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Cardiopulmonary > Cardiovascular Medications > Flashcards

Cardiovascular Medications Flashcards

1
Q

Drugs have two names

A
  • Generic name (scientific description)
  • Trade name (assigned to product by the individual drug company)
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2
Q

ACE inhibitors indications & adverse reactions

A
  • End in -pril
  • Indications: HTN, heart failure, coronary artery disease, renal disease
  • Adverse reactions: dry hacking cough, angioedema, hypotension, dizziness
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3
Q

Adrenergic agonists

A
  • Levophed
  • Indications: shock and heart failure
  • Adverse reactions: peripheral tissue necrosis, extravasation, dysrhythmias, myocardial ischemia, hyperglycemia
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4
Q

Alpha blockers

A
  • End in -osin
  • Indications: HTN, benign prostatic hyperplasia
  • Adverse reactions: dizziness, HA, hypotension, postural changes
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5
Q

ARBs

A
  • End in -sartan
  • Indications: heart failure with reduced ejection fraction
  • Adverse reactions: hypotension, fatigue, hyperkalemia, renal failure, dizziness, cough
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6
Q

Anticoagulants

A
  • Apixaban (Eliquis) and Warfarin (Coumadin)
  • Indications: prevention & tx of VTE & other blood clots, a-fb, artificial heart valves
  • Adverse reactions: bleeding, spinal/epidural hematoma
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7
Q

Antiplatelet agents

A
  • Indications: 2ndy prevention of MI or ischemic stroke, peripheral artery disease
  • Adverse reactions: bleeding, dyspnea, bradycardia/bradyarrhythmias
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8
Q

Beta blockers

A
  • End in -lol
  • Indications: acute MI, HTN, heart failure w/systolic dysfunction, dysrhythmia, migraine prophylaxis
  • Adverse reactions: bronchospasm, heart block, masks signs & sx of hypoglycemia
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9
Q

Calcium channel blockers

A
  • Diltiazem (Cardizem) and Verapamil (Calan)
  • End in -pine
  • Indications: HTN, dysrhythmias, ischemiic heart disease, vasospastic angina, peripheral vasospasm
  • Adverse reactions: bradycardia, OH, syncope, dizziness, lightheadedness, HA
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10
Q

Diuretics

A
  • End in -ide
  • Indications: heart failure, hypokalemia, HTN, Meniere’s, cirrhosis
  • Adverse reactions: fluid/electrolyte imbalance, hypotension, dehydration, HA, dizziness
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11
Q

Anticholinergics

A
  • End in -tropium
  • Indications: bronchoconstriction/bronchospasm, asthma, COPD
  • Adverse reactions: bronchitis, HA
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12
Q

Beta agonists

A
  • Indications: bronchoconstriction/bronchospasm, asthma, COPD
  • ADverse reactions: tremor, nervousness, bronchospasm, tachycardia
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13
Q

Positive inotrope

A
  • Indications: shock, heart failure, acute decompensated heart failure, dysrhythmia
  • Adverse reactions: dysrhythmias, hypotension, HA, bronchospasm
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14
Q

Nitrates & nitrites

A
  • Indications: angina pectoris, hypertensive crisis, hypertensive pulmonary edema, heart failure, low CO syndromes, acute MI
  • Adverse reactions: HA, dizziness, orthostatic hypotension, nausea
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15
Q

Describe enteral drugs bioavailability

A
  • Absorbed from the stomach & intestine & pass through the liver (portal circulation)
  • Some drugs may be inactivated in the liver when they pass through the first time (1st pass effect)
  • Greater the 1st pass effect, the less the bioavailability of the drug
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16
Q

Describe parenteral drug bioavailability

A
  • Bioavailability is often greater
  • Onset of action is often faster
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17
Q

Describe sublingual bioavailability

A
  • Enter circulation through the systemic veins that drain the oral mucosa
  • Do not pass through the GI system or portal circulation
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18
Q

Define distribution

A
  • Dispersion or dissemination of the drug throughout the fluids & tissues of the body
  • Circulatory system is most common route of distribution
  • May be general or restricted depending on ability of drug to pass cell membranes & permeability of capillaries for a particular drug
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19
Q

Define clearance

A
  • Removal of a drug from the plasma
  • Processes of drug clearance are influenced by genetic & environmental factors, nutritional habits, weight, exercise, & age
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20
Q

Define elimination

A
  • Process by which drugs are removed from the body
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21
Q

What are the major routes of drug elimination

A
  • Urine excretion through the kidney
  • Bile metabolism in the liver
  • Bodily fluids (sweat, saliva, mothers’ milk)
  • Gaseous substances through the lungs
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22
Q

Defend drug half-life

A
  • Time it takes for the plasma concentration of the drug to be reduced by 50%
  • Reflects rate at which the drug is eliminated from the body
  • Estimates length of time the effects last—the longer the half-life, the longer the effect
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23
Q

Define intermittent doses

A
  • Medications given at certain time intervals throughout the day by any route
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24
Q

Define pharmacodynamics

A
  • Describes the interaction of drugs with tissue receptors & the pharmacological effect
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25
Q

Describe agonists versus antagonists

A
  • Agonists: stimulate a receptor & enhance a physiologic effect
  • Antagonists: inhibit a receptor & decrease a physiologic effect
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26
Q

Postganglionic neurotransmitters in the ANS

A
  • Acetylcholine in parasympathetic system
  • Norepinephrine in the sympathetic system
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27
Q

Receptor types in the ANS

A
  • Cholinerrgic (parasympathetic): muscarinic receptors
  • Adrenergic (sympathetic): α-adrenergic and β-adrenergic adrenoceptors
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28
Q

How does adrenergic agonists affects the receptors

A
  • Mimic activity of NE, Epi, & dopamine
  • Stimulate the receptor
  • Vasoconstrict, increase BP, increase venous return
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29
Q

How does adrenergic antagonists affect the receptors

A
  • Decrease activity of SNS
  • Inhibit the receptor
  • Vasodilator, decrease BP, decrease venous return
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30
Q

How does cholinergic agonists affect the receptors

A
  • Increase activity of PNS
  • Stimulate the receptor
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31
Q

How does cholinergic antagonists affect the receptors

A
  • Decrease activity of PNS
  • Inhibit the receptor
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32
Q

List and describe the autonomic drugs

A
  • Sympathomimetics (adrenergic agonists): mimic activity of endogenous catecholamines epinephrine, norepinephrine, and dopamine
  • Sympatholytics (adrenergic antagonists): reduce the action of the sympathetic nervous system
  • Parasympathomimetics (cholinergic agonists): stimulate parasympathetic activity
  • Parasympatholytics (cholinergic antagonists): block cholinergic activity
33
Q

Define tolerance and physical dependence

A
  • Tolerance: the dosage may need to be increased, the drug replaced, or an additional drug prescribed to supplement the initial drug
  • Physical dependence: the drug should never be discontinued suddenly bc this can lead to a withdrawal syndrome
34
Q

Adverse drug events (ADEs) are defined as

A
  • Any injury resulting from drug therapy
35
Q

Medications often used to treat atherosclerosis

A
  • ACE inhibitors & beta blockers
  • Antiplatelet or anticlotting medicines
  • Calcium channel blockers
  • Medicines to control blood sugar
  • Metformin
  • Nitrates
  • Ranolazine
  • Statins
  • Other cholesterol lowering medicines
  • Thrombolytic medicines, sometimes called clot busters
36
Q

Anti-ischemic drugs reestablish the balance of O2 supply and demand through decreasing O2 demand or by increasing O2 supply (MVO2)

A
  • Drugs that decrease the heart rate or systemic BP decrease the MVO2
  • Drugs that increase arterial lumen size increase myocardial oxygen supply
37
Q

Drugs that decrease myocardial oxygen demand

A
  • Beta blockers: decrease HR & contractility
  • Calcium channel blockers: inhibit coronary vasospasm & dilate coronary blood vessels
  • Nitrates: vasodilate vasculature throughout the body
38
Q

Thrombolytiics

A
  • Breaks up blood clots
  • Adverse reactions: bleeding
  • No PT within 6-8hrs of administration time due to risk of acute ventricular arrhythmias
39
Q

What does HAS BLED stand for to determine the bleeding risk with anti-coagulation therapy

A
  • Hypertension (Uncontrolled)
  • Abnormal renal function (dialysis, transplant)
  • Stroke (prior Hx)
  • Bleeding
  • Labile INR (unstable/ high INR/time in therapeutic range <60%)
  • Elderly (age >65)
  • Drug or alcohol usage Hx (≥8 drinks/wk)
  • Advise stopping anticoagulation if score is ≥4 & cannot be modified
40
Q

Risk factors for increased bleeding

A
  • Active bleeding
  • Acute stroke
  • Acquired bleeding disorders
  • Concurrent use of anticoagulants known to increase the risk of bleeding
  • Lumbar puncture/epidural/spinal anesthesia expected to be given within next 12hr
  • Thrombocytopenia (platelets <7500)
  • Uncontrolled systolic HTN ( BP ≥230/120)
  • Untreated inherited bleeding disorders such as hemophilia or von Willebrrand’s disease
41
Q

Describe the cycle of heart failure

A
  • Cardiac lesion
  • Decreased cardiac performance: impaired pumping ability
  • Neurohumaral Compensation: increased - sympathetic activity, renin angiotensin II, & aldosterone
  • Increased cardiac workload: Increased - vascular resistance and fluid volume
  • Myocardial cell changes: structural damage and altered calcium transport
42
Q

Medications for treating heart failure are frequently titrated, especially ___________

A
  • Diuretics
43
Q

Pharmacologic treatment of HF address 3 primary goals

A
  • Slowing of disease progression
  • Improvement in symptoms
  • Prolongation of survival
44
Q

First-line management of heart failure with reduced ejection fraction (HFREF)

A
  • Diuretics
  • renin angiotensin system (RAS) inhibitors
  • β blockers
45
Q

Describe ARBs in relation to heart failure

A
  • Angiotensin-receptor blockers (ARBs) that inhibit the action of angiotensin II at the vasoconstrictor receptor are an alternative for those unable to tolerate ACE inhibitors.
  • Angiotensin receptor–neprilysin inhibitor (ARNIs)—inhibits both the angiotensin system and the natriuretic peptide neprilisyn for an enhanced effect.
  • Mineralocorticoid receptor antagonist (aldosterone antagonist)—spironolactone is primarily used as an aldosterone antagonist
46
Q

_______________ therapy is recommended for patients with HFREF with no or minimal residual fluid retention and after initiation of an angiotensin system blocker.

A
  • Beta blocker
47
Q

Angiotensin-converting enzyme inhibitors- (ACE inhibitors) when treating HFrEF decrease

A
  • Excess intravascular volume from sodium & water retention
  • Afterload bc of arterial vasoconstriction
48
Q

Describe Digitalis

A
  • 1) Inhibits the Na+/K+ ATPase pump
  • 2) Increases intracellular calcium
  • 3) Increases contractility
  • 4) Slows HR
49
Q

Signs and symptoms of Digitalis Toxicity

A
  • N/V
  • Fatigue/weakness
  • HA
  • Dizziness
  • AV block
  • Ventricular arrhythmias
  • V-fib/V-tachy
  • Visual disturbances
50
Q

Management of HFpEF

A
  • Lifestyle modifications and nutrition counseling
  • Medications
  • Control of systolic and diastolic hypertension
  • Fluid management
  • Management of atrial fibrillation if present
  • Possible use of aldosterone agonist (e.g. spironolactone) if BNP or NT-proBNP was recently elevated
51
Q

Effects of diuretics on HF

A
  • Diuretics decrease circulating blood volume, thereby decreasing preload.
  • Encourage diuresis and influence water and electrolyte balance by inhibiting sodium and water reabsorption.
  • Influence on diuresis depends on the drug’s site of action within the kidneys.
  • The strongest diuretics act at the Henle loop (loop diuretics).
  • Milder diuretics act on the proximal tubules and the collecting tubules and ducts.
52
Q

Affects of cardiac glycosides on HF

A
  • Digitalis increases contractility by inhibiting the sodium–potassium–ATPase enzyme that provides energy for the sodium–potassium pump
  • Common preparations—digitoxin and digoxin
  • Associated with wide variety of toxic effects
  • Limited to patients with persistent moderate to severe symptoms despite optimal initial and appropriate secondary therapy.
53
Q

Describe Sympathomimetics

A
  • Drugs that bind to adrenoceptors and partially or fully mimic the actions of epinephrine or norepinephrine
  • Given to optimize cardiac output
  • Reserved for hemodynamically compromised patients within a critical care setting
54
Q

Define Bipyridines/phosphodiesterase inhibitors

A
  • Act as positive inotropes and vasodilators by augmenting the amount of intracellular cyclic adenosine monophosphate available for myocardial contraction and smooth muscle relaxation
55
Q

Affects of dilators on HF

A
  • Venodilators: nitrates reduce preload via venodilation.
  • Arteriodilators: hydralazine and minoxidil decrease afterload by decreasing arterial resistance.
  • Combined arteriolar and venous dilators—nitroprusside (Nipride) affects both arterial resistance and venous capacitance.
  • Human-brain natriuretic peptide—nesiritide is used to manage patients with acute decompensated HF who have dyspnea at rest or with minimal activity.
56
Q

The gold standard for treatment of life threatening arrhythmias is an ______________________

A
  • Implanted defibrillator
57
Q

Affect of morphine on HF

A
  • Morphine—used in the treatment of severe HF for both its analgesic and its hemodynamic effects.
  • It decreases preload via marked venodilation and exhibits mild arterial vasodilation.
  • The anxiety and effort of dyspnea associated with severe HF appear to improve with the administration of morphine.
  • Sodium-glucose cotransporter 2 (SGLT2)–shown to reduce hospitalizations for patients with type 2 diabetes and HF.
58
Q

Classification of antihypertensive drugs is related to their primary receptor site and mode of action:

A
  • Diuretics, which act on kidneys to reduce volume
  • Drugs that act to limit sympathetic nervous system activity to cause vasodilation (arterial and venous) and to reduce cardiac output
  • Drugs that act on the renin–angiotensin–aldosterone system (RAAS) at the kidney to reduce volume and cause vasodilation
59
Q

What is the goal BP of HTN medications

A
  • <130/90
60
Q

Drugs used for antihypertensives

A
  • Diuretics
  • Sympatholyics
  • Vasodilators
  • Calcium channel blockers
61
Q

What do sympatholytics end in

A
  • End in -olol
62
Q

_________ are first line drug for lowering LDL-C

A
  • Statins
63
Q

Types of drugs used for lipid management

A
  • HMG-CoA reductase inhibitors (“statins”)
  • Cholesterol absorption inhibitors
  • PCSK9 inhibitors
  • Bile acid sequestrants
  • Nicotinic acid (niacin)
  • Fibric acid derivatives (fibrates)
  • Omega-3 fatty acids (“fish oils”)
64
Q

____________ is recognized as the most common adverse effect associated with statin therapy, ranging from myalgia to myositis

A
  • Myopathy
65
Q

__________ is the most commonly used drug in the intensive care unit (ICU)

A
  • Oxygen
66
Q

Nonautonomic nervous system vasodilators and inotropic agents used in critical care:

A
  • Sodium nitroprusside (Nipride)—a potent peripheral vasodilator and the parenteral treatment of choice for hypertension emergencies
  • Intravenous nitroglycerin—emergency drug of choice in the treatment of CHF associated with ischemic heart disease
  • Furosemide (Lasix)—diuretic often administered parenterally in the emergency treatment of pulmonary congestion and LV dysfunction
  • Phosphodiesterase inhibitors (e.g. Milrinone)—positive inotropic agents that are used cautiously in the treatment of acute decompensated HF
67
Q

Effects of Phosphodiesterase inhibitors (e.g. Milrinone)

A
  • Improves cardiac contractility (in-trophy), cardiac relaxation (lusitrophy), & inducing vasodilation
  • Increases cardiac output
  • Improves left ventricle arterial coupling
  • Enhances cardiac mechanical efficiency
68
Q

___________ and _____________ are the primary agents used to suppress ventricular ectopy in critically ill patients.

A
  • Lidocaine and Amiodarone
69
Q

____________, a calcium-channel blocker, has been used in the management of SVT not requiring cardioversion.

A
  • Verapamil
70
Q

______________ or nondihydropyridine calcium-channel blockers are first-line agents used to control the ventricular response rate to atrial flutter or fibrillation (Afib with RVR)

A
  • Beta blockers
71
Q

What do sodium channel blockers end in

A
  • End in -ide
72
Q

______________ is the drug of choice for management of myocardial ischemic pain

A
  • Morphine
73
Q

Adverse or suboptimal reactions to cardiac drugs are primarily caused by:

A
  • Decreases in renal function
  • Reduced liver metabolism
  • Altered blood flow (as in CAD and CHF)
74
Q

Geriatric patients show ____ sensitivity to the toxic effects of cardiac drugs (e.g. antiarrhythmics, digitalis, or β blockers).

A
  • More
75
Q

Drugs may have altered pharmacokinetics and pharmacodynamics in older adults. (True/False)

A
  • True
76
Q

Common cardiac conditions that warrant pharmacologic intervention in pediatric patients:

A
  • Heart failure
  • Blood pressure and lipid abnormalities
  • Arrhythmias
77
Q

______________ is first-line mono therapy for type II diabetes mellitus

A
  • Metformin
78
Q

Pharmacological interventions for heart transplant

A
  • Corticosteroids
  • Calcineurin inhibitors
  • Antiproliferative agents
  • Antilymphocyte antibodies
79
Q

Maintenance therapy for heart transplant

A
  • Most institutions use a triple-drug immunosuppressive regimen for the first year after transplant.
  • Addition of other drugs is guided by acute or chronic rejection or other complications.

Cardiopulmonary (18 decks)

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