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DPT 530 > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

what can cardiovascular (CV) medications treat?

A

HTN

angina

HF

arrhythmias

coagulation disorders

hyperlipidemia

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2
Q

is the heart innervated by the sympathetic or parasympathetic NS?

A

both

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3
Q

are ionotropic and chronotropic effects sympathetic or parasympathetic?

A

ionotropic is sympathetic

chronotropic is both

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4
Q

what NT does the adrenal medulla secrete?

A

E and NE

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5
Q

do E and NE increase sympathetic or parasympathetic effects?

A

sympathetic effects

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6
Q

epinephrine (E) has a greater affinity for what receptors?

A

beta adrenergic receptors

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7
Q

what does ionotropic mean?

A

modifying force/speed of contraction

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8
Q

what does chronotropic mean?

A

affecting rate/time of physiologic processes (HR)

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9
Q

what are the categories of autonomic drugs?

A

cholinergic drugs

adrenergic drugs

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10
Q

what are cholinergic drugs?

A

drugs that affect the affinity of Ach receptors

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11
Q

what is the primary NT in the ANS?

A

ACh (parasympathetic)

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12
Q

what are cholinergic agonists?

A

drugs that stimulate the parasympathetic activity

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13
Q

what are parasympathomimetic drugs?

A

drugs that stimulate the parasympathetic activity

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14
Q

are cholinergic agonists parasympathomimetic or parasympatholytics?

A

parasympathomimetics

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15
Q

what are cholinergic antagonists?

A

drugs that decrease parasympathetic activity

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16
Q

what are parasympatholytic drugs

A

drugs that decrease parasympathetic activity

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17
Q

are cholinergic antagonists parasympathomimetics or parasympatholytics?

A

parasympatholytics

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18
Q

what are adrenergic drugs?

A

drugs that stimulate activity in tissues that respond to E and NE

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19
Q

what are adrenergic agonists?

A

drugs that increase sympathetic response

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20
Q

what are sympathomimetic drugs

A

drugs that increase sympathetic response

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21
Q

are adrenergic agonsits sympathomimetic or sympatholytic?

A

sympathomimetic

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22
Q

what are adrenergic antagonists?

A

drugs that decrease sympathetic response

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23
Q

what are sympatholytic drugs?

A

drugs that decrease sympathetic response

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24
Q

are adrenergic antagonists sympathomimetic or sympatholytic?

A

sympatholytic

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25
Q

where are the muscarinic receptors?

A

in peripheral tissues supplied by parasympathetic and post ganglionic

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26
Q

where are the nicotinic receptors?

A

in autonomic ganglia and skeletal neuromuscular junction

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27
Q

where are B2 receptors?

A

respiratory tract (bronchioles and vascular smooth muscle)

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28
Q

where are B1 receptors?

A

heart and kidneys

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29
Q

where are A1 receptors?

A

most vascular smooth muscle

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30
Q

what are the types of anti-hypertensive drugs?

A

diuretics (KNOW THESE)

sympatholytics

vasodilators (KNOW THESE)

RAS inhibitors

calcium channel blockers (KNOW THESE)

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31
Q

what is the therapeutic classifications of diuretics?

A

antihypertensives

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32
Q

diuretics increase the formation and excretion of what?

A

urine

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33
Q

how do diuretics decrease BP?(KNOW THIS)

A

by increasing renal excretion of water and sodium to decrease the volume of fluid ion the vascular system

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34
Q

diuretics have been used for more than __ years

A

50

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35
Q

t/f: diuretics are inexpensive

A

true

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36
Q

what are the indications for diuretics?

A

mild to moderate HTN

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37
Q

what are the types of diuretics?

A

thiazide

loop diuretics

potassium sparing diuretics

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38
Q

what does thiazide do?

A

inhibits sodium reabsorption in the distal tubule of nephron so that more sodium and water can pass through the nephron and be excreted

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39
Q

what do thiazide drugs end in?

A

-thiazide

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40
Q

what are types of thiazide?

A

hydrochlorothiazide (main one)

chlorothiazide (Diuril)

Metolazone (Zaroxolyn)

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41
Q

what are loop diuretics?

A

drugs that inhibit the reabsorption of sodium and chloride from the loop of Henle to prevent reabsorption of water that follows the 2 electrolytes

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42
Q

t/f: loop diuretics don’t spare potassium

A

true

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43
Q

loop diuretics are often used in ___

A

HTN

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44
Q

what are the types of loop diuretics?

A

Furosemide (Lasix)

Torsemide (Demadex)

Bumetanide (Bumex)

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45
Q

what are potassium sparing diuretics? (BE FAMILIAR WITH THIS)

A

aldosterone antagonists

drugs that prevent the secretion of potassium into the dital tubule

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46
Q

what are the types of potassium sparing diuretics?

A

Spironolactone (Aldactone)

Amiloride (Midamor)

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47
Q

what are the common adverse reactions to diuretics?

A

fluid depletion
electrolyte imbalance
weakness and fatigue
OH

impaired glucose and lipid metabolism
GI disturbance
mood changes and confusion

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48
Q

what are sympatholytic drugs used to treat HTN?

A

bc they decrease sympathetic activities and HTN is often caused by increased sympathetic activity

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49
Q

what are the types of sympatholytic drugs?

A

beta adrenergic blockers (B1) (KNOW THIS)

alpha adrenergic blockers (BE FAMILIAR WITH THIS)

pre-synaptic adrenergic inhibitors

centrally acting agents

ganglion blockers

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50
Q

beta blockers primarily act on what receptors?

A

beta 1 receptors of the heart

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51
Q

what do beta blockers do (KNOW THIS)

A

reduce HR and force of myocardial contraction

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52
Q

beta blockers can be used for ___ , ____ and to normalize ____ in _____

A

HTN, angina, HR, arrhythmias

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53
Q

t/f: beta blockers have the ability to limit the extent of myocardial damage following an acute MI

A

true

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54
Q

beta blockers can improve cardiac fxn in some __

A

HF

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55
Q

are beta blockers selective or non-selective?

A

an be either

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56
Q

selective beta blockers block what receptors?

A

beta 1 receptors in the heart

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57
Q

non selective beta blockers block what receptors?

A

beta 1 and 2 receptors

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58
Q

beta blockers end in what?

A

-lol

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59
Q

t/f: beta blockers are “cardioselective” due to the preferential affect on primarily the myocardium

A

true

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60
Q

what are some beta blockers?

A

Metoprolol (Lopressor)

Carvedilol (Coreg)

Atenolol (Tenormin)

Bisoprolol (Zebeta)

Carteolol

Esmolol

Labetalol

Propranolol (Inderol)

Sotalol (Betapace)

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61
Q

what is Atenolol (Tenormin)?

A

an oral beta blocker that is taken immediately after an acute MI to prevent another one from occuring

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62
Q

what is Carvedilol (Coreg)?

A

a non-selective oral beta blocker used for the treatment of HTN, CHF, MI recovery

can cause systemic vasodilation

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63
Q

what is Esmolol?

A

an IV beta blocker selective to beta 1 for the short term treatment of arrhythmias

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64
Q

what is Labetalol?

A

a nonselective oral or IV beta blocker that is used for the treatment of HTN or emergent HTN in IV form

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65
Q

what is Metoprolol (Lopressor/Toprol)?

A

a cardioselective beta blockers used for the treatment of HTn, prevention of angina, and MI reinfarction

taken orally for HTN

IV for reinfarction followed by an oral dose

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66
Q

what is propranolol (Inderol)?

A

a classive selective beta blockers used for the treatment of HTN, angina, arrythmias, MI reinfarction, vascular headache

oral for long term use

IV for immediate control of arrhythmias

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67
Q

what is Sotalol (Betapace)?

A

a nonselective beta blocker, primarily used for arrhythmias

also used for HTN and angina

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68
Q

what are common adverse rxns to beta blockers (KNOW THIS)

A

bronchoconstriction
excessive depression of HR and contractility
dizziness
OH

tinnitus
syncope
GI disturbances
fever
rash

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69
Q

what patients may be adversely affected by nonselective beta blockers and should consider selective beta blockers?

A

pts with respiratory conditions like emphysema and bronchitis

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70
Q

what are the PT implications for beta blockers? (KNOW THIS)

A

PTs should consider ECG findings (increased PR interval=risk for skipped beats and bradycardia)

blunted HR response w/exercise (KNOW THIS)

pts shouldn’t use beta blockers if they have respiratory issues

pts shouldn’t abruptly stop taking them

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71
Q

if a pt is on a beta blocker, they can have a blunted HR response, so what should we use to measure how they are handling exercises?

A

the Borg RPE

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72
Q

what are alpha adrenergic blockers? (maybe know this?)

A

drugs that act primarily on the alpha 1 receptors on vascular smooth muscle to decrease BP

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73
Q

how do alpha adrenergic blockers decrease BP?

A

by decreasing peripheral vascular resistance (PVR)

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74
Q

what are alpha adrenergic blockers used to treat?

A

HTN and to vasodilate

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75
Q

alpha adrenergic blockers usually end in …

A

-zosin

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76
Q

what is an example of an alpha adrenergic blocker?

A

Doxazosin (Cardura)

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77
Q

what is Doxazosin (Cardura)?

A

an oral alpha adrenergic blockers that may also help decrease total cholesterol and triglycerides and decrease insulin resistance in type 2 DM

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78
Q

what are adverse effects of alpha adrenergic blockers?

A

reflex tachycardia

OH when 1st initiated in older adults

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79
Q

what are presynaptic adrenergic inhibitors? how do they work?

A

drugs that decrease the release of NE from presynaptic terminals of peripheral adrenergic neurons

primarily act on the heart and vascular smooth muscle to decrease BP

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80
Q

what kind of drug is Resperine?

A

a presynaptic adrenergic inhibitor

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81
Q

what are centrally acting agents?

A

drugs that act at the source to decrease sympathetic discharge to the BS to decrease stimulation of the heart and vasculature

ie: Clonidine (Catapres)

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82
Q

what are ganglionic blockers?

A

drugs that are primarily used to decrease BP in emergency situations

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83
Q

how do ganglionic blockers work?

A

the block synaptic transmission at the junction bw pre and post synaptic neurons of both sympathetic and parasympathetic NS

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84
Q

what kind of drug is Mecamylamine (Inversine, Vecamyl)?

A

a ganglionic blockers

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85
Q

what are vasodilators? (KNOW THESE)

A

drugs that have an inhibitory effects directly on vascular smooth muscle cells contraction

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86
Q

how do vasodilators decrease BP? (KNOW THIS)

A

by decreasing PVR

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87
Q

what are examples of vasodilators?

A

Hydralazine (Apresoline)

Minoxidil (Loniten)

Nitroprusside (Nipride/Nitropress)

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88
Q

when are vasodilators often indicated? (KNOW THIS)

A

in hypertensive crisis

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89
Q

what are common adverse rxns to vasodilators? (KNOW THIS)

A

reflex tachycardia
OH
weakness
fluid retention

dizziness
headache
nausea
hair growth

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90
Q

what are the 3 types of RAS inhibitors?

A

ACE inhibitors (KNOW THIS)

angiotensin 2 receptor blockers (ARBs) (KNOW THIS)

direct renin inhibitors

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91
Q

what do ACE inhibitors do? (KNOW THIS)

A

drugs that inhibit the enzyme that converts angiotensin 1 to angiotensin 2

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92
Q

ACE inhibitors usually end in …

A

-pril

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93
Q

t/f: ACE inhibitor decrease hypertensive side effects of angiotensin 2 by limiting its production

A

true

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94
Q

how do angiotensin 2 receptor blockers (ARBs) work? (KNOW THIS)

A

by blocking angiotensin 2 receptors on the tissues to decrease PVR and decrease CV hypertrophy and remodeling associated by HTN

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95
Q

ARBs usually end in…

A

-sartin

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96
Q

what are examples of ARBs?

A

Iosartan (Cozar), Valsartan (Diovan)

97
Q

how do direct renin inhibitors work?

A

by inhibiting renin from converting angiotensin to angiotensin 1

98
Q

what are examples of direct renin inhibitors?

A

Aliskiren (Tekturna) is the only one

99
Q

what are common adverse rxns to RAS inhibitors? (KNOW THIS)

A

drug cough (ACE cough)
renal failure
dizziness

rash
angioedema
chest pain

100
Q

t/f: RAS inhibitors are often well tolerated by most pts and work well and quickly

A

true

101
Q

what do calcium channel blockers do? (KNOW THIS)

A

block Ca2+ entry into CV smooth muscle cells

inhibit contractile process and thus cause vasodilation and a decrease in PVR

102
Q

calcium channel blockers were developed to treat what? (KNOW THIS)

A

angina and cardiac arrhythmias

103
Q

what are calcium channel blockers used to treat?

A

essential HTN and HTN-related kidney disease

104
Q

calcium channel blockers usually end in…

A

-pine
-zem

105
Q

what are Dihydropyrodine agents?

A

Ca2+ channel blockers

Nifedipine (Procardia) and Amiodipine

106
Q

what are non-dihydropyridine agents?

A

Ca2+ channel blockers

Diltiazem (Cardizein) and Verapamil

have greater effects on Ca2+ influx into myocardial cells

cause decrease in HR and decrease in myocardial contractile force

107
Q

t/f: Ca2+ channel blockers are very useful for arrhythmias and HTN

A

true

108
Q

what are common adverse rxns of Ca2+ channel blockers?

A

excessive vasodilation
OH
dizziness

HR abnormalities
tinnitus
nausea
headache
ECG changes (prolonged QT interval)

109
Q

what is a result of excessive vasodilation from Ca2+ channel blockers?

A

swelling in the feet and ankles from venous pooling

110
Q

initial drug therapy for HTN includes a 1st line med, what are the 1st line meds?

A

Ca2+ channel blockers, Thizide diuretic, or ACE inhibitor

111
Q

what is the drug treatment for stage 1 HTN?

A

experts advocate for aggressive treatment w/2 1st line meds

112
Q

what is the drug treatment for stage 2 HTN?

A

usually combine thiazide, Ca2+ channel blocker, and RAS inhibitor

113
Q

pts with DM receiving HTN meds respond best to ___/____ WITH ____, ____, AND _____

A

ACE inhibitors/ARBs, diuretics, Ca2+ channel blockers, beta blockers

114
Q

what are the PT implications for anti-hypertensives (KNOW THIS)?

A

PTs will encounter many pts who take BP meds

PT main concern would be for hypotension and OH (esp if changing positions quickly)

activity that produces widespread vasodilation must be avoided or used cautiously if pt is taking vasodilating meds

be cautious of heat

be aware of blunted HR response to exercise if on a beta blocker

115
Q

what are the types of meds that treat and prevent angina? (KNOW THESE)

A

organic nitrates (nitroglycerin)

beta blockers

Ca2+ channel blockers

116
Q

what is angina?

A

chest pain due to ischemic heart disease

supply of O2 to the heart is insufficient to meet myocardial demands

117
Q

t/f: ischemia causes metabolic, electrophysiologic, and contractile changes in the heart

A

true

118
Q

what do organic nitrates do? (KNOW THIS)

A

dilate vascular smooth muscle through production of cGMP w/in smooth muscle cells

119
Q

what does cGMP do?

A

inhibit smooth muscle contraction

120
Q

do nitrates vasodilate just the coronary arteries?

A

no, vasodilation occurs in all systemic vasculature

121
Q

how do nitrates decrease myocardial demands?

A

by vasodilating to decrease preload and afterload

122
Q

how do nitrates decrease angina?

A

by decreasing overall work of the heart

123
Q

what are examples of nitrates?

A

Nitroglycerin (Nitro-Bid, Nitro-Stat, Nitro-Dur)

124
Q

sublingual nitrates are best to treat what?

A

acute attack

125
Q

transdermal nitrates are best to treat what?

A

angina prophylactically (prevention of angina)

126
Q

can nitrates be an ointment?

A

yes

127
Q

if a patient is using an ointment nitrate, what would we be aware of?

A

not contacting the ointment with bare skin bc it can transfer vasodilation effects

128
Q

what is Isosorbide Dinitrate?

A

a nitrate used for prevention and treatment of angina

has hemodynamic effects that last longer (long acting nitrate)

administered sublingually, buccally, chewable tablets (best for prevention)

129
Q

it is important to check on what about pt’s nitro?

A

expiration date and make sure that are carrying it with them

130
Q

what are common adverse rxns to nitrates? (KNOW THIS)

A

headache, dizziness, nausea, OH

131
Q

if a pt takes more than _ nitro pills and there is NO relief of chest pain, the pt is most likely having an acute MI and they have to seek emergency medical attention ASAP

A

3

132
Q

how do beta blockers help pts with angina? (KNOW THIS)

A

by preventing an increase in myocardial oxygen demand

decrease HR and force of myocardial contractions

133
Q

the primary use of Ca2+ channel blockers for angina is their ability to do what? (KNOW THIS)

A

directly increase coronary blood flow due to their ability to dilate coronary arteries and peripheral vasculature

134
Q

t/f: dihydropyridine Ca2+ channel blockers vasodilate w/direct affect on cardiac excitibility/contractility

A

true

135
Q

why may dihydropyridine Ca2+ channel blockers be a good choice for pts w/angina that also have arrhythmias?

A

by don’t affect arrhythmias and can actually help them

136
Q

what is Ranolazine (Ranexa)?

A

another type of anti-anginal med that decreased Ca2+ concentration in the heart muscle cells

decreasing Ca2+ concentration leads to decreased contraction force, decreased cardiac workload and O2 demand, and decreased angina

137
Q

t/f: Ranolazine is reserved for pts who don’t respond well to conventional drugs for angina like nitrates, beta blockers, bihydropyridine Ca2+ channel blockers

A

true

138
Q

why may anticoagulant meds be used in pts with angina? (KNOW THIS)

A

bc angina is usually associated with coronary artery occlusion

139
Q

what is the role of anticoagulants in angina? (KNOW THIS)

A

they can be used to prevent a coronary artery from becoming completely blocked

140
Q

what are commonly used anticoagulant agents? (KNOW THESE)

A

platelet inhibitors (Aspirin)

anti-platelet drugs (Clopidogrel and Prasugrel)

Heparin/Enoxaparin (Lovenox)

141
Q

what are platelet inhibitors? (KNOW THIS)

A

Aspirin

drugs used to prevent platelet-induced clotting in the coronaries

inhibit the biosynthesis of PGs responsible for platelet activation

142
Q

what are anti-platelet drugs? (KNOW THIS)

A

Clopidogrel (Plavix) and Prasugrel (Effient)

reduce ability of adenosine diphosphate (ADP) to activate platelet

used alone or w/Aspirin in pts with high risk for MI

143
Q

what is Heparin/Enoxaparin (Lovenox)?

A

fast acting drug that inhibits thrombin

IV, parenterally (Heparin), SQ injection (Lovenox)

144
Q

what are the PT implications for anti-anginal meds? (KNOW THIS)

A

PTs must be aware of if pts are taking anti-anginal meds prophylactically or for acute attack

pts should have the drug on them for acute attack bc exercise and functional training increases myocardial O2 demand and may cause angina

PTs must be aware of cardiac implications of pts with angina and use caution to not overdo it and over exert the heart

nitrates can increase exercise tolerance as the pt may not be limited by angina

beta blockers have blunted HR response to exercise

be aware of side effects, esp hypotension w/peripheral vasodilation

be cautious w/application of heat to pts taking anti-anginal meds as it can lead to hypotension

145
Q

what are the 4 classes of meds for cardiac arrhythmias? (BE FAMILIAR WITH THESE)

A

class 1: sodium chennel blockers

class 2: beta blockers

class 3: potassium (K+) channel blockers

class 4: Ca2+ channel blockers

146
Q

t/f: meds for cardiac arrhythmias can cause abnormal HR and BP response in pts

A

true

147
Q

how do sodium channels blockers treat arrhythmias?

A

by binding to membrane Na+ channels in excitable tissues

normalizes the rate of Na+ entry into cardiac tissues, helping control cardiac excitation and conduction (slows it)

148
Q

how do subclass 1A Na+ channel blockers work?

A

they prolong repolarization of cardiac cells to treat arrhythmias originating in ventricles or atria to prevent from firing too quickly

Quinidine, Procalnamide, Disopyramide

149
Q

how do subclass 1B Na+ channel blockers work?

A

shorten re-polarization

treat more severe types of ventricular arrhythmias (VT, PVCs)

Lidocaine and Mexiletine

150
Q

how do subclass 1C Na+ channel blockers work?

A

slow cardiac conduction

treat ventricular arrhythmias (VT, PVCs)

Flecainide and Propafenone

151
Q

how do beta blockers treat arrhythmias?

A

they block beta 1 receptors on the myocardium

decrease the effects of the SNS (NE and E)

prolongs refractory period to slow HR

slow conduction through the myocardium and can control fxn of the AV node

A-fib and VT

152
Q

what are the most effective beta blockers for arryhthmias?

A

acebutolol, atenolol, esmolol, metoprolol, nadolol, propranolol, sotalol, timolol

153
Q

how do potassium (K+) channel blockers treat arrythmias?

A

they delay repolarization of cardiac cells through inhibition of potassium efflux during repolarization

limit the ability of k+ to leave the cell which prolongs repolarization and prevents the cell from firing another AP too rapidly

154
Q

what are the most effective k+ channel blockers to treat arrhythmias?

A

amiodarone, dofetilide, D ronedarone, ibutilide

155
Q

what is the most widely used anti-arrythmic drug?

A

Amiodarone

156
Q

why is Amiodarone so widely used to treat arrhythmias?

A

bc it has class 1, 2, and 4 effects and is therefore versatile and can be used to treat a variety of cardiac rhythm disturbances

157
Q

what are the adverse effects of k+ channel blockers?

A

pulmonary toxicity (esp with Amiodarone in older pts on high doses)

thyroid problems

liver damage

158
Q

how do Ca2+ channel blockers treat arrhythmias?

A

they inhibit Ca2+ influx by binding to specific channels in cell membranes of myocardium and vascular smooth muscle

alter the excitability and conduction of cardiac tissues

decrease rate of discharge of the SA node and inhibit conduction velocity through the AV node

159
Q

what are the most effective Ca2+ channel blockers for arrhythmias?

A

Verapamil and Diltiazem (Cardizem)

160
Q

what are the adverse effects of Ca2+ channel blockers? (KNOW THIS)

A

excessive bradycardia

hypotension

161
Q

what are other anti-arrhythmic meds that are not classified?

A

Digitalis glycosides

magnesium

adenosine

162
Q

what are Digitalis glycodides (BE FAMILIAR WITH THIS)

A

typically used for CHF but can prevent or treat arrhythmias including severe a fib and paroxysmal AV node re-entrant tachycardia

163
Q

what does IV magnesium treat?

A

severe ventricular arrythmias such as Torsade’s de Pointes

164
Q

what does IV adenosine terminate?

A

severe arrhythmias such as SVT

165
Q

what are common adverse rxns to anti-arrhythmic drugs? (KNOW THIS)

A

tendency to increase rhythm disturbances initially

can initiate/aggrevate other cardiac rhythm abnormalities

pts with HF, myocardial ischemia, and structural heart disease are esp prone to class 1 induced arryhthmias (should be avoided in these pts)

dizziness, visual disturbances, nausea, vomiting, or diarrhea

166
Q

what is the most common side effect of all anti-arrhythmic drugs?

A

tendency to increase rhythm disturbances initially

167
Q

what are the PT implications for anti-arrhythmic drugs? (KNOW THIS)

A

side effects of anti-arrhythmic meds are a primary problem

dizziness/faintness/hypotension

monitor BP and pulse rate to determine if OH vs abnormal HR response (caused by proarrhythmic effects) is the cause of dizziness/faintness

PT can detect presence of arrhythmias through ECG, palpation of pulse rate regularly

168
Q

what is the goal of meds used for HF?

A

to improve the pumping ability of the heart and increase contractility

169
Q

how do meds for HF improve pumping and increase contractility?

A

1) by producing a (+) ionotropic effect
2) by decreasing cardiac workload by affecting the heart, peripheral vasculature, or controlling fluid volume

170
Q

what meds for HF will produce a (+) ionotropic effect (decrease the force of muscles contraction)?

A

cardiac glycosides (Digoxin (Digitalis))
(BE FAMILIAR WITH THESE)

phosphodiesterase inhibitors (BE FAMILIAR WITH THESE)

dopamine and dobutamine

171
Q

what meds for HF will decrease cardiac workload?

A

ACE inhibitors, beta blockers, diuretics, and vasodilators

172
Q

what are the names of the cardiac glycosides?

A

Digoxin/Digotoxin (Digitalis)

173
Q

what is the primary drug used to treat CHF?

A

cardiac glycosides (Digitalis)

174
Q

cardiac glycosides are most effective for ___ and ____

A

systolic HF and A-fib

175
Q

how do cardiac glycosides increase exercise tolerance?

A

by increasing CO at rest and with exercise

176
Q

t/f: cardiac glycosides can decrease morbidity associated with CHF

A

true

177
Q

digitalis directly inhibits ___ nervous system activity, decreasing stress on the heart

A

sympathetic

178
Q

what are the mechanisms of action of cardiac glycosides? (BE FAMILIAR WITH THESE)

A

increased mechanical pumping ability of the heart by increasing intracellular Ca2+ concentration

inhibits the Na+/K+ pumpon myocardial cells membrane to cause Na+ to accumulate w/in the cell. leads to increased intracellular Ca2+ and improves contractility

increase Ca2+ to increase contractility by facilitating interaction bw actin and myosin resulting in stronger cardiac contraction

179
Q

what are common adverse rxns of digitalis?

A

potentially fatal side effects from the narrow therapeutic window and long 1/2 life (dig toxicity)

arrhythmias

GI disturbances

CNS effects (dizziness fatigue, weakness, headache, confusion, delirium)

visual disturbances (light sensitivity, color perception problems, blind spots)

ECG changes (prolonged PR interval and shortened QT interval)

180
Q

what are the phosphodiesterase inhibitors?

A

Inamrinone and Milrinone

181
Q

what do phosphodiesterase inhibitors do? (BE FAMILIAR WITH THIS)

A

they inhibit phosphodiesterase enzyme that breaks down cAMP in cardiac cells (this increased cAMP increases Ca2+)

182
Q

t/f: phosphodiesterase inhibitors increase myocardial contractility in a selective way

A

true

183
Q

what is the only route of administration of phosphodiesterase?

A

IV

184
Q

is phosphodiesterase inhibitor for long or short term use?

A

short-term

185
Q

when are phosphodiesterase inhibitors indicated? (BE FAMILIAR WITH THIS)

A

SEVERE cases of CHF and for pts awaiting heart transplant

186
Q

when is dopamine and dobutamine used? (don’t really need to know this)

A

in acute and severe cases of CHF

187
Q

how do dopamine and doputamine work? (don’t really need to know this)

A

by stimulating beta 1 receptors on the myocardium to produce a (+) ionotropic effect

188
Q

drugs that decrease cardiac workload affect what system?

A

RAS

189
Q

what HF meds decrease cardiac workload?

A

ACE inhibitors

angiotensin 2 receptor blockers

direct renin inhibitors

190
Q

t/f: ACE inhibitors are a very important drug in the treatment of systolic CHF

A

true

191
Q

what ACE inhibitors work in conjunction with diuretics and digitalis to decrease cardiac workload in HF?

A

Captopril (Capoten), Enalapril (Vasotec), and others

192
Q

how do ACE inhibitors decrease cardiac workload in HF? (KNOW THIS)

A

by decreasing cardiac afterload

inhibiting aldosterone secretion to prevent increase in vascular fluid volume and overstress on the heart

increased bradykinin (vasodilator) levels in the blood by preventing its breakdown

193
Q

t/f: ARBS are better than ACE inhibitors at treating HF and decreasing mortality

A

false, they are just as effective

194
Q

t/f: there are improved effects when ARBs are combined with ACE inhibitors

A

true

195
Q

what pts would be contraindicated for the use of ARBs?

A

pts with CHF and RENAL FAILURE

196
Q

how to beta blockers help with HF? (KNOW THIS)

A

they assist w/decreasing stress int he heart by blocking the effects of E and NE therefore decreasing SNS activity that can accelerate the pathological process of HF

197
Q

what is the optimal treatment of HF?

A

beta blockers w/ACE inhibitors, digitalis, and diuretics

198
Q

t/f: Carvedilol and Metoprolol are 2 beta blockers approved by the FDA for treatment of HF

A

true

199
Q

what are the meds for HF?

A

cardiac glycosides

ACE inhibitors

beta blockers

vasodilators

diuretics

phosphodiesterase inhibitors

dopamine and dobutamine

ARBs

direct renin inhibitors

200
Q

how do diuretics treat HF? (KNOW THIS)

A

by increasing the excretion of sodium and water to reduce fluid in the lungs and peripheral tissues

by decreasing cardiac preload

201
Q

what kind of diuretics are commonly used to treat HF?

A

loop diuretics

202
Q

what should you watch for when a pt is on diuretics?

A

dehydration, OH, dizziness, fatigue, confusion, and nausea

203
Q

t/f: vasodilators are successful in pts w/severe HF to reduce PVR and decrease cardiac preload and afterload

A

true

204
Q

how do vasodilators treat HF (KNOW THIS)

A

by reducing the PVR and therefore decreasing cardiac preload and afterload

205
Q

what are common vasodilators used to treat HF?

A

Prazosin, Hydralazine, and a organic nitrates

206
Q

what is Nesiritide (Natrecor)?

A

a newer vasodilator developed to produce arterial and venous dilation

derived from human brain natriuretic s peptide (BNP)

207
Q

what does BNP levels measure?

A

the degree of HF

208
Q

what drug is thought to stop the overproduction of BNP?

A

Nesiritide (Natrecor) a vasodilator

209
Q

what is the vasodilator Sildenafil (Revatio) used to treat?

A

pulmonary HTN

210
Q

what is the drug of choice for pulmonary HTN?

A

Sildenafil (Revatio) a vasodilator

211
Q

what are the meds for hyperlipidemia?

A

statins (KNOW THESE)

fibric acids

bile-acid binding drugs

212
Q

what do antihyperlipidemic drugs do?

A

control plasma lipid levels when non-pharmacological methods are unsuccessful

213
Q

what do statins do? (KNOW THIS)

A

they inhibit the enzyme that is the catalyst for cholesterol synthesis

decrease cholesterol production esp in liver cells

can effect triglyceride levels to some extent

may stabilize atherosclerotic plaque in arterial walls

decrease mortality and morbidity in pts with increased cholesterol or other CV risks

214
Q

statins usually end in…

A

-statin

215
Q

what are some statin drugs?

A

Atorvastatin (Lipitor)

Simvastatin (Zocor)

Rosuvastatin (Crestor)

Prerastatin (Prevachol)

216
Q

what statin drug is usually the 1st one used and is very commonly seen?

A

Atorvastatin (Lipitor)

217
Q

what do fibric acids (fibrates) do? (don’t really need to know these)

A

help lower triglycerides

produce beneficial increase in HDL and decrease in LDL levels

change plasma lipid metabolism

218
Q

fibrates are beneficial to what pts?

A

pts with mixed hyperlipidemia and type 2 DM

219
Q

what do bile-acid binding drugs do?

A

attach to bile acids to increase fecal excretion which leads to decreased plasma cholesterol concentrations

helps breakdown cholesterol

220
Q

what are the bile-acid binding drugs?

A

Cholestyramine (Questran)

Colesevelath (Welchol)

Colestipol (Colestid)

niacin

Ezetimibe (Zetia)

221
Q

how does niacin work to lower cholesterol?

A

braod spectrum antilipidemic med that effects the entire lipid profile

lowers LDL, increases HDL, and decreases triglycerides

reduces entry of fatty acids into the blood stream by binding to nicotinic acid receptors in fat cells

222
Q

how does Ezetimibe (Zetia) work to decrease cholesterol?

A

by inhibiting cholesterol absorption form the GI tract

decreased LDL levels

223
Q

t/f: Ezetimibe (Zetia) can be safely combined with statin for optimal treatment of hyperlipidemia

A

true

224
Q

what are common adverse rxns for antilipidemic drugs? (KNOW THESE)

A

stations can cause NM issues

myopathy (primary and most serious symptom) - muscles pain, weakness, atrophy, and inflammation

niacin can cause ctaneous vasodilation and “niacin flush”

liver dysfxn, pancreatitis, gallstones

225
Q

what are the risk factors for adverse rxns to antilipidemic drugs?

A

high doses, advanced age, multiple diseases, fragility, genetics, use of immunosupppressent drugs

226
Q

the risk for adverse rxns to antilipidemics increases if statin is combined with a ___

A

fibrate

227
Q

t/f: the adverse rxns to antilipidemic drugs is reversible once the med is discontinued and can regain m,muscle strength and bulk back

A

true

228
Q

what are common critical care/ICU drugs?

A

adrenergic agonists (alpha 1 agonists and beta 1 agonists)

alpha beta “mixed” agonists

229
Q

what is the primary use of alpha 1 adrenergic agonists?

A

to treat acute hypotension

230
Q

how do alpha 1 adrenergic agonists treat hypotension?

A

by activating alpha 1 receptors on vascular smooth muscle when causes vasoconstriction to increase PVR and increase BP

231
Q

what drugs are alpha 1 adrenergic agonists?

A

Midodrine (Pro-Amatine)

Phenylephrine (Neo-synephrine)

232
Q

how do beta 1 agonists treat hypotension?

A

by increasing sympathetic response by stimulating beta 1 receptors int he myocardium

stimulation of beta 1 receptors causes an increase in HR and force of myocardial contraction to increase CO

233
Q

t/f: beta 1 agonists are administered via IV

A

true

234
Q

when are beta 1 agonists administered?

A

in emergency cardiogenic/cardiovascular shock

for complications during cardiac surgery

short term for CHF

235
Q

what drugs are beta 1 agonists?

A

Bobutamine (Dobutrex)

Dopamine (Intropin)

236
Q

how do alpha beta “mixed” agonists treat hypotension?

A

with powerful sympathomimetic effects

increased NE release and decrease its re-uptake and breakdown

237
Q

how can alpha beta “mixed agonists be administered?

A

IV, IM, SQ

238
Q

what drugs are alpha beta “mixed agonists?

A

Ephedrine

Epinephrine

NE (Levophed)

239
Q

t/f: alpha beta “mixed” agonists treat severe, acute hypotension in shock situations (cardiogenic, sepsis, etc)

A

true

DPT 530 (14 decks)

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