Cardiovascular (Laurenπ) Flashcards
What effects does the Sympathetic Nervous system have on the cardiovascular system?
Increased HR (chronotropy)
Increased contractility (Inotropy)
Coronary vasodilation
Increased renin release
Blood vessels: Ξ± constricts (skin, splanchnic) and Γ dilates (skeletal muslce)
What kinds of physical exam findings would you expect from someone with CHF who stopped taking their diuretic?
Unable to complete full sentences
+JVD
Crackles in lung bases
3+ pitting edema
What is the BEST class of drug for someone who is completely fluid overloaded that will get all the fluid off really fast
Loop diuretics
What are the 4 loop diuretics?
Furosemide (Lasix)
Torsemide (Demadex)
Bumetanide (Bumex)
Ethacrynic Acid (Edecrin)
What is the contraindication to 3 of the loop diuretics
Sulfa allergy
Which loop diuretic is OK for someone with a sulfa allergy
Ethacrynic acid
What is the big risk of ethacrynic acid
Ototoxicity ππ»
What are the main side effects of all loop diuretics?
Hypokalemia
Hyponatremia
Hypocalcemia
Hyperuricemia (may precipitate gout at HIGH doses)
What kind of supplement might you want to give your patient who is on a loop diuretic?
Potassium
Is it ok to give Loop Diuretics or Thiazides to patients who are anuric (Donβt make pee)
NO you dumbass
What are the 3 thiazide diuretics?
HCTZ (Microzide)
Chlorothiazide (Diuril)
Metolazone (thiazide related)
What is the contraindication to HCTZ and Chlorothiazide?
Sulfa allergy
Metolazone, the thiazide-related diuretic just has a ~caution~ for sulfa allergy
What are the side effects of thiazide diuretics?
Hypokalemia
Hyponatremia
Hyperuricemia (may precipitate gout at HIGH doses)
Hypercholesterolemia
Hyperglycemia
Erectile dysfunction
What are the 2 drugs that are aldosterone antagonists?
Spironolactone (Aldactone)
Eplerenone (Inspra)
What are the 2 drugs that are K+ sparing diuretics?
Triamterene (Dyrenium)
Amiloride
What is the MOA of Triamterene (Dyrenium) and Amiloride?
Direct inhibitors of Na+ flux
Which one of these diuretics can you use by itself:
Spironolactone (Aldactone)
Eplerenone (Inspra)
Triamterene (Dyrenium)
Amiloride
NONE of them.
Theyβre all weak diuretics and are used in combination with other diuretics. (May eliminate the need for K+ supplementation)
What are the common contraindications oF all these:
Spironolactone (Aldactone)
Eplerenone (Inspra)
Triamterene (Dyrenium)
Amiloride
Hyperkalemia
Anuria
Severe kidney problems
What is the side effect of all of these:
Spironolactone (Aldactone)
Eplerenone (Inspra)
Triamterene (Dyrenium)
Amiloride
Hyperkalemia
What is a ~relative~ contraindication to these:
Spironolactone (Aldactone)
Eplerenone (Inspra)
Triamterene (Dyrenium)
Amiloride
If they are also on an ACE or ARB
What 2 classes of drugs will reduce mortality and improve symptoms in someone with HF?
ACE inhibitors
Γ blockers
What are the absolute contraindications of ACE inhibitors
Angioedema
Pregnancy
What is the MOA of ACE inhibitors?
Block ACE and stop the formation of angiotensin II
ACE inhibitors decrease (preload/afterload/both)
Both
What conditions are treated with ACE inhibitors/
HFrEF
HTN
STEMI
What are the side effects of ACE inhibitors?
Dry cough
Orthostatic hypotension
Hyperkalemia
Angioedema
Rash
Which two drug classes are considered first line for patients with diabetes, CKD, and HFrEF?
ACE inhibitors and ARBs
*********
(Had a blue star on it)
What are the contraindications to Γ-blockers?
Severe bradycardia
2nd or 3rdΒΊ AV block
Uncompensated HF
Systolic BP under 100
Cardiogenic shock
What would happen if your patient who takes a Γ-blocker goes on vacation and forgets to bring their medicine?
Theyβll die
Abrupt withdrawal can cause acute coronary events and severe increases in BP
What are the Non-Selective Γ-blockers?
Propranolol (Inderal)
Nadolol (Corgard)
Timolol
What are the cardioselective Γ-blockers?
Acebutolol (Sectral)
Atenolol (Tenormin)
Metoprolol (Lopressor)
Nebivolol (Bystolic)
Which two Γ-blockers have Intrinsic Sympathetic Activity?
Acebutolol (Sectral)
Pindolol
What is the difference between Non-selective and cardioselective Γ-blockers?
The non-selective ones are more likely to cause bronchospasm.
What are the side effects of Γ-blockers?
Bronchospasm
Fatigue
Worsen CHF (when itβs decompensated)
Raise lipids
Impaired glucose tolerance
Decreased libido/impotence
Depression
If someone develops a bothersome cough on an ACE inhibitor, what could you give them instead?
ARB
What are the contraindications to ARBs
Angioedema
Pregnancy
What drugs are ARBs?
Valsartan
Other ones that end in -sartan
What are the side effects of ARBs?
Orthostatic hypotension
Hyperkalemia
What effects does digoxin have on the heart?
Increased contractility (inotropy)
Decreased HR (Chronotropy)
Increased cardiac output
We all know that digoxin has a narrow margin of safety, but which patients are at a particular risk of toxicity?
Reduced renal clearance
Hypokalemia
What labs/tests do you need to keep an eye on if you put a patient on digoxin?
ECG
Electrolytes
Renal function
Serum digoxin concentrations
What is normal BP?
Less than 120/80
Both systolic AND diastolic need to be below 120/80
What is considered Prehypertension?
Systolic: 120-139
Diastolic: 80-89
What BP is considered Stage 1 hypertension?
Systolic: 140-159
Diastolic: 90-99
What BP is considered stage 2 hypertension?
Systolic: 160+
Diastolic: 100+
What are the 4 first line drugs for HTN?
HCTZ
ACE
ARB
CCB
Which of the big 4 HTN meds are better for black patient?
HCTZ
CCB
Which HTN meds are better for non-black patients?
ACE
Γ-blocker
Which of the big 4 HTN meds is best for patients with kidney disease?
ACE or ARBs
At what BP do we start HTN meds for someone who is 60+ and does not have diabetes or kidney disease
150/90
At what BP do we start HTN meds for anyone who is less than 60 or who has DM or CKD?
140/90
A 74 year old lady takes lisinopril (an ACE) for her HTN.
She does not have DM or CKD.
Her BP today is 148/90.
What do we need to do to her meds?
Nothing!!
She is over 60 without DM or CKD, so her goal BP is less than 150/90.
What are the rules for using more than one HTN meds?
There really arenβt any you can do whatever you want.
Maximize 1st med before adding 2nd
OR
Add second med before reaching max dose of first
OR
Start with 2 separate classes
What class of HTN meds can actually CAUSE peripheral edema?
Short acting CCBs ex: amlodipine
What are the 2 types of CCBs?
Dihydropyridines
Non-dihydropyridines
Which drugs are dihydropyridine CCBs?
Nifedipine
Amlodipine
Other ones that end in -dipine
Which drugs are non-dihydripyridine CCBs?
Verapamil (Calan)
DIltiazem (Cardizem)
Which one has a bigger effect on the HEART vs the vasculature:
Dihydropyridines or Non-dihydropyridines
Heart: Non-dihydropyridines (verapamil and diltiazem)
Vasculature: dihydropyridines
What is the caution for using dihydropyridine CCBs?
HF
What are the cautions for using non dihydropyridine CCBs
Γ-blockers
SA or AV node abnormalities
What drugs are the Ξ±1-blockers?
Selective:
Prazosin (Minipress)
Doxazosin (Cardura)
Terazosin
Non-selective:
Phenoxybenzamine (Dibenzyline)- pretty much only used for pheochromocytoma
What is the BIG side effect of Ξ±-blockers
Orthostatic hypotension
Which class of drugs is associated with the βfirst dose phenomenon?β
Ξ±-blockers
What is the first dose phenomenon?
First time you take an Ξ±-blocker it knocks you on your ass due to the orthostatic hypotension
Other than HTN, what other condition can Ξ±-blockers help with?
BPH π°
What class of drugs can help a guy with BPH go pee pee
Ξ± blockers
Which drugs are Central Ξ±-agonists?
Clonidine (Catapres)
Methyldopa
What are the side effects of central Ξ±-agonists?
Orthostatic hypotension
Sedation
Xerostomia
If you are taking Clonidine or Methyldopa and you take a trip to Mexico without your meds, whatβs gonna happen
You die due to a hypertensive crisis
Which classes of drugs in this lecture should NOT be stopped abruptly?
Γ-blockers
Central Ξ±-agonists
Which 2 HTN drugs are CLASSICALLY associated with being used during preganncy
Methyldopa
Labetalol
What labs do you have to monitor if someone is on Methyldopa?
CBC
Liver enzymes
Coombs test
RISK OF HEMOLYTIC ANEMIAπͺ
What is the most appropriotate drug to give someone who is diagnosed with stable angina?
Sublingual nitro PRN
What are the side effects of sublingual nitro?
Throbbing headache
Hypotension
Tachycardai
What are the instructions you need to give your patient for taking their sublingual nitro?
One dose every 5 min for up to 3 doses.
If chest pain doesnt go away, call 911
If after 1 dose it doesnβt get even little better, call 911
Nitroglycerin decreases (preload/afterload/both)
Both
What are the contraindications to nitroglycerin?
Within 24 hours of taking viagra
Hypertrophic Cardiomyopathy (HCM)
RV infarction
What is the difference between Nitroglycerin and Isosorbide dinitrate/mononitrate
Nitroglycerin= rapid acting
Isosorbide dinitrate/mononitrate= long acting (oral or topical)
What would you use long acting nitrates (isosorbide dinitrate/mononitrate) for?
Long term management of chronic stable angina
Is it easy to develop a tolerance to long acting nitrates (Isosorbide dinitrate/mononitrate)?
Yes, tolerance delvelops quickly
Can Γ-blockers and CCBs be used as long term management of chronic angina?
Yes
What is the best class of drug for Vasospastic (Prinzmetals) angina?
CCBs
