Class 1 Adrenergic Receptors (CV) Flashcards
Adrenergic receptors
-Alpha 1&2
-Beta 1&2
Alpha-1 effects
-Vasoconstriction
-Increases PVR, BP & closure of bladder sphincters
-Mydriasis (dilates pupils)
-NE>E
Alpha-2 effects
-Inhibits NE, Ach, & insulin release
-E>NE
Beta 1 effect on CV
-Increase HR, heart contractility, lipolysis, & renin
-E=NE
Beta 2 effects
-Vasodilation, decreases PVR
-Relaxes uterine smooth muscle
-Increases glycogenolysis & glucagon release
-E»NE
Management of HTN: Diuretics & anti-hypertensive therapy drugs
-Thiazide/thiazide-like diuretic
-ACE I
-ARBs
-Long-acting CCB
-Beta-blockers
-Single pill combination
-LATABS
Diuretics: general overview
▪ 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
Angiotensin converting enzyme inhibitors (ACE I): General overview
▪ 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
ACE I: MOA
-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)
ACE inhibitors “pril”
-“prils”
-Captopril
-Ramipril*
-Enalapril sodium*
-Fosinopril sodium
-Lisiopril*
-Perindopril erbumine
-Denotes ACE can be in combination with
hydrochlorothiazide (ERL)
ACE I: Indications for use
-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
ACE I contraindications
-K+> 5mmol/L
-Impaired kidney function
-Pregnant or lactating women
ACE I: Adverse events
-Fatigue, dizziness, mood changes, headaches, hypotension
-Non productive cough
-Hyperkalemia
-Angioedema
-Loss of taste, proteinuria, rash, pruritis, anemia, neutropenia, thrombocytosis and agranulocytosis
ACE I drug-drug interactions
-NSAIDS; reduce antihypertensive effects and may lead to nephrotoxicity
-Potassium supplements or Potassium sparing diuretics; hyperkalemia
-Lithium; lithium toxicity
Angiotensin receptor blockers (ARBs): MOA
-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
ARBs (TICLV)
-“Sartans”
▪ Losartan
▪ Valsartan
▪ Irbesartan
▪ Candesartan cilexetil
▪ Telmisartan
ARBs indications
-Heart Failure; decrease preload and afterload
-HTN
ARBs contraindications
-Pregnant or lactating women
-Older adults
-MI
ARBs: Adverse events
-Respiratory infections, dyspnea, nasal congestion, sinusitis, cough
-Headache, heartburn, dizziness, diarrhea & anxiety
-Inability to sleep, fatigue
-Back & muscle pain
ARBs toxicity & OD
-Hypotension
-Tachycardia
-Bradycardia occurs less often
ARBs: Drug to drug interactions
-NSAIDs; decreased antihypertensive effect; potential for kidney failure
-Lithium; inhibits Li+ elimination
-Phenobarbital; increases metabolism; decreases ARB effectiveness
-K+ sparing diuretics & K+ supplements; hyperkalemia
ACE I considerations & pt teaching
-Weaned off medication
-Na+ & K+ levels should be monitored during therapy
-May take several weeks to see therapeutic effects
ARBs considerations & pt teaching
-Reduced dosage with hypovolemia & liver dysfunction
-Report unusual dyspnea, dizziness, or excessive fatigue
Adrenergic blocking agents (beta blockers): General overview
-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)
Beta blockers: MOA (cardio-selective)
-Specific to Beta 1 receptors in the heart
-Reduces myocardial stimulation & oxygen demand by decreasing force of contraction
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
Beta blockers (cardio selective): BEAaNeM
“olol”
Metoprolol
Bisoprolol fumerate
Atenolol
Acebutalol
Esmolol
Nebivolol
Beta blockers (non-selective)
“olol”
Carvedilol
Labeltalol
Nadolol
Pindolol
Sotalol
Timolol
Propranolol
Beta blockers inidications for use
-Angina, AMI, HTN, HF, dysrhythmias
-Migraines & glaucoma
Beta blockers: Angina & AMI
-Decrease demand for myocardial energy and O2: decreases the work of the heart & pain
Beta blockers: Dysrhythmias
slows conduction to the AV node, appropriate for supraventricular dysrhythmias
Beta blockers: HTN
reduces SNS stimulation by decreasing HR and force of myocardial contraction
Beta blockers: HF
-Typically non-selective
Beta blockers: Migraines
due to liphophilicity, propranolol gains entry to CNS
Beta blockers: Glaucoma
topical agent of timolol reduces constriction in the eye
Beta blockers contraindications
Acute decompensated heart failure
Cardiogenic shock
Heart block
Bradycardia
Pregnancy
Severe Pulmonary Disease
Raynaud’s Disease
Beta blockers: Adverse events (CV)
-AV block, bradycardia, HF
Beta blockers: Adverse events (CNS)
-Dizziness, depression, drowsiness, unusual dreams, & fatigue
Beta blockers: Adverse events (GI)
-N/V, constipation, diarrhea
Beta blockers: Adverse events (hematologic)
-Agranulocytosis, thrombocytopenia
Beta blockers: Adverse events (metabolic)
-Hyperglycemia, mask the symptoms of hypoglycemia, dyslipidemia
Beta blockers: Adverse events (others)
-ED, alopecia, bronchospasm, wheezing, dry mouth
Beta blocker treatment of toxicity (bradycardia)
Atropine, if it persists then dopamine or NE
Beta blockers treatment of toxicity: Bradycardia or symptomatic HF
-Transvenous pacemaker
Beta blockers treatment of toxicity: hypotension
vasopressors for desired blood pressure
Beta blockers treatment of toxicity: Bronchospasm
monitor airway, may require intubation and supplemental oxygenation
Beta blockers treatment of toxicity: ECG
Monitor for prolonged QTc
Beta blockers treatment of toxicity: Seizures
Diazepam
Beta blockers treatment of toxicity: Hyperglycemia or hypoglycemia
insulin, monitor potassium levels
Glucagon for hypoglycemia
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
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
Calcium channel blockers: General overview
-3 classifications used
-Dihydropyridines - amlodipine
-Benzothiazepines - diltiazem
-Phenylakylamines – verapamil
-May be used to treat angina, dysrhythmias, and hypertension
-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
Ca+ channel blockers “pines”
-Phenilalkylamines; verapamil
-Benzothiazepines; diltiazem
-Dihydropyridines; 1st, 2nd, & 3rd generation
1st generation dihydropyridines
-Nifedipine
2nd generation dihydropyridines
-Isradipine
-Nicardipine
-Felodipine
3rd generation dyhydropyridines
-Amlodipine
Ca+ channel blockers indications for use
-Angina
-HTN
-SVT
-Short term management of Atrial Fibrillation
-Migraines
-Raynaud’s disease
Ca+ channel blockers contraindications
-AMI
-Second or Third Degree Heart Block (without a pacemaker)
-Hypotension
Ca+ channel blockers: Adverse events (CV)
-Hypotension, palpitations, tachycardia, or bradycardia
Ca+ channel blockers: Adverse events (CNS)
-Headaches, dizziness, fatigue
-Ca+ channel blockers: Adverse events (GI)
-Constipation, nausea
Ca+ channel blockers: Adverse events (other)
-Dermatitis, dyspnea, rash, flushing, peripheral edema
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
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
3 most common nitrates
Nitroglycerin
Sosorbide
Isisorbide-5-mononitrate
Nitrates MOA
dilation of blood vessels; decrease in afterload and reduced LV preload
Nitrates indications
– angina (stable, unstable, and vasospastic) and heart failure
Nitrates contraindications
-Anemia
-Closed-angle glaucoma
-Increased intraocular pressure
-Hypotension
-Head injury
-Patients taking erectile dysfunction medications
Nitrate forms
Sublingual, chewable, oral tabs, capsules, ointments, patches, a translingual spray and intravenous solution
Nitrate adverse effects
-Headache, dizziness, fatigue
-Orthostatic hypotension, tachycardia, reflex tachycardia
-Dermatitis, tolerance
Nitrate interactions
-Additive hypotensive with alcohol
-Beta-blockers
-CCB
-Phenothiazines (antipsychotic)
-Erectile-dysfunction drugs
-ABCPE
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
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
