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2021 Pharm 2 > Cardiovascular II > Flashcards

Cardiovascular II Flashcards

1
Q

classes of CV II drugs

A
  • cardiac glycosides
  • adrenergic agonists
  • organic nitrates
  • antidysrhythmics
  • antilipemics
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2
Q

HF

A

heart failure

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3
Q

heart failure types

A
  • systolic
  • diastolic
  • right-sided
  • left-sided
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4
Q

systolic phase

A

when blood is pumped out of heart

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5
Q

diastolic phase

A

when blood fills heart

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6
Q

heart failure

A

demand for blood is unmet by heart’s effort

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7
Q

S/Sx of left-sided HF

A
  • dyspnea
    • paroxysmal nocturnal
    • exertional
    • orthopnea
  • ↑ pulmonary capillary wedge pressure
  • pulmonary congestion
  • restlessness
  • confusion
  • orthopnea
  • tachycardia
  • fatigue
  • cyanosis
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8
Q

S/Sx of right-sided HF

A
  • fatigue
  • ↑ peripheral venous pressure
  • ascites
  • enlarged liver, spleen
  • may be 2/2 chronic pulmonary issues
  • JVD
  • anorexia
  • c/o GI distress
  • wt gain
  • dependent edema
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9
Q

S/Sx of pulmonary congestion

A
  • cough
  • crackles
  • wheezes
  • blood-tinged sputum (frothy)
  • tachypnea
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10
Q

One of the most common causes of pulmonary HTN is _______ _______ ______.

A

left-sided heart failure

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11
Q

Pts with long-standing ____ or ____ are at risk for left-sided HF.

A
  • HTN
  • CAD
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12
Q

Pulmonary HTN can exacerbate dz in what vital organ?

A

liver

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13
Q

systolic HF

A
  • heart doesn’t pump blood with enough force
  • muscle is weaker
  • less blood ejected
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14
Q

diastolic HF

A
  • heart doesn’t fill as much
  • thickened, stiff muscles
  • less blood ejected
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15
Q

SV x HR =

A

CO

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16
Q

SV

A

stroke volume

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17
Q

CO

A

cardiac output

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18
Q

average SV

A

70-80 mL/beat

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19
Q

average CO

A

5,500 mL/min

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20
Q

average HR

A

70 bpm

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21
Q

cardiac output

A

volume of blood pumped from each ventricle per minute

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22
Q

preload

A

volume of blood in ventricles at end of diastole

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23
Q

afterload

A

resistance left ventricle must overcome to circulate blood

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24
Q

drugs for HF

A
  • first-line
    • diuretics that inhibit the RAAS
    • beta blockers
  • if uncontrolled, cardiac glycosides
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25
Q

RAAS

A

renin-angiotensin-aldosterone system

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26
Q

cardiac glycoside prototype

A

digoxin

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27
Q

cardiac glycosides use

A
  • second-line Tx for
    • HF
    • dysrhythmias (a-fib)
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28
Q

inotropy

A

force of muscle ctx

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29
Q

+ inotropic effect

A
  • ↑ force of myocardial contraction
  • improves SV
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30
Q

chronotropy

A

affecting a time or rate, as in HR

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31
Q

– chronotropic effect

A
  • ↓ HR
  • slows rates of SA node depolarization and impulses through heart’s conduction system
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32
Q

+inotropy + –chronotropy =

A

more time for ventricles to fill → ↑ SV and CO

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33
Q

digoxin complications

A
  • dysrhythmias caused by interference with electrical conduction in myocardium
  • cardiotoxicity
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34
Q

cardiotoxicity of digoxin

A

→ bradycardia

35
Q

conditions that ↑ risk of digoxin-induced dysrhythmias

A
  • hypokalemia
  • ↑ serum digoxin levels
  • heart dz
  • older age
36
Q

digoxin toxicity

A
  • GI effects (usually first sign)
    • anorexia
    • N&V
    • abd pain
  • CNS effects
    • fatigue
    • weakness
    • vision changes
      • diplopia
      • blurred vision
      • yellow-green or white halos
37
Q

therapeutic digoxin level

A

0.5-2.0 ng/mL

38
Q

serum K+ level

A

3.5-5.0 mEq/L

39
Q

Digoxin dosage is based on what two factors?

A
  • serum levels
  • client response
40
Q

IV digoxin administration

A
  • infuse over at least 5 min
  • monitor for dysrhythmias
41
Q

What do you check before given digoxin?

A

HR and rhythm

42
Q

Before giving digoxin, check and document what?

A

HR and rhythm

43
Q

HRs to notify provider of before giving digoxin

A
  • < 60 bpm in adult
  • < 70 bpm in children
  • < 90 bpm in infants
44
Q

What supplement may be prescribed with digoxin, and what other drug may accompany it?

A
  • K+
  • diuretic
45
Q

baseline/periodic labs for digoxin

A
  • digoxin level
  • serum K+
46
Q

digoxin pt ed

A
  • take as prescribed
  • take at same time daily
  • missed dose: do not double next dose
  • avoid OTC meds
  • notify provider of toxicity Sx
    • fatigue
    • weakness
    • vision changes
    • GI effects
  • eat high-K+ foods
    • green leafies
    • bananas
    • potatoes
  • report Sx of hypokalemia
    • N&V
    • general weakness
  • monitor pulse rate, report changes before taking
    • irregular rate with early or extra beats
    • HR < 60 bpm or > 100 bpm
47
Q

digoxin contraindications and precautions

A
  • Pregnancy: C
  • contra: disturbances in ventricular rhythm
    • v-fibv
    • v-tach
    • second- and third-degree heart block
  • caution
    • hypokalemia
    • partial AV block
    • advanced HF
    • renal insufficiency
48
Q

digoxin + thiazide or loop diuretic =

A
  • possible hypokalemia
  • ↑ risk of dysrhythmias
49
Q

digoxin + ACE inhibitors or ARBs =

A

↑ risk of hyperkalemia → ↓ effects of digoxin

50
Q

digoxin + sympathomimetics =

A
  • complement inotropic action, ↑ rate and force of heart muscle contraction
  • May be beneficial, but also may ↑ risk of tachydysrhythmias
  • monitor ECG
  • instruct pt to measure HR, report palpitations
51
Q

digoxin + quinidine =

A
  • ↑ risk of digoxin toxicity
  • avoid concurrent use
52
Q

digoxin + verapamil =

A
  • ↑ plasma levels of digoxin
  • interventions
    • ↓ digoxin dose
    • usually avoided b/c verapamil’s cardiosuppression can counteract digoxin
53
Q

digoxin + antacids =

A
  • ↓ absorption of digoxin
  • can ↓ its effectiveness
  • pt: talk to provider before taking
54
Q

digoxin toxicity management

A
  • stop immediately
    • digoxin
    • K+-wasting meds
  • monitor K+ levels
  • disrhythmias: phenytoin or lidocaine
  • bradycardia: atropine
  • excessive overdose, admin one of the following
    • activated charcoal
    • cholestyramine
    • Digibind
55
Q

catecholamines

A

hormones produced by adrenal glands​

56
Q

commonly known/used catecholamines

A
  • epinephrine (adrenaline)
  • norepinephrine (noradrenaline)
  • dopamine (intropin)
57
Q

fxns of catecholamines

A
  • neurotransmitters
  • hormones that regulate physiological fxn
58
Q

adrenergic agonists (catecholamines)

A
  • epinephrine
  • dopamine
  • dobutamine
  • isoproterenol
  • norepinephrine
  • other
    • albuterol
    • terbutaline
    • ephedrine
59
Q

catecholamine receptors

A
  • Alpha1
  • Beta1
  • Beta2
  • dopamine
60
Q

alpha1 adrenergic receptor locations and action

A
  • arterioles of skin, viscera, mucous membranes
  • veins
  • vasoconstriction
61
Q

Beta1 adrenergic receptor locations and actions

A
  • heart
    • ↑ HR
    • ↑ contractility
    • ↑ rate of conduction through AV node
  • kidney
    • release of renin
62
Q

Beta2-adrenergic receptors locations and action

A
  • vasodilation: arterioles of heart, lungs, skeletal muscles
  • bronchodilation
  • relaxation: uterine smooth muscle
  • glycogenolysis: liver
  • contraction: skeletal muscle
63
Q

activation of dopamine receptors causes

A

dilation of renal blood vessels

64
Q

Epinephrine activates what 3 types of receptors?

A
  • alpha 1
  • beta 1
  • beta 2
65
Q

Dopamine activates what receptors?

A
  • low dose: dopamine receptors
  • moderate dose
    • dopamine
    • beta 1
  • high dose
    • dopamine
    • beta 1
    • alpha 1
66
Q

Dobutamine activates what receptors?

A

beta 1

67
Q

uses for dopamine

A
  • shock: vasoconstriction → ↑ systolic BP
  • HF
68
Q

uses for epinephrine

A
  • slower absorption of local anesthetics
  • manage superficial bleeding
  • ↓ congestion of nasal mucosa
  • ↑ BP
  • Tx of AV block and cardiac arrest
  • asthma
69
Q

use for dobutamine

A

Tx of HF

70
Q

AE of epinephrine

A
  • alpha 1 activation → vasoconstriction → hypertensive crisis
  • beta 1 activation
    • → dysrhythmias
    • ↑ workload of heart and O2 demand → angina
71
Q

AE of dopamine

A
  • beta 1 activation
    • → dysrhythmias
    • ↑ workload of heart and O2 demand → angina
  • necrosis from extravasation @ high doses
72
Q

AE of dobutamine

A

↑ HR

73
Q

interventions for epinephrine-induced vasoconstriction

A
  • continuous cardiac monitoring
  • report VS changes to provider
74
Q

interventions for possible dysrhythmias from epinephrine

A
  • continuous cardiac monitoring
  • Monitor closely for
    • dysrhythmias
    • change in HR
    • CP
  • Notify provider and treat per protocol
75
Q

interventions for possible dysrhythmias with dopamine admin

A
  • continuous cardiac monitoring
  • monitor closely for
    • dysrhythmias
    • change in HR
    • CP
  • notify provider and treat per protocol
76
Q

interventions for possible necrosis at dopamine IV site

A
  • monitor IV site carefully
  • infuse through central line if possible
  • D/C infusion at first sign of irritation
77
Q

interventions for dobutamine AE

A
  • continuous cardiac monitoring
  • report VS changes to provider
78
Q

catecholamines contraindications

A
  • pregnancy risk category
    • epinephrine and dopamine: C
    • dobutamine: B
  • tachydysrhythmias
  • ventricluar fibrillation
79
Q

catecholamines precautions

A
  • hyperthyroidism
  • angina
  • Hx of MI
  • HTN
  • DM
80
Q

pinephrine + MAOIs =

A
  • prolonged epinephrine effect
  • avoid concurrent use
81
Q

TCAs + epinephrine =

A
  • blocked epinephrine uptake → prolonged and intensified effects
  • ↓ dose of epinephrine
82
Q

general anesthetics + epinephrine =

A
  • dysrhythmias
  • continuous ECG
  • notify provider of
    • CP
    • dysrhythmias
    • ↑ HR
83
Q

epinephrine + alpha blockers =

A
  • counteracted
  • epinephrine antidote: phentolamine
84
Q
A

2021 Pharm 2 (18 decks)

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