Azilsartan (Edarbi) Candesartan (Atacand) Eprosartan (Teveten) Irbesartan (Avapro) Losartan (Cozaar) Olmesartan (Benicar) Telmisartan (Micardis) Valsartan (Diovan)

Cardiovascular drugs Flashcards by gem mgbn

What are the type of drugs acting on CVS?

anti-hypertensive
cardiotonic drugs
antiarrhythmic drugs
antianginal agents
lipid lowering agents
drugs affecting blood coagulation
drugs used to treat anemia

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hypertension with no known underlying cause

essential hypertension

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drugs that work by altering the normal reflexes that control blood pressure aimed at maintaining the blood pressure within normal limits to prevent the damage that hypertension can cause

anti-hypertensive drugs

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subclasses of anti-hypertensive drugs

angiotensin-converting enzyme (ACE) inhibitors
angiotensin II receptor blockers (ARBs)
calcium-channel blockers
vasodilators

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act in the lungs to prevent ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor and stimulator
of aldosterone release

ACE inhibitors

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action leads to a decrease in BP an in
aldosterone secretion, with a resultant of?

slight increase in serum potassium and loss of serum sodium and fluid

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Drugs Under ACE inhibitors?

Benazepril (Lotensin)
Captopril (Capoten)
Enalapril (Vasotec)
Enalaprilat (Vasotec IV)
Fosinopril (Monopril)
*Lisinopril (Prinivil, Zestril)
Moexipril (Univasc)
Perindopril (Aceon)
Quinapril (Accupril)
Ramipril (Altace)
Trandolapril (Mavik)

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for the treatment of heart failure and left ventricular dysfunction, ACE inhibitors can be taken with?

digoxin and diuretics

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Contraindication for ACE inhibitors?

Allergy
Impaired Renal Function
Pregnancy
Lactation
Heart Failure
Salt/volume depletion

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selectively bind with the angiotensin II receptors in vascular smooth
muscle and in the adrenal cortex to block vasoconstriction and the release of
aldosterone

Angiotensin II Receptor Blockers (ARBs)

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Drugs under ARBs

Azilsartan (Edarbi)
Candesartan (Atacand)
Eprosartan (Teveten)
Irbesartan (Avapro)
Losartan (Cozaar)
Olmesartan (Benicar)
Telmisartan (Micardis)
Valsartan (Diovan)

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These drugs are indicated to be used alone or in combination therapy for
the treatment of hypertension and for the treatment of heart failure in
patients who are intolerant to ACE inhibitors.

ARBs

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They also slow the progression
of renal disease in patients with hypertension and type 2 diabetes

ARBs

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ARBs are well
absorbed and undergo metabolism in the liver by
the?

cytochrome P450 system

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ARBs cross the placenta and are excreted via?

urine and feces

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ARBs contraindication?

Allergy
PRegnancy
Lactation
Presence of hepatic or renal dysfunction
Hypovolemia

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The risk of decreased serum levels and loss of effectiveness
increases if the ARB is taken in combination with?

phenobarbital,
indomethacin, or rifamycin.

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There may be a decrease in anticipated antihypertensive effects if
the ARBs is combined with

ketoconazole, fluconazole, or diltiazem

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ARBs should not be used with ___ because of the potential for serious adverse effects

ACE inhibitors or renin inhibitors

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These drugs inhibit the movement of calcium ions
across the membranes of myocardial and arterial muscle cells,
altering the action potential and blocking muscle cell contraction.

calcium-channel inhibitors

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Drugs under calcium-channel blockers

Amlodipine (Norvasc)
Felodipine (Plendil)
Isradipine (DynaCirc, DynaCirc CR)
Nicardipine (Cardene, Cardene SR)
Diltiazem (Cardizem, Dilacor CR)
Nifedipine (Procardia XL)
Nisoldipine (Sular)
Verapamil (Calan SR)
Clevidipine (Cleviprex)

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Calcium-channel blockers are also sometimes
used in the treatment of?

Raynaud’s disease and migraine headache

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These calcium channel blockers are available in IV form for short-term
use when oral administration is not feasible

Nicardipine
Clevidipine

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Contraindications of calcium-channel blockers

Allergy
Heart block or sick sinus syndrome
Renal or hepatic dysfunction
Pregnancy
Lactation

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diltiazem calcium-channel blocker should not be taken with --- cause it potentially serious effect to note which is an increase in serum levels and toxicity

cyclosporine

These anti-hypertensive drug act directly on vascular smooth muscle to cause muscle relaxation, leading to vasodilation and drop in BP.

vasodilators

Example of vasodilators

Diazoxide (Hyperstat) * Hydralazine (Apresoline) * Minoxidil (Loniten) * Nitroprusside (Nitropress)

vasodilators that are used intravenously

Diazoxide and nitroprusside

vasodilator that is available for oral and intramuscular

hydralazine

contraindication of vasodilators

Allergy Pregnancy Lactation Peripheral vascular disease, CAD, heart failure, tachycardia Functional hypoglycemia

Hydralazine can produce additive hypotensive effects when given with

adrenergic or other anti-hypertensive drugs

medications used to treat hypertension

anti-hypertensive drugs

specific receptors found in blood vessels and in the adrenal gland that react with angiotensin II to cause vasoconstriction and release of aldosterone.

angiotensin II receptors

common, often asymptomatic disorder in which systolic blood pressure persistently exceeds 140 mm Hg and/or diastolic pressure exceeds 90 mm Hg

hypertension

sustained blood pressure that is lower than that required to adequately perfuse all of the body’s tissues

hypotension

force that resists the flow of blood through the vessels, mostly determined by the arterioles, which contract to increase resistance; important in determining overall blood pressure

peripheral resistance

are drugs used to increase the contractility of the heart muscle for patients experiencing heart failure

cardiotonic agents

subclasses of cardiotonic agents

cardiac glycoside phosphodiesterase inhibitors

The cardiac glycosides were originally derived from the

foxglove or digitalis plant

e foxglove or digitalis plant were once ground up to make

digitalis leaf

a cardiotonic drug subclass which is indicated for treating heart failure and irregular heartbeats

cardiac glycosides

drugs under cardiac glycoside

digoxin digitoxin

it has a brand name called Lanoxin.

digoxin

digoxin is most frequently it is used for

atrial fibrillation, atrial flutter, and heart failure

is a cardiac glycoside used for the treatment of heart failure and certain kinds of heart arrhythmia

digitoxin

It is a phytosteroid and is similar in structure and effects to digoxin.

digitoxin

cardiac glycosides has a rapid onset of action and rapid absorption of ___ when taken orally, and ___ minutes when given intravenously

30-120, 5-30

There is a risk of increased therapeutic effects and toxic effects of cardiac glycosides if it is taken with

verapamil, amiodarone, quinidine, quinine, erythromycin, tetracycline, or cyclosporine

Cardiac glycosides drugs may be less effective if it is combined with

thyroid hormones, metoclopramide, or penicillamine

Absorption of oral cardiac glycosides may be decreased if it is taken with

cholestyramine, charcoal, colestipol, antacids, bleomycin, cyclophosphamide, or methotrexate

This belongs to a second class of drugs that act as cardiotonic (inotropic) agents

phosphodiesterase inhibitors

phosphodiesterase inhibitors include

inamrinone (Inocor) and milrinone (Primacor)

Approved only for use in patients with HF who does not have been responsive to digoxin, diuretics, or vasodilators

phosphodiesterase inhibitors

phospodiesterase inhibitors that are used intravenously

Inamrinone and milrinone

enlargement of the heart, commonly seen with chronic hypertension, valvular disease, and heart failure

cardiomegaly

a disease of the heart muscle that leads to an enlarged heart and eventually to complete heart muscle failure and death

cardiomyopathy

discomfort with respirations, often with a feeling of anxiety and inability to breathe, seen with left-sided heart failure.

dyspnea

a condition in which the heart muscle fails to adequately pump blood around the cardiovascular system, leading to a backup or congestion of blood in the system

heart failure

blood-tinged sputum, seen in left-sided heart failure when blood backs up into the lungs and fluid leaks out into the lung tissue

hemoptysis

getting up to void at night, reflecting increased renal perfusion with fluid shifts in the supine position when person has gravity-dependent edema related to heart failure; other medical conditions, including urinary tract infection, increase the need to get up and void

nocturia

difficulty breathing when lying down, often referred to by the number of pillows required to allow a person to breath comfortably

orthopnea

effect resulting in an increased force of contraction

positive inotropic

severe left-sided heart failure with backup of blood into the lungs, leading to loss of fluid into the lung tissue

pulmonary edema

rapid and shallow respirations, seen with left sided heart failure

tachypnea

also known as cardiac dysrhythmia medications, are a group of pharmaceuticals that are used to suppress abnormal rhythms of the heart (cardiac arrhythmias), such as atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation

antiarrhythmic agents

classes of antiarrhythmic agents

class 1,2,3,4

antiarrhythmics that are fast sodium channel blockers

class 1

class 1a antiarrhythmic drugs

Disopyramide (Norpace) Procainamide (Pronestyl) quinidine (Generic)

class 1b antiarrhythmics

lidocaine (Xylocaine) mexiletine (Mexitil)

class 1c antiarrhythmics

Flecainide (Tambocor) Propafenone (Ryhtmol)

antiarrhythmic drugs preferable in conditions such as tachycardia, in which the sodium gates are open frequently

class 1a

Also for the treatment of potentially life-threatening ventricular arrhythmias and should not be used to treat other arrhythmias because of the risk of a proarrhythmic effect

class 1a antiarrhythmic drugs

class 1a antiarrhythmic drugs should not be used to treat other arrhythmias because of the risk of

proarrhythmic effect

class 1 antiarrhythmic available in oral form

Disopyramid, Flecainide, and propafenone

class 1a available in intramuscular (IM), intravenous (IV), and oral forms

Procainamide and Quinidine

class 1b antiarrythmic that is administered by the IM or IV route, and can also be given as a bolus injection in emergencies when monitoring is not available to document the exact arrhythmia

Lidocaine

class 1b antiarrhythmics that is an oral drug administered to adults only

Mexiletine

antiarrhythmics that are conventional beta blockers

class 2

Drug under Class II Antiarrhythmics

● Acebutolol ● Esmolol ● Propranolol

these drugs competitively block beta-receptor sites in the heart and kidneys

class 2 antiarrythmics

class 2 antiarrhythmics are indicated for the treatment of

supraventricular tachycardias and PVCs

Acebutolol is administered

orally

Esmolol is administered

intravenously

Propranolol is administered

orally or intravenously

The use of class 2 antiarrhythmic drugs is contraindicated in the presence of

sinus bradycardia (rate less than 45 beats/min) AV block cardiogenic shock HF asthma respiratory depression diabetes thyroid dysfunction

these drugs act by blocking depolarizing currents and thereby prolonging the effective refractory period of the myocardium.

class 3 antiarrhythmics

drugs under class 3 antiarrhythmics

● Amiodarone ● Dofetilide ● Ibutilide ● sotalol

these drugs block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, prolonging it. All of these drugs are proarrhythmic and have the potential of inducing arrhythmias

class 3 antiarrhythmics

class 3 antiarrhythmic drug that is indicated for initiation of treatment and prophylaxis of frequently recurring ventricular fibrillation and hemodynamically unstable ventricular tachycardia in patients refractory to other therapy

Amiodarone HCl injection

Amiodarone is available in

an oral or intravenous form

Dofetilide and sotalol are administered only in

oral form

Ibutilide is given

antiarrhythmic drugs that are slow non-dihydropyridine calcium channel blockers

class 4 antiarrhythmics

Drug under Class IV Antiarrhythmics

● Diltiazem ● Verapamil

these antiarrhythmic drugs block the movement of calcium ions across the cell membrane, depressing the generation of action potentials and delaying phases 1and 2 of repolarization, which slows automaticity and conduction.

class 4 antiarrhythmics

diltiazem and verapamil are used as

antihypertensives and to treat angina

● Diltiazem is administered .

intravenously

When used as an antiarrhythmic, verapamil is used

intravenously

drugs that affect the action potential of cardiac cells and are used to treat arrhythmias and restore normal rate and rhythm

antiarrhythmics

slower-than-normal heart rate (usually less than60 beats/min)

bradycardia

the amount of blood the heart can pump per beat; influenced by the coordination of cardiac muscle contraction, heart rate, and blood return to the heart

cardiac output

large research study run by the National Heart and Lung Institute that found that long-term treatment of arrhythmias may havea questionable effect on mortality, and in some cases actually lead to increased cardiac death; basis for the current indication for antiarrhythmics (short-term use to treat life-threatening ventricular arrhythmias).

Cardiac Arrhythmia Suppression Test (CAST)

-blocks to conduction of an impulse through the cardiac conduction system; can occur at the atrioventricular node, interrupting conduction from the atria into the ventricles, or in the bundle branches within the ventricles,preventing the normal conduction of the impulse.

heart blocks

the study of the forces moving blood throughout the cardiovascular

hemodynamics

drugs are used to reduce ischemia by increasing the delivery of oxygen-rich blood to cardiac tissues or by reducing oxygen consumption by the coronary vessels. Either of these mechanisms can reduce ischemia and lead to a decrease in anginal pain.

antianginal agents

antianginal agents subclasses

nitrites and nitrates beta blockers calcium channel blockers

antianginals that work mainly by decreasing venous return to the heart (preload) and decreasing systemic vascular resistance (afterload)

nitrites and nitrates

are the rapid- and long-acting nitrates available for clinical use

Amyl nitrite (rapid acting) Nitroglycerin (both rapid and long acting Isosorbide dinitrate (both rapid and long acting) Isosorbide mononitrate (primarily long acting)

antianginal agent that are used to treat stable, unstable, and vasospastic (Prinzmetal) angina.

nitrates

Rapid-acting dosage forms of nitrates are most often

sublingual nitroglycerin tablets, or an intravenous drip

contraindication of nitrites and nitrates

severe anemia allergy to nitrates head trauma and cerebral hemorrhage pregnancy and lactation renal and hepatic disease

Nitrate antianginal drugs can produce additive hypotensive effects when taken in combination with

alcohol beta blockers calcium channel blockers, phenothiazines erectile dysfunction drugs

erectile dysfunction drugs examples

sildenafil (Viagra) , tadalafil, and vardenafil.

sildenafil should not be taken with erectile dysfunction drugs coz it will ___

cause dangerous drop in bp

Nitroglycerin is contraindicated in patients who have

severe anemia increased intracranial pressure hypersensitivity circulatory failure

these antianginals help by slowing the heart rate and decreasing contractility, thereby decreasing oxygen demands

beta blockers

beta blockers approved as antianginal drugs are

atenolol, metoprolol, nadolol, propranolol

these drugs are most effective in the treatment of exertional angina (i.e., that caused by exercise).

beta blockers

For an individual (often elderly) with significant angina, “exercise” may simply be carrying out the activities of daily living, such as

bathing dressing cooking housekeeping

The beta blockers are also approved for the treatment of

MI hypertension cardiac dysrhythmias essential tremor

these drugs decrease calcium influx into the smooth muscle, causing vascular relaxation. This either reverses or prevents the spasms of coronary vessels that cause the anginal pain associated with Prinzmetal or chronic angina.

calcium-channel blockers

There are three chemical classes of calcium channel blockers (CCBs)

phenylalkylamines, benzothiazepines, and dihydropyridines, commonly represented by verapamil, diltiazem, and amlodipine, respectively

these are considered first-line drugs for the treatment of such conditions as angina, hypertension, and supraventricular tachycardia

calcium-channel blockers

The dihydropyridine CCB nimodipine is indicated solely for

cerebral artery spasms associated with aneurysm rupture

CCBs are also used for the short-term management of

atrial fibrillation and flutter, migraine headaches, and Raynaud’s disease (a type of peripheral vascular disease)

contraindications of CCB

drug allergy acute MI second or third-degree AV block (unless the patient has a pacemaker) hypotension

Chest pain that occurs when the heart’s supply of blood carrying oxygen is insufficient to meet the demands of the heart

angina pectoris

A common form of arteriosclerosis involving deposits of fatty, cholesterol-containing material (plaques) within arterial walls

atherosclerosis

Chest pain that is primarily caused by atherosclerosis, which results in a long-term but relatively stable level of obstruction in one or more coronary arteries

chronic stable angina

Arteries that deliver oxygen to the heart muscle

coronary arteries

Any one of the abnormal conditions that can affect the arteries of the heart and produce various pathological effects, especially a reduced supply of oxygen and nutrients to the myocardium

coronary artery disease

Poor blood supply to an organ

ischemia

Poor blood supply to the heart via the coronary arteries

ischemic heart disease

Necrosis of the myocardium following interruption of blood supply; it is almost always caused by atherosclerosis of the coronary arteries and is commonly called a heart attack

Myocardial Infarction

A rapid heartbeat caused by a variety of autonomic nervous system effects, such as blood pressure changes, fever, or emotional stress.

reflex tachycardia

Early stage of progressive coronary artery disease.

unstable angina

induced myocardial chest pain caused by spasms of the coronary arteries; also referred to as Prinzmetal or variant angina.

vasospastic angina ischemia

these drugs lower serum levels of cholesterol and various lipids. These include bile acid sequestrants, HMG-CoA reductase inhibitors, and a cholesterol absorption inhibitor

lipid-lowering agents

subclasses of lipid lowering agents

bile acid sequestrants HMG-COA Reductase Inhibitors/ Statins cholesterol absorption inhibitors

these drugs prevent the reabsorption of bile salts, which are very high in cholesterol. Consequently, the liver will pull cholesterol from the blood to make new bile acids, lowering the serum cholesterol level.

bile acid sequestrants

drugs under bile acid sequestrants

● Cholestyramine (Questran) ● Colestipol (Colestid) ● Colesevelam (WelChol)

these drugs bind with bile acids in the intestine to form an insoluble complex that is then excreted in the feces.

bile acid sequestrants

these contain high levels of cholesterol.

bile acids

the liver use it to make more bile acids

cholesterol

This is used to treat pruritus associated with partial biliary obstruction.

Cholestyramine

Cholestyramine is a power that must be mixed with liquids and taken up to

6x a day

Colestipol is available in

powder and tablet form

Colestipol is taken only

4x a day

Colesevelam is available in

tablet form

Colesevelam is taken only

once or 2x a day

Bile Acid sequestrants are contraindicated in the presence of allergy to

any bile acid sequestrant

bile acid sequestrants also are contraindicated in the following conditions:

complete biliary obstruction abnormal intestinal function pregnancy or lactation

bile acid sequestrants decrease or delay the absorption of

thiazide diuretics digoxin warfarin thyroid hormones corticosteroids

Consequently, any of these drugs should be taken ____ after the bile acid sequestrant

1hour before or 4 to 6 hours

these drugs block the enzyme HMG-CoA reductase, resulting in lower serum cholesterol levels, a resultant breakdown of LDLs, and a slight increase in HDLs

HMG-CoA reductase inhibitors, or statins

Drug under HMG-COA Reductase inhibitors/ statins

● Artovastatin (Lipitor) ● Fluvastatin (Lescol) ● Lovastatin (Mevacor) ● Pravastatin (Pravachol) ● Rosuvastatin (Crestor) ● Simvastatin (Zocor)

The early rate-limiting step in the synthesis of cellular cholesterol involves the enzyme

HMG-COA reductase

if HMG-CoA reductase is blocked, what happens

serum cholesterol and LDL levels decrease because more LDLs are absorbed by the cells for processing into cholesterol

these enzymes block HMG-CoA reductase from completing the synthesis of cholesterol

HMG-CoA reductase inhibitor

(one of the oldest HMG-CoA drugs available

pravastatin lovastatin

are indicated for patients with documented CAD to slow progression of the disease

simvastatin

these statins are used to prevent a first myocardial infarction (MI) in patients who have multiple risk factors for developing CAD.

pravastatin lovastatin simvastatin atorvastatin

The peak effect of statin drugs is usually seen

within 2 to 4 weeks

a breakdown of muscles whose waste products can injure the glomerulus and cause acute renal failure, has also occurred with the use of all of these drugs

Rhabdomyolysis

The risk of rhabdomyolysis increases if any of statin drugs is combined with

erythromycin cyclosporine gemfibrozil niacin antifungal drugs

Serum levels and the risk of toxicity increase if statin drugs are combined with

grapefruit juice

works in the brush border of the small intestine to prevent the absorption of dietary cholesterol, which leads to increased clearance of cholesterol by the liver and a resultant fall in serum cholesterol.

cholesterol absorption inhibitor ezetimibe

these are very important parts of the overall treatment of a patient receiving a cholesterol absorption inhibitor

Change in diet and increased exercise

this drug works in the brush border of the small intestine to decrease the absorption of dietary cholesterol from the small intestine.

ezetimibe

Ezetimibe is absorbed well after oral administration, reaching peak levels in

4-6 hours

ezetimibe is metabolized in the liver and the small intestine, with a half-life of

22 hours

The risk of elevated serum levels of ezetimibe increases if it is given with

cholestyramine fenofibrate gemfibrozil antacids

ezetimibe should be taken at least___ before or ___ after the other drugs.

2 hours before 4 hours after

The risk of toxicity also increases if ezetimibe is combined with

cyclosporine

If ezetimibe is combined with any fibrate, the risk of ___ increases.

cholethiasis

___ levels increase in a patient who is also taking ezetimibe

warfarin

general term used for drugs used to lower lipid levels in the blood.

Antihyperlipidemic agents

cholesterol-containing acids found in the bile that act like detergents to break up fats in the small intestine

bile acids

necessary component of human cells that is produced and processed in the liver, then stored in the bile until stimulus causes the gallbladder to contract and send the bile into the duodenum via the common bile duct; a fat that is essential for the formation of steroid hormones and cell membranes; it is produced in cells and taken in by dietary sources

cholesterol

carrier for lipids in the bloodstream, consisting of proteins, lipids, cholesterol, and so forth.

chylomicron

endogenous substances that activate nervous system receptors that are important in the regulation of appetite, food intake, and metabolism.

Endocannabinoids

loosely packed chylomicron containing fats, able to absorb fats and fat remnants in the periphery; thought to have a protective effect, decreasing the development of coronary artery disease.

HDL

enzyme that regulates the last step in cellular cholesterol synthesis

HMG-CoA reductase

HMG-CoA reductase stands for

hydroxymethylglutaryl-coenzyme A reductase

increased levels of lipids in the serum, associated with increased risk of coronary artery disease development.

hyperlipidemia

tightly packed fats that are thought to contribute to the development of coronary artery disease when remnants left over from the LDL are processed in the arterial lining.

LDL

a collection of factors, including insulin resistance, abdominal obesity, low high-density lipoprotein and high triglyceride levels, hypertension, and proinflammatory and prothrombotic states, that increase the incidence of coronary artery disease

metabolic syndrome

factors that have been identified as increasing the risk of the development of a disease; for coronary artery disease, risk factors include genetic predisposition, gender, age, high-fat diet, sedentary lifestyle, gout, hypertension, diabetes, and estrogen deficiency

risk factors

subclasses of drugs affecting blood coagulation

anticoagulants antiplatelet drugs thrombolytic drugs

are drugs that interfere with the normal coagulation process by interfering with the clotting cascade and thrombin formation

anticoagulants

Drug under Anticoagulants

·antithrombin III (Thrombate III) ·argatroban (Acova) ·bivalirudin (Angiomax) ·desirudin (Iprivask) ·fondaparinux (Arixtra) ·heparin (generic) · warfarin (Coumadin)

these drugs interfere with the normal cascade of events involved in the clotting process

anticoagulants

these block the formation of thrombin from prothrombin

Heparin, argatroban, and bivalirudin

Adverse effects of anticoagulants can range from

bleeding gums with tooth brushing to severe internal hemorrhage

Warfarin has been associated with

alopecia dermatitis bone marrow depression

what happens if heparin is combined with oral anticoagulants, salicylates, penicillins, or cephalosporins

increased bleeding

this can occur if heparin is combined with nitroglycerin

decreased anticoagulation

To treat heparin drug overdose,

protamine sulfate

used to treat warfarin overdose

Vitamin K

this drug decrease the formation of the platelet plug by decreasing the responsiveness of the platelets to stimuli that would cause them to stick and aggregate on a vessel wall

antiplatelet agents

Drug under anticoagulant

·abciximab (ReoPro) ·anagrelide (Agrylin) ·aspirin ·cilostazol (Pletal) ·clopidogrel (Plavix) ·dipyridamole (Persantine) ·eptifibatide (Integrilin) ·sulfinpyrazone (Anturane) ·ticlopidine (Ticlid) ·tirofiban (Aggrastat).

this inhibit platelet adhesion and aggregation by blocking receptor sites on the platelet membrane, preventing platelet–platelet interaction or the interaction of platelets with other clotting chemicals.

antiplatelet agents

One drug ___ blocks the production of platelets in the bone marrow.

anagrelide

These agents are used effectively to treat cardiovascular diseases that are prone to produce occluded vessels; for the maintenance of venous and arterial grafts; to prevent cerebrovascular occlusion; and as adjuncts to thrombolytic therapy in the treatment of myocardial infarction (MI) and the prevention of reinfarction after MI. T

antiplatelet

these drugs break down the thrombus that has been formed by stimulating the plasmin system

thrombolytic agents

drugs under thrombolytic agents

·alteplase (Activase) ·reteplase (Retavase) ·streptokinase (Streptase) ·tenecteplase (TNKase) ·urokinase (Abbokinase)

All of the drugs that are available for this purpose work to activate the natural anticlotting system—conversion of plasminogen to ___

plasmin

The thrombolytics are effective only if the patient has ___ in the plasma

plasminogen

The most common adverse effect associated with the use of thrombolytic agents is

bleeding

The risk of hemorrhage increases if thrombolytic agents are used with

any anticoagulant or antiplatelet drug

Arrange to administer ___ to reduce mortality associated with acute MI as soon as possible after the onset of symptoms

tenecteplase or streptokinase

what to do with heparin if it is being given administration of a thrombolytic agent

discontinue

drugs that block or inhibit any step of the coagulation process, preventing or slowing clot formation

anticoagulants

drugs that interfere with the aggregation or clumping of platelets to form the platelet plug

antiplatelet agents

the process of blood’s changing from a fluid state to a solid state to plug injuries to the vascular system

coagulation

drugs that lyse, or break down, a clot that has formed; these drugs activate the plasminogen mechanism to dissolve fibrin threads

thrombolytic agents

drugs used to treat anemia subclasses

erythropoiesis stimulating agents agents used for iron-deficiency anemia agents used for other anemias

A substance that stimulates the bone marrow to make more red blood cells

erythropoiesis stimulating agents

are used to treat anemia caused by chronic kidney failure, some anticancer drugs, and certain treatments for HIV. They may also be used to lower the number of blood transfusions needed during and after certain major surgeries

erythropoiesis stimulating agents

drugs under erythropoiesis stimulating agents

● Darbepoetin alfa ● Epoetin alfa ● Methoxy polyethylene glycol-epoetin beta

Is a man-made form of a protein that helps your body produce red blood-cells. It is used to treat anemia caused by chemotherapy or chronic kidney disease.

Darbepoetin alfa (Aranesp)

This medicine is used to treat anemia associated with renal failure and patients on dialysis; reduction in need for transfusions in surgical patients; treatment of anemia associated with AIDS therapy; treatment of anemia associated with cancer chemotherapy

Epoetin alfa (Epogen)-

Used to treat anemia associated with chronic renal failure, including in dialysis patients

Methoxy polyethylene glycol-epoetin beta (Mircera)

Generally indicated in conditions where there is

impaired red blood cell production

The two primary FDA approved indications for ESAs are

anemia secondary to chronic kidney disease chemotherapy-induced anemia in patients with cancer

All ESA drugs are contraindicated in the presence of

uncontrolled hypertension

drugs under agents used for iron-deficiency anemia

● Ferrous fumarate (Feostat) ● Ferrous gluconate (Fergon) ● Ferrous sulfate (Feosol) ● Ferrous sulfate exsiccated (Feratab, Slow FE) ● Iron dextran (InFeD)

Treatment of iron deficiency in patients undergoing chronic hemodialysis or nondialysis patients with renal failure who are also receiving supplemental erythropoietin therapy

Iron sucrose (Venofer)

Treatment of iron deficiency in patients undergoing chronic hemodialysis who are also receiving supplemental erythropoietin therapy

Sodium ferric gluconate complex (Ferrlecit)

agents used for iron-deficiency anemia may also be used as adjunctive therapy in patients receiving an

erythropoiesis-stimulating drug

is a parenteral form of iron given by the Z-track method

Iron dextran

agents used for iron-deficiency anemia that are available for oral administration

Ferrous fumarate ferrous gluconate ferrous sulfate

agents used for iron-deficiency anemia are contraindicated in the following conditions

hemochromatosis (excessive iron) hemolytic anemias normal iron balance peptic ulcer colitis regional enteritis

Iron absorption decreases if iron preparations are taken with

antacids, tetracyclines, or cimetidine

Increased iron levels occur if iron preparations are taken with

chloramphenicol

AGENTS FOR MEGALOBLASTIC ANEMIAS

1. Folic Acid Derivatives 2. Vitamin B12

AGENT FOR SICKLE CELL ANEMIA

Hydroxyurea

a synthetic form of folate, a B vitamin, used to treat or prevent low folate levels, which can lead to certain types of anemia or birth defects.

Folic acid (Folvite)

used as “leucovorin rescue” after chemotherapy, allowing non cancerous cells to survive the chemotherapy; used with fluorouracil for palliative treatment of colorectal cancer

Leucovorin (Wellcovorin)

Folic Acid Derivatives

Folic acid (Folvite) Leucovorin (Wellcovorin) Levoleucovorin

used in adults and children to prevent harmful effects of methotrexate (Trexall) when methotrexate is used to treat osteosarcoma (cancer that forms in bones)

Levoleucovorin

a man-made form of vitamin B12 used to prevent and treat low blood levels of this vitamin.

Cyanocobalamin (Nascobal)

a manufactured version of the vitamin B12. It is used to treat and prevent vitamin B12 deficiency anemia

Hydroxocobalamin (Hydro-Crysti-12)

Vitamin B12 drugs

Cyanocobalamin (Nascobal) Hydroxocobalamin (Hydro-Crysti-12)

Megaloblastic anemia is treated with folic acid and vitamin B12 tissue.

folic acid and vitamin B12 tissue.

Vitamin B12 is also necessary for maintenance of the

myelin sheat in nerve tissue

Folate deficiency may result from increased loss of

folate

False low serum and red cell folate levels may occur if the patient has been taking antibiotics, such as tetracycline, which suppress the growth of

Lactobacillus casei

a cytotoxic antineoplastic drug that is also used to treat leukemia, ovarian cancer and melanoma. It interferes with the growth of cancer cells, which are eventually destroyed by the body.

Hydroxyurea

Reduction of frequency of painful crisis and need for blood transfusions in adult patients with

sickle cell anemia

used to treat sickle cell anemia

hydroxyurea

hydroxyurea has a half life of

3-4 hours

hydroxyurea has a peak levels of

1-4 hours

disorder involving too few red blood cells (RBCs) or ineffective RBCs that can alter the blood’s ability to carry oxygen

anemia

RBCs, responsible for carrying oxygen to the tissues and removing carbon dioxide; they have no nucleus and live approximately 120 days

erythrocytes

process of RBC production and life cycle; formed by megaloblastic cells in the bone marrow, using iron, folic acid, carbohydrates, vitamin B12, and amino acids; they circulate in the vascular system for about 120 days and then are lysed and recycled

erythropoiesis

glycoprotein produced by the kidneys, released in response to decreased blood flow or oxygen tension in the kidney; controls the rate of RBC production in the bone marrow

erythropoietin

low RBC count with low iron available because of high demand, poor diet, or poor absorption; treated with iron replacement

iron-deficiency anemia

anemia caused by lack of vitamin B12 and/or folic acid, in which RBCs are fewer in number and have a weak stroma and a short lifespan; treated by replacement of folic acid and vitamin B12

megaloblastic anemia

Cardiovascular drugs Flashcards

(259 cards)