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PHARMACOLOGY > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

It is defined as a persistent systolic pressure of greater than 140mmHg and/or a diastolic pressure of greater than 390mmHg. It is also a major risk factor for CAD, CVD, and death.

A

Hypertension

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2
Q

Blood pressure is determine by the product of

A

cardiac output and systemic resistance

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3
Q

What is cardiac output?

A

amount of blood ejected from the left ventricle and measured in Lpm

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4
Q

What is SVR?

A

resistance to blood flow that is determined by the diameter of the blood vessels and vascular musculature

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5
Q

Its goal is to reduce cardiovascular and renal morbidity and mortality.

A

Antihypertensive Therapy

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6
Q

Anti-hypertensive: Diuretics

A

Drugs that accelerate the rate of urine formation that results to the removal of sodium and water from the body

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7
Q

Diuretics: Carbonic Anhydrase Inhibitors

A
  • chemical derivatives of sulfonamide antibiotics
  • Drug : Acetazolamide
  • works along the carbonic anhydrase enzyme system in the proximal convoluted tubule Carbonic Anhydrase is needed to make hydrogen ions for the exchange of sodium and water.
  • treatment f Glaucoma, Edema and High-altitude sickness
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7
Q

Diuretics: Carbonic Anhydrase Inhibitors

A
  • chemical derivatives of sulfonamide antibiotics
  • Drug : Acetazolamide
  • works along the carbonic anhydrase enzyme system in the proximal convoluted tubule Carbonic Anhydrase is needed to make hydrogen ions for the exchange of sodium and water.
  • treatment f Glaucoma, Edema and High-altitude sickness
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8
Q

Diuretics: Loop

A
  • chemically related to sulfonamide antibiotics
  • Drugs : Bumetanide, Furosemide, Torsemide
  • Indications: edema associated with heart, hepatic or renal failure, control hypertension and increase renal excretion of calcium
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9
Q

Diuretics: Osmotic

A
  • Drug: Mannitol
  • a non-absorbable solute that works on the entire nephron esp. LoHand PCT. Increases osmotic pull in the filtrate which produces a rapid diuresis
  • DOC for preventing kidney damage during acute kidney injury and reduction of intracranial pressure and cerebral edema
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10
Q

Diuretics: Potassium-Sparing

A
  • Drugs: Spironolactone, Triamterene, Amiloride
  • works on the collecting ducts and DCT by blocking the aldosterone receptor
  • Indication: hyperaldosteronism, hypertension, reverse potassium loss caused by other diuretics, pediatric clients with heart failure
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11
Q

Diuretics: Thiazides

A
  • chemical derivatives of sulfonamides
  • Drugs: Chlorothiazide and Hydrochlorothiazide, Metolazone
    works in the DCT by inhibiting Na, K, and Cl resulting to osmotic water loss; can cause direct relaxation of arterioles which decreased afterload
  • Indications: Edema, Hypercalciuria, Diabetes insipidus, adjunct for heart and hepatic failure
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12
Q

Andrenergic Drugs

A

a. Central Acting –acts on the brain by decreasing NE production
Drugs: Clonidine, Methyldopa
b. Peripheral Acting –at the heart and blood vessels
Drugs: Alpha and Beta Blockers

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13
Q

Anti-Hypertensive: ACEI (Angiotensin-Converting Enzyme Inhibitors)

A
  • Drugs: Captopril, Enalapril, Lisinopril, Quinapril
  • Indications: Hypertension, adjunct for heart failure, stop progression of LVH
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14
Q

Anti-Hypertensive: Angiotensin II Receptor Blockers (ARBs)

A
  • Drugs: Losartan, Eprosartan, Valsartan, Irbisartan, Olmesartan, Telmisartan
  • block binding of AngiotensionII to its receptors and primarily affects the vascular smooth muscle and adrenal gland
  • Indication: hypertension and adjunct for heart failure
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15
Q

Anti-Hypertensives Drugs: Calcium Channel Blocker (CCBs)

A
  • blocks calcium from the excitation-contraction coupling process in heart and vascular smooth muscle cells resulting to vasodilation; decreases afterload, depression of conduction through SA and AV nodes
  • Indications: first line drugs for angina, hypertension, supraventricular tachycardias; coronary spasms, short-term mgt of atrial fibrillation and flutter, migraine, Raynaud’s disease
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16
Q

Three Types of Anti-Hypertensives: Calcium Channel Blocker (CCBs) and Sample Drugs

A
  1. Phenylalkylamines -Verapamil
  2. Benzothiazepines -Diltiazem
  3. Dihydropyridines –Amlodipine, Nicardipine, Nifedipine
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17
Q

Anti-Hypertensives: Direct Vasodilators

A
  • Drugs: Minoxidil, Hydralazine, Diazoxide, Nitroprusside
  • directly cause peripheral vasodilation
  • Indications: hypertension
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17
Q

Anti-Hypertensives: Direct Vasodilators

A
  • Drugs: Minoxidil, Hydralazine, Diazoxide, Nitroprusside
  • directly cause peripheral vasodilation
  • Indications: hypertension
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18
Q

Minoxidil

A

effectiveness in restoring hair growth

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19
Q

Nitroprusside

A

both arterial and venous vasodilation

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20
Q

It is an IV used in hypertensive emergencies

A

IV Nitroprusside and Diazoxide

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21
Q

It is caused by poor blood supply )decreased O2 and nutrients)

A

Angina Pectoris (chest pain) ad ischemia

22
Q

The heart and chest pains felt due to anaerobic metabolism that increases production of lactic acid which stimulates pain receptors.
(True or False)

A

True

23
Q

Three Types of Angina

A
  1. Chronic Stable Angina
    - intense but subsides within 15 mins of rest or medication and caused mainly by atherosclerosis and can be triggered by exertion or stress (cold, emotions) and exacerbated by smoking, alcohol, coffee and some drugs.
  2. Unstable Angina
    – early stage of progressive artery disease characterized by pain increasing in severity and frequency and may even occur at rest
    3.Vasospastic Angina
    – from spasms of the smooth muscle that surrounds the coronary arteries and occurs at rest without any triggers but usually occurring at the same time of day
24
Q

Goals of Anti-Anginal Drugs

A

Increase blood flow to the myocardium, decrease oxygen demand
1. Minimize frequency of attacks and decrease intensity of pain
2. Improve functional capacity with few adverse effects
3. Prevent or delay the worst possible outcome, MI

25
Q

Anti-Anginal Drugs: Nitrate and Nitrites

A
  • mainstay prophylaxis and treatment for angina
  • Drugs:
    *Amyl Nitrite (rapid acting)
    *Nitroglycerin (rapid and long acting)
    *Isosorbide dinitrate (rapid and long acting)
    *Isosorbide mononitrate (long acting)
  • dilates all blood vessels via relaxation of smooth muscles especially coronary arteries
  • Indications: stable, unstable and Prinzmetal angina
  • Acute Attacks –rapid acting sublingual tablets or IV drip
  • Prevention –long acting forms
26
Q

Anti-Anginal Drugs: Beta Blockers

A
  • most effective treatment of exertional angina
  • approved for treatment of MI, hypertension, cardiac dysrhythmias and essential tremor
27
Q

It is a pathologic state in which the heart is unable to pump i sufficient amounts from the ventricles to meet metabolic needs. It occurs due to a reduced ratio of ejection fraction to left-ventricular end-diastolic volume

A

Heart Failure

28
Q

Ejection fraction

A

amount of blood ejected with each contraction (65% of total ventricle volume)

29
Q

LV End-diastolic volume

A

total amount of blood in the ventricle before contraction

30
Q

Heart Failure Drugs: Positive Inotropic

A

– increase the force of myocardial contraction

31
Q

Heart Failure Drugs: Positive Chronotropic

A
  • increase the rate in which the heart beats
32
Q

Heart Failure Drugs: Positive Dromotropic

A
  • accelerate conduction
33
Q

HEART FAILURE DRUGS: B-TYPE NATRIURETIC PEPTIDE (BNP)

A
  • Drug: Nesiritide IV
  • synthetic BNP that vasodilates both arteries and veins, induce diuresis and natriuresis
  • Used in the ICU to treat severe, life-threatening heart failure
34
Q

Where does the oldest group of cardiac drugs came from?

A

foxglove or Digitalis plant

35
Q

Cardiac Glycosides

A
  • Drug: Digoxin
  • positive inotropic effect d/t inhibition of Na-K pump, augments PNS stimulation via vagusnerve; negative chronotropic and dromotropic effect; promotion of tissue perfusion and diuresis
  • Indications: Systolic Heart failure and Atrial fibrillation
36
Q

TOXICITY of CARDIAC GLYCOSIDES

A
  • due to low therapeutic index, digoxin levels are monitored
  • low K or Mg and declining renal function may increase potential for toxicity
  • Antidote: Digoxin Immune Fab (antibody that recognized digoxin as antigen) –severe cases only
37
Q

It is a deviation from the normal rythm of the heart

A

Dysrhythmias

38
Q

What is Lidocaine?

A

Lidocaine used as a topic anesthetic is with added epinephrine to control bleeding in the area. Never used intravenously. Plain lidocaine solution is used to treat cardiac conditions

39
Q

Quinidine

A

report complaints of angina, hypotension immediately, use infusion pump as needed

40
Q

Lidocaine

A

labeled for cardiac or non-cardiac use, stable for 24hr only

41
Q

Amiodarone

A

take with meals to prevent GI distress. For Photosensitivity and photophobia, wear sunscreen, protective clothing with emphasis on the eyes. Recommended high-fiber diet and fluids to prevent constipation

42
Q

It is a process that stops bleeding. It is done through: mechanical (compression), surgical (cautery, clamps), and physiologic clotting. Once a clot is formed and fibrin is present, Fibrinolysis (reverse clotting process) is initiated

A

Hemostasis

43
Q

Coagulation Modifiers

A

1.Anti-coagulants –inhibit the action or formation of clotting factors and prevents clots from forming
2.Antiplatelet –prevent platelet plugs from forming by inhibiting platelet aggregation
3.Hemorrheologic–alter platelet function without preventing the platelets from working
4.Thrombolytic –breaks down clots and thrombi that have already formed
5.Anti-fibrinolytic –hemostatic drugs, promote blood coagulation

44
Q

Anti-Coagulants

A
  • Prevent formation of a clot by inhibiting certain clotting factors
  • No direct effect on a blood clot that has already formed
  • Indications: prevent clot in patients with MI, unstable angina, atrial fibrillation, heart valves, orthopedic surgery, prolonged immobilization; DVT prophylaxis
45
Q

Antiplatelets

A
  • works to prevent platelet adhesion at the site of blood vessel injury, occurs before the clotting cascade
46
Q

Breaks down thrombi in the blood vessel especially coronary arteries; re-establishes blood flow to the blood-starved muscles

A

Lyses

47
Q

Thrombolytic Drugs Indications

A

acute MI, arterial thrombosis, DVT, occlusion of shunts/ catheters, pulmonary embolism and acute ischemic stroke

48
Q

Anti-fibrinolytic Drugs

A

It prevent lysis of fibrin by displacing plasmin from the fibrin clot or by increasing factor VII. Sample drugs are Aminocaproic Acid, tranexamic acid, desmopressin. Sample topical drugs are thrombin, microfibrillar collagen, absorbable gelatin, oxidized cellulose

49
Q

The two primary form of lipids in the blood

A

triglycerides and cholesterol

50
Q

triglycerides

A

energy source stores in adipose tissue

51
Q

Cholesterol

A

used to make steroid hormones, cell membranes, bile acids

52
Q

Lipoprotein

A

combination of triglycerides and cholesterol which transport lipids via the blood

53
Q

Coronary Heart Disease

A

1.Appropriate dietary intake of cholesterol and fat, weight control, physical activity and control of other lifestyle factors
2.Specific treatment guidelines for those at risk

54
Q

Fibric Acid Derivatives

A

Drugs: Fibrates (Gemfibrozil, Fenofibrate)
- activating lipoprotein lipase to breakdown cholesterol
- decrease TG and increase HDL levels, T3, T4, and T5 hyperlipidemia

PHARMACOLOGY (7 decks)

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