Cardio Pharm

Question 1

Diuretics

Answer 1

Overall decrease in blood vessel
increase water excretion
increased sodium

Adverse effects: electrolyte/fluid imbalance, orthostatic hypotension, change in mood, weakness/fatigue

IND: hypertension, CHF

Question 2

Beta Blockers

Answer 2

decrease HR, force contraction, sympathetic to heart

Adverse effects: bronchodilation, orthostatic hypotension, decrease max exercise capacity, psychotropic effects (depression, libido decrease, lethargy)

other blockers: centrally acting, ganglion, presynaptic adrenergic inhibitors, alpha blockers

IND: angina, arrythmias, heart failure, hypertension, raynauds disease, recovery from MI

Question 3

Vasodilators

Answer 3

inhibits smooth muscle contracts

Adverse effects: tachycardia, orthostatic hypotension, fluid edema, dizziness/HA, avoid systemic heat

IND: hypertension, heart failure

Question 4

Renin-angiotensin System drugs adverse effects

Answer 4

adverse effects: dizziness/naseua, allergic reaction/edema, dry cough due to bradykinesia, damage to CV or kidneys, may increase BP

Question 5

ACE Inhibitor

Answer 5

Angiotensin II converting enzyme inhibitor- prevents ANG II formation= decreased vasocostriction and less vasohypertrophy

Question 6

Angiontensin II receptor blocker

Answer 6

new drug, milder side effects

blocks receptor=decrease ANG II effect on BV/heart

Question 7

Renin Blocker

Answer 7

aliskien prevents renin from converting angiotensin into ANG I= no effect of ANG II effect

Question 8

Calcium channel blocker

Answer 8

stabilizes HR by decreasing Ca entry into smooth muscle

Adverse effects: swollen foot/ankle, orthostatic hypotension, change in HR, increase risk of MI, avoid systemic heat

IND: hypertension, angina, arrythmias

Question 9

Organic nitrates

Answer 9

administered sublingual or by patch

decrease preload (venous return to heart)
decreases postload (blood heart pumps against)

overall decrease in cardiac workload and oxygen demand

Question 10

Organic nitrates tolerance

Answer 10

patch= decrease effect
discontinuing application may increase effectiveness
prevent tolerance through interval application

Question 11

Organic nitrates adverse effects

Answer 11

dizziness/HA
orthostatic hypotension
avoid systemic heat

Question 12

Digitalis Mechanism

Answer 12

autonomic mechanism: decrease HR by stimulating vagus

mechanical: inhibits Na/K pump=increase Na in cell=increase Ca= increase myocardial Ca for contraction

Question 13

Digitalis Adverse effects

Answer 13

severe effect: fatal

GI problems
confusion
fatigue
depression
arrythmias
blurred vision

Question 14

Positive inotropes Mechanism

Answer 14

inhibit phosphodiesterase= prevent cAMP breakdown=increase intracellular Ca for contraction

stimulate dopamine B receptors

Question 15

Positive inotropes Adverse effects

Answer 15

digitalis just has effective
IV drip
only for acute heart failure

Question 16

Mechanism of Clot formation

Answer 16

intrinsic: CF XII contacts damaged BV
extrinsic: damaged BV release CF VII

together CF X converts prothrombin into thrombin

thrombin assists fibrinogen form fibrin

Question 17

Mechanism of clot breakdown

Answer 17

tissue Plasmin activator (tPA) converts plasminogen into plasmin

Question 18

Anti-coagulants

Answer 18

indicated for DVT
acts rapidly
administered paraenterally
increases effect of anti-thrombin III

Question 19

Heparin types

Answer 19

unfractionated heparin- unpredictable, IV admin, CF IXa Xa

low molecular weight heparin- predictable, safer, sub Q admin, CF Xa

Question 20

HIT types

Answer 20

heparin induced thrombocytopenia

type 1=asymptomatic, self resolving
type 2= limb threatening, immunre response to heparin

Question 21

Oral anticoagulants

Answer 21

inhibit the cycle of vit k conversion to vit k epoxide

Question 22

Warfin

Answer 22

administered 3-4 times/day to slowly ween into coumadin

warfin use after heparin

Question 23

Other anticoagulants

Answer 23

direct thrombin inhibitorrs

CF Xa inhibitors

Question 24

Anti-thrombotics in general

Answer 24

decrease platelet induced clot

Question 25

Aspirin

Answer 25

prevents formation of PG2 and Thromboxane

men more effective for MI
female more effective for CVA

baby aspirin may be therapeutic: irreversibly inhibit platelets

Question 26

ADP inhibitors

Answer 26

ADP stimulates platelets, ADP inhibitor inhibits ADP

Question 27

Glycoprotein inhibitor

Answer 27

GP stims fibrin, GP inhibitor inhibits GP

Question 28

Thrombolytics

Answer 28

initiates clot break down in coronary arteries

fibrinolytics activation

Question 29

Use of thrombolytics for MI

Answer 29

no one drug is superior
decreases mortality by 50% in admin within 1hr
effective within 3-12 hours

Question 30

Use of thrombolytics for CVA

Answer 30

must rule out hemorrhage
effective within 2 hr admin
use of r-TPA

Question 31

Adverse effects of thrombolytics

Answer 31

hemorrhage

dressing change, manipulation, debridement cautions

Question 32

Treating clotting deficiency (Hemophilia)

Answer 32

fibrinolytic inhibitors

vit k for new borns

Question 33

2 types of Hemophilia

Answer 33

type 1= factor VIII replacement

type II= factor IX

Question 34

2 main drrug to treat Hyperlipidemia

Answer 34

Statin- decreases cholesterol synthesis, increase LDL breakdown, increase HDL, decrease triglyceride

Fibric acid- activates nuclear receptor to affect lipid metabolism

Question 35

Other drugs to treat hyperlipidemia

Answer 35

niacin- decrease triglyceride

ezetimbe- affect GI lipid absorbtion

bile acid- decreases plasma cholesterol

Question 36

Antilipd concerns

Answer 36

GI problems
liver/renal toxicity
statin induced myopathy

Question 37

Statin induced myopathy

Answer 37

decrease cholesterol in muscle
decrease co-enzyme Q10
decrease prenylate protein for gene replication
increase enzyme require to regulate protein

Question 38

Factors that affect Statin induced myopathy

Answer 38

fixed factors
genetic
old age
female
renal/liver disease

modifiable
increase in exercise
high dose
lipophilic drug
combining drugs