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Class 1 Adrenergic Receptors (CV) Flashcards

1
Q

Adrenergic receptors

A

-Alpha 1&2
-Beta 1&2

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2
Q

Alpha-1 effects

A

-Vasoconstriction
-Increases PVR, BP & closure of bladder sphincters
-Mydriasis (dilates pupils)
-NE>E

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3
Q

Alpha-2 effects

A

-Inhibits NE, Ach, & insulin release
-E>NE

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4
Q

Beta 1 effect on CV

A

-Increase HR, heart contractility, lipolysis, & renin
-E=NE

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5
Q

Beta 2 effects

A

-Vasodilation, decreases PVR
-Relaxes uterine smooth muscle
-Increases glycogenolysis & glucagon release
-E»NE

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6
Q

Management of HTN: Diuretics & anti-hypertensive therapy drugs

A

-Thiazide/thiazide-like diuretic
-ACE I
-ARBs
-Long-acting CCB
-Beta-blockers
-Single pill combination
-LATABS

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7
Q

Diuretics: general overview

A

▪ First line treatment for HTN
▪ MOA: Decrease volumes of plasma and extracellular fluid; reduces preload, CO and SVR (afterload)
▪ Reduces the workload of the heart

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8
Q

Angiotensin converting enzyme inhibitors (ACE I): General overview

A

▪ First-line treatment of HTN, HF & diabetes (renal protection)
▪ Typically given in combination with diuretics or Ca+ channel blockers to increase adherence
▪ Contraindicated in 2nd & 3rd trimester

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9
Q

ACE I: MOA

A

-Inhibit ACE which converts angiotensin I to angiotensin II (reduces vasoconstriction/BP)
-Reduces SVR (afterload)
-Prevents Na+ & H2O resorption by inhibiting aldosterone which is an anti-diuretic (decreases preload; ideal for HF patients)

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10
Q

ACE inhibitors “pril”

A

-“prils”
-Captopril
-Ramipril*
-Enalapril sodium*
-Fosinopril sodium
-Lisiopril*
-Perindopril erbumine
-Denotes ACE can be in combination with
hydrochlorothiazide (ERL)

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11
Q

ACE I: Indications for use

A

-HTN; decrease afterload (SVR)
-HF; prevents Na+ & H2O resorption and causes diuresis, decreases preload, stops the progression of LV hypertrophy post heart attack
-Diabetes; reduces Glomerular filtration pressure

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12
Q

ACE I contraindications

A

-K+> 5mmol/L
-Impaired kidney function
-Pregnant or lactating women

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13
Q

ACE I: Adverse events

A

-Fatigue, dizziness, mood changes, headaches, hypotension
-Non productive cough
-Hyperkalemia
-Angioedema
-Loss of taste, proteinuria, rash, pruritis, anemia, neutropenia, thrombocytosis and agranulocytosis

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14
Q

ACE I drug-drug interactions

A

-NSAIDS; reduce antihypertensive effects and may lead to nephrotoxicity
-Potassium supplements or Potassium sparing diuretics; hyperkalemia
-Lithium; lithium toxicity

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15
Q

Angiotensin receptor blockers (ARBs): MOA

A

-Block binding of angiotensin II to type 1 angiotensin II receptors; block vasoconstriction
-Vasopressor effects and blocks aldosterone secretion
-ARBs do not cause cough
-Contraindicated in 2nd & 3rd trimester of pregnancy

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16
Q

ARBs (TICLV)

A

-“Sartans”
▪ Losartan
▪ Valsartan
▪ Irbesartan
▪ Candesartan cilexetil
▪ Telmisartan

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17
Q

ARBs indications

A

-Heart Failure; decrease preload and afterload
-HTN

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18
Q

ARBs contraindications

A

-Pregnant or lactating women
-Older adults
-MI

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19
Q

ARBs: Adverse events

A

-Respiratory infections, dyspnea, nasal congestion, sinusitis, cough
-Headache, heartburn, dizziness, diarrhea & anxiety
-Inability to sleep, fatigue
-Back & muscle pain

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20
Q

ARBs toxicity & OD

A

-Hypotension
-Tachycardia
-Bradycardia occurs less often

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21
Q

ARBs: Drug to drug interactions

A

-NSAIDs; decreased antihypertensive effect; potential for kidney failure
-Lithium; inhibits Li+ elimination
-Phenobarbital; increases metabolism; decreases ARB effectiveness
-K+ sparing diuretics & K+ supplements; hyperkalemia

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22
Q

ACE I considerations & pt teaching

A

-Weaned off medication
-Na+ & K+ levels should be monitored during therapy
-May take several weeks to see therapeutic effects

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23
Q

ARBs considerations & pt teaching

A

-Reduced dosage with hypovolemia & liver dysfunction
-Report unusual dyspnea, dizziness, or excessive fatigue

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24
Q

Adrenergic blocking agents (beta blockers): General overview

A

-Block SNS stimulation of Beta 1 by competing with E & NE
-Cause the release of free fatty acids from adipose tissue; elevated triglycerides and reduced levels of (HDL)

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25
Beta blockers: MOA (cardio-selective)
-Specific to Beta 1 receptors in the heart -Reduces myocardial stimulation & oxygen demand by decreasing force of contraction
26
Beta blockers MOA (Non-selective)
-Block both Beta 1&2 receptors -Reduces myocardial stimulation & myocardial oxygen demand by decreasing force of contraction -Block Beta 2 receptors on the smooth muscle of the bronchioles and blood vessels
27
Beta blockers (cardio selective): BEAaNeM
"olol" Metoprolol Bisoprolol fumerate Atenolol Acebutalol Esmolol Nebivolol
28
Beta blockers (non-selective)
"olol" Carvedilol Labeltalol Nadolol Pindolol Sotalol Timolol Propranolol
29
Beta blockers inidications for use
-Angina, AMI, HTN, HF, dysrhythmias -Migraines & glaucoma
30
Beta blockers: Angina & AMI
-Decrease demand for myocardial energy and O2: decreases the work of the heart & pain
31
Beta blockers: Dysrhythmias
slows conduction to the AV node, appropriate for supraventricular dysrhythmias
32
Beta blockers: HTN
reduces SNS stimulation by decreasing HR and force of myocardial contraction
33
Beta blockers: HF
-Typically non-selective
34
Beta blockers: Migraines
due to liphophilicity, propranolol gains entry to CNS
35
Beta blockers: Glaucoma
topical agent of timolol reduces constriction in the eye
36
Beta blockers contraindications
Acute decompensated heart failure Cardiogenic shock Heart block Bradycardia Pregnancy Severe Pulmonary Disease Raynaud’s Disease
37
Beta blockers: Adverse events (CV)
-AV block, bradycardia, HF
38
Beta blockers: Adverse events (CNS)
-Dizziness, depression, drowsiness, unusual dreams, & fatigue
39
Beta blockers: Adverse events (GI)
-N/V, constipation, diarrhea
40
Beta blockers: Adverse events (hematologic)
-Agranulocytosis, thrombocytopenia
41
Beta blockers: Adverse events (metabolic)
-Hyperglycemia, mask the symptoms of hypoglycemia, dyslipidemia
42
Beta blockers: Adverse events (others)
-ED, alopecia, bronchospasm, wheezing, dry mouth
43
Beta blocker treatment of toxicity (bradycardia)
Atropine, if it persists then dopamine or NE
44
Beta blockers treatment of toxicity: Bradycardia or symptomatic HF
-Transvenous pacemaker
45
Beta blockers treatment of toxicity: hypotension
vasopressors for desired blood pressure
46
Beta blockers treatment of toxicity: Bronchospasm
monitor airway, may require intubation and supplemental oxygenation
47
Beta blockers treatment of toxicity: ECG
Monitor for prolonged QTc
48
Beta blockers treatment of toxicity: Seizures
Diazepam
49
Beta blockers treatment of toxicity: Hyperglycemia or hypoglycemia
insulin, monitor potassium levels Glucagon for hypoglycemia
50
Beta blockers: Drug to drug interactions
-Antacids: Decrease absorption & B-blocker activity -Antimuscrinics & anticholinergics; antagonistic effect -Diuretics, CV drugs & alcohol; additive hypotensive effects -Neuromuscular blocking drugs; prolonged blockade -PO hypoglycemic drugs; mask effects of hypoglycemia, delays recovery
51
Beta blocker nursing considerations & pt teaching
-Oral fluids and sugarless gum or candy for dry mouth -Stand slowly; orthostatic hypotension -Minimize vasodilating activities -Contact physician if hypotensive -Report weakness, SOB, and peripheral edema -Wean off medication to avoid rebound HTN -Avoid caffeine or SNS stimulating beverages
52
Calcium channel blockers: General overview
-3 classifications used -Dihydropyridines - amlodipine -Benzothiazepines - diltiazem -Phenylakylamines – verapamil -May be used to treat angina, dysrhythmias, and hypertension
53
-Ca+ channel blocker: MOA
-Ca+ does not enter cell, prevents muscle contraction, and promotes relaxation -Coronary arteries dilate; increased O2 supply, decreased afterload, O2 demand & work of heart
54
Ca+ channel blockers "pines"
-Phenilalkylamines; verapamil -Benzothiazepines; diltiazem -Dihydropyridines; 1st, 2nd, & 3rd generation
55
1st generation dihydropyridines
-Nifedipine
56
2nd generation dihydropyridines
-Isradipine -Nicardipine -Felodipine
57
3rd generation dyhydropyridines
-Amlodipine
58
Ca+ channel blockers indications for use
-Angina -HTN -SVT -Short term management of Atrial Fibrillation -Migraines -Raynaud’s disease
59
Ca+ channel blockers contraindications
-AMI -Second or Third Degree Heart Block (without a pacemaker) -Hypotension
60
Ca+ channel blockers: Adverse events (CV)
-Hypotension, palpitations, tachycardia, or bradycardia
61
Ca+ channel blockers: Adverse events (CNS)
-Headaches, dizziness, fatigue
62
-Ca+ channel blockers: Adverse events (GI)
-Constipation, nausea
63
Ca+ channel blockers: Adverse events (other)
-Dermatitis, dyspnea, rash, flushing, peripheral edema
64
Ca+ channel blockers: Drug to drug interactions
-Beta blockers; additive effects, bradycardia & AV block -Digoxin; interferes with elimination, increased digoxin effects -Amiodarone hydrochloride; decreased metabolism, bradycardia & decreased CO -Azole antifungals, clarithromycin, erythromycin, HIV drugs; decrease metabolism, elevated levels and effects of CCBs -Statins; inhibited statin metabolism, increased risk for statin toxicity -Cyclosporine; decreased metabolism of either drug, possible toxicity
65
Nitrates: General overview
-Minimize frequency duration and intensity of angina's -Improve functional capacity -Prevent an MI -Increase blood flow to the ischemic myocardium, decrease O2 demand, or both -Often used in patients with HF through nitroglycerin patches to reduce afterload
66
3 most common nitrates
Nitroglycerin Sosorbide Isisorbide-5-mononitrate
67
Nitrates MOA
dilation of blood vessels; decrease in afterload and reduced LV preload
68
Nitrates indications
– angina (stable, unstable, and vasospastic) and heart failure
69
Nitrates contraindications
-Anemia -Closed-angle glaucoma -Increased intraocular pressure -Hypotension -Head injury -Patients taking erectile dysfunction medications
70
Nitrate forms
Sublingual, chewable, oral tabs, capsules, ointments, patches, a translingual spray and intravenous solution
71
Nitrate adverse effects
-Headache, dizziness, fatigue -Orthostatic hypotension, tachycardia, reflex tachycardia -Dermatitis, tolerance
72
Nitrate interactions
-Additive hypotensive with alcohol -Beta-blockers -CCB -Phenothiazines (antipsychotic) -Erectile-dysfunction drugs -ABCPE
73
Nitrate nursing considerations and pt teaching
-To prevent tolerance, remove nitro-patch at night and apply in morning -Before administration, check for hypotension, bradycardia, or tachycardia -If administration is for chest pain, assessment and documentation must include: heart rate, pain assessment, and presence of N/V
74
Nitrates: Nursing considerations and pt teaching (cont'd)
-SL nitrates should avoid light, plastic, cotton filler, and moisture -Do not to mix with ED medications

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