Cardiovascular

Question 1

What is angina?

Answer 1

a supply/demand problem (suppl of blood to myocardium is not sufficient to meet the demands)

Question 2

What is perfusion?

Answer 2

blood flow

Question 3

What are the consequences of angina?

Answer 3

decreased myocardial perfusion so decreased metabolite removal and decreased oxygenation

Question 4

Which drug is often administered for acute angina attacks?

Answer 4

Nitroglycerin (usually sublingual for fast acting effect)

Question 5

What are the methods of administration of nitroglycerin?

Answer 5

Sublingual tablets and spray (acute)

transdermal patches and ointment (chronic/prophylactic)

Question 6

Nitroglycerin mechanism of action?

Answer 6

pro drug: enters smooth muscle and converted to nitric oxide
can limit platelet adhesion and aggregation
dilates vessels intrinsically (heart) and extrinsically (peripheral vessels)

Question 7

Describe the timeframe of nitroglycerin action.

Answer 7

2 minutes: starts to work
4 minutes: PEAK
10 minutes: max effect
30-60 minutes: duration

Question 8

Nitroglycerin side effects?

Answer 8

flushing, headache, dizziness, reflex tachy

Question 9

What should be done to reduce side effects of nitroglycerin?

Answer 9

Pt should be seated to reduce pooling of blood to the legs which causes side effects.
When seated, the venous dilatation in the legs causes a decrease in blood pressure.

Question 10

What is the max dose of nitroglycerin for an acute attack?

Answer 10

3 tabs (distributed one at a time at 5 minute intervals)

Question 11

What if 3 nitroglycerin tabs don’t work?

Answer 11

Patient is probably having an MI (or the tabs have expired/deteriorated)

Question 12

What is mechanism of action of beta adrenergic blockers?

Answer 12

decrease myocardial oxygen consumption by reducing myocardial contractility, HR, and BP

Question 13

Why avoid sudden withdrawal of beta adrenergic blockers (especially with angina or post-MI therapy)?

Answer 13

risk for acute MI and sudden death

Question 14

What is mechanism of action of Ca Channel blockers?

Answer 14

dilate systemic arteries and main coronary arteries; heart pumps against less resistance; decreases myocardial oxygen consumption

Question 15

Ca Channel blockers (especially verapamil) may cause what changes?

Answer 15

decreased heart rate and myocardial contractility

Question 16

Causes of CHF?

Answer 16

ischemic heart disease, HTN, cardiomyopathy, vavular and pericardial disease

Question 17

CHF non-pharmacological interventions?

Answer 17

stop smoking, control HTN, dec sodium, moderate exercise, dec stress

Question 18

CHF pharmacological management is “mix and match” including:

Answer 18

ace inhibitors (usually first line of therapy)
thiazide loop diuretics, a-adrenergic blockers (B-Blockers), digoxin, hydralazine/isosorbine also used

Question 19

ACE inhibitors have names usually ending in -____.

Answer 19

-pril.

Question 20

What is mechanism of action of ACE inhibitors?

Answer 20

indirectly dec. aldosterone secretion
inhibits vascular smooth muscle contraction
VASODILATION
dec. peripheral resistance

Question 21

Side effects of ACE inhibitors?

Answer 21

cough, decreased/loss of taste perception, hypotension, potassium retention

Question 22

Angiotensin II Receptor Antagonists mechanism of action?

Answer 22

VASODILATION

increased sodium and water excretion

Question 23

Diuretic Classes (3)

Answer 23

thiazides
loop diuretics (lasix)
potassium-sparing diuretics

Question 24

Effect of diuretics?

Answer 24

control excessive fluid and edema, dec. workload on the heart

Question 25

Diuretics and CHF?

Answer 25

Used in combination for CHF: inc. effects and safety of ACEIs and Beta Blockers (but diuretics should not be used alone for CHF)

Question 26

Digoxin (Lanoxin) mechanism of action?

Answer 26

positive inotropic effect (increase strength of muscular contractions)

Question 27

Digoxin (Lanoxin) side effects?

Answer 27

side effects/adverse effects with toxicity can be FATAL: cardiac arrhythmia, CNS (mental status change, disorientation, blurred vision)

Question 28

What patients is Digoxin (Lanoxin) best for?

Answer 28

pts with abnormal contractility (often atrial flutter/fibrillation) or rapid ventricular rate

Question 29

What is usual dose of Digoxin (Lanoxin)?

Answer 29

0.125 mg

remember, toxicity is a huge problem ~25% of patients experience signs of toxicity

Question 30

Digoxin (Lanoxin) drug interactions?

Answer 30

diuretics - due to hypokalemia - directly increases risk of toxicity

Question 31

Vasodilator that has direct effect on smooth muscles of arterioles but no effect on veins:

Answer 31

Hydralazine (often used in combination with a diuretic and/or B-Blocker)

Question 32

What is the effect of B-blockers to notice with exercise?

Answer 32

muted cardiovascular response