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Adv Pharm > Chapter 41: Drugs to Treat Hypertension, Chapter 42: Drugs to Treat Heart Failure, Chapter 43: Antidysrhythmics > Flashcards

Chapter 41: Drugs to Treat Hypertension, Chapter 42: Drugs to Treat Heart Failure, Chapter 43: Antidysrhythmics Flashcards

1
Q

drugs to tx HTN

A

Diuretics​

Beta Blockers​: Metoprolol tart, atenolol​

ACEi and ARBs​

CCB (negative inotropes)

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2
Q

drugs to tx HF

A

ACEi and ARBs​

Diuretics​

Digoxin*​

Beta Blockers​:
Carvedilol (Coreg)​
Bisoprolol (Zebeta)​
SR metoprolol succinate (Toprol XL)​

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3
Q

1st line for Antidysrhythmias

A

BB

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4
Q

1st line for HF

A

ACEI

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5
Q

Digoxin

A

A cardiac Glycoside

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6
Q

dig uses

A

Use: Indicated for HF and antidysrhythmic​

Due to toxicity, it is considered a second line treatment for HF

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7
Q

Dig MOA

A

Positive inotropic increasing myocardial contractility
decrease rate

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8
Q

Dig safety and monitoring

A

Monitor pulse, report any changes in rate or irregularities. Hold med if HR< 50 (anywhere from 50-60)​

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9
Q

dig SE

A

Hypokalemia, elevated dig levels (0.5-2.0), dysrhythmias, dig toxicity

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10
Q

dig drug interactions

A

diuretics, ACEi and ARBs

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11
Q

dig toxicity

A

yellow, white, green spots in vision​, N/V, <50-60 bpm (excite vagus nerve)

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12
Q

dig and K

A

K and Dig inversely proportionate

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13
Q

dig prescribing considerations

A

Therapeutic Goal: To treat dysrhythmias and HF​

Baseline Data: EKG, electrolytes and kidney function​

Identify High Risk Patients: Caution with renal insufficiency and hypokalemia​

Evaluating Therapeutic Effectiveness: Assess for reduction In orthopnea, dyspnea on exertion, JVD, edema, and crackles. ​

Minimizing Adverse Effects: Teach patient to report early signs of hypokalemia and to inform the provider regarding signs of toxicity, including visual disturbances or nausea and vomiting​

​

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14
Q

2 basic types of dysrhythmias

A

Tachy dysrhythmias​

Brady dysrhythmias​

Dysrhythmia- Abnormal heart rhythm

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15
Q

antidysrythmic SE

A

Pro arrhythmic* ​

Drugs cause dysrhytmias ​

Only employ when benefit outweighs risk

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16
Q

Antidysrhythmic tx to replace medications

A

Ablation and implantable defibrillators

17
Q

Class I antidysrhythmics

A

NA channel blockers

Separated by strength. Block Na influx into cardiac cell. Ex. Lidocaine used to treat ventricular dysrhythmias. ​

A: quinidine, procainamide , disopyramide. use for maintenance of NSR after conversion of a fib or a flut. TX of symptomatic PVCs, SVT, and VT, prevention of v fib,.

B: lidocaine, mexietine. use for tx of symptomatic PVCs and VT, prevention of v-fib.

C: flecainide and propafenone. use for tx of symptomatic PVCs and VT; prevention of v fib.

18
Q

Class II antidysrhythmics

A

beta blockers

ex. propanolol, acebutolol, esmolol, sotalol

Block K from reentering the cell at the end of AP.

Used for atrial dysrhythmias. Any atrial tachycardia –SVT, a fib, a flut

19
Q

class III antidysrhythmics

A

K channel blockers

block K from leaving the cell in AP.

ex/ amiodarone, dofetilide, ibutlide, sotalol

Amiodarone is used to treat ventricular dysrhythmias like v tach and v fib. Maintenance of NSR. Also a fib an a flut when other atrial medications like BBB or CCB don’t work.

Blocks K from leaving cell in AP -> decrease excitability of cell. ​

20
Q

class IV antidysrhythmics

A

calcium channel blockers

block calcium influx into cells.

ex. ditilizem and verapamil

used to tx SVT

21
Q

unclassified antidysrhtymics

A

dig, adenosine, Mag

tx of tachydysrhythmias

adenosine -SVT

mag -torsades de pointes

22
Q

lido uses and dosages

A

stable VT: 1-1.5 mg/kg IV/IO + 0.5-0.75 mg/kg Q5-10min; 1-4 mg/min infusion after rhythm corrected

pulseless VT/VF: 1-1.5 mg/kg IV/IO + 0.5-0.75 mg/kg Q5-10min; 1-4 mg/min infusion after return of perfusion

status epilepticus: off label. 2 mg/kg IV, wait 2 min then 0.5 mg/kg IV, then 30ug/kg/min continuous IV

23
Q

lido SE

A

CV depression, resp depression, audiovisual disturbance, dizziness, sz, MH, methemogloibmia, lethargy, nausea (common)

24
Q

lido contraindications

A

hypersensitivity
amide anesthetic HS
adams-stokes
WPW
severe SA/AV/IV block

25
Q

lido preg category

A

B

26
Q

lido MOA

A

inhibit NA conduction. decrease AP initiation and propagation. cardiac and neuronal membrane stabilized.

27
Q

lido metabolism

A

hepatic, active metabolites CYP1A2/2A4 substrate, CYP2D6 inhibitor

28
Q

lido 1/2 life

A

1.5-2h

29
Q

lido excretion

A

renal

30
Q

lido cost

A

$4.59/mL 1% lido vial

31
Q

lido toxicity

A

Slurred speech or difficult speech. paresthesia, numb of lips and tongue.

Altered CNS. drowsiness, dizziness, arrhythmias, restlessness, confusion

Muscle twitching. tremors

Seizures. convulsions, resp depression, resp and cardiac arrest

32
Q

antidysrhythmic nonmonic

A

sure (S = class I) beats (B = II) picking (P = III) corn (C = IV)

33
Q

Sotolol

A

BB and PCB
pro-arrhythmic
asso with torsades de pointes

34
Q

amiodarone

A

lipophilic

slow HR and AV node conduction

block K channels -delays repolarization, prolong AP and effective refractory period.

Effective against both atrial and ventricular dysrhythmias

35
Q

amiodarone serious toxicities

A

Lung: pulmonary fibrous. If on ami long-term, need CXR every year dt chance of lung scarring ​

Eyes: corneal microdeposits. Causing visual disturbance. Need yearly eye exam. ​

Thyroid: can cause issues, need T3, T4, and TSH every year. ​

Liver: toxic. r/o cirrhosis. Need LFT every year.​

Skin: blue hue. Especially in sun. Photosensitivity. ​

CV: Sinus bradycardia.

36
Q

amiodarone prep

A

oral and IV

37
Q

amiodarone drug interactions

A

lots
esp grapefruit juice

38
Q

torsade’s de pointes

A

Monitor QT intervals to monitor ventricular depolarization and repolarization. As this prolongs, can cause TDP –QRS axis swings f or positive to negative direction in single lead.​

Treat TDP with Mag​

some causes:
precipitated by drugs that prolong QT interval
Class IA and IC antidysrhtmics
cyclic AD
droperidol
dofetilide
sotalol
phenothiazines
erythromycin
methadone
E disorders (hypoMag, hypo K)

39
Q

general antidysrhythmic SE

A

all can cause dysrhythmias
HS reactions: N/V/D, dizziness, blurred vision, HA

Adv Pharm (76 decks)

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