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Pharmacology > Cardiovascular Meds > Flashcards

Cardiovascular Meds Flashcards

1
Q

Cholinergic Drugs:

A

Atropine

-Atropine (prototype) is the only drug in this category used for cardiovascular purposes

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2
Q

Atropine

  • Causes Tachycardia (WANT to speed HR back up!)
  • Give for Bradycardia (<60) under standing orders as nurses (standing order = a list of medications that can be given in an emergency setting)
A

-Muscarinic antagonists selectively block the effects of acetylcholine at the muscarinic receptors.

-Indications:
Bradycardia (in ICU) since atropine increases heart rate, nursing gives per emergency protocols; surgical pretreatment to prevent bradycardia during surgery

-Adverse Effects:
dry mouth, blurred vision and photophobia, elevation of intraocular pressure (avoid in glaucoma), urinary retention; anhidrosis (avoid working in hot weather)

-Interactions:
with antihistamines, phenothiazine antipsychotics, tricyclic antidepressants

  • Dosage:
    0. 4 mg po; 0.5-1 mg IV infusion (diluted) or IM
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3
Q

Actions of Adrenergic Receptors

Alpha 1:

A

Arterioles and veins - constriction

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4
Q

Alpha 2:

A

Nerves only

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5
Q

Beta 1:

A

Heart and kidney

Heart - increase rate, force of contraction, AV conduction speed

Kidney - release of renin

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6
Q

Beta 2:

A

Bronchi - dilation, arterioles, heart, lung, skeletal muscle

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7
Q

Epinephrine stimulates alpha 1 and 2, beta 1 and 2, but not _______

A

dopamine

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8
Q

Norepinephrine stimulates

A

alpha 1 and 2

Beta 1

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9
Q

Dopamine stimulates

A

Alpha 1, Beta 1, and dopamine

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10
Q

Alpha Adrenergic Antagonists

(Sympatholytics - blocking the sympathetic system)

ends in -ZOSIN

A

Prazosin (Minipress)

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11
Q

Prazosin (Minipress)

A

-MOA:
Inhibits alpha 1 receptors arterioles and veins, causes vasodilation, resulting in decreased BP, decreased CO

-Indications:
Essential Hypertension, BPH, Raynaud’s

-Adverse Effects:
dizziness, Headaches, drowsiness, impotence (alpha 1 blockage inhibits ejaculation), reflex tachycardia, nasal congestion, edema, postural hypotension;

-diuretics and other hypotensive agents potentiate effects. WATCH for 1st dose effect. (GIVE AT BEDTIME)*

-Nursing implications:
IMPOTENCE is a major reason for nonadherence

Terazosin and doxasosin are other alpha adrenergic agonists (8 altogether)

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12
Q

Beta Blockade Therapeutic Effects:

A

Therapetuic Effects:

  • Reduced heart rate
  • Reduced peripheral vascular resistance with long term use
  • Reduced force of contraction
  • Reduced speed of AV conduction (risk for heart blocks)
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13
Q

Beta Blockade Indications:

A
  • Angina
  • Hypertension (not as effective as once thought)
  • Cardiac dysrhythmias (SA node, sinus tachy and PAC’s)
  • MI
  • Heart Failure
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14
Q

Beta Blockade Adverse Effects

A
  • Bradycardia
  • reduced CO
  • precipitation of heart failure
  • AV heart block
  • rapid withdrawal of drug will cause angina or ventricular dysrhythmias (need to taper withdrawal over several weeks).
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15
Q

Beta Adrenergic Antagonists (Beta Blockers)

ends in -olol

A
  • Propanolol
  • Metoprolol
  • Atenolol
  • Labetol (not on module)
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16
Q

Propanolol

  • Take apical pulse and BP before giving
  • May mask tachycardic symptoms of hypogylcemia
A

1st Generation Nonselective beta 1 and 2 adrenergic blocker

-MOA:
blocks adrenergic receptors in the cardiac (beta 1) and lungs (beta 2); renal (beta 1) suppresses renin secretion

-Therapeutic Action:
Antihypertensive, reduces HR, CO used in MI, CAD, HTN, cardiac dysrhythmias.

-Adverse Effects:
Hypotension, bradycardia, bronchoconstriction, may rarely cause depression

-CONTRAINDICATED in: BRONCHITIS & ASTHMA, COPD, DIABETES, & hx of DEPRESSION

-Drug Interactions:
Calcium channel blockers (may cause cardiac suppression, very low heart rate and B/P)).

Usually PO, sometimes IV

17
Q

Metoprolol (Lopressor, Toprol XL)

A

Prototype 2nd generation SELECTIVE B1 blocker (cardiac)

-MOA:
Blocks B1 cardiac receptors
Reduces heart rate, force of contraction, AV duration through the node, reduces secretion of renin

-Indications:
1st choice Antihypertensive drug; also approved for angina, MI, heart failure

-Adverse Effects:
bradycardia, reduced cardiac output, AV HEART BLOCK (1ST OR 2ND DEGREE); Also can CAUSE heart failure

-Dosage: 
IR tablets (immediate released) and SR tablets (sustained release), dosage varies depending on why it is being given; also there is an IV formulation
18
Q

Atenolol and Labetol

A

3rd generation beta-blockers

  • can dilate blood vessels |
  • dosing can be done once a day
  • block vascular alpha 1 receptors | IV/PO
19
Q

Central Acting Alpha 2 Agonists

A

Clonidine (Catapres)

20
Q

Clonidine

A

-MOA:
activates the central alpha 2 receptors in the brainstem and thus reduces sympathetic outflow to blood vessels and the heart.

-Indications:
Treatment of hypertension and in some cases treatment of pain.

-Adverse Effects:
Drowsiness and sedation; xerostomia; constipation, impotence, rebound hypertension in response to abrupt withdrawal; can cause fetal harm; can cause euphoria, hallucinations and can be abused.

  • Dosage: Oral, Transdermal (q 7 days)
  • Others: Methyldopa and Reserpine (not on module)
21
Q

ACE (Angiotensin Converting Enzyme) Inhibitor includes:

-pril

A
  • Captopril
  • Lisinopril
  • Enalapril (Vasotec)
22
Q

Captopril

A

-MOA:
Lowers BP by inhibition of ACE; this disrupts conversion of angiotensin I to II in the kidneys; since angiotensin II is a powerful vasoconstrictor, vasodilatation occurs and BP is lowered.

-Indications:
Hypertension, heart failure, MI, B/P med of choice for DM since it slows progression of ESRD

-A/E:
1st dose hypotension, arthralgia, DRY COUGH (increase in bradykinin), ANGIOEDEMA, bradycardia, neutropenia, agranulocytosis, fetal injury, hyperkalemia

-Interactions:
Other antihypertensives enhance hypotensive effect

-Nursing Implications:
Take BP and apical rate before giving; REPORT UNEXPLAINED FEVER; may cause hypoglycemia in DM, check BG

-Give Orally

23
Q

Lisinopril

A

USES- hypertension, heart failure, and acute MI

ACTIVE FORM

24
Q

Enalapril (Vasotec)

A

USES:
-hypertension, heart failure and asymptomatic LVD

-can reduce the risk of diabetic retinopathy

25
Q

Angiotensin II Receptor Blockers (ARBS)

-tan

A

Losartan

26
Q

Losartan

A

-MOA:
Block access of angiotensin II to its receptors in blood vessels, the adrenals and other tissues. Thus causes dilatation of arteries and veins

-Indications:
Hypertension, diabetic retinopathy (slows development) in Type I

ARBS:
They do NOT induce cough or hyperkalemia;

angioedema, renal failure

Interactions:
with other antihypertensives

27
Q

Calcium Channel Blockers

A
  • Verapamil (calan)
  • Diltiazem (cardizem)
  • Nifedipine (Procardia)
  • Amlodipine (Norvasc)
28
Q

Verapamil (calan)

A

-MOA:
Inhibits calcium ion influx through slow channels into myocardial muscle cells; dilates coronary artery and inhibits coronary spasm; increases myocardial O2 delivery, blocks influx of calcium in BOTH blood vessels and the heart

-Therapeutic Action:
1st line antihypertensive, reduces Heart rate, anti arrhythmic for SVT (supraventricular tachycardia) (IV), anti-anginal, decreases force of contraction

-A/E:
: Dizziness, headache, fatigue, sleep disturbances, hypotension, bradycardia, constipation (does not occur in nifedipine), nausea, edema in legs, elevated liver enzymes; Severe hypotension, cardiogenic shock, severe CHF

-Interactions:
GRAPEFRUIT JUICE may increase drug levels, increases levels of digoxin, potentiates effects of other antihypertensives

-Nursing Implication:
Take BP and HR before giving; teach pt to monitor use of grapefruit juice and avoid large amts; report gradual weight gain, liver and kidney fx tests

29
Q

Diltiazem (Cardizem)

A
  • similar effects and action to verapamil
  • oral diltiazem is well absorbed- first pass through the liver- effects are rapid.
  • ADV- like verapamil- except causes LESS CONSTIPATION- dizziness, flushing, headache, edema (ankles and feet)- chronic eczematous rash in older adults
  • IV reserved for dysrhythmias & Angina pectoris- 30 mg x4/day initial- maintenance- double dose.
30
Q

Nifedipine (Procardia)

A

DIHYDROPYRIDINES- act mainly on VASCULAR SMOOTH MUSCLES

  • blocks calcium in VSM- promotes vasodilation- LIMITED to blockade of calcium channel in VSM- has NO direct suppressant effects on automaticity, AV conduction, or contractile force.
  • lowers bp, increases HR, and increases contractile force
  • USES- Angina pectoris and Hypertension
  • ADV- REFLEX TACHYCARDIA
  • Angina pectoris- 10 mg x 3 – max. 180 mg/day
  • essential hypertension- SR tablets only- 30 mg x1/day
31
Q

Amlodipine (Norvasc)

A
  • produces selective blockade of calcium channels in blood vessels- minimal direct effects on the heart.
  • INDICATION- essential HTN and angina pectoris
  • PO
  • ADV- peripheral and facial edema
  • causes little reflex tachycardia
  • 5 mg x1/day- HTN-AP

Pharmacology (17 decks)

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