Cardiovascular Drugs Flashcards
what can cardiovascular (CV) medications treat?
HTN
angina
HF
arrhythmias
coagulation disorders
hyperlipidemia
is the heart innervated by the sympathetic or parasympathetic NS?
both
are ionotropic and chronotropic effects sympathetic or parasympathetic?
ionotropic is sympathetic
chronotropic is both
what NT does the adrenal medulla secrete?
E and NE
do E and NE increase sympathetic or parasympathetic effects?
sympathetic effects
epinephrine (E) has a greater affinity for what receptors?
beta adrenergic receptors
what does ionotropic mean?
modifying force/speed of contraction
what does chronotropic mean?
affecting rate/time of physiologic processes (HR)
what are the categories of autonomic drugs?
cholinergic drugs
adrenergic drugs
what are cholinergic drugs?
drugs that affect the affinity of Ach receptors
what is the primary NT in the ANS?
ACh (parasympathetic)
what are cholinergic agonists?
drugs that stimulate the parasympathetic activity
what are parasympathomimetic drugs?
drugs that stimulate the parasympathetic activity
are cholinergic agonists parasympathomimetic or parasympatholytics?
parasympathomimetics
what are cholinergic antagonists?
drugs that decrease parasympathetic activity
what are parasympatholytic drugs
drugs that decrease parasympathetic activity
are cholinergic antagonists parasympathomimetics or parasympatholytics?
parasympatholytics
what are adrenergic drugs?
drugs that stimulate activity in tissues that respond to E and NE
what are adrenergic agonists?
drugs that increase sympathetic response
what are sympathomimetic drugs
drugs that increase sympathetic response
are adrenergic agonsits sympathomimetic or sympatholytic?
sympathomimetic
what are adrenergic antagonists?
drugs that decrease sympathetic response
what are sympatholytic drugs?
drugs that decrease sympathetic response
are adrenergic antagonists sympathomimetic or sympatholytic?
sympatholytic
where are the muscarinic receptors?
in peripheral tissues supplied by parasympathetic and post ganglionic
where are the nicotinic receptors?
in autonomic ganglia and skeletal neuromuscular junction
where are B2 receptors?
respiratory tract (bronchioles and vascular smooth muscle)
where are B1 receptors?
heart and kidneys
where are A1 receptors?
most vascular smooth muscle
what are the types of anti-hypertensive drugs?
diuretics (KNOW THESE)
sympatholytics
vasodilators (KNOW THESE)
RAS inhibitors
calcium channel blockers (KNOW THESE)
what is the therapeutic classifications of diuretics?
antihypertensives
diuretics increase the formation and excretion of what?
urine
how do diuretics decrease BP?(KNOW THIS)
by increasing renal excretion of water and sodium to decrease the volume of fluid ion the vascular system
diuretics have been used for more than __ years
50
t/f: diuretics are inexpensive
true
what are the indications for diuretics?
mild to moderate HTN
what are the types of diuretics?
thiazide
loop diuretics
potassium sparing diuretics
what does thiazide do?
inhibits sodium reabsorption in the distal tubule of nephron so that more sodium and water can pass through the nephron and be excreted
what do thiazide drugs end in?
-thiazide
what are types of thiazide?
hydrochlorothiazide (main one)
chlorothiazide (Diuril)
Metolazone (Zaroxolyn)
what are loop diuretics?
drugs that inhibit the reabsorption of sodium and chloride from the loop of Henle to prevent reabsorption of water that follows the 2 electrolytes
t/f: loop diuretics don’t spare potassium
true
loop diuretics are often used in ___
HTN
what are the types of loop diuretics?
Furosemide (Lasix)
Torsemide (Demadex)
Bumetanide (Bumex)
what are potassium sparing diuretics? (BE FAMILIAR WITH THIS)
aldosterone antagonists
drugs that prevent the secretion of potassium into the dital tubule
what are the types of potassium sparing diuretics?
Spironolactone (Aldactone)
Amiloride (Midamor)
what are the common adverse reactions to diuretics?
fluid depletion
electrolyte imbalance
weakness and fatigue
OH
impaired glucose and lipid metabolism
GI disturbance
mood changes and confusion
what are sympatholytic drugs used to treat HTN?
bc they decrease sympathetic activities and HTN is often caused by increased sympathetic activity
what are the types of sympatholytic drugs?
beta adrenergic blockers (B1) (KNOW THIS)
alpha adrenergic blockers (BE FAMILIAR WITH THIS)
pre-synaptic adrenergic inhibitors
centrally acting agents
ganglion blockers
beta blockers primarily act on what receptors?
beta 1 receptors of the heart
what do beta blockers do (KNOW THIS)
reduce HR and force of myocardial contraction
beta blockers can be used for ___ , ____ and to normalize ____ in _____
HTN, angina, HR, arrhythmias
t/f: beta blockers have the ability to limit the extent of myocardial damage following an acute MI
true
beta blockers can improve cardiac fxn in some __
HF
are beta blockers selective or non-selective?
an be either
selective beta blockers block what receptors?
beta 1 receptors in the heart
non selective beta blockers block what receptors?
beta 1 and 2 receptors
beta blockers end in what?
-lol
t/f: beta blockers are “cardioselective” due to the preferential affect on primarily the myocardium
true
what are some beta blockers?
Metoprolol (Lopressor)
Carvedilol (Coreg)
Atenolol (Tenormin)
Bisoprolol (Zebeta)
Carteolol
Esmolol
Labetalol
Propranolol (Inderol)
Sotalol (Betapace)
what is Atenolol (Tenormin)?
an oral beta blocker that is taken immediately after an acute MI to prevent another one from occuring
what is Carvedilol (Coreg)?
a non-selective oral beta blocker used for the treatment of HTN, CHF, MI recovery
can cause systemic vasodilation
what is Esmolol?
an IV beta blocker selective to beta 1 for the short term treatment of arrhythmias
what is Labetalol?
a nonselective oral or IV beta blocker that is used for the treatment of HTN or emergent HTN in IV form
what is Metoprolol (Lopressor/Toprol)?
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
what is propranolol (Inderol)?
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
what is Sotalol (Betapace)?
a nonselective beta blocker, primarily used for arrhythmias
also used for HTN and angina
what are common adverse rxns to beta blockers (KNOW THIS)
bronchoconstriction
excessive depression of HR and contractility
dizziness
OH
tinnitus
syncope
GI disturbances
fever
rash
what patients may be adversely affected by nonselective beta blockers and should consider selective beta blockers?
pts with respiratory conditions like emphysema and bronchitis
what are the PT implications for beta blockers? (KNOW THIS)
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
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?
the Borg RPE
what are alpha adrenergic blockers? (maybe know this?)
drugs that act primarily on the alpha 1 receptors on vascular smooth muscle to decrease BP
how do alpha adrenergic blockers decrease BP?
by decreasing peripheral vascular resistance (PVR)
what are alpha adrenergic blockers used to treat?
HTN and to vasodilate
alpha adrenergic blockers usually end in …
-zosin
what is an example of an alpha adrenergic blocker?
Doxazosin (Cardura)
what is Doxazosin (Cardura)?
an oral alpha adrenergic blockers that may also help decrease total cholesterol and triglycerides and decrease insulin resistance in type 2 DM
what are adverse effects of alpha adrenergic blockers?
reflex tachycardia
OH when 1st initiated in older adults
what are presynaptic adrenergic inhibitors? how do they work?
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
what kind of drug is Resperine?
a presynaptic adrenergic inhibitor
what are centrally acting agents?
drugs that act at the source to decrease sympathetic discharge to the BS to decrease stimulation of the heart and vasculature
ie: Clonidine (Catapres)
what are ganglionic blockers?
drugs that are primarily used to decrease BP in emergency situations
how do ganglionic blockers work?
the block synaptic transmission at the junction bw pre and post synaptic neurons of both sympathetic and parasympathetic NS
what kind of drug is Mecamylamine (Inversine, Vecamyl)?
a ganglionic blockers
what are vasodilators? (KNOW THESE)
drugs that have an inhibitory effects directly on vascular smooth muscle cells contraction
how do vasodilators decrease BP? (KNOW THIS)
by decreasing PVR
what are examples of vasodilators?
Hydralazine (Apresoline)
Minoxidil (Loniten)
Nitroprusside (Nipride/Nitropress)
when are vasodilators often indicated? (KNOW THIS)
in hypertensive crisis
what are common adverse rxns to vasodilators? (KNOW THIS)
reflex tachycardia
OH
weakness
fluid retention
dizziness
headache
nausea
hair growth
what are the 3 types of RAS inhibitors?
ACE inhibitors (KNOW THIS)
angiotensin 2 receptor blockers (ARBs) (KNOW THIS)
direct renin inhibitors
what do ACE inhibitors do? (KNOW THIS)
drugs that inhibit the enzyme that converts angiotensin 1 to angiotensin 2
ACE inhibitors usually end in …
-pril
t/f: ACE inhibitor decrease hypertensive side effects of angiotensin 2 by limiting its production
true
how do angiotensin 2 receptor blockers (ARBs) work? (KNOW THIS)
by blocking angiotensin 2 receptors on the tissues to decrease PVR and decrease CV hypertrophy and remodeling associated by HTN
ARBs usually end in…
-sartin
what are examples of ARBs?
Iosartan (Cozar), Valsartan (Diovan)
how do direct renin inhibitors work?
by inhibiting renin from converting angiotensin to angiotensin 1
what are examples of direct renin inhibitors?
Aliskiren (Tekturna) is the only one
what are common adverse rxns to RAS inhibitors? (KNOW THIS)
drug cough (ACE cough)
renal failure
dizziness
rash
angioedema
chest pain
t/f: RAS inhibitors are often well tolerated by most pts and work well and quickly
true
what do calcium channel blockers do? (KNOW THIS)
block Ca2+ entry into CV smooth muscle cells
inhibit contractile process and thus cause vasodilation and a decrease in PVR
calcium channel blockers were developed to treat what? (KNOW THIS)
angina and cardiac arrhythmias
what are calcium channel blockers used to treat?
essential HTN and HTN-related kidney disease
calcium channel blockers usually end in…
-pine
-zem
what are Dihydropyrodine agents?
Ca2+ channel blockers
Nifedipine (Procardia) and Amiodipine
what are non-dihydropyridine agents?
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
t/f: Ca2+ channel blockers are very useful for arrhythmias and HTN
true
what are common adverse rxns of Ca2+ channel blockers?
excessive vasodilation
OH
dizziness
HR abnormalities
tinnitus
nausea
headache
ECG changes (prolonged QT interval)
what is a result of excessive vasodilation from Ca2+ channel blockers?
swelling in the feet and ankles from venous pooling
initial drug therapy for HTN includes a 1st line med, what are the 1st line meds?
Ca2+ channel blockers, Thizide diuretic, or ACE inhibitor
what is the drug treatment for stage 1 HTN?
experts advocate for aggressive treatment w/2 1st line meds
what is the drug treatment for stage 2 HTN?
usually combine thiazide, Ca2+ channel blocker, and RAS inhibitor
pts with DM receiving HTN meds respond best to ___/____ WITH ____, ____, AND _____
ACE inhibitors/ARBs, diuretics, Ca2+ channel blockers, beta blockers
what are the PT implications for anti-hypertensives (KNOW THIS)?
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
what are the types of meds that treat and prevent angina? (KNOW THESE)
organic nitrates (nitroglycerin)
beta blockers
Ca2+ channel blockers
what is angina?
chest pain due to ischemic heart disease
supply of O2 to the heart is insufficient to meet myocardial demands
t/f: ischemia causes metabolic, electrophysiologic, and contractile changes in the heart
true
what do organic nitrates do? (KNOW THIS)
dilate vascular smooth muscle through production of cGMP w/in smooth muscle cells
what does cGMP do?
inhibit smooth muscle contraction
do nitrates vasodilate just the coronary arteries?
no, vasodilation occurs in all systemic vasculature
how do nitrates decrease myocardial demands?
by vasodilating to decrease preload and afterload
how do nitrates decrease angina?
by decreasing overall work of the heart
what are examples of nitrates?
Nitroglycerin (Nitro-Bid, Nitro-Stat, Nitro-Dur)
sublingual nitrates are best to treat what?
acute attack
transdermal nitrates are best to treat what?
angina prophylactically (prevention of angina)
can nitrates be an ointment?
yes
if a patient is using an ointment nitrate, what would we be aware of?
not contacting the ointment with bare skin bc it can transfer vasodilation effects
what is Isosorbide Dinitrate?
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)
it is important to check on what about pt’s nitro?
expiration date and make sure that are carrying it with them
what are common adverse rxns to nitrates? (KNOW THIS)
headache, dizziness, nausea, OH
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
3
how do beta blockers help pts with angina? (KNOW THIS)
by preventing an increase in myocardial oxygen demand
decrease HR and force of myocardial contractions
the primary use of Ca2+ channel blockers for angina is their ability to do what? (KNOW THIS)
directly increase coronary blood flow due to their ability to dilate coronary arteries and peripheral vasculature
t/f: dihydropyridine Ca2+ channel blockers vasodilate w/direct affect on cardiac excitibility/contractility
true
why may dihydropyridine Ca2+ channel blockers be a good choice for pts w/angina that also have arrhythmias?
by don’t affect arrhythmias and can actually help them
what is Ranolazine (Ranexa)?
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
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
true
why may anticoagulant meds be used in pts with angina? (KNOW THIS)
bc angina is usually associated with coronary artery occlusion
what is the role of anticoagulants in angina? (KNOW THIS)
they can be used to prevent a coronary artery from becoming completely blocked
what are commonly used anticoagulant agents? (KNOW THESE)
platelet inhibitors (Aspirin)
anti-platelet drugs (Clopidogrel and Prasugrel)
Heparin/Enoxaparin (Lovenox)
what are platelet inhibitors? (KNOW THIS)
Aspirin
drugs used to prevent platelet-induced clotting in the coronaries
inhibit the biosynthesis of PGs responsible for platelet activation
what are anti-platelet drugs? (KNOW THIS)
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
what is Heparin/Enoxaparin (Lovenox)?
fast acting drug that inhibits thrombin
IV, parenterally (Heparin), SQ injection (Lovenox)
what are the PT implications for anti-anginal meds? (KNOW THIS)
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
what are the 4 classes of meds for cardiac arrhythmias? (BE FAMILIAR WITH THESE)
class 1: sodium chennel blockers
class 2: beta blockers
class 3: potassium (K+) channel blockers
class 4: Ca2+ channel blockers
t/f: meds for cardiac arrhythmias can cause abnormal HR and BP response in pts
true
how do sodium channels blockers treat arrhythmias?
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)
how do subclass 1A Na+ channel blockers work?
they prolong repolarization of cardiac cells to treat arrhythmias originating in ventricles or atria to prevent from firing too quickly
Quinidine, Procalnamide, Disopyramide
how do subclass 1B Na+ channel blockers work?
shorten re-polarization
treat more severe types of ventricular arrhythmias (VT, PVCs)
Lidocaine and Mexiletine
how do subclass 1C Na+ channel blockers work?
slow cardiac conduction
treat ventricular arrhythmias (VT, PVCs)
Flecainide and Propafenone
how do beta blockers treat arrhythmias?
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
what are the most effective beta blockers for arryhthmias?
acebutolol, atenolol, esmolol, metoprolol, nadolol, propranolol, sotalol, timolol
how do potassium (K+) channel blockers treat arrythmias?
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
what are the most effective k+ channel blockers to treat arrhythmias?
amiodarone, dofetilide, D ronedarone, ibutilide
what is the most widely used anti-arrythmic drug?
Amiodarone
why is Amiodarone so widely used to treat arrhythmias?
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
what are the adverse effects of k+ channel blockers?
pulmonary toxicity (esp with Amiodarone in older pts on high doses)
thyroid problems
liver damage
how do Ca2+ channel blockers treat arrhythmias?
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
what are the most effective Ca2+ channel blockers for arrhythmias?
Verapamil and Diltiazem (Cardizem)
what are the adverse effects of Ca2+ channel blockers? (KNOW THIS)
excessive bradycardia
hypotension
what are other anti-arrhythmic meds that are not classified?
Digitalis glycosides
magnesium
adenosine
what are Digitalis glycodides (BE FAMILIAR WITH THIS)
typically used for CHF but can prevent or treat arrhythmias including severe a fib and paroxysmal AV node re-entrant tachycardia
what does IV magnesium treat?
severe ventricular arrythmias such as Torsade’s de Pointes
what does IV adenosine terminate?
severe arrhythmias such as SVT
what are common adverse rxns to anti-arrhythmic drugs? (KNOW THIS)
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
what is the most common side effect of all anti-arrhythmic drugs?
tendency to increase rhythm disturbances initially
what are the PT implications for anti-arrhythmic drugs? (KNOW THIS)
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
what is the goal of meds used for HF?
to improve the pumping ability of the heart and increase contractility
how do meds for HF improve pumping and increase contractility?
1) by producing a (+) ionotropic effect
2) by decreasing cardiac workload by affecting the heart, peripheral vasculature, or controlling fluid volume
what meds for HF will produce a (+) ionotropic effect (decrease the force of muscles contraction)?
cardiac glycosides (Digoxin (Digitalis))
(BE FAMILIAR WITH THESE)
phosphodiesterase inhibitors (BE FAMILIAR WITH THESE)
dopamine and dobutamine
what meds for HF will decrease cardiac workload?
ACE inhibitors, beta blockers, diuretics, and vasodilators
what are the names of the cardiac glycosides?
Digoxin/Digotoxin (Digitalis)
what is the primary drug used to treat CHF?
cardiac glycosides (Digitalis)
cardiac glycosides are most effective for ___ and ____
systolic HF and A-fib
how do cardiac glycosides increase exercise tolerance?
by increasing CO at rest and with exercise
t/f: cardiac glycosides can decrease morbidity associated with CHF
true
digitalis directly inhibits ___ nervous system activity, decreasing stress on the heart
sympathetic
what are the mechanisms of action of cardiac glycosides? (BE FAMILIAR WITH THESE)
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
what are common adverse rxns of digitalis?
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)
what are the phosphodiesterase inhibitors?
Inamrinone and Milrinone
what do phosphodiesterase inhibitors do? (BE FAMILIAR WITH THIS)
they inhibit phosphodiesterase enzyme that breaks down cAMP in cardiac cells (this increased cAMP increases Ca2+)
t/f: phosphodiesterase inhibitors increase myocardial contractility in a selective way
true
what is the only route of administration of phosphodiesterase?
IV
is phosphodiesterase inhibitor for long or short term use?
short-term
when are phosphodiesterase inhibitors indicated? (BE FAMILIAR WITH THIS)
SEVERE cases of CHF and for pts awaiting heart transplant
when is dopamine and dobutamine used? (don’t really need to know this)
in acute and severe cases of CHF
how do dopamine and doputamine work? (don’t really need to know this)
by stimulating beta 1 receptors on the myocardium to produce a (+) ionotropic effect
drugs that decrease cardiac workload affect what system?
RAS
what HF meds decrease cardiac workload?
ACE inhibitors
angiotensin 2 receptor blockers
direct renin inhibitors
t/f: ACE inhibitors are a very important drug in the treatment of systolic CHF
true
what ACE inhibitors work in conjunction with diuretics and digitalis to decrease cardiac workload in HF?
Captopril (Capoten), Enalapril (Vasotec), and others
how do ACE inhibitors decrease cardiac workload in HF? (KNOW THIS)
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
t/f: ARBS are better than ACE inhibitors at treating HF and decreasing mortality
false, they are just as effective
t/f: there are improved effects when ARBs are combined with ACE inhibitors
true
what pts would be contraindicated for the use of ARBs?
pts with CHF and RENAL FAILURE
how to beta blockers help with HF? (KNOW THIS)
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
what is the optimal treatment of HF?
beta blockers w/ACE inhibitors, digitalis, and diuretics
t/f: Carvedilol and Metoprolol are 2 beta blockers approved by the FDA for treatment of HF
true
what are the meds for HF?
cardiac glycosides
ACE inhibitors
beta blockers
vasodilators
diuretics
phosphodiesterase inhibitors
dopamine and dobutamine
ARBs
direct renin inhibitors
how do diuretics treat HF? (KNOW THIS)
by increasing the excretion of sodium and water to reduce fluid in the lungs and peripheral tissues
by decreasing cardiac preload
what kind of diuretics are commonly used to treat HF?
loop diuretics
what should you watch for when a pt is on diuretics?
dehydration, OH, dizziness, fatigue, confusion, and nausea
t/f: vasodilators are successful in pts w/severe HF to reduce PVR and decrease cardiac preload and afterload
true
how do vasodilators treat HF (KNOW THIS)
by reducing the PVR and therefore decreasing cardiac preload and afterload
what are common vasodilators used to treat HF?
Prazosin, Hydralazine, and a organic nitrates
what is Nesiritide (Natrecor)?
a newer vasodilator developed to produce arterial and venous dilation
derived from human brain natriuretic s peptide (BNP)
what does BNP levels measure?
the degree of HF
what drug is thought to stop the overproduction of BNP?
Nesiritide (Natrecor) a vasodilator
what is the vasodilator Sildenafil (Revatio) used to treat?
pulmonary HTN
what is the drug of choice for pulmonary HTN?
Sildenafil (Revatio) a vasodilator
what are the meds for hyperlipidemia?
statins (KNOW THESE)
fibric acids
bile-acid binding drugs
what do antihyperlipidemic drugs do?
control plasma lipid levels when non-pharmacological methods are unsuccessful
what do statins do? (KNOW THIS)
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
statins usually end in…
-statin
what are some statin drugs?
Atorvastatin (Lipitor)
Simvastatin (Zocor)
Rosuvastatin (Crestor)
Prerastatin (Prevachol)
what statin drug is usually the 1st one used and is very commonly seen?
Atorvastatin (Lipitor)
what do fibric acids (fibrates) do? (don’t really need to know these)
help lower triglycerides
produce beneficial increase in HDL and decrease in LDL levels
change plasma lipid metabolism
fibrates are beneficial to what pts?
pts with mixed hyperlipidemia and type 2 DM
what do bile-acid binding drugs do?
attach to bile acids to increase fecal excretion which leads to decreased plasma cholesterol concentrations
helps breakdown cholesterol
what are the bile-acid binding drugs?
Cholestyramine (Questran)
Colesevelath (Welchol)
Colestipol (Colestid)
niacin
Ezetimibe (Zetia)
how does niacin work to lower cholesterol?
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
how does Ezetimibe (Zetia) work to decrease cholesterol?
by inhibiting cholesterol absorption form the GI tract
decreased LDL levels
t/f: Ezetimibe (Zetia) can be safely combined with statin for optimal treatment of hyperlipidemia
true
what are common adverse rxns for antilipidemic drugs? (KNOW THESE)
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
what are the risk factors for adverse rxns to antilipidemic drugs?
high doses, advanced age, multiple diseases, fragility, genetics, use of immunosupppressent drugs
the risk for adverse rxns to antilipidemics increases if statin is combined with a ___
fibrate
t/f: the adverse rxns to antilipidemic drugs is reversible once the med is discontinued and can regain m,muscle strength and bulk back
true
what are common critical care/ICU drugs?
adrenergic agonists (alpha 1 agonists and beta 1 agonists)
alpha beta “mixed” agonists
what is the primary use of alpha 1 adrenergic agonists?
to treat acute hypotension
how do alpha 1 adrenergic agonists treat hypotension?
by activating alpha 1 receptors on vascular smooth muscle when causes vasoconstriction to increase PVR and increase BP
what drugs are alpha 1 adrenergic agonists?
Midodrine (Pro-Amatine)
Phenylephrine (Neo-synephrine)
how do beta 1 agonists treat hypotension?
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
t/f: beta 1 agonists are administered via IV
true
when are beta 1 agonists administered?
in emergency cardiogenic/cardiovascular shock
for complications during cardiac surgery
short term for CHF
what drugs are beta 1 agonists?
Bobutamine (Dobutrex)
Dopamine (Intropin)
how do alpha beta “mixed” agonists treat hypotension?
with powerful sympathomimetic effects
increased NE release and decrease its re-uptake and breakdown
how can alpha beta “mixed agonists be administered?
IV, IM, SQ
what drugs are alpha beta “mixed agonists?
Ephedrine
Epinephrine
NE (Levophed)
t/f: alpha beta “mixed” agonists treat severe, acute hypotension in shock situations (cardiogenic, sepsis, etc)
true
