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Pharma 600 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Formula for BP

A

BP = CO X TPR

CO: cardiac output
TPR: total peripheral resistance to blood flow

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2
Q

Most important factor determining TPR

A

Blood vessel diameter

Volume and viscosity of blood also factors

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3
Q

Hypertension

A

140/90

“Silent killer”. Often asymptomatic.

Major risk factor for heart disease.

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4
Q

Average resting HR

A

70-72 bpm

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5
Q

Rapid heart rate …

A

Reduces the time frame in which the heart wall itself can be perfused with fresh blood.

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6
Q

Five functional categories of cardiovascular meds:

A
  1. Improve heart function
  2. Increase blood vessel diameter
  3. Alter blood coagulation mechanisms
  4. Reduce blood volume
  5. Lower blood lipid levels
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7
Q

Drugs that improve heart function:

A

Beta blockers

Cardiac glycosides

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8
Q

Beta blockers

A

Act on beta-adrenergic receptors in the surface of the heart (NE, epinephrine).

Metoprolol, atenolol, propranolol, labetolol.

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9
Q

Beta blockers: Mechanism

A

Hypertension: reduce cardiac output –> reduce BP

Ischemic heart disease: reduces HR and CO –> reduces workload

Heart failure: can reduce peripheral resistance and workload of heart

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10
Q

Beta blockers: Adverse effects

A

GI: nausea, trots

Resp: bronchospasm

Cardio: hypotension, bradycardia, heart failure

Endocrine: hypoglycaemia

CNS: fatigue, dizziness, depression

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11
Q

Beta blockers: massage guidelines

A

Be careful of hypotension.

Tx:Caution lying down.

Hydro: Don’t increase cardiac workload

Ex: ditto. Also fatigue.

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12
Q

Cardiac glycosides

A

Digitalis
Digoxin

Used to manage congestive heart failure; treatment and prevention of dysrhythmias.

Increases contractility of heart while decreasing heart rate.

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13
Q

Digoxin: mechanism

A

Reduces heart rate

Increases strength of contraction

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14
Q

Digoxin: adverse effects

A

Toxicity: fatigue, nausea, vomiting, visual disturbances, headache

Bradycardia

Hypotension

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15
Q

Digoxin: massage

A

Be aware of dysrhthmias, dyspnea, angina

General guidelines for heart failure.

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16
Q

Drugs that increase blood vessel diameter

A

Vasodilators
Alpha receptor
Calcium channel blockers
ACE inhibitors

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17
Q

Vasodilators

A

Nitrate-related compounds (nitroglycerine)

Used to manage angina, hypertension, congestive heart failure.

Can be administered via oral spray, sublingually, transdermally, IV
* almost complete first pass metabolism

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18
Q

Nitroglycerine: mechanism

A

Vasodilation of coronary arteries

Improves blood flow to heart; decreases preload and afterload (this decreasing workload to heart)

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19
Q

Nitroglycerine: adverse effects

A

Hypotension

Headache

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20
Q

Nitroglycerine: massage

A

Ischemic heart disease guidelines

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21
Q

Alpha receptor drugs

A

Found in smooth muscle of BV walls

Alpha-1 and Alpha-2

NE, epinephrine (adrenergic) receptors

Hypertension, congestive heart failure, reynauds

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22
Q

Alpha-2 receptor agonist: mechanism

A

Hypertension: acts on CNS to cause peripheral vasodilation

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23
Q

Alpha 1-receptor antagonist

A

Alpha 1 receptors in vascular smooth muscles. Cause vasoconstriction

Antagonists (ie Prazosin, doxazosin) cause vasodilation

Hypertension
Angina

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24
Q

Alpha 2 receptor agonist

A

Alpha 2 receptors in CNS –> decrease SNS –> peripheral vasoconstriction

Agonists (clonidine) –> vasodilation

Hypertension

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25
Alpha 1 receptor antagonist: mechanism
Hypertension: vasodilation and reduces force of heart contraction Angina: reduces workload of the heart by reducing contractility
26
Alpha 2 agonist: adverse effects
CNS: fatigue, drowsiness, sedation Cardio: hypotension (orthostatic and otherwise)
27
Alpha 1 receptor antagonist: adverse effects
Cardio: edema, bradycardia, congestive heart failure, hypotension, dizziness
28
Alpha Receptor Drugs: Massage
Postural hypotension (Alpha 1 antagonist: edema) Systemic heat risks hypotension and syncope
29
Calcium channel blockers
Acts on smooth muscle tone in BV walls Verapamil, nifedipine, ditiazem Used to treat hypertension and tachycardia and to prevent migraines and vascular spasm after brain hemorrhages.
30
Calcium channel blockers: mechanism
Hypertension: vasodilation, reduction of force of heart contraction Angina: reduces contractility so reduces workload
31
Calcium channel blockers: | Adverse effects
Edema, bradycardia, congestive heart failure, hypotension, dizziness
32
Calcium channel blockers: massage
Hypotension, edema, syncope
33
ACE Inhibitors
Vasodilation by interrupting action of enzyme in RAA system. --> reduces angiotensin II production Long term BP control Hypertension Congestive heart failure Lisinopril Captopril enalapril
34
ACE inhibitors: mechanism of action
Vasodilation | Reduced blood volume
35
ACE inhibitors: adverse effects
Dizziness, hypotension Cough Hyperkalemia (excess circulating K+)
36
ACE inhibitors: massage
Positional hypotension. Maybe not lying down. Syncope
37
Three categories of drugs that affect coagulation.
1. Anticoagulants 2. Antithrombics 3. Thrombolytics
38
Blood coagulant affecting drugs are used to treat:
DVT | Thromboembolic and circulatory disorders (heat attack, surgery, pulmonary embolism,TOA)
39
Anticoagulants: mechanism
Heparin: activation of anti thrombin II, decreased thrombin activity Warfarin: Vit K antagonist
40
Which drug is easily affected by food, resulting in over/under dose?
Coumadin (warfarin)
41
Anticoagulants: adverse effects
Hemorrhage | Ecchymosis
42
Anticoagulants: massage
Don't bruise 'em
43
Antithrombotics
AKA antiplatelet drugs. Aspirin Used to prevent thrombosis Inhibit formation of thromboxanes (aspirin specifically)
44
Thrombolytics
Promote disintegration of clots Increase plasmin formation (enzyme that breaks down thrombi) Used to treat arterial and venous thrombi, prevent after strokes and heart attacks, and to clear IVs etc
45
Streptokinase
Enzyme delivered as drug that combines with plasminogen to facilitate plasmid formation --> break up thrombi b
46
Cardiovascular response to heightened tissue demand:
1. Increase blood pressure 2 increase heart rate 3. Redirect blood flow to prioritize tissues under stress
47
Diuretics
Drugs that reduce blood volume. Hydrochlorithiazide, furosamide First drug of choice for hypertension and heart disease. Act directly on kidneys to reduce total blood volume.
48
Diuretics are used to manage
Primary hypertension Edema due to congestive heart failure, liver disease Pulmonary edema Diabetes insipidus
49
Diuretics: mechanism of action
Decrease absorption of water at kidney tubules --> increased urine output --> decreased blood volume and CO --> decreased BP
50
Diuretics: adverse effects
Hypotension Dizziness Hypokalemia
51
Diuretics: massage
Hypotension considerations. Muscle cramps and weakness, heart palpitations, may be a sign of potassium problems.
52
Diabetes medications work by:
1. Replacing insulin 2. Increase insulin sensitivity 3. Increase insulin secretion.
53
Symptoms of hypoglycemia
=> insulin shock ``` Stomach pains Hunger Sweating Weakness Headache Tachycardia Concussion Moist pale skin Convulsions. ```
54
Symptoms of hyperglycaemia
=> diabetic coma. ``` Thirst Polyuria Fatigue confusion reduced consciousness. Headache Blurred vision Constipation Dehydration ```
55
Normal blood glucose level
80-90 mg /100 ml
56
Insulin
SubQ injection Toronto, NPH, Lente, ultralente.
57
Insulin: mechanism of action
Allows glucose to enter cells, decreasing blood sugar. Inserts GLUT transporters into cell membrane.
58
Insulin: adverse effect
Hypoglycemia
59
Insulin: massage
Be wary of injection site, implant. Possible peripheral neuropathy
60
Oral hypoglycemia drugs
Sulfonylureas Biguanides Alpha-glucosidase inhibitors Thiazilodinedione
61
Sulfonylureas
Oral hypoglycemic (for diabetes) Only for Type 2 Glipizide, glyburide
62
Sulfonylureas: mechanism of action
Increase insulin secretion by pancreas
63
Sulfonylureas: adverse effects
Hypoglycemia Rarely: paresthesias and rashes
64
Sulfonylureas: massage
Implants and injection sites. Hypoglycemia (Can be increased by NSAIDS).
65
Biguanides
Hypoglycemic med (for diabetes) Metformin Type 2 only
66
Biguanides: mechanism of action
Decrease release of glucose by liver Decrease intestinal absorption of glucose Increase insulin sensitivity in peripheral tissue
67
Biguanides: adverse effects
Fatigue and weakness Nausea and barf Bruising, flatulence, lactic acidosis
68
Biguanides: massage
Avoid deep tissue work (bruising) Short Tx because of fatigue Diabetic neuropathy
69
Thiazolidinediones
Hypoglycemic drug (diabetes) Rosiglitazone Pioglitazone Type 2 only
70
Thiazolidinediones: mechanism of action
Increases sensitivity to insulin Beneficial CHO lipid profiles
71
Thiazolidinediones: adverse effects
Edema Headache Anemia Fatigue.
72
Thiazolidinedioles: massage
Peripheral edema and headache may not respond well to massage
73
Alpha-glucosidase inhibitors
Hypoglycemic meds (for diabetes) Precose
74
Alpha-glycosidase inhibitors: mechanism of action
Decrease glucose absorption by intestine
75
Alpha-glucosidase inhibitors: adverse effects
Flatulence
76
Alpha-glucosidase inhibitors: massage
Be wary of GI issues: diarrhea, bloating, gas

Pharma 600 (7 decks)

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