CP Lecture 3 Flashcards
Anticoagulants inhibit what hormone
thrombin
Stage A Heart disease
No structural heart disease, just a medical condition like hypertension
treatment: encourage lifestyle change, potentially ACE inhibitors
Stage B heart disease
Structural heart disease no symptoms
-Consider ACE inhibitor, ARB, or B Blockers
Stage C heart disease
Symptomatic structural heart disease
Treatment: diuretics, ACE inhibitor, b blocker, ARB, Digitalis, Aldosterone agonist, nitrate
Stage D heart disease
Severely symptomatic (end stage)
Treatment: critical care
In order to control hypertension you must (reduce OR increase) the renin-angiotensin-aldosterone system in order to:
Promote: ______ and reduce _______
Reduce
Promote: Vasodilation and reduce fluid volume
-lol suffix
Beta Blocker
How do beta blockers work?
Reduces B-receptor binding sites of epinephrine and norepinephrine
Selective vs non-selective beta blocker
Selective:
B1- Causes decrease HR and myocardial contractility
OR
B2- Causes bronchoconstriction, vasoconstriction
Non-selective:
BOTH
Nonselective betablockers are not indicated for individuals with….
PVD or COPD
Beta blocker effect on patient exercise tolerance:
Earlier fatigue and less exercise tolerance
Beta blockers are clinically indicated for….
Hypertension
Ischemic heart disease
Heart failure
Arrhymthia.
How can beta blockers effect patients with diabetes
May mask hypoglycemia by dulling response
Note: also patients on beta blockers are at increased risk of heat injury
Calcium channel blockers are clinically indicated for
Ischemic heart disease
Arrhythmia
BP control
Reduction of re-infarction in patients with non-Q wave infarcts
Calcium channel blocker side effects:
Very few except for negative inotropic effects
-pine suffix
Calcium channel blockers
Patients on calcium channel blockers may need to use RPE for exertion rating during exercise because….
HR response to exercise may be blunted
How do calcium channel blockers work?
- Decrease arterial blood pressure by: smooth muscle relaxation, vasodilation
- Reduces O2 demand by: Reducing intracellular CA++, Slow HR, Reduce strength of contraction
“Reduce afterload”
Nitrates are clinically indicated for……
Hypertension
Ischemic heart disease
Angina
Heart failure
How do nitrates work?
——»> Reduce blood to heart by dilating veins (reduce preload)
Cause heart to contract with less force
——-»» Both of these combined: Lower blood pressure —»»
Less resistance the heart has to push against (less afterload).
Nitrate is primarily used to treat _____
Angina, because they fix the oxygen supply and demand issue at the myocardium!
Note: most are delivered Parenteral route, some oral.
relief in chest pain its expected in 5 minutes. If chest pain doesn’t subside patient can take it 2 more times (15 mins) if chest pain continues go to ER.
Parenteral route has quicker onset
Angina is caused by
Imbalance of myocardial oxygen supply and demand
Lack of oxygen stimulates pain receptors within heart
Nitrates tend to have ____ in the name of the drug
“Nitr”
If nitrates are taken before exercise..
It is important to measure vitals before and after drugs are taken
Nitrate side effects:
Hypotension
Dizziness
Reflex Tachycardia
Flushing of skin/ vomiting
An ECG shift downward of ____ is indicative of ischemia
.5mm downward
Angina symptoms can be anywhere above the ________
Umbilicus
Stable vs Unstable angina
Stable: pain free at rest, worse with activity,
Unstable: Unpredicable, accelerating in frequency and intensity, duration over 15 mins
Note: unstable is a signal of progression of disease
Prinzmetal (variant) angina
Occurs exclusively at rest (often in morning)
ST segment elevation on ECG
Thought to be the result of cardiac vasospasm
If a patient needs to limit cardiac vasospasm, what should they take?
Calcium channel blockers
If a patient needs to cause vasodilation to increase blood flow to myocardium, what is a good class for medicine to take?
Nitrates, ARB, ACE
If a patient needs to decrease the workload of the heart and decrease heart rate, what is the best kind of medicine to take?
Beta blockers
How do thrombolytic agents work?
Facilitate the conversion of plasminogen to plasmin
Thrombolytic agents should be administered within ________ of evidence of thrombus formation
30 minutes
Note: Overall goal is to keep ischemic time to under 120 minutes
What are common side effects of thrombolytic agents?
Excessive bleeding
Hemorrhagic CVA possible
Note: watch out for these patients they cannot do high intensity exercise while on the medication
How do anti-platelet medications work?
Decrease platelet adherence to site of injury
Note: can be a primary or secondary method of preventing thrombus
Diuretics are used clinically for what conditions
Hypertension
Heart failure
How do duiretics work to help the heart?
More urination -> less blood volume -> less preload
Improved electrolyte balance
-ide suffix
Diuretics
diuretics can potentially caused hypo________
Hypokalemia
The most potent diuretics are what?
Loop diuretic
Act in the loop of henle
How do sodium-glucose transport inhibitors help cardiac issues?
Lowers blood sugar for Type 2 diabetes
Reduce cardiac deaths
Slows progression of kidney disease
Reduces systolic BP 3-5mmHG
Promotes weight loss (4-6lbs)
-ozin suffix
Sodium-Glucose transport inhibitors
Potential side effects of sodium/glucose transport inhibitors include:
____Gylcemia
____tension
UTIs
Diabetic Ketoacidosis
Hypoglycemia
Hypotension
UTIs
Diabetic ketoacidosis
ACE inhibitors block the conversion of Angiotensin 1 to Angiotensin 2
Angiotensin 2 causes:
Systemic vaso_______
Renal water and sodium _______
Aldosterone _______
Systemic vasoconstriction
Renal water and sodium constriction
Aldosterone stimulation
-ril suffix
ACE inhibitors
-sartan suffix
ARB
Angiotensin receptor blocker
Patients who are intolerant to ACE inhibitors can use….
ARBs
How do ARBs work? (Angiotensin receptor blockers)
Limits effects of angiotensin 2 (vasoconstriction) at arterial beds
What is Entresto
Neprolysin Inhibitor AND Angiotensin receptor blocker
How do neprolysin inhibitors work?
Reduces abnormal
remodeling of vessels
Promote diuresis + Vasodilation
Na excretion / K retention
Side effects of ACE inhibitors and ARBs
Hypotension
Light headedness
Dizziness
Angioedema (life threatening)
Hyperkalemia
Persistent dry cough
Digitalis and Digoxin are what kind of drugs?
Cardiac Glyocosides
Increase intracellular Ca+
Increase contraction strength
Decrease HR and conduction time
Out of Digitalis and Digoxin, which one is less toxic with a shorter half life
Digoxin
What kind of side effects do patients experience with cardiac glyocosides?
-GI sickness
-Neurological symptoms
Digoxin controls ___________ due to lengthening the PR interval
A-FIB
note: patient may have abnormal pulse on this medication
SO the pulse needs to be taken for the FULL MINUTE
What should you ask a patient on digoxin who is not feeling well?
Did you just start the medication?
did you increase the dose?
Report findings to physician!
What are Sympathomimetics used for?
Acute heart failure to improve CO
they mimic the sympathetic nerve system stimulation to increase contraction strength
How long should a patient use Sympathomimetics
SHORT PERIOD
minimize the possibility of sympathetic receptor desensitization
What medication is used when heart failure is present with systemic hypotension
Dopamine (Inotropin)
What medication is used short term for patients awaiting heart transplant?
Phosphodiesterase Inhibitors
last line of defense medication when cardiac glyocosides and Sympathomimetics failed
What do Phosphodiesterase Inhibitors do?
Increase intracellular Ca+
positive ionotropic
What are 3 medications that vasodilate?
Ca+ Channel Blockers
ACE inhibitors
Nitrates
how do Venodilators affect cardiac preload?
reduce
α Adrenergic Antagonists are used for…
hypertension and not heart failure
side effects of α Adrenergic Antagonists
increase in blood volume
reflex tachycardia
What medication dilates both veins and arteries?
Nipride
How does Nipride help patients?
Effective in treatment of severe heart failure
Increased venous capacitance reduces preload
Decreased arterial resistance reduces afterload
Result is reduced myocardial oxygen demand
How does morphine affect the veins and arteries??
Veno-dilation and mild arterial dialation
-also reduces anxiety which reduces heart effort for severe heart failure
What kind of side effects can Vasodilators have?
Compensatory sympathetic activation:
Tachycardia
Vasoconstriction
Increase aldosterone
Elevated plasma renin
—-> these side effects lead to patient taking more meds to control side effects
What are class 1 antiarrythmics
(Xylocaine)
Clinically indicated for:
Ventricular and supraventricular tachycardia
Atrial fib
Beta blockers are considered a ___________ anti-arrythmic
Class 2
Clinically indicated for:
Ventricular and supraventricular arrhythmia post MI and exercise
Calcium channel blockers are considered ______________ anti-arrythmics
Class 4
Cardiac glycosides should not be used in patients with….
2nd and 3rd degree heart blocks
(because it slows conduction time even more!)
