Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Pediatric Pharmacology Exam 1 > Cardiology 1 > Flashcards

Cardiology 1 Flashcards

1
Q

Preload

A

Ventricular filling pressure or left ventricular end-diastolic volume

(filling pressure and volume at the end of diastole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Afterload

A

Left ventricular wall tension or stress during systole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cardiac Output

A

Volume of blood ejected per unit of time

CO= HR x SV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cardiorenal HF

A

Sodium/Water excess –> think diuretics as first line of treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cardiocirculatory HF

A

inadequate contractility –> think positive inotropes for treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Neurohormonal HF

A

Initial insult activates sympathetic system; but progression is mediated by neurohormones –> modulate hormonal activation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Systolic Dysfunction (3)

A
  1. Decreased Ejection Fraction <40%
  2. Impaired wall motion
  3. Dilated ventricle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Diastolic Dysfunction (5)

A
  1. Preserved Ejection Fraction >40%
  2. Impaired ventricular relaxation and filling
  3. Normal wall motion
  4. Loss in elasticity of the cardiovascular system
  5. Usually caused by cardiomyopathies (restrictive, infiltrative, hypertrophic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Signs and Symptoms of HF (6)

A
  1. Growth failure (INCREASED METABOLISM)
  2. Respiratory distress
  3. Exercise intolerance, difficulty feeding
  4. Edema
  5. Dyspnea
  6. Fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PHFI +1 Classification for HF (5)

A
  1. Marked cardiomegaly by x-ray or physical exam
  2. Reported physical activity intolerance or prolonged feeding time
  3. Pulmonary edema by x-ray or auscultation
  4. Hepatomegaly less than 4cm below costal margin
  5. Mild to moderate tachypnea or dyspnea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PHFI +2 Classification for HF (8)

A
  1. Abnormal ventricular function by echo or gallop
  2. Dependent edema, pleural effusion, or ascites
  3. Failure to thrive or cachexia
  4. Poor perfusion by physical exam
  5. Resting sinus tachycardia
  6. Retractions
  7. Hepatomegaly over 4cm below costal margin
  8. Moderate to severe tachypnea or dyspnea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Medications for PHFI +1 (4)

A
  1. Digoxin
  2. Low to moderate dose diuretics
  3. ACE-Inhibitors, non-ACE inhibitor vasodilators or ARBs
  4. Beta Blockers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Medications for PHFI +2 (3)

A
  1. High dose diuretics or more than 1 diuretic
  2. Anticoagulants not related to prosthetic value
  3. Anti-arrhythmic agents or ICD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How to calculate PHFI

A

Total score derived by adding scores attributed to each individual criterion

0= no HF
30= severe HF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Vasoconstriction Compensatory Mechanisms of HF

A

Vasoconstriction increases BP and decreases CO to shunt blood to the brain and the heart; get a decrease in SV which further activates compensation of vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pharmacologic Therapy Principles for Systolic HF (6)

A
  1. Block the compensatory neurohormonal activation caused by decreased cardiac output
  2. Prevent/minimize Na and water retention
  3. Eliminate/minimize symptoms of HF
  4. Slow progression of cardiac dysfunction
  5. Decrease mortality (prolong survival)
  6. Increase quality of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diuretics Mechanism of Action (3)

A
  1. Inhibits reabsorption of sodium and chloride in the renal tubules
  2. Increased Na excretion –> increased volume excretion –> decreased preload
  3. Rapid improvement in edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Loop Diuretic Agents (3)

A
  1. Furosdemide (Lasix)
    * Main diuretic used with children; if patient is going from IV to oral, double the dose
  2. Torsemide
  3. Bumetanide (Bumex)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Loop Diuretic Site of Action, Mechanism of Action, and Adverse Effects (3)

A
  1. Site of Action: Ascending loop of henle
  2. Mechanism of Action: inhibits chloride, sodium, and potassium reabsorption
  3. Adverse Effects: increased potassium and sodium loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Thiazide Diuretics Available Agents (2)

A
  1. Hydrochlorothiazide

2. Chlorothiazide (Diuril)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Thiazide Diuretics Site of Action, Mechanism of Action, and Adverse Effects (3)

A
  1. Site of Action: Early distal tubule
  2. Mechanism of Action: Inhibits chloride reabsorption = inhibit sodium reabsorption
  3. Adverse Effects: Increased potassium, sodium, and chloride loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Aldosterone Antagonist (K sparing) Diuretic Agents (3)

A
  1. Spironolactone
    * Also commonly used with children
  2. Eplerenone
  3. Amiloride
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Aldosterone Antagonist (K sparing) Diuretic Site of Action, Mechanism of Action, and Adverse Effects (3)

A
  1. Site of Action: Late distal tubule, early collecting ducts
  2. Mechanism of Action: inhibits na/k antiports, so it inhibits sodium and increases potassium secretion
  3. Adverse Effects: increased potassium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Osmotic Diuretic Agent, Site of Action, Mechanism of Action, Adverse Effects (4)

A
  1. Agent: Mannitol
  2. Site of Action: proximal tubule, thin descending lim, distal tubule, and collecting ducts
  3. Mechanism of Action: prevents water reabsorption; indirectly inhibits sodium reabsorption
  4. Adverse Effects: increased electrolyte imbalance, hyperglycemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Carbonic Anyhydrase Inhibitors Diuretic Agent, Site of Action, Mechanism of Action, Adverse Effects (4)
1. Agent: Acetazolamide 2. Site of Action: Proximal Tubule 3. Mechanism of Action: Inhibits HCO3, H, Sodium reabsorption 4. Adverse Effects: HCO3 loss --> acidosis
26
Diuretics Resistance (2)
1. Decreased absorption due to edema at GI tract and hypoperfusion 2. Increased exposure leads to changes in renal tubules altering ion transport
27
How to overcome diuretic resistance (4)
1. Administer as continuous infusion 2. Add positive inotropic agent 3. Increase dose or frequency of diuretic* 4. Add additional diuretic for synergy
28
General Adverse Effects of Diuretics (4)
1. Electrolyte depletion - Decrease Na, K, Mg, Ca, Cl 2. Hypotension 3. Dizziness 4. Dehydration/azotemia * Azotemia=increased nitrogen-containing compounds
29
Loop Diuretic ADEs (4)
1. Nephrotoxic 2. Caution with sulfa allergy (all contain sulfur moiety) 3. hyperglycemia 4. Hearing loss (reversible)
30
Spironolactone ADEs (2)
1. Hyperkalemia --> used in pediatrics mainly for this affect 2. Gynecomastia
31
What to monitor with Diuretics (6)
1. All electrolytes 2. SCr (serum creatinine for renal function) 3. Vitals (BP) 4. Body weight - trend weight increases/decreases with urine output 5. HF symptoms 6. ADEs
32
Diuretic Clinical Pearls (5)
1. Loops are recommended as first line therapy 2. Do not over-diurese; maintain euvolemic state 3. Monitor and replace K and Mg as needed, especially with loops 4. Dose in morning! unless multiple daily dose are required 5. May combine classes of diuretics for synergy
33
Furosemide Pearls and Dosing (4)
1. Dosing: 1-2 mg/kg 2. Available as tablet and solution 3. Most common diuretic used in children 4. Generally well tolerated but can see rare and serious side effects
34
Acetazolamide Dosing and Pearls (2)
1. Dosing: 5mg/kg up to 3x/day | 2. Used in inpatient setting to help secrete bicarb (for alkalosis)
35
Spironolactone Dosing and Pearls (2)
1. Dosing: 1mg/kg q8-q24 | 2. Used primarily for potassium sparing effects to avoid KCl supplementation
36
KCl supplementation dosing and Pealrs (2)
1. Dosing: 1-4mEq/kg q8-24 | 2. Available as liquid and delayed release tablets
37
ACE Inhibitor Mechanism of Action (7)
1. Blocks production of angiotensin II 2. Decreased sympathetic stimulation 3. Decreased production of aldosterone and vasopressin 4. Decreased vasoconstriction (afterload) 5. Increased bradykinins 6. Increased vasodilatory prostaglandins 7. May affect cardio remodeling
38
ACE Inhibitor ADEs (6)
1. Non-productive cough 2. Increased potassium 3. Angioedema 4. Renal insufficiency 5. Hypotension 6. Neutropenia
39
ACE Inhibitor Monitoring (4)
1. BMP; mainly SCr and K 2. BP 3. CBC 4. HF symptoms
40
ACE Inhibitor and ARB Contraindications (3)
1. Potassium over 5.5 2. History of angioedema 3. Pregnancy
41
ACE Inhibitor and ARB Cautions (3)
1. Potassium over 4.5 or taking other medications that increase potassium 2. SCr over 3mg/dL (monitor SCr in children) 3. Bilateral renal artery stenosis
42
Enalapril Dose interval, available dosage forms, clinical pears (3)
Enalapril is the prodrug! 1. Dose interval: once daily dosing (can dose q12) 2. Available dosage forms: oral tablet, compound suspension, 1mg/ml manufacturer suspension 3. Clinical pearls: because of significant risk of Hypotension, test dose is 0.05mg/kg and max dose is 0.4mg/kg/dose BID
43
Captopril Dose interval, available dosage forms, clinical pears (3)
1. Dose interval: Usually given 3 times per day (shortest half-life) 2. Available dosage forms: tablet, compound suspension, transdermal patch IV 3. Clinical pearls: Shortest 1/2 lift so easier to titrate the dose initially, but for compliance not used as much
44
Lisinopril Dose interval, available dosage forms, clinical pears (3)
1. Dose interval: Once daily dosing 2. Available dosage forms: oral tablet, manufracturer suspension 3. Clinical pearls: All equally effective
45
Enalapril test dose and max dose
Because of significant risk of Hypotension, test dose is 0.05mg/kg and max dose is 0.4mg/kg/dose BID Ex: starting a patient on Enalapril and he weighs 8kg, what would the dose be? 0.05*8=0.4mg
46
ACE Inhibitor Clinical Pearls (1C, 2A)
1. May see more pronounced 1st dose response 1A. Decreased Serum Na, volume depletion, concurrent diuretics 1B. CHF exacerbations 1C. Hemodynamic instability 2. African American (AA) Patients are more likely to have low renin activity 2A. 2-4 fold incidence in angioedema and cough
47
ARB Mechanism of Action
Selectively blocks binding of angiotensin II to the AT1 receptor found in tissues - Decreased production of aldosterone and vasopressin - Decreased vasoconstriction (afterload) - Does not inhibit metabolism of bradykinin
48
Adverse Effects of ARBs
1. Increased K 2. Angioedema 3. Renal Insufficiency 4. Hypotension 5. Neutropenia
49
Monitoring for ARBs
1. BMP (SCr and K) 2. CBC 3. BP 4. HF symptoms
50
ARB Clinical Pearls (3)
1. Indicated in patients intolerant to ACE inhibitors due to cough or angioedema (although angioedema is a caution with ARBs) 2. Same cautions and contraindications as ACE inhibitors 3. Mainly used in pediatrics - Marfans syndrome
51
Beta Blocker Mechanism of Action (6)
1. Blocks effect of sympathetic neurotransmitters (norepinephrine) on the heart and vasculature. Beta receptor stimulation normally leads to increase in HR, myocardial contractility, BP and myocardial O2 demand. 2. Decreased ventricular arrhythmias 3. Decreased cardiac hypertrophy and myocardial cell death 4. Decreased vasoconstriction and HR 5. Beta 1 = heart 6. Beta 2 = lungs
52
Timolol
Non-selective Beta blocker topically used for intraocular pressure
53
Nadolol (4)
1. Non-selective Beta blocker with longer half life * Needs dosage adjustment if patient has renal impairment 2. 100% urine elimination 3. Nonselective so works on splancneic 4. Used commonly in patients with HTN or liver disease to decrease risk of esophageal varices
54
Propranolol (5)
Non-selective BB that is also used for: 1. Tet spells 2. HTN 3. Anxiety 4. Migrane ppx 5. Hemangioma
55
Sotalol
Non-selective BB primary used for arrhythmias
56
Atenolol (4)
1. Beta-1 selective (heart) 2. Requires renal adjustment (40% excreted as unchanged drug) 3. Once or twice daily administration 4. Only available as tablet so requires compounding for suspension
57
Esmolol (4)
1. Beta-1 selective (heart) 2. Used primarily for treatment of supraventricular tachycardia (SVT), atrial fib/flutter, and hypertensive emergency. 3. IV formulation only, very fast acting with short half life (3 to 6 min in children, 9 min in adults) 4. Causes dramatic drop in BP
58
Metoprolol (4)
1. Hepatic metabolism (no renal interactions) * good for patients with renal impairment 2. IV dosing is much lower 3. ER and IR oral formulations; recipe for suspension available (ER and IR would have different dosing) 4. Beta-1 selective (heart)
59
Carvedilol (3)
1. Beta-1 selective (heart) 2. B1 and alpha-1blockade --> decreased afterload 3. Greater reduction in BP compared to metoprolol
60
Labetalol
beta 1 selective and alpha1 blockade
61
Beta Blocker ADEs (6)
1. Hypotension 2. Decreased HR 3. Fluid retention 4. Depression 5. Fatigue/weakness 6. Sexual dysfunction
62
How to manage BB hypotension
Decreased vasodilator therapy --> if hypotension persists then decrease beta blocker dose
63
How to manage BB fluid retention
Increase diuretic dose --> if fluid retention persists then decrease BB dose
64
How to manage BB bradycardia
Decrease beta blocker dose! --> if bradycardia persists then d/c BB
65
Beta blocker cautions (4)
1. Severe bronchospastic disease (asthma) 2. Bradycardia 3. Symptomatic hypotension 4. 2nd or 3rd degree heart block
66
Beta blocker monitoring (4)
1. Body weight 2. Vitals (BP, HR) 3. HF symptoms 4. ADEs
67
Beta blocker clinical pearls (5)
1. Utilized in clinically stable patients on ACE-I and diuretics 2. Should be fluid stable before starting therapy 3. May become more symptomatic for first few weeks when starting therapy 4. ‘Start low, titrate slow’ 5. If therapy is held for over 72 hours, consider restarting beta blocker at 50% of previous dose
68
Aldosterone Antagonist Mechanism of Action (5)
1. Blocks effects of aldosterone in the kidneys, heart and vasculature 2. Decreased potassium and magnesium loss - decreased ventricular arrhythmias 3. Decreased sodium retention - decreased fluid retention 4. Decreased catecholamine potentiation - decreased BP 5. Blocks direct fibrotic actions on myocardium
69
Types of Aldosterone Antagonists (2)
1. Spironolactone | 2. Eplerenone
70
ADEs of Aldosterone Antagonists (3)
1. Increased K 2. Gynecomastia or breast pain 3. Sexual dysfunction
71
Clinical Pearls of Aldosterone Antagonists (3)
1. Spironolactone is used in pediatric cardiology primarily for potassium sparing effect 2. Only tablets are available so it requires compounding pharmacy to prepare suspension 3. Avoid used in combination with both an ACE-I and ARB due to risk of increased potassium
72
Benefits of Digoxin (4)
1. Improved symptoms 2. Improved exercise tolerance 3. Decreased hospitalizations 4. No effect on mortality
73
Digoxin Mechanism of Action
1. Inhibits Na-K ATPase 2. Decreased central sympathetic outflow 3. Decreased renal reabsorption of Na 4. Increased minimal in cardiac contractility due to inhibition of Na-K ATPase
74
Digoxin ADEs (4)
1. Dig toxicity 2. Cardiac toxicity - ventricular arrhythmias, heart blocks, bradycardia 3. GI disturbances 4. CNS toxicities - confusion, vision changes
75
Digoxin Risk Factors for ADEs (6)
1. Increased Ca 2. Decreased K 3. Decreased Mg 4. Hypothyroidism 5. Interacting medications 6. Renal insufficiency
76
Digoxin Contraindications
2nd or 3rd degree heart blocks
77
Digoxin Cautions while on.... (5)
1. Amiodarone 2. Diuretics (ex: Furosemide) 3. Cholestyramine 4. Spironolactone 5. Verapamil
78
Digoxin Monitoring (5)
1. BMP (K and SCr) 2. Serum digoxin levels - Therapeutic: 0.8-1.2 3. Vitals (HR) 4. HF symptoms 5. Signs/Symptoms of digoxin toxicity
79
Increased Digoxin Monitoring is required if...(4)
1. Changes in renal function 2. Changes in EKG 3. Signs/Symptoms of digoxin toxicity 4. Initiation or d/c of interacting medications
80
Digoxin Clinical Pearls (4)
1. NOT indicated for acute exacerbations 2. Loading dose not needed in HF 3. Decreased starting dose in patients with conduction abnormalities, decreased renal function, low lean body mass 4. Decreased dose by 50% for concomitant amiodarone therapy
81
Hydralazine Mechanism of Action (2)
1. Vasodilator | 2. Enhances effects of nitrates
82
Nitrates Mechanism of Action (2)
1. Stimulates nitric acid signaling in endothelium | 2. Decreases preload
83
Nitrates ADEs (5)
1. Headache 2. Hypotension 3. Dizziness 4. Flushing 5. Flu-like symptoms
84
Hydralazine ADEs (5)
1. Headache 2. Hypotension 3. Dizziness 4. Leucopenia/thrombocytopenia 5. Lupus-like symptoms
85
Nitrates and Hydralazine Monitoring (5)
1. CBC - WBC and Platelets 2. Vitals - BP 3. ANA profile - only if lupus symptoms appear 4. HF symptoms 5. ADEs
86
Calcium Channel Blocker Benefits (3)
1. No mortality benefit 2. May be beneficial in treatment of hypertension in patients at target doses of ACE-I, beta blockers, and ARBs 3. No observed decompensated HF when using amlodipine or felodipine
87
Anti-Arryhtmics (2)
1. ONLY 2 anti-arrhythmics have been proven safe in treating arrhythmias in HF – Amiodarone – Dofetilide 2. Therapy indicated for sustained or hemodynamically unstable ventricular tachycardia, ventricular fibrillation, recurrent/sustained atrial arrhythmias
88
Red Flag Medications in HF (12)
1. All class I agents of anti-arrhytmics (ex: Stalol) - Instead, use amiodarone or dofetilide 2. Ditiazem 3. Verapamil 4. Metformin (oral hypoglyemic) 5. Rosiglitazone (oral hypoglyemic) 6. Pioglitazone (oral hypoglyemic) 7. Systemic glucocorticoids - prednisone, methylprednisolone, hydrocortisone, dexamethasone 8. HRT therapies (estrogens and androgens) 9. NSAIDs - Ibuprofen and Naproxen 10. Doxorubicin 11. Daunorubicin 12. Cilostazol
89
Aspirin (5)
1. Used post Norwood and other procedures that require the least amount of anticoagulation 2. Used for IVIG resistant Kawasaki Disease for anti-inflammatory effects as well as protection from aneurysm clotting 3. Dosing: 5-10mg/kg, 1/4, 1/2, and 1 tablet dosing 4. Unstable in liquid, therefore tablet must be crushed and diluted with small amount of water just before administration 5. Caution with Reye's syndrome
90
Warfarin Mechanism of Action (3)
1. Competitively inhibits VKORC1 depleting functional Vitamin K reserves 2. Limits the amount of vitamin K dependent coagulation factors needed for clotting 3. Factors affected: Factors II, VII, IX, X, Protein C & S (natural anticoagulants) * blocks body's natural coagulants and increases clearance to form a clot; hyperthrombotic patient on heparin/lovenox to prevent hyperthrombotic state
91
Warfarin Place in Pediatric Medicine (2)
1. Post-Fontan procedures | 2. Extracardiac devices (usually INR is higher)
92
Warfarin Dosing (3)
1. 0.2mg/kg starting dose 2. Usually given at night for AM lab draws 3. May require a bridge anticoagulation for first 3-4 days or until therapeutic INR due to earlier depletion of protein C and S
93
Warfarin Monitoring (2)
1. Nutrition 2. INR goal (2-3) * Especially watch INR in patients on antibiotics 3. Drug/Food Interactions - Many! - Watch Vitamin K intake because Warfarin is a Vitamin K antagonist; if they eat increased Vitamin K they may need higher dose of Coumadin
94
Enoxaparin (4)
Lovenox 1. DVT prophylaxis; inhibits factor Xa to prevent clots 2. Tx of any thrombosis (ex: pulmonary embolism, catheter associated clot) 3. Dosing is based on therapeutic anti-Xa 4. Monitoring is based on the peak level drawn 4-6 hours after the dose 5. Protamine is only minimally useful in reversing anticoagulation
95
Enoxaparain Dosing in children
1-2 mg/kg/dose q12 hours | *only available in SC injection

Advanced Pediatric Pharmacology Exam 1 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions