Cardiac Pharmacology Flashcards
What are the initial recommendations for treatment of cardiac disease?
- healthy diet
- being physically active
- maintaining a healthy weight
- quitting smoking
- moderating alcohol consumption
- managing stress
What are the major routes of administration for cardiac pharmacology?
Oral Intravenous Intramuscular Subcutaneous Sublingual Rectal
What levels must oral medications pass through prior to entering the systemic circulation?
intestinal epithelium, portal venous system, and the liver
What is first pass metabolism?
when a drug is taken orally and passes through the liver and intestine that limits the bioavailability of the drug and limits the amount delivered to the systemic circulation
What is the steady state of a drug?
the situation during chronic drug administration when the amount of drug administered per unit time equals drug eliminated per unit time
What is the advantage of taking medication intravenous rather than orally?
if drug is administered intravenously it does not go through the liver or intestine or be metabolized early so you can have lower doses of medication (a typical intravenous does of verapamil is 1-5 mg, compared to a single oral dose of 40-120 mg)
Also some drugs cannot be taken orally due to the drug not being able to make it through the liver or intestine
What medications can help with HTN?
ACE inhibitors and diuretics
How do diuretics address HTN?
What are the three main types?
reduce blood pressure by reducing blood volume via kidneys
3 most common types:
-Loop: blocks the NA+/K+/2Cl- resorption in the loop of henle (most common is furosemide for HF)
- Thiazide: block NA+ reabsoprtion in the distal tubule of nephron (most common is HCTZ for essential HTN)
- Aldosterone receptor atagonists: blocks aldosterone (most commin is aldactone)
What are betablockers used for?
What are the two categories?
reduce HR/BP/sympathetic tone and also has antiarrhythmic properties
Specific and nonspecific
What patients should be cautious to use beta blockers?
- patients w/ kidney or renal dysfunction
- patients w/ pulmonary dysfunction or asthma (especially with non-selective beta blockers which can cause bronchoconstriction)
- diabetics (may suppress sympathetic response to hypohlycemia)
What are alpha 1 blockers and alpha 2-agonists?
Alpha 1-blockers
- block alpha-1 receptors on vascular smooth muscle
- effective in treating benign prostate hypertrophy
Alpha 2-agonists
- reduces vascular tone by central mediated methods by stimulating alpha 2 receptors
- suppresses sympathetic outflow to vasomotor centers from the brainstem
- not commonly used
What do ACE-inhibitors do?
Block conversion of Ang 1 to Ang 2 in order to reduce BP
-decreases afterload and improves survival in pts w/ HF
What are ARBs? What are they used for?
Angiotensin 2 receptor blockers
similar effects to ACE-inhibitors but used when pts. don’t tolerate ACEI side effects such as coughing
also used to treat pts w/ obstructive sleep apnea
What are calcium channel blockers?
What are they used for?
meds that selectively block Ca2+ entry into vascular smooth muscle cells
Used to manage HTN, angina, vasospasm, treat supraventricular arrhythmia and reduce cardiac contractile force
Why should you avoid stopping exercise suddenly in patients who take HTN medications?
may lead to sudden excessive hypotension post exercise
