CARDIOVASCULAR SYSTEM Flashcards
1
Q
Cardiovascular System has
A
-Heart
-Blood
-Blood vessels
2
Q
The heart is a
A
PUMP
3
Q
It pumps blood through a system of
A
Blood vessels that has a limited volume capacity
4
Q
Maintains regular rate and rhythm
A
Electric conduction system
5
Q
When the heart can no longer pump enough blood to meet the metabolic demands of the body
A
Heart Failure
6
Q
When blood volume is great compared to the space available inside blood vessels
A
Hypertension
7
Q
When the electrical conduction pathway malfunction
A
Arrhythmia
8
Q
The heart’s way of signaling that some of the cells are not getting enough oxygen
A
Angina
9
Q
When oxygen-starved areas of the heart begin dying
A
Myocardial Infarction
10
Q
Cardiovascular Drugs
A
Anti-hypertensives
Drugs for Heart Failure
Anti-anginal and Drugs for MI
Anti-arrhythmic Agents
11
Q
Determinants of Blood Pressure
A
-Cardiac Output
-Stroke Volume
-Heart Rate
-Fluid Content of Blood
-Total Peripheral Resistance
12
Q
-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)
A
Cardiac Output
13
Q
-Volume of blood pumped out by the heart in every contraction
-Determined by inotropic activity and venous return
A
Stroke Volume
14
Q
Strength of cardiac contraction
A
Inotropic activity
15
Q
Cardiac preload; amount of blood delivered to the heart from the veins; affected by the tone of the veins
A
Venous Return
16
Q
Speed of Heart Contraction
A
Heart Rate
17
Q
Resistance or pressure encountered by the heart as it pumps out blood into the peripheral circulation (cardiac afterload)
A
Total Peripheral Resistance (TPR)
18
Q
The period during which the ventricles are contracting
A
Systole
19
Q
The period during which the ventricles are relaxed and filling with blood
A
Diastole
20
Q
Hypertension with no identifiable cause
A
Essential Hypertension
21
Q
Resulting from identifiable causes
A
Secondary Hypertension
22
Q
Firs Line treatment of Hypertension
A
Diuretics and beta blockers
23
Q
Alternative treatment of Hypertension for px who cannot tolerate first line agents
A
ACE inhibitors
ARBs
Alpha Blockers
Calcium Channel Blockers
24
Q
Anti-Hypertensive Drugs
A
-Diuretics
-Sympathoplegics
-Vasodilators
-Calcium Channel Blockers (CCBs)
-ACE inhibitors
-Angiotension II Receptor Blockers (ARBs)
25
Agents that cause urinary loss of Na+ and H20
Diuretics
26
Five Major Classes
1. Thiazides and thiazide-like
2. Loop Diuretics
3. Potassium-sparing
4. Carbonic anhydrase inhibitors
5. Osmotic diuretics
27
Carbonic Anhydrase Inhibitors
Acetazolamide
Brinzolamide
Dorzolamide
28
Side Effects of Carbonic Anhydrase Inhibitors
-metabolic acidosis
-bone marrow depression (sulfonamide-like toxicity)
-allergic reactions (Stevens-Johnson's Syndrome)
29
-aka high ceiling diuretics
-act on the thick ascending Loop of Henle
Loop Diuretics
30
Loop Diuretics Drugs
Furosemide
Bumetanide
Torsemide
Ethacrynic Acid
31
Side effect of this drugs include hypovolemia, ototoxicity, increase serum creatinine
Loop Diuretics
32
-Bicarbonate is lost in the urine
- INCREASED calcium excretion (Hypocalcemia)
Hypokalemia
33
This side effects are due to the electrolyte imbalances
Ototoxicity
34
Thiazide Diuretics Drugs
-Chlorothiazide
-Hydrochlorothiazide
-Chlorthalidone
-Indapamide
35
-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
36
Side effects of Thiazide Diuretics
Hypokalemia
Hyponatremia
Hyperuricemia
Hyperglycemia
Hyperlipidemia
37
Decreased calcium excretion
Hypercalcemia
38
Decreased uric acid secretion
Hyperuricemia
39
Potassium-Sparing Diuretics
Spironolactone
Eprenolone
Amiloride
Triamterene
40
For patients where potassium loss is significant and supplementation is not feasible
Potassium-Sparing Diuretics
41
Potassium-Sparing Diuretics Precaution
Avoid in px with acute renal failure
42
Potassium Rich Foods (TOPP PNBB's)
T-Tomatoes
O-Oranges
P-Peaches
P-Potatoes
P-Prunes
N-Nuts
B-Banana
B- Broccoli
S- Spinach
43
Side effects of Potassium-Sparing Diuretics
-Hyperkalemia
-Gynecomastia
-Impotence
-Sterility
44
Increase the osmotic pressure at the proximal convoluted tubule and Loop of Henle preventing water reabsorption
Osmotic Diuretics
45
Osmotic Diuretics Drugs
-Mannitol
-Sorbitol
-Urea
46
Sympathoplegics drugs
Centrally Acting
Peripherally-acting
Alpha-1 Blockers
Beta Blockers
47
Centrally-Acting Sympathoplegics
-Clonidine (Leading to vasodilation)
-Methyldopa
-Guanfacine
-Guanabenz
48
Used in the management of HTN in pregnancy (pre-eclampsia, eclampsia)
Methyldopa
49
Indicator of a possible immune-mediated hemolytic anemia
Coomb's Test
50
Peripherally-Acting Sympathoplegics
Trimethaphan
Reserpine
Guanethidine
Guanadrel
51
-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
52
-Plant alkaloid
-Inhibits catecholamine (NE, Epi, Dopamine, Serotonin) storage
Reserpine
53
Alpha 1 Blockers Drugs (ends with sin)
Prazosin
Doxazosin
Alfazosin
Terazosin
54
Inhibit the alpha-1 receptors, resulting to vasodilation of arteries and veins
Alpha-1 Blockers
55
Used for initial therapy of HTN; effective for patients with rapid testing HR or concomitant IHD
Beta Blockers
56
Beta Blockers contraindicated to:
Patients with bronchospastic disease:
COPD
Bronchial Asthma
57
Beta Blockers Selective Drugs "olol" (BBEAAM)
B-Betatoxol
B- Bisoprolol
E- Esmolol
A- Acebutolol
A-Atenolol
M- Metoprolol
58
Beta Blockers Membrane Stabilizing Activity (PPALM)
P-Proponolol
P- Pindolol
A-Acebutolol
L-Labetalol
M- Metoprolol
59
-Second line Agents
-Directly relax the peripheral vascular smooth muscles
Vasodilators
60
Common S/E of Vasodilators
-Reflex tachycardia
-Peripheral edema
61
Vasodilators drugs
-Hydralazine
-Diazoxide
-Minoxidil
-Sodium Nitroprusside
62
Used in the management of HTN in pregnancy
Hydralazine
63
Used in the emergency treatment of hypertensive crisis
Diazoxide
64
1st line drug for almost all types of HTNsive emergencies
Sodium Nitroprusside
65
Sodium Nitroprusside must protect from
LIGHT
66
Alternative for the mgt of HTN
CALCIUM CHANNEL BLOCKERS
67
block CA channels in the blood vessels
Dihydropyridine
68
Block CA channels both in the heart and blood vessels
Non-Dihydropyridine
69
Short acting drugs for ACE Inhibitors
Captopril
70
Long Acting Drug for ACE Inhibitors
Enalapril
Lisinopril
Perindopril
71
Direct inhibitors of angiotensin II receptors
Angiotensin II Receptor Blocker (ARBs)
72
What kind of drugs is this:
Losartan
Valdesartan
Candesartan
ARB or Angiotensin II Receptor Blocker
73
-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
74
-uncommon
-caused by excessive need for cardiac output
-high metabolic demands
High-output
75
-caused by disorders that impair the pumping ability of the heart (IHD)
-normal, metabolic demands, heart unable to meet them
Low-output
76
-long Term compensatory mechanism
-increased in the number of contractile elements in myocardial cells as a means of increasing their myocardial performance
Myocardial Hypertrophy
77
is the intrinsic ability of the heart to adapt to changing volumes of inflowing blood
Frank-Starling Mechanism
78
Drugs for CHF
-Inotropic Agents
-Unloaders
79
Inotropic Agents
Cardiac glycosides
Beta Agonists
Phosphodiesterase Inhibitors
80
Unloaders
ACE Inhibitors & ARBS
Beta Blockers
Diuretics
Vasodilators
81
From digitalis species
Cardiac Glycosides
82
- -75% Bioavailable
–half-life: 36-40 hours
–20-40% protein bound
–excreted in the urine
Digoxin
83
->90% Bioavailable
–half-life: 168 hours
–>90% protein bound
–excreted in the bile
Digitoxin
84
Beta-1 Agonists drugs
-Dopamine
-Dobutamine
85
-Given as IV infusion
-primarily used in the management of acute heart failure in the hospital setting
Dobutamine
86
–preload and afterload unloaders
–vasodilating effect
–Captopril, Enalapril
ACE Inhibitors & ARBS
87
-vasodilating effect
–Carvedilol,labetalol
Beta Blockers
88
-preload unloaders
–Spironolactone
Diuretics
89
-Hydralazine
-Nitroprusside
Vasodilator
89
-Hydralazine
-Nitroprusside
Vasodilator
90
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
91
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
92
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
93
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
94
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
95
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
96
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
97
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
98
–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
99
–deprivation of oxygen to a portion of the myocardium (reversible)
Myocardial Ischemia
100
severe, prolonged deprivation of oxygen to a portion of the myocardium that leads to myocardial tissue necrosis (reversible)
Myocardial Infarction
101
-chest pain
*a symptom of myocardial ischemia in the absence of an infaction
Angina Pectoris
102
Drugs for Angina Pectoris
-Nitrates
-Beta Blockers
-Calcium Channel Blockers
103
Decrease oxygen demand and facilitate coronary blood flow
Nitrate
104
Drug of choice for stable angina
Beta Blockers
105
Unstable angina with no CI; IV doses given after 3 sublingual nitroglycerin tabs have failed to relieve pain
Morphine
106
Indefinite in px with stable or unstable angina
Aspirin
107
Together with aspirin 🡪hospitalized px with unstable angina until resolved
Heparin, Enoxaparin, Dalteparin
108
Results from prolonged myocardial ischemia, precipitated in most cases by an occlusive coronary thrombus at the site of a pre-existing atherosclerotic plaque
MI
109
persistent, severe chest pain or pressure 🡪“crushing”, “squeezing” or heavy “an elephant sitting on the chest”
Myocardial Infarction
110
Immediate treatment for myocardial infarction (MONA)
Morphine
Oxygen
Nitroglycerine
ASA
111
Drugs for MI
-Nitrates
-Oxygen
-Morphine
-Thrombolytic Agents
112
For patients who have chest pain and who may be ischemic
Oxygen
113
Causes venous pooling and reduces preload, cardiac workload, and oxygen consumption
Morphine
114
prevents platelet aggregation; shown to reduce post-infarct mortality
Aspirin
115
prevent re-occlusion once a coronary artery has been opened
Heparin
116
reduce mortality, prevent recurrent MI
Warfarin
117
used for px who develop ventricular arrhythmia
Lidocaine
118
decrease incidence of reinfarction in px with non-Q-wave infarcts; not for acute mgt.
Calcium Channel Blockers
119
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
120
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
121
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
122
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
123
Anti-arrhythmic Agents
-Sodium Channel Blockers
-Beta Adrenergic Blockers
-Potassium Channel Blockers
-Calcium Channel Blockers
124
Quinidine and Procainamide is in a class of
Class IA
