CARDIOVASCULAR SYSTEM Flashcards
Cardiovascular System has
-Heart
-Blood
-Blood vessels
The heart is a
PUMP
It pumps blood through a system of
Blood vessels that has a limited volume capacity
Maintains regular rate and rhythm
Electric conduction system
When the heart can no longer pump enough blood to meet the metabolic demands of the body
Heart Failure
When blood volume is great compared to the space available inside blood vessels
Hypertension
When the electrical conduction pathway malfunction
Arrhythmia
The heart’s way of signaling that some of the cells are not getting enough oxygen
Angina
When oxygen-starved areas of the heart begin dying
Myocardial Infarction
Cardiovascular Drugs
Anti-hypertensives
Drugs for Heart Failure
Anti-anginal and Drugs for MI
Anti-arrhythmic Agents
Determinants of Blood Pressure
-Cardiac Output
-Stroke Volume
-Heart Rate
-Fluid Content of Blood
-Total Peripheral Resistance
-Volume of blood pumped out by the heart in 1 minute
-Approximately 2.2 - 3.5 L/min/m2 BSA
-Determined by Stroke Volume (SV) and Heart Rate (HR)
Cardiac Output
-Volume of blood pumped out by the heart in every contraction
-Determined by inotropic activity and venous return
Stroke Volume
Strength of cardiac contraction
Inotropic activity
Cardiac preload; amount of blood delivered to the heart from the veins; affected by the tone of the veins
Venous Return
Speed of Heart Contraction
Heart Rate
Resistance or pressure encountered by the heart as it pumps out blood into the peripheral circulation (cardiac afterload)
Total Peripheral Resistance (TPR)
The period during which the ventricles are contracting
Systole
The period during which the ventricles are relaxed and filling with blood
Diastole
Hypertension with no identifiable cause
Essential Hypertension
Resulting from identifiable causes
Secondary Hypertension
Firs Line treatment of Hypertension
Diuretics and beta blockers
Alternative treatment of Hypertension for px who cannot tolerate first line agents
ACE inhibitors
ARBs
Alpha Blockers
Calcium Channel Blockers
Anti-Hypertensive Drugs
-Diuretics
-Sympathoplegics
-Vasodilators
-Calcium Channel Blockers (CCBs)
-ACE inhibitors
-Angiotension II Receptor Blockers (ARBs)
Agents that cause urinary loss of Na+ and H20
Diuretics
Five Major Classes
- Thiazides and thiazide-like
- Loop Diuretics
- Potassium-sparing
- Carbonic anhydrase inhibitors
- Osmotic diuretics
Carbonic Anhydrase Inhibitors
Acetazolamide
Brinzolamide
Dorzolamide
Side Effects of Carbonic Anhydrase Inhibitors
-metabolic acidosis
-bone marrow depression (sulfonamide-like toxicity)
-allergic reactions (Stevens-Johnson’s Syndrome)
-aka high ceiling diuretics
-act on the thick ascending Loop of Henle
Loop Diuretics
Loop Diuretics Drugs
Furosemide
Bumetanide
Torsemide
Ethacrynic Acid
Side effect of this drugs include hypovolemia, ototoxicity, increase serum creatinine
Loop Diuretics
-Bicarbonate is lost in the urine
- INCREASED calcium excretion (Hypocalcemia)
Hypokalemia
This side effects are due to the electrolyte imbalances
Ototoxicity
Thiazide Diuretics Drugs
-Chlorothiazide
-Hydrochlorothiazide
-Chlorthalidone
-Indapamide
-First line drug for uncomplicated hypertension as recommended by JNC 7
-Effective initial therapy together with beta-blockers
-Also used for Nephrogenic Diabetes
Thiazide Diuretics
Side effects of Thiazide Diuretics
Hypokalemia
Hyponatremia
Hyperuricemia
Hyperglycemia
Hyperlipidemia
Decreased calcium excretion
Hypercalcemia
Decreased uric acid secretion
Hyperuricemia
Potassium-Sparing Diuretics
Spironolactone
Eprenolone
Amiloride
Triamterene
For patients where potassium loss is significant and supplementation is not feasible
Potassium-Sparing Diuretics
Potassium-Sparing Diuretics Precaution
Avoid in px with acute renal failure
Potassium Rich Foods (TOPP PNBB’s)
T-Tomatoes
O-Oranges
P-Peaches
P-Potatoes
P-Prunes
N-Nuts
B-Banana
B- Broccoli
S- Spinach
Side effects of Potassium-Sparing Diuretics
-Hyperkalemia
-Gynecomastia
-Impotence
-Sterility
Increase the osmotic pressure at the proximal convoluted tubule and Loop of Henle preventing water reabsorption
Osmotic Diuretics
Osmotic Diuretics Drugs
-Mannitol
-Sorbitol
-Urea
Sympathoplegics drugs
Centrally Acting
Peripherally-acting
Alpha-1 Blockers
Beta Blockers
Centrally-Acting Sympathoplegics
-Clonidine (Leading to vasodilation)
-Methyldopa
-Guanfacine
-Guanabenz
Used in the management of HTN in pregnancy (pre-eclampsia, eclampsia)
Methyldopa
Indicator of a possible immune-mediated hemolytic anemia
Coomb’s Test
Peripherally-Acting Sympathoplegics
Trimethaphan
Reserpine
Guanethidine
Guanadrel
-Ganglionic receptor blocker
-Given via IV infusion
-Used in hypertensive emergencies caused by pulmonary edema or aortic aneurism when other agents cannot be used
Trimethaphan
-Plant alkaloid
-Inhibits catecholamine (NE, Epi, Dopamine, Serotonin) storage
Reserpine
Alpha 1 Blockers Drugs (ends with sin)
Prazosin
Doxazosin
Alfazosin
Terazosin
Inhibit the alpha-1 receptors, resulting to vasodilation of arteries and veins
Alpha-1 Blockers
Used for initial therapy of HTN; effective for patients with rapid testing HR or concomitant IHD
Beta Blockers
Beta Blockers contraindicated to:
Patients with bronchospastic disease:
COPD
Bronchial Asthma
Beta Blockers Selective Drugs “olol” (BBEAAM)
B-Betatoxol
B- Bisoprolol
E- Esmolol
A- Acebutolol
A-Atenolol
M- Metoprolol
Beta Blockers Membrane Stabilizing Activity (PPALM)
P-Proponolol
P- Pindolol
A-Acebutolol
L-Labetalol
M- Metoprolol
-Second line Agents
-Directly relax the peripheral vascular smooth muscles
Vasodilators
Common S/E of Vasodilators
-Reflex tachycardia
-Peripheral edema
Vasodilators drugs
-Hydralazine
-Diazoxide
-Minoxidil
-Sodium Nitroprusside
Used in the management of HTN in pregnancy
Hydralazine
Used in the emergency treatment of hypertensive crisis
Diazoxide
1st line drug for almost all types of HTNsive emergencies
Sodium Nitroprusside
Sodium Nitroprusside must protect from
LIGHT
Alternative for the mgt of HTN
CALCIUM CHANNEL BLOCKERS
block CA channels in the blood vessels
Dihydropyridine
Block CA channels both in the heart and blood vessels
Non-Dihydropyridine
Short acting drugs for ACE Inhibitors
Captopril
Long Acting Drug for ACE Inhibitors
Enalapril
Lisinopril
Perindopril
Direct inhibitors of angiotensin II receptors
Angiotensin II Receptor Blocker (ARBs)
What kind of drugs is this:
Losartan
Valdesartan
Candesartan
ARB or Angiotensin II Receptor Blocker
-Is the failure of the heart as a pump
-Inability of the heart to pump sufficient amount of blood to the body
Congestive Heart Failure
-uncommon
-caused by excessive need for cardiac output
-high metabolic demands
High-output
-caused by disorders that impair the pumping ability of the heart (IHD)
-normal, metabolic demands, heart unable to meet them
Low-output
-long Term compensatory mechanism
-increased in the number of contractile elements in myocardial cells as a means of increasing their myocardial performance
Myocardial Hypertrophy
is the intrinsic ability of the heart to adapt to changing volumes of inflowing blood
Frank-Starling Mechanism
Drugs for CHF
-Inotropic Agents
-Unloaders
Inotropic Agents
Cardiac glycosides
Beta Agonists
Phosphodiesterase Inhibitors
Unloaders
ACE Inhibitors & ARBS
Beta Blockers
Diuretics
Vasodilators
From digitalis species
Cardiac Glycosides
- -75% Bioavailable
–half-life: 36-40 hours
–20-40% protein bound
–excreted in the urine
Digoxin
->90% Bioavailable
–half-life: 168 hours
–>90% protein bound
–excreted in the bile
Digitoxin
Beta-1 Agonists drugs
-Dopamine
-Dobutamine
-Given as IV infusion
-primarily used in the management of acute heart failure in the hospital setting
Dobutamine
–preload and afterload unloaders
–vasodilating effect
–Captopril, Enalapril
ACE Inhibitors & ARBS
-vasodilating effect
–Carvedilol,labetalol
Beta Blockers
-preload unloaders
–Spironolactone
Diuretics
-Hydralazine
-Nitroprusside
Vasodilator
-Hydralazine
-Nitroprusside
Vasodilator
Drugs that have been found to be useful in one or more types of heart failure include all of the following EXCEPT
A.Na+/K+ ATPase inhibitors
B.Alpha-adrenoceptor agonists
C.Beta-adrenoceptor agonists
D.ACE inhibitors
B. Alpha-adrenoceptor agonists
The mechanism of action of digitalis is associated with
A. A decrease in calcium uptake by the sarcoplasmic reticulum
B. An increase in ATP synthesis
C.A modification of the actin molecule
D. An increase in systolic intracellular calcium levels
E. A block of cardiac B adrenoceptors
D. An increase in systolic intracellular calcium levels
A 65-year old woman has been admitted to the coronary care unit with a left ventricular myocardial infarction. If this patient develops acute severe heart failure with mark pulmonary edema, which one of the following would be most useful?
A. Digoxin
B.Furosemide
C.Minoxidil
D.Propanolol
E.Spironolactone
B. Furosemide
Drugs associated with clinically useful or physiologically important positive inotropic effects include all of the following EXCEPT
A. Amrinone
B. Captopril
C. Digoxin
D. Dobutamine
E. Norepinphrine
B. Captopril
Successful therapy of heart failure with digoxin will result in which one of the following?
A. Decreased heart rate
B. Increased afterload
C. Increased aldosterone
D. Increased renin secretion
E. Increased sympathetic outflow to the heart
A. Decreased Heart Rate
Which of the following has been shown to prolong life in patients with chronic congestive failure but has a negative inotropic effect on cardiac contractility?
A. Carvedilol
B. Digoxin
C. Dobutamine
D. Enalapril
E. Furosemide
A. Carvedilol
Which of the following is the drug of choice in treating suicidal overdose of digitoxin?
A. Digoxin antibodies
B. Lidocaine
C. Magnesium
D. Phenytoin
E. Potassium
A. Digoxin antibodies
Occurs when the coronary arteries become so narrowed by atherosclerosis that they are unable to deliver sufficient blood to the heart muscle
Coronary Artery Disease
–episodic, reversible oxygen insufficiency
–severe chest pains generally radiating to the left shoulder and down the inner side of the arm
–usually precipitated by physical exertion or emotional stress
Angina Pectoris
–deprivation of oxygen to a portion of the myocardium (reversible)
Myocardial Ischemia
severe, prolonged deprivation of oxygen to a portion of the myocardium that leads to myocardial tissue necrosis (reversible)
Myocardial Infarction
-chest pain
*a symptom of myocardial ischemia in the absence of an infaction
Angina Pectoris
Drugs for Angina Pectoris
-Nitrates
-Beta Blockers
-Calcium Channel Blockers
Decrease oxygen demand and facilitate coronary blood flow
Nitrate
Drug of choice for stable angina
Beta Blockers
Unstable angina with no CI; IV doses given after 3 sublingual nitroglycerin tabs have failed to relieve pain
Morphine
Indefinite in px with stable or unstable angina
Aspirin
Together with aspirin 🡪hospitalized px with unstable angina until resolved
Heparin, Enoxaparin, Dalteparin
Results from prolonged myocardial ischemia, precipitated in most cases by an occlusive coronary thrombus at the site of a pre-existing atherosclerotic plaque
MI
persistent, severe chest pain or pressure 🡪“crushing”, “squeezing” or heavy “an elephant sitting on the chest”
Myocardial Infarction
Immediate treatment for myocardial infarction (MONA)
Morphine
Oxygen
Nitroglycerine
ASA
Drugs for MI
-Nitrates
-Oxygen
-Morphine
-Thrombolytic Agents
For patients who have chest pain and who may be ischemic
Oxygen
Causes venous pooling and reduces preload, cardiac workload, and oxygen consumption
Morphine
prevents platelet aggregation; shown to reduce post-infarct mortality
Aspirin
prevent re-occlusion once a coronary artery has been opened
Heparin
reduce mortality, prevent recurrent MI
Warfarin
used for px who develop ventricular arrhythmia
Lidocaine
decrease incidence of reinfarction in px with non-Q-wave infarcts; not for acute mgt.
Calcium Channel Blockers
2 years later, Mr. Green returns complaining that his nitroglycerin works well when he takes it for an acute attack but that he is having frequent attacks now and would like something to prevent them. Useful drugs for the prophylaxis of angina of effort include which one of the following?
A. Amyl nitrite
B. Diltiazem
C. Sublingual isosorbide dinitrate
D. Sublingual nitroglycerin
B. Diltiazem
The major common determinant of myocardial oxygen consumption is
A. Blood volume
B.Cardiac output
C.Diastolic blood pressure
D.Heart rate
E.Myocardial fiber tension
D. Heart rate
You are considering therapeutic options for a new patient who presents with hypertension and angina. In considering adverse effects, you note that an adverse effect which nitroglycerin, prazosin, and ganglion blockers have in common is
Orthostatic Hypotension
A patient is admitted to the emergency department following a drug overdose. He is noted to have severe tachycardia. He has been receiving therapy for hypertension and angina. A drug that often causes tachycardia is
A. Diltiazem
B. Guanethidine
C. Isosorbide dinitrate
D.Propanolol
E.Verapamil
Anti-arrhythmic Agents
-Sodium Channel Blockers
-Beta Adrenergic Blockers
-Potassium Channel Blockers
-Calcium Channel Blockers
Quinidine and Procainamide is in a class of
Class IA