Cardiac Pt 1 Flashcards
adrenergic agents
- antihypertensive
- lower BP
- ANS: alpha 1 (vasoconstrict) : want to block
- alpha 2 agonists: mimic alpha 2 effect - vasodilate (good)
- beta blockers: affect HR, help reduce BP
ACE inhibitors
*“prils” and first line drug
angiotensin-converting enzyme inhibitors
-block the enzyme that helps convert angiotensin I to angiotensin II
Indication: HTN, HF
Conta: K+ of >5meq/L, lactation
AE: fatigue, dizzy, mood change, HA, **dry, non-productive cough, hyperkalemia (promote K resorption), hypotension
-interactions: NSAIDS, antiHTN, lithium (lithium toxicity)
calcium channel blockers
make it so the muscle can’t contract
alpha 2 agonists
*adrenergic agonists
**antihypertensive
MOA: synthetic stimulation of alpha 2 receptors in CNS
- Peripherally causes kidneys to reduce the amount of renin produced
- Indications: HTN (not first line), opioid withdrawal
- Contra: allergy, hypotension, MAOIs, acute HF
- AE: orthostatic hypotension, hypotension, HTN, fatigue, dizzy
- Additive- Diuretics, nitrates, other antihypertensives; Competitive- MAOIs, Amphetamines
alpha blockers
- adrenergic-blocking
- *antihypertensive
- MOA : Block Alpha 1 receptors; Vasodilation
- Indications: HTN & BPH
- Contra: Allergy, hepatic & renal disease, hypotension, acute HF
- AE: Hypotension, Orthostatic Hypotension, Palpitations, Tachycardia, Chest Pain, Dizziness, Head ache
- Interactions: Additive Effect-CNS Depressants, alcohol, beta blockers, antihypertensives
angiotensin II receptor blockers
“sartans”
*antiHNT
MOA: blocks angiotensin II from binding to type I receptors
indication: HTN / HF
Contra: pregnancy, elderly, renal dysfunction
AE: URI, HA, dizzy, hypotension, hyperkalemia
Interactions: NSAID, lithium, rifampin, K supplements
vasodilators
*antiHTN
MOA: relaxes vascular smooth muscle
indications: HTN and HTN crisis
Contra: hypotension, head injury**, AMI, CAD, HF
AE: dizzy, HA, orthostatic hypotension, NA and water retention, dysrhythmias, hyperglycemia in diabetics
interactions: other antiHTN
clondine
antiHTN
- alpha 2 adrenergic receptor stimulator
- topical and oral patch for remove old one first
doxazosin
antiHTN
- alpha 1 blocker
- vasodilation of both arterial and venous dilation
labetalol
antiHTN
- alpha and beta blockers
- po & iv alpha and beta used for hypertensive emergencies Carvedilol is also an effective antihypertensive
captopril
antiHTN
- ACE inhibitor
reduce left vent. Dysfunct after mi-shortest half life must be taken multiple times a day
enalapril
antiHTN
- ACE inhibitor
iv and oral-oral form is pro drug so a functioning liver is a must
lisinopril
antiHTN
- ACE inhibitor
losartan
antiHTN
- ARBs
hydralazine
antiHTN
- vasodilator
- is not used much any more but with patients who can not take po this does have an iv form
sodium nitroprusside
antiHTN
- vasodilator
- metabolites cyanide thiocynate levels-sodium nitroprusside has reduced this slightly
- watch for increasing cyanide levels
beta blocker drugs
antianginal drugs
MOA: Selective v. Non-selective-Slow Heart rate
indications: angina, MI, Hypertension, dysrhythmias
contra: acute, Conduction disturbances, bronchial asthma
AE: Bradycardia, hypotension, dizziness, blood glucose changes, wheezing, mask hypoglycemia
interactions: additive - diuretics, Ca channel blockers
**metroprolol : beta 1 adrenergic blocker
calcium channel blockers
antianginal drugs
MOA: Blocks calcium channels in muscle- Vasodilation- especially coronary arteries, decreased muscle contraction
indications: first line drugs
- angina, hypertension, tachycardia
contra: AMI, heart block
AE: hypotension, rhythm disturbances, palpitations
Interactions: beta blockers, dig, amiodarone, addivite, statins mycins, cyclosporine, grapefruit juice
**if apical is less than 60, do not admin Ca+ channel blocker — already slow, would/could stop heart
- *diltiazem
- *amoldipine
antianginal nitrates
MOA: Relaxation of Smooth muscle-vasodilation
Indications: Vasospastic angina, angina
Contra: Anemia, closed angle glaucoma, hypotension, head injury
AE: Headache, tachycardia, postural hypotension
Interactions: Additive hypotensive effects (Alcohol, beta blockers, ca channel blockers)
isosorbide dinitrite
nitrate
pill for chronic angina
nitroglycerine
nitrate
topical - angina
sublingual: should see reaction in 5 min, if not, can give another, wait 5 min and give one final (3 max in 15 min)
carvedilol
beta blocker, alpha 1 blockers, calcium channel blocker
labetalol
alpha and beta blockers
B-Type Natriuretic Peptide
HF drug
MOA/DE: Synthetic B-Type Natriuretic Peptide-Vasodilation (especially in the coronary arteries) and Diuresis
Indications: Acute Decompensated Heart Failure
Contraindications: Drug Allergy
Adverse Effects: Hypotension, cardiac dysrhythmias, insomnia, Headaches and abdominal pain
Interactions: Additive hypotensive effects with antihypertensives.
cardiac glycosides
HF drugs
MOA: Inhibition of the sodium-potassium adenosine triphosphatase pump
Indications: Systolic Heart Failure & Atrial Fibrillation
Contraindications: Bradycardia & advanced heart blocks, Diastolic Heart Failure
Adverse Effects: Bradycardia, Tachycardia, Hypotension, Colored vision, Halo Vision, Headache, fatigue, confusion
Interactions: Antidysrhythmics, Beta-Blockers, Calcium Channel Blockers
**colored/halo vision = dig toxicity
Carbonic anhydrase inhibitor
**diuretic
MOA: Dec. H+ formation
Indications: glaucoma & edema
Contraindications: Allergy, hyponatremia, hypokalemia, hepatic or renal dysfunction, sensitivity to sulfonamide antibiotics, diabetes.
Adverse Effects: Metabolic Abnormalities, Drowsiness, Anorexia, paresthesias, hematuria, melena, hyperglycemia
Interactions: Digoxin, Corticosteroids, Amphetamines, carbamazepine, cyclosporine, phenytoin & quinidine
***drives K down, drives glucose up
loop diuretic
**diuretic
MOA: Blocks chloride and sodium resorption
Indication: Heart Failure, renal failure, liver failure and HTN
Contraindications: Allergy, allergy to sulfonamide antibiotics, hepatic coma, severe electrolyte imbalances
AE: Dizziness, headache, tinnitus, ototoxicity (especially when parenteral forms are administered too quickly), and electrolyte disturbances (especially K+!)
Interactions: ibuprofen, digoxin
Osmotic diuretics
**diuretic
MOA: Proximal convoluted tubule and the descending loop of Henle—diuresis.
Indications: Early, oliguric phase of ARF (as long as renal perfusion is adequate).
Contraindications severe renal disease & pulmonary edema
AE: Convulsions, pulmonary congestion, and thrombophlebitis at the site of injections.
No significant interactions
**effective in liver and head injuries
K+ sparing diuretics
**diuretic
MOA: binding to aldosterone receptors and blocking resportion of sodium and water.
Indications: Hyperaldosteronism, HTN, counteract electrolyte loss among those taking potassium-wasting diuretics, and CHF
Contraindications: hyperkalemia, severe renal failure,
AE: Gynecomastia (large mammory glands: AKA, breasts) in men and dysmenorrhea in women, hyperkalemia!
Interactions: Lithium, NSAIDS, K+ supplements!
Thiazides
MOA: distal convoluted tubule—Diuresis
Indications: Edema, HTN, and HF
Contraidications: hepatic coma
AE: Electrolyte disturbances, dehydration, orthostatic hypotension, impotence, and decreased libido
Interactions: NSAIDS, Lithium, digoxin, Table 28-6
**low Na, high K+
