CP Lecture 3 Flashcards by Chavez Girls

Anticoagulants inhibit what hormone

thrombin

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Stage A Heart disease

No structural heart disease, just a medical condition like hypertension

treatment: encourage lifestyle change, potentially ACE inhibitors

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Stage B heart disease

Structural heart disease no symptoms

-Consider ACE inhibitor, ARB, or B Blockers

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Stage C heart disease

Symptomatic structural heart disease

Treatment: diuretics, ACE inhibitor, b blocker, ARB, Digitalis, Aldosterone agonist, nitrate

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Stage D heart disease

Severely symptomatic (end stage)

Treatment: critical care

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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

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-lol suffix

Beta Blocker

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How do beta blockers work?

Reduces B-receptor binding sites of epinephrine and norepinephrine

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Selective vs non-selective beta blocker

Selective:

B1- Causes decrease HR and myocardial contractility

B2- Causes bronchoconstriction, vasoconstriction

Non-selective:

BOTH

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Nonselective betablockers are not indicated for individuals with….

PVD or COPD

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Beta blocker effect on patient exercise tolerance:

Earlier fatigue and less exercise tolerance

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Beta blockers are clinically indicated for….

Hypertension
Ischemic heart disease
Heart failure
Arrhymthia.

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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

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Calcium channel blockers are clinically indicated for

Ischemic heart disease

Arrhythmia

BP control

Reduction of re-infarction in patients with non-Q wave infarcts

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Calcium channel blocker side effects:

Very few except for negative inotropic effects

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-pine suffix

Calcium channel blockers

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Patients on calcium channel blockers may need to use RPE for exertion rating during exercise because….

HR response to exercise may be blunted

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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”

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Nitrates are clinically indicated for……

Hypertension
Ischemic heart disease
Angina
Heart failure

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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).

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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

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Angina is caused by

Imbalance of myocardial oxygen supply and demand

Lack of oxygen stimulates pain receptors within heart

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Nitrates tend to have ____ in the name of the drug

“Nitr”

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If nitrates are taken before exercise..

It is important to measure vitals before and after drugs are taken

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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!)