Cardiovascular Medications Flashcards
Drugs have two names
- Generic name (scientific description)
- Trade name (assigned to product by the individual drug company)
ACE inhibitors indications & adverse reactions
- End in -pril
- Indications: HTN, heart failure, coronary artery disease, renal disease
- Adverse reactions: dry hacking cough, angioedema, hypotension, dizziness
Adrenergic agonists
- Levophed
- Indications: shock and heart failure
- Adverse reactions: peripheral tissue necrosis, extravasation, dysrhythmias, myocardial ischemia, hyperglycemia
Alpha blockers
- End in -osin
- Indications: HTN, benign prostatic hyperplasia
- Adverse reactions: dizziness, HA, hypotension, postural changes
ARBs
- End in -sartan
- Indications: heart failure with reduced ejection fraction
- Adverse reactions: hypotension, fatigue, hyperkalemia, renal failure, dizziness, cough
Anticoagulants
- Apixaban (Eliquis) and Warfarin (Coumadin)
- Indications: prevention & tx of VTE & other blood clots, a-fb, artificial heart valves
- Adverse reactions: bleeding, spinal/epidural hematoma
Antiplatelet agents
- Indications: 2ndy prevention of MI or ischemic stroke, peripheral artery disease
- Adverse reactions: bleeding, dyspnea, bradycardia/bradyarrhythmias
Beta blockers
- 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
Calcium channel blockers
- 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
Diuretics
- End in -ide
- Indications: heart failure, hypokalemia, HTN, Meniere’s, cirrhosis
- Adverse reactions: fluid/electrolyte imbalance, hypotension, dehydration, HA, dizziness
Anticholinergics
- End in -tropium
- Indications: bronchoconstriction/bronchospasm, asthma, COPD
- Adverse reactions: bronchitis, HA
Beta agonists
- Indications: bronchoconstriction/bronchospasm, asthma, COPD
- ADverse reactions: tremor, nervousness, bronchospasm, tachycardia
Positive inotrope
- Indications: shock, heart failure, acute decompensated heart failure, dysrhythmia
- Adverse reactions: dysrhythmias, hypotension, HA, bronchospasm
Nitrates & nitrites
- Indications: angina pectoris, hypertensive crisis, hypertensive pulmonary edema, heart failure, low CO syndromes, acute MI
- Adverse reactions: HA, dizziness, orthostatic hypotension, nausea
Describe enteral drugs bioavailability
- 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
Describe parenteral drug bioavailability
- Bioavailability is often greater
- Onset of action is often faster
Describe sublingual bioavailability
- Enter circulation through the systemic veins that drain the oral mucosa
- Do not pass through the GI system or portal circulation
Define distribution
- 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
Define clearance
- Removal of a drug from the plasma
- Processes of drug clearance are influenced by genetic & environmental factors, nutritional habits, weight, exercise, & age
Define elimination
- Process by which drugs are removed from the body
What are the major routes of drug elimination
- Urine excretion through the kidney
- Bile metabolism in the liver
- Bodily fluids (sweat, saliva, mothers’ milk)
- Gaseous substances through the lungs
Defend drug half-life
- 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
Define intermittent doses
- Medications given at certain time intervals throughout the day by any route
Define pharmacodynamics
- Describes the interaction of drugs with tissue receptors & the pharmacological effect
Describe agonists versus antagonists
- Agonists: stimulate a receptor & enhance a physiologic effect
- Antagonists: inhibit a receptor & decrease a physiologic effect
Postganglionic neurotransmitters in the ANS
- Acetylcholine in parasympathetic system
- Norepinephrine in the sympathetic system
Receptor types in the ANS
- Cholinerrgic (parasympathetic): muscarinic receptors
- Adrenergic (sympathetic): α-adrenergic and β-adrenergic adrenoceptors
How does adrenergic agonists affects the receptors
- Mimic activity of NE, Epi, & dopamine
- Stimulate the receptor
- Vasoconstrict, increase BP, increase venous return
How does adrenergic antagonists affect the receptors
- Decrease activity of SNS
- Inhibit the receptor
- Vasodilator, decrease BP, decrease venous return
How does cholinergic agonists affect the receptors
- Increase activity of PNS
- Stimulate the receptor
How does cholinergic antagonists affect the receptors
- Decrease activity of PNS
- Inhibit the receptor
List and describe the autonomic drugs
- 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
Define tolerance and physical dependence
- 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
Adverse drug events (ADEs) are defined as
- Any injury resulting from drug therapy
Medications often used to treat atherosclerosis
- 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
Anti-ischemic drugs reestablish the balance of O2 supply and demand through decreasing O2 demand or by increasing O2 supply (MVO2)
- Drugs that decrease the heart rate or systemic BP decrease the MVO2
- Drugs that increase arterial lumen size increase myocardial oxygen supply
Drugs that decrease myocardial oxygen demand
- Beta blockers: decrease HR & contractility
- Calcium channel blockers: inhibit coronary vasospasm & dilate coronary blood vessels
- Nitrates: vasodilate vasculature throughout the body
Thrombolytiics
- Breaks up blood clots
- Adverse reactions: bleeding
- No PT within 6-8hrs of administration time due to risk of acute ventricular arrhythmias
What does HAS BLED stand for to determine the bleeding risk with anti-coagulation therapy
- 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
Risk factors for increased bleeding
- 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
Describe the cycle of heart failure
- 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
Medications for treating heart failure are frequently titrated, especially ___________
- Diuretics
Pharmacologic treatment of HF address 3 primary goals
- Slowing of disease progression
- Improvement in symptoms
- Prolongation of survival
First-line management of heart failure with reduced ejection fraction (HFREF)
- Diuretics
- renin angiotensin system (RAS) inhibitors
- β blockers
Describe ARBs in relation to heart failure
- 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
_______________ therapy is recommended for patients with HFREF with no or minimal residual fluid retention and after initiation of an angiotensin system blocker.
- Beta blocker
Angiotensin-converting enzyme inhibitors- (ACE inhibitors) when treating HFrEF decrease
- Excess intravascular volume from sodium & water retention
- Afterload bc of arterial vasoconstriction
Describe Digitalis
- 1) Inhibits the Na+/K+ ATPase pump
- 2) Increases intracellular calcium
- 3) Increases contractility
- 4) Slows HR
Signs and symptoms of Digitalis Toxicity
- N/V
- Fatigue/weakness
- HA
- Dizziness
- AV block
- Ventricular arrhythmias
- V-fib/V-tachy
- Visual disturbances
Management of HFpEF
- 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
Effects of diuretics on HF
- 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.
Affects of cardiac glycosides on HF
- 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.
Describe Sympathomimetics
- 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
Define Bipyridines/phosphodiesterase inhibitors
- Act as positive inotropes and vasodilators by augmenting the amount of intracellular cyclic adenosine monophosphate available for myocardial contraction and smooth muscle relaxation
Affects of dilators on HF
- 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.
The gold standard for treatment of life threatening arrhythmias is an ______________________
- Implanted defibrillator
Affect of morphine on HF
- 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.
Classification of antihypertensive drugs is related to their primary receptor site and mode of action:
- 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
What is the goal BP of HTN medications
- <130/90
Drugs used for antihypertensives
- Diuretics
- Sympatholyics
- Vasodilators
- Calcium channel blockers
What do sympatholytics end in
- End in -olol
_________ are first line drug for lowering LDL-C
- Statins
Types of drugs used for lipid management
- 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”)
____________ is recognized as the most common adverse effect associated with statin therapy, ranging from myalgia to myositis
- Myopathy
__________ is the most commonly used drug in the intensive care unit (ICU)
- Oxygen
Nonautonomic nervous system vasodilators and inotropic agents used in critical care:
- 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
Effects of Phosphodiesterase inhibitors (e.g. Milrinone)
- Improves cardiac contractility (in-trophy), cardiac relaxation (lusitrophy), & inducing vasodilation
- Increases cardiac output
- Improves left ventricle arterial coupling
- Enhances cardiac mechanical efficiency
___________ and _____________ are the primary agents used to suppress ventricular ectopy in critically ill patients.
- Lidocaine and Amiodarone
____________, a calcium-channel blocker, has been used in the management of SVT not requiring cardioversion.
- Verapamil
______________ or nondihydropyridine calcium-channel blockers are first-line agents used to control the ventricular response rate to atrial flutter or fibrillation (Afib with RVR)
- Beta blockers
What do sodium channel blockers end in
- End in -ide
______________ is the drug of choice for management of myocardial ischemic pain
- Morphine
Adverse or suboptimal reactions to cardiac drugs are primarily caused by:
- Decreases in renal function
- Reduced liver metabolism
- Altered blood flow (as in CAD and CHF)
Geriatric patients show ____ sensitivity to the toxic effects of cardiac drugs (e.g. antiarrhythmics, digitalis, or β blockers).
- More
Drugs may have altered pharmacokinetics and pharmacodynamics in older adults. (True/False)
- True
Common cardiac conditions that warrant pharmacologic intervention in pediatric patients:
- Heart failure
- Blood pressure and lipid abnormalities
- Arrhythmias
______________ is first-line mono therapy for type II diabetes mellitus
- Metformin
Pharmacological interventions for heart transplant
- Corticosteroids
- Calcineurin inhibitors
- Antiproliferative agents
- Antilymphocyte antibodies
Maintenance therapy for heart transplant
- 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.
