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488 > Class 1 Adrenergic Receptors (CV) > Flashcards

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
Q

Beta blockers: MOA (cardio-selective)

A

-Specific to Beta 1 receptors in the heart
-Reduces myocardial stimulation & oxygen demand by decreasing force of contraction

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26
Q

Beta blockers MOA (Non-selective)

A

-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

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27
Q

Beta blockers (cardio selective): BEAaNeM

A

“olol”
Metoprolol
Bisoprolol fumerate
Atenolol
Acebutalol
Esmolol
Nebivolol

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28
Q

Beta blockers (non-selective)

A

“olol”
Carvedilol
Labeltalol
Nadolol
Pindolol
Sotalol
Timolol
Propranolol

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29
Q

Beta blockers inidications for use

A

-Angina, AMI, HTN, HF, dysrhythmias
-Migraines & glaucoma

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30
Q

Beta blockers: Angina & AMI

A

-Decrease demand for myocardial energy and O2: decreases the work of the heart & pain

31
Q

Beta blockers: Dysrhythmias

A

slows conduction to the AV node, appropriate for supraventricular dysrhythmias

32
Q

Beta blockers: HTN

A

reduces SNS stimulation by decreasing HR and force of myocardial contraction

33
Q

Beta blockers: HF

A

-Typically non-selective

34
Q

Beta blockers: Migraines

A

due to liphophilicity, propranolol gains entry to CNS

35
Q

Beta blockers: Glaucoma

A

topical agent of timolol reduces constriction in the eye

36
Q

Beta blockers contraindications

A

Acute decompensated heart failure
Cardiogenic shock
Heart block
Bradycardia
Pregnancy
Severe Pulmonary Disease
Raynaud’s Disease

37
Q

Beta blockers: Adverse events (CV)

A

-AV block, bradycardia, HF

38
Q

Beta blockers: Adverse events (CNS)

A

-Dizziness, depression, drowsiness, unusual dreams, & fatigue

39
Q

Beta blockers: Adverse events (GI)

A

-N/V, constipation, diarrhea

40
Q

Beta blockers: Adverse events (hematologic)

A

-Agranulocytosis, thrombocytopenia

41
Q

Beta blockers: Adverse events (metabolic)

A

-Hyperglycemia, mask the symptoms of hypoglycemia, dyslipidemia

42
Q

Beta blockers: Adverse events (others)

A

-ED, alopecia, bronchospasm, wheezing, dry mouth

43
Q

Beta blocker treatment of toxicity (bradycardia)

A

Atropine, if it persists then dopamine or NE

44
Q

Beta blockers treatment of toxicity: Bradycardia or symptomatic HF

A

-Transvenous pacemaker

45
Q

Beta blockers treatment of toxicity: hypotension

A

vasopressors for desired blood pressure

46
Q

Beta blockers treatment of toxicity: Bronchospasm

A

monitor airway, may require intubation and supplemental oxygenation

47
Q

Beta blockers treatment of toxicity: ECG

A

Monitor for prolonged QTc

48
Q

Beta blockers treatment of toxicity: Seizures

A

Diazepam

49
Q

Beta blockers treatment of toxicity: Hyperglycemia or hypoglycemia

A

insulin, monitor potassium levels
Glucagon for hypoglycemia

50
Q

Beta blockers: Drug to drug interactions

A

-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
Q

Beta blocker nursing considerations & pt teaching

A

-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
Q

Calcium channel blockers: General overview

A

-3 classifications used
-Dihydropyridines - amlodipine
-Benzothiazepines - diltiazem
-Phenylakylamines – verapamil
-May be used to treat angina, dysrhythmias, and hypertension

53
Q

-Ca+ channel blocker: MOA

A

-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
Q

Ca+ channel blockers “pines”

A

-Phenilalkylamines; verapamil
-Benzothiazepines; diltiazem
-Dihydropyridines; 1st, 2nd, & 3rd generation

55
Q

1st generation dihydropyridines

A

-Nifedipine

56
Q

2nd generation dihydropyridines

A

-Isradipine
-Nicardipine
-Felodipine

57
Q

3rd generation dyhydropyridines

A

-Amlodipine

58
Q

Ca+ channel blockers indications for use

A

-Angina
-HTN
-SVT
-Short term management of Atrial Fibrillation
-Migraines
-Raynaud’s disease

59
Q

Ca+ channel blockers contraindications

A

-AMI
-Second or Third Degree Heart Block (without a pacemaker)
-Hypotension

60
Q

Ca+ channel blockers: Adverse events (CV)

A

-Hypotension, palpitations, tachycardia, or bradycardia

61
Q

Ca+ channel blockers: Adverse events (CNS)

A

-Headaches, dizziness, fatigue

62
Q

-Ca+ channel blockers: Adverse events (GI)

A

-Constipation, nausea

63
Q

Ca+ channel blockers: Adverse events (other)

A

-Dermatitis, dyspnea, rash, flushing, peripheral edema

64
Q

Ca+ channel blockers: Drug to drug interactions

A

-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
Q

Nitrates: General overview

A

-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
Q

3 most common nitrates

A

Nitroglycerin
Sosorbide
Isisorbide-5-mononitrate

67
Q

Nitrates MOA

A

dilation of blood vessels; decrease in afterload and reduced LV preload

68
Q

Nitrates indications

A

– angina (stable, unstable, and vasospastic) and heart failure

69
Q

Nitrates contraindications

A

-Anemia
-Closed-angle glaucoma
-Increased intraocular pressure
-Hypotension
-Head injury
-Patients taking erectile dysfunction medications

70
Q

Nitrate forms

A

Sublingual, chewable, oral tabs, capsules, ointments, patches, a translingual spray and intravenous solution

71
Q

Nitrate adverse effects

A

-Headache, dizziness, fatigue
-Orthostatic hypotension, tachycardia, reflex tachycardia
-Dermatitis, tolerance

72
Q

Nitrate interactions

A

-Additive hypotensive with alcohol
-Beta-blockers
-CCB
-Phenothiazines (antipsychotic)
-Erectile-dysfunction drugs
-ABCPE

73
Q

Nitrate nursing considerations and pt teaching

A

-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
Q

Nitrates: Nursing considerations and pt teaching (cont’d)

A

-SL nitrates should avoid light, plastic, cotton filler, and moisture
-Do not to mix with ED medications

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