CARDIAC PHARMACOLOGY Flashcards
Drugs used to treat angina:
- Nitrates / Vasodilators
- β – blockers
- Ca⁺ channel blockers
Pump dysfunction; meds are focused on restoring the balance between oxygen supply and demand
Drugs used to treat arrythmias:
- Sodium Channel blockers
- Beta blockers
- Ca+ channel blockers
Pump dysfunction, drugs that prolong repolarization
DRUGS USED TO TREAT CARDIOVASCULAR PUMP DYSFUNCTION
-
Angina: restoring the balance between oxygen supply and demand
- Nitrates/Vasodilators, Beta Blockers, Ca channel blockers
-
Cardiac arrythmias: Drugs that prolong repolarization
- Sodium channel blockers, Beta Blockers, Ca Channel Blockers
Nitrates are vasodilators that cause what in the heart?
Decreases workload on myocardium → decrease preload and afterload → decrease O2 demand
Used to ease chest pain, angina
in addition to nitrates, what other drugs may cause vasodilation?
Ca channel blockers, ACE inhibitors, Alpha blocker
what are the uses of nitrates/vasodilators?
angina, CHF, HTN, post myocardial infarction
what are the side effects of nitrates/vasodilators?
- Reflex tachychardia
- Dizzines, headaches
- Hypotension/Orthostasis
- Peripheral edema
which is the most common nitrate?
Route of administration?
Nitroglycerin
- Tablet (sublingual) - at onset of anginal attack, pt will use at home, very fast acting
- Patch - Used preventatively May lose effectiveness if on constantly
how do beta blockers work?
decrease HR by blocking type 1 beta adrenergic receptors (stimulate the heart)
→ blocking catecholamines (epinephrine (adrenaline), norepinephrine (noradrenaline), and dopamine)
β1-adrenergic receptor stimulation
Increases heart rate and force of contraction
β2-receptor stimulations
Increases vasodilation of capillary beds & relaxation in bronchial tract
High levels of circulating epinephrine cause
vasoconstriction
Lower levels of circulating epinephrine → β-adrenoreceptor stimulation dominates → producing an overall _______
vasodilation
β- blockers ↓ _________ stimulation of the heart, therefore ↓ HR and Cardiac Output → DECREASE WORKLOAD
(These changes will occur at rest and with exercise)
sympathetic
Side effects of β- blockers
- May decrease the HR too much causing low BP
- Lightheadedness
- Exacerbation of bronchospasm
- Possible effects with sexual dysfunction/depressio
- Metropolol / Lopressor
- Propranolol / Inderal
- Atenolol / Tenormin
- Labetolol
Beta Blockers - Beta Adrenergic Blocking Agents
uses of Beta Blockers
- Angina
- After MI
- Heart failure
- Arrythmias, rate control/Afib
- HTN
What is the impact of β- Blockers in PT Intervention?
- decreases HR of the patient
- May lead to a more productive exercise session as β-blockers help control Angina and Arrhythmias
- May be necessary to exercise these patients sub-maximally
- Use Borg Scale or Rate of Perceived Exertion
What ALPHA ADRENERGIC ANTAGONIST AGENTS do?
Decrease peripheral vascular tone by blocking alpha-1-adrenergic receptors → causing dilation of arterioles and veins and decreases BP
– Cardura (doxazosin)
– Minipress (prazosin)
– Hytrin (terazosin)
Alpha Blockers
What do Calcium (Ca ⁺) Channel Blockers do?
Decrease entry of calcium into vascular smooth muscle cells → vasodilation, decreased myocardial contraction, and decreased oxygen demand of the heart
Decrease heart’s pumping strength and relax blood vessels → vasodilation in peripheral vessels
some uses of Calcium (Ca ⁺) Channel Blockers
- Angina
- HTN
- A-fib
- Coronary vasospasm
- Paroxysmal supraventricular tachycardia
Ca⁺ Channel Blockers adverse side effects
- Headache
- Dizziness
- Hypotension
- Brady arrhythmias
- Pedal edema
- GI upset
Amlodipine / Norvasc
Nifedipine / Procardia
Diltiazem / Cardizem
Verapamil / Calan/Verlan
Ca⁺ Channel Blockers
Amlodipine / Norvasc
Nifedipine / Procardia
Ca⁺ Channel Blockers more selective for vasculature
Diltiazem / Cardizem
Verapamil / Calan/Verlan
Ca⁺ Channel Blockers - More selective for myocardium
what are the classes of drugs considered ANTIARRYHTHMICS
- Class I: Sodium Channel Blockers
- Class II: β – blockers
- Class III: Drugs that prolong repolarization
- Class IV: Ca ⁺ channel blockers
What do sodium (Na+) Channel Blockers do?
- Antiarryhtmic
- Control myocardial excitability by stabilizing sodium channels on heart cell membranes
Lidocaine (Xylocane)
- Sodium (Na+) Channel Blockers
- Antiarrhythmic
- Drug of choice;
- Used for prophylaxis and therapeutically in acute myocardial ischemia
Side effects of Sodium Channel Blockers:
(lidocaine, quinine)
- N/V
- dizziness
- drowsiness
- fatigue
- possible orthostasis
Drugs that Prolong Repolarization are
Antiarrhythmics
Amiodarone, Bretylium
- Antiarrhythmics: drugs that prolong repolarization
- Lengthens time between heartbeats (diastole)
- Useful in treating tachycardia
drugs used to treat cardiovascular pump failure
- Angiotensin-Converting Enzyme (ACE) Inhibitors
- Diuretics
-
Digitalis – Cardiac Glycosides:
- Digitoxin/Lanoxin
- Digoxin
ACE inhibitors, what do they do?
- “Inhibits” enzyme that converts angiotensin I to angiotensin II (a vasoconstrictor)
- Decrease peripheral & arterial vasoconstriction → decrease BP
- Relaxation of arteries
- Increase CO
uses of ACE inhibitors
HTN, CHF, CAD
side effects of ACE inhibitors
- Dry cough
- Hypotension - high incidence of lightheadedness, dizziness for the first few days
- Kidney problems secondary to K+ retention
– Captopril / Capoten
– Quini_pril_ / Vasotec
– Ramapril / Zestril
– Accupril / Altase
ACE Inhibitors
Angiotensin II Receptor Blockers
- Newer drug
- Bind and occupy angiotensin II receptor on cardiovascular tissues → so limit vasocontriction and stimulation of vascular tissue
- Losartan / Cozaar
Losartan / Cozaar
Angiotensin II Receptor Blockers
Newer drud
Diuretics act on the kidneys to:
- ↑ excretion of Na ⁺ and H₂O
- ↓ Na⁺ and H₂O = ↓ fluid in the vascular system
- ↓ BP via ↓ fluid in the peripheral vasculature
- ↓ cardiac workload via ↓ the amount of fluid the heart must pump (preload)
diuretics are useful in the treatment of:
- HTN
- heart failure
- edema
diuretics prescription depends on…
- age
- medical history
- adverse drug interactions
problems with diuretics may occur when…
- Overdose & excrete too much Na+ and K+ from the body
- When severely restricts fluid intake
diuretics adverse side effects
– Hypotension
– Dehydration
– Electrolyte imbalance
– Hyperglycemia
patient taking diuretics can become….
– Confused
– Dizzy
– Unreasonable
– Fatigued
– Depressed
supplement to combat fatigue from diuretics include
potassium
– Furosemide(g)/Lasix (t)
– Bumetanide(g)/Bumex(t)
Diuretics
what are the effects of glycosides?
Inhibits the Na+/K+ pump, which allows Ca+ to come in →
Increases cellular Ca+ → Increases heart contractility → Increases contraction FORCE → Increases pump ability
glycosides side effects
- GI problems
- ↓ appetite
- CNS disturbances (ataxia, visual disturbances)
- Fatigue
- Confusion
- Small therapeutic window
Group of meds called statins, what do they do?
Directly inhibit hepatic cholesterol production
- Decrease total cholesterol
- Decrease plasma LDL/VLDL
- Slightly decrease triglycerides
- Slightly increase HDL
- Help decrease atherosclerotic plaque formation
adverse effects of statins (Antihyperlipidemia Medication)
- Stomach Pain
- Nausea
- Diarrhea
- Gas
- Heartburn
- Muscle cramps
- Severe weakness and/or fatigue
– Lipitor
– Crestor
– Zocor
- *Antihyperlipidemia** Medication
- *statins**
Fibric Acids action
- Decrease triglycerides
- Decrease VLDL
- Increase HDL
Tricor
Lopid
Fibric Acids
(Antihyperlipidemia Medication)
Colestid
Questran
Bile acid sequestrants medications
(Antihyperlipidemia Medication)
Action of bile acid sequestrants medications
- ↓ total cholesterol
- ↓ LDL
- Adheres to bile acids in the GI tract
Adverse side effects associated with bile acid sequestrants meds and meds that inhibit cholesterol absorption from the GI tract
-
GI problems
- Nausea
- Stomach pain
- Gas
- Diarrhea
Niacin
Zetia
Inhibit cholesterol absorption from the GI tract
(Antihyperlipidemia Medication)
contraindications for smoking cessation medications
- s/p MI, s/p CVA,
- Angina and life threatening arrhythmias
insulin preparations
- vials
- prefilled syringes
- jet injector (expensive)
- insulin pump
– Humulin
– Novolin
– Lantus
insulin
side effects of insulin
- Hypoglycemia
- Lipodystrophy
- Skin reaction at site of injection
- Insulin allergy (RARE as humulin—human insulin—is nonallergenic)
Oral Hypoglycemic Agents are used to
lower blood glucose levels
avandia
Oral Hypoglycemic Agent
(Thiazolidinediones)
Smoking Cessation Medications:
- Nicotine replacement therapy (N, HA)
- Bupropion/Zyban (dopamine↑; dry mouth, insomnia)
- Verenicline/Chantix (nicotine receptors antagonist; HA, drowsiness, GI problems)
Sympathetic appetite suppressants, what do they do?
Increase influence of norepinephrine and dopamine in the brain → decrease appetite
– Benzphetamine
– Methamphetamine
Sympathetic appetite suppressants, side effects
HTN and cardiac arrhythmias (these can be severe)
Lipase inhibitors, mechanism of action
Decrease fat absorption by inhibiting fat breakdown in the GI tract
Used to Treat Obesity
– Alli (t)
– Xenical (t)
lipase inhibitors, side effects:
GI problems
Serotonin-norepinephrine reuptake inhibitors:
Increase effects of serotonin & norepinephrine in the brain → Supress appetite
Side Effects: Increase blood pressure – Dry mouth – Insomnia – Dizziness – Nausea
types of Anti-Clotting Medications
- Anticoagulants: Heparin Coumadin
- Antithrombotic Agents: Aspirin
- Thrombolytics: Streptokinase, tPA (tissue plasminogen activator)
Lab monitoring: PTT/aPTT used to assess for:
heparin
lab monitorin
PT/INR used to assess for __________
coumadin
Coumadin/Warfarin, mechanism of action
Impairs the hepatic synthesis of clotting factors → helps to break up clots
types of anticoagulants:
- Heparin
- Coumadin/Warfarin
Aspirin, mechanism of action
Anti-platelet drug → prevents platelets from sticking to one another
(classifies as Antithrombotic Agent)
Drugs that block effects of adenosine diphosphate (ADP) on platelets
Other Antithrombotic Agents
Glycoprotein (GP) IIb—IIIa Inhibitors
Inhibit effects of other platelet stimulating substances (ex: fibrinogen)
Antithrombotic Agents
Thrombolytics are used to
acutely destroy (lyse) or decrease clot formation
Thrombolytics side effects
– Bleeding/hemorrhage
– Not tissue specific, potential for bleeding elsewhere…
– Streptokinase
– Alteplace
– Urokinase
– tPA (tissue plasminogenactivator)
Common Thrombolytics (often the “-ase” drugs)
Thrombolytics, mechanism of action
Facilitate conversion of plasminogen to plasmin
– Facilitate process to lyse clots
