Cardiovascular Flashcards
Patients with systolic
dysfunction, have lower than normal cardiac ejection fractions
(EF < 40%).
due to stroke volume reductions along with increases in end diastolic volumes.
Frank–Starling mechanism
increased fiber dilation heightens
the contractile force, which then increases the energy released
beta-adrenergic blockers interfere with the sympathetic nervous system. In what all ways?
norepinephrine induced (all the below list)-
peripheral vasoconstriction,
sodium excretion by the kidney,
cardiac hypertrophy
arrhythmia generation,
hypokalemia, or cell death (apoptosis) How cell death????????
through increased stress owing to norepinephrine stimulation.
blockers should not be taken without diuretics in patients with a current or recent history of fl uid
retention
to avoid its development and to maintain sodium balance.
Patients should be monitored for signs of fl uid retention & report any significant increases,
which might warrant increases in diuretic doses or reductions
in the dose of the beta-adrenergic blocker
fatigue, hypotension, bradycardia,
and heart block are reported side eff ects that
should be monitored to ensure appropriate attention
and management.
beta-Adrenergic blockers are generally used in conjunction with
diuretics, ACEIs, or ARBs
ACEIs contraindications include:
H/Ointolerance or adverse reactions
serum potassium >5.5 mEq/L
serum creatinine levels >3 mg/dL, symptomatic hypotension,
severe renal artery stenosis, pregnancy.
ACEIs: 1st method: They inhibit the ACE and this action significantly decreases total peripheral resistance(as Ang II is potent vasoconstrictor), which aids in reducing afterload.
2nd method: Inhibiting the production of angiotensin II interferes with stimulation of aldosterone release, thus indirectly reducing retention of sodium and water, which decreases venous return and preload.
ACEIs side effects to be monitored include
hypotension (patients should be well hydrated before initiation of ACEIs), dizziness,
reduced renal function (increased serum creatinine of 0.5 mg/dL or more requires reassessment),
cough
potassium retention (if potassium levels
are high without supplementation, discontinue the ACEI for several days and then try to restart at lower dose)
Angioedema is a life-threatening S.E
May elevate Li+ levels (monitor Li+ levels, adjust dose).
It is critical to wait______ hours between the administration of an ACE inhibitor and
valsartan/sacubitril (or switching back to an ACE inhibitor), to minimize the risk of
angioedema.
36
Patients who experience diuretic resistance or tolerance to their effects
might need intravenous administration, a combination of two DIURETIC agents with differing mechanisms or the addition of agents, such as dopamine or dobutamine VASODILATOR, which increase renal blood flow.
THIAZIDE
agents are relatively weak because they are able to increase the fractional excretion of sodium to only 5% to 10% of the filtered load. and lose their effectiveness with moderately impaired renal function (creatinine clearance <30 mL/min).
LOOP diuretics
ability to increase sodium excretion to 20% to 25% of the filtered load and to maintain their efficacy until renal function is severely impaired (creatinine clearance < 5 mL/min) plus have the added advantage of reducing venous return independent of diuresis.
SAR of statins
https://youtu.be/U_f7E5C7d1M
CYP3A4 inhibitor and so avoid with grape fruit juice
SAL
Simvastatin, Atorvastatin, Lovastatin
