the heart to speed up)
12
Q
What are Negative Chronotropes?
A
Slow down the heart.so the IV classes of anti-arrhythmic
13
Q
Define Sodium Channel blockers
list a example
A
- suppresses ventricular arrhythmias and decreases myocardial conduction
- increases VF threshold
Lidocaine
14
Q
What results do B-blockers have?
A
Decrease in:
- HR
- BP
- Myocardial contraction and oxygen consumption
- mild vasoconstriction due to blocking of the B2 receptors on the peripheral
15
Q
Adenosine has a very short
A
half life; pushed via bolus
16
Q
Mechanism of action for nitrate vasodilators
A
Breakdown liberates nitric oxides which binds vascular receptors that produce venodilation and some arterial dilation
- dilates the coronary arteries and collaterals improving blood supply to the myocardium
17
Q
How does the body respond to nitrate vasodilators such as nitroglycerin?
A
Increases CO by reducing SVR and afterload Reduces preload by increasing captaincy of veins
18
Q
Mechanism of action for ACE inhibitors [angiotensin-converting enzyme inhibitors]
A
Prevents synthesis of angiotensin II [vasoconstrictor]
Result:
- ends w/systemic vasodilation and decrease in BP
19
Q
Indications for ACE inhibitors
A
- Hypertension
- Suspected MI
20
Q
ACE inhibitors usually end in what suffix?
A
PRIL
i.e captopril, enalapril, ramipril etc.
21
Q
drug suffix ending in “ase” are typically what?
A
clot busters
22
Q
Where are Dopaminergic receptors located?
A
smooth muscles in the cerebral coronary and renal vascular beds/.
23
Q
Action of Dopaminergic receptors?
(Depends on dose)
A
Low to mid: Agonist stimulations causes vasodilation and increases blood flow to smooth muscles.
High: vasoconstriction
24
Q
Function and use of: Epinephrine (Adrenalin)
A
Both an A & B agonist
Combo properties of vasopressors, inotropic, dromotropic, and chronotropic
Used for stimulation
25
What pressures doe epinephrine affect?
Increases coronary and CPP pressures
26
What is epinephrine used as treatment for?
Cardiac arrhythmias and hypotension
**Pulseless arrhythmias** such as:
- VT
- VF
- PEA asystole
27
What does dosage and admin typically look like for Epi?
Initial dose 1 mg (1 : 10,000 solution) IV, 10;
may repeat every 3 to 5 minutes.
28
What would hypotension epi be used for specifcally?
I.e using epi to induce hypotension
Anaphylaxis or severe allergic reactions
Admined SQ or IM
29
Drug class and Trade name for Norepinephrine (NE)
Cardiac
Levophed
30
Norepinephrine (NE) mechanism of action
Powerful A & B1 receptor agonist.
**B1 will increase myocardial contractility (inotrope)**
31
Indications for Levophed
Severe hypotension due to low SVR.
*caution*
- can cause extreme vasoconstriction to peripheries
32
Drug class and trade name for Dopamine?
Cardiac
Inotropin
33
What is Dopamine used for?
**Hypotension**
Precursor to Norepi
34
Mechanism of action for Dopamine
- Innervates which receptors?
Stimulates A, B1, and Dopaminergic receptors as therapy for Hypotension
35
What is a low dose of Dopmaine known as, and what is it used for?
1-5 ug/kg/min
Known as: **Renal dose**
causes the vasodilation of renal arteries,
**increasing U/O**
36
What is a moderate dose of Dopmaine known as, and what is it used for?
5-10 ug/kg.min
Known as:**Cardiac dose**
Enhances effects on the renal system causes an **increase in CO**
37
What is a high dose of Dopmaine known as, and what is it used for?
**Vasopressor dose**
Causes [A] affects, causing an increase in SVR and vasoconstriction.
**Used to treat hypotension.**
38
Drug class and trade name for Dobutamine
Cardiac
Dobutrex
39
Drug class and Generic name for Dobutrex?
Cardiac
Dobutamine
40
What is the function of Dobutamine?
[B1] effects
Net change on BP varies
41
Difference between activation of B1 and B2 receptors?
B1 = Excites
B2 = Relaxes
42
Indications for Dobutamine?
**Cardiogenic shock**
Used for patients with pump problems who have good systolic blood volume
**cannot pump enough blood to brain and organs**
43
Drug class and Trade name for Isoproterenol
Cardiac
Isuprel
44
Drug class and Generic name for Isuprel?
Cardiac
Isoproterenol
45
Mechanism of action of Isoproterenol?
**Beta Agonist**
(potent inotrope and chronotrope) but decreased BP due to B2 stimulation.
46
Isoproterenol is not usually a agent of choice now, when considered what were the indications for it?
Refractory bradycardia or B-blocker OD
47
Why is Dopamine a precursor to norepi?
Dopamine is a precursor to Levophed because it is the molecule that is used by the body to synthesize norepinephrine, which is the active ingredient in Levophed.
48
Vasopressin
A naturally occurring hormone
**non-adrenergic peripheral vasopressor PIPE**
49
Indications for Vasopressin use
Used on patients with **hypotension due to distributive shocks**, and treats diabetes insipidus.
50
Drug class and Generic name for Neo-Synephrine?
Cardiac
Phenylephrine
51
Drug class and Trade name for Phenylephrine?
Cardiac
Neo-synephrine
52
Mechanism of action for Phenylephrine
Alpha agonist w/minimal B stim.
Acts similar to epi, but w/longer duration.
53
Indications for phenylephrine?
Hypotension due to dist. Shocks
and pre med in a RSI if pt. BP is dropping.
54
What is one big difference between norepi and epi?
Norepi does not innervate beta 2 receptor sites.
EPI innervates all A and B receptors
55
High doses of dopamine innervate which receptor?
A1
56
Moderate dose of dopamine innervates which receptor?
B1
57
Low dose of dopamine innervates which receptor site?
Dopaminergic
58
What happens when dopaminergic sites are innervated?
(Depends on dose)
Multiple effects like **vasoconstriction, increased heart rate, and CNS excitation**
Dilation of renal vasculature
59
What does dilation of renal vasculature imply and what receptor is typically associated with this activation?
Increased renal blood flow and urine output
Dopaminergic
60
Inarinone and Milrinone indications
Used for severe CHF or cardiogenic shock
Refractory to medical therapy
61
Mechanism of action for Inarinone and Milrinone
Inodilators, causes inotropic effects in the heart and vasodilation in the periphery.
**decreases afterload**
62
How do Inarione and Milrinone improve CO?
**Decreasing afterload/decreasing resistance to blood flow**
Bonus Info:
Both are used to treat heart failure; a condition where the heart is unable to pump enough blood to meet the body's needs.
- These medications work by **increasing the strength of the heart's contractions and improving blood flow throughout the body**.
63
What are the 4 classes of Antiarrhythmics?
1. Sodium Channel Blockers
2. Beta Blockers
3. Potassium Channel Blockers
4. Calcium Channel Blockers
64
What is a class I antiarrhythmic drug?
Give 1 example
Lidocaine
- Sodium Channel Blocker
65
What is a class II antiarrhythmic drug?
Give 1 example
Metoprolol
- Beta Blockers
66
What is a class III antiarrhythmic drug?
Give 1 example
Amiodarone
Potassium Channel Blocker
67
What is a class IV antiarrhythmic drug?
Give 1 example
Verapamil and Diltiazem
- Calcium Channel Blocker
68
What are class I antiarrhythmic drugs used for?
**Ventricular Arrhythmias**
VF/VT or Tachycardias
69
What do Sodium Channel Blockers do?
**Increase VF threshold**
Explanation:
If sodium channels are blocked, it takes more stimulus to result in depolarization
70
What do beta blockers do?
Act as **anti-hypertensives**
Resulting in:
- Decrease HR
- Decrease BP
- Decrease myocardial contractility
- Decrease myocardial oxygen consumption
(mild vasoconstriction due to blocking of the β2 receptors on the peripheral vasculature)
71
Indications for Beta Blockers?
Acute coronary syndromes
Hypertension
Acute Tachyarrhythmias (SVTs)
72
What are potassium channel blockers used for?
**To control rate and covert rhythm in certain tachycardias**
Such as Vf/VT in cardiac arrest
73
Cautions of potassium channel blockers?
Overdose may cause:
- May produce vasodilation and decrease BP
- May have negative inotropic effects
- Can have toxic effects ---> ”Amiodarone lung”
74
Cautions for Beta Blockers
- May result in **hypotension and/or bradycardias**
- Avoid in bronchospastic diseases!
If β2 receptors are also blocked (a sympatholytic action) and this **can result in bronchospasm!**
75
What is the first choice of drug for Afib/flutter over digoxin?
Diltiazem and Verapamil
(Calcium channel blockers)
76
What are Calcium Channel Blockers used for?
**Vasodilation**
And ventricular arrhythmias
- **slows down sa and av node**
**Considered a anti-hypertensive**
77
Mechanism of action for Calcium Channel Blockers?
Decrease SA node automaticity; slows av node conduction
Increase AV node refractory period = slower HR
78
Indications for Calcium Channel Blockers
**Narrow complex tachycardias (SVTs)**
These are second line agents after adenosine (along with β-blockers)
79
Cautions for Calcium Channel Blockers
1. Do not give to tachycardias with a wide-complex or WPW
2. *Expect BP to drop due to peripheral vasodilation*
3. Do not give to patients who are receiving β-blockers (can cause profound hypotension
80
What drug is used to manipulate rate and rhythm?
Adenosine
81
Indications for Adenosine?
**To treat SVT**
First drug of choice for narrow complex tachycardias (SVTs), including WPW
BUT, will not convert AFib/AFlutter or VT
Vagal maneuvers should be tried first
82
What is Adenosine used for?
Chemical cardioversion
83
Cautions for Adenosine?
1.Warn patient of the possible symptoms they may feel during
administration (heat, flushing, chest pain/tightness)
**2. Expect a few seconds of asystole/bradycardia
3. Contraindicated in asthma due to risk of bronchospasm**
84
Admin method for Adenosine?
Adenosine and Saline flush both into port, clamp IV tubing, fast bolus adenosine followed by the flush, unclamp tubing.
85
What is the mechanism of action for Adenosine
**Depresses both SA and AV nodes**
In other words;
Slows down rhythm to identify if there is p waves in a wide complex tachy (helps w/classification)
86
Importance of Adenosine aka treatment?
Important in symptomatic tachycardias
**- Used to treat SVT's and wide QRS.**
87
General Indications and use of Digoxin?
Indications:
**-Helps to lower Ventricular response in Afib/ Aflutter**
- prevent heart failure
General use:
Increase contraction force (inotrope)
88
Mechanic of action for Digoxin?
An anti-arrhythmic and inotropic drug
1. (+) inotrope
2. (-) chronotrope [slows conduction via av node]
89
Cautions for Digoxin?
A very narrow therapeutic range!!! (Especially if potassium depletion is present)
->**digitoxicity can cause serious arrhythmias and precipitate cardiac arrest**
90
List 4 types of anti-hypertensives
- Nitrates
- ACE Inhibitors
- B-blockers
- Calcium Channel Blockers
91
Mechanism of action for ACE inhibitors
Antihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II **(powerful vasoconstrictor).**
Result:
- Decreased BP
- Decreased Aldosterone Secretions
- Sodium and fluid loss
92
Precautions for ACE inhibitors?
**Hypotension**
- Check BP before giving.
93
Nitrate Vasodilators; mechanism of action
Liberates nitric oxides
What does that mean?
**- dilates coronary arteries and increases blood to myocardium**
94
Which conditions would you use Nitrate Vasodilators!
Used for angina, MI, CHF, and hypertension
95
What affects do Nitrate Vasodilators produce systemically?
Bind to vascular receptors that produce **primarily venodilation and some arterial dilation**
Result:
- Reduces preload by increasing capacitance of the veins
- Increase CO by reducing SVR and afterload
- Dilates the large coronary arteries and collaterals improving blood supply to the myocardium
96
What class of drug is nitroglycerin and sodium nitroprusside [Nipride]
Nitrate Vasodilators
97
Precautions of Nitrate Vasodilators
Can result in Hypotension
98
What does Aldosterone do systemically to our bodies pressure?
Increases BP
By:
- Increasing sodium and water reabsorption
99
Understanding Relationships:
Explain how beta blockers decrease BP with the following equation?
- BP = SVR x CO
CO = [HR x SV]
When HR drops, so does the net equation. The whole system is affected.
100
3 types of antithrombotic agents
- Anticoagulants
- Antiplatelet
- Thrombolytics
101
mechanism of action: Anticoagulants
Prevent fibrin clotting.
102
What is the use of anticoagulants?
Used for prevention of thromboembolisms, PE, AFIB, and DIC
103
Indications for anticoagulants?
- For prevention and treatment of venous or arterial thromboembolism and PE
- Atrial fibrillation
- DIC (Disseminated Intravascular Coagulation)
104
Precautions for Anticoagulants?
- Bleeding, bruising, hematoma
- Thrombocytopenia
105
What class of drug is heparin?
Anticoagulant
106
What class of drug is Coumadin?
- what is the generic name?
Anticoagulant
Generic name = Warfarin
107
Indications for Heparin?
- For prevention and treatment of venous or arterial thromboembolism and PE
- Atrial fibrillation
- DIC (Disseminated Intravascular Coagulation)
108
Two categories of treatment for heparin?
- What is the main trait difference?
Unfractionated/High-molecular weight
- Cleared faster = needs frequent dosing
Fractionated/Low-molecular weight (LMWH)
- Used long term anti-coagulation
109
How would you monitor Heparin treatment according to:
- Unfractionated/High-molecular weight (APTT)
- Fractionated/Low-molecular weight (LMWH)
APTT
- Blood test to monitor
LMWG
- not a clue lol
110
Antidote for Heparin toxicity
Protamine sulfate
111
What does heparin bind to?
Anti-thrombin III
- inhibits thrombin and factor Xa
112
Mechanism of action for Coumadin
Interferes with liver synthesis of Vitamin K dependent clotting factors bc it is structurally similar
113
Antidote for Coumadin toxicity?
Vitamin K
114
How would you monitor Coumadin therapy?
By observing INR via blood test
115
Precautions for Coumadin?
Hemorrhage
116
Indications for Coumadin?
- Prevention and treatment of venous or arterial thromboembolism and PE
- Atrial fibrillation
- Used post MI to prevent further thrombus development
- **Often used post-heparin therapy**
117
Antiplatelet function and characteristics
Inhibit action of platelet clotting process
i.e decrease stickiness of platelets.
118
Indication for antiplatelets?
- Prophylaxis of thrombus formation
- Often seen in PTCA (pre & post) to prevent reocclusion
MI
119
What is Percutaneous Transluminal Coronary Angioplasty
[PTCA]?
A minimally invasive procedure that opens blocked coronary arteries to improve blood flow to the heart muscle.
120
Precautions of Antiplatelet agents?
- Increased risk of bleeding
- Relatively contraindicated when thrombolytics are used
121
What drug class does ASA fall under?
- what is the trade name of ASA?
**Antiplatelet** and NSAID
ASA = Aspirin
122
Mechanism of action for ASA
Prevents thromboxane formation (an inflammatory mediator and platelet aggregator)
- we see anti-inflammatory actions and decreased platelet aggregation
123
Indications for ASA
**Prophylaxis of thrombus formation**
AMI
124
Drug class and generic name for: ReoPro
Antiplatelet
Abciximab
125
Drug class and generic name for: Plavix
Antiplatelet
Clopidogrel
126
Mechanism of action: Antithrombic agents
Degrades fibrin by plasmin conversion
**- degrades fibrin clots**
Ex) anything that ends with "-ase" (alteplase, streptkinoase)
127
Use of Anti-thrombolytic agents
used in:
- MI,
- Ischemic stroke,
- pulmonary emboli
128
Indications for Anti-thrombolytic agents?
Acute myocardial infarction
- More specifically those that have an acute ST elevation
Patient should receive thrombolytic within 12 h of the onset of symptoms
Ischemic stroke
Pulmonary embolus (if life threatening)
129
What are most MI's caused by?
Thrombus [blood clot]
130
Why are Anti-thrombolytic agents important?
**If thrombus is dissolved we can reperfuse the area** and hopefully **save some of the heart tissue**
131
Precautions to Anti-thrombolytic agents?
**Increased risk of bleeding**
- active internal bleeding
- Aneurysm/cerebrovascular problems, AV malformation
- **avoid after recent surgery or trauma**
Use with caution in those aged > 75 due to higher risk of fatal hemorrhagic stroke
132
Drug class and tradename for: Alteplase
tPa
Anti-Thrombolytic
133
Drug class and tradename for: Reteplase
Retavase
Anti-thrombolytic
134
Drug class and tradename for: Streptokinase
Streptase
Antithrombolytic
135
Drug class and tradename for: Tenecteplase
TNK
Anti-thrombotic
136
Antithrombotic agents vs. other clotting agents
1. Target the platelet aggregation process, which is the initial step in the formation of a blood clot.
- Prevent platelets from sticking together and forming a clot.
2. Faster onset of action
3. Fewer side effects
4. Efficacy in Arterial Thrombosis:
- **more effective in preventing and treating arterial thrombosis, which is the formation of blood clots in arteries.**
137
Vagual maneuver
138
Next step after atropine admin?
Transcutaneous pacing
139
What should be the first thing that should be done when treating svt?
Vagal maneuvers
140
What is a second line treatment after pushing adenosine
Calcium channel blockers (IV)
Goal is to treat SVTs
141
Which cardiac drug acts on the sinus node?
Beta Blockers
142
Mechanism of action:
How do beta blockers decrease HR?
- What are the latent affects?
They block beta receptors, which block conduction at the sinus node
- HR is decreases which leads to BP decreasing.
143
Aside from Verapamil and Diltiazem,
Calcium Channel Blockers typically end in with which suffix?
"pine"
i.e Nifedipine or felodipine
144
Which calcium channel blockers act on the heart muscles?
Verapamil/Diltiazem.
145
Which calcium channel blockers act on blood vessels?
Nifedipine or felodipine
146
What do beta blockers, Calcium channel blockers, and nitrates relive?
Angina, Hypertension, Arrhythmias, and cardiac failure.
147
What do ACE inhibitors and diuretics' relieve?
Hypertension and cardiac failure
148
Why are the kidneys important in relation to BP?
They release renin when BP is low, causing vasoconstriction.
- Renin stims angiotension I than II
149
Mechanism of Action:
How do Calcium Channel blockers [CCB] act on blood vessels?
When there is change in Ca in the cells, they cause muscles to contract.
- So, ** when [CCB] blocks Ca from entering, it causes vasodilation**
150
What site do Nitrates act on/affect action?
Direct affect on veins.
151
What happens when veins dilate?
- systole?
- diastole?
Less blood returns to the heart
**Systole drops**:
- heart doesn't need to pump as hard/fast
**Diastole increases**
- resting phase is longer, meaning more blood/O2 enters the myocardium
152
Which antiplatelet drugs are both a contraindicated by active bleeding disorders?
ASA and Clopidogrel
153
Indications for a sodium channel blocker?
Atrial fib/flutter
Life threatening ventricular arrhythmias
154
On a ECG, what do beta blockers prolong?
- P-P Interval
- P-R Interval
155
Which drug class would you administer for the following ECG
Beta Blockers
- i.e Metoprolol or Propanolol
156
Which drug class would you administer for the following ECG?
Mainly a potassium channel blocker
i.e Amiodarone (Cordarone)
157
Which drug class would you administer for the following ECG
Mainly a potassium channel blocker
i.e Amiodarone (Cordarone)
158
Therapeutic affects of Amiodarone
(potassium channel blocker)
- Prolongs action potential
- Prolongs refractory period
- Reduce HR
159
Indications and Contraindications for Amiodarone (Potassium Channel Blocker)
Indication:
- Life threatening ventricular arrhythmias
Contraindications:
- Bradycardias or SA dysfunction.
- 2nd or 3rd degree heart block.
- Pulmonary conditions which predispose to fibrosis
160
Calcium normally mediates what action?
Action potential prolongation
161
Therapeutic affects of Atropine?
Increase HR in bradydyshrythmias
162
Which arrhythmia is Digoxin ideal for use?
Heart failure coupled w/A-fib or A-flutter
163
What are the therapeutic affects of magnesium sulfate?
Can lengthen QT interval.
164
Indications for Magnesium sulfate specifically ?
Torsades de Pointes
164
Indications for Magnesium sulfate specifically ?
Torsades de Pointes
165
Amiodarone is used for
antiarrhythmic for atrial and ventricular
arrhythmias. I
