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Pharm > Ch 37 > Flashcards

Ch 37 Flashcards

1
Q

heart failure

A

myocardium weakens and enlarges> loss of ability to pump blood through the heart, and into the systemic circulation.
Compensatory mechanisms fail>peripheral and lung tissues become congested.
Increased preload> excess blood volume in ventricle at end of diastole > thickening of ventricular walls > greater filling pressure > weakened heart.
Classified in stages based on severity.
Two types: left or right sided

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2
Q

left sided HF

A
  1. Ventricle does not contract sufficiently to pump blood returned from the lungs and left atrium out through the aorta into the peripheral circulation> blood backs up into lungs
  2. SOB, dyspnea
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3
Q

right sided HF

A
  1. Heart doesn’t sufficiently pump blood returned into the right atrium from the systemic circulation
  2. Blood backs up into peripheral tissues > peripheral edema, JVD
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4
Q

nonpharm tx for HF

A

a. Dietary changes: Water restriction > reduce circulating volume, Sodium restriction <2,000 mg/day ( 1 tsp).
b. No smoking: deprivation of oxygen to myocardial cells
c. Mild exercise

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5
Q

lab testing for HF

A

BNP

  • Desired value is < 100
  • Gold standard for heart failure/fluid overload
  • Secreted from atrial cardiac cells
  • Considered more sensitive than ANP in diagnosing heart failure
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6
Q

digoxin class, PT, PD, CI, adv, labs, NI

A

cardiac glycoside.
tx HF and A FIB by inhibiting Na/K ATPase, promoting ^ force of heart contraction, CO, and tissue perfusion. Also decreases ventricular rate.
CI ventricular dysrhythmia/2nd or 3rd degree heart block.
adv: bradycardia. life thrt: AV block, dysrhythm.
causes hypokalemia, hypomagnesemia, hypercalcemia –> increased risk of dig toxicit.
-monitor dig tox/serum dig.
-apical pulse 1 min. hold <60BPM
-teach s/s of dig tox
-consume high K foods to prevent hypokalemia which would potentiate dig tox

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7
Q

foods high in K

A
  • fresh/dried fruits
  • fruit juice
  • sweet potatoes
  • kidney beans
  • spinach
  • avocado
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8
Q

dig toxicity, s/s

A

accumulation of digoxin –> digitalis tox.
s/s: n/v/d/a, brady/PVC/dysrhythm, headache/malaise/blurry/confusion/delirium, yellow green halos.
severe adv rxn: cardio tox (3 cardiac altered fx)

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9
Q

3 cardiac altered fx that contribute to digoxin induced ventricular dysrhtyhm:

A
  1. Suppression of AV conduction
  2. Increased automaticity
  3. Decreased refractory period in ventricular muscle
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10
Q

antidote for dig tox

A

Digoxin immune Fab (ovine, Digibind)
-Binds with digoxin to form complex molecules> excreted in urine, making digoxin unable to bind at cellular site of action

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11
Q

antianginal drug types

A

nitrates, beta blockers, calcium channel blockers

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12
Q

antidysrhtyhm drugs

A 
restore cardiac rhythm to normal.
class I: sodium channel blockers (Class IA, IB, IC)
class II: beta blockers
class III: drugs prolonging repolarization
class IV: calcium channel blockers
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13
Q

antianginal drugs tx what?

A

tx angina pectoris

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14
Q

angina pectoris description/causes/complications

A 
condition of acute cardiac pain from inadequate blood flow to myocardium (decreased oxygen to tissues > pain)
Causes:
1.	Plaque occlusions
2.	Spasms of coronary arteries 
*Anginal attacks may lead to a MI
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15
Q

angina pectoris tests

A

Tests need to be performed to determine severity of blockage

i. ECHO
ii. Stress test
iii. Cardiac enzymes
iv. Possible cardiac catheterization

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16
Q

nonpharm methods for angina

A

i. Combination of pharmacologic and nonpharmacologic to control/prevent recurrences
ii. Avoid heavy meals, smoking, extreme weather changes, strenuous exercise, emotional upset
iii. proper diet, moderate exercise, smoking cessation, stress reduction

17
Q

nitrates

A

antianginal drug.
reduces venous tone>decreases workload of heart>vasodilation.
generalized vascular/coronary vasodilation>increased blood flow to myocardial cells

18
Q

nitroglycerin(nitro-bid) Class, PD, route, PT, CI, SE, NI, DFL, ADV

A

nitrate antianginal drug
dec myocardial demand for o2, decreases preload by dilating (indirect decrease in afterload) to control angina pectoris.
-PO, IV, subling, transd, or aerosol spray.

CI: ^ICP, severe anemia, cardiomyopathy.
adv: hypotn, reflex tachy, paradox brady. life thrt: circulatory collapse.
SE: headache (discuss OTC pain relief for headache)
hold SBP<90 if not emergent. rotate sites if transd, and don’t place near defib (explosion or burns).
^eff with alc, B blockers, Ca blockers, antihypertensives, ASA, benzos, vasodilators.
dec eff of heparin.

19
Q

nitrate doses

A

subling: 0.4mg every 5 mins x3. if still unrelieved, call 911.
patch/paste: must have off periods to prevent ___?
must be kept in sealed container, protected from light to prevent degradation

20
Q

beta blockers

A

antianginal drug.
decrease conduction velocity, automaticity, recovery time.
examples: propranolol (Inderal), acebutolol (Sectral), sotalol (Betapace)

21
Q

calcium channel blockers

A

antianginal.

  1. Block calcium influx > decreasing excitability and contractility (negative inotropic)
  2. Increases refractory period of AV node> decreases ventricular response
  3. Examples: verapamil (Calan), diltiazem (Cardizem)
22
Q

cardiac dysrhythmia definition, types, dx test, frequently follow what?

A

Any deviation from normal rate or pattern of the heartbeat

  1. Too slow: bradycardia
  2. Too fast: tachycardia
  3. Irregular
    - An ECG (electrocardiogram) identifies dysrhythmias
    - Dysrhythmias frequently follow an MI, hypoxia, hypercapnia, thyroid disease, CAD, cardiac surgery, excess catecholamines, or electrolyte imbalances
23
Q

sodium channel blockers

A 
class I antidisrhythm drugs.
decrease Na influx into cardiac cells > decrease conduction velocity in cardiac tissues > suppress automaticity > decrease ectopic foci.
Class Ia: slow conduction, prolong repolarization
Class 1b: slow conduction, shorten repolarization.
Class 1c: prolong conduction, little to no effect on repolarization
24
Q

beta blockers

A

Class II antidysrhtyhm.
decrease conduction velocity/recovery time.
ex: propoanolol(Inderal), sotalol(Betapace), acebutolol (Sectral)

25
Q

drugs prolonging repolarization

A

Class III antidysrhythm.
for emergency management of ventricular dysrhythmias when antidysrhythmics are ineffective.
ex: amiodarone (Cordarone)

26
Q

calcium channel blocker

A

Class IV antidysrhythm
block Ca influx > decrease excitability, contractility (neg inotrope).
inc refractory period of AV node > dec ventricular response

Pharm (20 decks)

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