Cardiology Flashcards
What drugs are used in HTN emergencies and ICU settings?
What are important s/e?
Direct Acting Vasodilators: Hydralazine; Nipride (Nitroprusside; ET for pulmonary vasodilation)
S/e: REFLEX TACHYCARDIA, syncope, hypotension, headache
What is the 1st line of tx for HTN?
- MOA
- Characteristics
- Common drug (1)
Diuretics lower BP by increasing urine output.
- Furosemide (Lasix)
s/e:
- Ototoxic (hearing/vision loss)
- Nocturia
- Dehydration
- High drug-drug interactions
*Monitor electrolyte levels (hyperglycemia, hypo/hyperkalemia, hyponatremia)
Hydrocholorothiazide (HCTZ)
Thiazide: blocks reabsorption of Na, Cl, K @Distal convoluted tubule
- Caffeine + ETOH enhances its hypotensive effects
s/e:
- Hyponatremia
- Hypokalemia
- Hyperglycemia (insulin resistance)
Cholorothiazide (Diuril)
Thiazide: blocks reabsorption of Na, Cl, K @Distal convoluted tubule
Caffeine + ETOH enhances its hypotensive effects
s/e:
- Hyponatremia
- Hypokalemia
- Hyperglycemia (insulin resistance)
Metolazone (Zaroxolyn)
Thiazide: blocks reabsorption of Na, Cl, K @Distal convoluted tubule
- Caffeine + ETOH enhances its hypotensive effects
s/e:
- Hyponatremia
- Hypokalemia
- Hyperglycemia (insulin resistance)
Spironolactone (Aldactone)
- t1/2?
K-sparing: blocks renal aldosterone receptors @Distal tubule
- Long t1/2: 1-2 days
s/e: hyperkalemia
What circumstances are Mannitol (Osmitrol) / Isosorbide typically used in?
What class of drugs are they? What is their MOA?
Osmotic diuretics
Tx for cerebral edema + intraocular HTN
- Pulls water into renal circulation
- Inhibits Renin release
What drug class does Labetalol belong to? What is it used to treat?
Adrenergic antagonist (antihypertensive) Tx: Pre-eclampsia
What is the recommended therapeutic dose for Ginseng?
20-30 mg/day
Losartan (Cozaar)
ARB
s/e: hypotension
Hyazaar HCT
Cosart-H
Thiazide + ARB combo
Tx: HTN and HF
Aldactazide - what drug combo is it? Why is it a good option for HTN tx?
K+ sparing and Thiazide combo
- Balances out K+
- Excellent maintenance HTN therapy
Ibesartan (Avapro)
ARB
s/e: hypotension
What are first line medications for HF? What are the s/es?
ACE inhibitors
s/e: severe hypotension
- Enalapril (Vasotec)
- Captopril
- Monopril
- Ramipril (Altace)
Nifedipine (Adalat)
CCB: vascular selective
s/e:
- Dizziness, flushing, hypotension
- Reflex tachycardia
- Peripheral edema
- Dysrhythmias
- Exacerbation of HF
Amlodipine (Norvasc)
CCB: vascular selective
s/e:
- Dizziness, flushing, hypotension
- Reflex tachycardia
- Peripheral edema
- Dysrhythmias
- Exacerbation of HF
Verapamil (Isoptin)
CCB: cardio selective
s/e:
- Dizziness, flushing, hypotension
- Reflex tachycardia
- Peripheral edema
- Dysrhythmias
- Exacerbation of HF
Diltiazem (Cardizem)
CCB: cardio selective
s/e:
- Dizziness, flushing, hypotension
- Reflex tachycardia
- Peripheral edema
- Dysrhythmias
- Exacerbation of HF
Prazosin and Phentolamine
Alpha receptor blockers (adrenergic antagonist)
= peripheral vasodilation
What is the normal fx of Alpha-1 adrenergic receptors?
PERIPHERAL VASOCONSTRICTION
- Dilate pupils
- Increase closure of internal urinary sphincter
- Stimulate secretions (salivary glands)
What is the normal fx of Alpha-2 adrenergic receptors?
PERIPHERAL VASOCONSTRICTION
- Decrease GI motility
- Decrease smooth m. motility
- Contract male genitalia during ejaculation
What drug class do Atenolol*; Propranolol**; Metoprolol belong to?
Beta blockers (stimulate heart)
- Atenolol - vasodilation
- *Propranolol - antiarrhythmic
What is the normal fx of beta-1 receptors?
Cardiac muscle
- Increase myocardial activity
- Increase HR
- Increase renin release
What is the normal fx of beta-2 receptors?
Smooth muscle in BVs, bronchi
- Vasodilation/Bronchodilation
- Increase glycogenolysis in muscle + liver = Incease glucagon release from alpha cells (pancreas)
Lopressor HCT
Diuretic + Adrenergic antagonist
Clonidine; Methyldopa**
Tx?
Centrally-acting Alpha-2 Adrenergic Agonist
- NOT 1st line of HTN therapy
- *Methyldopa = prodrug
Tx: RESISTANT HTN
s/e:
- Hypotension
- Headache
What effects do anti-arrhythmic medications often induce?
- Slow conductivity b/w nodes + fibres
2. Synchronized cardial aversion (letting the heart restart by stopping all activity momentarily)
What is atrial fibrillation?
What are the clinical presentations? (3)
What is the tx protocol?
Blood stasis so heart can’t complete systole
Presentations:
- Irregular HR
- Clot formation/Coagulation
- Altered Q
Tx protocol:
- Assess cardiac fx
- Meds: epinephrine > CCB (CS) > Beta blockers
MOA of Centrally-acting Alpha-2 Adrenergic Agonists?
Tx for _____?
Directly stimulates CNS Alpha-2 receptors in vasomotor centre.
Decreases presynaptic Ca levels > Inhibits release of NE > Net decrease in sympathetic tone in BV
Tx: RESISTANT HTN
List the classes of drugs used to treat hypertension.
- Direct acting vasodilators
- Duretics
- Renin-Angiotensin: ACE inhibitors, ARBs
- CCB
- Adrenergic antagonists
- CA A2 Adrenergic agonists
What are centrally-acting Alpha2 Adrenergic Agonists used to treat? What is the MOA?
Resistant HTN
MOA: stimulates CNS alpha2 receptors in vasomotor centre directly
What is dilated cardiomyopathy?
What is its treatment?
It is when the ventricle stretches and thins out, impairing the heart’s contractility.
Treatment
- If low CO = Acute HF tx
- If long term = heart transplant
What are the mechanisms of anti-arrhythmics? (3)
- slow SA-AV node conduction
- Digoxin - Depress ectopy (abnormal heartbeats) @ ventricular level
- Enhance normal AV conduction
- Lidocaine (Na channel)
- Amiodarone (K channel)
What is SVT and what are the treatments for it?
Type of arrhythmia where a group of abnormally rapid heartbeats start in the atrias d/t issues with electrical system
Treatment:
- Cardioversion (vagal manuvers)
- Adenosine (inhibits cerebral synapse at receptors; sedative)
- Anti-arrhythmics
Which class of drugs do the following belong to?
- Lidocaine
- Amiodarone
- Adenosine
Anti-arrhythmics
- Lidocaine (Na channel)
- Amiodarone (K channel)
Sedative
- Adenosine (used for SVT tx)
Abdominal Aortic Aneurysm
A bulge formed in a distended aorta d/t weak vessel wall.
Sx:
- Often asymptomatic
- Bruits*
- Back + abdomen pain (esp if ruptured = hypovolemic shock)
Aortic Dissection
A tear in the aorta intima, creating a false lumen that blood pools into
If ruptures = cardiac tamponade
Type A (heart and above)
- progresses quickest
- Significant change in SBP in arms
Type B (below heart)
Tx: lower HR first, then lower BP (or else reflexive tachycardia)
Cardiac tamponade
- Signs (4)
Blood pools in pericardium sac
Sx:
1. Narrow PP
2. Muffled heart sounds
3. Hypotension
4. JVP distention
Pulsus paradoxus
When SBP decreases with inspiration caused by cardiac tamponade
ABNORMAL = >10mmHg difference in pressure
How to measure orthostatic hypotension?
Wait 2-5 min b/w each position.
Tell HCP if SBP difference is >20mmHg
DBP difference is >10mmHg
