cardio meds Flashcards
Antagonists
inhibit change by blockingreceptors, beta blockers.
Agonists
initiate a sequence of changes within a cell
+ Chronotropes
speed up the heart
(atropine, dopamine, epinephrine)
It ends in an INE.
- Chronotropes slow down the heart
slow down the heart (metoprolol, diltiazem,verapamil)
Inotropes affect
contractility (digoxin is a + inotrope)
Dromotropes affect
conduction velocity
Diltiazem is
a Ca channel blocker
Diltiazem is a Ca channel blocker,
it causes vasodilation and slows conduction, dromotrope, through the A-V node which decreases HR, -chronotrope, and causesthe heart to contract less strongly, -ionotrope.
.
Drugs that work to ↓ myocardial oxygendemand
- Beta-blockers,
* Nitrates, if you have night rades, you need to have a low heart rate to be calm.
Beta-blockers
• Antagonists that bind to beta receptor sites
where epinephrine and norepinephrine
usually bind
• Blocks SYMPATHETIC input
• inhibition of stimulation from the adrenal
glands works to ↓ • Antagonists that bind to beta receptor sites
where epinephrine and norepinephrine
usually bind
• Blocks SYMPATHETIC input
• inhibition of stimulation from the adrenal
glands works to ↓ HR, ↓ contractility, ↓ BPand ↓ cardiac output , negative chronotrope, negative ionotrope.
LOLs are
Beta blockers
Most beta blockers end in?
LOL.
Patients on _________ will have a bluntedresponse to exercise.
beta blockers
Two scales to assess exertion.
VAS and BORG.
If prescription of beta-blockers are too strong pt will c/o
dizziness and low energy
Why is it that If prescription of beta-blockers are too strong pt will c/o?
inhibition of stimulation from the adrenal
glands works to ↓ HR, ↓ contractility, ↓ BPand ↓ cardiac output.
Nitrates
Are a beta blocker, they vasodilate,
nitroglycerine works selectively on smoothmuscle
• ↓ preload via venodilation, because less blood gets into the right ventricle
• ↓ afterload via arteriodilation
• relaxes coronary artery smooth muscle
Patch (What happens if you cut the patch inhalf so your supply lasts longer?)
It may be released faster.
NTG
• Must be stored ________,
- Should not be exposed to _________
- Taken PRN* so check __________dates
Properly,
Light,
Expiration
NTG: ____ Strikes and You’re Out!
3
NTG: 3 Strikes and You’re Out!
How so?
Take 1 SLNTG, wait five minutes, if no relief orworsening call 911, this time you actually go to the EX right away, but if…
• Take 1 SLNTG, if symptoms are significantly
improved repeat NTG 2 times more every five minutes up to 3 doses if after 3rd time
symptoms are not totally resolved call 911
Drugs that work to ↑ myocardial oxygen supply
- Thrombolytic agents
- Blood viscosity regulators: commonly called blood thinners
- Calcium Channel Blockers
Thrombolytic agents does what?
Break down the thrombus.
need to be administered within _________ of
occurrence of ischemia (ST Δs) to be effective
Hours
Name me two different thrombolytic agents
Streptokinase
And
• TPA (tissue plasminogen activator)
commonly called blood thinners
Blood viscosity regulators
Antiplatelet agents
↓ platelet adherencereducing risk of thrombus formation
ASA (acetylsalicylic acid) aspirin used prophylactically
Plavix/Clopidogrel
Brilinta/Ticagrelor (NEW)
.
Heparin is given through
IV
Warfarin/Coumadin is given through…
Orally
Dabigatran, Apixaban, Rivaroxiban – (orally)
Require ________ monitoring, and have ________ reversal agent
Less INR; No
Warfarin/Coumadin
• Interferes with ability to make _________, lower levels of protein lead to ↓ clotting
Vitamin K,
When taking ________, will Need to keep dietary intake of vitamin K steady?
Warfarin, because it interfers with the production of vitamin K.
Drawbacks of Warfarin/Coumadin:
– INR needs to be kept in narrow range – Req’s frequent monitoring – Imperfect compliance leads to risk of clotting orbleeding if levels aren’t closely followed – Interacts with lots of foods – Interacts with lots of medications
Blood Thinners (New)
• Dabigatran/Pradaxa (direct thrombin inhibitor)
• Apixaban/Eliquis (inhibits FXa to↓ thrombin)
• Rivaroxiban/Xarelto (inhibits FXa to↓ thrombin)
(These are all taken orally, they do not have reversal agents and may becontraindicated for pt’s with mech valves or valve dz.)
Drawbacks of Newer Agents:
– Contraindicated for pts with valve problems
-Contraindicated for pts with artificial valves
New meds interact with thevalves, like when you pour a new chemical into the car, will the valves hold up. WILL THEY?!
Who is suseptible to ICH?
People on blood thinners
Which blood thinner is administered pvia IV?
Warfarin which is also known as counadin
The war is farin with International Victories.
Epistaxis
Nose bleeds
Who is at risk for SDH?
Blood thinner.
All types of bleeds are usually due to blood thinners.
How will you be able to measure quanifiably how thin a person’s blood is?
INR
Aspirin
Acts multiplicatively with other thinners
Calcium Channel Blockers work by…
preventing smooth muscle contractions within the heart and
blood vessels by keeping Ca from entering cells
So if calcium channel blockers do not allow the heart to contract as much because they do not allow calcium to enter the heart so it do not cantract as strongly, then what is calcium channle blockers a good use for?
Lowering blood pressure,
Calcium channel blockers lower the contractility if the heart, ao that makes them…
Ionotropes, and specificaly negative ionotrope as compared to digitoxin that is a positive ionotrope.
Drugs that work to alter fluid volume and BP inthe body
- Diuretics
- Ace inhibitors
- ARBs Angiotensin Receptor Blockers
Diuretics lower the body’s fluid levels thus lowering the blood pressure, how do they lowert he body’s fluid levels?
By not allowing the reabsorption of sodium and water, so then the bidy’s fluid levels are less.
If there is a lot of fluid unretention from diuretics, then what levels must be properly monitored?
Electrolytes
What problems cana rise from electrolyte imbalances?
Mentation for sure, but for other things… Maybe, let me know what they are…
Ace stands for?
Angiotensin converting enzyme
Give them an _____ and they will cough in your face.
ACE, causes coughing.
Angiotensin II Receptor Blockers
Have effects similar to ACE inhibitors• Different mechanism of action
All the ideas of the angiotensin make it that the kidneys do not retain water.
ARBs block the binding
of angiotensin IIto muscles on blood vessels
Here the angiotensin was actually made, but it just cannot bind.
So you either stop its production or you go and not have it bind.
Besides retaing water what else does angiotensin do?
Vasoconstricts, so you have mkre blood and smaller vessel diameter, so for sure it increases the blood pressure
Drugs that work to increase contractility(positive inotropes)
- Cardiac Glycosides
- Sympathomimetics, like mimickng the sympathetic.
- Bipyradines,
Cardiac Glycosides increase contractility by
(Positive ionotrope)
inhibiting Na pump and increase Ca+ influx to heart
Digitalis, Digoxin, “Dige”
• (narrow range between therapeutic and toxicdoses)
An example of?
Well, know that digoxin is a medication that increases the heart’s contractility, and so it is a positive ionitrope, and also it sounds alot like toxin, somthe therapuetic range is very small.
Sympathomimetics/Pressors• Bind to receptors and
mimic epinephrine andnorepinephrine – seen in critical care setting
Bipyradines
• Bipyradines: inhibit phosphodiasterase
to ↑ intracellular Ca influx, enhances actin –
myosin bond, ↑ CO, ↑ SV, cause vasodilation
Again another example of the calcium increasing.
Vasodilators
Examples:
Nitroglycerine
Calcium channel blockers, lower the contractility of the heart and also vasodilate, so it lowers BP.
ACE inhibitors and ARBs
Morphine
All of these that lower blood pressure, also cause the vasodilation to lower the blood pressure.
Morphine
• In addition to its vasodilation properties:
- reduces anxiety
- relieves dyspnea
Makes you calm
Anti-arrhythmics
Anti-arrhythmic drugs suppress abnormal
impulse formation or conduction by alteringcell membrane permeability to specific ions (e.g. Na+ or Ca++)
So dromotropes.
And we see calcium yet again involved not just in the idea of ionotropes as in the calcium channel blockers or the digoxin, but also as a dromotrope to affect the conduction of the heart.
Class I anti-arrhythmics
inhibits fast sodium channels and depolarization
We did say that arrythmia meds are to affect both calcium and/or sodium.
Class II anti-arrhythmics
blocks beta receptors at atrioventricular and sinus nodes
Because the beta are two, so, class two is beta blockers.
Class III anti-arrhythmics
blocks K+ channels – prolongs depolarization
Because the K is a kick and you give three i
Kicks.
Class IV anti-arrhythmics
blocks Ca+ channels - slows
conduction at atrioventricular and sinus nodes
Statins
Statins: lipid-lowering drugs to ↓ risk associated with ↑ chol
Hypercholesterolemia =
> 240 mg/dl
HDL deficiency =
< 40 mg/dl
Statins cause what to the urine?
Color changes
Statins also csn cause what condition, at rare time?
Rhabdomyolysis
O2
- Oxygen therapy – combats hypoxemia
* REMEMBER, OXYGEN IS A DRUG
Remember to add humidifier (bubbler) if supplemental O2 >________
5L
Fasting plasma glucose level ≥ 126 mg/dL TWICE
Indication of diabetes
Plasma glucose ≥ 200 mg/dL two hours after a 75 goral glucose load as in a glucose tolerance test
Indication of diabetes
Symptoms of hyperglycemia and casual plasma glucose≥ 200 mg/dL
Indication of diabetes
Glycated hemoglobin (Hb A1C) ≥ 6.5%. HbA1C measures a person's average blood glucose level over the past 2 to 3 months (the test shows the amount of glucose that sticksto the red blood cell, which is proportional to the amount of glucose in the blood)
Indication of diabetes
Normal: Less than _____
Pre-diabetes: ________
Diabetes: _________
5.7%
5.7-6.4%
>6.5%
Hypoglycemia
BS < 70
Common causes of diabetic hypoglycemia include:
– Taking too much insulin or diabetes medication
– Not eating enough
– Postponing or skipping a meal or snack
– Increasing exercise or physical activity without eating moreor adjusting medications
– Drinking alcohol
Early signs and symptoms of diabetichypoglycemia include:
• Shakiness • Dizziness • Sweating • Hunger • Irritability or moodiness Anxiety or nervousness Headache • Pounding heartbeat
All the things that you will have when you will be hungry.
If early symptoms of diabetic hypoglycemia gountreated, can progress to:
• Clumsiness or jerky movements • Muscle weakness • Difficulty speaking or slurred speech Blurry or double vision • Drowsiness • Confusion • Convulsions or seizures • Unconsciousness
More severe than just being hungry, but it affects the mind.
If hyperglycemia goes untreated, it can cause:
• • • • • • • • • Toxic acids (ketones) to build up in your blood and urineFruity-smelling breath Nausea and vomiting Abdominal pain Shortness of breath Dry mouth Weakness Confusion Coma
Diabetic Ketoacidosis
An emergency condition where extremely high
blood glucose levels combined with a severe lack of insulin, result in the breakdown of body fat for energy
Signs of DKA are
nausea and vomiting, stomach pain, fruity breath odor and rapid breathing
Because there is acid, so you feel nausious and you vomit, the acid, like the acid in your stomach out, and so there will also be stomach pain. And your breath will smell fruity, and to exhale the CO2 to lower the acidosis you will breath rapidly.
Immunosuppressive drugs
Corticosteroids (especially for transplantpatients)
Corticosteroids (especially for transplantpatients)
• Side effects:
Edema, moon face, OP, Anemia
