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PA 2 (RESP 262) > Cardiac Pharm General > Flashcards

Cardiac Pharm General Flashcards

1
Q

Criteria for normal airway clearance?

A
  • Patent airway functional
  • mucociliary escalator
  • Effective cough
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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

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3
Q

3 agents that affect HR

A
  • Chronotrope
  • Inotrope
  • Dromotrope
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4
Q

Define Chronotrope

A

Agent that affects HR (+/-)

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5
Q

Define Inotrope

A

Agent that affect myocardial contraction(+/- contraction strength)

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6
Q

Define Dromotrope

A

Agent that affects the rate of conduction(increase or negative conduction velocity)

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7
Q

Agents that affect vessel tone/pressure?

A

Vasoactive
Vasopressors
Catecholamine

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8
Q

what action do vasoactive agents have?

A

Affect blood vessel tone
(dilation/contraction)

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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

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10
Q

How do catecholamine agents a act?

A

1 group of similar compounds having sympathomimetic action

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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)

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12
Q

What are Negative Chronotropes?

A

Slow down the heart.so the IV classes of anti-arrhythmic

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13
Q

Define Sodium Channel blockers

list a example

A
  • suppresses ventricular arrhythmias and decreases myocardial conduction
  • increases VF threshold

Lidocaine

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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

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15
Q

Adenosine has a very short

A

half life; pushed via bolus

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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
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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

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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

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19
Q

Indications for ACE inhibitors

A
  • Hypertension
  • Suspected MI
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20
Q

ACE inhibitors usually end in what suffix?

A

PRIL
i.e captopril, enalapril, ramipril etc.

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21
Q

drug suffix ending in “ase” are typically what?

A

clot busters

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22
Q

Where are Dopaminergic receptors located?

A

smooth muscles in the cerebral coronary and renal vascular beds/.

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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

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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

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25
Q

What pressures doe epinephrine affect?

A

Increases coronary and CPP pressures

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26
Q

What is epinephrine used as treatment for?

A

Cardiac arrhythmias and hypotension

Pulseless arrhythmias such as:
- VT
- VF
- PEA asystole

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27
Q

What does dosage and admin typically look like for Epi?

A

Initial dose 1 mg (1 : 10,000 solution) IV, 10;

may repeat every 3 to 5 minutes.

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28
Q

What would hypotension epi be used for specifcally?

I.e using epi to induce hypotension

A

Anaphylaxis or severe allergic reactions

Admined SQ or IM

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29
Q

Drug class and Trade name for Norepinephrine (NE)

A

Cardiac

Levophed

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30
Q

Norepinephrine (NE) mechanism of action

A

Powerful A & B1 receptor agonist.

B1 will increase myocardial contractility (inotrope)

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31
Q

Indications for Levophed

A

Severe hypotension due to low SVR.

caution
- can cause extreme vasoconstriction to peripheries

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32
Q

Drug class and trade name for Dopamine?

A

Cardiac

Inotropin

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33
Q

What is Dopamine used for?

A

Hypotension

Precursor to Norepi

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34
Q

Mechanism of action for Dopamine

  • Innervates which receptors?
A

Stimulates A, B1, and Dopaminergic receptors as therapy for Hypotension

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35
Q

What is a low dose of Dopmaine known as, and what is it used for?

A

1-5 ug/kg/min

Known as: Renal dose
causes the vasodilation of renal arteries,

increasing U/O

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36
Q

What is a moderate dose of Dopmaine known as, and what is it used for?

A

5-10 ug/kg.min

Known as:Cardiac dose

Enhances effects on the renal system causes an increase in CO

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37
Q

What is a high dose of Dopmaine known as, and what is it used for?

A

Vasopressor dose

Causes [A] affects, causing an increase in SVR and vasoconstriction.

Used to treat hypotension.

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38
Q

Drug class and trade name for Dobutamine

A

Cardiac

Dobutrex

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39
Q

Drug class and Generic name for Dobutrex?

A

Cardiac

Dobutamine

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40
Q

What is the function of Dobutamine?

A

[B1] effects

Net change on BP varies

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41
Q

Difference between activation of B1 and B2 receptors?

A

B1 = Excites

B2 = Relaxes

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42
Q

Indications for Dobutamine?

A

Cardiogenic shock

Used for patients with pump problems who have good systolic blood volume

cannot pump enough blood to brain and organs

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43
Q

Drug class and Trade name for Isoproterenol

A

Cardiac

Isuprel

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44
Q

Drug class and Generic name for Isuprel?

A

Cardiac

Isoproterenol

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45
Q

Mechanism of action of Isoproterenol?

A

Beta Agonist
(potent inotrope and chronotrope) but decreased BP due to B2 stimulation.

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46
Q

Isoproterenol is not usually a agent of choice now, when considered what were the indications for it?

A

Refractory bradycardia or B-blocker OD

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47
Q

Why is Dopamine a precursor to norepi?

A

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.

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48
Q

Vasopressin

A

A naturally occurring hormone

non-adrenergic peripheral vasopressor PIPE

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49
Q

Indications for Vasopressin use

A

Used on patients with hypotension due to distributive shocks, and treats diabetes insipidus.

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50
Q

Drug class and Generic name for Neo-Synephrine?

A

Cardiac

Phenylephrine

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51
Q

Drug class and Trade name for Phenylephrine?

A

Cardiac

Neo-synephrine

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52
Q

Mechanism of action for Phenylephrine

A

Alpha agonist w/minimal B stim.

Acts similar to epi, but w/longer duration.

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53
Q

Indications for phenylephrine?

A

Hypotension due to dist. Shocks

and pre med in a RSI if pt. BP is dropping.

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54
Q

What is one big difference between norepi and epi?

A

Norepi does not innervate beta 2 receptor sites.

EPI innervates all A and B receptors

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55
Q

High doses of dopamine innervate which receptor?

A

A1

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56
Q

Moderate dose of dopamine innervates which receptor?

A

B1

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57
Q

Low dose of dopamine innervates which receptor site?

A

Dopaminergic

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58
Q

What happens when dopaminergic sites are innervated?

(Depends on dose)

A

Multiple effects like vasoconstriction, increased heart rate, and CNS excitation

Dilation of renal vasculature

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59
Q

What does dilation of renal vasculature imply and what receptor is typically associated with this activation?

A

Increased renal blood flow and urine output

Dopaminergic

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60
Q

Inarinone and Milrinone indications

A

Used for severe CHF or cardiogenic shock
Refractory to medical therapy

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61
Q

Mechanism of action for Inarinone and Milrinone

A

Inodilators, causes inotropic effects in the heart and vasodilation in the periphery.

decreases afterload

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62
Q

How do Inarione and Milrinone improve CO?

A

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.
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63
Q

What are the 4 classes of Antiarrhythmics?

A
  1. Sodium Channel Blockers
  2. Beta Blockers
  3. Potassium Channel Blockers
  4. Calcium Channel Blockers
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64
Q

What is a class I antiarrhythmic drug?

Give 1 example

A

Lidocaine

  • Sodium Channel Blocker
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65
Q

What is a class II antiarrhythmic drug?

Give 1 example

A

Metoprolol

  • Beta Blockers
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66
Q

What is a class III antiarrhythmic drug?

Give 1 example

A

Amiodarone

Potassium Channel Blocker

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67
Q

What is a class IV antiarrhythmic drug?

Give 1 example

A

Verapamil and Diltiazem

  • Calcium Channel Blocker
68
Q

What are class I antiarrhythmic drugs used for?

A

Ventricular Arrhythmias

VF/VT or Tachycardias

69
Q

What do Sodium Channel Blockers do?

A

Increase VF threshold

Explanation:
If sodium channels are blocked, it takes more stimulus to result in depolarization

70
Q

What do beta blockers do?

A

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
Q

Indications for Beta Blockers?

A

Acute coronary syndromes
Hypertension
Acute Tachyarrhythmias (SVTs)

72
Q

What are potassium channel blockers used for?

A

To control rate and covert rhythm in certain tachycardias

Such as Vf/VT in cardiac arrest

73
Q

Cautions of potassium channel blockers?

A

Overdose may cause:
- May produce vasodilation and decrease BP
- May have negative inotropic effects
- Can have toxic effects —> ”Amiodarone lung”

74
Q

Cautions for Beta Blockers

A
  • 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
Q

What is the first choice of drug for Afib/flutter over digoxin?

A

Diltiazem and Verapamil

(Calcium channel blockers)

76
Q

What are Calcium Channel Blockers used for?

A

Vasodilation

And ventricular arrhythmias
- slows down sa and av node

Considered a anti-hypertensive

77
Q

Mechanism of action for Calcium Channel Blockers?

A

Decrease SA node automaticity; slows av node conduction

Increase AV node refractory period = slower HR

78
Q

Indications for Calcium Channel Blockers

A

Narrow complex tachycardias (SVTs)

These are second line agents after adenosine (along with β-blockers)

79
Q

Cautions for Calcium Channel Blockers

A
  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
Q

What drug is used to manipulate rate and rhythm?

A

Adenosine

81
Q

Indications for Adenosine?

A

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
Q

What is Adenosine used for?

A

Chemical cardioversion

83
Q

Cautions for Adenosine?

A

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

  1. Contraindicated in asthma due to risk of bronchospasm**
84
Q

Admin method for Adenosine?

A

Adenosine and Saline flush both into port, clamp IV tubing, fast bolus adenosine followed by the flush, unclamp tubing.

85
Q

What is the mechanism of action for Adenosine

A

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
Q

Importance of Adenosine aka treatment?

A

Important in symptomatic tachycardias
- Used to treat SVT’s and wide QRS.

87
Q

General Indications and use of Digoxin?

A

Indications:
-Helps to lower Ventricular response in Afib/ Aflutter
- prevent heart failure

General use:
Increase contraction force (inotrope)

88
Q

Mechanic of action for Digoxin?

A

An anti-arrhythmic and inotropic drug

  1. (+) inotrope
  2. (-) chronotrope [slows conduction via av node]
89
Q

Cautions for Digoxin?

A

A very narrow therapeutic range!!! (Especially if potassium depletion is present)

->digitoxicity can cause serious arrhythmias and precipitate cardiac arrest

90
Q

List 4 types of anti-hypertensives

A
  • Nitrates
  • ACE Inhibitors
  • B-blockers
  • Calcium Channel Blockers
91
Q

Mechanism of action for ACE inhibitors

A

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
Q

Precautions for ACE inhibitors?

A

Hypotension

  • Check BP before giving.
93
Q

Nitrate Vasodilators; mechanism of action

A

Liberates nitric oxides

What does that mean?
- dilates coronary arteries and increases blood to myocardium

94
Q

Which conditions would you use Nitrate Vasodilators!

A

Used for angina, MI, CHF, and hypertension

95
Q

What affects do Nitrate Vasodilators produce systemically?

A

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
Q

What class of drug is nitroglycerin and sodium nitroprusside [Nipride]

A

Nitrate Vasodilators

97
Q

Precautions of Nitrate Vasodilators

A

Can result in Hypotension

98
Q

What does Aldosterone do systemically to our bodies pressure?

A

Increases BP

By:
- Increasing sodium and water reabsorption

99
Q

Understanding Relationships:

Explain how beta blockers decrease BP with the following equation?

  • BP = SVR x CO
A

CO = [HR x SV]

When HR drops, so does the net equation. The whole system is affected.

100
Q

3 types of antithrombotic agents

A
  • Anticoagulants
  • Antiplatelet
  • Thrombolytics
101
Q

mechanism of action: Anticoagulants

A

Prevent fibrin clotting.

102
Q

What is the use of anticoagulants?

A

Used for prevention of thromboembolisms, PE, AFIB, and DIC

103
Q

Indications for anticoagulants?

A
  • For prevention and treatment of venous or arterial thromboembolism and PE
  • Atrial fibrillation
  • DIC (Disseminated Intravascular Coagulation)
104
Q

Precautions for Anticoagulants?

A
  • Bleeding, bruising, hematoma
  • Thrombocytopenia
105
Q

What class of drug is heparin?

A

Anticoagulant

106
Q

What class of drug is Coumadin?
- what is the generic name?

A

Anticoagulant

Generic name = Warfarin

107
Q

Indications for Heparin?

A
  • For prevention and treatment of venous or arterial thromboembolism and PE
  • Atrial fibrillation
  • DIC (Disseminated Intravascular Coagulation)
108
Q

Two categories of treatment for heparin?

  • What is the main trait difference?
A

Unfractionated/High-molecular weight
- Cleared faster = needs frequent dosing

Fractionated/Low-molecular weight (LMWH)
- Used long term anti-coagulation

109
Q

How would you monitor Heparin treatment according to:
- Unfractionated/High-molecular weight (APTT)
- Fractionated/Low-molecular weight (LMWH)

A

APTT
- Blood test to monitor

LMWG
- not a clue lol

110
Q

Antidote for Heparin toxicity

A

Protamine sulfate

111
Q

What does heparin bind to?

A

Anti-thrombin III
- inhibits thrombin and factor Xa

112
Q

Mechanism of action for Coumadin

A

Interferes with liver synthesis of Vitamin K dependent clotting factors bc it is structurally similar

113
Q

Antidote for Coumadin toxicity?

A

Vitamin K

114
Q

How would you monitor Coumadin therapy?

A

By observing INR via blood test

115
Q

Precautions for Coumadin?

A

Hemorrhage

116
Q

Indications for Coumadin?

A
  • 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
Q

Antiplatelet function and characteristics

A

Inhibit action of platelet clotting process

i.e decrease stickiness of platelets.

118
Q

Indication for antiplatelets?

A
  • Prophylaxis of thrombus formation
  • Often seen in PTCA (pre & post) to prevent reocclusion
    MI
119
Q

What is Percutaneous Transluminal Coronary Angioplasty
[PTCA]?

A

A minimally invasive procedure that opens blocked coronary arteries to improve blood flow to the heart muscle.

120
Q

Precautions of Antiplatelet agents?

A
  • Increased risk of bleeding
  • Relatively contraindicated when thrombolytics are used
121
Q

What drug class does ASA fall under?
- what is the trade name of ASA?

A

Antiplatelet and NSAID

ASA = Aspirin

122
Q

Mechanism of action for ASA

A

Prevents thromboxane formation (an inflammatory mediator and platelet aggregator)

  • we see anti-inflammatory actions and decreased platelet aggregation
123
Q

Indications for ASA

A

Prophylaxis of thrombus formation
AMI

124
Q

Drug class and generic name for: ReoPro

A

Antiplatelet

Abciximab

125
Q

Drug class and generic name for: Plavix

A

Antiplatelet

Clopidogrel

126
Q

Mechanism of action: Antithrombic agents

A

Degrades fibrin by plasmin conversion
- degrades fibrin clots

Ex) anything that ends with “-ase” (alteplase, streptkinoase)

127
Q

Use of Anti-thrombolytic agents

A

used in:
- MI,
- Ischemic stroke,
- pulmonary emboli

128
Q

Indications for Anti-thrombolytic agents?

A

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
Q

What are most MI’s caused by?

A

Thrombus [blood clot]

130
Q

Why are Anti-thrombolytic agents important?

A

If thrombus is dissolved we can reperfuse the area and hopefully save some of the heart tissue

131
Q

Precautions to Anti-thrombolytic agents?

A

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
Q

Drug class and tradename for: Alteplase

A

tPa

Anti-Thrombolytic

133
Q

Drug class and tradename for: Reteplase

A

Retavase

Anti-thrombolytic

134
Q

Drug class and tradename for: Streptokinase

A

Streptase

Antithrombolytic

135
Q

Drug class and tradename for: Tenecteplase

A

TNK

Anti-thrombotic

136
Q

Antithrombotic agents vs. other clotting agents

A
  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
Q

Vagual maneuver

A
138
Q

Next step after atropine admin?

A

Transcutaneous pacing

139
Q

What should be the first thing that should be done when treating svt?

A

Vagal maneuvers

140
Q

What is a second line treatment after pushing adenosine

A

Calcium channel blockers (IV)

Goal is to treat SVTs

141
Q

Which cardiac drug acts on the sinus node?

A

Beta Blockers

142
Q

Mechanism of action:

How do beta blockers decrease HR?
- What are the latent affects?

A

They block beta receptors, which block conduction at the sinus node

  • HR is decreases which leads to BP decreasing.
143
Q

Aside from Verapamil and Diltiazem,

Calcium Channel Blockers typically end in with which suffix?

A

“pine”

i.e Nifedipine or felodipine

144
Q

Which calcium channel blockers act on the heart muscles?

A

Verapamil/Diltiazem.

145
Q

Which calcium channel blockers act on blood vessels?

A

Nifedipine or felodipine

146
Q

What do beta blockers, Calcium channel blockers, and nitrates relive?

A

Angina, Hypertension, Arrhythmias, and cardiac failure.

147
Q

What do ACE inhibitors and diuretics’ relieve?

A

Hypertension and cardiac failure

148
Q

Why are the kidneys important in relation to BP?

A

They release renin when BP is low, causing vasoconstriction.

  • Renin stims angiotension I than II
149
Q

Mechanism of Action:

How do Calcium Channel blockers [CCB] act on blood vessels?

A

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
Q

What site do Nitrates act on/affect action?

A

Direct affect on veins.

151
Q

What happens when veins dilate?
- systole?
- diastole?

A

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
Q

Which antiplatelet drugs are both a contraindicated by active bleeding disorders?

A

ASA and Clopidogrel

153
Q

Indications for a sodium channel blocker?

A

Atrial fib/flutter

Life threatening ventricular arrhythmias

154
Q

On a ECG, what do beta blockers prolong?

A
  • P-P Interval
  • P-R Interval
155
Q

Which drug class would you administer for the following ECG

A

Beta Blockers

  • i.e Metoprolol or Propanolol
156
Q

Which drug class would you administer for the following ECG?

A

Mainly a potassium channel blocker

i.e Amiodarone (Cordarone)

157
Q

Which drug class would you administer for the following ECG

A

Mainly a potassium channel blocker

i.e Amiodarone (Cordarone)

158
Q

Therapeutic affects of Amiodarone

(potassium channel blocker)

A
  • Prolongs action potential
  • Prolongs refractory period
  • Reduce HR
159
Q

Indications and Contraindications for Amiodarone (Potassium Channel Blocker)

A

Indication:
- Life threatening ventricular arrhythmias

Contraindications:
- Bradycardias or SA dysfunction.

  • 2nd or 3rd degree heart block.
  • Pulmonary conditions which predispose to fibrosis
160
Q

Calcium normally mediates what action?

A

Action potential prolongation

161
Q

Therapeutic affects of Atropine?

A

Increase HR in bradydyshrythmias

162
Q

Which arrhythmia is Digoxin ideal for use?

A

Heart failure coupled w/A-fib or A-flutter

163
Q

What are the therapeutic affects of magnesium sulfate?

A

Can lengthen QT interval.

164
Q

Indications for Magnesium sulfate specifically ?

A

Torsades de Pointes

164
Q

Indications for Magnesium sulfate specifically ?

A

Torsades de Pointes

165
Q

Amiodarone is used for

A

antiarrhythmic for atrial and ventricular
arrhythmias. I

PA 2 (RESP 262) (14 decks)

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