Cardio Flashcards
ACEs (-prils) Uses & MOA
Uses: HTN, angina, prevent/tx HF, prevent MI
MOA: block conversion of angiotensin 1 to 2; breaks down bradykinins
ACE (-prils) Side/Adverse effects
ANGIOEDEMA
orthostatic hypotension
dry, hacking cough (SWITCH TO ARB)
ACE (-prils) Contraindications/Precautions
bilateral renal artery stenosis
angioedema
pregnancy
hyperkalemia
impaired renal function
hypovolemia/hyponatremia
hepatic impairment
ACE (-prils) Interactions
CYP450 inhibitors
additive hypotensive effects (diuretics, BP agents, phenothiazines, alcohol)
K+ supplements = hyperkalemia
K+ sparing diuretics = hyperkalemia
NSAIDs/ASA = DEC effect
ACE (-prils) Monitoring/Patient education
monitor: obtain baseline, dosage changes, periodically; BP, weight, pulse; renal function DEC dose if serum >2.5; potassium
education: take med same time each day, do NOT double dose, CONTACT PCP BEFORE USING OTC MEDS; avoid salt substitutes
ARBs USES & MOA
Uses: HTN, prevent diabetic nephropathy, angina, post MI, HF
MOA: blocks angiotensin 2 at receptor
ARB side/adverse effects
orthostatic hypotension (fall risk)
ARB contraindications/precautions
bilateral renal artery stenosis
angioedema
pregnancy
hyperkalemia
impaired renal function
hypovolemia/hyponatremia
hepatic impairment
ARB interactions
CYP450 inhibitors
additive hypotensive effects (diuretics, BP agents, phenothiazines, alcohol)
K+ supplements = hyperkalemia
K+ sparing diuretics = hyperkalemia
NSAIDs/ASA = DEC effect
ARB Monitoring/patient education
Monitoring: obtain baseline, dosage changes, periodically; BP, pulse, weight; renal function DEC dose if serum >2.5; potassium; CHECK LFTs
education: no reflex tachycardia, no effect on bradykinin pathway, take same time each day, do NOT double doses, CONTACT PCP BEFORE TAKING OTC MED; avoid salt substitutes
DRIs USES/MOA
Uses: HTN, angina, post MI, HF
MOA: block renin
DRI side/adverse effects
ANGIOEDEMA
orthostatic hypotension
DRI contraindications/precautions
NO renal function <60 mL/min
bilateral renal artery stenosis
angioedema
pregnancy
hyperkalemia
impaired renal function
hypovolemia/hyponatremia
hepatic impairment
DRI interactions
CYP450 inhibitors
additive hypotensive agents: diuretics, BP agents, phenothiazines, alcohol
K+ supplements = hyperkalemia
K+ sparing diuretics = hyperkalemia
NSAIDs/ASA = DEC effects
DRI monitoring/patient education
monitoring: obtain baseline, dosage changes, periodically; BP, pulse, weight; renal function DEC dose if serum Cr >2.5; potassium
education: take same time each day, do NOT double doses, CONTACT PCP BEFORE USING OTC MEDS, avoid salt substitutes
CCBs Uses/MOA
Medications: Type 1 (verapamil, diltiazem), Type 2 (dihydropyridines - nifedipine)
Receptors: Type 1 (heart, heart contractility/HR control), Type 2 (peripheral/vascular smooth muscle, BP control)
Uses: HTN, SVT/Afib, unstable angina (only if vasospasm present, verapamil used)
MOA: bind to L-type channels in depolarized membranes to DEC channel opening
DEC calcium = INC muscle relaxation
CCB side/adverse effects
orthostatic sx
N/V, reflux
peripheral edema
reflex tachycardia
LESS COMMON W/ SR FORM
CCB Contraindications/precautions
STRONG INOTROPIC EFFECT & BRADYCARDIA (DEC PRELOAD, AFTERLOAD, HR)
AVOID IN HF
immediate post MI
ventricular arrhythmias
DIHYDROPYRIDINES - AVOID w/ peripheral edema and unstable angina
hepatic impairment
pregnancy
CCB interactions
additive HTN effects
DEC BP w/ NSAIDs
additive bradycardia w/ BBs and digoxin
verapamil alter Li levels
grapefruit juice
VERAPAMIL AND DILTIAZEM INC RISK MYALGIA W/ STATINS
CCB monitoring/patient education
monitoring: verapamil monitor Li levels, LIVER FUNCTION AT BASELINE & PERIODICALLY, monitor for HF
education: take same time each day (best in AM), gradual withdrawal to prevent MI, careful if pharmacy switches brands or old vs new med, HF sx, constipation relief
Cardiac Glycosides (CGs) (Digoxin) Uses/MOA
Uses: Afib, PVST (DEC HR = help convert rhythm); HF (add after ACE/ARB + diuretic in place)
MOA: inhibits Na-K-ATPase pump = keep Na in/push K out = strong ventricular contraction + INC cardiac output
CGs (Digoxin) side/adverse effects
GI- from CNS reactions and stimulus of CTZ
fatigue, disorientation, hallucinations
yellow vision or green halos
gynecomastia = rare
CG (Digoxin) contraindications/precautions
AV block
uncontrolled ventricular arrhythmias
IHSS
Cor pulmonale
severe renal impairment
ELECTROLYTE ABNORMALITIES
DEC albumin states
pregnancy
babies sensitive to dig
CG (Digoxin) Interactions
NARROW THERAPEUTIC INDEX
drugs that cause: hypokalemia, hypercalcemia, hypomagnesemia
K+ and CGs antagonize each other
hypercalcemia = INC risk arrhythmia, as does hypomagnesemia
CG (digoxin) monitoring/education
monitoring: digitalis effect (EKG changes- scooped ST, lengthened PR, T wave blunting); serum dig levels
education: monitor for TOXICITY (serum level >2 mg/mL); toxicity sx: INC HR, CNS/visual disturbances; HOLD med, K+, lidocaine (vent arrhythmias), digibind
take same time each day, pill container, do NOT alter forms, MONITOR HR: CONTACT PCP IF <60 OR >100
Antiarrhythmics (C1: procainamide, lidocaine, flecanide); (C2: propranolol, atenolol); (C3: amiodarone, sotalol); (C4: verapamil)
USES/MOA
Uses: atrial arrhythmias, ventricular arrhythmias
MOA: DEC ectopic pacemakers or alter abnormal impulse conduction by…
Na channel blockade, blockade of SNS, prolongation of effective refractory period, calcium channel blockade
Antiarrhythmics monitoring/primary care responsibilities
monitoring: labs (K+, renal & hepatic function, drug levels (draw 4-6 hours after last dose)), EKG, EPS
primary care responsibilities: understand beneficial effects, know adverse effects, any required monitoring, patient education, cardiology should initiate therapy
Nitrates Uses/MOA
Uses: angina - INC MOS by facilitating movement of O2 across arterial-myocardial cells
MOA: vasodilation DEC afterload (resistance) and preload (venous pooling)
Nitrates Side/adverse effects
orthostatic hypotension
tachycardia
throbbing HA: tylenol
ischemia, arrhythmias, rebound HTN
rash w/ flushing (transdermal)
ED, N/V, incontinence, urinary frequency
Nitrates contraindication/precautions
vasodilation INC ICP
vasodilation cause postural hypotension
volume DEC & anemia
INC IOP (glaucoma)
hypersensitivity
pregnancy
Nitrates interactions
additive hypotensive effects
anticholinergic DEC absorption of SL or buccal
ASA INC concentration
Nitrates DEC heparin
Nitrates starting therapy/patient education
starting therapy: start LOW and SLOW, advance dose Q1-2 wks, guidelines to INC (DEC or absent angina w/ usual activity, resting HR INC <15 bpm, No orthostatic hypotension)
Education: tolerance: nitrate free interval 10-12 hrs/day, use BB or CCB during nitrate free interval, AVOID SR products
**DOSE FOR ACUTE: 0.4-0.6MG Q 5MIN X3. 3RD DOSE CALL 911.
Peripheral vasodilators (minoxidil, hydralazine) Uses/MOA
Add-on therapy, NOT first line
Uses: resistant HTN, PVD often used w/ nitrates for HF
MOA: direct relaxation of arteriolar smooth muscle to DEC peripheral vascular resistance
Vasodilators side/adverse effects
may trigger compensatory SNS and RAAS stimulation:
prevent orthostatic hypotension and ED
precipitate tachycardia, INC contractility, INC output, Na/water retention, HA, tachyphylaxis
vasodilator contraindications/precautions
use caution in CVD patients
pregnancy
hydralazine OK for lactation
minoxidil NOT recommended in lactation
vasodilator interactions
additive antihypertensive effects
NSAIDs DEC effectiveness
BBs & LOOPS MAY PREVENT ADVERSE EFFECTS OF PADs
vasodilator medication administration
INC absorption w/ food
hydralazine may induce lupus-like syndrome w/ dose >50 mg
Diuretics (loop, thiazide, potassium sparing) Uses/MOA
FIRST LINE THERAPY: HF, HTN
USES: HTN, Edema
MOA:
loop - block Na/water absorption, K+ wasting, POWERFUL
thiazide - block Na/water absorption distal tubule, longer acting
potassium sparing - block aldosterone from receptor = K+ in circulation, Na excreted; WEAK diuretic
Diuretic side/adverse effects
ELECTROLYTE IMBALANCES
glucose intolerance + DEC K+ levels = thiazide loops
hypotension/fluid volume deficit
gynecomastia = spironolactone
photosensitivity long after d/c thiazides
hyperlipidemia = thiazides
Diuretics contraindications/precautions
electrolyte disorders
POTASSIUM SPARING W/ SEVERELY IMPAIRED RENAL FUNCTION = RISK FOR HYPERKALEMIA
hepatic dysfunction
gout/renal calculi
DM
older adults - INC risk hypotension, falls, tinnitus, hearing loss
DEC placental perfusion
Diuretics Interactions
additive hypotensive effects
synergistic hypokalemia
additive hyperkalemia w/ PCNs, amphotericin B, glucocorticoids
K+ sparing + ACE/ARB = hyperkalemia
warfarin
NSAIDs/Salicylates DEC diuretic effect
ARNI (sacubitril/valsartan) Entresto USES/MOA
Class II-III HF, Add-on or switch, NOT first line
Prodrug
Uses: Class II-III HF
MOA: inhibits the enzyme from degrading atrial and BNP; more BNP available
ARNI side/adverse effects
hypotension
hyperkalemia
impaired renal function
angioedema
ARNI contraindications/precautions
HX ANGIOEDEMA (inc BRADYKININ PRODUCTION)
do NOT use within 36 hours of ACE = bradykinin INC w/ ARNI + ACE
do NOT use w/ DRI
Sinus node inhibitor (Ivabradine) Uses/MOA
Uses: to reduce HF hospitalization in patients w/ symptomatic class II-III HF w/ LVEF <35%
MOA: blocks a gated channel responsible for the cardiac pacemaker
DEC HR w/o DEC contractility
SNI med administration/patient education
med admin: must be in NSR w/ HR >70 bpm, management must include BB at maximum tolerated dose
patient education: does NOT reduce risk of cardiac death or MI
