Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PathoPharm > CV Concepts > Flashcards

CV Concepts Flashcards

1
Q

first line drugs

A
  • Diuretics
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers (ARBs)
  • Calcium channel blockers
  • Beta-adrenergic antagonists/blockers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

second line drugs

A
  • Alpha1-adrenergic antagonists
  • Alpha2-adrenergic agonists
  • Direct-acting vasodilators
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Centrally acting alpha2 receptor agonists characteristics

A
  • Stimulate alpha2-adrenergic receptors in the brain
  • TX of HTN
  • Decrease sympathetic outflow from the CNS
  • Decrease norepinephrine production
  • Stimulate alpha2-adrenergic receptors, thus reducing renin activity in the kidneys
  • Result in decreased blood pressure
  • Primary alpha 2 action: Vasodilation, Constrict pupils, v CNS, v HR, contractility
  • used after other drugs failed because of adverse effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Centrally acting alpha2 receptor agonists examples

A
  • clonidine (Catapres) (Oral or transdermal)

- methyldopa (Aldomet) Can be used for hypertension in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Peripheral alpha1 blockers/antagonists: example and characteristics

A
  • doxazosin (Cardura)
  • terazosin (Hytrin)
  • prazosin (Minipress)
  • Block alpha1-adrenergic receptors
  • reflexive tachycardia and first dose phenomenon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Beta blockers: examples and characteristics

A
  • nebivolol (Bystolic)
  • propranolol (Inderal)
  • atenolol (Tenormin)
  • others
  • Reduce BP by reducing heart rate and contractility through beta1 blockade
  • Cause reduced secretion of renin
  • Long-term use causes reduced peripheral vascular resistance
  • Non selective beta blockers can cause bronchoconstriction
  • can worsen HF by lowering cardiac output too much, so must be started on lower target dose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

adrenergic drugs: Dual-action alpha1 and beta receptor blockers: examples and characteristics

A
  • carvedilol (Coreg)
  • labetalol
  • nonselective
  • Reduce heart rate (beta1 receptor blockade)
  • Cause vasodilation (alpha1 receptor blockade)
  • Result in decreased blood pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Adrenergic Drugs: Adverse Effects

A
  • High incidence of orthostatic hypotension
  • Most common: Bradycardia or reflex tachycardia, Dry mouth, Drowsiness, sedation, fatigue, Constipation, Depression, Edema, Sexual dysfunction (impotence)
  • Other: Headaches, Sleep disturbances, Nausea, Rash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List of ACE inhibitors:

A
  • captopril (Capoten)
  • benazepril (Lotensin)
  • enalapril (Vasotec)
  • fosinopril (Monopril)
  • lisinopril (Prinivil)
  • moexipril (Univasc)
  • quinapril (Accupril)

FLEM CQB + -pril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ACE Inhibitors: Mechanism of Action and characteristics

A
  • Block angiotensin-converting enzyme, thus preventing the formation of angiotensin II (which is a potent vasoconstrictor)
  • Result in decreased systemic vascular resistance (afterload), vasodilation, and therefore decreased blood pressure
  • Also results in a decrease in aldosterone secretion which reduces blood volume***, causes excretion of sodium and retention of potassium
  • May be combined with a thiazide diuretic or calcium channel blocker
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ACE Inhibitors: Indications

A
  • Hypertension
  • HF (either alone or in combination with diuretics or other drugs) (Slows progression of heart failure)
  • Slow progression of left ventricular hypertrophy after MI (cardioprotective***) (Lowers mortality after acute MI)
  • prevent MI and protect heart during MI
  • Renal protective effects in patients with diabetes (Neuropathy effect also)
  • Prevent or delays progression of retinopathy in diabetic patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ACE Inhibitors: special consideration for Captopril and Lisinopril

A
  • ***they are NOT prodrugs (Prodrugs are inactive in their administered form and must be metabolized in the liver to an active form so as to be effective)
  • Captopril and lisinopril can be used if a patient has liver dysfunction, unlike other ACE inhibitors that are prodrugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ACE Inhibitors: Adverse Effects

A
  • Fatigue
  • Dizziness
  • Headache
  • Mood changes
  • Impaired taste
  • ***Possible hyperkalemia (more likely with ACE than ARB)
  • Dry, nonproductive cough, which reverses when therapy is stopped
  • Angioedema: rare but potentially fatal

NOTE: First-dose hypotensive effect may occur

  • ***Pregnancy category C (first trimester)
  • ***Pregnancy category D (second and third trimesters)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ACE Inhibitors Prototype Drug: Lisinopril (Prinivil, Zestril): nursing responsibilities

A
  • Complete health history
  • Monitor BP before administration and 30 min to 1 hour after
  • Keep patient in supine position if hypotension occurs
  • Evaluate effect of drug

Teach patient and family:

  • Immediately report any swelling
  • Proper diet (careful K intake)
  • Take BP
  • Take missed dose as soon as remembered (pneumonic to remember)
  • Make position changes slowly
  • Drink 6 to 8 glasses of water daily
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Angiotensin II Receptor Blockers (ARBs): characteristics

A
  • Well tolerated
  • Do not cause a dry cough

Mechanism of action:

  • Allow angiotensin I to be converted to angiotensin II, but block the receptors that receive angiotensin II
  • Block vasoconstriction and release of aldosterone so result is vasodilation, elimination of sodium and water and the retention of potassium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Angiotensin II Receptor Blockers (ARBs): list of drugs

A
  • losartan (Cozaar)
  • eprosartan (Teveten)
  • valsartan (Diovan)
  • irbesartan (Avapro)
  • candesartan (Atacand)
  • olmesartan (Benicar)
  • telmisartan (Micardis)
  • azilsartan (Edarbi)

LEVICOTA + -sartan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Angiotensin II Receptor Blockers (ARBs): indications

A
  • Hypertension
  • Adjunctive drugs for the treatment of HF
  • May be used alone or with other drugs such as diuretics
  • Prevention of diabetic nephropathy
  • Heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Angiotensin II Receptor Blockers (ARBs): Adverse Effects

A
  • Upper respiratory infections
  • Headache
  • May cause occasional dizziness, inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue
  • Hyperkalemia much LESS likely to occur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Angiotensin II Receptor Blockers (ARBs): PT teaching and nursing responsibilities

A
  • Monitor BP regularly
  • Immediately report any swelling
  • Proper diet
  • Report vomiting, diarrhea, heavy sweating
  • Take missed dose as soon as remembered
  • Make position changes slowly
  • Drink 6 to 8 glasses of water daily
  • Baseline vital signs and labs (BMP, CBC, liver and renal function tests)
  • Monitor for hypotension
  • Evaluate effects of drug and adverse effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Direct Renin Inhibitor: examples and characteristics

A
  • aliskiren (Tekturna)
  • Indication: hypertension
  • MOA: inhibits the release of renin and prevents the activation of the RAAS.
21
Q

Calcium Channel Blockers: Mechanism of Action

A
  • Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction

Results in:

  • Decreased peripheral smooth muscle tone
  • Decreased systemic vascular resistance
  • Decreased blood pressure
22
Q

Calcium Channel Blockade: effects on vascular smooth muscle, coronary arteries, SVR, myocardium, and conduction

A

Effects on vascular smooth muscle
- Prevents contraction of peripheral arterioles (Vasodilation, Fall in BP)

Afterload reduced
- Lower myocardial oxygen demand and less workload for heart

Dilation of coronary arteries
- More blood flow to heart

Effects on myocardium
- Reduces force of myocardial contraction (negative inotropic effect)

Effects on cardiac conduction

  • Negative chronotropic effect
  • SA node generates fewer action potentials
  • Slows automaticity
  • Decreases HR
23
Q

Calcium Channel Blockers: Arteriole selective drugs (dihydropyridines) examples

A
  • Relax arterial smooth muscle
  • Treat hypertension and angina
  • Nifedipine (Procardia, Adalat)
  • amlodipine (Norvasc)

AVND (A Very Nice Drug), -dipine

24
Q

Calcium Channel Blockers: Nonselective drugs (non-dihydropyridines) examples

A
  • Relax arterial smooth muscle
  • Decrease myocardial contractility and heart rate better
  • Treat hypertension and coronary artery disease
  • Verapamil (Calan)
  • diltiazem (Cardizem)

AVND (A Very Nice Drug)

25
Q

Other calcium channel blockers: list

A
  • Felodipine (Plendil)
  • Isradipine (DynaCirc)
  • Nicardipine (Cardene)
  • Nimodipine (Nimotop)

FINN + -dipine

26
Q

Calcium Channel Blockers: Indications

A
  • Angina
  • Hypertension
  • Tachycardia
  • Migraine headaches
  • Raynaud’s disease
  • Vasospasms
27
Q

Calcium Channel Blockers: Adverse Effects

AVND only

A

Diltiazem and Verapamil (non-dihydropyridine non-selective):

  • Bradycardia
  • CHF
  • Hypotension
  • Constipation

Amlodipine and Nifedipine (dihydropyridine, selective):

  • Rebound tachycardia (from the drop in BP)
  • Hypotension
  • Edema
  • Hepatic impairment
28
Q

Calcium Channel Blockers: drug interactions

A
  • Elevates blood levels of **digoxin
  • Additive hypotension or bradycardia with other antihypertensive drugs
  • Risk of myopathy increases significantly with **statins
  • **Carbamazepine serum concentration may increase (Antiseizure med, narrow therapeutic index)
  • Grapefruit juice may increase levels
    Important to know especially for Ca drugs
29
Q

Calcium Channel Blockers: nursing responsibilities and PT/family teaching

A

Nursing responsibilities

  • Monitor for heart block or bradycardia with digoxin use
  • Monitor intake and output
  • Monitor ECG
  • Check BP and HR before and after administration

Patient/family teaching

  • Take with food and full glass of water
  • Monitor BP, drinking alcohol could cause BP to decrease
  • Do not stop taking medication without consent of HCP, should be discontinued gradually if stop drug
  • Take radial pulse before each dose
  • Do not eat grapefruit or drink grapefruit juice
  • Decrease intake of caffeinated beverages
30
Q

Diuretics: action and characteristics

A
  • Decrease plasma and extracellular fluid volumes
    v blood volume

Results:

  • Decreased preload
  • Decreased cardiac output
  • Decreased total peripheral resistance

Overall effect
- Decreased workload of the heart and decreased blood pressure

MOA
- Reduce blood volume, lowering pressure

31
Q

Diuretics general : indications

A
  • Hypertension
  • Heart failure
  • Renal failure (some work for a while then not as much)
  • Liver failure/cirrhosis
  • Pulmonary edema (lungs fill up)
32
Q

Diuretics general: adverse effects

A
  • Dehydration (daily weight)
  • Lowering the blood pressure too much
  • Hyponatremia
  • Hypokalemia (less with potassium-sparing diuretics)
  • Nocturia (if taken too late in the day)
33
Q

Thiazide diuretics: examples

A
  • Most common diuretic for hypertension.
  • Chlorthalidone (Thalitone)
  • Hydrochlorothiazide (Microzide) (HCTZ)
  • Metolazone (Zaroxolyn) is a thiazide-like diuretic, intermediate acting

CHM + -one + -thiazide

34
Q

Thiazide diuretics: action and characteristics

A

Mechanism of action

  • Acts on distal tubule to decrease reabsorption of sodium
  • Results in less water reabsorption, increased diuresis
  • Block Na+ reabsorption at distal tubule
  • Not effective in renal failure

Indications

  • Hypertension
  • Edema
  • Therapeutic classification: Antihypertensive
  • Pharmacologic classification: Thiazide-type diuretic
35
Q

Thiazide Diuretics: nursing implications

A

Pregnancy category B

Precautions
- Diabetes (thiazides can cause hyperglycemia)

Nursing Implications

  • Teach patient to avoid prolonged exposure to sun and sunscreen due to potential for photosensitivity
  • Thiazides can cause hypercalcemia, hyperuricemia, hyperglycemia, GOUT attacks
36
Q

Potassium-sparing diuretics: examples

A
  • Triamterene (Dyrenium)
  • Spironolactone (Aldactone)
  • amiloride (Midamor)
  • Eplerenone (Inspra)
  • Not as effective as others at diuresis
  • Risk of hyperkalemia with renal impairment AND use of ACE-I
  • Cannot use salt substitutes

SEAT + -ide + -one + -ene

37
Q

Potassium-Sparing Diuretics: Spironolactone (Aldactone) characteristics

A

Mechanism of action

  • Inhibits action of aldosterone in distal tubule and collecting ducts of nephron
  • Sodium, chloride, and water excretion are increased
  • Body retains potassium
  • prevent cardiac remodeling

Therapeutic classification
- Antihypertensive

Pharmacologic classification
- Potassium-sparing diuretic/***aldosterone antagonist

38
Q

Potassium-Sparing Diuretics: Spironolactone (Aldactone) considerations

A
  • Pregnancy category D

Drug interactions

  • Can cause hyperkalemia with potassium supplements, ACE inhibitors, ARB
  • Additive hypotensive results with other anti-hypertensives
  • Cannot use salt substitutes
39
Q

Loop diuretic: examples

A
  • Furosemide (Lasix)
  • Bumetanide (Bumex)
  • torsemide (Demadex)
  • ethacrynic acid (Edecrin)

Usually not used for HTN, potent diuretics
Only used for renal failure for a while?

BEFT + -semide + -tanide

40
Q

Loop Diuretics: characteristics and indications

A
  • Powerful High doses effective even with renal failure
  • Block Na+ reabsorption at loop of Henle

Indications

  • Edema
  • Heart failure
  • Hypertension
  • Pulmonary edema
41
Q

Loop Diuretics: nursing responsibilities

A
  • Administer early in day
  • ***Cannot give IV furosemide faster the 10 mg/min
  • ***Ethacrynic acid is the most likely to cause ototoxicity
  • Torsemide is twice as potent
  • Must monitor patient for hypokalemia
  • Teach patient foods high in potassium
  • Monitor fluid balance status
  • Can cause metabolic alkalosis (furosemide)
  • Can cause ototoxicity
42
Q

Osmotic Diuretic: examples and characteristics

A
  • Mannitol (Osmitrol)
  • ***Raise osmolality of intravascular space pulling fluids from the extravascular space to the intravascular space
  • Rarely drugs of first choice

Indications

  • Increased intracranial pressure
  • High intraocular pressure
  • Renal failure
  • May cause fluid/electrolyte imbalance
43
Q

Osmotic Diuretic: adverse effects

A
  • Electrolyte imbalances
  • CHF
  • Pulmonary edema
  • Hypovolemia
  • Dehydration
  • Fatigue
  • Nausea
  • Vomiting
  • Dizziness
  • Convulsions
  • Tachycardia
44
Q

Carbonic Anhydrase Inhibitors: examples and characteristics

A
  • Acetazolamide (Diamox)
  • Block carbonic anhydrase at proximal tubule to inhibit reabsorption of Na+ and HCO3
  • Can then absorb H ions (different from other diuretics which can make you alkalotic)
  • Weak diuretic effect
  • Used as adjunctive therapy when loop diuretics cause alkalosis
  • Therapeutic classification: Drug for edema, anti-glaucoma agent
45
Q

Carbonic Anhydrase Inhibitors: adverse effects

A

Adverse effects

  • Hypokalemia
  • Metabolic Acidosis (other diuretics can make you alkalotic)
46
Q

Vasodilators: examples

A
  • diazoxide (Hyperstat)
  • hydralazine HCl (Apresoline)
  • minoxidil (Loniten)
  • sodium nitroprusside (Nipride, Nitropress) – break down to light, hard on kidneys

SMDH

47
Q

Vasodilators: Mechanism of Action

A
  • Directly relax arteriolar and/or venous smooth muscle

Results in:

  • Decreased systemic vascular response
  • Decreased afterload
  • Peripheral vasodilation
48
Q

Vasodilators: Indications

A
  • Treatment of hypertension
  • May be used in combination with other drugs
  • Sodium nitroprusside and intravenous diazoxide are reserved for the management of hypertensive emergencies
49
Q

Vasodilators: Adverse effects and Serious Adverse effects

A

Adverse effects

  • Headache
  • Tachycardia
  • Palpitations
  • Flushing
  • Nausea
  • Diarrhea
  • Orthostatic hypotension
  • Edema

Serious adverse effects

  • Blood dyscrasias
  • Thiocyanate toxicity with Nitroprusside
  • Indications include changes in mental status, hyper-reflexia, muscle cramps, vomiting, seizures, tinnitus

PathoPharm (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions