Cardiovascular Pharm Flashcards
If a patients SpO2 is 85% on 2L/min nasal cannula and pursed lip breathing is not working what should you do?
Titrate the oxygen to 3-4 L/min, take appropriate safety precautions, and reassess response
When should BP medication be started?
If pt has stage 1 hypertension for greater than 6 months or if pt has stage 2 hypertension at all
What are drug classes for congestion?
Antitussives, decongestants, expectorants, mucolytics, and antihistamines
What are drug classes for obstruction?
Bronchodilators, glucocorticoids
What are bronchodilators?
Beta-adrenergic agonist
Anti-cholinergic
Xanthine derivatives
What do beta-adrenergic agonists (SABAs and LABAs) do?
Activate beta 2 adrenergic receptors in the airway smooth muscle to cause bronchodilation
What do anti-cholinergic (SAMAs, LAMAs) do?
Block action of AcH in the airways by blocking muscarinic receptors causing Bronchodilation
What are anti-inflammatory drug classes?
Glucocorticoids
Cromones
Leukotriene inhibitors
How does ACE inhibitor affect the RAAS?
Blocks angiotensin 1 from converting into angiotensin 2
How does ARB affect RAAS?
It does not allow angiotensin 2 to cause blood vessels to vasoconstrict
What is the most common manifestation of intolerance to an ACE inhibitor?
Sustained cough
What are the 1st line medications used for hypertension?
Diuretics, ACE inhibitors, Angiotensin receptor blockers, and CCBs
What are the 2nd line medications used for hypertension?
Loop diuretics, potassium sparing diuretics, beta blockers, and direct vasodilators
What are the basic targets for treating hypertension?
Direct cardiac agent
Peripheral vascular agent
Renal agents
Where do diuretics take action at?
Kidneys
What are diuretics anti hypertension effect?
Decrease plasma fluid volume
Where do sympatholytics take action at?
Sympathetic nervous system
What are the anti hypertensive effects of sympatholytics?
Decreased sympathetic influence on heart
Where is the primary action of vasodilators?
Peripheral vasculature
What is the anti hypertensive effects of vasodilators?
Lower vascular resistance
Where is the primary action of ACE inhibitors?
Peripheral vasculature and certain involved organs
Where is the primary action of calcium channel blockers?
Vascular smooth muscle and cardiac muscle
What are the anti hypertensive effects of calcium channel blockers?
Decreased contractility and cardiac force
What do thiazide medications do to help hypertension?
Inhibit sodium reuptake (first line option)
What are common thiazides used for hypertension?
Hydrochlorothiazide
Chlorthalidone
Metolazone
Chlorothiazide
Indapamide
What is the route of HCTZ?
Orally
What is the route of metolazone?
Orally
What is the route of chlorothiazide?
IV
What is the route of chlorothalidone?
Orally
What do loop diuretic targets do to help with hypertension?
Inhibit Na, K, Ca, Mg reabsorption in loop of Henle (decrease Afterload)
What are loop diuretic targets often used for?
Edema and heart failure patients
What is the most common loop diuretic used?
Furosemide (lasix)
What is the route of furosemide?
Orally or IV
What is the route of bumetanide?
Orally or IV
What is the route of torsemide?
Orally
What is the route of ethacrynic acid?
Orally or IV
What is the mechanism of action of aldosterone antagonists (potassium sparing diuretics)?
Inhibits aldosterone by inhibiting sodium-potassium exchange site in the distal tubule
What do aldosterone antagonist excrete and retain?
Excretes sodium and water
Retains potassium
What are aldosterone antagonists used to treat?
Hypertension and heart failure
What are types of aldosterone antagonists?
Spironolactone
Eplerenone
How are all aldosterone antagonists taken?
Orally
What do ACE inhibitors do?
Inhibit conversion of angiotensin 1 to angiotensin 2
What causes peripheral vasoconstriction?
AT2
What line option is an ACE inhibitor?
First
What are the therapeutic uses of ACE inhibitors?
Hypertension
Post MI
Heart failure
Diabetes
What are side effects of ACE inhibitors and angiotensin receptor blockers?
Angiodema
Cough
Hypotension
Hyperkalemia
What is the suffix for ACE inhibitors?
Pril
How are ACE inhibitors often administered?
Orally
What is the action of angiotensin receptor blocker?
Action of angiotensin 2 is blocked despite its production
What should angiotensin receptor blocker not be combined with?
ACE inhibitors
What is the suffix for ARBs?
Sartans
What do calcium channel blockers inhibit?
Sympathetic stimulation of vascular smooth muscle
What is the mechanism of action of calcium channel blockers?
Blocks calcium re entry which results in reduced contractility and HR
What is suffix for calcium channel blockers?
Pine
What do calcium channel blockers do to peripheral vasodilation?
Decrease it
What do calcium channel blockers do to coronary blood flow?
Increase it
What do calcium channel blockers do to myocardial O2 demand?
Decrease it
What are the primary functions of sympatholytics (beta blockers)?
Beta 1 blockade
What are the secondary effects of sympatholytics (beta blockers)?
Beta 2 blockade
What does the beta 1 blockade inhibit?
Sympathetic cardiac stimulation of the SA node and renin secretion
What does the beta 2 blockade do?
Vasodilation of GI vasculature
What line of therapy are sympatholytics (beta blockers)?
Second line for hypertension
What is the suffix for beta blockers?
-olol
Why would you combine alpha and non selective beta blockers?
It lowers BP more than just beta blockers without combination
What are the most common combined alpha and non-selective beta blockers?
Carvedilol
Labetalol
What are the two ways to treat ischemic heart disease?
Reduce cardiac oxygen demand and increase cardiac oxygen supply
What are the treatment options for angina?
Nitrates
Beta blockers
Calcium channel blockers
Ranolazine
How do nitrates treat angina?
Lower O2 demand
How do beta blockers treat angina?
Lower O2 demand
How do calcium channel blockers treat angina?
Increase O2 supply and lower O2 demand
How does ranolazine treat angina?
Mechanism unknown
What are the different types of angina?
Stable
Prinzmetals (variant)
Unstable
What is best at treating Prinzmetals (variant) angina?
Calcium channel blockers due to reducing vasospasm
What are drugs trying to do to help with angina?
O2 supply=O2 demand
What line of therapy are beta blockers for angina?
1st line (reduces cardiac oxygen demand by limiting HR)
What line of therapy are nitrates for angina?
Short acting 1st line for angina attacks
2nd acting after beta blockers
How do calcium channel blockers help with angina?
Block calcium re entry (reduce contractility and HR)
What medications should you be on post MI?
Aspirin
P2Y inhibitor (at least 12 months)
Beta blocker
Statin
ACE inhibitor
What are aspirin and P2Y inhibitors?
Anti platelet agents that may cause bruising
What is the most common side effect of statins?
Myopathy
What should you do if a patient experiences a MI?
Give nitro and have them chew and swallow 325 mg of aspirin
What are the letters of heart failure?
A- risk only (no symptoms and no damage)
B- damage (no symptoms)
C- symptoms and damage
D- end stage
What do medications do to treat chronic heart failure?
Decrease cardiac load and resistance
Increase contractility
What medications are taken for chronic heart failure?
Cardiac glycosides
ACE inhibitors
Beta blockers
Aldosterone antagonists
Vasodilators
Diuretics
What will cardiac glycoside (digoxin) do?
Increase heart contractility
Why is it easy to overdose on cardiac glycoside (digoxin)?
Narrow therapeutic index
What are the side effects of cardiac glycoside (digoxin)?
Visual disturbances
Bradycardia
Anorexia
Nausea and vomiting
What do class 1 antiarrhythmic drugs do?
Block Na+ channels
What do class 2 antiarrhythmic drugs do?
Beta blockers
What do class 3 antiarrhythmic drugs do?
Prolong repolarization
What do class 4 antiarrhythmic drugs do?
Calcium channel blockers
